Browsing by Author "Burgess, Lauren"
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Item Acute Effects of Obstructive Sleep Apnea on QT interval(2018-03-14) Davis, Tyler; Elias, Christopher; Burk, John; Smith, Michael; Burgess, LaurenOver 20 million people in the United States suffer from Obstructive Sleep Apnea (OSA). Compared to the general population, OSA patients are 2.6 times more likely to experience sudden cardiac death (SCD), and it is suspected that this is due, in part, to QT prolongation leading to fatal dysrhythmias. We recently showed that 20 min of simulated OSA in healthy young individuals caused significant increases in QTc, however, it is not known what effect actual OSA events have on QT interval and what factors influence these responses. Thus, the purpose of this study was to evaluate whether obstructive apneic events in OSA patients leads to QT prolongation compared to baseline. Methods: We determined QTc intervals (determined by Bazett’s formula) from the electrocardiograms of 14 patients undergoing polysomnography for diagnosis of OSA and titration of treatment with positive airway pressure. IRB approval was obtained for our protocol (UNTHSC #2018-019). Patients that were selected had an apnea hypopnea index >20/Hr and had no prior myocardial infarction or heart failure. Each patient’s ECG during their sleep study was analyzed to assess QT interval throughout the night. Baseline QT intervals were compared to QT intervals during obstructive apneas before midnight (Early) and apneas after midnight (Late), thus, representing those in which there were few prior apneas (Early) versus those with numerous prior apneas (Late). The QTc intervals were compared between baseline awake and baseline asleep, and between baseline and Late apneas. Statistical comparisons were made with paired t tests. Results: Baseline QTc intervals were not different between awake and sleep (p > 0.60); however, during apneas (whether Early or Late), the QTc intervals were significantly prolonged (p = 0.008). Conclusions: In conclusion, OSA is often associated with acute QTc prolongation with the magnitude ranging from 5-42 msec in this patient cohort. Further analyses will be performed to determine factors that affect the magnitude of QT prolongation accompanying apneas during the night. In addition, future studies will focus on QTc changes in OSA patients with prior heart disease, as these are the patients at greatest risk for developing serious arrhythmias during the night.Item Bilateral Pulmonary Embolism as Initial Presentation of Invasive Adenocarcinoma of the Colon(2019-03-05) Burgess, Lauren; Salas, Gabriel; Subramaniam, Smita; Gnasigamany, JasonBackground:Venous thromboembolism (VTE) is a frequently encountered diagnosis, and there are numerous genetic and acquired risk factors for this affliction. Thromboembolism due to hypercoagulability in cancer is well-known, and it is a common cause of death in these patients. Thrombosis represents the second most frequent cause of death in cancer patients, and cancer accounts for almost 20% of all VTE events. The highest incidence of VTE is in mucin-producing pancreatic, lung, and ovarian carcinomas. Although pulmonary embolism (PE) incidence in colon cancer is not as high as other malignancies, VTE may reflect more aggressive cancer and is a predictor of death within one year of diagnosis. In this report, we present a patient with syncope and anemia, a common scenario which uncovered the diagnosis of PE and subsequently colon adenocarcinoma. Case Information:A 43-year-old male presented with syncope, and had experienced fatigue, chest pain and dyspnea for a week. Aside from hypertension, there is no significant history. Vitals showed tachycardia, tachypnea and decreased oxygen saturation. Physical exam was unremarkable, and labs revealed severe microcytic anemia and a BNP of 2,285 ( Conclusions:Cancer patients treated with anticoagulation have lower mortality, and guidelines recommend low-molecular-weight heparin (LMWH) for cancer-associated thromboembolism. However, new evidence suggests that direct oral anticoagulants (DOACs) are reasonable alternatives. For our patient, we decided to give Apixaban for its ease of use over LMWH, and recent approval of DOACs is increasing the confidence regarding their safety. The unique aspects of this case involving anemia and bleeding risk with the need for anticoagulation raise the awareness of the varied co-existing disorders that can impact the diagnosis and treatment of cancer patients.Item Current Endeavors to Support the Homeless Population of Fort Worth(2017-03-14) Alavi, Michael; Burgess, Lauren; Dolan, Kathryn J.; Phillips, KaitlinPurpose: The aim of this research was to identify and explore current solutions in supporting the homeless population in Fort Worth, Texas, particularly through the services provided by local non-profit organizations. Methods: We identified the terms of eligibility, services provided, service access, and barriers to effective outreach provided by five local non-profit organizations, including John Peter Smith Health Network, Tarrant County Samaritan Housing, Arlington Life Shelter, Salvation Army DFW, and Union Gospel Mission of Tarrant County. Results/Conclusions: Frequent terms of eligibility include valid U.S. identification and proof of low-income or homeless status, and common service access methods include hospital referrals, word of mouth, and flyers in well-populated public areas. Services provided included shelter, aid in employment search, navigation to health services, and a variety of supportive services to integrate those who have been recently homeless into society. These organizations have encountered multiple barriers to effective outreach, such as client mental illness, client lack of appropriate paperwork, shortage of affordable housing, and transportation difficulties. Non-profit organizations in Fort