Influenza Vaccine Connection to Narcolepsy Retracted


After further investigation, researchers at Stanford University are questioning a previously believed connection between H1N1 vaccine and narcolepsy. According to an article in by Emily Underwood, the connection theory emerged in 2009 when a small percentage of children in Europe who received the flu vaccine Pandemrix developed narcolepsy.


Last week, that promising explanation “was dealt a setback when prominent sleep scientist Emmanuel Mignot of Stanford University in Palo Alto, California, and colleagues retracted their influential study reporting a potential link between the H1N1 virus used to make the vaccine and narcolepsy.”


Some researchers were taken aback. “This was one of the most important pieces of work on narcolepsy that has come out,” says neuroimmunologist Lawrence Steinman, a close friend and colleague of Mignot’s, who is also at Stanford. The retraction, announced in Science Translational Medicine (STM), “really caught me by surprise,” he says in Others say that journal editors should have detected problems with the study’s methodology.


The work provided the first substantiation of an autoimmune mechanism for narcolepsy, which could explain the Pandemrix side effect, researchers say. “The vaccine, used only in Europe, seems to have triggered the disease in roughly one out of 15,000 children who received it,” writes Underwood. “The affected children carried a gene variant for a particular human leukocyte antigen (HLA) type—a molecule that presents foreign proteins to immune cells—considered necessary for developing narcolepsy.”


Had Mignot’s results held, “they could have led to the first proven example of a vaccine triggering an autoimmune response by mimicking the body’s own proteins,” says vaccinologist Hanna Nohynek, who is working with Vaarala at THL. The retraction “sets us back to kind of a zero point.”

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Link Between Sleep Deprivation and False Memories


Researchers at the University of California and Michigan State University found that sleep deprivation may actually create false memories. Physical disorders have long been linked to poor sleep, and the study titled “Sleep Deprivation and False Memories” published in Psychological Science builds on previous work that found a poor/false memory connection to sleep.


Previous studies on sleep deprivation have shown an association with various types of impaired cognitive functions and memory distortion regarding remembering things like lists of words. This study, however, showed memory distortion regarding real life events that involve people.


The experiment set up in the study was to test participants on their ability to recall information from crime photos. First, the subjects read narratives of eyewitness statements that were given in regard to a crime. The eyewitness statements provided different data compared to the information in the crime photos, which were subsequently shown to the participants in the study.


For example, a narrative might say that the thief put the stolen wallet in the pocket of his pants, but the photo would show the wallet was actually put in his jacket. The job of the subject was to accurately describe what was in the crime photo. One group of subjects was allowed to sleep during the night and another group of subjects had to stay up all night without sleeping. Also, subjects performed the memory task before sleeping for the night.


Previously, the researchers found that sleeping less than five hours at night was associated with false memory formation. The recently reported study was an extension of this previous study. In the recent study, the subjects that stayed up all night were significantly more likely to indicate that the details in the narratives were the same as in the crime photos, which was incorrect, rather than correctly indicating that the narrative contained information that was different from that in the photos.


Click Here for Abstract

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Drug Induced Sleep Endoscopy is Key Tool for Apnea Surgery


A study in Anesthesia & Analgesia (Safety and Efficacy of Drug-Induced Sleep Endoscopy Using a Probability Ramp Propofol Infusion System in Patients with Severe Obstructive Sleep Apnea) declares that Drug Induced Sleep Endoscopy (DISE) can help surgeons envision the mechanism of severe sleep apnea, which could be a significant aid prior to surgery.


Dr. Joshua H. Atkins and Dr. Jeff E. Mandel of the University of Pennsylvania and their colleagues have reportedly developed a new “ramp control” anesthetic technique for putting patients to sleep briefly—just enough to show the “obstructive anatomy” responsible for sleep apnea. The simplified technique requires no special expertise and limits drops in blood oxygen level during testing.


Researchers evaluated their anesthetic technique in 97 patients participating in a study of robot-assisted surgery for severe sleep apnea. Visualizing the site of the obstruction in the upper airway is an important part of planning for apnea surgery.


This can be done using a procedure called ‘drug-induced sleep endoscopy’ in which stepwise doses of anesthetic doses are given to put the patient to sleep and reproduce the airway obstruction causing apnea. However, it’s challenging to achieve just the right anesthetic dosage-enough to cause typical sleep-related obstruction without causing prolonged unconsciousness or causing a deep drop in blood oxygen level (oxygen saturation). The standard technique for DISE is time-consuming and not well-suited for widespread clinical use.


According to a report in News-Medical, the 97 patients studied had severe sleep apnea, with a median of 48 apnea-hypopnea events (complete or partial interruptions of breathing) per hour on standard testing in the sleep laboratory. The patients were being evaluated for surgery after receiving no benefit from continuous positive airway pressure (CPAP), the standard treatment for sleep apnea.


Click Here for Abstract

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Surgical Apnea Treatment Leads to Obesity?


A recent study found that overweight kids who had surgery were more likely to become obese within seven months. As reported, the study from Boston Children’s Hospital singled out tonsillectomies as particularly problematic, especially if children were already overweight.

