Implementing a Discharge Opioid Bundle in Adult Trauma Patients Decreases the Amount of Opioids Prescribed at Discharge

BACKGROUND

Opioids remain the mainstay treatment of acute pain caused by trauma. The lack of evidence driven prescribing creates a challenging situation for providers. We hypothesized that the implementation of a trauma discharge opioid bundle (TDOB) would decrease the total morphine milligram equivalents (MME) prescribed at discharge while maintaining pain control.

METHODS

This was a pre-post study of adult trauma patients before and after implementation of a TDOB to guide the prescription of opioids and discharge prescription education in patients discharged from a level one trauma center. The pre-group and post-group, included consecutively discharged patients from September through November in 2018 and 2019. The primary outcome was the total MME prescribed at discharge.

RESULTS

A total of 377 patients met inclusion criteria. One hundred and fifty-one patients were included in the pre-group and 226 in the post-group. The total MME prescribed at discharge (225 ± [150-300] pre vs 200 ± [100-225] post, P = < .001) and maximum MME/day (45 ± [30-45] vs 30 ± [20-45], P = .004) were significantly less in the post-group. Incidence of outpatient refills within fourteen days were similar. More non-opioid pain adjuncts were prescribed post-intervention and discharge pain education was provided more frequently.

CONCLUSION

The implementation of a TDOB significantly reduced the MME prescribed at discharge without increasing the number of opioid refills.

Pediatric reference intervals for endocrine markers in healthy children and adolescents on the Liaison XL (DiaSorin) immunoassay system

OBJECTIVES

Prominent physiological changes occurring throughout childhood and adolescence necessitate the consideration of age and sex in biomarker interpretation. Critical gaps exist in pediatric reference intervals (RIs) for specialized endocrine markers, despite expected influence of growth and development. The current study aimed to establish and/or verify RIs for six specialized endocrine markers on a specialized immunoassay system.

METHODS

Samples were collected from healthy children and adolescents (5 to <19 years) and apparently healthy outpatients (0 to <5 years) as part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER). Serum samples were analysed for aldosterone, renin (plasma), thyroglobulin, anti-thyroglobulin, growth hormone, and insulin-like growth factor-1 (IGF-1) on the Liaison XL (DiaSorin) immunoassay platform. RIs (2.5th and 97.5th percentiles) were established for aldosterone, renin, thyroglobulin, anti-thyroglobulin, and growth hormone. Manufacturer-recommended pediatric RIs for IGF-1 were verified.

RESULTS

Age-specific RIs were established for aldosterone, renin, and thyroglobulin, while no age-specific differences were observed for anti-thyroglobulin or growth hormone. IGF-1 was the only endocrine marker studied that demonstrated significant sex-specific differences. Manufacturer-recommended IGF-1 RIs were verified for children aged 6 to <19 years, while those for children aged 0 to <6 years did not verify.

CONCLUSIONS

This study marks the first time that pediatric RIs for aldosterone and renin were established in the CALIPER cohort and highlights the dynamic changes that occur in water and sodium homeostasis during the first years of life. Overall, these data will assist pediatric clinical laboratories in test result interpretation and improve clinical decision-making for patients tested using Liaison immunoassays.

Clinician-family relationships may impact neonatal intensive care: clinicians' perspectives

OBJECTIVE

Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown.

STUDY DESIGN

Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed.

RESULTS

Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care.

CONCLUSION

This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.

Diabetic mitochondria are resistant to palmitoyl CoA inhibition of respiration, which is detrimental during ischemia

