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Schlafstorungen und schlafbezogene Atmungsstorungen sind bei idiopathischer Lungenfibrose (IPF) sehr haufig, aber wenig beachtet. Darstellung der klinischen Bedeutung und der vermuteten Ursachen von Schlafstorungen und schlafbezogenen Atmungsstorungen bei IPF sowie der Konsequenzen fur das diagnostische und therapeutische Management der IPF. Auswertung der zur Verfugung stehenden Literatur zum Thema IPF – Schlaf – Schlafstorungen – schlafbezogene Atmungsstorungen. Die Ursachen fur Schlafstorungen bei IPF sind vielfaltig, u. a. sind es der nachtliche Husten, schlafbezogene Atmungsstorungen (SBAS) sowie ein gesteigerter Atmungsantrieb. Der Epworth Sleepiness Scale Score (ESS-Score) ist zur Erfassung der Tagesschlafrigkeit bei IPF wenig geeignet. Bessere Ergebnisse liefern der Functional Outcomes of Sleep Questionnaire (FOSQ) und die Fatigue Severity Scale (FSS). Sauerstoffentsattigungen im Schlaf konnen durch die Lungenfunktion nicht sicher vorhergesagt werden, eher noch durch den arteriellen Sauerstoffpartialdruck (PaO2) im Wachzustand. Es gibt Hinweise fur eine Mortalitatssteigerung und damit Prognoseverschlechterung bei Patienten mit haufigen nachtlichen Hypoxamien und zusatzlicher pulmonaler Hypertonie. Allerdings existieren fur die IPF bisher keine evidenzbasierten Empfehlungen fur die Indikationsstellung zur Sauerstofftherapie und nichtinvasiven Beatmung im Schlaf. Obstruktive Schlafapnoen (OSA) kommen bei IPF haufiger vor, insbesondere bei IPF-Patienten mit erhohtem Body-Mass-Index (BMI). Treten OSA bei einer IPF auf, sind die Sauerstoffentsattigungen deutlich starker ausgepragt als bei alleiniger Schlafapnoe. Die Therapie von Schlafstorungen und SBAS bei IPF ist nur individuell durchzufuhren. Bei Fehlen effektiver Therapiemoglichkeit der IPF erscheint die Optimierung der Schlaf- und Lebensqualitat durch die Behandlung von Schlafstorungen und schlafbezogenen Atmungsstorungen ein wichtiges Ziel.

We investigated the impact of parathyroidectomy on sleep quality in patients with primary hyperparathyroidism (pHPT). Thirty consecutive patients with pHPT were enrolled in the study within 1 year. pHPT was diagnosed by typical symptoms accompanied by an elevated level of parathormone. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of sleep 1 day before and 6 months after parathyroidectomy. The mean total PSQI score was elevated to 6.8 ± 0.6 points before surgery, which was in the pathological cut-off of greater than ≥5, indicating impaired sleep quality. After parathyroidectomy, the total score declined insignificantly, amounting to 5.6 ± 0.4 (p 0.05). Nevertheless, the number of patients with a score of ≥5 before surgery decreased from 21 (70%) to 16 (53%) after surgery. There also was a significant improvement in sleep latency (p = 0.05) and sleep efficiency (p = 0.02) domains of PSQI. We conclude that 70% of patients with untreated pHPT suffered from sleep disorders that improved after parathyroidectomy. The clinical consequence is that patients with pHPT should be questioned about having sleep disorders, which might influence the decision-making concerning parathyroidectomy. With the relation reversed, patients without pHPT but suffering from sleep disturbance should be tested for pHPT.

