MedicalResearch.com Interview with:
Dr. Jonathan R. Skirko, MD , MHPA, MPH
Assistant professor
Division of Pediatric Otolaryngology
University of Utah HealthMedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea is a common problem that that impacts the lives of many people. Understanding treatment effectiveness is important and Health-State Utility is a standardized way of assessing quality of life. Before this study, we didn't have a way of measuring quality of life in this population in this important way.
You have to accurately measure something before you can improve it. (more…)
MedicalResearch.com Interview with:
Mireia Dalmases Cleries, MDHospital Universitari Arnau de Vilanova and Santa Maria
Group of Translational Research in Respiratory Medicine
Lleida, Cataluña, SpainMedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea has been associated with poor blood pressure control and resistant hypertension. Moreover, it has been described that its treatment with continuous positive pressure (CPAP) could be an effective means of controlling blood pressure in this population.
Nevertheless, studies assessing OSA prevalence, characteristics and association with blood pressure control in resistant hypertensive patients are limited and that’s the reason why we decided to perform this study.
(more…)
MedicalResearch.com Interview with:
Gillian R. Diercks, MD, MPH
Instructor in Otolaryngology, Harvard Medical School
Department of Otolaryngology
Massachusetts Eye and Ear Infirmary
Boston, MassachusettsMedicalResearch.com: What is the background for this study? What are the main findings?Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually. A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration.
In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home. This leaves limited options for pain control, including acetaminophen and ibuprofen. However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood. At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding. Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead.
Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. (more…)
MedicalResearch.com Interview with:
Dayna A. Johnson PhD
Department of Epidemiology
Emory University
Atlanta, GA
MedicalResearch.com: What is the background for this study? What are the main findings?Response: There are several studies that have determined that African Americans have the highest prevalence of hypertension and are the most likely to have uncontrolled hypertension compared to other racial/ethnic groups. We were interested in studying whether sleep apnea contributed to hypertension control among African Americans.
We found that participants with sleep apnea were more likely to have resistant hypertension than those without sleep apnea. In particular, individuals with severe sleep apnea had the highest risk of resistant hypertension. Most of the participants with measured sleep apnea were undiagnosed (96%).(more…)
MedicalResearch.com Interview with:
Tom Marshall, MSc, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham, Birmingham, UK
MedicalResearch.com: What is the background for this study? Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea).
Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems.
Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.
(more…)
MedicalResearch.com Interview with:
Matthew P Butler, PhD
Assistant Professor, Oregon Institute of Occupational Health Sciences
Assistant Professor, Department of Behavioral Neuroscience
Oregon Health & Science University
Portland, OR 97239
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Obstructive sleep apnea (OSA) is associated with heart disease and mortality, but how OSA does this is not well understood. We are therefore looking for sub-phenotypes within OSA that will help us predict who is at greatest risk.
Current diagnosis of OSA is made on the basis of the apnea-hypopnea index (AHI – the number of respiratory events per hour of sleep). But the AHI is not a very good predictor of future mortality.
We tested the hypothesis that the duration of events (how long the breathing interruptions are) would predict risk. We found that those with the shortest breathing interruptions had the highest risk of dying, after accounting for other conditions like age, gender, race, and smoking status.(more…)
MedicalResearch.com Interview with:
Dr M Blagojevic-Bucknal
Senior Lecturer in Statistics Arthritis Research UK Primary Care Centre
Research Institute for Primary Care & Health Sciences
Keele University Staffordshire UKMedicalResearch.com: What is the background for this study? Response: Evidence suggests that elevated serum uric acid levels, the cause of gout, are also frequently identified in patients with sleep apnoea However, despite prevalent hyperuricaemia in patients with sleep apnoea, shared risk factors with gout of obesity and alcohol consumption, and research identifying the associations between gout and other co-morbidities, few studies have considered the possibility of an association between sleep apnoea and gout in short and long term.
(more…)
MedicalResearch.com Interview with:
Nathan E. Cross PhD, first author
School of Psychology.
