PURPOSE-Cross-sectional studies have documented the co-occurrence of obstructive sleep apnea (hereafter sleep apnea) with glucose intolerance, insulin resistance, and type II diabetes mellitus (hereafter diabetes). It has not been determined, however, whether sleep apnea is independently associated with the subsequent development of diabetes, accounting for established risk factors. METHODS-This observational cohort study examined 1233 consecutive patients in the VeteranAffairs Connecticut Health Care System referred for evaluation of sleep-disordered breathing; 544 study participants were free of preexisting diabetes and completed a full, attended, diagnostic polysomnogram. The study population was divided into quartiles based on severity of sleep apnea as measured by the apnea-hypopnea index. The main outcome was incident diabetes defined as fasting glucose level > 126 mg/dL and a corresponding physician diagnosis. Compliance with positive airway pressure therapy, and its impact on the main outcome, was also examined.RESULTS-In unadjusted analysis, increasing severity of sleep apnea was associated with an increased risk of diabetes (P for linear trend < 0.001). After adjusting for age, sex, race, baseline fasting blood glucose, body mass index (BMI), and weight change, an independent association was found between sleep apnea and incident diabetes (hazard ratio per quartile 1.43; CI 1.10 -1.86). Among patients with more severe sleep apnea (upper two quartiles of severity), 60% had evidence of regular positive airway pressure use, and this treatment was associated with an attenuation of the risk of diabetes (log-rank test P=0.04).CONCLUSION-Sleep apnea increases the risk of developing diabetes, independent of other risk factors. Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk.

The persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor - other than increase in afterload - is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.

Balloon angioplasty for native coarctation of the aorta in infants and children is gaining acceptance as an alternative to surgery in discrete membranous obstruction. The aim of this study was to assess the immediate and intermediate-term effectiveness and safety of balloon angioplasty in infants and children with discrete membranous obstruction and mild complex arch anomalies. We performed a retrospective study evaluating the immediate and intermediate-term results of balloon angioplasty in 46 consecutive patients with native coarctation of the aorta done between March 1998 and June 2003. Isolated discrete fibromembranous obstruction occurred in 32 patients, and 14 patients had mild complex arch anomalies. Follow-up was obtained in 40 patients. There was no early mortality. The procedure was initially successful in 43 patients (93%). There were three immediate failures. Of the 40 patients who were followed, 32 (80%) had maintained a cuff pressure gradient of 20 mmHg across the dilated area. Four patients developed restenosis, which was successfully treated by repeated balloon angioplasty. The other four patients continued to have mild gradient (20-22 mmHg) with systolic hypertension and without angiographic evidence of restenosis but with isthmus hypoplasia; they received atenolol and captopril. Serial echocardiographic measurement of left ventricular dimension and function revealed significant improvement after balloon angioplasty of aortic coarctation in patients with the echocardiographic picture of hypertensive cardiomyopathy. Balloon angioplasty may be considered as a tool in the armamentarium of management of aortic coarctation in different anatomic variants, taking into consideration the clinical presentation and patient age.

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