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Rinehart MC, Ghorashi S, Heavner MS, Tata A, Bathula M, Kelly S, Yan A Yeung S, Landolf K, So JY, Goel N, Grover BE. An Assessment of a Sleep Aid and Sleep Promotion Practices in Hospitalized Medical Patients. J Am Pharm Assoc (2003) 2024:102042. [PMID: 38382836 DOI: 10.1016/j.japh.2024.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Half of patients admitted to medicine units report sleep disruption, which increases the risk of sleep deprivation. Non-pharmacological interventions are the first step to improving sleep. However, utilization of sleep aids continues to be prevalent. Limited data are available on sleep aid prescribing practices across transitions of care. OBJECTIVES The aim of this study was to describe the current practices for assessing sleep and prescribing of pharmacologic agents to promote sleep in the adult medicine population. METHODS This study was designed as a single center, retrospective, observational cohort study of all patients discharged by the general medicine teams over a 3-month period (September 2019- November 2019). Prior to admission, inpatient and discharge prescriptions for sleep aids were recorded and documentation of sleep assessments and non-pharmacological interventions were evaluated. RESULTS Of 754 patients included, 211 (28%) were prescribed a sleep aid while inpatient. During hospitalization, 124 (16%) patients had at least one documented sleep assessment and only 22 (3%) were ordered the institutional non-pharmacological sleep promotion order set. The most prescribed sleep aid inpatient was melatonin (50%), as well as prior to admission (35%) and at discharge (25%). Overall, the relative reduction in sleep aid prescriptions between admission to discharge was 67%. CONCLUSION Inpatient sleep aid prescribing is common in medical patients. Despite this, sleep assessments and the standard of care of non-pharmacological interventions are rarely utilized. Future efforts should focus on implementation of strategies to make sleep assessments and non-pharmacological sleep promotion routine and consistent in the inpatient setting.
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Affiliation(s)
- Marisa C Rinehart
- PharmD, Atrium Health Wake Forest Baptist, Department of Pharmacy, 1 Medical Center Blvd, Winston-Salem, NC 27157.
| | - Sona Ghorashi
- Early/Late Oncology Clinical Development Fellow. Pfizer.
| | - Mojdeh S Heavner
- Associate Professor and Vice Chair for Clinical Services University of Maryland School of Pharmacy, Department of Pharmacy Practice & Science. 20 N Pine St, Baltimore, MD 21201.
| | - Asha Tata
- Internal Medicine Clinical Specialist, Department of Pharmacy, University of Maryland Medical Center. 22 S Greene St, Baltimore, MD 21201.
| | - Matthew Bathula
- Internal Medicine Clinical Specialist Department of Pharmacy, University of Maryland Medical Center. 22 S Greene St, Baltimore, MD 21201.
| | - Sean Kelly
- Internal Medicine Clinical SpecialistUniversity of Maryland School of Pharmacy Department of Pharmacy Practice & Science. 20 N Pine St, Baltimore, MD 21201.
| | - Siu Yan A Yeung
- Critical Care Clinical Specialist Department of Pharmacy, University of Maryland Medical Center. 22 S Greene St, Baltimore, MD 21201.
| | - Kaitlin Landolf
- Clinical Assistant Professor University of Maryland School of Pharmacy Department of Pharmacy Practice & Science. 20 N Pine St, Baltimore, MD 21201.
| | - Jennifer Y So
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland School of Medicine. 655 W Baltimore St S, Baltimore, MD 21201.
| | - Nidhi Goel
- Assistant Professor of Medicine and Pediatrics, University of Maryland School of Medicine. 655 W Baltimore St S, Baltimore, MD 21201.
| | - Brian E Grover
- Internal Medicine Clinical Specialist, Department of Pharmacy, University of Maryland Medical Center. 22 S Greene St, Baltimore, MD 21201.
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2
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Wade RC, Ling SX, Helgeson ES, Voelker H, Labaki WW, Meza D, O’Corragain O, So JY, Criner GJ, Han MK, Kalhan R, Reed RM, Dransfield MT, Wells JM. Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD. Chronic Obstr Pulm Dis 2024; 11:101-105. [PMID: 37963303 PMCID: PMC10913922 DOI: 10.15326/jcopdf.2023.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
Introduction In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment. Methods The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation. Results Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08-1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04-3.70, p=0.04), respectively. Conclusions CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.