The bioactive lipid intermediate palmitoyl CoA (PCoA) can inhibit mitochondrial ADP/ATP transport, though the physiological relevance of this regulation remains unclear. We questioned whether myocardial ischemia provides a pathological setting in which PCoA regulation of ADP/ATP transport would be beneficial, and secondly, whether the chronically elevated lipid content within the diabetic heart could make mitochondria less sensitive to the effects of PCoA. PCoA acutely decreased ADP‐stimulated state 3 respiration and increased the apparent K_m for ADP twofold. The half maximal inhibitory concentration (IC₅₀) of PCoA in control mitochondria was 22 µM. This inhibitory effect of PCoA on respiration was blunted in diabetic mitochondria, with no significant difference in the K_m for ADP in the presence of PCoA, and an increase in the IC₅₀ to 32 µM PCoA. The competitive inhibition by PCoA was localised to the phosphorylation apparatus, particularly the ADP/ATP carrier (AAC). During ischemia, the AAC imports ATP into the mitochondria, where it is hydrolysed by reversal of the ATP synthase, regenerating the membrane potential. Addition of PCoA dose‐dependently prevented this wasteful ATP hydrolysis for membrane repolarisation during ischemia, however, this beneficial effect was blunted in diabetic mitochondria. Finally, using ³¹P‐magnetic resonance spectroscopy we demonstrated that diabetic hearts lose ATP more rapidly during ischemia, with a threefold higher ATP decay rate compared with control hearts. In conclusion, PCoA plays a role in protecting mitochondrial energetics during ischemia, by preventing wasteful ATP hydrolysis. However, this beneficial effect is blunted in diabetes, contributing to the impaired energy metabolism seen during myocardial ischemia in the diabetic heart.

Short-term legacy effects of feedlot manure application on soil mesofauna

Little research exists on short-term legacy effects of feedlot manure application on soil mesofauna. This long-term (since 1998) study was on an irrigated clay loam soil in southern Alberta cropped to barley (Hordeum vulgare L.). We sampled the soil 3-4 yr (2017-2018) into the legacy period following 17 annual manure applications (1998-2014). The selected treatments sampled were stockpiled feedlot manure containing straw bedding applied at 0, 13, 39, and 77 Mg ha^-1 (dry wt.). Intact soil cores were taken at three depth intervals (0-3, 3-6, and 6-9 cm) in the fall over 2 yr to determine the densities of Acari (mites) suborders and Collembola (springtails) families. Significant (P ≤ .05) application rate effects occurred on Oribatida and Astigmata after 3 yr (but not after 4 yr) into the legacy phase, whereas Prostigmata were unaffected. Densities of Astigmata after 3 yr were 3.2- to 4.1-fold greater at the 77 Mg ha^-1 rate compared with three lower rates. Significant application rate effects occurred on Entomobryidae, Isotomidae, and Onychiuridae after 4 yr (but not after 3 yr), with no treatment effects on Neelidae. Densities of mesofauna were generally greater at higher than at lower rates, except for Entomobryidae in 2018, where the reverse trend occurred. Significant application rate effects were attributed to lower soil bulk density and greater volumetric soil water content and soil organic carbon. Therefore, legacy effects of feedlot manure application generally persisted on soil mesofauna 3-4 yr into the legacy phase but depended on mesofauna type, year, and depth.

Influence of Organic Amendment and Compaction on Nutrient Dynamics in a Saturated Saline-Sodic Soil from the Riparian Zone

Cattle grazing in wet riparian pastures may influence nutrient dynamics due to nutrient deposition in feces and urine, soil compaction, and vegetation loss. We conducted a lab incubation study with a saline-sodic riparian soil to study nutrient (N, P, S, Fe, Mn, Cu, and Zn) dynamics in soil pore water using Plant Root Simulator (PRS) probes and release of nutrients into the overlying ponded water during flooding. The treatment factors were organic amendment (manure, roots, and unamended control), compaction (compacted, uncompacted), and burial time (3, 7, and 14 d). Amendment treatment had the greatest impact on nutrient dynamics, followed by burial time, whereas compaction had little impact. The findings generally supported our hypothesis that organic amendments should first increase nitrate loss, then increase Mn mobility, then Fe mobility and associated release of P, and finally increase sulfate loss. Declines in nitrate due to amendment addition were small because nitrate was at low levels in all treatments due to high denitrification potential instead of being released to soil pore water or overlying water. Addition of organic amendment strongly increased Mn and Fe concentrations in overlying water and of adsorbed Fe on PRS probes but only increased Mn on PRS probes on Day 3 due to subsequent displacement from ion exchange membranes. Transport of P to overlying water was increased by organic amendment addition but less so for manure than roots despite higher P on PRS probes. The findings showed that saline-sodic soils in riparian zones are generally a nutrient source for P and are a nutrient sink for N as measured using PRS probes after 3 to 7 d of flooding.

Irreversible electroporation of the lumbar vertebrae in a porcine model: is there clinical-pathologic evidence of neural toxicity?

PURPOSE

To evaluate the effects of irreversible electroporation (IRE) in the porcine spine.

