Obstructive sleep apnea (OSA) and diabetes has been known to be closely related to each other and both diseases impact highly on the public health. There are many evidence of reports that OSA is associated with diabetes with a bidirectional correlation. A possible causal mechanism of OSA to diabetes is intermittent hypoxemia and diabetes to OSA is microvascular complication. However, OSA and diabetes have a high prevalence rate in public and shares the common overlap characteristic and risk factors such as age, obesity, and metabolic syndrome that make it difficult to establish the exact pathophysiologic mechanism between them. In addition, studies demonstrating that treatment of OSA may help prevent diabetes or improve glycemic control have not shown convincing result but have become a great field of interest research. This review outlines the bidirectional correlation between OSA and diabetes and explore the pathophysiologic mechanisms by approaching their basic etiologies.
Study Objectives: Evaluate consequences of intermediate to high risk of undiagnosed obstructive sleep apnea (OSA) among individuals with chronic obstructive pulmonary disease (COPD). Methods: Using data from the Long Term Oxygen Treatment Trial (LOTT), we assessed OSA risk at study entry among patients with COPD. We compared outcomes among those at intermediate to high risk (modified STOP-BANG score ≥ 3) relative to low risk (score < 3) for OSA. We compared risk of mortality or first hospitalization with proportional hazard models, and incidence of COPD exacerbations using negative binomial regression. We adjusted analyses for demographics, body mass index, and comorbidities. Last, we compared St. George Respiratory Questionnaire and Quality of Well-Being Scale results between OSA risk groups. Results: Of the 222 participants studied, 164 (74%) were at intermediate to high risk for OSA based on the modified STOP-BANG score. Relative to the 58 low-risk individuals, the adjusted hazard ratio of mortality or first hospitalization was 1.61 (95% confidence interval 1.01-2.58) for those at intermediate to high risk of OSA. Risk for OSA was also associated with increased frequency of COPD exacerbations (adjusted incidence rate ratio: 1.78, 95% confidence interval 1.10-2.89). Respiratory symptoms by St. George Respiratory Questionnaire were 5.5 points greater (P = .05), and Quality of Well-Being Scale scores were .05 points lower (P < .01) among those at intermediate to high risk for OSA, indicating more severe respiratory symptoms and lower quality of life. Conclusions: Among individuals with COPD, greater risk for undiagnosed OSA is associated with poor outcomes. Increased recognition and management of OSA in this group could improve outcomes.
Obstructive sleep apnea (OSA) is a common condition that impairs quality of life and health. Diagnosis and treatment of OSA is cost-effective; however, the economics of various management strategies remain to be defined. Home sleep apnea tests (HSAT) provide an alternative to laboratory based polysomnography (PSG) and are less expensive than PSG on a per test basis; however, when utilized within a framework that has been demonstrated to provide comparable clinical outcomes, home testing pathways incur additional costs to compensate for failed studies and lower diagnostic accuracy. A cost-minimization analysis from a randomized controlled trial showed that the cost advantage of a home management pathway narrowed significantly when these additional costs are considered. Further, when the actual costs of providing HSAT rather than what is reimbursed by insurance were considered, the cost advantage was further attenuated. A comprehensive cost-effectiveness analysis (CEA), favored a lab over a home approach based on modeling that projected that the costs of erroneous diagnosis over a long time span for the home approach outweighed lower test costs. Studies have identified the following factors that influence costeffectiveness of home-based management: cost of untreated OSA, prevalence of OSA, performance characteristics of the selected test, time horizon, and whether backup PSG is used for failed HSAT. More clinical studies are needed to provide the inputs for more robust CEA regarding this issue.
A 48-year-old man had erythema without warmth over his right ankle and dorsomedial foot, with nontender, nonpalpable purpura over the foot dorsum and scattered petechiae over the right lower leg 6 weeks after immobilization for an ankle fracture; temperature was 38.2°C (100.8°F) and the erythema faded when he elevated his leg above heart level. What is the diagnosis and what would you do next?
PAP data download preferences were mixed among new veteran users. Veterans placed a high value on the potentially competing concerns of convenience and information privacy. Veterans preferring modem factored convenience as important in their decision making, independent of privacy concerns.
Sleep VA-ECHO (Veterans Affairs–Extension for Community Healthcare Outcomes) is a national telementorship program intended to improve knowledge about sleep disorders among non-specialty providers. The project goal was to describe the characteristics of Sleep VA-ECHO participants from primary care and their use of program-obtained knowledge in practice. Sleep VA-ECHO consisted of 10 voluntary, 75-min teleconference sessions combining didactics and case discussion. Out of 86 participants, 21 self-identified as primary care team members and completed a program evaluation. Participants self-reported their application of knowledge gained, including changes to practice as a result of program participation. These 21 participants represented 18 sites in 11 states and attended a median of 5.0 sessions. They included physicians (29%), nurse practitioners (24%), and registered nurses (24%). Nearly all participants (95%) reported using acquired knowledge to care for their own patients at least once a month; 67% shared knowledge with colleagues at least once a month. Eighty-five percent reported improved quality of sleep care for their patients, and 76% reported an expanded clinical skillset. The greatest self-reported change in practice occurred in patient education about sleep disorders (95%) and non-pharmacologic management of insomnia (81%).
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