Obstructive sleep apnea: Risk factor for arrhythmias, conduction disorders, and cardiac arrest.
mortality; arrhythmia; conduction disorder; national inpatient sample; obstructive sleep apnea
Background Obstructive sleep apnea (OSA) has been described as a risk factor for cardiac arrhythmias. Its association with atrial fibrillation has been established. However, relationships with other arrhythmias and conduction disorders have not been fully studied. Methods We used the National Inpatient Sample database from 2009 to 2011 to explore the relationship between OSA and arrhythmias and conduction disorders. The presence of diagnosis was determined based on the International Classification of Disease-9 (ICD-9) codes. Univariate and multivariate logistic regressions were used to establish mortality risks among all groups. Results Multivariate logistic regression showed increased mortality in patients with OSA in comparison to patients without OSA and patients across all categories of arrhythmias and conduction disorders. One significant finding was the increased association of cardiac arrest in patients with OSA versus patients without OSA (OR: 95.72; CI: 89.13-105.81, p < 0.001). Conclusions OSA is significantly associated with non-atrial fibrillation arrhythmias, conduction disorders, and sudden cardiac arrest. Awareness regarding this association is important for early screening for OSA in obese patients to prevent cardiovascular morbidity and mortality. The use of continuous positive airway pressure (CPAP) might be beneficial against all kinds of arrhythmias and sudden cardiac death. (Copyright © 2020, Acharya et al.)
Acharya R;Basnet S;Tharu B;Koirala A;Dhital R;Shrestha P;Poudel D;Ghimire S;Kafle S
Cureus
2020
2020-08-24
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.7759/cureus.9992" target="_blank" rel="noreferrer noopener">10.7759/cureus.9992</a>
An unusual case of evolving localized tetanus despite prior immunization and protective antibody titer
vaccination; immunization; persistence; decennial booster; evolving tetanus; localized tetanus; protective antibody titer; tetanus titer
Centers for Disease Control and Prevention has reported that tetanus infection in a fully immunized person with the last dose within 10 years is extremely rare. The prevalence of localized tetanus in such a scenario is unknown. Only two case reports of localized tetanus in previously immunized patients have been reported so far, making this the third one. Also, this is the first case of its kind to demonstrate evolving localized tetanus. Our patient is a 19-year-old man who presented with shortness of breath, pain in right upper extremity, shoulder, and neck. His chest X-ray and creatine kinase were normal. The patient was sent home. He presented again to our hospital two days later with difficulty swallowing and speaking as well as chest tightness. Routine blood tests, electrocardiogram, CT angiography of the chest, and transthoracic echocardiogram were normal. He gave a history of a cut in the right middle finger while removing the carpet a week before his presentation. His immunization history was complete with documented last tetanus shot nine years and two months ago. He was treated with tetanus vaccine and penicillin. His tetanus antitoxoid titer came out protective.
Tharu B; Ibrahim S; Shah M; Basnet S; Park T
Cureus
2020
2020-07-31
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.7759/cureus.9498" target="_blank" rel="noreferrer noopener">10.7759/cureus.9498</a>