Dr. Deodhar[/caption]
Atul A. Deodhar, MD, MRCP, FACP, FACR
Professor of Medicine
Medical Director, Rheumatology Clinics
Medical Director, Immunology Infusion Center
Oregon Health & Science University
MedicalResearch.com: What is the background for this study?
Response: The GO-ALIVE study (CNTO148AKS3001) is a multicenter, randomized, double-blind, placebo-controlled study of golimumab, an anti-TNFα monoclonal antibody, administered intravenously (IV), in adult patients with active ankylosing spondylitis (AS). The primary objective is to evaluate the efficacy of golimumab 2 mg/kg in patients with active AS by assessing the reduction in signs and symptoms of AS. The secondary objectives include assessing efficacy related to improving physical function, range of motion, health-related quality of life, and other health outcomes.
A total of 208 patients who had a diagnosis of definite ankylosing spondylitis (per modified New York criteria) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4, total back pain visual analogue scale (VAS) ≥4, and CRP ≥0.3 mg/dL were randomized. Patients were treated with IV golimumab (n=105) at Weeks 0, 4, and every 8 weeks through Week 52 or placebo (n=103) at Weeks 0, 4, and 12, with crossover to IV golimumab at Week 16 and through Week 52.
Dr. Brodner[/caption]
David C. Brodner, M.D.
Founder and Principle Physician, The Center for Sinus, Allergy, and Sleep Wellness
Double Board-Certified in Otolaryngology (Head and Neck Surgery) and Sleep Medicine
Assistant Clinical Professor
Florida Atlantic University College of Medicine
Medical Director, Good Samaritan Hospital Sleep Laboratory
Senior Medical Advisor, Physician’s Seal, LLC®
MedicalResearch.com: What is the background for this study?
Response: Chronic sleep and wakefulness disorders affect an estimated 50 to 70 million Americans, and long-term sleep deprivation has been associated with negative health consequences, including an increased risk of diabetes, hypertension, heart attack, stroke, obesity and depression.
Sleep/wake cycles are regulated by melatonin, levels of which normally begin to rise in the mid- to late evening and remain high for the majority of the night. Levels begin to decline towards early morning, as the body’s wake cycle in triggered. Melatonin levels typically decline with age, with a significant decrease after age 40.
And as people age, their bodies may no longer produce enough melatonin to ensure adequate sleep. In addition to difficulties falling asleep, sleep in older populations can include fragmented and sustained sleep problems. Melatonin supplementation has been shown to promote and maintain sleep in older populations.
In this study, we compared the pharmacokinetics (PK) profile of REMfresh®, a continuous release and absorption melatonin (CRA-melatonin), with that of a leading immediate-release melatonin (IR-melatonin) formulation.
Dr. Prabhakaran[/caption]
Shyam Prabhakaran, MD, MS
Department of Neurology
Feinberg School of Medicine
Northwestern University
Chicago, IL
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Wake-up stroke, or stroke onset during sleep, accounts for one-quarter of stroke presentations. Yet, there are few studies exploring mechanisms or triggers of onset during sleep. We explored whether blood pressure variability which is known to have circadian patterns could trigger wake-up stroke. We found that in the first 24 hours after stroke, those with wake-up stroke had greater blood pressure variability than non-wake up stroke patients.
Dr. Scullin[/caption]
Michael K. Scullin, Ph.D.
Assistant Professor of Psychology and Neuroscience
Director, Sleep Neuroscience and Cognition Laboratory
Baylor University
Waco, TX 76798
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In studio-based courses (e.g., design, architecture, art), students have a large project due at the end of the semester that requires creativity and attention to detail. Anecdotally, they will work long hours without sleep to finish the project.
The problem is that cutting back on sleep may actually be impeding their ability to execute the project successfully.
We used wristband actigraphy (a device that detects movement and light) to monitor sleep for one week in 28 interior design students—many of whom had a final project due. At the beginning and end of the week, the participants completed tests of attention and creativity.
