RESUMEN
Across the EU, programmes of measures have been introduced as part of river basin management planning as a means of tackling problems of diffuse pollution from agriculture. Evidence is required to demonstrate the effectiveness of these measures and with this overarching objective, monitoring of an agricultural catchment in Eastern Scotland was initiated in 2007. As a precursor to evaluating the effect of new management measures it is essential to understand how other factors, including hydrology and land use changes, could have influenced water quality. This study undertook an analysis of the trends in concentrations and loads of nitrate, soluble reactive phosphorus (SRP), suspended solids (SS) and turbidity measured at six points in the catchment over a six year period. The results identified both differing trends between determinands and differing trends occurring over varying spatial scales. The only direct relationships between land use and water quality that could be identified based on annual data was a positive link between arable cropping and nitrate concentrations. At the sub-catchment scale some temporal changes in land use and management explained short-term trends in nitrate but not in SRP. Lags in the system were identified due to soil adsorption, in-stream/loch processing and groundwater transport making the identification of cause and effect problematic. The results have implications for the demonstration of effectiveness of measures over the shorter term and the timescales of recovery from diffuse pollution. Longer term monitoring at small scales will be important in this regard.
Asunto(s)
Agricultura , Monitoreo del Ambiente , Contaminantes Químicos del Agua/análisis , Contaminación del Agua/estadística & datos numéricos , Hidrología , Nitratos , Fósforo/análisis , Escocia , Calidad del AguaRESUMEN
In humid temperate areas, after harvest of potatoes, it is difficult to prevent soil erosion and diffuse pollution. In some autumn weather conditions, in-field mitigation such as cultivation or sowing are not possible, while edge of field measures can be costly and inflexible. We have assessed the potential of modified sediment fences, widely used on building sites, for erosion mitigation post-harvest of potato crops. Field scale assessments were conducted on fields in the Lunan catchment, eastern Scotland. Sediment retention was estimated by two methods: a topographic survey method using a hand held Real Time Kinematic Global Positioning System (RTK-GPS), and direct measurement of sediment depth using a graduated cane. In the 2010/11 trial the main fence comprised 70 m of entrenched fine mesh (0.25 mm) and coarser mesh (4mm) fabric pinned to a contour fence near the base of the field. This retained an estimated 50.9 m(3) (80.2 tonnes) of sediment, with weighted mean total P (TP) content of 0.09 % in the<2mm soil fraction. In the 2011/12 trial, the main 146 m fence was of intermediate mesh size (1.2mm). The fence was partitioned into nine upslope plots, with 3 replicates of each of 3 cultivation methods: T1 (full grubbing--a light, tined cultivator), T2 (partial grubbing) and T3 (no grubbing). Average plot slopes ranged from 9.9 to 11.0 %. The amounts of TP accumulating as sediment at the fences were: 9.3 (sd=7.8), 11.8 (sd=10.2) and 25.7 (sd=5.8)kg P/ha of upslope plot for the T1, T2 and T3 treatments respectively.
RESUMEN
In humid temperate areas, after harvest of potatoes, it is difficult to prevent soil erosion and diffuse pollution. In some autumn weather conditions, in-field mitigation such as cultivation or sowing are not possible, while edge of field measures can be costly and inflexible. We have assessed the potential of modified sediment fences, widely used on building sites, for erosion mitigation post-harvest of potato crops. Field scale assessments were conducted on fields in the Lunan catchment, eastern Scotland. Sediment retention was estimated by two methods: a topographic survey method using a hand held Real Time Kinematic Global Positioning System (RTK-GPS), and direct measurement of sediment depth using a graduated cane. In the 2010/11 trial the main fence comprised 70 m of entrenched fine mesh (0.25 mm) and coarser mesh (4mm) fabric pinned to a contour fence near the base of the field. This retained an estimated 50.9 m(3) (80.2 tonnes) of sediment, with weighted mean total P (TP) content of 0.09 % in the<2mm soil fraction. In the 2011/12 trial, the main 146 m fence was of intermediate mesh size (1.2mm). The fence was partitioned into nine upslope plots, with 3 replicates of each of 3 cultivation methods: T1 (full grubbing--a light, tined cultivator), T2 (partial grubbing) and T3 (no grubbing). Average plot slopes ranged from 9.9 to 11.0 %. The amounts of TP accumulating as sediment at the fences were: 9.3 (sd = 7.8), 11.8 (sd = 10.2) and 25.7 (sd = 5.8)kg P/ha of upslope plot for the T1, T2 and T3 treatments respectively.