Sharon L. Naismith, PhD, senior author
Leonard P Ullman Chair in Psychology
Brain and Mind Centre
Neurosleep, NHMRC Centre of Research Excellence
The University of Sydney, AustraliaMedicalResearch.com: What is the background for this study? What are the main findings?Response: Between 30 to 50% of the risk for dementia is due to modifiable risk factors such depression, hypertension, physical inactivity, obesity, diabetes and smoking.
In recent years, multiple longitudinal cohort studies have observed a link between sleep apnoea and a greater risk (1.85 to 2.6 times more likely) of developing cognitive decline and dementia. Furthermore, one study in over 8000 people also indicated that the presence of obstructive sleep apnoea (OSA) in older adults was associated with an earlier age of cognitive decline, and that treatment of OSA may delay the onset of cognitive impairment.
This study reveals important insights into how sleep disorders such as OSA may impact the brain in older adults, as it is associated with widespread structural alterations in diverse brain regions. We found that reduced blood oxygen levels during sleep are related to reduced thickness of the brain's cortex in both the left and right temporal areas - regions that are important in memory and are early sites of injury in Alzheimer's disease. Indeed, reduced thickness in these regions was associated with poorer ability to learn new information, thereby being the first to link this structural change to memory decline. (more…)
MedicalResearch.com Interview with:
[caption id="attachment_38315" align="alignleft" width="200"] One CPAP modelImage by Bryan Alexander[/caption]
Sebastian M. Jara, MD
Resident Physician & Research Fellow
Department of...
MedicalResearch.com Interview with:
Ricardo S Osorio MD
Center for Brain Health
Department of Psychiatry
Center of Excellence on Brain Aging
NYU Langone Medical Center
New York, NY 10016, USAMedicalResearch.com: What is the background for this study? What are the main findings?Response: This was a study that was performed in a group of healthy normal elderly from the community that volunteered for studies on memory and aging.
The main findings were that sleep apnea was very common, in almost all cases undiagnosed, and that it was associated with a longitudinal increase in amyloid burden which is considered one of the hallmark lesions of Alzheimer's disease
(more…)
MedicalResearch.com Interview with:
Stephanie S. Faubion, MD, FACP, NCMP, IF
Director, Executive and International Medicine
Director, Office of Women’s Health
Associate Professor of Medicine
Division of General Internal MedicineMedicalResearch.com: What is the background for this study? What are the main findings?Response: The Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was used for this study investigating the association between vasomotor symptoms (hot flashes and night sweats) and risk for obstructive sleep apnea, a common and underdiagnosed sleep disorder in women which is associated with increased cardiovascular risk.
We found that Women who had severe or very severe hot flashes or night sweats were more likely to be at increased risk for obstructive sleep apnea. This association held even after adjusting for age, body mass index, smoking and hypertension, such that the odds of women having intermediate /high risk for obstructive sleep apnea were 1.87 times higher for those with severe/very severe hot flashes/night sweats compared to those with less severe symptoms. We decided to analyze the group of women with normal body mass index, and indeed, this finding was still significant in the lean group of women.
(more…)
MedicalResearch.com Interview with:
Yue Leng, M.Phil, MD, PhD
Postdoctoral Research Fellow
Department of Psychiatry,
University of California, San Francisco
SFVAMCMedicalResearch.com: What is the background for this study? What are the main findings?
Response: Sleep-disordered breathing (SDB) is a very common but treatable condition in older adults. Recent evidence has suggested a link between SDB and cognitive decline in the elderly, but previous studies have been conflicting and have used different methods to examine SDB or cognition. Therefore, it is difficult to draw conclusion on the consistency of this association based on each individual study. Moreover, because each study has reported on specific domains using different scales, it is unclear if Sleep-disordered breathing has differential effects on cognitive domains.
The current study is the first to quantitively synthesize all published population-based studies, which covers a total of over 4 million adults, and concluded that people with Sleep-disordered breathing were 26% more likely to develop cognitive impairment than those without SDB. They also had slightly worse performance in executive function but not in global cognition or memory.(more…)
MedicalResearch.com Interview with:
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).