We found that students slept less than contemporary recommendations (7 to 9 hours; Associated Professional Sleep Societies) on approximately half of the nights, and shorter sleep was associated with declining attention and creativity scores across the week. The more thought provoking result was that many individuals showed inter-night variability in how long they slept (e.g., going from 4 hours to 11 hours to 5 hours to 8 hours, etc.). Inter-night variability in sleep duration was an even stronger predictor than total sleep time in how creativity scores changed across the week.
Dr. Trudel-Fitzgerald[/caption]
Claudia Trudel-Fitzgerald Ph.D.
FRQS Postdoctoral research fellow & Clinical psychologist (OPQ)
Department of Social and Behavioral Sciences
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is very limited research on the association between sleep characteristics and survival among individuals with cancer. However, this is an important question, especially among breast cancer patients because sleep disturbances are frequently reported by these women. Preliminary studies have suggested that sleep duration is related to mortality. The novel findings of our research indicate that not only sleep duration, but also changes in sleep duration before versus after diagnosis, as well as regular difficulties to fall or stay asleep, may also be associated with mortality among women with breast cancer over a period of up to 30 years.
Dr. Jen-Hao Chen[/caption]
Jen-Hao Chen PhD
Assistant Professor
Department of Health Sciences and School of Public Affairs
University of Missouri - Columbia
MedicalResearch.com: What is the background for this study?
Response: It has been well known that sexual minority adults in the US have worse health as compared with heterosexual peers. Queer folks are found to have poorer physical, mental and behavioral health outcomes because of their marginalized status and social environments. But we know very little about prevalence of sleep problems in the population of sexual minorities compared to heterosexual people. Do sexual minorities lose sleep? Do they wake up more often during the night? Do they sleep less? This study aims to address this important gap in the LGBT health literature. Using recent nationally representative data, we exam whether sexual minority adults have greater odds of having short sleep duration and poor sleep quality. In addition, we also investigate sexual minorities’ sleep in the context of gender and race/ethnicity
Dr. Christopher O’Connor[/caption]
Christopher M. O’Connor, MD FACC
CEO and Executive Director,
Inova Heart & Vascular Institute
IHVI Administration
Falls Church, Virginia 22042
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Sleep apnea is a very common comorbidity of patients with heart failure (both reduced ejection fraction and preserved ejection fraction). Early evidence from observational and small studies suggested that treating sleep apnea with adaptive servo-ventilation (ASV) therapy may improve patient outcomes. There is minimal clinical evidence about identifying and treating sleep apnea in those who’ve been hospitalized with acute decompensated heart failure. The CAT-HF study was designed to help address this, with the primary endpoint being cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. It was also planned to expand on the SERVE-HF study that was investigating the use of ASV therapy to treat central sleep apnea (CSA) in chronic stable heart failure patients with reduced ejection fraction patients (HFrEF).
Dr. Taveras[/caption]
Dr. Elsie M. Taveras, MD MPH
Chief, Division of General Pediatrics
Director, Pediatric Population Health Management
Director, Raising Healthy Hearts Clinic
MassGeneral Hospital for Children
MedicalResearch.com: What are the primary findings of this study and why are they important?
Response: The primary findings of this study are that children who get an insufficient amount of sleep in their preschool and early school age years have a higher risk of poor neurobehavioral functioning as reported by their mothers and independently by their teachers at age 7. These behaviors included poorer executive function and more hyperactivity/inattention, emotional symptoms, conduct problems, and peer relationship problems.
Dr. Simone Baiardi[/caption]
Dr. Simone Baiardi MD
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum
University of Bologna
MedicalResearch.com: What is the background for this study?
Response: Drug-induced sleep endoscopy (DISE) is an useful tool for studying the upper airway dynamic in patients with obstructive sleep apnea syndrome (OSAS), and it’s crucial for the therapeutic choice (especially for non ventilatory treatment, such as surgery). The main limits of DISE are the lack of standardization of procedure and the low inter-observer reliability among non-experienced ENT surgeons.
