Bi Level Research Articles

Opioid-associated central sleep apnea: a case series

Subjects on methadone maintenance for drug addiction have been reported to have central sleep apnea (CSA). However, there are few reports of disordered breathing in patients receiving opioids for chronic pain. We report on six patients (ages 41-68, two females, body mass index 27-34, morphine equivalent doses 120-420 mg/day, Epworth Scales 7-21) referred to our sleep center receiving sustained release opioids for more than 6 months with excessive daytime sleepiness. CSA was defined as apnea-hypopnea index (AHI) more than 5 per hour with > or =50% central events. Bilevel (BLV) titration was done to determine settings and all patients were followed for at least 6 months on nocturnal BLV. AHI ranged 28.4-106 per hour. Time less than 90% O(2) saturation ranged 1.8 min to 6.4 h. Four of the patients were treated with chronic BLV ventilation with settings ranging 12-16 cm H(2)O (inspiratory positive airway pressure)/4-8 cm H(2)O (expiratory positive airway pressure) with backup rate of 12-16. Among the four patients who used BLV treatment for at least 6 months, Epworth scores improved (by 4, 12, 5, and 9, respectively). Treatment of opioid-associated CSA with BLV corrected nocturnal hypoxemia and reduced sleep fragmentation. Randomized controlled trials, with objective measures of daytime function, are recommended in opioid-induced CSA patients.

後期高齢入所者における高齢者用栄養素補充飲料による栄養状態の改善効果

A liquid nutrient mixture especially rich in vitamin B1 was given for 8 weeks to 10 nursing home residents with poor nutritional status. The intake of trace minerals (zinc and copper) and water-soluble vitamins (B1 and B2) by these subjects had been much less than the RDA levels, although the energy intake was relatively adequate. Three of the 10 subjects showed hypoalbuminemia (serum albumin less than 3.5mg/dl), and six showed a low serum vitamin B1 level (less than 28ng/ml).The administration of the supplement did not affect the intake of the diet, but provided an increased intake of various nutrients, especially the water-soluble vitamins. The serum vitamin Bi level was increased to the standard level in all the 10 subjects after 4 weeks of administration. The three subjects with hypoalbuminemia showed an increased serum albumin concentration after 8 weeks. A body weight gain was also observed up to 8 weeks which disappeared when the administration was stopped. The administration of a supplement to provide energy, protein and water-soluble vitamins may be useful for improving the condition of elderly people with poor nutritional status.

Yrast states of neutron-richN=83nuclei from fission productγ-ray studies

Prompt $\ensuremath{\gamma}$-ray cascades in $N=83$ fission product nuclei near ${}^{132}$Sn have been studied at Eurogam II using a ${}^{248}$Cm source. Cross coincidences observed between $\ensuremath{\gamma}$ rays from complementary light and heavy fission fragments were vital for isotopic assignments. Yrast states in the $N=83$ isotones ${}^{134}$Sb, ${}^{135}$Te, and ${}^{136}$I are reported. The interpretation of the level schemes is based mainly on results of shell model calculations using empirical proton-proton interaction energies from ${}^{134}$Te, and proton-neutron interactions estimated from the well-known ${}^{210}$Bi level spectrum.