(more…)
MedicalResearch.com Interview with: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.
(more…)
MedicalResearch.com Interview with:Ken M. Kunisaki , MD
Associate Professor of Medicine
Pulmonary, Allergy, Critical Care and Sleep Medicine
University of MinnesotaMedical Research: What is the background for this study? What are the main findings?
Dr. Kunisaki : Obstructive sleep apnea (OSA) is a very common condition that is the result of recurrent complete or partial closure of the upper airway during sleep. OSA leads to poor sleep quality and excessive daytime sleepiness.
A previous study suggested that OSA is more common in the winter, but there were no vitamin D measurements in that study, which seemed potentially relevant since many people have lower vitamin D levels in the winter, due to less sunlight exposure in the winter. Several studies have also shown that people with low vitamin D levels have worse muscle function. Since muscles are partially responsible for keeping the upper airway open during sleep, we wondered whether people with low vitamin D levels might have weaker upper airway muscles and therefore be more prone to having OSA.
In our study, we found that indeed, persons with OSA had lower vitamin D levels than those without OSA, but this was explained by obesity. In other words, the low vitamin D levels seen in OSA patients is likely just a marker of obesity and not likely related to the presence or absence of OSA.
(more…)
[caption id="attachment_19645" align="alignleft" width="140"] Dr. Kohler[/caption]
MedicalResearch.com Interview with:
Prof. Malcolm Kohler, MD
Chair Respiratory Medicine
Clinical Director Department of Pulmonology
University Hospital of Zurich
Zurich...
MedicalResearch.com Interview with:
Soroush Zaghi, MDDepartment of Head and Neck Surgery
David Geffen School of Medicine at UCLA
University of California, Los Angeles
MedicalResearch: What is the central message for clinicians and surgeons from your results?Dr. Zaghi: Multiple studies from different practitioners and institutions agree that Maxillomandibular Advancement (MMA) is a highly effective surgical option for patients with obstructive sleep apnea who cannot tolerate positive pressure therapy and have not found success with other surgical procedures.
(more…)
MedicalResearch.com Interview with:
Sunil Sharma, M.DAssociate professor of pulmonary medicine
Sidney Kimmel Medical College at Thomas Jefferson University
Medical Research: What is the background for this study? What are the main findings?
Dr. Sharma: Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant cardiovascular implications. In this condition the patient may repeatedly quit breathing during sleep, sometimes hundreds of times, leading to loss of oxygen and frequent arousals throughout the night. OSA has been associated with high blood pressure, congestive heart failure, coronary artery disease, arrhythmias and stroke, among other conditions. While overall awareness is improving, the condition is under-recognized in hospitalized patients. Due to multiple co-morbid conditions these patients may be at higher risk for complications. Recent studies have also shown that early recognition of OSA in hospitalized patients may reduce readmission rates. In our study, we used a simple and cost-effective clinical pathway to determine high-risk patients. Of the 149 patient's determined to be high risk by our protocol, 128 (87%) were confirmed with the diagnosis by a polysomnography (gold standard test). Furthermore, data derived from a simple and cost-effective oxygen measuring device (pulse-oximeter) was found to co-relate well with the polysomnography. (more…)
MedicalResearch.com Interview with:
Marie Marklund, DDS senior lecturer
Department of Odontology, Faculty of Medicine
Umeå University
Sweden
MedicalResearch: What is the background for this study? What are the main findings?Response: Snoring and obstructive sleep apnea are common in the population and these disorders continuously increase because of the ongoing obesity epidemic in many countries. Today, 34% of men and 17% of women in the US suffer from obstructive sleep apnea of all severities. Symptoms include daytime sleepiness, poor sleep quality, headache, insomnia and restless legs. In the longer term, a more severe sleep apnea is associated with serious consequences, such as hypertension, stroke, cancer, traffic accidents and early death.