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Affiliation(s)
- R. Chad Wade
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - Sharon X. Ling
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
- †Deceased
| | - Erika S. Helgeson
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Helen Voelker
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Daniel Meza
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
| | - Oisin O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
| | - Jennifer Y. So
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
| | - Robert M. Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - J. Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
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3
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Hwig N, Diaz-Abad M, Peng VT, So JY, Lasso-Pirot A. Successful Treatment of Respiratory Failure in a Patient with Prader-Willi Syndrome with Noninvasive Ventilation with AVAPS. Case Rep Med 2023; 2023:9925144. [PMID: 37113317 PMCID: PMC10129413 DOI: 10.1155/2023/9925144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Prader-Willi syndrome (PWS) is the most prevalent syndromic form of obesity, which starts during early childhood in the setting of hyperphagia. Due to the development of obesity, there is a high prevalence of obstructive sleep apnea (OSA) among these patients. This case report presents a patient with PWS with morbid obesity, severe OSA, and obesity hypoventilation syndrome admitted to the hospital for hypoxemic and hypercapnic respiratory failure. Noninvasive ventilation (NIV) with average volume-assured pressure support, a newer NIV modality, was used successfully to treat this patient, achieving major clinical and gas exchange improvement both during the hospitalization and long term after discharge.
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Affiliation(s)
- Nauras Hwig
- Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Montserrat Diaz-Abad
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victor T. Peng
- Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jennifer Y. So
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anayansi Lasso-Pirot
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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4
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Khosla S, Beam E, Berneking M, Cheung J, Epstein LJ, Meyer BJ, Ramar K, So JY, Sullivan SS, Wolfe LF, Gurubhagavatula I. The COVID-19 pandemic and sleep medicine: a look back and a look ahead. J Clin Sleep Med 2022; 18:2045-2050. [PMID: 35621129 PMCID: PMC9340605 DOI: 10.5664/jcsm.10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic is a reminder that global infectious disease outbreaks are not new, and they have the potential to cause catastrophic morbidity and mortality, disrupt health care delivery, demand critical decision-making in the absence of scientific certainty, interrupt trainee education, inflict economic damage, and cause a spike in demand for health care services that exceeds societal capacity. In this document, we look back at how the sleep medicine community adapted to challenges imposed by the COVID-19 pandemic. To mitigate viral transmission, perhaps the single most effective and efficient adaptation was the rapid adoption of telemedicine. Many additional strategies were taken up virtually overnight, including more home sleep apnea testing, reconsideration of potential risks of positive airway pressure therapy, a reduction or cessation of laboratory services, and deployment of workers to provide front-line care to infected patients. During some periods, critical shortages in essential personal protective equipment, respiratory assist devices, and even oxygen added to logistical challenges, which were exacerbated by persistent financial threats and insufficient staffing. Through ongoing innovation, resiliency and adaptability, breakthroughs were made in assigning staff responsibilities and designing workflows, the use of clinical spaces, legislative support, and in professional society collaboration and guidance so that the missions of health care, teaching and academic pursuit could continue. Here we summarize what we have learned through these critical months and highlight key adaptations that deserve to be embraced as we move forward.
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Affiliation(s)
- Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | - Elena Beam
- Department of Internal Medicine, Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph Cheung
- Division of Pulmonary and Sleep Medicine, Mayo Clinic, Jacksonville, Florida
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Brittany J Meyer
- ProHealth Care Sleep Center, Delafield, Wisconsin.,Sweet Dreams Sleep Services, Gering, Nebraska
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Y So
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shannon S Sullivan
- Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Lisa F Wolfe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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5
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So JY, O'Hara NN, Kenaa B, Williams JG, deBorja CL, Slejko JF, Zafari Z, Sokolow M, Zimand P, Deming M, Marx J, Pollak AN, Reed RM. Population Decline in COPD Admissions During the COVID-19 Pandemic Associated with Lower Burden of Community Respiratory Viral Infections. Am J Med 2021; 134:1252-1259.e3. [PMID: 34126098 PMCID: PMC8196237 DOI: 10.1016/j.amjmed.2021.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/27/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has led to widespread implementation of public health measures, such as stay-at-home orders, social distancing, and masking mandates. In addition to decreasing spread of severe acute respiratory syndrome coronavirus 2, these measures also impact the transmission of seasonal viral pathogens, which are common triggers of chronic obstructive pulmonary disease (COPD) exacerbations. Whether reduced viral prevalence mediates reduction in COPD exacerbation rates is unknown. METHODS We performed retrospective analysis of data from a large, multicenter health care system to assess admission trends associated with community viral prevalence and with initiation of COVID-19 pandemic control measures. We applied difference-in-differences analysis to compare season-matched weekly frequency of hospital admissions for COPD prior to and after implementation of public health measures for COVID-19. Community viral prevalence was estimated using regional Centers for Disease Control and Prevention test positivity data and correlated to COPD admissions. RESULTS Data involving 4422 COPD admissions demonstrated a season-matched 53% decline in COPD admissions during the COVID-19 pandemic, which correlated to community viral burden (r = 0.73; 95% confidence interval, 0.67-0.78) and represented a 36% greater decline over admission frequencies observed in other medical conditions less affected by respiratory viral infections (incidence rate ratio 0.64; 95% confidence interval, 0.57-0.71, P < .001). The post-COVID-19 decline in COPD admissions was most pronounced in patients with fewer comorbidities and without recurrent admissions. CONCLUSION The implementation of public health measures during the COVID-19 pandemic was associated with decreased COPD admissions. These changes are plausibly explained by reduced prevalence of seasonal respiratory viruses.
