Sensitivity of Epworth Sleepiness Scale in Detecting Obstructive Sleep Apnea in Pakistani Adults

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Sensitivity of Epworth Sleepiness Scale in Detecting Obstructive Sleep Apnea in Pakistani Adults

Background: Self-reported measures of Excessive daytime Sleepiness, such as the Epworth Sleepiness Scale (ESS), have been widely used as a screening tool for OSA, but their accuracy in predicting OSA has been questioned. Objective: The main objective of this research is to re-evaluate the usage of ESS in predicting Obstructive Sleep Apnea (OSA) and to consider additional screening tools, such as polysomnography, to improve the accuracy of OSA diagnosis in the Pakistani population. Methods: It was a retrospective cross-sectional study design, conducted on 500 participants. Data was obtained from the hospital records at the Sleep Lab of Dow University Hospital from January 2021 to March 2023 who completed the Epworth Sleepiness Scale (ESS), received a clinical evaluation from a doctor, and underwent diagnostic polysomnography (PSG), polysomnography is a comprehensive sleep study that monitors various physiological parameters to diagnose sleep disorders. Results: Out of a total sample of 500 participants, 272 were males and 228 were females. The average age was 51 ± 12 years. The average body mass index (BMI) was 37.2 ± 8.1 Kg/m2 . The average Epworth Sleepiness Scale (ESS) score of the participants was 12.4 ± 4.2. The finding of our study shows Epworth sleepiness score is a good predictor of OSA (AUC: 0.84, 95% CI: 0.757-0.923). However, the optimal cutoff of ESS is 8.4 and above which shows sensitivity and specificity of 83.1% and 81.8% respectively. Conclusion: The results suggest that the Epworth Sleepiness Scale may be a useful tool for identifying individuals with OSA, although it also has a low false positive rate, there is a need for further research, and the importance of combining clinical assessment and diagnostic tests for accurate OSA diagnosis

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Relationship of Neck Circumference and Obstructive Sleep Apnea: A Cross-sectional Study in Pakistani Population

Objective: This study aimed to determine the reliability of neck circumference in comparison to BMI for a measure of Obstructive Sleep Apnea and determine the interaction between neck circumference and the severity of apnea in the Pakistani adult population.&#x0D; Materials and Methods: A total of 306 subjects, were recruited retrospectively for the cross-sectional research in the Department of Pulmonary Vascular and Sleep Disorders in Dow University Hospital, Karachi. We reviewed the hospital records to evaluate the BMI, neck circumference, and AHI from June 2018 to February 2022 by non-Random Purposive sampling. The patients 1) who were adults with age more than 18 years and 2) patients with obstructive sleep apnea who were diagnosed through the Polysomnography test were included. IBM SPSS statistics 25 was used for data analysis. Statistical significance was considered as a p-value &lt;0.05.&#x0D; Results:  The average age was 52.3 ± 11.4 years. Results showed that sleep apnea was found to be more prevalent and severe in males than in females. Increased neck circumference is associated with the severity of sleep apnea and is found to be significant in male subjects (p=0.018) but not in females (0.577). The neck circumference and the BMI had a statistically significant relationship among the male group and female group (p=0.006 and p=&lt;0.001) which shows that individually neck circumference is not a significant risk factor to diagnose OSA. In multivariate regression, we found a strong association between obesity (OR: 4.3; 95% CI: 2.03-9.38; p-value: 0.00) and males (OR: 2.3; 95% CI: 1.41-3.73; p-value: 0.001) among obstructive sleep apnea patients.&#x0D; Conclusion:  In conclusion, the individuals who have large neck circumference have raised BMI, and the traditional indicators for instance males, older age, and BMI were associated with OSA but a larger neck circumference as an independent element was not linked to OSA. In addition, the correlation of large necks with OSA is found to be significant in male subjects but not in females.</jats:p

Role of Angiotensin-converting Enzyme Inhibitors (ACEI)/Angiotensin Receptor Blockers (ARBs) and Hydrocortisone in COVID-19 Patients Admitted to the Intensive Care Unit

Objective: The purpose of study was to assess the role of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) and hydrocortisone in patients with COVID-19 and their outcome during hospitalization.&#x0D; Materials and Methods: A clinical comparative prospective hospital-based study was conducted in the Department of Pulmonology &amp; Intensive Care Unit (ICU) of Dow University of Medical &amp; Health Sciences, Karachi in patients positive for COVID-19 infection during their hospitalization. A comparative analysis was performed between two groups, i) those who received an injection of hydrocortisone and ii) those who received oral ACEi/ARB. All the baselines and clinical variables were recorded in a structured questionnaire and the data were evaluated in the Statistical Package for the Social Sciences (SPSS) version 22.0. A p-value of &lt;0.05 is considered statistically significant.&#x0D; Results: The final analysis was performed on 130 patients among them 68 patients received an injection of hydrocortisone and 62 patients received the tablet ACEi/ARB, which ever indicated. Patients who need injection hydrocortisone were older than patients who received ACEi/ARB, 58.37±15.20 and 51.01±90.22. Patients who received injection hydrocortisone were more likely to receive mechanical ventilation support as compared to other groups, 11.7% vs. 4.8%, respectively, p-value 0.02. The overall mortality rate was 10% (n = 13) in both groups in which a higher number of deaths was observed in patients who were taking ACEi/ARB as compared to patients who were receiving injection hydrocortisone, 12.9% vs. 7.3%, respectively, but it had an insignificant association, p-value 0.17.&#x0D; Conclusion: We have observed in our study that patients who received an injection of hydrocortisone had lower rates of mortality irrespective of their gender and age while patients who received ACEi/ARB during hospitalization had lower complications rate but higher mortality rates.</jats:p