Asunto(s)
Agricultura/instrumentación , Conservación de los Recursos Naturales/métodos , Sedimentos Geológicos/química , Fósforo/análisis , Agricultura/métodos , Conservación de los Recursos Naturales/estadística & datos numéricos , Sistemas de Información Geográfica , Modelos Teóricos , Escocia , Solanum tuberosum/crecimiento & desarrolloRESUMEN
We investigated a range of microbiological community assays performed on scrapes of biofilms formed on artificial diffusing substrates deployed in 8 streams in eastern Scotland, with a view to using them to characterize ecological response to stream water quality. The assays considered were: Multiplex Terminal Restriction Fragment Length Polymorphism or M-TRFLP (a molecular method), Phospholipid Fatty Acid or PLFA analysis (a biochemical method) and MICRORESP™ (a physiological method) alongside TDI, diatom species, and chlorophyll a content. Four of the streams were classified as of excellent status (3-6µg/L Soluble Reactive Phosphorus (SRP)) with respect to soluble P content under the EU Water Framework Directive and four were of borderline good/moderate or moderate status (43-577µg/L SRP). At each site, 3 replicates of 3 solute diffusion treatments were deployed in a Latin square design. Solute diffusion treatments were: KCl (as a control solute), N and P (to investigate the effect of nutrient enrichment), or the herbicide isoproturon (as a "high impact" control, which aimed to affect biofilm growth in a way detectable by all assays). Biofilms were sampled after 4weeks deployment in a low flow period of early summer 2006. The chlorophyll a content of biofilms after 4weeks was 2.0±0.29mg/m(2) (mean±se). Dry matter content was 16.0±13.1g/m(2). The M-TRFLP was successfully used for generating community profiles of cyanobacteria, algae and bacteria and was much faster than diatom identification. The PFLA and TDI were successful after an increase in the sample size, due to low counts. The MICRORESP(™) assays were often below or near detection limit. We estimated the per-sample times for the successful assays as follows: M-TRFLP: 20min, PLFA 40min, TDI 90min. Using MANOVA on the first 5 principal co-ordinates, all the assays except MICRORESP(™) showed significant differences between sites, but none of the assays showed a significant effect of either initial stream trophic status (as classified by the EU Water Framework Directive using chemical standards for soluble P), or of the diffusing solute treatment. Multiple Procrustes analysis on the ordination results showed that the diatom and M-TRFLP data sets hold distinct, though as yet unexplored, information about the ecological factors affecting stream biofilms. The diatom data were subjected to principal components analysis, to identify which taxa were more strongly influenced by site variables, trophic status or treatment effects. These were Acnanthes lanceolata, A. minutissimma, Nitzchia spp., Coccineis spp. and Navicula spp. Further experimentation and data analysis on a larger number of sites, to identify specific M-TRFLP bands that could be used as indicators linked to specific taxa, are desirable. Results highlight the need for a multifactorial approach to understanding controls on stream ecology.