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Affiliation(s)
- Jennifer Y So
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore
| | - Blaine Kenaa
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - John G Williams
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore
| | - Christopher L deBorja
- Department of Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, Md
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Michael Sokolow
- Quality Management Department, University of Maryland Medical System, Baltimore
| | - Paul Zimand
- Quality Management Department, University of Maryland Medical System, Baltimore
| | - Meagan Deming
- Division of Infectious Disease, University of Maryland School of Medicine, Baltimore
| | - Jason Marx
- Department of Medicine, University of Maryland St. Joseph's Medical Center, Towson
| | - Andrew N Pollak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore
| | - Robert M Reed
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore.
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6
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Shah CH, Reed RM, Villalonga-Olives E, Slejko JF, Eakin MN, So JY, Zafari Z. Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States. Expert Rev Respir Med 2020; 14:937-947. [PMID: 32500756 DOI: 10.1080/17476348.2020.1776612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogenous condition. This study aims to quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in COPD patients in the United States (US). Methods Data from 2008-2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgroups using mixed-effects modeling and G-computation. The Physical Composite Summary (PCS) and Mental Composite Summary (MCS) scores from the Short-Form-12 questionnaire were utilized. We also compared the heterogeneity of HRQoL in our COPD cohort against that in a matched non-COPD cohort. Results The final sample consisted of 1,866 (weighted = 19,952,143) COPD patients with a mean age of 63.2 years (Standard error (SE):0.38), mean MCS score of 46.84 (SE:0.35), and mean PCS score of 35.65 (SE:0.32). The adjusted MCS and PCS scores ranged from 36.19 to 53.06, and from 25.52 to 48.27, respectively, for COPD subgroups. COPD patients had statistically significantly lower MCS and PCS scores by 4.61, and 5.86 points, respectively, compared to the matched non-COPD cohort, and MCS scores showed a wider variability in the COPD cohort. Conclusion Our study quantifies substantial heterogeneity of HRQoL in COPD in the US and provides evidence for prioritizing COPD subgroups with the lowest HRQoL for targeted interventions.
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Affiliation(s)
- Chintal H Shah
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary Medicine and Critical Care, Johns Hopkins University , Baltimore, MD, USA
| | - Jennifer Y So
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
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7
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Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is uncommon following solid organ transplantation. We present a case of PTLD presenting as hematochezia and abdominal pain in a 66-year-old man, who had undergone bilateral lung transplantation with alemtuzumab induction 7 months prior to presentation. The transplant serologic status was "high-risk" for the presence of both Epstein-Barr virus (EBV) serologies in the donor and negative serologies in the recipient. Biopsies taken during colonoscopy stained strongly positive for EBV-encoded RNA. Mediastinal lymph node biopsies also showed atypical, EBV-positive lymphohistiocytic infiltration with focal necrosis. The patient's hospital course was complicated by treatment side effects, most notably bowel perforation following rituximab. In this case report the topic of PTLD is reviewed and consideration is given to whether alemtuzumab induction may have contributed to the patient's development of PTLD.
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Affiliation(s)
- Hassan A Haji
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Douglas S Corwin
- Pulmonary and Critical Care Medicine, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Jennifer Y So
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert M Reed
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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8
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Abstract
Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance dialysis and following successful kidney transplantation. Sleepiness may be secondary to medical comorbid conditions, medication side effect, insufficient sleep syndrome, and sleep-disordered breathing or the result of a primary central disorder of hypersomnolence, such as narcolepsy. Unrecognized and untreated sleep disorders are associated with substantial morbidity and mortality among patients with end-stage kidney disease. Effective management of hypersomnolence can improve quality of life in patients with kidney disease. This review focuses on the principal causes of sleepiness in patients with end-stage kidney disease. Awareness of these disorders by treating nephrologists is crucial. This review provides a systematic approach to guide providers through the recognition, early diagnosis, and treatment of hypersomnolence, which is commonly encountered in this patient population. Areas of future research are also suggested.
