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Effectiveness of Adaptive Servo Ventilation in the treatment of hypocapnic central sleep apnea of various etiologies.

Effectiveness of Adaptive Servo Ventilation in the treatment of hypocapnic central sleep apnea of various etiologies.

Sleep Med. 2011 Oct 24;

Authors: Carnevale C, Georges M, Rabec C, Tamisier R, Levy P, Pépin JL

Abstract
BACKGROUND: Central sleep apnea (CSA) occurs in clinical situations that induce hypocapnia and respiratory instability during sleep. This is true, not only in heart failure patients, but also in patients suffering from neurological diseases and idiopathic CSA. Adaptive Servo Ventilation (ASV) is frequently prescribed in France for the treatment of CSA, but only a few studies have evaluated ASV treatment with regards to long term effectiveness and compliance. METHODS: Retrospective chart review in two French centers of the outcome of 74 CSA patients treated by ASV with a mean follow up on ASV of 36±18months. RESULTS: Thirty-three of the 74 patients suffered from CSA related to heart failure (HF), whereas the 41 others exhibited CSA mainly associated with neurological disorders or idiopathic CSA. Mean ASV compliance was 5.2±2.6 and 5.9±2.9h per night in cardiac failure and non-cardiac failure patients, respectively. All patients significantly improved their apnea+hypopnea index (from 47.4±19.8 to 6.9±9.3/h [p<0.001]) and mean nocturnal SaO(2) (from 92.1±2.6% to 93.6±3.2% [p<0.001]). The Epworth sleepiness scale score was reduced from 10.2±5.2 to 6.5±3.9 (p<0.01) in compliant patients but not in non-compliant patients (less than 3h per night). Moreover, compliant cardiac failure patients demonstrated a significant improvement in their NYHA score [p<0.05]. Lastly, ASV significantly reduced chronic hyperventilation as assessed by blood gases. CONCLUSION: Our findings suggest that ASV is well tolerated and effective for most patients with hypocapnic central sleep apnea and chronic hyperventilation.

PMID: 22030207 [PubMed - as supplied by publisher]

Smoking, Occupational Risk Factors, and Bronchial Tumor Location: A Possible Impact for Lung Cancer Computed Tomography Scan Screening.

Smoking, Occupational Risk Factors, and Bronchial Tumor Location: A Possible Impact for Lung Cancer Computed Tomography Scan Screening.

J Thorac Oncol. 2011 Oct 25;

Authors: Gonzalez M, Vignaud JM, Clement-Duchene C, Luc A, Wild P, Bertrand O, Thiberville L, Martinet Y, Benichou J, Paris C

Abstract
INTRODUCTION:: The aim of this study was to describe associations between lung tumor location and smoking as well as selected occupational exposures. In the context of lung cancer screening by computed tomography scan, tumor location may have an interest. Computed tomography scan is known to better detect more peripheral tumors. METHODS:: Lung cancer cases diagnosed in two French University hospitals between 1997 and 2009 were included. Tumors visible on white-light bronchoscopy were defined as central. Occupational exposures were assessed by the same expert. Data were analyzed by case-case comparisons using unconditional logistic regressions. RESULTS:: A total of 1701 cases were included, comprising mainly men (86.3%), current smokers (52.8%), or former smokers (42.8%). Main histological subtypes of cancer were adenocarcinomas (33.8%) and squamous cell carcinomas (32.6%). The tumor location was found to be central in 61% of cases, and never smokers and women had more often peripheral tumors. Exposure to asbestos was significantly associated with central location with dose-response relationship (odds ratio [OR] for peripheral tumors = 0.45, 95% confidence interval [CI] 0.29-0.70) for the highest level of exposure. Exposure to silica dust was significantly associated with peripheral tumor (OR for peripheral tumors = 3.28, 95%CI 1.50-7.17) for the highest level of exposure. Exposure to welding fumes was associated with central location (OR for peripheral tumors = 0.51, 95% CI 0.26-0.96) for the first level of exposure). CONCLUSIONS:: Smoking characteristics and occupational exposures have to be considered to define more accurately high-risk populations suitable for lung cancer screening or early detection programs.

PMID: 22031233 [PubMed - as supplied by publisher]

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Low-Dose Intradermal Flu Vaccine Effective as Intramuscular

Injecting a lower dose of influenza vaccine intradermally in chronically ill adults was more immunogenic than a traditional full-dose intramuscular injection.
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