Sleep, Obesity-related disease Archives - Page 2 of 3 - PulmCCM

Sleep, Obesity-related disease Articles

Jan 072012

One thing I thought I knew was that overweight and obesity cause coronary artery disease and make it worse. People with CAD who are obese should lose weight … right? Recent research shows it’s not that simple (although the answer is still “yes, probably”). Did you know about the “obesity paradox?” Or the “lean paradox,” [... read more]

Dec 262011

Wijesinghe et al randomized and crossed-over 24 people who were recently diagnosed with obesity hypoventilation syndrome to breathe either 100% oxygen or room air for 20 minutes on 2 separate days, while measuring their minute ventilation, expired tidal pCO2, and dead space-to-tidal volume ratio. In 44% of patients, pCO2 increased by at least 4 mm [... read more]

Dec 072011
Trouble sleeping? Don't read this, it'll only make it worse (Circulation)

If you spend your nights lying awake worrying about having a heart attack, you’re entirely justified. But you’re probably just making it more likely. Lars Laugsand et al followed 52,610 Norwegian people for 11 years after the subjects completed an initial survey (investigators can do this in Norway, since they’ve got everyone’s health records in [... read more]

Nov 112011

Obesity may impose extra burdens on critical care staff (think turning, transport, intubation and central line placement), but reviews suggest people with “ordinary” obesity (BMI 30-39) with have the same mortality from critical illness as overweight or healthy-weight people. In fact, obese people may have a survival advantage, despite possible longer durations of mechanical ventilation and ICU stays. But what about extreme obesity (BMI > [... read more]

Oct 312011

Poor people have higher rates of obesity. There are those who believe that’s because the poor lack self-control and discipline, overeating when they should be pulling themselves up by their bootstraps. That hard-core personal responsibility ethic is hard to refute, maybe because it contains a grain of truth, maybe because it lets all us non-poor [... read more]

Oct 072011

Non-invasive positive pressure ventilation (NIPPV or NPPV or NIV), overnight or during the day, has not been shown to help most people with stable COPD and daytime hypercarbia. Citing their own previous findings, Dreher, Windisch et al argue that’s because you can’t just use wimpy ordinary settings — you’ve got to crank that sucker to [... read more]

Aug 232011

Obesity was named as a risk factor for severe H1N1 influenza during the pandemic. What about for influenza in general? Kwong et al analyzed community survey data in Ontario over 12 influenza seasons, 1996-2008. Severe obesity (BMI >= 35) carried an odds ratio of 2.1 for respiratory hospitalization during flu season. In those with no [... read more]

Aug 202011

Obstructive sleep apnea and other sleep disorders have long been associated with cognitive dysfunction, but so far not in a prospective study. So, Yaffe et al followed 298 older women (~82 years) who had already had polysomnography as part of an osteoporosis study. 105 had sleep disordered breathing (cases), defined as an apnea-hypopnea index >= [... read more]

Aug 192011

A minority of people develop central sleep apneas during polysomnography with continuous positive airway pressure titration for obstructive sleep apnea. Others develop central apneas later, discovered on interrogation of their CPAP machine. The fact is, no one knows much about this so-called complex sleep apnea — its natural course, prognosis / risks, and whether or [... read more]

Jul 212011

Kuniyoshi et al prospectively observed people admitted to Mayo for myocardial infarction, performing polysomnography and measuring flow-mediated dilation in their brachial arteries. A whopping 69% (45 of 64) were found to have obstructive sleep apnea. Those with moderate to severe OSA had poorer arterial responsiveness, a surrogate marker for subsequent cardiovascular risk, compared to people [... read more]

Jul 152011

Teo et al randomized 24 people with newly diagnosed obstructive sleep apnea (AHI > 15) to crossover between nasal and oronasal (full-face) masks during 2 consecutive nights of CPAP titration. The nasal mask had more leaks and people wearing it had more arousals. However, they liked it better than the face mask, and there was [... read more]

Jun 262011

Flexible pressure CPAP reduces pressure briefly during expiration, to try to make it more comfortable. Bakker & Marshall meta-analyzed 10 randomized trials in >500 patients testing flexible pressure vs standard CPAP in people with obstructive sleep apnea; there were no differences in compliance or any other outcome. CHEST 2011;139:1322-1330.

Jun 032011

Lee et al report phase III trial results for this prodrug of gabapentin. It improved symptoms in people with moderate-to-severe RLS at the end of 12 weeks, compared to placebo. However, time (placebo) also worked well. The FDA approved the drug for moderate-to-severe RLS in April 2011. J Clin Sleep Med 2011;7:282-292.

May 252011

Bitter et al performed CPAP titration on 192 patients with congestive heart failure and obstructive sleep apnea, unmasking residual central sleep apnea (so-called complex sleep apnea) in 34 (18%). Providing adaptive servoventilation (dynamic delivery of pressure support to achieve a target minute ventilation) improved AHI, NYHA class, BNP levels, ejection fraction, and other variables, at ~1 year [... read more]

May 092011

Parra et al diagnosed OSA in 140 patients hospitalized for stroke in Spain and randomized them to nasal auto-titrating CPAP or no therapy. The CPAP-treated patients had better Rankin and Canadian stroke outcome scores at all follow-up visits. They had the same rate of subsequent cardiovascular events, but events occurred at a median 15 months [... read more]