Asunto(s)
Biodiversidad , Biopelículas/crecimiento & desarrollo , Ecosistema , Metagenoma , Ríos/microbiología , Técnicas de Química Analítica , Ecología/métodos , Metagenómica/métodos , Ríos/química , EscociaAsunto(s)
Enfermedad de Hodgkin/patología , Linfoma de Células del Manto/patología , Anciano , Cromosomas Humanos Par 11/genética , Cromosomas Humanos Par 14/genética , Ciclina D1/análisis , Ciclina D1/genética , Resultado Fatal , Femenino , Enfermedad de Hodgkin/genética , Enfermedad de Hodgkin/metabolismo , Humanos , Hibridación Fluorescente in Situ , Antígeno Ki-1/análisis , Antígeno Lewis X/análisis , Linfoma de Células del Manto/genética , Linfoma de Células del Manto/metabolismo , Células de Reed-Sternberg/metabolismo , Células de Reed-Sternberg/patología , Translocación GenéticaRESUMEN
The Integrated Nitrogen in CAtchments model (INCA) was applied to the River Dee, Aberdeenshire, NE Scotland. To a first approximation the model was able to simulate the annual mean streamwater NO3-N concentrations observed along the length of the main channel. This provided the basis for using INCA to subsequently explore the effects of N deposition and land use management on streamwater NO3-N concentrations and loads. On an annual timescale, the model predictions suggest that NO3-N concentrations will decrease by 5% following a 20% reduction in fertiliser application. Furthermore, model results also suggest that a 50% increase in N deposition will cause a 15% increase in the streamwater NO3-N concentrations. The utility of INCA as a tool for catchment management is discussed, current limitations are highlighted and possible improvements are suggested.
Asunto(s)
Modelos Teóricos , Nitrógeno/metabolismo , Contaminantes del Agua/análisis , Agricultura , Fertilizantes , Nitrógeno/farmacocinética , EscociaRESUMEN
PURPOSE: The lack of a precise working definition of interstitial cystitis may have resulted in the de facto use of the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) "research" definition by clinicians. We evaluated these strict criteria in light of the broader inclusion criteria for patients evaluated in the Interstitial Cystitis Database study to determine their utility in clinical practice as a useful basis for the diagnosis of interstitial cystitis. MATERIALS AND METHODS: A total of 379 women who completed screening for the Interstitial Cystitis Database before January 1, 1996 met the basic criteria of urinary frequency, urgency or pain for at least 6 months in duration without a diagnosable etiology. Of these patients 148 underwent cystoscopy and hydrodistention of the bladder as a part of the evaluation. All patients were followed for a minimum of 1 year. Comparisons were made between patients judged to have a clinical diagnosis of interstitial cystitis and those who met the NIDDK research definition of the syndrome. RESULTS: Almost 90% of patients potentially meeting NIDDK criteria are believed by experienced clinicians to have interstitial cystitis, confirming the research value of these criteria in defining a homogeneous population for study. However, strict application of NIDDK criteria would have misdiagnosed more than 60% of patients regarded by researchers as definitely or likely to have interstitial cystitis. CONCLUSIONS: The NIDDK criteria are too restrictive to be used by clinicians as the diagnostic definition of interstitial cystitis.
Asunto(s)
Cistitis Intersticial/diagnóstico , Bases de Datos Factuales , Femenino , Humanos , National Institutes of Health (U.S.) , Estados UnidosRESUMEN
Recent blood pressure trends reflect progress in hypertension control, but prevalent drug therapy precludes direct estimation of the component due to primary prevention. In data gathered on persons aged 35-74 years in three successive US health examination surveys (1960-1980), systolic blood pressure levels assuming no drug therapy were imputed by reassigning blood pressure to the upper end of the distribution for respondents reporting use of antihypertensive medication. Blood pressure was partitioned into four ordinal categories based on weighted percentiles of the 1960-1962 distributions for 35- to 44-year-old males and females who reported no use of antihypertensive medication. Cumulative logit models (alpha = 0.01) were used to estimate age- and sex-specific trends for blacks and whites within two strata (<25 or > or =25) of body mass index (BMI) (weight (kg)/height (m)2). Before imputation, systolic blood pressure decreased between 1960 and 1980; after imputation, significant decreases remained only in 35- to 44-year-olds. Strong associations of black race and BMI > or =25 with higher blood pressures were present in models with and without drug therapy. Thus, according to the models, there has been little progress in decreasing racial or BMI-related blood pressure differentials. Above the age of 44 years, blood pressure trends were largely attributable to medication use. In contrast, data for 35- to 44-year-olds suggest progress in primary prevention.
