Tag: sleep

Categories : LungTags :

Sleep Doctors are Concerned Over CPAP Negative Evaluation

On By ModernMedia

Sleep doctors are concerned about a draft report casting doubt on the clinical benefits of continuous positive airway pressure (CPAP), the clinical gold standard for sleep apnoea.

Reviewers from the Agency for Healthcare Research and Quality (AHRQ) found that studies of continuous positive airway pressure (CPAP) have consistently failed to show improvements in non-sleep-related outcomes linked to obstructive sleep apnea (OSA), such as stroke, heart attack, diabetes, and depression.

The report concluded that the published evidence “mostly does not support that CPAP prescription affects long-term, clinically important outcomes,” and it highlighted research gaps and methodological weaknesses in the available studies, along with significant CPAP compliance issues, which have all contributed to the failure to show long-term benefits for the treatment.

OSA specialists who spoke to MedPage Today about AHRQ’s research review agreed that CPAP remains by far the most effective treatment for sleep-related symptoms of OSA. They worried that the report could be misinterpreted as meaning that the treatment has no value. 
The US offers coverage for CPAP therapy under Medicare for patients with OSA, amounting to hundreds of millions of dollars per annum.. One recent study of Medicare recipients 56% were at high risk for OSA and possible candidates for treatment.

“The big fear that I have, and many of my colleagues have, is that the way this report is worded could easily be misinterpreted as saying that prescribing CPAP doesn’t improve these (long-term) outcomes, so we shouldn’t be paying for it,” said David Rapoport, MD, who directs the sleep medicine research program at the Icahn School of Medicine at Mount Sinai in New York City.

He said that it is widely recognised that CPAP is the most effective treatment for improving OSA symptoms, such as snoring and daytime sleepiness.

“Nothing else even comes close,” he said. “CPAP is really a remarkable treatment for addressing the breathing disorder associated with obstructive sleep apnea. But it has to be used, and compliance remains a big issue.”

The AHRQ review included data from 47 long term (≥6 or 12 months) randomised clinical trials for OSA.

Investigators noted that the studies used “highly inconsistent” definitions of measures such as respiratory events, as well as the Apnoea-Hypopnoea Index (AHI) metric.

“No standard definition of this measure exists and whether AHI (and associated measures) are valid surrogate measures of clinical outcomes is unknown,” the report states.

Elise Berliner, PhD, of AHRQ, told MedPage Today that addressing the inconsistencies and limitations of the existing studies should be a top priority of the sleep research community. She added that definitions should be standardised.

“I do think the community needs to get together and figure out how to do better studies,” she said. “We need larger and longer studies, and there is also the issue of compliance. In most of the studies, people were not using these devices all night long.”

The report found that the existing randomized controlled trials provide low strength of evidence that CPAP affects all-cause mortality, stroke and myocardial infarction risk, or other cardiovascular outcomes. Researchers also concluded that insufficient evidence exists showing an impact for CPAP on the risk for automobile accidents, depression, and anxiety and hypertension.

Sanjay Patel, MD, of the University of Pittsburgh, agreed inconsistency and poor CPAP compliance in sleep studies have made it difficult to assess its  impact on mortality and most other long-term outcomes.

But he, like Dr Rapoport, expressed concern that some will interpret the findings to mean that CPAP is ineffective.

“The thinking in the field has been that treatment may help prevent diseases like diabetes and heart disease that are related to sleep apnea,” he told MedPage Today. “This report says we don’t have good evidence on this, but it doesn’t really distinguish between outcomes where we do and do not have enough research to say definitively that treatment with CPAP isn’t beneficial.”

Dr Patel served on the writing committee for the American Academy of Sleep Medicine’s (AASM) latest clinical practice guidelines for OSA treatment with CPAP. He observed that the guidelines differ from the AHRQ findings, in that CPAP has been shown to lower blood pressure in hypertensive OSA patients.

The AHRQ analysis was also restricted to 6 month follow-ups or longer, while the AASM’s writing committee considered studies with shorter follow-up times.

“The effect [of CPAP] on blood pressure can be seen at 1 month,” he said. “Multiple studies with 3 months of follow-up show improvements in blood pressure, but AHRQ did not look at those studies.”

While CPAP is still considered the most effective treatment for OSA, Dr Rapoport said there is a growing recognition within the sleep medicine field that it’s not for everyone, given the ongoing issues with compliance.

“In the past, other treatments such as mandibular advancement devices have been marginalized,” he said. “These treatments don’t work nearly as well as CPAP in terms of lowering AHI, but they do work well for many patients, and people who are prescribed them actually use them. Until recently, there wasn’t much acceptance that this was good enough. But there is now greater recognition that we should maybe be prescribing treatments that aren’t perfect if people are more likely to use them.”

Source: MedPage Today

Categories : Neurodegenerative DiseasesTags :

Sleep Apnoea Treatment May Reduce Risk of Dementia

On By ModernMedia

Older adults receiving positive airway pressure therapy for obstructive sleep apnoea (OSA) may have a lower risk of developing Alzheimer’s disease and other kinds of dementia, according to a new study.

In a nationally representative study, Researchers from Michigan Medicine’s Sleep Disorders Centers analysed Medicare claims of over 50 000 Medicare beneficiaries 65 and older with OSA. They sought to find out whether people using positive airway pressure therapy had less risk of receiving a new diagnosis of dementia or mild cognitive impairment over the next 3 years, compared to those not using positive airway pressure therapy.

