A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma.

OBJECTIVE: To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE). DESIGN: Systematic review. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine. SEARCH STRATEGY: names and descriptors of the therapies and LE. STUDY SELECTION: All human studies assessing the four therapies for LE. MAIN RESULTS: Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size. CONCLUSIONS: There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.

[Evaluation of a new model for a Polish continuous positive airway pressure device (POL-CPAP 2)]. / Ocena nowego modelu polskiego aparatu do wytwarzania stalego dodatniego cisnienia w drogach oddechowych (POL-CPAP 2).

The aim of the study was to compare physical and technical features of a new, improved, model of polish CPAP device (POL-CPAP2). The new model is smaller and lighter than the previous one. The new model produces higher flow and maximal working pressures 335 L/min and 19 mbar respectively. Device is also less noisy at usually applied pressures. Important novelty is a 20 minutes ramp pressure increase facilitating patient to fall asleep.

[Estimation of the value of a self-designed questionnaire in diagnosing patients with suspected obstructive sleep apnea]. / Próba oceny wartosci wlasnego kwestionariusza we wstepnym badaniu chorych podejrzanych o obturacyjny bezdech senny.

We have investigated the use of our own sleep questionnaire as a screening test for patients suspected of obstructive sleep apnoea (OSA). We examined 156 unselected patients (mean age 49.5 +/- 0.9 years) referred to our clinic because of snoring or excessive daytime sleepiness. Each subject answered the questionnaire and underwent full standard polysomonography (PSG). Diagnosis of OSA, based on PSG, was established when AHI > 10. Significant correlations between AHI and questionnaire questions were found for BMI (r = 0.54, p < 0.001), questions considering snoring (r = 0.3, p < 0.001), questions considering apnoeas during sleep, difficulties with falling asleep and nycturia (r = 0.21, p < 0.01) and questions asking for dry mouth and tongue in the morning and excessive daytime sleepiness (r = 0.16, p < 0.05). Sensitivity and specificity of investigated questionnaire to confirm the disease were: 92% and 38%, respectively. Evaluated questionnaire helps to select patients with severe form of OSA demanding quick diagnosis and treatment.

[Comparison of automatic (AUTO-CPAP)and "manual" CPAP pressure titration in patients with obstructive sleep apnea]. / Porównanie automatycznego (AUTO-CPAP) i "recznego" doboru cisnienia leczniczego u chorych na obturacyjny bezdech senny (OBS).

UNLABELLED: Auto-CPAP gives an opportunity to decrease costs of evaluating patient with OSA, replacing manual titration of pressure during PSG. The aim of this study was to compare automatic (auto-CPAP) and manual CPAP pressure titration in patients with OSA. We studied 50 obese patients (BMI--35 +/- 6 kg/m2), mean age 52.4 +/- 9.4 years with severe OSA, mean: AHI--62.9 +/- 22.1, mean overnight SaO2--89.1 +/- 3.7%, T90--54.4 +/- 29.6%. Two polysomnographies were performed: first when patient slept with CPAP and pressure was titrated manually by a technician and second on auto-CPAP device. Both methods had similar efficacy in reduction of AHI (< 10/h) and hypoxaemia, despite lower pressure established during auto-CPAP mode preventing apnoeas and hypopnoes during 90% of sleep time (8.2 +/- 1.7 cm H2O) compared to manual CPAP titration (9.2 +/- 1.7 cm H2O) (p < 0.05). CONCLUSION: Auto-CPAP seems to be a reliable alternative to manual titration of the therapeutic pressure in patients with OSA. This may help to cut a waiting list for PSG of patients suspected of OSA.

[The effect of long-term therapy of obstructive sleep apnea syndrome with CPAP for symptoms of daytime sleepiness]. / Wplyw dlugotrwalego leczenia obturacyjnego bezdechu sennego za pomoca CPAP na objawy sennosci dziennej.

The study was undertaken to investigate whether a long-term CPAP therapy improves the symptoms of daytime sleepiness in patients with the obstructive sleep apnoea syndrome. Seventy six patients (72 men and 4 women) with AHI = 53(+/- SE = 3), BMI 35 (+/- SE = 0.8), mean age 46.3 (+/- SE = 11.4) have undergone CPAP therapy for at least one year (mean: 2.48 +/- SE = 0.33). The aggravation of alterations of the daytime sleepiness was estimated using the questionnaire from Sleep Laboratory at the Marburg University and the Epworth Sleepiness Scale (ESS). After the CPAP therapy, we have observed the decrease of the symptoms of the excessive daytime sleepiness (p < 0.001). Negative correlation between CPAP compliance and ESS outcome was observed (r = 0.4; p < 0.001). There was not correlation between the term of using CPAP and the degree of the complaints decrease.