MATERIALS AND METHODS

This study was approved by the institutional animal care and use committee. Twenty computed tomographically guided IRE ablations in either a transpedicular location or directly over the posterior cortex were performed in the lumbar vertebrae of 10 pigs by a single operator. T1- and T2-weighted magnetic resonance (MR) imaging was performed with and without contrast material 2 or 7 days after ablation. Mathematical modeling was performed to estimate the extent of ablation. Clinical, radiologic, pathologic, and simulation findings were analyzed. The Miller low-bias back transformation was used to construct 95% confidence intervals for the mean absolute percentage difference between the maximum length and width of the ablation zone on MR images and pathologic measurements by using square-root-transformed data.

RESULTS

Bipolar IRE electrode placement and ablation were successful in all cases. The mean distances from the IRE electrode to the posterior wall of the vertebral body or the exiting nerve root were 2.93 mm ± 0.77 (standard deviation) and 7.87 mm ± 1.99, respectively. None of the animals had neurologic deficits. Well-delineated areas of necrosis of bone, bone marrow, and skeletal muscle adjacent to the vertebral body were present. Histopathologic changes showed outcomes that matched with simulation-estimated ablation zones. The percentage absolute differences in the ablation measurements between MR imaging and histopathologic examination showed the following average errors: 24.2% for length and 28.8% for width measurements on T2-weighted images, and 26.1% for length and 33.3% for width measurements on T1-weighted contrast material-enhanced images.

CONCLUSION

IRE ablation in the porcine spine is feasible and safe and produces localized necrosis with minimal neural toxicity. Signal intensity changes on images acquired with standard MR imaging sequences demonstrate the ablation zone to be larger than that at histopathologic examination.

Transport of Residual Nitrogen and Carbon through Intact Soil Cores Amended with Stockpiled Feedlot Manure with Wood-Chip or Straw Bedding

The environmental impact of using wood chips instead of straw bedding with feedlot manure on transport and leaching potential from feedlot manure is unknown. Our main objective was to determine if transport of total N, total organic N, NO-N, and nonpurgeable organic C (NPOC) to subsurface soil was lower for soils amended with feedlot manure if combined with wood chips compared with straw. A secondary objective was to compare transport of N and NPOC with organic amendments versus inorganic fertilizer. Stockpiled feedlot manure (SM) with wood chip (SM-WD) or barley straw (SM-ST) bedding at 39 Mg (dry wt.) ha, and inorganic fertilizer (IN) at 100 kg N ha, was applied annually for 13 yr to a clay loam soil in a replicated field experiment in southern Alberta, Canada. Intact soil cores were taken in fall 2011 (0-30 cm depth) from the three treatments, and the residual N and NPOC were eluted from the soil cores. Total N, total organic N, and NPOC were determined on filtered (1.0 μm) effluent samples that are primarily dissolved fraction but may contain some small particulate N and C. Peak concentrations, flow-weighted mean concentrations, and mass loss of total N, total organic N, NO-N, and NPOC were significantly ( ≤ 0.05) lower by 35 to 86% for SM-WD compared with SM-ST. Mean recoveries were also significantly lower for SM-WD than SM-ST by 0.07 to 8% (absolute difference). The transport behavior was similar for SM-WD and IN treatment, but solute transport was greater for SM-ST than for IN. Application of stockpiled feedlot manure with wood chips instead of straw bedding may be a beneficial management practice to reduce transport and leaching potential of N fractions and NPOC.

A mathematical model of adult subventricular neurogenesis

Neurogenesis has been the subject of active research in recent years and many authors have explored the phenomenology of the process, its regulation and its purported purpose. Recent developments in bioluminescent imaging (BLI) allow direct in vivo imaging of neurogenesis, and in order to interpret the experimental results, mathematical models are necessary. This study proposes such a mathematical model that describes adult mammalian neurogenesis occurring in the subventricular zone and the subsequent migration of cells through the rostral migratory stream to the olfactory bulb (OB). This model assumes that a single chemoattractant is responsible for cell migration, secreted both by the OB and in an endocrine fashion by the cells involved in neurogenesis. The solutions to the system of partial differential equations are compared with the physiological rodent process, as previously documented in the literature and quantified through the use of BLI, and a parameter space is described, the corresponding solution to which matches that of the rodent model. A sensitivity analysis shows that this parameter space is stable to perturbation and furthermore that the system as a whole is sloppy. A large number of parameter sets are stochastically generated, and it is found that parameter spaces corresponding to physiologically plausible solutions generally obey constraints similar to the conditions reported in vivo. This further corroborates the model and its underlying assumptions based on the current understanding of the investigated phenomenon. Concomitantly, this leaves room for further quantitative predictions pertinent to the design of future proposed experiments.

