Ami-Hai E. Rubin

Prevalence of sleep apnea syndrome among patients with essential hypertension

The purpose of this study was to investigate the prevalence of sleep apnea syndrome (SAS) among patients with essential hypertension. Sixteen of 50 patients with essential hypertension were suspected of having SAS based on their responses to a sleep questionnaire. Whole-night polysomnographic recordings revealed that 11 of the 16 patients, which is 22% of the initial sample, had SAS as defined by the occurrence of at least 10 apneas lasting 10 seconds each per hour of polygraphically defined sleep. The preponderant finding of SAS in this group indicates that the possibility of the syndrome should be taken into consideration in the clinical evaluation of these patients.

Difficult-to-control asthma and obstructive sleep apnea.

This study tested the hypothesis that asthma can promote obstructive sleep apnea (OSA) by looking at the prevalence of OSA among patients with difficult‐to‐control asthma receiving long‐term oral corticosteroid (CS) therapy and examined some possible etiological factors. The study design was a prospective cohort study and was conducted in the pulmonary outpatient clinic of a tertiary care center in Haifa, Israel. Twenty‐two consecutive patients with severe unstable asthma, 14 on continuous and 8 on bursts of oral CS, in addition to their standard therapy for a mean of 8.9 ± 3.3 years, underwent a night polysomnography in a sleep laboratory regardless of sleep complaints. A standard questionnaire was completed upon attending the sleep laboratory. The OSA was defined as respiratory disturbance index (RDI) of ≥ 5 and typical complaints. The correlation between RDI to asthma and morphometric parameters was tested. All but one patient had OSA [95.5% prevalence], with mean RDI of 17.7 ± 2.5. The RDI values were significantly higher in the continuous CS therapy subgroup (21.4 ± 3.4 vs. 11.1 ± 1.6, p < 0.05]. The study group had above normal neck circumferences and body mass index. The former increased by 12.1% ± 3.1% to 29.8% ± 1% during the oral CS therapy interval but had no significant effect on RDI as a covariant. This study showed an unexpectedly high prevalence of OSA among patients with unstable asthma receiving long‐term chronic or frequent burst of oral CS therapy. It may be assumed that prolonged and especially continuous oral CS therapy in asthma increases airway collapsibility.

Periodic leg movements in sleep Effect of clonazepam treatment

Periodic leg movements in sleep were diagnosed in 8 patients with insomnia and in 12 patients with hypersomnia. Polysom-nography did not reveal any difference in the number of leg movements in these groups, the mean duration of a leg movement, or the number of activity epochs. Those with insomnia, however, had a shorter intermovement interval than those with hypersomnia, with more leg movements in each activity epoch. Treatment with 0.5 to 2 mg clonazepam improved subjective complaints and decreased the number of leg movements without affecting the intermovement interval or movement duration.

Physician assessments of patient compliance with medical treatment

In a study of how physicians evaluate patient compliance, practitioner judgments were compared to the self-reports of 138 adult patients receiving treatment for pulmonary diseases at an outpatient clinic. The research found no significant relationship between physician evaluations of compliance and accounts given by the same patients. The conclusions of physicians regarding patient compliance proved to be influenced by their views on the seriousness of the condition and the effectiveness of treatments, but patient reports were different. Physicians clearly have difficulties in appraising the compliance behavior of their patients.

Menstrual asthma: use of a gonadotropin-releasing hormone analogue for the treatment of cyclic aggravation of bronchial asthma *

A new clinical indication for GnRH-a treatment seems to exist in addition to the many indications known so far. The successful treatment of cyclic severe attacks of bronchial asthma during ovulation and the menstrual periods with a GnRH-a is described. A 45-year-old woman with long-standing bronchial asthma was hospitalized because of severe bronchial asthma and status asthmaticus 11 times during the 5 months before her referral. The hospitalizations were either during the ovulatory or menstrual period, and in two of them they were so grave to require artificial ventilation through an endotracheal tube. To induce pituitary-ovarian desensitization and amenorrhea, the patient was put on monthly injections of depot GnRH-a, which she has been receiving for the last 20 months. Subjective improvement was accompanied by a significant improvement in spirometric indices, by lack of hospitalizations, and decrease in glucocorticoid daily dosage. Although a trial of sequential add-back HRT was unsupportable because of respiratory aggravation, low-dose continuous HRT was tolerated by the patient. In light of the dramatic subjective and objective improvement in association with the GnRH-a treatment, we conclude that this new application deserves further experience.

Preliminary Clinical Experience with Imipramine HCl n the Treatment of Sleep Apnea Syndrome

In the last 2 years we have systematically treated 31 sleep apnea patients with 25-50 mg imipramine HCl given 30 min before bedtime. Imipramine treatment was attempted for nonoverweight patients with negative ear, nose and throat (ENT) findings and for patients who had not responded to weight reduction or ENT surgery (in all patients the apneas were not considered life threatening). Thirteen of the 31 (41.9%) patients, of whom 9 had central apnea, reported subjective improvement in diurnal and nocturnal symptoms within 10-15 days from the initiation of treatment. Sleep laboratory recordings conducted 1-5 months after the beginning of treatment revealed a significant decrease in the total number of apneas from 242 +/- 156 to 142.8 +/- 120.1 (p less than 0.01) in these patients. We concluded that treatment with imipramine may benefit selected sleep apnea patients particularly of the central type.

Sarcoidosis in residents of northern Israel of Arabic and Jewish origin: a comparative study

Background:  This study describes the features of sarcoidosis among Arab patients and compares it to Jewish patients residing in northern Israel.

Scientific articles and national medical cultures: A comparison of Russian and American medical journals

Medical journals are products of national medical cultures, which influence the organization of medical research and the readiness to employ different research methodologies. A content analysis was undertaken to ascertain the characteristics of scientific papers in nine Russian and three American medical journals published in 1992. The American medical journals were thriving, both in appearance, and with research contributions coming from a decentralized national system of research institutions and also from European and other international research centers. Much of American medical research is “big science” based on collaborative efforts of researchers at a number of institutions. Russian medical journals, in contrast, were more parochial in content, reporting mainly local research, with several primary journals serving as outlets for endeavors of sponsoring institutes. While Russian medical culture did appear to discourage usage of classical random experimental designs, the choice of research methodologies proved to be influenced more by medical specialization than by national culture.