The Relationship between Obstructive Sleep Apnea and Asthma

 

Is there a statistical relationship of consequence between obstructive sleep apnea (OSA) and asthma patients? How does OSA impact patients with difficult-to-treat asthma (DTA)?

 

Airway obstruction is a common pathophysiology signature of both obstructive sleep apnea (OSA) and asthma. OSA is known to occur more commonly in asthma patients than in the general population. It has also been shown that asthma symptoms can be improved after initiating continuous positive airway pressure (CPAP). An awareness of this determinant of asthma control could thus help achieve critical disease management.

 

Guven SF, Dursun AB, Ciftci B, Erkekol FO, Kurt OK conducted a study among 47 DTA patients to evaluate the presence of OSA and their sleep quality. The Sleep Questionnaire, the Epworth Sleepiness Scale and overnight polysomnography were the three components of this study. The demographic and asthma severity assessments included (a) age at diagnosis, (b) duration of illness (c) smoking and atopy status, (d) results of pulmonary function tests, (e) number of asthma control medications used, and (f) number of hospitalizations and emergency room visits due to asthma and analgesic hypersensitivity according to apnea–hypopnea index (AHI) scores.

 

The study showed a remarkably high prevalence of OSA in DTA. No statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, but there were enough deductions to recommend that all DTA patients be assessed for OSA.

 

 

For the link to the full article, click on

http://apjai.digitaljournals.org/index.php/apjai/article/viewFile/1412/1149

The post The Relationship between Obstructive Sleep Apnea and Asthma appeared first on Sleep Diagnosis and Therapy.

The Relationship between Obstructive Sleep Apnea and Asthma

 

Is there a statistical relationship of consequence between obstructive sleep apnea (OSA) and asthma patients? How does OSA impact patients with difficult-to-treat asthma (DTA)?

 

Airway obstruction is a common pathophysiology signature of both obstructive sleep apnea (OSA) and asthma. OSA is known to occur more commonly in asthma patients than in the general population. It has also been shown that asthma symptoms can be improved after initiating continuous positive airway pressure (CPAP). An awareness of this determinant of asthma control could thus help achieve critical disease management.

 

Guven SF, Dursun AB, Ciftci B, Erkekol FO, Kurt OK conducted a study among 47 DTA patients to evaluate the presence of OSA and their sleep quality. The Sleep Questionnaire, the Epworth Sleepiness Scale and overnight polysomnography were the three components of this study. The demographic and asthma severity assessments included (a) age at diagnosis, (b) duration of illness (c) smoking and atopy status, (d) results of pulmonary function tests, (e) number of asthma control medications used, and (f) number of hospitalizations and emergency room visits due to asthma and analgesic hypersensitivity according to apnea–hypopnea index (AHI) scores.

 

The study showed a remarkably high prevalence of OSA in DTA. No statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, but there were enough deductions to recommend that all DTA patients be assessed for OSA.

 

 

For the link to the full article, click on

http://apjai.digitaljournals.org/index.php/apjai/article/viewFile/1412/1149

The post The Relationship between Obstructive Sleep Apnea and Asthma appeared first on Sleep Diagnosis and Therapy.

‘Catch-up’ Option for Lost Sleep in Teenagers a Myth

 

Can teenagers really catch up on the sleep they lose out on school days by   sleeping late on weekends? “NO’ is the firm answer.

 

A 2006 National Sleep Foundation poll showed that less than 20 percent of them actually get the required sleep of eight and a half to nine and a half hours of sleep on school nights. It is even worse today, shows a study in Fairfax, VA. Only 6 percent of children in the 10th grade and only 3 percent in the 12th grade get the recommended amount of sleep. Two in three teens were found to be severely sleep-deprived, losing two or more hours of sleep every night.

 

The reasons? Biological. Behavioral. Environmental. And yes, the invasion of personal electronics.

 

The impact? The American Academy of Pediatrics’ assessment is profoundly alarming. High blood pressure. Type 2 diabetes. Obesity. Depression. Suicidal ideation. Risk-taking behavior. In short, they say, lack of sleep can be fatal.