Cognitive functioning after transplantation, which could influence medication compliance and independence, has not been well studied. This study investigated cognitive impairment after lung transplantation. Patients undergoing bilateral transplant between March 2013 and October 2015 underwent comprehensive neuropsychological assessment at 60.1 ± 44.1 months post-transplantation: verbal memory (Auditory-Verbal Learning Test, digit span forward), visual memory (Corsi Block-Tapping Test forward, Benton Visual Retention Test), concentration/speed of processing/attention (D2 Test of Attention, Trail Making Test (TMT) A, Grooved Pegboard), and executive functioning (TMT B, Stroop Color-Word Test, semantic and phonematic verbal fluency, digit span backward, Corsi Block-Tapping Test backward). Mean scores were compared with a normative dataset using a one-sample t-test. A cognitive domain was judged impaired if the score on two or more domain-specific tests was greater than one standard deviation below the normative dataset age range mean. Of 124 lung transplant recipients (51% male, 54.3 ± 9.0 years), 70% showed cognitive impairment in one or more domains. Executive function was most often impaired (78% of recipients not within the age range) followed by verbal memory impairment (72% not within the age range). Cognitive function reductions were largely independent of age, gender, education, immunosuppressive medications, and time since transplantation. The findings show that cognitive impairment is common after lung transplantation and should be subject to rehabilitation and psychological resilience strategies.

We investigated the impact of parathyroidectomy on sleep quality in patients with primary hyperparathyroidism (pHPT). Thirty consecutive patients with pHPT were enrolled in the study within 1 year. pHPT was diagnosed by typical symptoms accompanied by an elevated level of parathormone. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of sleep 1 day before and 6 months after parathyroidectomy. The mean total PSQI score was elevated to 6.8 ± 0.6 points before surgery, which was in the pathological cut-off of greater than ≥5, indicating impaired sleep quality. After parathyroidectomy, the total score declined insignificantly, amounting to 5.6 ± 0.4 (p > 0.05). Nevertheless, the number of patients with a score of ≥5 before surgery decreased from 21 (70%) to 16 (53%) after surgery. There also was a significant improvement in sleep latency (p = 0.05) and sleep efficiency (p = 0.02) domains of PSQI. We conclude that 70% of patients with untreated pHPT suffered from sleep disorders that improved after parathyroidectomy. The clinical consequence is that patients with pHPT should be questioned about having sleep disorders, which might influence the decision-making concerning parathyroidectomy. With the relation reversed, patients without pHPT but suffering from sleep disturbance should be tested for pHPT.

Cognitive functioning after transplantation, which could influence medication compliance and independence, has not been well studied. This study investigated cognitive impairment after lung transplantation. Patients undergoing bilateral transplant between March 2013 and October 2015 underwent comprehensive neuropsychological assessment at 60.1 ± 44.1 months post-transplantation: verbal memory (Auditory-Verbal Learning Test, digit span forward), visual memory (Corsi Block-Tapping Test forward, Benton Visual Retention Test), concentration/speed of processing/attention (D2 Test of Attention, Trail Making Test (TMT) A, Grooved Pegboard), and executive functioning (TMT B, Stroop Color-Word Test, semantic and phonematic verbal fluency, digit span backward, Corsi Block-Tapping Test backward). Mean scores were compared with a normative dataset using a one-sample t-test. A cognitive domain was judged impaired if the score on two or more domain-specific tests was greater than one standard deviation below the normative dataset age range mean. Of 124 lung transplant recipients (51% male, 54.3 ± 9.0 years), 70% showed cognitive impairment in one or more domains. Executive function was most often impaired (78% of recipients not within the age range) followed by verbal memory impairment (72% not within the age range). Cognitive function reductions were largely independent of age, gender, education, immunosuppressive medications, and time since transplantation. The findings show that cognitive impairment is common after lung transplantation and should be subject to rehabilitation and psychological resilience strategies.