Continuous positive airway pressure is a highly effective treatment for sleep apnea patients. Adherence problems, for instance from nasal stuffiness and claustrophobia reduces its effectiveness. An oral appliance holds the lower jaw forwards during sleep in order to reduce snoring and sleep apneas. This therapy has primarily been suggested for snorers and patients with mild and moderate sleep apnea. No previous placebo-controlled study has, however, evaluated this specific group of patients. Results from more severe sleep apnea patients have shown a good effect on sleep apneas. The effect of oral appliances on daytime symptoms is unclear. Symptomatic improvement is an important outcome for milder sleep apnea patients.
The primary aims of the present study were to study the effects on daytime sleepiness and quality of life of a custom-made, adjustable oral appliance in patients with daytime sleepiness and snoring or mild to moderate sleep apnea, i.e. the primary target group for this type of therapy. Secondary aims included the effects on sleep apnea, snoring and various other symptoms of sleep disordered breathing such as headaches and restless legs. We found that oral appliance therapy was effective in reducing sleep apneas, snoring and symptoms of restless legs. The apnea-hypopnea index was normal (<5) in 49% of patients using the active appliance and in 11% using placebo, with a numbers needed to treat of three. Daytime sleepiness and quality of life did not differ during active treatment and the placebo intervention. The patients experienced reduced headaches with active treatment, but the results did not differ from placebo. It was concluded, that a custom-made, adjustable oral appliance reduces obstructive sleep apneas, snoring and possibly restless legs. The efficacy on daytime sleepiness and quality of life was weak and did not differ from placebo in this group of patients. (more…)
MedicalResearch.com Interview with:
Dr. Larry Chinitz MD
Professor of Medicine and Director, Cardiac Electrophysiology
NYU Langone Medical Center
MedicalResearch: What is the background for this study? What are the main findings?Dr. Chinitz: The treatment algorithms proposed currently for maintenance of sinus rhythm in patients with atrial fibrillation focus on use of anti-arrhythmic drugs and catheter ablation. Data available to evaluate the effect of modification of known adverse clinical factors on atrial fibrillation recurrence is scant.
Obstructive sleep apnea in a known factor associated with both new onset atrial fibrillation as well as its recurrence after catheter ablation. Through a meta-analysis of available data we found that use of continuous positive airway pressure in patients with sleep apnea was associated with a 42% relative risk reduction in recurrence of atrial fibrillation. This effect was similar across patient groups irrespective of whether they were medically managed or with catheter ablation.(more…)
MedicalResearch.com Interview with:
Dmitry Yaranov, MD
Danbury Hospital
Western Connecticut Health Network
Medical Research: What is the background for this study? What are the main findings?
Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification. (more…)
MedicalResearch.com Interview with:
Ron B. Mitchell, MD
Professor of Otolaryngology and Pediatrics
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children's Medical Center Dallas
ENT Clinic Dallas, TX 75207
Medical Research: What is the background for this study? What are the main findings?
Dr. Mitchell: The “gold standard” for the diagnosis of and quantification of obstructive sleep apnea (OSA) is polysomnography (PSG or a ‘sleep study’). However, the majorities of T&A procedures are done without PSG and are based on a clinical diagnosis. This is because PSG is expensive, requires overnight observation and is often unavailable. It is important to diagnose and quantify OSA as it allows for surgical planning and predicts the need and type of treatment after surgery.
We used data from the Childhood Adenotonsillectomy (CHAT) study; a large multicenter
trial (RCT), to look at the ability of clinical parameters to predict the severity of obstructive sleep apnea in children scheduled for a T&A.
The main findings of the study are that certain clinical parameters such as obesity and African American race as well as high scores on certain validated questionnaires (such as the pediatric sleep questionnaire- PSQ) are associated, but cannot predict OSA severity. PSG remains the only way to measure objectively the severity of OSA.
(more…)
MedicalResearch.comInterview with:
Amro Qaddoura BHSc
Research Student of Adrian Baranchuk, MD
Department of Medicine, Queen's University, Kingston, Ontario, Canada
MedicalResearch: What is the...
