Suchergebnisse

Status migrainosus (SM) is a subtype of migraine defined by migraine lasting >72 hours and is difficult to treat in clinical practice. Magnesium is commonly used in the treatment of migraine. We conducted a retrospective cohort study to determine if length of admission was associated with IV magnesium therapy in patients with SM. We reviewed the charts of all patients admitted to a large military treatment facility from October 2013 to December 2018 with the admission diagnosis of migraine. There were 333 patients that were reviewed and 141 met the inclusion criteria. Nearly half of patients received IV magnesium therapy with routine care (46.8%, n = 66). IV magnesium therapy was not associated with length of admission (58 hours (IQR 25.5, 86) compared to 42 hours (IQR 25.5, 80.5) respectively, p = 0.47). Of the cases without Neurology consultation, patients who received magnesium therapy (n = 5) had numerically shorter admission but this difference did not meet statistical significance (n = 12) (17 hours (IQR 13.75, 31.25) versus 24.5 hours (IQR 15.25, 58.75), p = 0.0534). This study contributes to the limited pool of available data on the treatment of SM. Prospective research is needed to study magnesium therapy in patients with prolonged migraine.

STUDY OBJECTIVES: Studies of older and less active patients with obstructive sleep apnea (OSA) have reported decreased exercise capacity as measured by peak oxygen uptake (VO(2) max) during cardiopulmonary exercise testing (CPET). We looked to determine whether VO(2) max was decreased in younger patients with OSA who regularly exercise as would be encountered in the military. METHODS: We evaluated military personnel who had undergone pulmonary function testing (PFT), CPET, and polysomnography (PSG) as part of the larger STAMPEDE III study for comprehensive evaluation of exertional dyspnea. For analysis, patients were classified into two groups, the OSA group with an apnea-hypopnea index (AHI) ≥ 15 events/h and a control group with an AHI < 15 events/h. RESULTS: Mean AHI was 32.7 in the OSA group (n = 40) versus 5.8 in the control group (n = 58) with no significant difference in age (40.7 years versus 39.4 years) or body mass index (30.4 kg/m(2) versus 29.9 kg/m(2)). PFT was normal in both groups including diffusing capacity (100.7% versus 96.5%) and FEV(1) (89.2% versus 86.2%). VO(2) max was not significantly different in the OSA group compared to the control group (101.3% versus 102.8%; P = .60) with both groups having normal exercise capacity. Exercise blood pressure response was normal and peak heart rate trended toward a blunted response in the OSA group (166.0 bpm versus 171.6 bpm, P = .09). CONCLUSIONS: Younger military personnel with moderate to severe OSA do not have decreased exercise capacity. The effect of OSA on exercise tolerance may be influenced by additional factors and is likely too small to be noted in this population. COMMENTARY: A commentary on this article appears in this issue on page 819. CITATION: Powell TA, Mysliwiec V, Aden JK, Morris MJ. Moderate to severe obstructive sleep apnea in military personnel is not associated with decreased exercise capacity. J Clin Sleep Med. 2019;15(6):823–829.

Objective: To assess whether a self-care toolkit (SCT) provided to breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery.