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Obstructive sleep apnea in sickle-cell disease patients in Cameroon
Abstracts / Journal of the Neurological Sciences 333 (2013) e679–e727
factors for OSA (AOR 106.19 95% CI 2.52–4471.29 and AOR 3238.54 95% CI 4.76–1.0 × 106 for ≥4 crises respectively). On the other hand having been hospitalized more than twice in the past year was a protective factor (AOR 0.002 95% CI 0.00–0.74). Sex, age of participant, age at diagnosis, number of transfusions in the past year, and past histories of stroke, enuresis, and hydroxyurea use were not significant predictors. None of the above-named factors were identified as predictors of RLS. Conclusion: Vaso-occlusive crises and tonsillar hypertrophy predispose to OSA while hospital admissions are protective. Prevention and prompt management of pain crises and enlarged tonsils as well as hospital management of SCD crises appear to prevent sleep OSA in sickle-cell patients. doi:10.1016/j.jns.2013.07.2471
Abstract — WCN 2013 No: 3108 Topic: 36 — Other Topic Obstructive sleep apnea in sickle-cell disease patients in Cameroon J.Y. Fonsaha, E.T. Chokoteb, E.N. Mbongc, L.N. Nforb, L. Ngarkab, A.A. Njohb, N. Kokid, A.K. Njamnshia, W.F.T. Munae. aNeurology, Yaounde Central Hospital, Cameroon; bGeneral Medicine, University of Yaounde 1, Cameroon; cPublic Health, Ministry of Health, Cameroon; d Pediatrics, Chantal Biya Foundation, Cameroon; eCardiology, Yaounde General Hospital, Yaounde, Cameroon Background: Obstructive sleep apnea is a major cause of poor sleep in sickle-cell disease (SCD). Poor sleep affects functional status, quality of life and may precipitate acute pain crises. Data on OSA in SCD is limited in Africa and does not exist in Cameroon to our knowledge. Patients and methods: A case–control study of 45 SCD patients (hemoglobin SS) age- and sex-matched with 45 non-sickle cell disease controls aged 2 to 17 years employed the Pediatric Sleep Quality (PSQ) scale to screen for obstructive sleep apnea (OSA) and the Epworth Sleepiness Scale (ESS) for daytime sleepiness. Results: Obstructive sleep apnea was significantly more common in sickle-cell patients compared to the controls (26.7% versus 2.2%, p = 0.002, OR 15.9 95% 1.98–125). Snoring as well as inattention hyperactivity PSQ scores were significantly higher in the cases compared to the controls (0.91 ± 1.18 versus 0.09 ± 0.29, p b 0.001 and 2.11 ± 1.90 versus 0.96 ± 1.92 p = 0.002). More sickle-cell patients with OSA had enlarged tonsils than not (47.4% versus 12.5% p = 0.017 OR 6.30 95% CI: 1.39–28.46). Excessive daytime sleepiness was more common in sickle-cell patients with OSA compared to those without (27.3% versus 0.0%, p = 0.012). Conclusion: Obstructive-sleep apnea is common in sickle cell disease patients in Cameroon. The management and prevention of tonsillar hypertrophy should be part of OSA management in SCD as well as excessive daytime sleepiness, inattention hyperactivity and its consequences. doi:10.1016/j.jns.2013.07.2472
Abstract — WCN 2013 No: 3115 Topic: 36 — Other Topic Bedwetting and sleep disorders in sickle cell disease patients in Cameroon E.N. Mbonga, L. Ngarkab, E.T. Chokoteb, L.N. Nforb, A.A. Njohb, J.Y. Fonsahc, N. Kokid, A.K. Njamnshic, W.F.T. Munae. aPublic Health, Ministry of Public Health, Cameroon; bGeneral Medicine, University of Yaounde 1, Cameroon; cNeurology, Yaounde Central Hospital,
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Cameroon; dPediatrics, Chantal Biya Foundation, Cameroon; eCardiology, Yaounde General Hospital, Yaounde, Cameroon Background: Bedwetting and enuresis are known predictive factors of sleep disorders in sickle-cell disease (SCD). Poor sleep affects functional status, quality of life and may precipitate acute painful crises. Data on bedwetting in SCD is limited in Africa and does not exist in Cameroon. Patients and methods: A case–control study of 45 SCD patients (hemoglobin SS) age- and sex-matched with 45 non-sickle cell anemia controls aged 2 to 17 years. We used the Pediatric Sleep Quality (PSQ) scale to screen for obstructive sleep apnea (OSA) and restless legs syndrome (RLS) and the Epworth Sleepiness Scale (ESS) for daytime sleepiness. Results: Though cases gained bladder control earlier than controls (78.6% versus 66.7% before the age of 2 years, p = 0.229) bedwetting was two and a half times more common in the former than in the latter (56.8% versus 22.7%, p = 0.001, OR 4.54 95% CI 1.79–11.11). This was true for males as well as for females (54.5% versus 21.7%, p = 0.023 and 59.1% versus 23.8%, p = 0.019 respectively). Enuresis was more common in the cases than in the controls though not significantly (63.2% versus 42.9% p = 0.407). Enuresis was significantly more common in sickle-cell patients with OSA compared to those without (100.0% versus 46.2%, p = 0.044). This was observed for RLS and daytime sleepiness, though not significantly (100.0% versus 56.2%, p = 0.263 and 100.0% versus 50.0%, p = 0.106). Conclusion: Bedwetting and enuresis are common in sickle-cell disease in Cameroon and appropriate management strategies are needed. doi:10.1016/j.jns.2013.07.2473
