To investigate the association between sleep apnea syndrome (SAS) and automobile accidents, and to evaluate potential underlying mechanisms, we prospectively recruited 60 consecutive patients with SAS (apnea-hypopnea index, 58 +/- 3 h-1) and 60 healthy control subjects, matched for sex and age. The number of automobile accidents during the past 3 yr was obtained from participants and insurance companies. We quantified the degree of daytime sleepiness (Epworth scale), anxiety and depression (Beck tests), and we assessed the level of vigilance (PVT 192) and driving performance (Steer-Clear). Patients had more accidents than control subjects (OR: 2.3; 95% CI: 0.97 to 5.33) and were more likely to have had more than one accident (OR: 5.2; 95% CI: 1.07 to 25.29, p < 0.05). These differences persisted after stratification for km/yr, age, and alcohol consumption. Patients were more somnolent, anxious, and depressed than control subjects (p < 0.01), and they had a lower level of vigilance and poorer driving performance (p < 0.01). Yet, we did not find any correlation between the degree of daytime sleepiness, anxiety, depression, the number of respiratory events, nocturnal hypoxemia, level of vigilance, or driving simulator performance and the risk of automobile accidents among SAS patients. In conclusion, patients with SAS have an increased risk of automobile accidents. None of the clinical or physiological markers commonly used to define disease severity appear able to discriminate those patients at higher risk of having an automobile accident.

Daytime sleepiness, impaired cognitive performance and dysphoric mood are often present in patients with obstructive sleep apnoea syndrome (SAS). This prospective controlled study evaluates the effects of treatment with continuous positive airway pressure (CPAP) during 1 yr on daytime functioning in a large group of patients with SAS.The authors studied 80 patients (mean SEM 49 1 yrs) with SAS with a mean apnoea-hypopnoea index of 60 2 h -1 , and 80 healthy control subjects matched for sex and age (46 1 yrs.). Measurements were obtained at the beginning of the study and 12 1 months later, and included: daytime sleepiness (Epworth scale), depression and anxiety (Beck tests), vigilance (Steer-Clear1) and reaction time (Psychometer Vigilance Test 1921). Drug, coffee and alcohol intake, as well as the sleep schedule, were also recorded.Results showed that, before treatment, patients were more somnolent (p<0.001), anxious (p<0.01) and depressed (p<0.001) than control subjects. Also, they had a longer reaction time (p<0.05) and poorer vigilance (p<0.01). The use of CPAP improved significantly the levels of somnolence (p<0.0001) and vigilance (p<0.01), but failed to modify anxiety and depression. Reaction time changes were minor. Variables with a potential confounding effect did not change during the study.These results provide firm evidence to substantiate the use of continuous positive airway pressure in patients with sleep apnoea syndrome. Eur Respir J 2000; 15: 676±681.

Almost all the information about the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) comes from clinical trials involving only middle-aged patients. The objective of this study was to assess the effect of CPAP treatment in elderly patients with severe OSA on clinical, quality-of-life and neurocognitive spheres.We performed an open-label, randomised, multicentre clinical trial in a consecutive clinical cohort of 224 elderly (⩾70 years old) patients with confirmed severe OSA (apnoea-hypopnea index ⩾30) randomised to receive CPAP (n=115) or no CPAP (n=109) for 3 months. A sleep study was performed by either full polysomnography or respiratory polygraphy. CPAP titration was performed by an autoCPAP device. The primary endpoint was quality of life (Quebec Sleep Questionnaire) and secondary endpoints included sleeprelated symptoms, presence of anxiety/depression, office-based blood pressure and some neurocognitive tests.The mean±SD age was 75.5±3.9 years. The CPAP group achieved a greater improvement in all qualityof-life domains ( p<0.001; effect size: 0.41-0.98), sleep-related symptoms ( p<0.001; effect size 0.31-0.91) as well as anxiety ( p=0.016; effect size 0.51) and depression ( p<0.001; effect size: 0.28) indexes and some neurocognitive tests (digit symbol test ( p=0.047; effect size: 0.20) and Trail Making Test A ( p=0.029; effect size: 0.44)) in an intention-to-treat analysis.In conclusion, CPAP treatment resulted in an improvement in quality of life, sleep-related symptoms, anxiety and depression indexes and some neurocognitive aspects in elderly people with severe OSA. @ERSpublications CPAP is effective in elderly patients with severe OSA in clinical and neurocognitive terms improving quality of life

Penile incarceration by foreign objects for sexual stimulation purposes is a situation described in universal literature, however it is a rare situation that the urologist must face in the emergency room. A 75-year-old male is presented to whom his sexual partner had placed a ring in the coronal sulcus.

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