Update on obstructive sleep apnea and its relation to COPD.

Chronic obstructive pulmonary disease (COPD) is a common and preventable lung disease that affects millions of people in the United States. Sleep disorders including obstructive sleep apnea (OSA) are also common. It is not surprising that many people with COPD also suffer from OSA. This relationship, however, puts people at risk for more nocturnal desaturations and potential complications related to this, including pulmonary hypertension and heart rhythm disturbances. This update focuses on the physiology of sleep disturbances in COPD as well as the clinical implications of OSA in COPD.

Risk factors for sleep apnea in children with bipolar disorder.

BACKGROUND: While studies have suggested an increased prevalence of Obstructive Sleep Apnea (OSA) in adults with Bipolar Disorder (BPD), little is published about children with BPD. Behavioral difficulties including emotional liability, depression and poor school performance are commonly reported in children with either BPD or OSA. Comorbid medical disorders may exacerbate the course of BPD. We reviewed demographic and polysomnogram characteristics of children with BPD to help outpatient identification of OSA. METHODS: A single center retrospective chart review of children with BPD referred for a polysomnogram (PSG) over a ten-year period was conducted. There were 27 children identified whose diagnosis of BPD was independently verified by a child psychiatrist using DSM-IV standard criteria. RESULTS: Six (22%) children had OSA with a median apnea-hyponea index of 7.5 events per hour. Variables that were significantly different between the OSA and non-OSA groups were: median BMI (47 vs 30 kg/m(2), p=0.001); sleep efficiency (78.2% vs 91%, p=0.009); and oxygen saturation nadir (82% vs 92%, p=0.0003). There was no difference found in snoring percentage on PSG between the two groups. LIMITATIONS: The retrospective design from a single tertiary center limited the cohort size. Only secondary verification of the diagnosis of BPD from the available medical record was possible. CONCLUSIONS: Our findings suggest that extreme obesity (BMI >40 kg/m(2)), oxygen desaturation during sleep and frequent nocturnal awakenings are associated with OSA in children with BPD. Traditional clinical parameters for obesity and snoring, per se, are poor predictors of OSA in children with BPD.

Multidetector computed tomography pulmonary angiogram in the assessment of myocardial infarction.

PURPOSE: The objective of this study is to evaluate the effectiveness of nonelectrocardiographic gated multidetector computed tomography (MDCT) performed for the purpose of assessment of pulmonary embolus in the evaluation of myocardial infarction (MI). METHODS: We retrospectively evaluated 147 consecutive patients who had a computed tomography angiogram for pulmonary embolus on a 16-detector MDCT. Of this cohort, we determined 11 patients to have acute MIs based on electrocardiogram, positive troponin levels, and clinical findings and history. Four additional patients were found to have chronic MI based on history. The MDCT data were evaluated by an attending Radiologist, blinded to the clinical data, for quantitative and qualitative attenuations. Each MI was assigned a region of the heart based on its anatomical sections. RESULTS: We were able to detect 10 of 15 MIs, resulting in an overall sensitivity and specificity of 66.6% and 91.4%, respectively. The overall accuracy was 76.7%. If non-Q wave MIs are excluded from the data set, the sensitivity increased to 76.9%. Quantitative analysis of each region of the heart showed that there was a statistically significant difference (P < 0.01) between the infracting regions of the heart (69 +/- 3.3 SEM) and those with normal perfusion (93.3 +/- 1.0 SEM). CONCLUSIONS: While this method did prove to be effective at determining patients who had an MI, the low sensitivity and inability to differentiate chronic from acute myocardial infarction suggest that this technique is very limited in clinical practice.