Abstract — WCN 2013 No: 3117 Topic: 36 — Other Topic Vitamin B12 status does not influences central motor conduction time in asymptomatic elderly people: A transcranial magnetic stimulation study J.M. Matamalaa, R. Verdugoa, C. Nuñeza, L. Lerab, H. Sanchezb, C. Albalab, J.L. Castilloa. aDepartment of Neurological Science, Faculty of Medicine, University of Chile, Chile; bPublic Health and Nutrition Unit, Nutrition and Food Technology Institute, University of Chile, Santiago, Chile Background: Vitamin B12 deficiency causes neurologic and psychiatric disease, especially in older adults. Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract. Objective: To test corticospinal tract projections using motor evoked potentials (MEPs) by transcranial magnetic stimulation (TMS) in asymptomatic older adults with low vitamin B12 (B12) levels. Patients and methods: Cross-sectional study of 53 healthy older adults (N70 years). MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles, at rest and during slight tonic contraction. Central motor conduction time (CMCT) was derived from MEP latency and peripheral motor conduction time (PMCT). Neurophysiological variables were analyzed statistically according B12 status. Results: Median age was 74.3 ± 3.6 years (58.5% women). Twenty-six out of the 53 subjects had low vitamin B12 levels (B12 b 221 pmol/L). MEPs were recorded for all subjects in the upper and lower extremities. There were no significant differences in either latency or amplitude of MEPs and CMCT between low and normal B12 groups. There was a significant PMCT delay in the lower extremities in the low B12 group (p = 0.014). Conclusion: No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12 deficient older adults. The peripheral
factors for OSA (AOR 106.19 95% CI 2.52–4471.29 and AOR 3238.54 95% CI 4.76–1.0 × 106 for ≥4 crises respectively). On the other hand having been hospitalized more than twice in the past year was a protective factor (AOR 0.002 95% CI 0.00–0.74). Sex, age of participant, age at diagnosis, number of transfusions in the past year, and past histories of stroke, enuresis, and hydroxyurea use were not significant predictors. None of the above-named factors were identified as predictors of RLS. Conclusion: Vaso-occlusive crises and tonsillar hypertrophy predispose to OSA while hospital admissions are protective. Prevention and prompt management of pain crises and enlarged tonsils as well as hospital management of SCD crises appear to prevent sleep OSA in sickle-cell patients. doi:10.1016/j.jns.2013.07.2471
Abstract — WCN 2013 No: 3108 Topic: 36 — Other Topic Obstructive sleep apnea in sickle-cell disease patients in Cameroon J.Y. Fonsaha, E.T. Chokoteb, E.N. Mbongc, L.N. Nforb, L. Ngarkab, A.A. Njohb, N. Kokid, A.K. Njamnshia, W.F.T. Munae. aNeurology, Yaounde Central Hospital, Cameroon; bGeneral Medicine, University of Yaounde 1, Cameroon; cPublic Health, Ministry of Health, Cameroon; d Pediatrics, Chantal Biya Foundation, Cameroon; eCardiology, Yaounde General Hospital, Yaounde, Cameroon Background: Obstructive sleep apnea is a major cause of poor sleep in sickle-cell disease (SCD). Poor sleep affects functional status, quality of life and may precipitate acute pain crises. Data on OSA in SCD is limited in Africa and does not exist in Cameroon to our knowledge. Patients and methods: A case–control study of 45 SCD patients (hemoglobin SS) age- and sex-matched with 45 non-sickle cell disease controls aged 2 to 17 years employed the Pediatric Sleep Quality (PSQ) scale to screen for obstructive sleep apnea (OSA) and the Epworth Sleepiness Scale (ESS) for daytime sleepiness. Results: Obstructive sleep apnea was significantly more common in sickle-cell patients compared to the controls (26.7% versus 2.2%, p = 0.002, OR 15.9 95% 1.98–125). Snoring as well as inattention hyperactivity PSQ scores were significantly higher in