[The effect of CPAP treatment on excessive daytime somnolence in patients with obstructive sleep apnea]. / Wplyw leczenia metoda CPAP na nadmierna sennosc dzienna u chorych na obturacyjny bezdech senny.

The study was undertaken to investigate whether a CPAP therapy improves symptoms of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnoea (OSA). In seventy six patients (66 M and 10 F) with AHI = 50 +/- 3.3, BMI = 34 +/- 0.9 kg/m2 and mean age = 50.4 +/- 1 years OSA was diagnosed using standard polysomnography. EDS was assessed using Epworth Sleepiness Scale (ESS). Each patient was examined two or three times, before, after 1 and/or 2-15 months of CPAP treatment. Significant reduction of EDS within 1 month of CPAP therapy was found. Mean ESS was reduced from 14.3 +/- 0.9 to 7.0 +/- 0.7 after 1 month therapy (p < 0.001). Continuation of treatment had no further effect on decrease of symptoms of daytime sleepiness. There was a correlation between percent of sleep spent with CPAP and improvement in ESS.

[Compliance to treatment recommendations in patients with obstructive sleep apnea at least one year after diagnosis]. / Stosowanie sie do zalecen leczniczych chorych na obturacyjny bezdech senny (OBS) w co najmniej rok po ustaleniu rozpoznania.

UNLABELLED: 102 OSA patients, qualified for nCPAP treatment at least one year ago were investigated by questionnaire and direct examination. CPAP device has been used by 76 patients (75%). Other subjects (26 persons) did not use it for various reasons. Subjects treated (Group L) and not treated (Group NL) were compared. Before qualifying for nCPAP treatment, Group L compared to Group NL, had significantly higher apnoea/hyponoea index, AHI (p < 0.001) and more severe hypoxaemia during sleep (p < 0.01). Subjects of Group L were more obese (p < 0.01) and smoked more cigarettes per day (p < 0.05) than Group NL. Group L patients have been using nCPAP for 6.3 +/- 0.2 nights per week and 6.4 +/- 0.2 hours per night. From variables characterizing OSA and obesity, the intensity of nCPAP usage positively correlated with AHI (p < 0.05) and negatively with severity of daytime sleepiness (p < 0.001). Among Group L patients, 93% reported general improvement, 84% woke up refreshed and rested in the morning and 70% did not feel sleepy during the daytime. Concentration improved in 66% of treated patients. Main complaints were associated with rhinitis (38%), uncomfortable mask (34%) or air leaks around the mask (26%), dryness in throat and nose (33%), shallow, unquiet sleep with frequent awakenings (about 31%), chest pain (23%) or headache (22%). 33% of subjects complained of machine noise, troubling sleep partner. CONCLUSIONS: The acceptance of nCPAP treatment was 75% and depended on the OSA severity. nCPAP device was effective in OSA treatment, mild side effects were reported by around one third of studied patients.

[Treatment outcome in tobacco dependence after nicotine replacement therapy and group therapy]. / Wyniki leczenia uzaleznienia od tytoniu za pomoca nikotynowej terapii zastepczej oraz terapii grupowej.

The deletorious health effects of smoking are generally known. In spite of that, great numbers of people still smoke tobacco in the whole world. It is primarily due to the addictive properties of nicotine. Cigarette smoking is also dependent on various social and psychologic factors making quitting very difficult. Among various treatment modalities for tobacco dependence we aimed to assess the efficacy of nicotine replacement therapy (NRT) vs group therapy. 325 subjects smoking at least 15 cigarettes/day for more than 3 years were studied. They were allocated to group therapy (neurolinguistic programming) or NRT (gum or patch) at their will. Non-smoking was validated at each of follow-up visits, at 1 and 2 weeks 1, 3, 6, 12 months by measuring CO in expired air. All groups were matched in age, smoking history and nicotine dependence. The best quit rate was observed as a result of group therapy (41% at 1 year, p. < 0.001) as compared to nicotine patch (2%) and nicotine gum (9%).

[Ten years experience of the sleep laboratory at the Institute of Tuberculosis and Lung Disease in Warsaw]. / Dziesiec lat doswiadczen pracowni zaburzen oddychania w czasie snu w Instytucie Gruzlicy i Chorób pluc.

