NY Train Tragedy Spawns Mandatory Sleep Testing


In the wake of last year’s Bronx commuter train derailment that killed four passengers, Metro-North officials have issued a directive that would require the 350 engineers who work for the railway to be evaluated in the coming months for sleep apnea.


The report from ABC News reiterates that the engineer on the ill-fated train suffered from “severe” sleep apnea. According to reporter N.J. Burkett, the rail union has no objections. Mike Doyle, general chairman of the Officials with the Association of Commuter Rail Employees union, told ABC Eyewitness News in a statement that, “recognizing that an undiagnosed sleep disorder likely was a major contributing factor to the tragic accident…our organization is working with Metro-North to establish a program to help identify engineers who may suffer from the same medical condition.”


MTA chief spokesman Adam Lisberg said there are still a lot of questions about the screening and that it will be extended to all safety-sensitive personnel. “We haven’t agreed on what to do in the program,” he told Burkett. “We’re working on plans for addressing sleep apnea for critical safety personnel, but have no final plans yet for what we’ll do.”


Dr. Steven Feinsilver, of Mount Sinai, applauded the move, but warned that screening for sleep apnea is easier said than done. “Feinsilver said the best testing is an overnight sleep study which can be a ‘relatively complicated thing to do,’” wrote Burkett.

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Positional Component of OSA Explored in New Study


A study from Carlsbad, Calif-based Advanced Brain Monitoring (Assessment of a Neck-based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea) showed that 73% of patients with positional OSA (> 2 times as severe when on their back) is essentially equivalent from an AHI of 2 up to an AHI of 60. It is only those with an AHI > 60 that do not have a positional component.


The findings published in the Journal of Clinical Sleep Medicine using ABM’s Night Shift revealed:

• 83% of POSA participants responded to Night Shift therapy with > 50% reduction in AHI; the median AHI reduction was 79%;

• participants had significantly less sleep fragmentation and hypoxemia, and slept more deeply;

• a majority of participants experienced reduced daytime sleepiness and depression symptoms were significantly reduced; and

• across participants, the percent of time snoring above 50 dB was significantly reduced.


Another Advanced Brain Monitoring study published in the March Journal of Clinical Monitoring and Computing demonstrated the capability of the Night Shift to differentiate benign snores from those with likely OSA.


Key findings were:

• positional snoring measured from the neck was high correlated with overall, supine and non-supine AHI; and

• snoring from the back of the neck was more effective in screening for OSA compared to commonly used questionnaires, provided a sensitivity of 0.82 and a specificity of 0.87.

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COPD and OSA Form “Complex Relationship”



Efficient management of COPD patients should include a comprehensive sleep history, including sleep hygiene and OSA, according to a recent article titled “Update on obstructive sleep apnea and its relation to COPD” from Ohio State University researchers.


The article available via NIH update reiterated that chronic obstructive pulmonary disease (COPD) is a common and preventable lung disease that affects millions of people in the United States, while pointing out that many people with COPD also suffer from OSA, although it is a “complex relationship.”


“This relationship, however, puts people at risk for more nocturnal desaturations and potential complications related to this, including pulmonary hypertension and heart rhythm disturbances,” wrote researchers. “This update focuses on the physiology of sleep disturbances in COPD as well as the clinical implications of OSA in COPD.”


Nocturnal COPD symptoms have been reported in a significant number of patients, and may affect sleep, with Klink et al finding that nocturnal cough and wheezing resulted in 53% of the patients reporting difficulty initiating or maintaining sleep, and 23% reporting excessive daytime sleepiness.


“In addition, several studies have shown that sleep quality is worse in people with COPD compared to healthy individuals,” wrote researchers in the update. “Beyond symptoms, there are nocturnal alterations in ventilation and gas control in patients with COPD. The result for patients with significant daytime hypoxemia and hypercapnia may be more profound nocturnal changes in hypoxemia, especially during rapid eye movement (REM) sleep. In addition to increased nocturnal symptoms, poor sleep quality, and effects on gas exchange, there are a number of COPD patients who may also have comorbid obstructive sleep apnea (OSA).”


Click here to read full article

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Osteoporosis Risk Heightened Among Sleep Apnea Patients



A diagnosis of obstructive sleep apnea may raise the risk of osteoporosis, particularly among women or older individuals, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM) titled “Obstructive Sleep Apnea and Risk of Osteoporosis: A Population-Based Cohort Study in Taiwan”.