Asunto(s)
Presión Sanguínea , Hipertensión/epidemiología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Distribución por Edad , Anciano , Población Negra , Índice de Masa Corporal , Femenino , Indicadores de Salud , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Distribución por Sexo , Sístole , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVES: The goal of this study was to correlate the cystometric findings with the presenting symptoms of the 388 women enrolled in the NIH/NIDDK-funded interstitial Cystitis Data Base (ICDB) Study as of December 31, 1995. METHODS: All patients underwent a complete history and physical and completed standardized questionnaires to assess voiding symptoms and quality of life (QOL). A 3-day voiding log was also obtained, followed by a baseline urodynamic exam. All results are expressed as mean values +/- 1 standard deviation, and all reported correlations were significant. RESULTS: A correlation was seen between reported daytime, nighttime, and 24-hour frequency, and both volume at first sensation to void (VFSV) and maximal cystometric capacity (VMCC). Patients with constant severe urgency had smaller VFSV, 63 +/- 59 mL versus 108 +/- 90 mL, and lower VMCC, 163 +/- 102 mL versus 288 +/- 135 mL, than patients without the complaint. A negative trend was seen for both VFSV and VMCC versus the global severity. An inverse trend was seen between minimal and maximal pain scores over the 4 weeks before the exam and VMCC. (No correlation existed between current pain noted during baseline screening visits and VFSV or VMCC). No urodynamics correlates were seen with global measures of body pain and global health. Uninhibited detrusor contractions (UDCs) were seen in 56 of 384 patients (14.6%). A positive correlation was seen between urgency symptoms and the presence of UDCs. Correlations between the VFSV and VMCC were made with both the average voided volume (AVV) and the average maximal voided volume (AMVV) as determined by a 3-day voiding log. Significant positive correlations were seen with each pair-wise comparison (P = 0.001). CONCLUSION: These findings confirm that subjective measurements of symptoms associated with interstitial cystitis can be confirmed objectively with urodynamic studies.
Asunto(s)
Cistitis Intersticial/diagnóstico , Cistitis Intersticial/fisiopatología , Urodinámica , Adulto , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: To determine if specific symptoms or physical findings were associated with findings on cystoscopic examination under anesthesia in patients participating in the Interstitial Cystitis Data Base (ICDB) Study. METHODS: Subjects entering the ICDB Study completed symptom questionnaires and underwent physical examinations. Additionally, at the discretion of study investigators, 150 women underwent cystoscopy under anesthesia following a specific protocol of bladder distension at 70 to 80 cm irrigating fluid height and reinspection after capacity was reached and the irrigant drained. RESULTS: Statistically significant (p < 0.01) associations between bodily pain and urinary urgency with the presence of a Hunner's patch, and urinary frequency and urgency with a reduced bladder capacity under anesthesia were seen. Neither the findings of bloody irrigating fluid nor glomerulations were strongly associated with any symptom, and except for an association of urethral tenderness with Hunner's patch, no physical examination finding was associated with any cystoscopic findings. CONCLUSIONS: The strong associations of Hunner's patch and reduced bladder capacity under anesthesia with severe pain and urinary urgency, and urgency and frequency, respectively, indicate not only the importance of these findings in diagnosing interstitial cystitis, but also their potential utility in subclassifying this disease.