“You can’t just treat the sleep apnea. You have to have nutrition and lifestyle counseling, too,” said lead researcher Dr. Eliot Katz, a respiratory disease specialist at Boston Children’s Hospital.


“Nutrition and exercise are just as important as treating the sleep apnea with a single procedure,” said Dr. Sangeeta Chakravorty, who co-directs the pediatric sleep evaluation center at Children’s Hospital of Pittsburgh, and was not involved in the study.


The new study in the August print issue of the journal Pediatrics, offers “certainty” that it’s actually an effect of the treatment, Katz said. “That’s because children in the study were randomly assigned to have surgery or to ‘watchful waiting’ putting off surgery and staying with other options, such as medications to better control any nasal allergies or asthma symptoms. “Altogether, 204 children aged 5 to 9 were assigned to have surgery right away, while 192 stuck with watchful waiting. Katz’s team found that over seven months, children who underwent surgery showed a quicker average weight gain, versus kids in the comparison group.


There are a few possible explanations for the post-surgery weight gain, according to Katz’s team. Calorie-burning may dip when children are no longer laboring to breathe during sleep. And some kids may burn fewer calories during the day because they become less active after their sleep apnea improves.


Source: Pediatrics

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ResMed Tussles with 3B Medical and Apex Medical


BMC Medical Co Ltd and 3B Medical Inc. launched a “global strategy” last week to “go on offense” and seek to invalidate portions of ResMed’s patent portfolio in China, Germany and the United States.


James Xu, president of BMC Medical, confirmed via press release that challenges to a large body of patents have already been filed simultaneously in all three countries, with trials concluded in both the United States and China. “We have a significant investment in research and development, but we believe that ResMed is misusing the patent system in an anti-competitive manner, and so we have to be proactive on the global landscape to assert our right to compete in this product space,” said Mr. Xu.


Meanwhile, ResMed won a permanent injunction in Germany against Taiwanese medical device manufacturer APEX Medical Corp prohibiting sales of infringing headgear used on APEX WiZARD 210 and 220 masks. According to a ResMed press release, the judgment was entered by the Regional District Court in Munich, is appealable, and applies throughout Germany.


The permanent injunction continues a preliminary injunction that was entered by the same court on Nov. 12, 2013. The court rejected APEX’s request to stay the injunction and its challenge to the validity of ResMed’s patent. The judgment also requires APEX to forfeit its inventory of infringing products, to report on its sales of the infringing products, and to pay damages to ResMed.

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Good Start and Reinforcement Necessary for CPAP Compliance


If CPAP therapy starts well, it tends to go well. Researchers essentially confirmed this truism, while also adding that it is necessary to “maintain reinforcing interventions over time” to boost the chances of long term compliance.


The study “Usefulness of reinforcing interventions on continuous positive airway pressure compliance” from Italian researchers followed 40 patients with OSA undergoing counseling and a one-year follow-up on a quarterly basis. Twenty subjects (intervention group) underwent reinforcing interventions with telephone interviews in the first month of therapy, and twenty (control group) remained without reinforcing interventions. The two populations were homogeneous for age, severity of illness and BMI.


“During the first month, intervention group patients showed a higher number of nights with a device use ≥4 hours. Average treatment adherence in the first month (days of therapy with at least 4 hours per night on the total number of days from device delivery) was 77.5% in the intervention group and 55.7% in the control group (p=0.022),” wrote researchers. “At one year the differences between the two groups were not significant.”


Researchers concluded: “Our findings suggest that it is important that adequate time and effort is spent to ensure patient comfort at the time of CPAP therapy start to optimize acceptance and adherence to treatment, and suggest that it is necessary to maintain reinforcing interventions over time. Although we can measure side effects and improve re-attendance, more work is necessary to tailor interventions for early identification of poor users, and especially to look out for patients who do not re-attend at all.

Our experience has confirmed the benefit of a medical, motivational and technical support in the first month. However it was not effective in the long term, suggesting that patients treated with CPAP need to maintain a reinforcement beyond the first month of therapy.”


Click Here to Read Full Article


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Night Owls at a Disadvantage?


If you are Bono or Mick Jagger, the tendency to be a “night owl” may be a distinct advantage, at least in the world of rock and roll. Unfortunately for most night owls, the real world demands a 9 to 5 existence.

Recent research from the University of Barcelona confirms that night owls have it tougher in the working world.

The study compared “morning people,” those early birds who like to get up at dawn, and “evening people,” night owls who prefer to stay up late and sleep in. Among the differences they found is that morning people tend to be more persistent. Morning types are also more resistant to fatigue, frustration and difficulties, which often translates into lower levels of anxiety and lower rates of depression, higher life satisfaction and less likelihood of substance abuse.


On the other hand, “evening people tend to be more extravagant, temperamental, impulsive and novelty- seeking, “with a higher tendency to explore the unknown.” They are more likely to suffer from insomnia and ADHD. They also appear to be more likely to develop addictive behaviors, mental disorders and antisocial tendencies, and even to attempt suicide.”