 

School start times are coming under the microscope. Kyla Wahlstrom’s study of 9,000 students in eight Minnesota public high schools showed that starting school a half-hour later resulted in an hour’s more sleep a night and an increase in the students’ grade point averages and standardized test scores.

 

Problems lurk beyond the bedroom too. Overscheduled lives on account of sports, clubs, volunteer work and paid employment can cut seriously into the time needed for schoolwork leading to shorter nights. Also at risk are teenagers from low-income and minority families with overcrowding, excessive noise and safety concerns.

 

Compensating for sleep deprivation on weekends further compromises an adolescent’s sleep-wake cycle. It induces permanent jet lag and shifts their internal clock, making it even harder to get to sleep Sunday night and wake up on time for school Monday morning.

 

For the full article visit

http://well.blogs.nytimes.com/2014/10/20/sleep-for-teenagers/?_php=true&_type=blogs&_r=0

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Fatty Acids Equals Better Sleep Equals Better Health in Children?

 

Do long-chain omega-3 fatty acids such as docosahexaenoic acid (DHA) have a role to play in improving sleep among children? What is the relationship between blood fatty acid concentrations and subjective sleep?

 

A randomized controlled trial study of 395 healthy children aged 7–9 years from mainstream UK schools examined the association between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age-standardized parent questionnaire). The study titled “Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial” also explored whether a 16-week supplementation (600 mg day) with algal DHA versus placebo could improve children’s sleep in a subset of 362 children who were underperforming in reading. Plus, an objective assessment of sleep through actigraphy was also done in a randomly selected sample of 43 children.

 

Though not conclusive, the results seemed to lend credence to the suggestion that higher blood levels of DHA may relate to better child sleep (as rated by parents). Higher blood DHA status was associated significantly with better sleep among the children assessed even when controlled for demographic variables.

The pilot actigraphy subsample results indicated significant group differences post the DHA supplement. Sleep duration improved by 58 min in children receiving active treatment versus placebo. Higher sleep efficiency was also recorded in this group, with fewer and shorter night waking.

 

As the authors themselves concede, these findings should be interpreted with caution. The results are preliminary and the numbers of relationships tested do not lend themselves to statistically significant results. Yet, this study has strengths that merit further investigation to substantiate the findings. For one, its large, non-clinical sample of children is a fair representative of the general population of UK children aged 7–9 years. Secondly, the use of fingerstick blood samples is an objective measurement of blood fatty acid status. And thirdly, sleep assessment was done both subjectively and objectively.

 

The improvements in sleep found in this study could be clinically important and, if replicated, may be expected to lead to significant benefits in physical health, mood, behavior, cognition and academic performance in children.

 

For the full article click on

http://onlinelibrary.wiley.com/doi/10.1111/jsr.12135/full

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Daytime Sleepiness and Parkinson’s Disease – More than Meets the Eye

 

Daytime Sleepiness and Parkinson’s Disease: The Contribution of the Multiple Sleep Latency Test

What is the prevalence of excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) patients? What are the factors that influence their daytime sleep latency?

A recent analysis using studies from current literature reveals variables that need to be looked at more extensively.

 

Previous studies show broad agreement that DSL in PD patients may be influenced by three factors.

  1. It may be primary to the disease itself, due to loss of both dopaminergic and non-dopaminergic neurons that control of the sleep-wake cycle
  2. It may arise as secondary to nocturnal sleep deprivation from coexistent sleep disorders
  3. It may also be the result of daytime medications with sedative effect

 

A small size sample review of 23 studies from current literature was undertaken to study the major factors that influence EDS in PD patients. Multiple Sleep Latency Test (MSLT) was used for an objective assessment of sleepiness. Sleep-onset REM periods (SOREMPs) during naps were assessed and results were interpreted independent of external factors (such as self-perception of sleep).

 

Yet, all three factors that influence DSL in PD patients seemed to present contradictory data. It is possible that the variability of results may be due to the small sample size, and that neuropathological heterogeneity of the disease was not fully considered.

 

This underscores the need for a more specific and meticulous approach. Before carrying out longitudinal studies with significant samples, careful analysis should also be done by assigning a specific agent on the responsibility of EDS in PD patients.