Between 1991-2000 2052 patients (81% men and 19% women) were referred to our Sleep Laboratory because of OSA suspision. In 1194 (58%) subjects (88% men and 12% women) diagnosis of obstructive sleep apnoea (OSA, AHI > 10) was confirmed. In 430 of them (36%) mild OSA (AHI 11-25), in 243 (20%) moderate OSA (AHI 26-40), and in 521 (44%) severe OSA (AHI > 40) was diagnosed. Epworth sleepiness scale score in those groups was 10.4, 10.5 and 13.0 points respectively. 908 (76%) of patients with OSA were submitted to nCPAP treatment. Effective CPAP pressure ranged from 5 to 20 milibars, mean 8.4 mbars. In 21 patients upper airway resistance syndrome (UARS) was diagnosed. Central sleep apnoea, most frequently of Cheyne-Stokes respiration type was diagnosed in 13 patients. The most common diseases accompanying OSA were: systemic hypertension (46%), coronary heart disease (29%), diabetes (12%), and COPD (9%). Majority of OSA patients (61%) were obese (BMI > 30 kg/m2), 32% were over weight (BMI 25-30 kg/m2). Only 7% had normal body weight (BMI 20-25 kg/m2). Long-term (more than one year) compliance to treatment was found in 70% of patients prescribed CPAP.

[Obstructive sleep apnea and risk factors for coronary artery disease]. / Obturacyjny bezdech senny a czynniki ryzyka choroby niedokrwiennej serca.

STUDY AIM: Obstructive sleep apnoea (OSA) is strongly associated with obesity, especially abdominal obesity. Obesity in turn is a well-known risk factor for coronary artery disease (CAD). The aim of our study was to evaluate the relationship between OSA severity and CAD risk factors. MATERIAL AND METHODS: The sample consisted of 73 subjects (mean age +/- SE, 46.7 +/- 1 years) referred to a sleep laboratory. Subjects were either: 1. obese with OSA (O-OSA group n = 35; body mass index, BMI l 30 kg/m2; apnoea/hypopnoea index, AHI > 35), 2. non-obese with OSA (BO-OSA group n = 14; BMI < 27 kg/m2; AHI > 35), or 3. obese without OSA (O-Z group n = 24; BMI l 30 kg/m2; AHI < 5). All subjects underwent full overnight polysomnography. Blood samples were taken from all subject, for fasting levels of insulin (INS), glucose (GLU), total, HDL and LDL cholesterol, triglyceride (TG) and uric acid (UA). RESULTS: O-OSA had significantly higher INS and UA levels (p < 0.05) compared to BO-OSA and O-Z. GLU and lipid levels were comparable in the studied groups. GLU level correlated (p < 0.05) negatively to minimum oxyhemoglobin saturation (SAT-MIN) and positively to neck circumference. TG and UA levels were correlated (p < 0.05) positively to AHI and negatively to SAT-MIN. UA level was also positively correlated (p < 0.05) to BMI, waist/hip circumference ratio (WHR), and INS level. INS level correlated (p < 0.05) positively to AHI, T90, WHR and UA, and negatively to SAT-MIN and mean oxyhemoglobin saturation. After adjusting for the influence of OSA and obesity (multiple regression analysis), we found independent negative correlations (p < 0.05) between: GLU level and SAT-MIN, UA level and SAT-MIN, and INS level and SAT-MIN. An independent, positive correlation (p < 0.05) was found between TG level and AHI. CONCLUSIONS: Results of our study suggest that OSA increases the risk of coronary artery disease by increasing plasma levels of glucose, triglyceride and insulin, independent of obesity.

Forecast of labour force in Poland to the year 2020: methodology and results.

"In 1995 the Labour Statistics Division of the Central Statistical Office (CSO) started methodological work on the preparation of a forecast of the labour force in Poland to the year 2020.... Variant ¿intermediate' assumes a slow reconstruction of the economic activity of population from the level of the period 1978-88 (census 1978 and census 1988). The main part of this ¿reconstruction' will take place in the years 1995-2010. The greatest anticipated changes concern youths (18-24 years), persons of immobility age (males 45-64 years and females 45-59 years) and the first groups of the retirement age. Variant ¿maximum' assumes that the anticipated ¿reconstruction' labour force participation rate will be faster (compared with variant ¿intermediate')."

[Marked polyglobulia in patients with obstructive sleep apnoea]. / Skrajna poliglobulia u chorych na obturacyjny bezdech senny.

