Shrinking lung syndrome: vanishing in non-rapid eye movement sleep.

Shrinking lung syndrome is a rare complication of systemic lupus erythematosus; its impact on sleep-disordered breathing is not well understood. We describe a case of a 36-year-old female with systemic lupus erythematosus experiencing shrinking lung syndrome and frequent pain crises. We review manifestations of her disease during non-rapid eye movement (NREM) and rapid eye movement sleep. Shrinking lung syndrome with its restrictive physiology and associated diaphragmatic myopathy is expected to decrease minute ventilation during NREM and rapid eye movement sleep. Normalization of respiratory rate during NREM, as opposed to rapid eye movement and awake state, should alert clinicians to dysfunctional breathing that is suppressed in NREM when cortical breathing is overridden by involuntary breathing. Recognition of dysfunctional breathing disorders by sleep providers is important for addressing all contributors to dyspnea in patients with systemic lupus erythematosus; polysomnogram can be a valuable tool in detecting incongruent ventilation parameters that deviate from expected NREM and rapid eye movement norms and point to dysfunctional breathing disorders. Abnormalities in respiratory rate and gas exchange that improve or vanish in NREM sleep can serve as an additional diagnostic clue of dysfunctional breathing disorders. CITATION: Saleh D, Loewen A. Shrinking lung syndrome: vanishing in non-rapid eye movement sleep. J Clin Sleep Med. 2023;19(11):1975-1979.

A Systematic Evaluation of the Quality, Accuracy, and Reliability of Internet Websites about Pulmonary Arterial Hypertension.

Rationale: Patients with pulmonary arterial hypertension (PAH) or their caregivers may seek information about their disease online, but the accuracy and quality of websites on PAH is not known. Objectives: To assess the quality, reliability, and accuracy of information on websites about PAH. Methods: We searched Google, Yahoo, and Bing for "pulmonary arterial hypertension" and screened the first 200 sites from each search engine. Website quality was evaluated by two authors using the validated DISCERN tool (best score is 80) and the Journal of the American Medical Association (JAMA) benchmark criteria (best score is 4). Content accuracy was assessed according to 39 prespecified disease-relevant topics from international PAH guidelines. Linear regression models and generalized estimating equations were used to assess the association between website characteristics with JAMA benchmark criteria, DISCERN scores, and content scores. Results: One hundred seventeen eligible sites were included (50% scientific organizations, 20% foundation and/or advocacy organizations, 14% industry or for-profit, 12% personal commentary or blogs, and 4% news and media sites), with most sites hosted in North America. The median time since last website update was 1.2 years (interquartile range [IQR], 0.4-2.6). Website readability was at the high school or college education level (Flesh Reading Ease score 39.9 ± 15.2; reading grade, 11.9 ± 2.7), which is more challenging than the recommendation by the American Medical Association for patient medical information to be written at fifth- to sixth-grade levels. Only 23% had Health on the Net Code of Conduct certification for ethical presentation of healthcare information. The median DISCERN total score and JAMA benchmark score were 29.5 (IQR, 22.5-35.5) and 1.5 (IQR, 0.5-2.5), respectively, indicating poor transparency, reliability, and quality of information. Foundation/advocacy organization sites had higher DISCERN scores than personal commentary/blog sites and higher content scores than industry/for-profit sites. Websites with Health on the Net Code of Conduct certification were more reliable and had higher JAMA benchmark scores. A minority of websites addressed exercise/rehabilitation, palliative care, pregnancy, and financial concerns relevant to patients. Conclusions: Most internet websites on PAH were not easily readable, comprehensive, or transparent. Using a systematic appraisal approach, we identified the highest-quality internet websites with balanced and accurate coverage of relevant issues and treatment options for patients with PAH, which may be useful for patients, caregivers, and clinicians.

The outcomes of severe COVID-19 pneumonia managed with supportive care in Palestine: an experience from a developing country.

INTRODUCTION: About 14% of COVID-19 patients experience severe symptoms and require hospitalization. Managing these patients could be challenging for limited-resource countries, such as Palestine. This study aimed to evaluate hospitalized severe COVID-19 patients' treatment outcomes managed with supportive care and steroids. METHODOLOGY: This was a single-center observational retrospective cohort study that enrolled COVID-19 patients admitted to the "Martyrs medical military complex- COVID Hospital" in Palestine. The managing physicians manually collected data through chart reviews, including patients' characteristics, complications, outcomes, and different management modalities. Continuous and categorical variables between those who were discharged alive and who died were compared using t-test and Chi-squares test, respectively. RESULTS: Overall, 334 patients were included in this study. Median (IQR) age was 62(11) years, 49.1% were males, and 29.6% were ICU status patients. The median (IQR) PaO2/FiO2 ratio was 76 (67), and 67.6% of these patients had moderate to severe acute respiratory distress syndrome, and 4.8% of the patients received invasive mechanical ventilation. Most of the patients (78.7%) had at least one comorbidity, and 18.3% developed at least one complication. The overall mortality was 12.3% (95% CI 8.9-16.2%), and the median (IQR) length of hospital stay was 11 (8) days. Age (aOR 1.05, p = 0.08), smoking (aOR 4.12, p = 0.019), IMV (aOR 27.4, p < 0.001) and PaO2/FiO2 ratio (aOR 1.03, p < 0.001) were found to predict higher mortality. CONCLUSIONS: Supportive care for patients with severe COVID-19 pneumonia in a Palestinian hospital with limited resources was associated with in-hospital mortality of 12.3%.