Asunto(s)
Cistitis Intersticial/diagnóstico , Cistoscopía , Cistitis Intersticial/complicaciones , Bases de Datos Factuales , Femenino , Humanos , Dolor/etiología , Examen Físico , Calidad de VidaRESUMEN
OBJECTIVES: Interstitial cystitis is a symptom complex characterized by pelvic pain, urinary urgency, urinary frequency, and nocturia. Patients with these symptoms, at the 5 clinical centers participating in the National Interstitial Cystitis Data Base (ICDB) Study, have been evaluated with history and physical exams, questionnaires, and urodynamic studies. METHODS: Of the 388 female subjects entered in the study as of December 31, 1995, 150 women have undergone cystoscopy with hydrodistension. The data from the endoscopic procedures and the urodynamic studies were analyzed. The associations among cystoscopic and urodynamic findings were reviewed. RESULTS: Patient demographics of this subgroup show a predominance of Caucasians 139/150 (92.7%), with the average age being 43 (+/-13.2) years. Of the total, 17 patients (11.3%) had a Hunner's patch (HP). The prevalence by center varied from a low of 2/38 (5.3%) to a high of 3/9 (33.3%). Bloody effluent following hydrodistension was present in 113/150 (75.3%). Glomerulations appeared in varying degrees (mild, moderate, severe) in 91.3% of the 150 patients. There was a strong inverse relationship (P < 0.001) between bladder capacity under anesthesia and the presence of a HP (mean of 845 cc with HP absent versus a mean of 531 cc when present). The incidence of HP varied from 67.6% among women with a bladder capacity at hydrodistension of < 400 cc to 3.8% for those with a bladder capacity of at least 800 cc. The presence and increasing severity of glomerulations was positively associated (P < 0.003) with the presence of HP, ranging from 0/13 (0%) when glomerulations were not present to 6/31 (19.4%) when glomerulations were graded as severe. Of the patients with HP, 17/17 (100%) had glomerulations after hydrodistension. HP is more closely associated with the moderate to severe range of glomerulations (P < 0.01). Nearly half of the patients with HP or 8/17 (47.1%) had "moderate" glomerulations, while 6/17 (35.3%) had "severe" glomerulations. The volume at first sensation to void on urodynamics (mean 87 cc without HP versus 34.7 cc with HP) was highly inversely associated (P = 0.002) with the presence of HP, but not with any of the other cystoscopic findings. Of patients with HP, 94% had a volume at first sensation to void of < or = 50 cc where only 36% of patients without HP had a volume at first sensation to void of < or = 50 cc. The volume at maximum capacity on urodynamics was positively associated with the volume at hydrodistension (P < 0.001). CONCLUSIONS: Overall, patients with HP had lower bladder capacities, lower volumes at first sensation to void, and more severe glomerulations. Thus, the presence of HP would imply a more severe case of interstitial cystitis. Logically, a higher bladder capacity on cystometrogram is associated with a higher volume at the time of hydrodistension, and bloody effluent is associated with more severe glomerulations.
Asunto(s)
Cistitis Intersticial/diagnóstico , Cistitis Intersticial/fisiopatología , Cistoscopía , Urodinámica , Adulto , Protocolos Clínicos , Bases de Datos Factuales , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Sleep problems in the healthy elderly were studied in 628 community-dwelling older adults. Self-report of daytime sleepiness in this group was evaluated. Self-reported snoring was significantly associated with reports of daytime sleepiness (p < 0.001), and reported health showed significant associations with age group (p < 0.001), reports of breathing problems (p < 0.001), and reports of excessive daytime sleepiness (p < 0.01). The data strongly support the impact of sleep-related factors on self-perceptions of health in community dwelling older adults. Even as a subjective self-report measure, snoring readily predicts self-reported problems with daytime sleepiness.