Two patients with obstructive sleep apnoea are presented. Both had marked hypoxaemic polycythaemia treated for many years with phlebotomies before a proper diagnosis was established. Diagnosis of obstructive sleep apnoea and introduction of CPAP treatment resulted in clinical improvement and regression of polycythaemia. In secondary polycythaemia differential diagnosis should include obstructive sleep apnoea.

Snoring and excessive daytime somnolence among Polish middle-aged adults.

There is considerable interest in the association of snoring and health consequences that have been linked to more severe sleep-disordered breathing, including obstructive sleep apnoea syndrome. The goal of this investigation was to assess the independent association of heavy, habitual snoring and daytime sleepiness. For this, a cross-sectional, population based study of snoring, sleepiness and other factors was conducted using the Warsaw sample of the Multinational Monitoring of Trends and Determinants of Cardiovascular Diseases (MONICA) study, a population-based multicentre study of cardiovascular disease. The well-defined MONICA sample of middle-aged males and females also allowed estimation of age- and sex-specific prevalences of habitual snoring in Polish adults. Data on self-reported snoring frequency and loudness, and daytime sleepiness using the Epworth Sleepiness Scale (ESS) and other questions, were collected with a postal questionnaire. Seventy-nine per cent of the MONICA sample completed the questionnaire, yielding a total of 1,186 participants. Of the total sample, 27% of the females and 48% of the males reported habitual snoring ("often" or "always"). There was an independent association of habitual snoring and excessive daytime sleepiness (EDS), sleepiness that interfered with work and with increasing ESS scores. Habitual snorers were 5.8 and 3.1 times more likely to report EDS in active and passive situations, respectively, compared to nonsnorers (all p<0.01). It is concluded that habitual snorers, most of whom are probably unlikely to have frank sleep apnoea syndrome, are at substantial risk for daytime sleepiness. These findings add support to the hypothesis that simple snoring is not benign and underscores the need for further research on health outcomes associated with this prevalent condition.

[Excessive daytime somnolence in the adult population of Warsaw]. / Nadmierna sennosc dzienna wsród doroslych mieszkanców Warszawy.

We studied prevalence of excessive daytime somnolence (EDS) in a representative cohort of people living in Warsaw, aged 38-67y. Forty eight items questionnaire concerning sleep habits and symptoms including Epworth Sleepiness Scale assessing EDS was mailed twice to 1503 subjects. The response rate was 79%. The average sleep time on working days was 7.1 +/- 1.1h and 8.1 +/- 1.3h on week-ends. Moderate DS was found in 21% and severe DS in 7.5% of the studied group. 0.4% of studied subjects admitted falling asleep while driving a car. These figures are comparable to that reported in recent literature. There was no relation between EDS and short hours of sleep. Severe DS was twice as frequent among men than among women (p < 0.001). There was no clear-cut relations between age and EDS.

[Snoring and excessive daytime somnolence and risk of cardiovascular diseases]. / Chrapanie i nadmierna sennosc dzienna a ryzyko chorób sercowo-naczyniowych.

Snoring and excessive daytime somnolence (EDS) are very common in middle-age adults. The goal of the investigation was to assess links between those symptoms and risk for cardiovascular diseases (CVD). The population studied included 1186 inhabitants of Warsaw (mean age 52 years), participants of the international multicentre study of cardiovascular disease MONICA II, who completed the sleep disordered breathing (SDB) questionnaire. Snoring was reported by 78% of males (48% habitual and 30% occasional) and 59% of females (27% habitual and 32% occasional). Every fourth (26.8%) subject declared observed apnoeas, in 9.2% apnoeas were observed every night. EDS was declared by 28.7% of studied sample. The results of the questionnaire were compared to the results of MONICA study. Snorers had significantly higher systolic and diastolic blood pressure (133.2 +/- 23/84.6 +/- 13 mm Hg) compared to non-snorers (126.4 +/- 22/80.4 +/- +/- 12 mm Hg) (p < 0.0001). The high total serum cholesterol (> or = 200 mg%) and triglycerides (> or = 200 mg%) concentration, and also obesity (BMI > or = 30 kg/m2) were more prevalent in snorers. Subjects reporting apnoeas more often had coronary artery disease (p < 0.001) or history of stroke (p = 0.002) compared to non-apnoeics. There was no relationship between EDS and risk of cardiovascular disorders, and also between diabetes and SDB. In conclusion, snoring was strongly associated with hyperlipidaemia, obesity or hypertension, well known risk factors for development of cardiovascular disorders. Reported apnoeas were related to risk of coronary artery disease.