Carotid intima media thickness in patients with obstructive sleep apnea: comparison with a community-based cohort.

BACKGROUND: The impact of obstructive sleep apnea (OSA) on the development of atherosclerotic cardiovascular disease (CVD) in the absence of overt CVD or risk factors is unclear. Our purpose was to assess whether patients with OSA without overt CVD or risk factors have subclinical atherosclerosis as evaluated by carotid intima medial thickness (CIMT) compared to matched controls. METHODS: We measured CIMT in patients >40 years old, who underwent polysomnography for suspected OSA and did not have a history of CVD or risk factors (smoking, hypertension, diabetes, hyperlipidemia). OSA severity was classified according to apnea-hypopnea index. Serum levels of high-sensitivity C-reactive protein, fibrinogen, and lipids were assessed and relationships with OSA severity explored. CIMT measurements from patients with OSA were compared those of to age-, gender-, and BMI-matched controls from a community-based cohort without known CVD or OSA. RESULTS: Fifty-one patients were studied. Of these, patients with severe OSA had an increased CIMT compared to patients without OSA, but the relationship was not significant after controlling for age (p = 0.10). However, 37 patients had OSA and were matched to 105 controls. CIMT was significantly increased in OSA patients versus controls (0.77 vs. 0.68 mm, p = 0.03). The difference between patients and controls was greater for patients with severe OSA (0.83 vs. 0.71 mm) than for patients with mild-to-moderate OSA (0.71 vs. 0.67 mm). CONCLUSIONS: Patients with OSA but without a history of or risk factors for CVD have increased CIMT compared to a BMI-, age-, and gender-matched cohort. This provides evidence that OSA is an independent risk factor for the development of CVD.

Bear maulings treated in Calgary, Alberta: Their management and sequelae.

BACKGROUND: Between 1994 and 2005, seven patients underwent surgery at the Foothills Medical Centre, Calgary, Alberta, for injuries sustained in bear maulings. The purpose of the present study was to document these cases and add to the literature on the management and the potential complications of bear attacks. METHODS: Data were collected retrospectively from charts. RESULTS: Seven patients were treated for injuries ranging from lacerations and puncture wounds to fractures and avulsed tissue. On average, patients underwent three operations and spent 22 days in hospital. Mean time from attack to arrival at the trauma centre was 19 h. Irrigation, debridement and intravenous antibiotics did not prevent wound infections in two patients. Six of seven patients developed acute stress disorder, and one of these patients went on to suffer from post-traumatic stress disorder. Complications ranged from infection to pulmonary embolism. CONCLUSIONS: Bear attacks result in a spectrum of injuries. Infections and psychiatric disorders are common sequelae.