Introduction:Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire.Materials and Methods:Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose.Results:A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m2 (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose.Conclusion:Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.
Background Left‐to‐right (L‐R) shunts are characterized by a pathological connection between high‐ and low‐pressure systems, leading to a mixing of oxygen‐rich blood with low oxygenated blood. They are typically diagnosed by phase‐contrast cardiac magnetic resonance imaging (MRI) which requires extensive planning. T2 is sensitive to blood oxygenation and may be able to detect oxygenation differences between the left (LV) and right ventricles (RV) caused by L‐R shunts. Purpose To test the feasibility of routine T2 mapping to detect L‐R shunts. Study Type Retrospective. Population Patients with known L‐R shunts (N = 27), patients with RV disease without L‐R shunts (N = 21), and healthy volunteers (HV; N = 52). Field Strength/Sequence 1.5 and 3 T/balanced steady‐state free‐precession (bSSFP) sequence (cine imaging), T2‐prepared bSSFP sequence (T2 mapping), and velocity sensitized gradient echo sequence (phase‐contrast MRI). Assessment Aortic (Qs) and pulmonary (Qp) flow was measured by phase‐contrast imaging, and the Qp/Qs ratio was calculated as a measure of shunt severity. T2 maps were used to measure T2 in the RV and LV and the RV/LV T2 ratio was calculated. Cine imaging was used to calculate RV end‐diastolic volume index (RV‐EDVi). Statistical Tests Wilcoxon test, paired t‐tests, Spearmen correlation coefficient, receiver operating curve (ROC) analysis. Significance level P < 0.05. Results The Qp/Qs and T2 ratios in L‐R shunt patients (1.84 ± 0.84 and 0.89 ± 0.07) were significantly higher compared to those in patients with RV disease (1.01 ± 0.03 and 0.72 ± 0.10) and in HV (1.04 ± 0.04 and 0.71 ± 0.09). A T2 ratio of >0.78 showed a sensitivity, specificity, and negative predictive value of 100%, 73.9%, and 100%, respectively, for the detection of L‐R shunts. The T2 ratio was strongly correlated with the severity of the shunt (r = 0.83). Data Conclusion RV/LV T2 ratio is an imaging biomarker that may be able to detect or rule‐out L‐R shunts. Such a diagnostic tool may prevent unnecessary phase‐contrast acquisitions in cases with RV dilatation of unknown etiology. Level of Evidence 3 Technical Efficacy Stage 2
Objectives To compare volumetric and functional parameters of the atria derived from highly accelerated compressed sensing (CS)–based cine sequences in comparison to conventional (Conv) cine imaging. Methods CS and Conv cine sequences were acquired in 101 subjects (82 healthy volunteers (HV) and 19 patients with heart failure with reduced ejection fraction (HFrEF)) using a 3T MR scanner in this single-center study. Time-volume analysis of the left (LA) and right atria (RA) were performed in both sequences to evaluate atrial volumes and function (total, passive, and active emptying fraction). Inter-sequence and inter- and intra-reader agreement were analyzed using correlation, intraclass correlation (ICC), and Bland-Altman analysis. Results CS-based cine imaging led to a 69% reduction of acquisition time. There was significant difference in atrial parameters between CS and Conv cine, e.g., LA minimal volume (LAVmin) (Conv 24.0 ml (16.7–32.7), CS 25.7 ml (19.2–35.2), p < 0.0001) or passive emptying fraction (PEF) (Conv 53.9% (46.7–58.4), CS 49.0% (42.0–54.1), p < 0.0001). However, there was high correlation between the techniques, yielding good to excellent ICC (0.76–0.99) and small mean of differences in Bland-Altman analysis (e.g. LAVmin − 2.0 ml, PEF 3.3%). Measurements showed high inter- (ICC > 0.958) and intra-rater (ICC > 0.934) agreement for both techniques. CS-based parameters (PEF AUC = 0.965, LAVmin AUC = 0.864) showed equivalent diagnostic ability compared to Conv cine imaging (PEF AUC = 0.989, LAVmin AUC = 0.859) to differentiate between HV and HFrEF. Conclusion Atrial volumetric and functional evaluation using CS cine imaging is feasible with relevant reduction of acquisition time, therefore strengthening the role of CS in clinical CMR for atrial imaging. Key Points • Reliable assessment of atrial volumes and function based on compressed sensing cine imaging is feasible. • Compressed sensing reduces scan time and has the potential to overcome obstacles of conventional cine imaging. • No significant differences for subjective image quality, inter- and intra-rater agreement, and ability to differentiate healthy volunteers and heart failure patients were detected between conventional and compressed sensing cine imaging.
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