Medical news of the day : The current guidelines from the ACP recommend polysomnography (PSG) as a first-line means to diagnose OSA. Among clinical outcomes, OSA is most associated with a higher risk for mortality. According to the ACP, treating OSA with CPAP is most effective for alleviating daytime sleepiness. Overall, the ACP makes 2 major recommendations based on its review of the evidence for the diagnosis of OSA: Patients with unexplained daytime sleepiness should undergo a sleep study. PSG should be a first-line test to diagnose OSA. Portable monitors may be substituted for PSG among patients without serious comorbidities when PSG is unavailable. Regarding the association between OSA and clinical outcomes, the strongest evidence demonstrates that OSA with an AHI of more than 30 is associated with a higher risk for all-cause mortality. Nonfatal cardiovascular disease and type 2 diabetes may be more common among patients with untreated OSA, but this is based on poor evidence. It is unclear if OSA promotes hypertension or higher rates of cardiovascular mortality, and no association has been found between OSA and the risk for stroke or overall quality of life. The New England Journal of Medicine reported last week a phase I study of a new drug (PER977, Aripazine) that may be effective as an antidote for several of the new oral anticoagulants, as well as some of the established anticoagulants. Shift work chronically impairs cognition, with potentially important safety consequences, not only for the individuals concerned but also for society. The harmful effects on the brain can be reversed when shift work ends, but it may take up to 5 years to achieve full recovery. Shift work is also associated with chronic health complaints (e.g., cardiovascular disease, metabolic syndrome, breast cancer and reproductive problems) (Philip Tucker, PhD, Psychology Department, College of Human and Health Sciences, Swansea University, United Kingdom, in November 3 in the journal Occupational and Environmental Medicine). Symptoms associated with AF: Dr. Green’s Response: (Philip Green, MD, Assistant in Clinical Medicine, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York) Yes! There certainly is a problem here. The way in which patients experience symptoms related to atrial fibrillation can be assigned to 1 of 3 categories. Indeed, the minority of patients experience classic palpitations with or without associated shortness of breath or chest discomfort and they know they are in atrial fibrillation. In those patients, the timing of AF onset and the frequency of fibrillation episodes can influence the rhythm control and even the anticoagulation strategy. Those patients should pay special attention to the symptoms associated with AF. The remaining patients either experience non-specific symptoms including shortness of breath or fatigue that may be related to but not exclusive to their AF. The last group experiences no symptoms at all. In those patients, our fear is that the first symptom or sign of AF will be a stroke. It is therefore extremely important to understand that AF often poses risk even in the absence of symptoms. (October 2014)
Posted on: Wed, 12 Nov 2014 05:26:19 +0000
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