Die Standardtherapie obstruktiver schlafbezogener Atmungsstorungen (oSBAS) ist die kontinuierliche Positivdruckatmung („continuous positive airway pressure“, CPAP, automatisches CPAP, APAP). Unterkieferprotrusionsschienen (UPS) konnen bei leichter bis mittelschwerer obstruktiver Schlafapnoe (AHI ≤ 30/h) alternativ zur CPAP/APAP-Therapie eingesetzt werden. Dies gilt insbesondere bei Patienten mit einem Body-Mass-Index unter 30 kg/m2 und lageabhangiger Schlafapnoe. Bei einem hoheren AHI bzw. einem hoheren BMI konnen Unterkieferprotrusionsschienen erwogen werden, falls die Positivdrucktherapie trotz Ausschopfung aller unterstutzenden Masnahmen nicht eingesetzt werden kann. Wahrend die CPAP-Therapie durch den Schlafmediziner in der Regel unmittelbar nach Diagnosestellung eingeleitet wird, werden UPS durch einen schlafmedizinisch qualifizierten Zahnarzt/Kieferorthopaden in einem zeitlich, ortlich und personell abgegrenzten Umfeld angefertigt. Obwohl die Indikationen fur UPS in der Behandlung der oSBAS mittlerweile klar definiert sind, gibt es bisher keine detaillierten und konsentierten Handlungsempfehlungen fur die Kooperation zwischen Schlaf- und Zahnmedizinern in dieser Situation. Das Ziel dieses Konsensuspapiers ist es daher, Grundlagen fur eine interdisziplinare Zusammenarbeit zunachst in Nordrhein-Westfalen/Deutschland zu schaffen.

Das Antibiotikum Nitrofurantoin wird zur Therapie von Patienten mit unkompliziertem Harnwegsinfekt eingesetzt. Ein 75-jahriger Mann mit persistierender Infektion nahm es einen Monat ein und entwickelte eine Belastungsdyspnoe, weshalb er beim Pneumologen vorstellig wurde.

Der 54-jahrige Heinz D. stellt sich mit wiederholt von seiner Ehefrau gemessenen erhohten Blutdruckwerten vor. Bei naherem Nachfragen berichtet er, dass er in letzter Zeit auch zunehmend mude sei und manchmal auch ungewollt spontan einschlafe.

Die Koinzidenz von Schwangerschaft und obstruktivem Schlafapnoe-Syndrom (OSAS) scheint im Hinblick auf Schwangerschaftskomplikationen sowohl für die Schwangere als auch das Ungeborene ein gesundheitliches Risiko darzustellen. Dieser potenziellen Koinzidenz müssen nicht nur Schlafmediziner, sondern auch insbesondere Gynäkologen zunehmend Beachtung schenken.

Schlafbezogene Atmungsstorungen (SBAS) sind vielfaltige im Schlaf auftretende Storungen der Atmung. SBAS fuhren uber einen gestorten Schlaf sowie durch komplexe Kreislaufreaktionen zu Folgeerscheinungen wie vermehrte Tagesschlafrigkeit und gesteigerte Morbiditat und Mortalitat. Das obstruktive Schlafapnoe-Syndrom (OSAS) stellt hierbei eine der wichtigsten SBAS dar. Durch adaquate Therapie des OSAS mittels CPAP-Therapie werden die Tagesmudigkeit und Tagesschlafrigkeit und in der Folge das Unfallrisiko sowie die kardiovaskulare Mortalitat der Patienten signifikant gesenkt.

The prevalence of sleep-disordered breathing (SDB) after lung transplantation (LTX) is high. It is well-established that SDB is associated with decreased health-related quality of life (HRQoL), but the impact of SDB on exercise capacity is less clear. In this study we investigated HRQoL and exercise capacity in LTX recipients with or without SDB. In addition, we also investigated associations between sleep parameters and both HRQoL and exercise capacity. There were 53 stable LTX recipients (age 18 years, 31 males, time from LTX 9-120 months) enrolled into the study. They all underwent polysomnography examination. HRQoL was assessed using the Short Form-36 (SF-36). Exercise capacity was measured using the 6-min walk test and cardiopulmonary exercise testing (CPET). We found inverse correlations between severity of SDB and both the predicted maximal workload (r = 0.24, p = 0.04) and maximal oxygen uptake (r = -0.26, p = 0.03) during CPET. Relative oxygen uptake positively correlated with sleep efficiency (r = 0.27, p = 0.03). SF-36 scores did not differ between patients with and without SDB, and were not significantly associated with SDB parameters. In conclusion, the presence of SDB is associated with a slight reduction in maximal exercise capacity in LTX recipients, and there is no appreciable relationship between SDB and HRQoL.