MedicalResearch.com Interview with: Dr. Marcus Povitz MD
Department of Community Health Sciences
University of Calgary, Calgary, Alberta, Canada
Adjunct Professor and Clinical Fellow
Western University Department of Medicine,
Western University, London, Ontario, Canada
Medical Research: What is the background for this study? What are the main findings?Dr. Povitz: Both depression and obstructive sleep apnea are important causes of illness and have overlapping symptoms. Both feature poor quality sleep, difficulty with concentration and memory as well as daytime sleepiness or fatigue. Previous research showed that depression is common in individuals with sleep apnea, but studies investigating the effect of treating sleep apnea on depressive symptoms have had conflicting results. Our study combined the results of all randomized controlled trials of participants who were treated for sleep apnea with CPAP or mandibular advancement devices where symptoms of depression were measured both before and after treatment. We found that in studies of individuals without a lot of symptoms of depression there was still a small improvement in these symptoms after treatment with CPAP or mandibular advancement device. In 2 studies of individuals with more symptoms of depression there was a large improvement in symptoms of depression.
(more…)
MedicalResearch.com Interview with:
Dr. Swati Gulati, MD Internal Medicine
John H. Stroger Hospital of Cook County
Chicago, IL
Medical Research: What are the...
MedicalResearch.com Interview with:Chitra Lal, MD. Assistant Professor
Medical University of South Carolina
Medical Research: What are the main findings of the study?Dr. Lal:We studied the prevalence of cognitive problems in early postmenopausal women (age 45-60 years) with obstructive sleep apnea syndrome (OSAS+) and without obstructive sleep apnea syndrome (OSAS-) using a questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI).
We found that the mean MCFSI scores after adjusting for depression were significantly higher in obstructive sleep apnea syndrome+ then the OSAS- group, indicating more self-reported cognitive difficulty in OSAS+ women
(more…)
MedicalResearch.com Interview with: Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen's University
Kingston, Ontario, Canada
Medical Research: What are the main findings of the study?Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.
We also found that the risk increases in patients with more severe obstructive sleep apnea.
This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
(more…)
MedicalResearch.com Interview with: Paul M. Macey, Ph.D.
Assistant Professor in Residence
Associate Dean for Information Technology and Innovations,
Chief Innovation Officer UCLA School of Nursing and Brain Research Institute
Medical Research: What are the main findings of the study?Dr. Macey:People with sleep apnea are less able to control the blood flowing to their brain, in particular when they grip tightly, or have their foot put in cold water. We measured changes in blood flowing through the brain using an MRI scanner while people gripped hard, had their foot placed in cold water, and breathed out hard into a tube with a very small hole in it. These activities all lead to more blood flowing to the brain in healthy people, which probably helps protect the cells from being starved of blood and oxygen. However, people with sleep apnea send less blood that the healthy participants during the gripped and cold foot activities.
A further important finding is that women with sleep apnea are worse off than men. The female patients showed much weaker blood flow than the males, even accounting for normal differences between men and women.
(more…)
MedicalResearch.com Interview with: Marcia KleinM.D., Ph.D.
Adjunctive professor Rio de Janeiro State University
This study was conducted at the Discipline of Clinical and Experimental Pathophysiology - Rio de Janeiro State University and the financial support of FAPERJ.
Medical Research: What was the main findings of the study?Dr. Klein: The main findings were that a diet with moderate calories restriction in obese patients with obstructive sleep apnea may be able not only to reduce body fat but also to reduce obstructive sleep apnea severity and blood pressure.
(more…)
MedicalResearch.com Interview with: Prof. Mary J MorrellFaculty of Medicine, National Heart & Lung InstituteProfessor of Sleep & Respiratory Physiology
Imperial College, London
Medical Research: What are the main findings of the study?Prof. Morrell:Our results showed that when older patients with obstructive sleep apnea were treated with continuous positive airway pressure (CPAP) they had significantly less daytime sleepiness than those not treated with CPAP. A comparison of the costs and benefits of treatment suggested that CPAP would meet the usual criteria for being funded by the NHS.
(more…)
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