The findings by Taiwanese researchers add yet another ailment to the growing list of conditions made worse by sleep apnea. “Ongoing sleep disruptions caused by obstructive sleep apnea can harm many of the body’s systems, including the skeletal system,” said one of the study’s authors, Kai-Jen Tien, MD, of Chi Mei Medical Center in Tainan, Taiwan. “When sleep apnea periodically deprives the body of oxygen, it can weaken bones and raise the risk of osteoporosis. The progressive condition can lead to bone fractures, increased medical costs, reduced quality of life and even death.”


The retrospective cohort study used records from Taiwan’s single-payer National Health Insurance program to track treatment of 1,377 people who were diagnosed with obstructive sleep apnea between 2000 and 2008. During the course of the next six years, researchers compared the rate of osteoporosis diagnosis in this group of obstructive sleep apnea patients to 20,655 people comparable in age and gender who did not have the sleep disorder.

Click Here for Abstract


Researchers found the incidence of osteoporosis was 2.7 times higher among patients with sleep apnea than their counterparts, after adjusting for age, gender, other medical problems, geographic location and monthly income. Women and older individuals faced increased risk of developing the bone condition.


“As more and more people are diagnosed with obstructive sleep apnea worldwide, both patients and health care providers need to be aware of the heightened risk of developing other conditions,” Tien said. “We need to pay more attention to the relationship between sleep apnea and bone health so we can identify strategies to prevent osteoporosis.”


Source: Endocrine Society

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Google-Aided Study Tests Seasonal Trends in Snoring



Researchers at the University of Wisconsin set out to use Google to determine whether there is a seasonal component to snoring and sleep apnea. Study authors used search engine query data retrieved via Google Trends (from January 2006 to December 2012) via the following search terms: “snoring” and “sleep apnea”. The study is titled “Seasonal trends in sleep-disordered breathing: evidence from Internet search engine query data” was published in the march edition of Sleep and Breathing.


Seasonal effects were investigated by fitting cosinor regression models. In addition, the search terms “snoring children” and “sleep apnea children” were evaluated to examine seasonal effects in pediatric populations.


Statistically significant seasonal effects were found using cosinor analysis in both USA and Australia for “snoring” (p < 0.00001 for both countries).


According to the study’s abstract, “seasonal patterns were observed for ‘sleep apnea’ in the USA (p = 0.001); however, cosinor analysis was not significant for this search term in Australia (p = 0.13). Seasonal patterns for “snoring children” and “sleep apnea children” were observed in the USA (p = 0.002 and p < 0.00001, respectively), with insufficient search volume to examine these search terms in Australia. All searches peaked in the winter or early spring in both countries, with the magnitude of seasonal effect ranging from 5 to 50 %.”


Findings indicate that there are significant seasonal trends for both snoring and sleep apnea internet search engine queries, “with a peak in the winter and early spring. Further research is indicated to determine the mechanisms underlying these findings, whether they have clinical impact, and if they are associated with other comorbid medical conditions that have similar patterns of seasonal exacerbation.”


Click Here for Abstract

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Scientists Unwind a Circadian Clock Mystery



Researchers from RIKEN, Hiroshima University and the University of Michigan say a particular gene plays a key role in influencing circadian rhythms. In their study (A Novel Protein, CHRONO, Functions as a Core Component of the Mammalian Circadian Clock), which appears in PLOS Biology, the team performed a genome-wide chromatin immunoprecipitation analysis for genes that were the target of BMAL1, a core clock component that binds to many other circadian clock genes, regulating their transcription.


The new gene, dubbed Chrono, shows that it functions as a transcriptional repressor of the negative feedback loop in the mammalian clock. The Chrono protein binds to the regulatory region of clock genes, with its repressor function oscillating in a circadian manner. The expression of core clock genes is altered in mice lacking the Chrono gene, and the mice have longer circadian cycles.


“In vivo loss-of-function studies of Chrono including Avp neuron-specific knockout (KO) mice display a longer circadian period of locomotor activity. Chrono KO also alters the expression of core clock genes and impairs the response of the circadian clock to stress,” add investigators. “Chrono forms a complex with the glucocorticoid receptor and mediates glucocorticoid response. Our comprehensive study spotlights a previously unrecognized clock component of an unsuspected negative circadian feedback loop that is independent of another negative regulator, Cry2, and that integrates behavioral stress and epigenetic control for efficient metabolic integration of the clock.”


Click Here for Full Article

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“Nightmare of Narcolepsy” Documented



Narcolepsy in young children is not frequently talked about, but The Indepenent.ie Web site took the time to explore the “nightmare” that one 9-year-old has experienced. The article by details the life of a child who must take a 20-minute nap in school each morning at 10 a.m., and another 30-minute doze in the afternoon when he returns to the family home in Rathgar (Ireland).


This is despite the strong medication which his mother, Mairead Lawless, says, is actually licensed for use by adults, but which is crucial to keep Alex alert in the mornings, and provide the deep night-sleep denied him by his debilitating condition.