Dr. Ron Mitchell[/caption]
Ron B. Mitchell, MD
Professor and Vice Chairman,
Department of Otolaryngology, Head and Neck Surgery
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children's Medical Center Dallas
Dallas, TX 75207
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obstructive Sleep Apnea (OSA) has not been widely studies in adolescents. This is one of a few studies that was targeted at 12-17 year olds who were referred for a sleep study for possible OSA. The study included 224 adolescents (53% male). aged 12 to 17 years. The mean BMI was 33.4 and most were either Hispanic or African American (85.3%). A total of 148 (66.1%) were obese. Most adolescents referred for a sleep study (68%), had Obstructive Sleep Apnea. Normal-weight adolescents were least likely to have OSA at 48%, while obese children were most likely at 77%. Severe OSA was most likely in obese males with tonsillar hypertrophy.
Dr. Sullivan[/caption]
Kelly L. Sullivan, PhD
Assistant Professor
Department of Epidemiology
Jiann-Ping Hsu College of Public Health
Georgia Southern University
Statesboro, Georgia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The original aim of this study was to determine which factors were associated with getting sufficient sleep in men and women. In this analysis, we considered many possible influences including BMI, age, race, education, marital status, exercise, employment status, and income in addition to having children in the household. The aim was to determine which factors were most strongly associated with insufficient sleep in men and women specifically in order to inform efforts to best address their sleep challenges.
In this study, we found that younger women with insufficient sleep time were more likely to have children in the household compared with women who reported sufficient sleep. Each child in the household was associated with a nearly 50% increase in a woman’s odds of insufficient sleep.
This finding held after controlling for the potential effects of age, exercise, employment status and marital status. Children in the household were also associated with the frequency of feeling unrested among younger women, but not among younger men. Women with children reported feeling tired about 25% more frequently compared to women without children in the household.
Dr. Matthew Pase[/caption]
Dr. Matthew P. Pase
Sidney Sax NHMRC Fellow, Department of Neurology
Boston University School of Medicine
Investigator, Framingham Heart Study;
Senior Research Fellow, Swinburne University of Technology.
Boston MA 02118
MedicalResearch.com: What is the background for this study?
Response: Sleep disturbances are common in dementia. However, most studies have focused on patients who already have dementia and so it is unclear whether disturbed sleep is a symptom or a cause of dementia.
We studied 2,457 older participants enrolled in the Framingham Heart Study, a large group of adults sampled from the community in Framingham, Massachusetts. We asked participants to indicate how long they typically slept each night. Participants were then observed for the following 10-years to determine who developed dementia, including dementia due to Alzheimer’s disease. Over the 10 years, we observed 234 cases of dementia. Information on sleep duration was then examined with respect to the risk of developing dementia.
Dr. Alex Krist[/caption]
Dr. Alex Krist, MD MPH
Task Force member
Associate Professor
Fairfax Family Medicine Residency
Co-director, Ambulatory Care Outcomes Research Network
Virginia Commonwealth University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea.
Dr. Nicola Barclay[/caption]
Dr. Nicola Barclay, BA(Hons), MSc, PhD.
Lecturer in Sleep Medicine
Sleep and Circadian Neuroscience Institute (SCNi)
Nuffield Department of Clinical Neurosciences
Sir William Dunn School of Pathology
University of Oxford
MedicalResearch.com: What is the background for this study?
Response: We know that extreme sleep deprivation impairs our cognitive functions, particularly attention. This impairment in attention is likely to be driven by physiological mechanisms that change across the waking day (increasing sleep pressure), but also by factors associated with our biological clock. The timing of physiological processes particularly related to attention differ between morning and evening type people (our so called early morning larks and night owls), and so we hypothesised that morning and evening types would differ in their impairments in attention at different times of day, prior to and following 18 hours of sustained wakefulness.
