Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery

Background. Roux-en-Y gastric bypass (RYGB) can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration

The Relationship Among Morningness-Eveningness, Sleep Duration, Social Jetlag, and Body Mass Index in Asian Patients With Prediabetes

Background: Circadian system is known to influence energy metabolism. Recent evidence suggested that evening preference could be associated with higher body mass index (BMI). Moreover, evening preference is known to be associated with insufficient sleep duration and greater social jetlag, both described to be associated with obesity. This study aimed to explore whether morningness-eveningness was directly associated with BMI or its effect was transmitted through sleep duration or social jetlag in patients with prediabetes.Methods: A total 2,133 patients with prediabetes were enrolled. Morningness-eveningness was assessed using a Composite Scale of Morningness (CSM). Average weekly sleep duration and sleep timing were obtained, and social jetlag was calculated. BMI was calculated by weight (kg)/height2 (m2). A mediation analysis was performed based on two pathways, i.e. CSM→sleep→duration→BMI and CSM→social jetlag→BMI. A sequential equation model was used to estimate the direct and indirect effects of CSM on BMI.Results: Mean (SD) age and BMI were 63.6 (9.2) years and 25.8 (4.0) kg/m2. For CSM→sleep duration→BMI pathway, every one point decrease in CSM (more evening preference) was associated with a decrease in sleep duration by 0.054 h (95% CI 0.043–0.066), whereas sleep duration was negatively associated with BMI (coefficient = −0.156, 95%CI −0.288, −0.024). Mediation analysis indicated that a change in CSM (from 90th to 10th percentile, more evening preference) was associated with a decrease in sleep duration and an increase in BMI by 0.102 kg/m2 (95% CI 0.015, 0.207). In addition, this change in CSM was directly associated with an increase in BMI by 0.511 kg/m2 (95%CI 0.030, 0.952). The CSM→social jetlag→BMI pathway analysis revealed that social jetlag was not significantly associated with BMI. A subgroup analysis in those aged ≤60 years (n = 784) revealed that each hour increase in social jetlag was associated with an increase in BMI by 0.56 kg/m2 (p = 0.026) while CSM and sleep duration were not.Conclusion: In patients with prediabetes, more evening preference was directly associated with higher BMI and indirectly through insufficient sleep duration, while social jetlag did not mediate the relationship between CSM and BMI. In those ≤60 years, only greater social jetlag was associated with higher BMI. These data could inform further interventional studies to reduce BMI in this high risk group

The Relationship between Diabetes-Related Complications and Obstructive Sleep Apnea in Type 2 Diabetes

This study explored the relationship between obstructive sleep apnea (OSA) and the presence of any diabetes-related complications in type 2 diabetes and whether this was mediated by hypertension. Secondly, the relationship between OSA severity and estimated glomerular filtration rate (eGFR) was investigated. A total of 131 patients participated. OSA was diagnosed using a home monitor, and severity was measured by apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). OSA was found in 75.6% of the participants, 40.5% with moderate-to-severe degree. Any diabetes-related complications (retinopathy, neuropathy, nephropathy, or coronary artery disease) were present in 55.5%, and 70.2% of the participants had hypertension. Mediation analysis indicated that, compared to those with mild or no OSA, those with moderate-to-severe OSA were 3.05 times more likely to have any diabetes-related complications and that this relationship was mediated by the presence of hypertension. After adjusting for confounders, ODI (B = −0.036, p=0.041), but not AHI, was significantly associated with lower eGFR. In conclusion, moderate-to-severe OSA was related to the presence of any diabetes-related complications in type 2 diabetes, and the relationship was mediated by hypertension. The severity of intermittent hypoxia was associated with lower eGFR. Whether OSA treatment will delay or reduce diabetes-related complications should be investigated

Sex-specific associations between self-reported sleep characteristics and 10-year cardiovascular disease risk in men and women of African descent living in a low socioeconomic status environment

