Jose C. Yataco

Psychiatric Disorder Does Not Preclude Adequate Continuous Positive Airway Pressure Titration

Abstract:Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with significant morbidity and multiple complications. A large proportion of patients with OSA also have a coexisting primary psychiatric disorder. The effect of psychiatric disorders on the ability to tolerate continuous positive airway pressure (CPAP) titration is not known. In this study, whether the presence of psychiatric disorders precludes the patients’ ability to tolerate CPAP titration for OSA was investigated. A retrospective chart review on a sample of 284 patients who underwent sleep studies in a single-center, university-based Veterans Affairs hospital was performed. A total of 143 patients with OSA who underwent titration of CPAP therapy were identified. The prevalence of psychiatric disorders between patients who tolerated titration and those who did not tolerate it was compared using the &khgr;2 test. The percentages of patients with psychiatric disorders who tolerated and did not tolerate CPAP were 33.6% and 33.3%, respectively. No statistically significant difference between the 2 groups (&khgr;2 = 0.051 with 1 degree of freedom; P = 0.82) was found. The predominantly male patient population, exclusion of mild OSA, lack of data about the level of control of the psychiatric symptoms and the sleep technicians not being blinded to the patients’ psychiatric diagnoses were some of the limitations of this study. No significant difference existed in the prevalence of psychiatric disorders between patients intolerant to CPAP titration and those who tolerated CPAP for OSA.

The ICU “Golden Hour” vs Morning Admissions: Do They Compete?

receive a BMD-sparing drug during follow-up than those in the placebo arm (34% vs 19%, respectively; relative risk, 1.79; p 0.03), which further complicates the BMD data. Predictably, it would be very hard to tease out the medication effect of ICS therapy. On the basis of the evidence presented, while this trial has added to the body of literature, it has not resolved the controversy of whether or not ICS therapy aggravates or causes osteoporosis. It is fair to say that conducting a trial that will yield clinically relevant end points for osteoporosis in COPD patients is no easy task, and that it may not be done any time soon. So, what lessons can we take away from the TORCH study? As a community of medical specialists, we should bear in mind the high prevalence of osteopenia and osteoporosis in COPD patients when we meet our next patient, and we should look for these related diagnoses. In the TORCH study, the authors reported a decline of about ‘3% of BMD over 3 years in subjects with moderate-to-severe COPD, but medications could increase BMD for a net gain of about 4% over the same period. When osteopenia or osteoporosis is confirmed, we should seriously consider the use of a BMD-sparing medication, regardless of whether or not the subject is receiving therapy with an ICS.