The prevalence of sleep-disordered breathing (SDB) after lung transplantation (LTX) is high. It is well-established that SDB is associated with decreased health-related quality of life (HRQoL), but the impact of SDB on exercise capacity is less clear. In this study we investigated HRQoL and exercise capacity in LTX recipients with or without SDB. In addition, we also investigated associations between sleep parameters and both HRQoL and exercise capacity. There were 53 stable LTX recipients (age > 18 years, 31 males, time from LTX 9–120 months) enrolled into the study. They all underwent polysomnography examination. HRQoL was assessed using the Short Form-36 (SF-36). Exercise capacity was measured using the 6-min walk test and cardiopulmonary exercise testing (CPET). We found inverse correlations between severity of SDB and both the predicted maximal workload (r = 0.24, p = 0.04) and maximal oxygen uptake (r = −0.26, p = 0.03) during CPET. Relative oxygen uptake positively correlated with sleep efficiency (r = 0.27, p = 0.03). SF-36 scores did not differ between patients with and without SDB, and were not significantly associated with SDB parameters. In conclusion, the presence of SDB is associated with a slight reduction in maximal exercise capacity in LTX recipients, and there is no appreciable relationship between SDB and HRQoL.

The extracapsular tumor extension (ECE) of nodal metastasis is an important prognostic factor in different types of malignancies. However, there is a lack of recent data in patients with non-small-cell lung cancer (NSCLC). In addition, the TNM staging system does not include ECE status as a prognostic factor. This systematic review and meta-analysis has been conducted to summarize and pool existing data to determine the prognostic role of ECE in patients with lymph node-positive NSCLC. Two authors performed an independent search in PubMed using a predefined keyword list, without language restrictions with publication date since 1990. Prospective or retrospective studies reporting data on prognostic parameters in subjects with NSCLC with positive ECE or with only intracapsular lymph node metastasis were retrieved. Data were summarized using risk ratios (RR) for the survival with 95% confidence intervals (CI). The data was analyzed using Mix 2 (ref: Bax L: MIX 2.0 - Professional software for meta-analysis in Excel. Version 2.015. BiostatXL, 2016. https://www.meta-analysis-made-easy.com ). There 2,105 studies were reviewed. Five studies covering a total of 828 subjects met the inclusion criteria and were included in the meta-analysis. Two hundred and ninety-eight (35.9%) patients were categorized as ECE+, of whom 54 (18.1%) survived at the end of follow-up. In the ECE-negative group, 257 patients (48.4%) survived by the end of follow-up. Thus, ECE status is associated with a significantly decreased survival rate: pooled RR 0.45 (95% CI 0.35-0.59), Q

The extracapsular tumor extension (ECE) of nodal metastasis is an important prognostic factor in different types of malignancies. However, there is a lack of recent data in patients with non-small-cell lung cancer (NSCLC). In addition, the TNM staging system does not include ECE status as a prognostic factor. This systematic review and meta-analysis has been conducted to summarize and pool existing data to determine the prognostic role of ECE in patients with lymph node-positive NSCLC. Two authors performed an independent search in PubMed using a predefined keyword list, without language restrictions with publication date since 1990. Prospective or retrospective studies reporting data on prognostic parameters in subjects with NSCLC with positive ECE or with only intracapsular lymph node metastasis were retrieved. Data were summarized using risk ratios (RR) for the survival with 95% confidence intervals (CI). The data was analyzed using Mix 2 (ref: Bax L: MIX 2.0 – Professional software for meta-analysis in Excel. Version 2.015. BiostatXL, 2016. https://www.meta-analysis-made-easy.com). There 2,105 studies were reviewed. Five studies covering a total of 828 subjects met the inclusion criteria and were included in the meta-analysis. Two hundred and ninety-eight (35.9%) patients were categorized as ECE+, of whom 54 (18.1%) survived at the end of follow-up. In the ECE-negative group, 257 patients (48.4%) survived by the end of follow-up. Thus, ECE status is associated with a significantly decreased survival rate: pooled RR 0.45 (95% CI 0.35–0.59), Q(4) = 4.06, Pvalue = 0.39, and I2 = 68.00% (95 CI 0.00–79.55%). In conclusion, ECE has a significant impact on survival in NSCLC patients and should be considered in diagnostic and therapeutic decisions in addition to the current TNM staging. Postoperative radiotherapy may be an option in ECE-positive pN1 NSCLC patients.