“It’s a struggle to keep him awake enough to do his homework,” says Lawless in the article. “He struggles to concentrate and focus, and finds it difficult to pay attention in school. He can be very bad-tempered when he’s tired and he’s a very different child to what he was.”


Quinlan writes that the child “can no longer find the energy for the sports he once adored – while other boys of his age are out kicking footballs and getting into mischief, his mother says all Alex wants to do is sit on the sofa. Once an active, outgoing child, who was full of energy and had lots of friends, Alexander has become quiet, lacking in energy and unable to participate in activities with his pals.”


Click Here to read the full article.

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Sleep Apnea Boosts Risk of Pneumonia


A study published in the Canadian Medical Association Journal (CMAJ) titled “Sleep apnea and risk of pneumonia: a nationwide population-based study” analyzed evidence to determine the risk of pneumonia in patients with obstructive sleep apnea.


Researchers explored the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy. According to the article, from January 1, 2000, researchers identified adult patients with sleep apnea from the Taiwan National Health Insurance Research Database. A control cohort without sleep apnea, matched for age, sex and comorbidities, was selected for comparison. The two cohorts were followed until Dec. 31, 2010, and observed for occurrence of pneumonia.


Click for Abstract


CMAJ reports that of the 34 100 patients (6816 study patients and 27,284 matched controls), 2,757 (8.09%) had pneumonia during a mean follow-up period of 4.50 years, including 638 (9.36%) study patients and 2119 (7.77%) controls.


“Kaplan–Meier analysis showed a higher incidence of pneumonia among patients with sleep apnea (log rank test, p< 0.001),” writes CMAJ editors. “After multivariate adjustment, patients with sleep apnea experienced a 1.20-fold (95% confidence interval 1.10–1.31) increase in incident pneumonia. The risk was even higher among patients who received CPAP therapy. Interpretation: Sleep apnea appeared to confer a higher risk for future pneumonia, possibly in a severity-dependent manner.”


Click Here to Access Full Study

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Insomnia May Boost Stroke Risk


A new study published in Stroke titled “Insomnia Subtypes and the Subsequent Risks of Stroke” reveals that young adults with insomnia may be up to eight times more likely to suffer a stroke than those who have no trouble sleeping.


A summary of the abstract shows that Taiwanese researchers compared health records of more than 21,000 patients with insomnia to 64,000 patients without the sleep disorder.


Click for Abstract


While the overall risk of stroke was small among adults ages 18 to 35, those who were insomniacs were eight times more likely to suffer a stroke over a four-year period compared to those without sleep issues. The same group of insomniacs was also 54 percent more likely to end up in the hospital after having a stroke. The researchers found that insomniacs with diabetes had a higher risk of stroke than those without diabetes.

Insomnia has been previously linked to higher blood pressure, higher sugar levels, and inflammation of the arteries, which are all factors that increase stroke risk, the researchers wrote.”


The study cautions that researchers did not conclusively prove that insomnia causes stroke. The study was conducted on one ethnic group, so findings may not apply to a wider population.


Read full article from American Heart Association

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Sleep Deprivation Linked to Cardiac Hospitalizations


New research presented at the recent European Society of Cardiology meeting in Scavenger Norway, recently concluded that poor sleep doubles hospitalizations among individuals with heart failure.


As summarized in a press release from the European Society of Cardiology, Swedish researcher Peter Johansson, first author of the study which will be titled “Poor sleep doubles hospitalisations in heart failure patients“and a heart failure nurse at the University Hospital of Linköping, Sweden, said: “Sleep is important for everyone and we all have to sleep to feel good. We know that sleep problems are common among patients with heart failure. But until now there was no data on whether poor sleep persists over time and how that relates to hospitalizations.”


The study included 499 patients hospitalized for heart failure who participated in the evaluating Outcomes of Advising and Counseling in Heart failure study. After 12 months the researchers recorded the number and cause of unplanned hospitalizations during the follow up period and assessed sleep again. Researchers found that 215 patients (43 percent) had sleep problems at discharge from the initial hospitalization and nearly one-third (30 percent) had continued sleep problems at 12 months.


Patients with continued sleep problems were two times more likely to be hospitalized during the followup period than those without any sleep problems. Risk was double for all-cause hospitalizations and for cardiovascular hospitalizations.


“Our finding that consistently poor sleep leads to twice as many hospitalizations in patients with heart failure underlines the impact that sleep can have on health,” said Johansson. “In Sweden we don’t generally ask our heart failure patients about sleep and this study shows that we should. If patients say their sleep is poor that may be a warning signal to investigate the reasons.”


Source: ESC Press Office

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