MedicalResearch.com Interview with: Roi Levy The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, The Mina and Everard Goodman Faculty of Life Sciences Bar Ilan University Ramat Gan, Israel
MedicalResearch.com: What is the background for this study? Response: Long-term memory after an experience takes many hours to be reach its final form. During the consolidation period, the nascent memory is labile: the consolidation can be interrupted by new experiences, or new experiences that are too insignificant to be remembered can capture the consolidation process, and thereby be remembered. To avoid potentially maladaptive interactions between a new experience and consolidation, a major portion of the consolidation is deferred to the time in which we sleep, when new experiences are unlikely. For over 100 years, studies have demonstrated that sleep improves memory formation. More recent studies have shown that consolidation occurs during sleep, and that consolidation depends on the synthesis of products that support memory formation. Consolidation is unlikely to be shut off immediately when we are awakened from sleep. At this time, even a transient experience could capture the consolidation, leading to a long-lasting memory of an event that should not be remembered, or could interfere with the consolidation. We have identified a mechanism that prevents long-term memories from being formed by experiences that occur when awakened from sleep.
Dr. Lee M. Ritterband[/caption]
Lee M. Ritterband, Ph.D.
Professor, Department of Psychiatry and Neurobehavioral Sciences
Director, Center for Behavioral Health and Technology
University of Virginia School of Medicine
Ivy Foundational Translational Research Building
Charlottesville, VA 22903
MedicalResearch.com: What is the background for this study?
Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I.
This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year).
Dr. Ben Carter[/caption]
Dr Ben Carter PhD
Senior Lecturer in Medical Statistics
Statistics Editor for the Cochrane Skin Group
(Honorary Associate Professor, Nottingham University)
Institute of Primary Care and Public Health
Cardiff University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study leads from the growing use of mobile and media device use in children. We report the impact of devices leads to poorer sleep outcomes.
MedicalResearch.com: What should readers take away from your report?
Response: Using or even merely access to your mobile and media device should be restricted 90 minutes prior to bedtime.
Dr. Hadine Joffe[/caption]
Hadine Joffe, MD, MSc
Associate Professor of Psychiatry, Harvard Medical School
Vice Chair for Psychiatry Research
Director of Division of Women's Mental Health / Dept of Psychiatry / Brigham and Women’s Hospital
Director of Psycho-Oncology Research / Dept of Psychosocial Oncology and Palliative Care /Dana Farber Cancer Institute
www.brighamwharp.org
MedicalResearch.com: What is the background for this study?
Response: We conducted this study to advance our understanding about causes of mood disturbance in the menopause transition that are specifically related to menopause. We used an experimental model to dissect out the contributions of hot flashes and sleep disturbance from contribution of changing levels of estrogen because hot flashes, sleep problems, and estrogen fluctuations co-occur and are difficult to distinguish from one another. Understanding whether hot flashes and/or sleep disturbance are causally related to mood disturbance will help us identify who is at risk for mood changes during the menopause transition. This is incredibly important now that we are finding effective non-hormonal treatments for hot flashes and sleep disruption.
Frida Rångtell[/caption]
Frida Rångtell PhD Student
Department of Neuroscience, Division of Functional Pharmacology
Uppsala University, Sweden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous studies have demonstrated that evening use of electronic devices emitting blue light, e.g. tablet computers, increases time to fall asleep, reduces the quality of slow-wave sleep (a sleep stage that has for instance been shown to boost memory consolidation and immune functions), and decreases the time in rapid eye movement sleep (which has been proposed to play a role in emotional regulation and consolidation of emotional memories). One explanation could be the blue light-mediated suppression of the sleep-promoting hormone melatonin. Blue LED Warehouse or bedroom lights have a much lower effect on this because they are not shining straight into the viewer's eyes, like phone LEDs.