Chronic kidney disease (CKD) often accompanies obstructive sleep apnea (OSA). A causative connection of the two disease entities is uncertain. However, eliminating OSA improves the prognosis of CKD patients. In the present study we examined a possible relationship between OSA and CKD, and whether there would be a mutual enhancing interaction in the severity of the two diseases. The study was of a retrospective nature and encompassed 382 patients over the period of 1 January 2014-30 June 2015. The OSA diagnosis was supported by a polysomnographic examination in 363 (95.0%) patients. Blood samples were taken for the determination of kidney function indices. The influence on OSA and CKD of comorbidities also was examined. We found a high probability of a simultaneous occurrence of OSA and CKD; with the odds ratio of 3.94 (95% CI 1.5-10.3%; p = 0.005). The 363 patients with OSA were stratified into 73 (20.1%) mild, 98 (27.0%) moderate, and 192 (52.9%) severe OSA cases according to the apnea-hypopnea index. CKD was found in 43 (58.9%) patients with mild OSA, 73 (74.5%) with moderate OSA, and 137 (71.4%) with severe OSA. Most OSA patients also suffered from hypertension and obesity. For comparison, CKD was detected in 7 (36.8%) out of the 19 patients without OSA (p0.003). We conclude that CKD develops significantly more often in patients with OSA than in those without it, and CKD frequency increases with the severity of OSA.

Die Diagnostik und Therapie schlafbezogener Atmungsstorungen (SBAS) unterliegt wesentlichen Veranderungen sowohl in medizinisch-wissenschaftlicher Hinsicht als auch in Bezug auf die Versorgungssituation der Patienten und soziookonomische Aspekte. Die Relevanz der SBAS fur die Morbiditat und Mortalitat Betroffener ist neben der besseren Differenzierung und Phanotypisierung der Untertypen der SBAS Gegenstand intensiver Forschungsaktivitaten. Diese differenzierte Betrachtung verandert die Vorgehensweise beim Verdacht auf SBAS erheblich. Dem stehen Trends zur Simplifizierung des diagnostischen Prozederes und der Therapieeinleitung, der Verlagerung medizinischer Leistungen auf nicht-medizinisches Personal und Fragen der Kostenminimierung entgegen. In diesem Konsensuspapier werden daher vor dem Hintergrund der aktuellen Situation die Prinzipien der Diagnostik, Therapieeinleitung und Versorgung, sowie die Rolle der verschiedenen Beteiligten am Gesundheitssystem und die Bewertung der Therapieangebote vorgestellt. Zu den Kernstucken gehoren die Differenzierung der Diagnostik in Screening, Bestatigungsdiagnostik und Differenzialdiagnostik, der Zugang zum Patienten nach der Vortestwahrscheinlichkeit und ein therapeutischer Algorithmus.

Die Begriffe „Müdigkeit“ und „Schläfrigkeit“ werden teilweise synonym verwandt, unterscheiden sich jedoch aus schlafmedizinischer Sicht. Müdigkeit beschreibt einen Zustand der Erschöpfung und des Bedürfnisses nach Ruhe- und Erholung. Nicht selten ist Müdigkeit mit depressiven Störungen und Schwierigkeiten, im Schlaf Erholung zu finden, verbunden. Schläfrigkeit bedeutet die Unfähigkeit, sich unter reizarmen Bedingungen wachzuhalten, insbesondere zu den Zeiten der zirkadian-rhythmischen Leistungstiefs. „Sekundenschlaf“ ist häufig die Folge von Schläfrigkeit (1).

