RESUMEN
Continuous positive airway pressure (CPAP) is a safe therapy for the management of obstructive sleep apnea (OSA). Complications such as sinus infection, bronchitis, ear pain, nasal congestion, and dryness of mucous membranes secondary to CPAP use have been reported. To follow, we describe a rare case of alternobaric vertigo secondary to CPAP therapy. To date, there has been only one reported case of hearing loss and vertigo during CPAP treatment with complete resolution of symptoms after cessation of PAP. However, re-challenging the patient with CPAP at gradual increments was never reported.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Apnea Obstructiva del Sueño/terapia , Vértigo/etiología , Presión de las Vías Aéreas Positiva Contínua/métodos , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Resultado del Tratamiento , Vértigo/prevención & controlRESUMEN
It is often assumed that the mutation rate is an evolutionarily optimized property of a taxon. The relevant mutation rate is for mutations that affect fitness, U, but the strength of selection on the mutation rate depends on the average effect of a mutation. Determination of U is complicated by the possibility that mutational effects depend on the particular environmental context in which the organism exists. It has been suggested that the effects of deleterious mutations are typically magnified in stressful environments, but most studies confound genotype with environment, so it is unclear to what extent environmental specificity of mutations is specific to a particular starting genotype. We report a study designed to separate effects of species, genotype, and environment on the degradation of fitness resulting from new mutations. Mutations accumulated for >200 generations at 20 degrees in two strains of two species of nematodes that differ in thermal sensitivity. Caenorhabditis briggsae and C. elegans have similar demography at 20 degrees, but C. elegans suffers markedly reduced fitness at 25 degrees. We find little evidence that mutational properties differ depending on environmental conditions and mutational correlations between environments are close to those expected if effects were identical in both environments.