In the current experiment however, after 6.5 hours of constant bright light exposure during the day, there were no effects on sleep or melatonin levels after reading a traditional book versus the same book on a self-luminous tablet for two hours before bedtime. Even though the light from the self-luminous tablet was enriched in blue light. Our null findings may at first glance appear surprising, especially in light of previous epidemiological findings linking the use of electronic devices before bedtime with sleep disturbances.
One plausible explanation for these discrepant results across experiments, in our view, is that bright light exposure during daytime – similar to that employed in the present study (~570 lux over 6.5 hours prior to evening light stimulation) – has previously been shown to attenuate the suppressive properties of evening light exposure on melatonin levels.
Our results could therefore suggest that light exposure during the day, e.g. by means of outdoor activities or light interventions in offices, may help combat sleep disturbances associated with evening blue light stimulation. Finally, it must be borne in mind that reading is generally considered to be a cognitively demanding task. Thus, it could be speculated that evening reading may contribute to greater sleep pressure, which may have hampered our ability to detect differences in sleep between the tablet reading and physical book reading conditions. A recent study involving young children has for instance demonstrated that reading at bedtime is associated with improved sleep, as indicated by longer total nocturnal sleep duration.
Dr. Kunisaki[/caption]
Ken Kunisaki, MD, MS
Associate Professor of Medicine
Minneapolis Veterans Affairs Health Care System and University of Minnesota and
[caption id="attachment_26803" align="alignleft" width="98"]
Dr. Prichard[/caption]
Roxanne Prichard, PhD
Associate Professor of Psychology and Neuroscience
University of St. Thomas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: CPAP devices, or continuous positive airway pressure devices, are used to treat obstructive sleep apnea, a common condition that causes people to intermittently stop breathing during their sleep. This leads to poor sleep quality and often results in symptoms like excessive sleepiness in the daytime. In the United States, CPAP devices are classified by the Food and Drug Administration as Class II medical devices with possible risks; their sale requires a medical prescription. We were aware of online advertisements for secondhand, used CPAP machines, but we have not seen publications that have analyzed this practice.
Once a week, our research team monitored online advertisements for secondhand CPAP devices on Craigslist.org in 18 U.S. cities and areas over a one-month period. During that time, we found 270 advertisements, most of which did not describe who previously had used the device or why it was being sold. Only 5 of the advertisements mentioned anything about the legal requirements of a prescription and 61 percent of the devices included a used mask without information about its age or how it was cleaned.
CPAP devices create air pressure and attach to a nose or face mask that delivers that pressure to a patient’s airway, thereby keeping him or her breathing during sleep. The amount of air pressure delivered by the devices is adjusted for each patient and usually is determined by a medical exam that includes an overnight stay in a laboratory. Our study found that most of the Craigslist advertisements failed to mention the devices’ pressure settings—settings that were prescribed for the original owners.
The average price for a CPAP device listed on Craigslist was $291, much less than the $600 to $2,000 cost of a new device.
Dr. Jim Burch[/caption]
Jim Burch, MS, PhD
Associate Professor
Dept. of Epidemiology & Biostatistics
Cancer Prevention & Control Program
Arnold School of Public Health
University of South Carolina, Columbia, SC and
Health Science Specialist
WJB Dorn Department of Veterans Affairs Medical Center
Columbia, SC
MedicalResearch.com: What is the background for this study?
Response: Over 21 million Veterans live in the U.S., and nearly 9 million of them receive healthcare through the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. The military population is particularly vulnerable to sleep disturbances due to their work schedules, living conditions, and other physical and psychological factors that accompany their jobs. However, previous studies have not comprehensively described the scope and characteristics of sleep disorders among Veterans. Sleep is considered a physiological necessity. Inadequate sleep has been associated with a wide range of adverse health outcomes, including an increased risk of chronic diseases such as heart disease and cancer, psychiatric disorders, reduced quality of life, and increased mortality.