Effects of Near-infrared Laser Irradiation of Biodegradable Microspheres Containing Hollow Gold Nanospheres and Paclitaxel Administered Intraarterially in a Rabbit Liver Tumor Model

PURPOSE

To evaluate the effects of near-infrared (NIR) laser irradiation of microspheres (MS) containing hollow gold nanospheres (HAuNS) and paclitaxel (PTX) administered intraarterially in an animal model.

MATERIALS AND METHODS

For the ex vivo experiments, VX2 tumor-bearing rabbits underwent administration of MS-HAuNS or MS via the hepatic artery (HA). The animals were killed, the liver tumors were subjected to NIR irradiation, and temperature changes were estimated with magnetic resonance (MR) imaging. For the in vivo study, VX2 tumor-bearing rabbits were randomly assigned to three groups: MS-HAuNS-PTX-plus-NIR, MS-HAuNS-PTX, and saline-plus-NIR. Laser irradiation was delivered at 1 hour and at 3 days after administration of saline or MS-HAuNS-PTX via the HA. Animals were euthanized, and tumors were analyzed for necrosis and apoptosis. Plasma samples were collected from the MS-HAuNS-PTX-plus-NIR animals for PTX analysis.

RESULTS

Ex vivo experiments showed intratumoral heating in animals that received MS-HAuNS but no temperature change in animals that received MS. Animals treated with MS-HAuNS-PTX-plus-NIR showed a transient increase in plasma PTX levels after each NIR irradiation and significantly greater tumor necrosis than animals that received MS-HAuNS-PTX or saline-plus-NIR (44.9% vs 13.8% or 23.7%; P < .0001). The mean apoptotic index in the MS-HAuNS-PTX-plus-NIR group (5.01 ± 1.66) was significantly higher than the mean apoptotic index in the MS-HAuNS-PTX (2.99 ± 0.97) or saline-plus-NIR (1.96 ± 0.40) groups (P = .0013).

CONCLUSIONS

NIR laser irradiation after MS-HAuNS-PTX administration results in intratumoral heating and increases the efficacy of treatment. Further studies are required to evaluate the optimal laser settings to maximize therapeutic efficacy.

Influence of streambank fencing on the environmental quality of cattle-excluded pastures

Limited information exists on the effect of streambank fencing on riparian zone pastures. The objective of this study was to test the hypothesis that 4 to 6 yr of streambank fencing would improve the environmental quality of the cattle-excluded pasture compared with the grazed pasture and cause the fenced pasture to act as a buffer or filter strip. Rangeland health, vegetative and soil properties, and rainfall simulation runoff were measured in the cattle-excluded and adjacent grazed native pastures along the fenced reach of the Lower Little Bow River in southern Alberta, Canada, for 3 yr (2005-2007). Rangeland health was improved (health score increase from 55 to 72%); vegetation cover (13-21%) and standing litter (38-742%) were increased; and bare soil (72-93%) and soil bulk density (6-8%) were decreased under cattle exclusion, indicating an improvement in environmental quality from streambank fencing. In contrast, other vegetation (total and live basal area, fallen litter) and soil properties (soil water and soil C, N, and P) were not improved by cattle exclusion. Cattle exclusion significantly (P </= 0.10) reduced surface runoff depth of water (21-32%) and mass loads of total N fractions (21-52%) in 2 of 3 yr compared with the grazed pasture, suggesting that this fenced pasture may act as a buffer for certain runoff variables. In contrast, other runoff variables (turbidity, electrical conductivity, pH, concentrations and loads of total suspended solids, and certain N and P fractions) in the cattle-excluded pasture were generally not improved by streambank fencing. Overall, streambank fencing improved the quality of certain environmental variables within the cattle-excluded pasture.