Worth provide varying degrees of support for the homeless population and have identified areas for improvement that that citizens, volunteers, local government, and the organizations themselves can consider in broadening their outreach.Item Optimizing Treatment Success in Sleep Apnea(2018-03-14) Davis, Tyler; Burgess, Lauren; Burk, John; Smith, Michael; Elias, ChristopherAbstract Purpose: Obstructive Sleep Apnea (OSA) is an exceedingly common disorder in America with estimates of disease prevalence ranging from 3-7% of the entire population, and it is likely that this is a gross underestimation. OSA is considered a multifactorial disorder with a diverse range of influences including developmental, environmental, and genetic factors. The current gold standard of treatment is Positive Airway Pressure (PAP). PAP treatment, while proven to be effective, is heavily influenced by many patient features. As a result, treatment success of OSA is difficult to predict and current standards do not take all the critical factors into account. The purpose of this study was to determine which patient traits can be used to predict treatment success. Methods: We performed a retrospective analysis (IRB #2018-019) of de-identified patient data from sleep studies in 150 patients over time to calculate a newly developed Treatment Success Index (TSI). TSI is a novel measure that comprehensively measures patient treatment success by combining Apnea Hypopnea Index derived from the sleep data (AHI, a clinical measurement of disease severity) and specific measures of patient PAP compliance. We performed predictive statistical analyses to determine how several different parameters affected the calculated TSI. Results: A linear regression was performed between BMI and TSI, which revealed a significant increase in treatment success secondary to increasing patient BMI (p=0.00002). In addition, patients were divided into three groups based on their length of treatment (LoTx), and a linear regression between the group average LoTx’s and their respective TSI’s revealed significant results (p=0.003). Conclusions: These findings present new insights into factors that best predict treatment efficacy for OSA and may assist in optimizing patient treatment. Future studies will expand the scope of the utility of TSI as a new measure of treatment efficacy for OSA.Item Sex-related Effects on Treatment Success in Obstructive Sleep Apnea(2018-03-14) Elias, Christopher; Burgess, Lauren; Burk, John; Smith, Michael; Davis, TylerAbstract Purpose: Obstructive Sleep Apnea (OSA) has a high prevalence in adults in the US (over 20 million estimated diagnoses) for which the current gold standard treatment for OSA is Positive Airway Pressure (PAP). Current literature suggests a much higher occurrence in men than women and there appear to be sex-related disparities for treatment compliance as well. Current standards for treatment adequacy only require 4 hours/night and 5 days/week. We have developed a more rigorous Treatment Success Index (TSI) that combines key measures of PAP patient compliance and treatment efficacy. The purpose of this study was to determine whether there is a gender difference in TSI and, if so, what factors appear to contribute to these differences. Methods: Retrospective analyses of sleep data from 150 patients were performed (#2018-019) to assess sex-related differences in TSI and determine how several treatment parameters and demographic factors affect the TSI. Results: The findings revealed three main points. First, length of treatment versus TSI was significant for the males (P = 0.0307) but not the females (P = 0.0760). Second, age versus TSI was not significant for either gender (P [greater than] 0.05). Third, BMI versus TSI was significant for females (P = 0.0031) but not males (P = 0.1182). This suggests a longer treatment time in males and a higher baseline BMI in females are significant predictors of treatment success. Conclusions: These data further define sex-related distinctions in the treatment efficacy of OSA and should be considered when physicians consider the management of their patients with OSA. Further studies will focus on the effects these factors might have on clinical outcomes.Item The Effects of Obstructive Sleep Apnea on Cardiac Arrhythmia Risk(2020) Smith, Michael; Burk, John; Burgess, Lauren; Allen, Julie; Jouett, Noah; Biben, EmilyBackground: Over 20 million people in the United States suffer from Obstructive Sleep Apnea (OSA). Compared to the general population, OSA patients are 2.6 times more likely to experience sudden cardiac death (SCD), and it is suspected that this is due in part to QT prolongation leading to fatal dysrhythmias. We examined the factors that affect QT interval during periods of sleep apnea including OSA severity, time of night, and quantity of obstructive apneic events during sleep. Methods: We determined QTc intervals from the electrocardiograms of 41 patients undergoing polysomnography for diagnosis of OSA. Patients that were selected had an apnea hypopnea index >20/Hr and had no prior heart disease. Each patient's ECG during their sleep study was analyzed to assess QT interval throughout the night. Results: Early analyses of data showed that QTc intervals in early and late apneas were significantly prolonged compared to baseline. Patients with longer apneas tended to have greater increases in QTc. Furthermore, there were no significant differences in the prolongation of QTc between males and females. Conclusions: Sleep apneic events are associated with periods of mild QTc prolongation despite some cardiac cycle shortening. The prolongation tends to become enhanced later in the night, implying that there is a cumulative effect of numerous prior apneas. Future studies will focus on QTc changes in OSA patients with prior heart disease, as these are the patients at greatest risk for serious arrhythmias during the night.