Schlafbezogene Hypoventilationen bei Patienten mit chronisch obstruktiver Lungenerkrankung („chronic obstructive pulmonary disease“, COPD) grunden auf einer Vielzahl sowohl biochemischer als auch mechanischer Faktoren, die beim Ubergang von Wach- zum Schlafstadium bzw. insbesondere im REM-Schlaf zum Tragen kommen. Hierbei seien insbesondere die schlafbezogenen Hypoventilationen genannt, die vor allem im REM-Schlaf auftreten und pathologische Sauerstoffentsattigungen sowie Anstiege des paCO2 zur Folge haben. Die Auswirkungen dieser nachtlichen Blutgasveranderungen sind zum Teil noch nicht hinreichend analysiert (z. B. pathologische CO2-Anstiege im Schlaf) bzw. in ihren Auswirkungen auf Hochdruckentstehung im kleinen Kreislauf oder gar Mortalitat bei nachtlichen Hypoxamien widerspruchlich, was moglicherweise fehlende Schweregraddefinitionen (z. B. nachtlicher paCO2) oder unterschiedliche Schweregraddefinitionen (z. B. fur nachtliche Sauerstoffentsattigungen) als Ursache hat. Hinzukommen sehr kurze Beobachtungszeitraume bei Fragestellungen um PAP-Entstehung bzw. Mortalitat. Therapie der Wahl nach Ausschopfung aller konservativen Methoden ist die Langzeitsauerstofftherapie bei uberwiegend pathologischen Sauerstoffentsattigungen. Bei Hinweisen auf eine Erschopfung der Atmungspumpe sollte die nichtinvasive Beatmungstherapie zum Tragen kommen.

Die obstruktive Schlafapnoe ist haufig mit verschiedenen, vor allem internistischen Erkrankungen assoziiert. Hierbei stehen Herz-Kreislauferkrankungen wie arterielle Hypertonie, koronare Herzkrankheit, Herzinsuffizienz, Herzrhythmusstorungen, pulmonale Hypertonie, Schlaganfall und auch metabolische Storungen wie der Diabetes mellitus ganz im Vordergrund. Hierdurch ist die Mortalitat von Schlafapnoe-Patienten gesteigert, andererseits sind Patienten mit Herz-Kreislauf-Erkrankungen und zusatzlicher Schlafapnoe besonders gefahrdet. In der internistischen Diagnostik und Therapie muss daher diese eng, z. T. kausal verknupfte Assoziation und Komorbiditat von Herz-Kreislauferkrankungen mit der Schlafapnoe unbedingt berucksichtigt werden, um die Prognose der Patienten zu verbessern.

Chronic kidney disease (CKD) often accompanies obstructive sleep apnea (OSA). A causative connection of the two disease entities is uncertain. However, eliminating OSA improves the prognosis of CKD patients. In the present study we examined a possible relationship between OSA and CKD, and whether there would be a mutual enhancing interaction in the severity of the two diseases. The study was of a retrospective nature and encompassed 382 patients over the period of 1 January 2014–30 June 2015. The OSA diagnosis was supported by a polysomnographic examination in 363 (95.0%) patients. Blood samples were taken for the determination of kidney function indices. The influence on OSA and CKD of comorbidities also was examined. We found a high probability of a simultaneous occurrence of OSA and CKD; with the odds ratio of 3.94 (95% CI 1.5–10.3%; p = 0.005). The 363 patients with OSA were stratified into 73 (20.1%) mild, 98 (27.0%) moderate, and 192 (52.9%) severe OSA cases according to the apnea-hypopnea index. CKD was found in 43 (58.9%) patients with mild OSA, 73 (74.5%) with moderate OSA, and 137 (71.4%) with severe OSA. Most OSA patients also suffered from hypertension and obesity. For comparison, CKD was detected in 7 (36.8%) out of the 19 patients without OSA (p < 0.003). We conclude that CKD develops significantly more often in patients with OSA than in those without it, and CKD frequency increases with the severity of OSA.