Computed tomographic emphysema distribution: relationship to clinical features in a cohort of smokers

Computed tomography (CT) scanning allows precise assessment of both the extent and distribution of emphysema. There has been little work on the relationship between the distribution of emphysema and clinical features of the disease. The current study investigated the association between clinical features and distribution of emphysema. A total of 129 patients with smoking-related chronic obstructive pulmonary disease underwent CT assessment of the extent and distribution of their emphysema (core/rind and upper/lower zone predominance). Emphysema was found predominantly in the upper/core zone and this distribution was related to the extent of disease. Core predominance was associated with lower forced expiratory volume in one second (FEV(1)), FEV(1)/forced vital capacity ratio and body mass index (BMI); and with higher BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) index and Medical Research Council dyspnoea score. Upper-zone predominance was associated with female sex and an increased total St George's Respiratory Questionnaire score. Using multiple linear regression age, sex and whole lung emphysema severity were independently associated with core/rind distribution, while sex and whole lung emphysema severity were independently related to upper/lower distribution. Distribution of emphysema related best to clinical features when divided into core/rind predominance. However, the effects were not independent of the extent of emphysema. Increased age and female sex were related to disease distribution independent of emphysema severity. These findings may be related to differences in development of emphysema.

Aberration correction by maximizing generalized sharpness metrics

The technique of maximizing sharpness metrics has been used to estimate and compensate for aberrations with adaptive optics, to correct phase errors in synthetic-aperture radar, and to restore images. The largest class of sharpness metrics is the sum over a nonlinear point transformation of the image intensity. How the second derivative of the point nonlinearity varies with image intensity determines the effects of various metrics on the imagery. Some metrics emphasize making shadows darker, and other emphasize making bright points brighter. One can determine the image content needed to pick the best metric by computing the statistics of the image autocorrelation or of the Fourier magnitude, either of which is independent of the phase error. Computationally efficient, closed-form expressions for the gradient make possible efficient search algorithms to maximize sharpness.

Hydrological properties of a clay loam soil after long-term cattle manure application

Limited information exists on the effect of long-term application of beef cattle (Bos taurus) manure on soil hydrological properties in the Great Plains region of North America. A site on a clay loam soil (Typic Haploboroll) was used to examine the effect of manure addition on selected soil hydrological properties in 1997 and 1998. The manure was annually applied in the fall for 24 yr at one, two, and three times the recommended rates (in 1973) under dryland (0, 30, 60, and 90 Mg ha(-1) wet basis) and irrigation (0, 60, 120, and 180 Mg ha(-1)). Manure significantly (P < or = 0.05) increased soil water retention (0-5 and 10-15 cm) by 5 to 48% compared with the control at most potentials between 0 and -1500 kPa. Field soil water content (0-5 and 10-15 cm) was increased by 10 to 22% in the summers of 1997 and 1998. Manure increased ponded infiltration by more than 200% at 90 Mg ha(-1) under dryland (1998) and at rates > or = 120 Mg ha(-1) under irrigation (1997). Field-saturated hydraulic conductivity (Kfs) of surface soil (1-cm depth) was significantly increased by 76 to 128% under dryland (1998) and irrigation (1997), as were number of pores > 1120 microm in diameter (37-128% increase). In contrast, manure rate had little or no effect on unsaturated hydraulic conductivity [K(psi)] values (-0.3, -0.5, -0.7, and -1.0 kPa) in 1997 and 1998. Overall, soil hydrological parameters generally had a neutral or positive response to 24 yr of annual manure addition.

Preischemic hyperglycemia-aggravated damage: evidence that lactate utilization is beneficial and glucose-induced corticosterone release is detrimental

Aerobic lactate utilization is crucial for recovery of neuronal function posthypoxia in vitro. In vivo models of cerebral ischemia pose a conceptual challenge when compared to in vitro models. First, the glucose paradox of cerebral ischemia, namely, the aggravation of delayed neuronal damage by preischemic hyperglycemia, cannot be reproduced in vitro. Second, in vitro elevated glucose levels protect against ischemic (hypoxic) damage, an outcome that has seldom been reproduced in vivo. Employing a rat model of cardiac-arrest-induced transient global cerebral ischemia (TGI), we found that hyperglycemic conditions, when induced 120-240 min pre-TGI, significantly reduced post-TGI neuronal damage as compared to normoglycemic conditions. In contrast, hyperglycemia, when induced 15-60 min pre-TGI, significantly aggravated post-TGI neuronal damage. Brain lactate levels in rats loaded with glucose either 15 min or 120 min pre-TGI were significantly and equally higher than those of control, saline-injected rats. The beneficial effect of 120 min pre-TGI glucose loading was abolished by lactate transport inhibition. A significant increase in blood corticosterone (CT) levels was observed upon glucose loading that peaked at 15-30 min and returned to baseline levels by 60-120 min. When rats loaded with glucose 15 min pre-TGI were treated with metyrapone, a CT synthesis inhibitor, a significantly lower degree of delayed neuronal damage in comparison to both untreated, 15 min glucose-loaded rats and normoglycemic, control rats was observed. Thus, although elevated levels of brain lactate cannot explain the glucose paradox of cerebral ischemia, hyperglycemia-induced, short-lived elevation in CT blood levels could. More importantly, lactate appears to play a crucial role in improving postischemic outcome.