the cases compared to the controls (0.91 ± 1.18 versus 0.09 ± 0.29, p b 0.001 and 2.11 ± 1.90 versus 0.96 ± 1.92 p = 0.002). More sickle-cell patients with OSA had enlarged tonsils than not (47.4% versus 12.5% p = 0.017 OR 6.30 95% CI: 1.39–28.46). Excessive daytime sleepiness was more common in sickle-cell patients with OSA compared to those without (27.3% versus 0.0%, p = 0.012). Conclusion: Obstructive-sleep apnea is common in sickle cell disease patients in Cameroon. The management and prevention of tonsillar hypertrophy should be part of OSA management in SCD as well as excessive daytime sleepiness, inattention hyperactivity and its consequences. doi:10.1016/j.jns.2013.07.2472
Abstract — WCN 2013 No: 3115 Topic: 36 — Other Topic Bedwetting and sleep disorders in sickle cell disease patients in Cameroon E.N. Mbonga, L. Ngarkab, E.T. Chokoteb, L.N. Nforb, A.A. Njohb, J.Y. Fonsahc, N. Kokid, A.K. Njamnshic, W.F.T. Munae. aPublic Health, Ministry of Public Health, Cameroon; bGeneral Medicine, University of Yaounde 1, Cameroon; cNeurology, Yaounde Central Hospital,
e717
Cameroon; dPediatrics, Chantal Biya Foundation, Cameroon; eCardiology, Yaounde General Hospital, Yaounde, Cameroon Background: Bedwetting and enuresis are known predictive factors of sleep disorders in sickle-cell disease (SCD). Poor sleep affects functional status, quality of life and may precipitate acute painful crises. Data on bedwetting in SCD is limited in Africa and does not exist in Cameroon. Patients and methods: A case–control study of 45 SCD patients (hemoglobin SS) age- and sex-matched with 45 non-sickle cell anemia controls aged 2 to 17 years. We used the Pediatric Sleep Quality (PSQ) scale to screen for obstructive sleep apnea (OSA) and restless legs syndrome (RLS) and the Epworth Sleepiness Scale (ESS) for daytime sleepiness. Results: Though cases gained bladder control earlier than controls (78.6% versus 66.7% before the age of 2 years, p = 0.229) bedwetting was two and a half times more common in the former than in the latter (56.8% versus 22.7%, p = 0.001, OR 4.54 95% CI 1.79–11.11). This was true for males as well as for females (54.5% versus 21.7%, p = 0.023 and 59.1% versus 23.8%, p = 0.019 respectively). Enuresis was more common in the cases than in the controls though not significantly (63.2% versus 42.9% p = 0.407). Enuresis was significantly more common in sickle-cell patients with OSA compared to those without (100.0% versus 46.2%, p = 0.044). This was observed for RLS and daytime sleepiness, though not significantly (100.0% versus 56.2%, p = 0.263 and 100.0% versus 50.0%, p = 0.106). Conclusion: Bedwetting and enuresis are common in sickle-cell disease in Cameroon and appropriate management strategies are needed. doi:10.1016/j.jns.2013.07.2473
Abstract — WCN 2013 No: 3117 Topic: 36 — Other Topic Vitamin B12 status does not influences central motor conduction time in asymptomatic elderly people: A transcranial magnetic stimulation study J.M. Matamalaa, R. Verdugoa, C. Nuñeza, L. Lerab, H. Sanchezb, C. Albalab, J.L. Castilloa. aDepartment of Neurological Science, Faculty of Medicine, University of Chile, Chile; bPublic Health and Nutrition Unit, Nutrition and Food Technology Institute, University of Chile, Santiago, Chile Background: Vitamin B12 deficiency causes neurologic and psychiatric disease, especially in older adults. Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract. Objective: To test corticospinal tract projections using motor evoked potentials (MEPs) by transcranial magnetic stimulation (TMS) in asymptomatic older adults with low vitamin B12 (B12) levels. Patients and methods: Cross-sectional study of 53 healthy older adults (N70 years). MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles, at rest and during slight tonic contraction. Central motor conduction time (CMCT) was derived from MEP latency and peripheral motor conduction time (PMCT). Neurophysiological variables were analyzed statistically according B12 status. Results: Median age was 74.3 ± 3.6 years (58.5% women). Twenty-six out of the 53 subjects had low vitamin B12 levels (B12 b 221 pmol/L). MEPs were recorded for all subjects in the upper and lower extremities. There were no significant differences in either latency or amplitude of MEPs and CMCT between low and normal B12 groups. There was a significant PMCT delay in the lower extremities in the low B12 group (p = 0.014). Conclusion: No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12 deficient older adults. The peripheral