Asunto(s)
Envejecimiento , Estado de Salud , Narcolepsia , Trastornos del Inicio y del Mantenimiento del Sueño , Factores de Edad , Anciano , Humanos , Masculino , Autoevaluación (Psicología) , Factores Sexuales , Síndromes de la Apnea del Sueño/complicaciones , Sueño REM , Ronquido/etiologíaRESUMEN
Comparative mapping studies of X-linked genes in mammals have provided insights into the evolution of the X chromosome. Many reptiles including the American alligator, Alligator mississippiensis, do not appear to possess heteromorphic sex chromosomes, and sex is determined by the incubation temperature of the egg during embryonic development. Mapping of homologues of mammalian X-linked genes in reptiles could lead to a greater understanding of the evolution of vertebrate sex chromosomes. One of the genes used in the mammalian mapping studies was ZFX, an X-linked copy of the human ZFY gene which was originally isolated as a candidate for the mammalian testis-determining factor (TDF). ZFX is X-linked in eutherians, but maps to two autosomal locations in marsupials and monotremes, close to other genes associated with the eutherian X. The alligator homologue of the ZFY/ZFX genes, Zfc, has been isolated and described previously. A detailed karyotype of A. mississippiensis is presented, together with chromosomal in situ hybridisation data localising the Zfc gene to chromosome 3. Further chromosomal mapping studies using eutherian X-linked genes may reveal conserved chromosomal regions in the alligator that have become part of the eutherian X chromosome during evolution.
Asunto(s)
Caimanes y Cocodrilos/genética , Proteínas de Unión al ADN/genética , Cariotipificación , Proteínas de Reptiles , Animales , Bandeo Cromosómico , Mapeo Cromosómico , Genes , Hibridación in Situ , Mamíferos/genética , Reptiles/genética , Análisis para Determinación del Sexo , Especificidad de la EspecieRESUMEN
We evaluated sleep/wake, medical, and psychological parameters in a cohort of healthy men and women between 50 and 80 years of age. Consistent with previous investigations of sleep-disordered breathing (SDB) in older persons, nocturnal breathing disturbances were quite common in our normal-aged subjects, with more than 15 percent experiencing five or more SDB events per hour of sleep. However, when SDB indices were correlated with comprehensive measures of daytime functioning, the number of statistically significant relationships was at or below expectations from chance alone. Additionally, comparison of high-SDB subjects (AHI greater than or equal to 5) with low-SDB subjects (AHI less than 5) failed to reveal reliable differences on measures of daytime functioning. We conclude that SDB occurring in otherwise healthy older persons is not a cause for immediate concern, although longitudinal studies may yet demonstrate significant long-term sequelae of SDB in this population.
Asunto(s)
Envejecimiento/fisiología , Síndromes de la Apnea del Sueño/fisiopatología , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Respiración/fisiología , Fases del Sueño/fisiologíaRESUMEN
Six eyes of six patients with myopia between -4.00 and -8.00 diopters underwent 193 nm Argon/fluoride excimer laser photorefractive keratectomy as part of a Phase II-A FDA Study. Six months after surgery, four of the six eyes had a spherical equivalent refraction within +/- 1.00 D; five eyes saw 22/30 or better without correction. All corneas demonstrated a faint reticulated subepithelial haze most visible by sclerotic scatter illumination. There were no episodes of delayed epithelial healing or recurrent erosions, and patients had no loss of contrast sensitivity, visual acuity under glare testing, or corneal sensation at the 3-month or 6-month visit. In this limited clinical trial, the excimer laser was capable of changing the refractive power of the cornea for correction of myopia. Long-term follow up of these patients will be necessary to determine the safety and efficacy of the procedure.
Asunto(s)
Córnea/cirugía , Terapia por Láser , Miopía/cirugía , Adulto , Recuento de Células , Sensibilidad de Contraste , Endotelio Corneal/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Refracción Ocular , Agudeza Visual , Cicatrización de HeridasRESUMEN
Nocturnal bruxing events were recorded during a single night of sleep for 12 subjects with sleep-disordered breathing and 12 age- and sex-matched controls. The results suggest that bruxing events are very common in both groups and are closely associated with sleep arousals. There were few differences in the number, duration, or type of bruxing events between these two groups. Bruxing events were common during stage 1, stage 2, and REM sleep, while they rarely occurred during stage 3 and 4 sleep. The average duration of bruxing events ranged from 3.82 to 6.68 seconds. There was a trend toward more bruxing events occurring while sleeping on the back than on the side.