 

For the complete article visit 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121261/

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End-to-end Integration of Sleep Therapy Data for Efficient Patient Care

 

Imagine a quick and easy way of integrating patients’ sleep and respiratory treatment data from their patient management platforms to home medical equipment (HME) and other health care providers’ systems. This would certainly enable timely and secure access to critical patient information.

 

The recently released ResMed Data Exchange program provides such an interface. This comprehensive suite of software and service solutions enables fast, secure and reliable access to integrated patient data in applications they already use every day, including billing and care management.

 

Diverse software environments have posed considerable challenges to healthcare organizations in providing effective and efficient care. With its suite of application program interfaces and integration tools ResMed believes its data exchange solution will pave the way to streamline workflows for seamless outcomes and improved care. ResMed will also provide a team of dedicated healthcare informatics solutions engineers to work directly with HMEs and partner providers during all phases of the integration process, from solution design to application certification and ongoing support.

 

Within the ResMed portfolio, it is an end-to-end solution. Its Data Exchange complements its Air Solutions suite of sleep-disordered breathing and respiratory care product line (this includes AirSense™ 10 and AirCurve™ 10 device series with built-in remote monitoring capabilities). Through remote monitoring, daily therapy information is delivered to ResMed’s U-Sleep and AirView patient management platforms, as well as to integrated third-party health care applications.

 

Source: ResMed

For more information on ResMed, visit

www.resmed.com

 

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Sleep Loss Affects Risk for Ulcerative Colitis

 

If overall mortality, cardiovascular disease and cancer were not enough risks associated with chronic sleep loss, you can now add ulcerative colitis to the list as well.

 

A new research study published in Clinical Gastroenterology and Hepatology, the journal of the American Gastroenterological Association, found individuals who lose out on the recommended seven to eight hours of sleep each night are more likely to develop this digestive disorder.

 

This study “Sleep Duration Affects Risk for Ulcerative Colitis: A Prospective Cohort Study” is based on an analysis of women enrolled in the Nurses’ Health Study (NHS) I since 1976 and NHS II since 1989. The findings linked sleep duration and risk of ulcerative colitis, independent of other risk factors.

 

It is not just too little sleep that causes trouble. Too much of it is an equally damaging culprit. Says noted lead researcher Ashwin N. Ananthakrishnan, M.D., of Massachusetts General Hospital, ““We found that less than six hours of sleep per day and more than nine hours of sleep per day are each associated with an increased risk of ulcerative colitis.”

 

An earlier study (also published in Clinical Gastroenterology and Hepatology in 2013) by Dr. Ananthakrishnan and his colleagues reported a two fold increase in risk of Crohn’s disease at six months of poor sleep quality.

 

Next time you think of mere chronic fatigue as a risk of poor sleep, pause to think again. Sleep disruption profoundly impacts our immune system, and we need to be aware of it. There is also a critical need for providers to routinely inquire and analyze sleep duration and quality as important parameters of health in patients with inflammatory bowel diseases.

 

Click here for Abstract: http://www.cghjournal.org/article/S1542-3565(14)00627-2/abstract

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CHEST 2014 Sleep Apnea, Sex and Sleepiness – CPAP Does Not Negatively Impact Sexual Quality of Life

 

Using continuous positive airway pressure (CPAP) has no negative impact on sexual quality of life.

True? Or False?

 

True, say researchers at Rosalind Franklin University. And that should be music to the ears for patients with obstructive sleep apnea (OSA)

 

A new study abstract released in the journal CHEST presents the results of a survey among 52 OSA patients to determine if sexual quality of life (SQOL) differed between CPAP-compliant and noncompliant patients. (Patients are considered compliant if they use CPAP more than 4 hours per night for 70% of days).

 

Studies have shown that the use of CPAP improves erectile dysfunction (ED) that is common in sleep apnea patients. Yet, patients using CPAP tend to believe that its use may have a negative effect on sexual quality. The results of this study reassure them that there is no cause for worry.

 

Each of the 27 compliant and 25 non-compliant patients responded to 10 questions regarding different physical and emotional aspects of lovemaking.

Both groups were chosen similar in age, body mass index, ED (and the use of medication to treat it) and the presence of depression. SQOL scores were similar between both groups when adjusted for all confounding variables. In short, CPAP compliance did not predict sexual quality of life.

