News briefs from the journal Chest, January 2005

January 10, 2005

DEPRESSION INFLUENCES TREATMENT PREFERENCES IN PATIENTS WITH COPD

A new study finds that health-related quality of life does not affect end-of-life treatment preferences in patients with chronic obstructive pulmonary disease (COPD); yet, depression may influence treatment decisions in the same group of patients. In a study of 101 patients (median age 67.4 years) with severe COPD, researchers from the University of Seattle, Seattle, WA, compared depression and health-related quality of life scores with patient preferences for cardiopulmonary resuscitation (CPR) and mechanical ventilation. The majority of patients reported they would want CPR and mechanical ventilation, but, as age increased, so did the likelihood that patients would refuse both treatments. Further analysis revealed that health-related quality of life was not associated with end-of-life treatment preferences, but that a higher burden of depressive symptoms was significantly associated with a preference against CPR, although it was not associated with preference for mechanical ventilation. Researchers conclude that clinicians should recognize the influence depression may have on patient treatment preferences and that improvement in depression symptoms may warrant reassessment of patient treatment preferences. The study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

SLEEP-DISORDERED BREATHING A RISK FACTOR FOR CARDIOVASCULAR MORBIDITY

According to a recent study, sleep-disordered breathing (SDB) may be a possible risk factor for cardiovascular morbidity, but researchers also found a diagnosis of SDB may be inaccurate in unstable patients. In a study of 26 patients presenting with unstable angina, myocardial infarction, or left ventricular failure, researchers from the University of Otago, Dunedin, New Zealand, found 13 patients (50%) had SDB. In a follow-up study of 18 of the patients, only 10 patients (56%) were classified as having SDB, five (28%) had obstructive sleep apnea (OSA), six had false-positive results for SDB, and one had a false-negative result for SDB. The follow-up study's 33% false-positive rate may be attributable to actual false-positive results or could mean that SDB abnormalities may be temporary. Researchers recognize that a diagnosis of SDB could be important for secondary prevention of cardiovascular events, but advise that testing be done on stable patients to ensure accuracy. The study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

SLEEP APNEA MAY LEAD TO IRREGULAR HEARTBEATS

Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) are more likely to have irregular heartbeats than snorers and nonsnorers, according to a new study. In a study of 21 patients with OSAHS, 12 people who snore and 15 control subjects, researchers from Madrid, Spain, found that patients with OSAHS more frequently had irregular heartbeats (cardiac arrhythmias) and ST-segment dynamic changes than other subjects. The differences between results for OSAHS patients and those who snore, but do not have OSAHS, show that the changes in heart function cannot be attributable to snoring alone. Researchers speculate that sleep fragmentation and sympathetic tone in OSAHS patients may be partially responsible for the ST-segment depression episodes, while many heart rhythm irregularities are associated with sleep fragmentation, nocturnal hypoxemia, and urinary catecholamine excretion. The study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
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American College of Chest Physicians

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