In the study, researchers reportedly looked at the lifestyles and personality traits of 700 Spanish psychology students from two universities. The subjects ranged in age from 18 to 32 and included slightly more women than men. So where do these differences between night owls and early birds stem from? There are two possible explanations, the researchers said.


“One is that people’s genes play a role in determining their circadian rhythm — the inner clock that regulates sleep and other physiological processes,” said study author Ana Adan at the University of Barcelona. “Several studies have linked different circadian rhythm genes with the development of mood disorders, schizophrenia and drug consumption.”


Click Here for Abstract

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Stroke, Diabetes, High Blood Pressure – Evidence Continues to Mount


The question may yet become, what is not affected by poor sleep? The latest research from the University of Alabama at Birmingham, is yet another reminder that people who get less than six hours’ sleep in the night are at a higher risk of suffering from a stroke, developing type 2 diabetes and high blood pressure.


According to Dr. Phyllis C. Zee, associate director for Sleep & Circadian Biology at the Northwestern University School of Medicine, sleeping less or severe sleep deprivation can raise the risk of stroke, simply because it causes changes in the autonomic functions of the body, including blood pressure, heart rate, inflammation and glucose levels. “It not only affects the blood vessels to the heart and body, but also to the brain,” says Zee.


According to an article by Smitha Nambiar, those who get less than seven hours of sleep per day are found to be uncoordinated, with slower reaction times, bad moods and bad interpersonal skills.


Researcher Megan Ruiter, who led the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study at the University of Alabama at Birmingham, reviewed data collected from approximately 30,239 people participating in the study to assess the effect of sleep deprivation on people.


“The research was sponsored by the National Institutes of Health,” writes Nambiar. “The study revealed that normal people with a body mass index of 18.5 to nearly 25, and getting less than six hours of sleep every night were at nearly  4.5 times at a higher risk of developing stroke symptoms than whose who slept seven and eight hours a night.”


Source: University of Alabama at Birmingham


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CDC Uses “Public Epidemic” Phrase to Describe National Sleep Problems


The Centers for Disease Control and Prevention says insufficient sleep is a public epidemic with roughly 20% of Americans possibly suffering from excessive sleepiness.


As quoted in Fox News NY and elsewhere, Dr. David Rapapport, director of NYU’s Sleep Medicine Program, says sleep deprivation carries a steep price when it comes to our brain function, our waist lines and so much more. “Sleep affects everything, it affects every system in the body, every organ in the body,” he says. “There are these studies that are now appearing that suggest that sleep behavior influences your tendency towards dementia.”


As for the digital age, it has done little to help with slumber. ”We are walking around with all of these electronic devices getting all this extra bright light exposure that we did not evolve with,” says Anne Mooney, assistant professor of Medicine in an article by Stacy Delikat. “That blue glow coming from our phones and tablets is tricking our brains. It has significant impact on our brain’s melatonin secretion patterns, which then regulate our circadian rhythms and our ability to fall asleep.”


In recognition of the importance of sleep to the nation’s health, CDC surveillance of sleep-related behaviors has increased in recent years. Additionally, the Institute of Medicine encouraged collaboration between CDC and the National Center on Sleep Disorders Research to support development and expansion of adequate surveillance of the U.S. population’s sleep patterns and associated outcomes.

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Sleepless and Forgetful? A Connection May Exist


Research findings published in Psychological Science suggest that sleep deprivation may increase susceptibility to false memories. According to a report in the University Herald, researchers found that sleep-deprived people who viewed photographs of a crime being committed, and then read false information about the photos were more likely to report remembering the false details in the photos than were those who got a full night’s sleep.


Researcher Steve Frenda noticed a gap in the literature when it came to sleep and memory. “Over the years I noticed that whenever I had a bad night’s sleep, my perception and memory seemed to get fuzzy until I had a good recovery sleep,” Frenda said in the Herald. “I was surprised to find that there were so few empirical studies connecting sleep deprivation with memory distortion in an eyewitness context. The studies that do exist look mostly at sleep deprived people’s ability to accurately remember lists of words-not real people, places and events.”


A preliminary study conducted by Frenda and colleagues suggested that getting 5 hours of sleep or less was associated with the formation of false memories. The researchers then designed an experiment to investigate whether pulling an all-nighter would increase the likelihood of forming false memories.


According Baulkman, researchers recruited more than 100 college-age participants and assigned them to one of four groups. Two groups were presented with a series of photos depicting a crime being committed as soon as they arrived to the lab – one group was then allowed to go to sleep, while the other group had to stay awake all night in the lab. The remaining two groups did things in the reverse order—they either slept or stayed awake all night and then viewed the crime photos in the morning.


“In the second part of the experiment, the participants read narratives containing statements that contradicted what the photographs actually showed,” writes Baulkman. “The researchers found that only those students who had been sleep deprived for all parts of the experiment – that is, they viewed the photos, read the narratives, and took the memory test after having stayed up all night – were more likely to report the false details from the text narrative as having been  present in the crime photos. The students who viewed the photos before staying up all night, however, were no more susceptible to false memories than the students who’d been allowed to sleep.”


Source: Psychological Science Journal

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