Sleep apnoea and its relationship with cardiovascular, pulmonary, metabolic and other morbidities.

Sleep apnoea (OSAS) is a multisystem disorder. There is a high prevalence of cardiovascular and metabolic morbidities in patients investigated for sleep apnoea. We aim to evaluate any association between cardiovascular, metabolic and pulmonary co morbidities in patients investigated for OSAS and whether clinical findings based on Epworth sleep score (ESS) and snoring helps in diagnosing sleep apnoea. 258 consecutive patients who were electively admitted for sleep assessment in Peamount Hospital, Dublin from Sept 2009 to Aug 2011 were retrospectively reviewed. 139/258 were diagnosed as OSAS. Cardiovascular, metabolic and pulmonary co morbidities were 46.12%, 37.2% and 29% respectively. There is no correlation found between ESS, Snoring with Apnoea Hypopnoea Index in OSAS group. Screening for OSAS should be considered in patients with certain cardiovascular and metabolic disorders. PSG is so far considered the gold standard investigation to diagnose OSAS and better clinical evaluating tools need to be formulated

What lies beneath a deep vein thrombosis

Presentation We describe a case of non-small cell lung carcinoma (NSCLC) initially presenting with migratory VTE in a previously healthy never smoker. This case demonstrated unexpected wisespread metastatic spread to a variety of unusual sites which have only been rarely reported in the literature. Diagnosis Initial doppler ultrasound confirmed lower limb deep vein thrombosis. Subsequent CTPA revealed pulmonary embolism and a suspicious lung lesion which was later confirmed as NSCLS on histology. PET CT revealed extensive metastatic disease. Treatment Therapeutic anticoagulation was the mainstay of therapy along with symptom management. Discussion Malignancy is linked with venous thromboembolism (VTE) by a two way clinical association . Trousseau Syndrome, which is inconsistently defined in the literature, is considered a paraneoplastic phenomenon manifesting as hypercoagulability in the context of underlying malignancy. Our patient was previously well with no identifiable risk factors for venous thromboembolism or lung cancer. This highlights the importance of high clinical suspicion for an underlying cause even in the most benign appearing cases of venous thromboembolism. </div