Minerva: August 2001

Treating sleep apnoea may save lives. More than 200 adults with sleep apnoea were treated with nasal continuous positive airways pressure for at least three years. Their motor vehicle collision records three years before and after treatment were compared with those of a similar number of control drivers. Untreated patients had had more recorded collisions than the controls, but after the treatment the rate in both groups became equal (Thorax 2001;56:508–12). One commentator estimates that treating 500 patients for three years could prevent 180 serious crashes. Dyspepsia guidelines commonly used in clinical practice say that referrals for endoscopy should be limited to patients over the age of 45 and those who present with “alarm” symptoms such as weight loss, recurrent vomiting, or dysphagia. But an American multivariate analysis of over 20 000 patients reports that such rules are not effective predictors of endoscopic findings: major disease was found at endoscopy in only 21% of cases (sensitivity 87%, specificity 26%). The authors recommend that more effective strategies are needed …