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Leaving Against Medical Advice
She was never even supposed to be in the hospital. We got a telephone call from an ophthalmologist who suspected a stroke in a woman in her early 70s after finding a visual field defect. She had gone to the clinic because she was bumping into objects for a few days, but she expected to do a few tests, get a diagnosis, and go home, because whatever was wrong did not even bother her much. Instead, she was treated to an admission to our stroke center and a nothing by mouth designation overnight after she failed the nurse ’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and phys...
Source: JAMA Neurology - February 26, 2018 Category: Neurology Source Type: research

Improved Outcomes in Asymptomatic Obstructive Sleep Apnea
This study enrolled 1522 randomly selected, employed research subjects and observed them for 2 decades. The goal of WSCS was to answer one aspect of a US Congressional mandate to determine the overall public burden of sleep d isorders. The WSCS had a surprising finding: mild OSA was seen in 17% of adults, and, most concerning, 6% of adults had moderate to severe OSA. The WSCS finding most relevant to the current USPSTF recommendation statement is that only 35% of WSCS participants with moderate OSA and 37% of participant s with severe OSA reported excessive daytime sleepiness, the cardinal daytime symptom of OSA. This sugg...
Source: JAMA Neurology - January 24, 2017 Category: Neurology Source Type: research

Proton Pump Inhibitors and Dementia Incidence
To the Editor I read with interest the article by Gomm et al investigating the association of proton pump inhibitors and dementia. The authors are to be commended for their large data set, analysis, and detailed proposed pathophysiologic mechanism by which this association might occur. However, 2 important medical comorbidities seem to be missing from their study: gastroesophageal reflux disease and obstructive sleep apnea. Both of these comorbidities can cause cognitive issues, especially in those with apolipoprotein E genetic variants and those who have had a stroke. Gastroesophageal reflux disease would constitute the r...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research