Sleep breathing disorder frequency, risk factors, and treatment among adults with cystic fibrosis.

BACKGROUND: Our understanding of the epidemiology of sleep breathing disorders among adults with cystic fibrosis (CF) is limited. Our purpose was to describe the frequency, risk factors and treatment of sleep breathing disorders among adults with CF. METHODS: This was a retrospective analysis of linked data from laboratory-based diagnostic polysomnography (PSG) undertaken at St. Michael's Hospital (Toronto, Canada) and the Canadian CF Registry. Adults (≥19 years old) with CF that underwent a diagnostic PSG at St. Michael's Hospital between 2002 and 2021 were included. Sleep breathing disorder frequency, risk factors, and treatment were described, using descriptive statistics and logistic regression. RESULTS: There were 42 patients included (33.3 % women and median age at diagnostic PSG was 34.7 years). Obstructive sleep apnea [OSA] was the most commonly observed sleep breathing disorder (found in 64.3 %), followed by sustained nocturnal hypoxemia (16.7 %), and sleep hypoventilation (9.5 %). Only 41 % of individuals with an elevated total apnea-hypopnea index were receiving positive airway pressure [PAP] therapy. Corticosteroid use (either oral or inhaled) was the only factor with a significant positive association with presence of any sleep breathing disorder (odds ratio 5.00, 95 % confidence interval 1.28-22.78). CONCLUSIONS: Among adults with CF, OSA occurs more commonly than previously appreciated and the majority of sleep breathing disorders were not being treated with PAP or supplemental oxygen. Management of sleep breathing disorders among adults with CF reflects a potentially important care gap, but further research is needed to determine the health impacts of treating sleep breathing disorders in CF.

Trends of type 1 diabetes in Karachi, Pakistan.

OBJECTIVE: Our study aims to assess the presentation, prevalence, and associations of acute and chronic complications in subjects with type 1 diabetes mellitus (T1DM) at their first visit to outpatient departments. STUDY DESIGN AND SETTING: Study was carried out at two centers, Diabetic Association of Pakistan and WHO Collaborating Centre and Baqai Institute of Diabetology and Endocrinology, Karachi. Records of 591 T1DM subjects divided into two groups were studied. Group 1 (62.1%, n = 367) includes patients with known T1DM and group 2 (n = 224, 37.9%), newly diagnosed T1DM. Clinical features [polyuria, polydipsia, polyphagia, history of weight loss, and history of diabetic ketoacidosis (DKA)] were recorded. Biochemical parameters including fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c, urinary ketones, and proteinuria were recorded. Arterial blood gases was done in suspected cases of DKA. RESULTS: In group 1, male predominance was seen (57.8 vs. 42.2%). Mean age at presentation was 19.1 +/- 10 yr. Mean duration of diabetes was 16 +/- 9 yr. Two percent subjects presented with DKA, while 21% had a history of DKA. Among the subjects with >10 yr of diabetes, 20.1% had hypertension, 5.5% had nephropathy, 2.9% had neuropathy, and 7.7% had retinopathy. In group 2, 224 T1DM subjects were identified, with mean age of 17 +/- 11 yr. Equal number of males (50.9%) and females (49.1%) were diagnosed at their first presentation. Most subjects (40.8%, n = 91) diagnosed between 11 and 20 yr of age presented with polyuria (81.3%), polydipsia (77.2%), polyphagia (56.7%), and weight loss (79.5%). Ketonuria was positive in 4.9%, while 5.8% presented with DKA. CONCLUSIONS: This is the first study in Pakistan to assess the mode of presentation and prevalence of acute and chronic complications in T1DM. Larger scale prospective studies are needed to have more detailed informative data.