Bei der COPD steht im klinischen Alltag die Diagnostik und Therapie am Tag, sei es im Ruhe- und/oder Belastungszustand, ganz im Vordergrund unserer ärztlichen Bemühungen. Wir wissen aber auch, dass der COPD-Patient gerade in der Nachtphase und aus dem Schlaf heraus symptomatisch werden kann, z. B. mit Luftnot- oder Hustenanfällen sowie Ein- und Durchschlafstörungen. Dennoch ist der Schlaf bei COPD ein immer noch vernachlässigter Zeitraum im Management der Erkrankung. Die nachfolgende Übersicht soll daher versuchen, die klinisch relevanten Aspekte des Schlafs bei COPD näher zu beleuchten.

Malaria is an acute, life-threatening infectious disease that spreads in tropical and subtropical regions. Malaria is mainly brought over to Germany by travelers, so the disease can be overlooked due to its nonspecific symptoms and a lack of experience of attending physicians. The aim of this study was to analyze, retrospectively, epidemiological and clinical data from patients examined for malaria. Patient data were collected from hospital charts at the Department of Internal Medicine, Saarland University Medical Center, Germany, for the period of 2004-2012. The data of patients with and without malaria were compared in terms of their epidemiological, demographic, clinical, and medical treatment aspects. We identified found 15 patients with malaria (28.3 %, mean age 42.3 ± 16.5 years, three females [20 %]; 95 % confidence interval of 0.2-0.4) out of the 53 patients examined. Mainly locals brought malaria over to Homburg, Germany (p = 0.009). Malaria tropica was the most common species (p 0.0001). One patient (6.7 %) with malaria, who had recently traveled, had a mixed infection of Plasmodium falciparum and Plasmodium malariae (p = 0.670). Malaria is characterized by thrombocytopenia (p = 0.047) and elevated C-reactive protein (p = 0.019) in serum, and fever is the leading symptom (p = 0.031). In most cases, malaria was brought from Ghana (33.3 %). Further, patients had contracted malaria despite malaria prophylaxis (33.3 %, p = 0.670). In conclusion, malaria test should be used in patients with fever after a journey from Africa. Malaria caused by Plasmodium falciparum is the most common species of brought over malaria. Mixed-species Plasmodium falciparum and Plasmodium malariae are uncommon in travelers with malaria.

Cannabis is the most widely smoked illicit substance in the world. It can be smoked alone in its plant form, marijuana, but it can also be mixed with tobacco. The specific effects of smoking cannabis are difficult to assess accurately and to distinguish from the effects of tobacco; however its use may produce severe consequences. Cannabis smoke affects the lungs similarly to tobacco smoke, causing symptoms such as increased cough, sputum, and hyperinflation. It can also cause serious lung diseases with increasing years of use. Cannabis can weaken the immune system, leading to pneumonia. Smoking cannabis has been further linked with symptoms of chronic bronchitis. Heavy use of cannabis on its own can cause airway obstruction. Based on immuno-histopathological and epidemiological evidence, smoking cannabis poses a potential risk for developing lung cancer. At present, however, the association between smoking cannabis and the development of lung cancer is not decisive.

Background Many antibiotics have no effect on Gram-positive and Gram-negative microbes, which necessitates the prescription of broad-spectrum antimicrobial agents that can lead to increased risk of antibiotic resistance. These pathogens constitute a further threat because they are also resistant to numerous beta-lactam antibiotics, as well as other antibiotic groups. This study retrospectively investigates antimicrobial resistance in hospitalized patients suffering from pneumonia triggered by Gram-negative Serratia marcescens or Proteus mirabilis. Methods The demographic and clinical data analyzed in this study were obtained from the clinical databank of the HELIOS Clinic, Witten/Herdecke University, Wuppertal, Germany, for inpatients presenting with pneumonia triggered by S. marcescens or P. mirabilis from 2004 to 2014. An antibiogram was conducted for the antibiotics utilized as part of the management of patients with pneumonia triggered by these two pathogens. Results Pneumonia was caused by Gram-negative bacteria in 115 patients during the study period from January 1, 2004, to August 12, 2014. Of these, 43 (37.4 %) hospitalized patients [26 males (60.5 %, 95 % CI 45.9 %–75.1 %) and 17 females (39.5 %, 95 % CI 24.9 %–54.1 %)] with mean age of 66.2 ± 13.4 years had pneumonia triggered by S. marcescens, while 20 (17.4 %) patients [14 males (70 %, 95 % CI 49.9 %–90.1 %) and 6 females (30 %, 95 % CI 9.9 %–50.1 %)] with a mean age of 64.6 ± 12.8 years had pneumonia caused by P. mirabilis. S. marcescens showed an increased antibiotic resistance to ampicillin (100 %), ampicillin-sulbactam (100 %), and cefuroxime (100 %). P. mirabilis had a high resistance to tetracycline (100 %) and ampicillin (55 %). S. marcescens (P

