Biomedical subjects
Publications and source records attributed to M Partinen.
Snoring is an inspiratory sound caused during sleep by vibration of different parts of the upper airways. It is one of the main symptoms of obstructive sleep apnoea in addition to excessive daytime sleepiness. This review asks what the clinician should know about snoring and considers the following aspects: mechanism, prevalence, significance in cardiovascular and pulmonary diseases, association with psychosocial problems, diagnosis and treatment.
In 1979-80, 82 cases of grand mal status epilepticus (71 patients, 39 male and 32 female) were admitted to the Casualty Department of Meilahti University Hospital in Helsinki, Finland. The cause of the underlying epilepsy was symptomatic in 43 cases (52.4%) and idiopathic in 19 cases (23.2%). In 6 cases (7.3%), there was a history of alcohol withdrawal seizures, and in 14 cases (17.1%) there was no earlier history of convulsions. Status epilepticus was associated with an acute or progressive cerebral disorder in 14 episodes. These comprised 6 bouts of status with brain tumour, 4 with acute stroke and 4 with brain injury. Alcohol abuse preceded the status in 29 episodes (35.4%), 23 of which occurred in men (53.5% of the male cases). Excessive use of alcohol was the only obvious precipitating factor for status in 16 cases, and in 6 cases the status presented as a prolonged alcohol withdrawal seizure. A change or irregularity of anticonvulsive drug therapy could be documented in 14 cases and an acute infection outside the central nervous system in 7 cases. Intravenous diazepam, used as the only therapy for status epilepticus, was effective in 58 of 78 episodes. In 7 cases of prolonged status, a thiopental sodium anaesthesia proved effective. The total mortality was 4.2%, including 2 deaths from concomitant extracerebral disorders and one late death from brain metastasis.
Complaints of insomnia were inquired about in a questionnaire survey of 6 268 persons (2 801 men; 3 467 women, mean age 50.5 years, range 45-57 years) in 40 different occupational groups. Among bus drivers 18.9% complained of having rather or very much difficulty falling asleep. Among female cleaners, male teachers, male directors, and male physicians the respective percentages were 18.8, 18.0, 3.7, and 4.9. Disturbed nocturnal sleep was complained of the most often by male laborers (28.1% waking up at least three times a night), female cleaners (26.6%) and female hospital aides (26.4%). Disturbed nocturnal sleep was rare among male physicians (1.6%), male directors (7.4%), female head nurses (8.9%), and female social workers (9.4%). Complaints of waking up too early in the morning were the most common among female laborers (13.2% often or always), male construction workers (9.1%), and female cleaners (8.4%). They were rare among male physicians (1.6%), male directors (1.8%), nurses in outpatient wards (1.2%), and female bathers (2.0%). Sleeping pills were used the most frequently by male gardeners (7.1% were frequent or habitual users), female social office workers (5.8%), and male construction workers (5.4%). Some aspects of work which could explain the differences are discussed.
Relatively little systematic research has been directed towards the potential effects, either etiologic or aggravating, of industrial chemicals on cardiovascular diseases. While some evidence indicates that exposure to certain pesticides might affect lipoprotein metabolism in man, there is no consistent documentation to support the view that atherosclerosis is caused in man by chemical exposures in industry. In this respect results from some animal studies are highly interesting, eg, exposure to some carcinogens, but the hypotheses presented have not yet been vigorously tested in man. Exposure to carbon monoxide is detrimental to the myocardium, especially in patients with ischemic heart disease, but there are no reliable data on elevated cardiac mortality due to carbon monoxide exposure in industrial populations. A few studies have reported arrhythmias or sudden deaths among workers exposed to solvents and organic nitrates. The effects of lead and cadmium upon human blood pressure have remained controversial, although the bulk of controlled epidemiologic studies suggests that they, if at all existent, are not strong.
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Self-reported sleep data from 2238 monozygotic and 4545 dizygotic adult twin pairs indicated a significant hereditary effect on sleep length [overall heritability estimate (h2 = 0.44)] and on sleep quality (h2 = 0.44). When the data were examined in subgroups defined by sex, age (18-24 years and 25 or more years of age), and cohabitation status of the twin pair, the highest heritability estimates for sleep length were for twins living together aged 25 or older. For twins living apart the heritability estimates were statistically significant in all women and men aged 25 or older. For sleep quality significant heritability estimates were found for all groups except women living together.
A patient with pontocerebellitis associated with infectious mononucleosis is described. The clinical picture with transitory limb and truncal ataxia was compatible with previous reports of cerebellitis. CT showed wide pontocerebellar cisterns and a hypodense area in the pons.
In a cross-sectional study of 5419 Finnish adult men, a higher prevalence of diagnosed myocardial infarction was found among those who slept more than 9 hours, whilst those sleeping less than 6 hours per night had more symptomatic coronary heart disease (CHD). This relationship held after controlling by multivariate analysis for age, sleep quality, use of sleeping pills and tranquilizers, smoking, alcohol use, Type A score, neuroticism, use of cardiovascular drug and history of hypertension. The cardiovascular physiology and pathophysiology of sleep is reviewed and the relationship of some specific sleep disorders to CHD is discussed.
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Sleep Expert--a medical decision support system--is a prototype program, with knowledge based on the International Classification of Sleep Disorders (1990). The goal of this project was to evaluate Sleep Expert. In the evaluation project the knowledge of the program was first validated. Three physicians, experts in sleep disorders, were asked to choose 10 typical patient cases with sleep disorders, and to write a description. They also made a diagnosis for each case. Next, each expert made a diagnosis of the cases supplied by the other experts. They were not given the original diagnosis. The 'right diagnosis' (so-called majority agreement) was determined from the three diagnoses. Then the diagnosis of each expert was compared with the 'right diagnosis'. Two physicians, not experts in sleep disorders, were asked to make a diagnosis by using Sleep Expert. Compared to the 'right diagnosis' the diagnoses of each user (non-expert physician) were correct to 63 and 70% of cases, which is quite a good result, although it does not reach the level of the expert physicians (> or = 87%). The functionality of Sleep Expert was studied by using a limited inquiry. On the basis of the user inquiry Sleep Expert provided a useful clinical tool for non-experts.