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Affiliation(s)
- Jennifer Y So
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine at the University of Maryland School of Medicine, Baltimore, MD.
| | - Karen M Warburton
- Division of Nephrology, Department of Medicine at the University of Virginia School of Medicine, Charlottesville, VA
| | - Ilene M Rosen
- Division of Sleep Medicine, Department of Medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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9
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Affiliation(s)
- Yaniv Dotan
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jennifer Y So
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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10
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So JY, Mamary AJ, Shenoy K. Asthma: Diagnosis and Treatment. EMJ 2018. [DOI: 10.33590/emj/10313763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asthma is an obstructive lung disease affecting >230 million people worldwide and a significant cause of morbidity in patients of all ages. It is a heterogeneous disease with a complex pathophysiology and phenotype. Diagnosis is made with thorough history-taking and physical examination, and the condition is characterised by variable airflow obstruction and airway hyper-responsiveness. Understanding the severity of the disease is important, and treatment is aimed at symptom control and the prevention of future exacerbations. Pharmacologic treatment with beta-agonists for intermittent asthma and inhaled corticosteroids and a combination of inhaled corticosteroids and long-acting beta-2 agonists for persistent asthma are recommended. Additional and alternative treatments with leukotriene modifiers, anticholinergics, biologics, and bronchial thermoplasty are also available. However, understanding an individual’s disease phenotype, endotype, and comorbidities is necessary for asthma treatment, with appropriate consultation with asthma specialists required for those with severe asthma.
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Affiliation(s)
- Jennifer Y. So
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Albert J. Mamary
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Kartik Shenoy
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
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11
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So JY, Dhungana S, Beros JJ, Criner GJ. Statins in the treatment of COPD and asthma-where do we stand? Curr Opin Pharmacol 2018; 40:26-33. [PMID: 29334676 DOI: 10.1016/j.coph.2018.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/01/2018] [Indexed: 01/26/2023]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are the two most prevalent obstructive lung diseases that account for tremendous morbidity and mortality throughout the world. These diseases have strong inflammatory components, with multiple prior studies showing elevated levels of various inflammatory markers and cells in those with COPD and asthma. Therefore, efforts to target inflammation in management of these diseases are of great interest. Statins, which define a class of drugs that are HMG-CoA inhibitors, are used to decrease cholesterol levels and have also been described to have many pleotropic effects that include anti-inflammatory and anti-oxidative properties. These properties have led to multiple studies looking at the potential use of statins in decreasing inflammation in many diseases, including COPD and asthma. This review aims to address the current evidence behind the potential use of statins in the treatment of asthma and COPD.
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Affiliation(s)
- Jennifer Y So
- Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
| | - Santosh Dhungana
- Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Joanna J Beros
- Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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12
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So JY, Lastra AC, Zhao H, Marchetti N, Criner GJ. Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2015; 3:398-405. [PMID: 28848862 DOI: 10.15326/jcopdf.3.1.2015.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rationale: Chronic obstructive pulmonary disease, (COPD) is a major cause of morbidity and mortality in the United States. Peak expiratory flow rate (PEFR) monitoring could provide a daily objective measurement of lung function in COPD patients at home. We hypothesized that individuals with greater variability in daily PEFR would signal an unstable patient population with worse outcomes. Methods: This was a retrospective analysis of prospectively collected data using an electronic diary to record daily PEFR and symptoms in severe and very severe COPD patients. Rates of PEFR change were used to characterize patients into stable and unstable groups determined by the distribution of slopes. Exacerbation-free days, time to first hospitalization, hospitalization rate, length of hospitalization, and all-cause mortality were assessed. Results: A total of 104 severe and very severe COPD patients met entry criteria, and were observed for 37,702 patient-days. There were no significant differences in baseline symptoms, demographics, forced expiratory volume in 1 second (FEV1) or comorbidities between stable versus unstable groups. The unstable group had 34.7 less exacerbation-free days and significantly shorter 6 minute walk distances (6MWD) (227.1 versus 270.7 meters, p=0.031), shorter time to first hospitalization (163 versus 286 days, p=0.017), more frequent hospitalizations (2.6 versus 1.7 per year, p=0.032) and higher all-cause mortality (10.8 versus 5.1%, p= 0.04). Conclusion: Patients with severe to very severe COPD with greater changes in PEFR have shorter 6MWD, reduced time to first hospitalization, more frequent hospitalizations, and higher all-cause mortality despite similar demographic, spirometric and comorbid parameters at baseline. Daily peak flow monitoring can be a useful tool in identifying COPD patients predisposed to worse outcomes.
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Affiliation(s)
- Jennifer Y So
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Alejandra C Lastra
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Nathaniel Marchetti
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Gerard J Criner
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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