BackgroundRisk factors for cardiovascular disease (CVD) and sleep health are well-known to be sex- and race-specific. To build on the established relationship between sleep duration and CVD risk, this cross-sectional study aimed to describe sex-specific associations between CVD risk and other sleep characteristics (sleep quality, sleep timing and sleep onset latency) in low-income adults of African descent.MethodsSelf-reported sleep (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]), demographic and lifestyle data were collected in 412 adults (56% women, 35.0±7.6y, 40% employed) living in an informal settlement in South Africa. CVD risk was determined using the BMI-modified Framingham 10-year CVD risk formula.ResultsLogistic regression analyses, adjusted for employment, alcohol use and physical activity, indicated that men reporting poor sleep quality (OR: 1.9[95%CI: 1.1-3.5],p=0.025) and earlier bedtimes (0.54[0.39-0.74],p&lt;0.001) were more likely to belong to a higher 10-year CVD risk score quintile. Women reporting earlier bedtimes (0.72[0.55-0.95],p=0.020) and wake-up times (0.30[0.1-0.7],p=0.007), longer sleep-onset latency (1.5[1.4-1.9],p=0.003), shorter total sleep times (0.84[0.7-0.9],p=0.029), higher PSQI global scores (1.9[1.3-2.9],p=0.001) and more moderate to severe symptoms of insomnia (ISI≥15)(3.24[1.04-10.04],p=0.016) were more likely to belong to higher 10-year CVD risk score quintile.ConclusionIn addition to sleep duration, we found that sleep quality, sleep timing and sleep onset latency are additional risk factors for CVD in adults of African descent. Sex-specific differences in the sleep-CVD-risk relationship observed suggests that future studies and recommendations about sleep health in relation to CVD should take sex into account.<br/

Associations between self-reported sleep duration and cardiometabolic risk factors in young African-origin adults from the five-country Modeling the Epidemiologic Transition Study (METS)

To investigate associations between self-reported sleep duration and cardiometabolic (CM) risk factors in African-origin adults residing in five countries spanning the epidemiologic transition. Cross-sectional. Ghanaian (n = 491), South African (n = 503), Jamaican (n = 508), Seychellois (n = 501) and American (n = 480) men and women. Self-reported sleep duration was obtained using questionnaires. Sex- and site-stratified logistic regression analyses investigated relationships between sleep duration, individual CM risk factors and a binary CM risk variable (presence of ≥3 CM risk factors), adjusting for age, physical activity and education. Sleep duration distributions varied by cohort: 44.5%, 41.4%, 35.9%, 16.8% and 2.5% of American, Jamaican, Seychellois, Ghanaian and South African men reported &lt;7 h sleep per night respectively (p &lt; 0.001). Similarly, 42.6%, 28.6%, 25.2%, 12.8% and 1.5% of American, Jamaican, Seychellois, Ghanaian and South African women reported &lt;7 h sleep respectively (p &lt; 0.001). American men reporting ≤6 h sleep were more likely to be in the elevated CM risk group (OR: 2.52, 95%CI: 1.02, 6.22, p = 0.045) and to have a high waist circumference (OR: 2.44, 95%CI: 1.07, 5.57, p = 0.034) compared to those reporting 8 h sleep. Jamaican women reporting ≤6 h sleep (OR: 2.53, 95%CI: 1.19, 5.36, p = 0.016) and American women reporting 7 h sleep (OR: 2.71, 95%CI: 1.17, 6.26, p = 0.002) were more likely to be obese than those reporting 8 h sleep. Associations between short sleep and CM risk factors were only evident in the American men and women and Jamaican women. Future interventions to address CM risk and sleep health may need to be country-specific when targeting high-risk populations

Associations between fears related to safety during sleep and self-reported sleep in men and women living in a low-socioeconomic status setting

South Africans living in low socioeconomic areas have self-reported unusually long sleep durations (approximately 9–10 h). One hypothesis is that these long durations may be a compensatory response to poor sleep quality as a result of stressful environments. This study aimed to investigate whether fear of not being safe during sleep is associated with markers of sleep quality or duration in men and women. South Africans (n = 411, 25–50 y, 57% women) of African-origin living in an urban township, characterised by high crime and poverty rates, participated in this study. Participants are part of a larger longitudinal cohort study: Modelling the Epidemiologic Transition Study (METS)–Microbiome. Customised questions were used to assess the presence or absence of fears related to feeling safe during sleep, and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index were used to assess daytime sleepiness, sleep quality and insomnia symptom severity respectively. Adjusted logistic regression models indicated that participants who reported fears related to safety during sleep were more likely to report poor sleep quality (PSQI &gt; 5) compared to participants not reporting such fears and that this relationship was stronger among men than women. This is one of the first studies outside American or European populations to suggest that poor quality sleep is associated with fear of personal safety in low-SES South African adults