Auch wenn die Pravalenz der schlafbezogenen Atmungsstorungen (SBAS) mit zunehmendem Alter ansteigt, ist nach wie vor unklar, ob es sich hierbei um ein altersabhangiges oder altersassoziiertes Phanomen handelt. Unter der Annahme, dass es sich um eine altersabhangige Erkrankung handelt, erwachst die Forderung nach einer genauso konsequenten Diagnostik und Therapie wie auch im jungeren Lebensalter. Die Indikation fur die Einleitung einer Therapie ergibt sich aus der Einschrankung des Patienten insbesondere im Hinblick auf seine kognitive Tagesleistungsfahigkeit. Unabhangig vom Alter sollte in diesen Fallen ein CPAP-Therapieversuch unternommen werden.

CPAP (continuous positive airway pressure) ist die Therapie der Wahl des obstruktiven Schlafapnoe-Syndroms (OSAS). Ca. 70 % der Patienten mit eingeleiteter CPAP-Therapie nutzen das Gerat dauerhaft wahrend 70 % der Nachte fur mindestens 4 Stunden pro Nacht. Im Vergleich zur objektiv uber Druckmesser registrierten Nutzungsdauer wird die subjektive Anwendungsdauer vom Patienten um ca. eine Stunde pro Nacht uberschatzt, dennoch betragt die objektive Nutzungsdauer mindestens 4 Stunden pro Nacht bei > 70 % der Patienten. Auch uber langere Nachbeobachtungszeitraume lassen sich Nutzungsdauern von uber 5 Stunden pro Nacht bei uber 60 % der Patienten feststellen. Pradiktoren fur eine gute CPAP-Langzeitcompliance sind der Schweregrad der Atmungsstorung bzw. der Storung der Schlafarchitektur, der Auspragungsgrad der Tagesschlafrigkeit sowie die Patientenzufriedenheit mit dem diagnostischen und therapeutischen Procedere. Eine Steigerung der CPAP-Compliance ist durch intensive Patientenschulung zu erzielen

BACKGROUND: In patients with COPD and isolated night time hypoxemia, oxygen administration has not shown any effects on life expectancy and the development of pulmonal arterial hypertension. The aim of the present pilot study was to investigate the influence of nocturnal oxygen therapy on the quality of life in daytime normoxemic COPD patients with nocturnal oxygen desaturations. PATIENTS AND METHODS: 19 patients with COPD, in a stable phase of the disease without need for oxygen supplementation under rest (PaO 2 62.7 ± 4.9 mm Hg) and nocturnal hypoxemia (t 90 = 55.5 ± 33.4 % of registration time, mean SaO 2 89.8 ± 1.9 %, minimal SaO 2 81.1 ± 4.8 %) were randomly assigned to either oxygen or placebo treatment, both generated by identical concentrator devices. Each treatment period lasted 6 weeks, after six weeks a cross-over was performed by a technician. Quality of life was assessed before and at the end of each treatment period by the SF-36, Nottingham Health Profile and Saint George’s Respiratory Questionnaire. RESULTS: Significant differences for the comparison of placebo and verum were only seen for the dimension sleep (NHP), all other dimensions showed no differences between placebo and oxygen. However, both placebo and oxygen improved the majority of the quality of life items significantly. CONCLUSIONS: The prescription of supplemental oxygen in COPD patients with isolated nocturnal hypoxemia in the present pilot study is not able to improve the quality of life within 6 weeks after initiation of therapy. It cannot, therefore, be generally recommended, but may be indicated in patients with a documented improvement of sleep quality.