Asunto(s)
Bruxismo/complicaciones , Síndromes de la Apnea del Sueño/complicaciones , Fases del Sueño , Adulto , Anciano , Bruxismo/fisiopatología , Electromiografía , Humanos , Masculino , Persona de Mediana Edad , Postura , Síndrome de las Piernas Inquietas/complicaciones , Síndrome de las Piernas Inquietas/fisiopatologíaRESUMEN
Thirty healthy geriatric subjects were studied during a single night of sleep in a sleep laboratory. Unilateral masseter muscle activity was recorded in addition to the standard polysomnographic study. The geriatric subjects in this study exhibited fewer bruxing events than other subjects reported in the literature. Certain conditions that have not been previously investigated, such as sleep position, type of bruxing event, and relationship to the state of the dentition, are reported.
Asunto(s)
Bruxismo/epidemiología , Anciano , Anciano de 80 o más Años , Bruxismo/fisiopatología , Ritmo Circadiano , Dentición , Dentadura Completa , Dentadura Parcial , Electromiografía , Femenino , Humanos , Masculino , Músculo Masetero/fisiopatología , Persona de Mediana Edad , Contracción Muscular/fisiología , Postura , Sueño/fisiología , Síndromes de la Apnea del Sueño/fisiopatología , Factores de TiempoRESUMEN
We compared 8 patients diagnosed with geriatric sleep apnea syndrome (GSAS) with 12 healthy older controls (GCON) matched on age, sex, weight, education, and socioeconomic standing. GSAS was diagnosed if patients had an apnea + hypopnea index (AHI) greater than or equal to 10 and an impairment involving at least two of the following: hypertension, cardiac arrhythmias, or daytime hypersomnolence. In addition to significant differences on selection variables (e.g., AHI, frequency of hypertension, Multiple Sleep Latency Test), GSAS patients had significantly more sleep disturbance, were sleepier on subjective measures, were more depressed, and had lower scores on tests of nonverbal problem solving and nonverbal memory. Thus, GSAS resembles SAS described in middle-aged populations. More research is needed to determine the most efficient diagnostic parameters for identifying pathological levels of SDB in older persons.
Asunto(s)
Síndromes de la Apnea del Sueño/diagnóstico , Anciano , Arritmias Cardíacas/complicaciones , Electrocardiografía , Humanos , Hipertensión/complicaciones , Masculino , Pruebas Psicológicas , Respiración/fisiología , Sueño/fisiología , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/psicologíaRESUMEN
Nasal CPAP is presently accepted as first-line therapy for obstructive sleep apnea, but a significant minority of patients do not tolerate nasal CPAP. The purpose of this study was to compare the benefits of nasal CPAP, nasal oxygen (O2), and placebo (air) using patients as their own controls. We studied eight men, aged 33 to 72 (mean 57 years), who had mild obstructive sleep apnea. To be eligible for study, patients had to have an apnea plus hypopnea index greater than or equal to 5, plus one or more of the following: blood pressure greater than 150/95 mm Hg, multiple sleep latency test mean score less than or equal to 10 minutes, or significant nocturnal cardiac ectopy. After a baseline study, patients received a month each of nocturnal O2 at 4 LPM and air at 4 LPM, presented in random order. The third month of treatment consisted of nasal CPAP (range 2.5 to 12.5 cm H2O). Patients underwent evaluation at baseline and after each month of treatment. It was concluded that oxygen was more effective in improving oxygenation and hypopneas than is nasal CPAP. However, oxygen did not reduce apneas or improve daytime hypersomnolence as well as nasal CPAP in patients with mild OSA. Oxygen might be considered as an alternate form of treatment for patients who are not hypersomnolent, or as an adjunct to nasal CPAP.