Purpose of review Obstructive sleep apnea (OSA) is a highly prevalent condition that has been associated with cardiovascular morbidity and mortality, impaired glucose metabolism and daytime functional impairment. Compared with non-rapid eye movement (NREM) sleep, rapid eye movement (REM) sleep is associated with higher sympathetic activity and cardiovascular instability in healthy individuals and more so in patients with OSA. Recent findings Recent studies have indicated that REM OSA is independently associated with prevalent and incident hypertension, non-dipping of nocturnal blood pressure, increased insulin resistance and impairment of human spatial navigational memory. Summary These findings have significant clinical implications for the duration of continuous positive airway pressure (CPAP) use that is needed to decrease the health risks associated with OSA. Further research is needed to establish the duration of CPAP needed to effectively treat REM OSA and to evaluate patients with REM OSA with an overall normal apnea-hypopnea index (AHI).

Phyllodes tumors of the breast have biphasic histological features with both epithelial and stromal components. Careful characterization of the stromal compartment is critical since it is the pathologic features of the stromal cells that determine its malignant potential. We present a case report of a woman with an aggressive malignant phyllodes tumor with sarcomatous differentiation, who succumbed to metastatic disease within 8 months of initial presentation.

No abstract

This chapter outlines the growing evidence that obstructive sleep apnea during rapid-eye-movement sleep (REM-related OSA) is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. The authors also review the clinical implications of the duration of nightly continuous positive airway pressure (CPAP) use that is needed to effectively treat REM-related OSA. Current CPAP adherence guidelines of 4 hours/night potentially leave the majority of REM-related OSA untreated. Thus, the optimal duration of positive airway pressure therapy to effectively treat REM OSA requires clarification. Clinicians should encourage patients with REM-related OSA to increase CPAP usage to include the early morning hours, before awakening. Further research is needed to establish whether patients with significant REM-related OSA but an overall normal Apnea–Hypopnea Index would benefit from treatment.

Figure 1. A computerized tomography of the chest revealed cardiomegaly, bilateral pleural effusions and pericardial calcification noted diffusely with focal regions of pericardial thickening greater than 4 mm. A 62-year-old woman, with a past medical history significant for oxygen dependent COPD, paroxysmal atrial fibrillation, and obstructive sleep apnea, presented to the hospital with hypoxemic respiratory failure requiring intubation and mechanical ventilation. A computerized tomography of the chest revealed cardiomegaly, bilateral pleural effusions, and pericardial calcification that was noted diffusely with focal regions of pericardial thickening greater than 4 mm. A cardiac catheterization revealed elevated right-sided pressure; markedly elevated left ventricular end diastolic pressure; equalization of LV-RV diastolic pressures; and sharp Y descent on the right atrial pressure waveform; which is all suggestive of constrictive physiology. The patient was medically optimized and diuresed and eventually underwent a successful pericardiectomy.

No abstract

No abstract

No abstract