A previously healthy 37-year-old man presented with a 2-week history of right upper quadrant pain, jaundice, dark urine, clay-colored stools, pruritis and nausea. Initial evaluation revealed elevated hepatic enzymes, bilirubin, and alkaline phosphatase, but negative hepatitis serologies and no evidence of gastrointestinal bleeding. Workup for vasculitis was negative. Initial abdominal ultrasound revealed a large aneurysm of the hepatic artery with elevation and compression of the common bile duct and porta hepatis. Computed tomographic angiography was performed, revealing multiple visceral aneurysms of the celiac, hepatic, superior mesenteric, and left renal arteries, the largest of which involved the common, proper, and Panel A right hepatic arteries, measuring 3.6 × 3.4 × 7.4 cm (Panels A and B; arrows).
Association of θavg with OAI and OAHI shows that θavg reflects airway obstruction and has potential use as a quantitative indicator of OSA. RIP provides valuable information that is readily available in PSG. The significant difference between θavg in stage N3 sleep and stage R sleep confirms the clinical observation that there is more asynchrony during rapid eye movement sleep than non-rapid eye movement sleep.
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