Abstract The detailed comorbidity status of hospitalized elderly patients throughout Japan has remained largely unknown; therefore, our goal was to rigorously explore this situation and its implications as of the 2015 fiscal year (from April 2015 to March 2016). This study was based on a health insurance claims database, covering all insured policy holders in Japan aged ≥60 years (male: n = 2,135,049, female: 1,969,019) as of the 2015 fiscal year. Comorbidity status was identified by applying principal factor analysis to the database. The factors identified in male patients were [1] myocardial infarction, hypertension, dyslipidemia, and diabetes mellitus; [2] congestive heart failure (CHF), cardiac arrhythmia, and renal failure; [3] Parkinson’s disease, dementia, cerebrovascular disease, and pneumonia; [4] cancer and digestive disorders; and [5] rheumatoid arthritis and hip fracture. However, in female patients, the results obtained for the quaternary and quinary factors were the opposite of those obtained in male patients. In superelderly patients, dementia, cerebrovascular disease, and pneumonia appeared as the tertiary factor, and hip fracture and osteoporosis appeared as the quaternary factor. The comorbidities in the elderly patients suggest the importance of coronary heart disease and its related metabolic disorders; in superelderly patients, fracture and osteoporosis appeared as factors, in addition to dementia and pneumonia.
Introduction: Polyunsaturated fatty acids (PUFAs), especially omega-3 fatty acids, have several important roles in the pathogenesis of cardiovascular diseases. Several studies have reported the anti-inflammatory and anti-atherogenic effects of omega-6 and omega-3 fatty acids. However, the clinical significance of PUFAs metabolism in the acute phase of cardiovascular diseases remains unknown. Therefore, we investigated the association between circulating PUFAs levels and clinical prognosis in patients admitted to the cardiac intensive care unit. Methods: We recruited 414 consecutive patients (acute decompensated heart failure: 36.0%, acute coronary syndrome: 38.4%) admitted to the cardiac intensive care unit in our University Hospital from April 2012 to October 2013. Fasting plasma PUFAs levels, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-gamma-linolenic acid (DGLA), were measured within 24 h after admission. After excluding patients with malignant diseases, end stage kidney disease, and received EPA therapy, 328 patients were followed up until December 2015. Results: During the 2.4 year mean follow-up period, 51 patients died. The levels of DGLA (31.3 ± 12.2 vs. 23.6 ± 11.3 μg/mL, P < 0.01) and AA (171.6 ± 51.9 vs. 147.8 ± 44.2 μg/mL, P < 0.01), but not EPA (53.6 ± 34.8 vs. 47.5 ± 26.4 μg/mL, NS) and DHA (127.2 ± 43.1 vs. 116.7 ± 36.4 μg/mL, NS), were significantly lower in the non-survivor group compared with the survivor group. Kaplan-Meier survival analysis showed that low DGLA, AA levels and DGLA/AA, but not EPA and DHA levels, were associated with all-cause mortality. Furthermore, Kaplan-Meier survival analysis showed that low DGLA, AA levels and DGLA/AA were associated with all-cause mortality in 114 patients with acute decompensated heart failure (ADHF), whereas each PUFAs levels were not significantly associated with all-cause mortality in 137 patients with acute coronary syndrome. Conclusion: Decreased levels of circulating DGLA and AA in patients admitted to the cardiac intensive care unit were significantly associated with total mortality, especially patients with ADHF. The present study showed it is possible DGLA levels predict long-term mortality.
Purpose: Female athletes with menstrual abnormalities have poor sleep quality.However, whether female athletes with poor sleep quality based on subjective assessment have distinctive changes in objective measures of sleep in association with menses remains unclear.This study aimed to compare changes in objective sleep measurements during and following menses between collegiate female athletes with and without poor subjective sleep quality.Patients and Methods: Female collegiate athletes (age range/mean ± standard deviation: 18-22/ 22.2±1.1)with regular menstrual cycles were recruited.The participants underwent home electroencephalogram monitoring during the first and second nights after the onset of menses and one night between the seventh and 10th nights after menses onset (mid-follicular phase).The Pittsburgh Sleep Quality Index (PSQI) was used to assess the subjective sleep quality.Interactions between the presence of poor subjective sleep quality (ie, PSQI ≥6) and changes in objective measures of sleep in association with menses were analyzed.Results: Data of 45 athletes, including 13 with poor subjective sleep quality, showed that changes in arousal index in athletes with poor subjective sleep quality were distinctive from those in athletes without poor subjective sleep quality (p = 0.036 for interaction).In athletes with poor subjective sleep quality, the arousal index was significantly increased in menses (p for analysis of variance, 0.015), especially on the first night after the onset of menses compared with during the mid-follicular phase (p = 0.016).Conclusion: Collegiate female athletes with regular menstrual cycles are likely to have poor subjective sleep quality in association with more frequent arousal during the first night after the onset of menses than during the mid-follicular phase.
Patients with obstructive sleep apnea syndrome (OSAS) sometimes have atrioventricular (AV) block during sleep. However, significant resolution of such AV block with treatment for OSAS has been reported. On the other hand, during rapid eye movement (REM) sleep, conduction disturbances not associated with the apnea event can be observed, particularly in young healthy subjects. We report the case of a 67-year-old man with severe OSAS and 2:1 AV block that occurred only during the phasic events of REM sleep; continuous positive airway pressure (CPAP) treatment did not result in resolution of the AV block. No specific abnormalities were found on cardiac evaluation. Based on the analysis of overnight heart rate variability, CPAP treatment resulted in a markedly reduced ratio of low-frequency to high-frequency power and an increased high-frequency power, though high-frequency power was not increased during REM sleep on CPAP.
