Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and onethird (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.
Background: Leptospirosis is an infectious disease caused by the spirochete of the genus leptospira. It is thought to be the most common zoonosis globally and has a wide range of clinical presentations with pulmonary hemorrhage being one of its most severe manifestations. This entity known as acute pulmonary syndrome carries a high fatality rate. However, it can be effectively managed with methylprednisolone therapy. Case: We report a case of leptospirosis in a 26-year-old Bangladeshi male who was otherwise healthy. He presented with a 7-day history of fever with chills and rigors, and hemoptysis for a duration of 2 days. Physical examination revealed a febrile and lethargic man. Respiratory examination exhibited bilateral generalized crepitations over the lung fields. A chest radiograph performed showed bilateral alveolar shadowing. The diagnosis of leptospirosis was made based on positive Immunoglobulin M enzyme-linked immunosorbent assay serology, which was then confirmed by the microscopic agglutination test for leptospirosis. The patient was commenced on intravenous antibiotics and methylprednisolone at this time. He responded well clinically with resolution of fever and hemoptysis and a marked decrease in crepitations upon auscultation. This correlated with radiological improvement evidence by an obvious reduction in alveolar shadowing on subsequent chest radiograph 2 days later. Conclusion: This case is highly pertinent to the medical field as leptospirosis is an ever-growing problem and acute pulmonary syndrome is an emerging manifestation of it. Therefore, early recognition and intervention is required as this can be effectively treated with methylprednisolone therapy even in resource-limited settings
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