Excessive Daytime Sleepiness and Obstructive Sleep Apnea in Patients With Sarcoidosis.

Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis.

Filed under: Depression Treatment

Chest. 2012 Dec 20;
Patterson KC, Huang F, Oldham J, Bhardwaj N, Hogarth DK, Mokhlesi B

ABSTRACT BACKGROUND: Systemic symptoms are common in sarcoidosis and are associated with a decreased quality of life. Excessive daytime sleepiness (EDS) is often associated with obstructive sleep apnea (OSA), but may be a systemic symptom independently associated with sarcoidosis. The aim of this study was to assess the relationship between sarcoidosis and EDS. METHODS: In a retrospective analysis, we compared sleepiness by the Epworth Sleepiness Scale score in 62 patients with sarcoidosis to 1,005 adults without sarcoidosis referred for polysomnography for suspicion of OSA. Linear regression models controlled for covariates. In a subgroup analysis of sarcoidosis patients, sleepiness scores and polysomnogram results were compared between those with normal and abnormal pulmonary function based on total lung capacity. RESULTS: EDS was more common in sarcoidosis than in controls, and sarcoidosis remained an independent predictor of increased sleepiness after controlling for covariates. Compared to controls referred for polysomnography, fewer sarcoidosis patients had clinically significant OSA. However, among sarcoidosis patients, OSA was more severe in those with abnormal lung function. CONCLUSIONS: Sarcoidosis is independently associated with EDS. Sleepiness may contribute to the morbidity of sarcoidosis, and should be followed even after treating for potentially co-existing OSA or depression. Abnormal lung function in sarcoidosis may contribute to OSA, although the mechanisms for this are not known.
HubMed – depression

 

[Internalizing symptoms in depressive adolescents – manifestations and methods of identification in schools].

Filed under: Depression Treatment

Z Kinder Jugendpsychiatr Psychother. 2013 Jan; 41(1): 11-22
Gander M, Buchheim A

Objective: In order to improve teacher-training programs it is important to analyze the different manifestations of depressive symptoms in adolescent students. This study examined the severity and frequency of internalizing symptoms in adolescents with depressive symptoms and the relationship thereof to an increased risk of suicide. Method: 403 students (212 girls and 191 boys) at Austrian secondary schools aged between 16 and 18 years completed the Reynolds Adolescent Depression Scale-2, the Youth Self-Report, and the Suicide Probability Scale. Results: 35 %, and thus more than one third, of the students with depressive symptoms showed high scores on the internalizing scale while being in the normal range on the externalizing scale. Using regression analysis we found that adolescents with internalizing problems show higher levels of physical complaints, anxiety, and depression. Furthermore, attention problems and thought problems are predictors of depression. In addition to depression, anxiety and thought problems, social problems, and aggressive behavior are predictive of a higher suicide risk. Conclusions: These results are discussed with respect to existing studies concerning how to recognize behavioral problems in school. The integration of these results into teachers’ education and training serves to raise their awareness of depressive students with internalizing problems and thus helps them when taking appropriate steps to facilitate treatment.
HubMed – depression

 

Problems in obtaining sufficient anaesthesia with propofol and remifentanil: three cases, a test infusion, and a review.

Filed under: Depression Treatment

Br J Anaesth. 2012 Dec 20;
Bache S, Stendell L, Olsen NV, Olsen KS

BACKGROUND: /st>Over a 5 yr period, we have encountered three patients in whom remifentanil appeared to have no clinical effect during general anaesthesia (GA). We describe seven anaesthetics in these three patients. METHODS: /st>We reviewed the literature on this subject. A simple reproducible test to explore this response was designed. This involved a controlled infusion of increasing doses of remifentanil while observing respiratory variables, pain threshold, pupil size, and Glasgow coma scale score. In addition, blood was sampled for genotyping. RESULTS: /st>No description of this impaired response was found in the review of the literature. Two of the patients agreed to participate in the test. In both patients, we found a seemingly normal analgesic response but a lack of respiratory depression and almost no depression of consciousness, even at doses well above the recommended level for clinical use. The genotyping did not explain the results of the test. CONCLUSIONS: /st>The potential causes of this effect are discussed. We advise clinicians to be aware of this unusual response to remifentanil. If such a response is suspected, we recommend the use of another opioid. If this is suspected before GA, we propose the use of our test as a diagnostic tool.
HubMed – depression

 

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