 

This study was presented at CHEST 2014, the recent annual meeting of the American College of Chest Physicians in Austin, Texas.

 

So, OSA patients go ahead and use your CPAP devices to treat your sleep apnea. And improve ED too.

 

 

Source: American College of Chest Physicians 2014 CHEST 

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Could SARS be the Teacher in Dealing with Ebola

 

If nothing is a world away in spreading diseases, neither are best practices and learning. The efficiency and diligence with which we controlled SARS in 2003 in Canada could be a great teacher in preparing for and managing a potential Ebola outbreak, says Dr. Andrew E. Simor, Chief of the Department of Microbiology and the Division of Infectious Diseases at Sunnybrook Health Sciences Centre in Toronto.

 

Diligence in infection control practice to manage Ebola cases needs to be equally demanding, feels Dr. Simor who is also senior scientist at Sunnybrook Research Institute a professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. While Ebola may, in theory, be less contagious than the airborne SARS, he draws attention to tragically fatal outcomes it has unleashed through direct contact with infected body fluids or organs.

 

We have learnt, says Dr Simor, that…

 

…Infections may be spread and acquired by patients, visitors and staff in health care settings. Protocols are thus in place for screening new patients with their travel history, for training health care providers on the right use of personal protective equipment and ensuring rigorous environmental cleaning practices for all patient care areas.

 

…Hand hygiene is a non-negotiable compliance. Washing with soap and water, and use of an alcohol-based hand wash rub, before and after each patient contact are fundamental practices they now follow. Regular audits are conducted to monitor compliance.

 

…The measures taken to strengthen public health services, infection prevention and control infrastructure and hospital accreditation standards and policies need to be meticulously deployed and executed.

 

…Communication is vitally important dealing with such wide-impact events. As is accountability for doing it right. Today, their channels of communication have opened to make everyone (patients and staff internally, and communities externally) aware of the situation and the measures being implemented.

 

This planning process, says Dr. Simor, began months ago in collaboration with public health agencies for the eventuality that their hospital may encounter an Ebola patient. “It is not an eventuality we look forward to, but given the lessons we have learned, we are better informed and prepared.”

 

Source: CNN

Click here for the full article

http://www.cnn.com/2014/10/20/opinion/simor-ebola-sars-canada/index.html?

 

 

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Technology’s Handshake for a Safety Net in Sleep Management

 

Imagine a helping hand from technology to alert us of fatigue and inform us of the need of recovery sleep. In an article titled “Sleepiness and safety: Where biology needs technology“, two emerging areas of technology seem to promise support in managing fatigue risk – especially in safety-sensitive occupations.

 

One involves optimizing work schedules using biomathematical models of performance changes associated with sleep and circadian dynamics. The current use of simple linear fatigue models is acknowledged as grossly inadequate given the non-linear interaction of sleep homeostatic drive and circadian regulation.

 

The other involves detecting transient fatigue from drowsiness. The Psychomotor Vigilance Test (PVT), developed for evaluating behavioral alertness prior to or during work, seems to have been extensively validated for its sensitivity to deficits in attention from sleep loss and circadian misalignment.

An online tracking of the ‘percent of slow eyelid closures’ (PERCLOS) to reflect momentary fluctuations of vigilance is another example.

 

Such fatigue management technologies show potential to predict and prevent operator errors and accidents in safety-sensitive areas of work. They are also expected to help monitor the onset of physiological and mental diseases due to inadequate sleep and circadian misalignment – hypertension, diabetes, obesity, depression and cancer to name a few.

 

Certainly there is need to establish their validity, safety value, acceptance, use adherence, and abuse potential. If done right, use of technology may minimize safety risks arising out of reliance on self-reported fatigue sleepiness given our inability to subjectively estimate the degree of impairment in alertness and performance due to inadequate sleep.

 

More importantly, they could allow use of countermeasures to mitigate sleepiness and fatigue and provide timely alerts for the need for recovery sleep. This may significantly contribute to prevent various diseases associated with inadequate sleep.

 

Source: Sleep and Biological Rhythms

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