Intracranial surgery: to shave or not to shave?

OBJECTIVE

In an effort to improve patient confidentiality as well as cosmesis, the authors have stopped shaving for all intracranial procedures. The objective was to determine whether this lack of shaving increased the postoperative infection rate.

DESIGN

A retrospective study was performed comparing all intracranial surgical procedures performed in the last 2(1/2) years, when hair was not shaved, with the infection rate in patients who did have their hair shaved in the preceding 3(1/2) years.

SETTING

An academic tertiary care referral center.

PATIENTS

Every patient (children and adults) who underwent an intracranial procedure by the skull base surgery team was included. Similar patient demographics were used for the hair-shaved group.

INTERVENTION(S)

Intracranial procedures consisted of acoustic tumor removal, vestibular nerve sections, skull base surgery procedures, vascular decompressions, and craniotomies for benign and malignant tumors.

MAIN OUTCOME MEASURES

The most essential criterion was to determine whether postoperative wound infection developed in a patient. This was documented as either minor (stitch abscess or wound dehiscence), moderate (wound breakdown requiring inpatient or outpatient therapy, such as oral or intravenous antibiotics), or severe (significant wound breakdown that required hospitalization, with surgical debridement and antibiotics).

RESULTS

In all, 150 patients were not shaved for their intracranial procedures; postoperative wound infections developed in 11 (7%). The infections were minor (6), moderate (5), and severe (0). By comparison, 100 patients undergoing intracranial procedures had their hair shaved. In this group, the number of infections noted was 6 (6%). Their categorization into mild, moderate, and severe was 4, 2, and 0, respectively. Statistical analysis did not reveal any significant difference between the two infection rates.

CONCLUSIONS

The rate of postoperative wound infection was statistically no greater when the hair was shaved than when it was not. Thus, for patient confidentiality as well as patient esteem, we recommend not shaving hair for intracranial procedures.

Sleep disorders: a risk factor for normal-tension glaucoma?

PURPOSE

To determine the prevalence of sleep-related symptoms and sleep-related breathing disorders by polysomnography in patients with normal-tension glaucoma (NTG).

PATIENTS AND METHODS

This comparative case series included 23 patients with NTG, 14 NTG suspects, and 30 comparison patients without NTG. A sleep history was obtained and determined to be positive or negative. Polysomnography was offered for patients with a positive sleep history. Prevalence of a positive sleep history and prevalence of sleep disorders were the main outcome measures.

RESULTS

The NTG, NTG suspect, and comparison groups did not differ with respect to age, body mass index, systemic disease, gender, or race. Thirteen (57%) of 23 patients with NTG, 6 (43%) of 14 NTG suspects, and 1 (3%) of 30 comparison patients had a positive sleep history (P = 0.001). Nine of 13 patients with NTG and four of six NTG suspects with a positive sleep history chose to undergo polysomnography. Seven (78%) of nine patients with NTG and all four NTG suspects undergoing polysomnography were diagnosed with a sleep disorder. Five patients with NTG had sleep apnea and two had sleep hypopnea. Two NTG suspects had sleep apnea; one had sleep hypopnea; and one had upper airway resistance syndrome. The one comparison patient with a positive sleep history had upper airway resistance syndrome by polysomnography.

CONCLUSIONS

Sleep-disturbed breathing may be a risk factor for NTG. Although we do not provide evidence for a cause-and-effect relationship, various physiologic factors produced by sleep-disturbed breathing may play a significant role in the pathogenesis of this optic neuropathy. We recommend obtaining a sleep history from patients with NTG and performing polysomnography in those patients with sleep disturbance symptoms.