“We found a significant association between positive airway pressure use and lower risk of Alzheimer’s and other types of dementia over three years, suggesting that positive airway pressure may be protective against dementia risk in people with OSA,” said lead author Galit Levi Dunietz, PhD, MPH, an assistant professor of neurology and sleep epidemiologist.

The findings stress the impact of sleep on cognitive function. “If a causal pathway exists between OSA treatment and dementia risk, as our findings suggest, diagnosis and effective treatment of OSA could play a key role in the cognitive health of older adults,” said principal investigator Tiffany J. Braley, MD, MS, associate professor of neurology.

Obstructive sleep apnoea is a condition where there are episodes of complete or partial collapse of the airway with an associated decrease in oxygen saturation or arousal from sleep. This disturbance results in fragmented, nonrestorative sleep, and is associated with a variety of other neurological and cardiovascular conditions. Many older adults are at high risk for OSA. Dementia is prevalent as well, with roughly 5.8 million Americans currently living with it, said Prof Braley.

Source: Medical Xpress

Journal information: G L Dunietz et al, Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults, Sleep (2021). DOI: 10.1093/sleep/zsab076

Categories : Metabolic Disorders PaediatricsTags :

Regular Sleep Patterns in Toddlers Important for BMI

On By ModernMedia

Although getting regular sleep patterns in toddlers has long been a priority for parents, researchers have shown it is important for toddlers’ BMI.

The researchers, led by Lauren Covington, an assistant professor in the University of Delaware School of Nursing, investigated the link between poverty, regular sleep patterns and BMI in toddlers. According to The National Sleep Foundation, toddlers 1- to 3-years-old should have 12 to 14 hours of sleep in a 24-hour period.

“We’ve known for a while that physical activity and diet quality are very strong predictors of weight and BMI,” said Prof Covington, the lead author of the article. “I think it’s really highlighting that sleep may be playing a bigger role here than it’s been given credit for.”

The researchers aimed to investigate the relationship between poverty and BMI in toddlers, and wanted to see whether sleep behaviour, activity or food intake could provide the explanation.

Using data from families in an obesity prevention trial, 70% of whom were below the poverty line, and all eligible for nutritional supplementation grants, Toddlers were given accelerometers to wear to measure physical activity and parents filled out food diaries.

The researchers found that children from households with greater poverty were more likely to have greater inconsistent bedtimes, and those with more inconsistent bedtimes had higher BMI percentages.

Prof Covington said this is likely to be a bidirectional relationship. “There’s a lot of teasing out the relationships of the mechanisms that are at play here, which is really difficult to do because I think they’re all influencing each other,” she said.

Having consistent bedtimes where children go to bed within one hour of the normal time is a recommended guideline, but for families in poverty this may be impossible for a variety of reasons. Single parent households and juggling multiple jobs are part of the challenges they face.

“Implementing a consistent bedtime could be one behavioural change that a family could potentially do,” said Prof Covington. “It’s more attainable than maybe getting healthy food at the grocery store or playing outside on the playground, especially now with the cold weather. Just having a consistent bedtime can help provide some sense of structure, but then maybe have better implications for health and BMI as well.”

Source: Medical Xpress

Journal information: Lauren Covington et al. Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families, Annals of Behavioral Medicine (2020). DOI: 10.1093/abm/kaaa100

Categories : GeneticsTags :

Study Reveals the Genetics of Daytime Napping

On By ModernMedia

Genes play a role in how often, if at all, people take daytime naps, research has revealed.

Identifying dozens of genetic regions associated with napping, a team of researchers from Massachusetts General Hospital (MGH) and the University of Murcia in Spain conducted the largest study of its kind. Additionally, they discovered genetic links to cardiometabolic health. 

“Napping is somewhat controversial,” said Hassan Saeed Dashti, PhD, RD, of the MGH Center for Genomic Medicine, co-lead author of the report. Dashti noted that some countries (such as Spain) which featured daytime napping in their culture now discourage it. Conversely, some companies in the United States now promote napping as a productivity. “It was important to try to disentangle the biological pathways that contribute to why we nap,” said Dashti.

In a Genome-Wide Association Study, the MGH researchers used genomic data obtained from the UK Biobank, which holds the genomes of 452 633 people. They replicated their findings using data from the company 23andMe which has obtained data from 541 333 people. The participants had rated their daytime napping habits, and a subset wore accelerometers to provide objective verification of resting behaviour. A number of the genes analysed were also already known to be associated with sleep.

The GWAS identified 123 genetic areas associated with napping. On further investigation, the researchers identified three factors which promote napping:

Sleep propensity: Some people require more sleep than others.
Disrupted sleep: Daytime napping can make up for poor sleep the previous night.
Early morning awakening: People who wake up too early can ‘get back’ some sleeping` time.

“This tells us that daytime napping is biologically driven and not just an environmental or behavioural choice,” said Dashti. Some of these subtypes were linked to cardiometabolic health concerns, such as waist circumference.

“Future work may help to develop personalised recommendations for siesta,” concluded Garaulet.

A number of the genes related to napping were already associated with orexin, a neuropeptide involved in wakefulness, as well as a number of other areas such as mood and feeding behaviour. This pathway is known to be associated with narcolepsy, but the findings suggested that smaller perturbations seem to be associated with napping.

Source: Medical Xpress

Journal information: Dashti, H.S., Daghlas, I., Lane, J.M. et al. Genetic determinants of daytime napping and effects on cardiometabolic health. Nat Commun 12, 900 (2021). doi.org/10.1038/s41467-020-20585-3 , www.nature.com/articles/s41467-020-20585-3