News briefs from the journal Chest, September 2005

September 12, 2005

DEPRESSED? SLEEP THERAPY MAY HELP

Patients who experience symptoms, such as sleepiness, fatigue, poor motivation, irritability, and difficulty concentrating, are often diagnosed with depression and are treated with antidepressants. A new study suggests that many of these patients have obstructive sleep apnea (OSA), and their symptoms may be reduced with continuous positive airway pressure (CPAP) therapy. Researchers from The Sleep Center at University Community Hospital, Tampa, FL, found that 38 percent of patients were receiving antidepressant medication, and, after using CPAP therapy consistently for 4 to 6 weeks, 98 percent of patients showed improvements in depression and sleep scores. Researchers speculate that these patients were misdiagnosed with depression and actually had OSA or patients had related OSA events and subsequent sleep fragmentation that possibly affected the brain and caused depression. It is also possible that OSA and depression share an underlying mechanism. Researchers suggest that physicians test patients presenting with symptoms of depression for OSA and, if necessary, offer CPAP treatment. The study appears in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

DEADLY PULMONARY COMPLICATIONS UNDIAGNOSED IN BONE MARROW TRANSPLANT RECIPIENTS

The most common cause of death in bone and marrow transplant (BMT) recipients is pulmonary complications, which are frequently overlooked and mistreated, according to a new study. Researchers from Mayo Clinic, Rochester, MN, looked at 71 deceased adult BMT recipients and found 96 pulmonary complications in 63 patients (89 percent), of which 69 (72 percent) complications were undiagnosed while the patients were alive. Infectious complications were more likely to be diagnosed before death than noninfectious complications (48 percent vs. 20 percent). Autopsy results show that as many of 88 percent of patients with certain respiratory conditions were not receiving treatment for the condition at time of death, while other patients were treated for conditions their autopsies showed they did not have. The majority of patients' immediate cause of death was respiratory failure (52 percent). The study results indicate that a significant number of patients with potentially treatable pulmonary complications did not have the correct diagnosis while they were living and did not receive the appropriate treatment. The study appears in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

OVERLOOKED LUNG LESIONS DETECTED BY COMPUTER TECHNOLOGY

One-third of patients whose CT results appeared normal when examined by radiologists actually had significant lung lesions that were detected by an automated computer-aided detection (CAD) system. Researchers from Harvard, Boston, MA; the University of Munich, Germany; R2 Technology, Inc, Sunnyvale, CA; and the Medical University of South Carolina, Charlestown, SC, took 100 CT chest scans that had been classified as normal by radiologists and processed them using a CAD system. Of the 53 significant lung lesions detected, 5 were of high significance (greater than or equal to 10 mm) (9.4 percent), 21 were of intermediate significance (5 to 9 mm) (39.6 percent), and 27 were of low significance (less than or equal to 4 mm) (40.9 percent). CAD detected significant lung lesions in 12 of the 33 patients with suspected pulmonary embolism (36.4 percent), lesions in 8 of 28 patients from a high-risk population for lung cancer who were participating in a lung cancer screening (28.6 percent), and lesions in 13 of 39 patients with a history of cancer who were in remission and undergoing a routine follow-up scan (33.3 percent). There was an average false-positive rate of 1.25 per case. Study results indicate that by using CAD as an additional reader, human error in analyzing imaging can be reduced, and significant lung lesions, that may have otherwise been overlooked, will be detected. The study appears in the September 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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