Correlation Between Perceived Stress and BMI Among Obstructive Sleep Apnea Individuals

Objective: To investigate the potential association between higher perceived stress levels and elevated Body Mass Index (BMI) in patients with obstructive sleep apnea (OSA). Methodology: This prospective study was conducted at the Pulmonology Department of Dow University Hospital, Dow University of Health Sciences, from July to October 2020. The study included adults aged 18 and above, of both genders, diagnosed with OSA through clinical evaluation and sleep studies. BMI was calculated using the formula BMI = kg/m², and the Perceived Stress Scale (PSS) was utilized to assess participants' perceived stress levels. The PSS questionnaire, comprising 10 items, was completed by participants, with each item rated on a 5-point Likert scale (ranging from 0 to 4). Higher scores indicated higher perceived stress. Relevant clinical data were recorded, and the Pearson correlation coefficient was calculated to determine the direction of the relationship. Results: The study included 160 OSA cases, with an average age of approximately 50.29 years. The majority of participants were male (59.4%), while females constituted 40.6% of the sample. BMI categories revealed that 13.8% were overweight, 85.0% were obese, and only two individuals had a normal BMI. Concerning stress levels, 41.3% experienced low stress, 45.6% reported moderate stress, and 13.1% reported high perceived stress. Importantly, the study found an insignificant association between BMI and perceived stress (p-value &lt; 0.278). Conclusion: The study identified a predominant occurrence of obesity among OSA patients. A positive correlation between elevated BMI and perceived stress was observed. The limited number of similar studies and the acknowledged limitations of the current study underscore the necessity for further research and interventions to explore the impact of BMI on stress in OSA

Impact of Continuous Positive Airway Pressure Therapy on Body Weight in patients with Obstructive Sleep Apnea

Aim: To determine the impact of Continuous Positive Airway Pressure therapy on body weight in Obstructive Sleep Apnea patients and assess the relationship between the weight change and other associated symptoms of Obstructive Sleep Apnea. Methods: From a Tertiary care Hospital, Karachi we enrolled 184 Obstructive Sleep Apnea patients of both gender with age more than 18 years of whom 92 patients were exposed to Continuous Positive Airway Pressure while 92 patients were not exposed. In a pre-and post-treatment, information on height, weight, Body mass Index, and neck circumference were recorded. Sleep score was evaluated through Epworth Sleepiness Scale. Results: Results revealed that CPAP effects on weight and BMI. 24% of participants exposed with CPAP gained weight (p=0.03) whereas 72% of participants reduced the weights (p=0.004). The paired t-test showed the mean difference of 3.53±7.5kg (mean±SD, p-value: 0.00). The multivariate analysis showed that CPAP lessens the poor concentration (OR: -4.852; p-value: &lt;0.001), decreases daytime sleepiness (OR: -3.91; p-value: &lt;0.001) and the persons who used dietary plan with CPAP therapy were 6.3 times (p-value: &lt;0.001) more likely to change the weight. Conclusion: The weight of the patient changes with the treatment of OSA after taking a minimum of six months of CPAP therapy. The frequency of weight change in this study population was directed toward weight loss. Elimination of OSA symptoms is directly linked with weight reduction. Keywords: Obstructive sleep apnea, Continuous Positive Airway Pressure therapy, Bodyweight.</jats:p

Association of The Laproscopic Cholecystectomy Outcomes With Duration of Hospital Stay In Rural Areas of District Sangar, Sindh, Pakistan.

To find out the laproscopic cholecystectomy outcomes association with duration of hospital stay in rural area of district Sanghar, Sindh, Pakistan. Methods: This longitudinal and interventional study was conducted in a private hospital of Tando Adam District Sanghar the rural area of Sindh, Pakistan from March 2013 to October 2019. Patients above 15 years of age from both genders were taken by using convenient sampling technique, having symptomatic gallstones, favorable or unfavorable anatomical conditions, acute and chronic cholecystitis. Patients with dilated common bile duct (&gt;8 mm in diameter), jaundice, mass at porta hepatis and uncorrectable coagulopathy were excluded. SPSS-22 was used for the statistical analysis. Results: This study included 28(13.9%) males and 173(86.1%) females. Mostly participants fall between the age of 30 to 39 years 65(32.3%). 146(72.6%) participants stayed in the hospital for up to 24 hours.  Non-significant association (p-value&gt; 0.05) was found between the duration of the hospital stay and outcome of laparoscopic cholecystectomy. Conclusion:  Non-significant association was observed between duration of the hospital stay and outcome of laparoscopic cholecystectomy</jats:p

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

International audienceBackground: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable