Archive for April, 2007

Cleveland study of weight-loss surgery patients finds that 90 percent have medical condition

Nine in every 10 patients awaiting weight-loss surgery suffer from sleep apnea, a much higher percentage than are typically diagnosed, a University Hospitals of Cleveland study has found.

In a group of 249 patients followed between December 2003 and August 2005, 19 percent had been diagnosed with obstructive sleep apnea. However, after all the patients were tested in sleep labs before surgery, it was found that 91 percent of those patients actually had the condition.

“It’s a medical disease that is really under-recognized,” said Dr. Peter Hallowell, a UH bariatric surgeon who led the study with Dr. Thomas A. Stellato.

“Hypertension is known as the silent killer and sleep apnea is the same exact thing,” he said. “People are going to work everyday, getting sleepy during the day, getting sleepy behind the wheel and getting in accidents. There’s a certain public health concern with this. That’s one of the big take-home messages of this.”

Sleep apnea is a condition that causes people to stop breathing for 10 to 20 seconds during sleep, sometimes as often as 20 to 30 times an hour. It can lead to hypertension, daytime sleepiness, mood swings, headaches and depression.

A mild head injury can increase your chance of developing a sleep disorder, according to a study published in the April 3, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.

Researchers say these findings highlight the need for improved diagnosis and treatment of sleep disorders in mild traumatic brain injury patients who complain of insomnia.

“As many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia,” said study author Liat Ayalon, PhD, with the University of California, San Diego. “This is concerning since sleeping problems may exacerbate other brain injury symptoms such as headache, emotional distress, and cognitive impairment, making the rehabilitation process much harder.”

For the study, researchers assessed 42 people who reported to the Sheba Medical Center in Israel with complaints of insomnia after mild traumatic brain injury.

Those suspected of having a circadian rhythm sleep disorder (CRSD) (i.e. problems with the timing of sleep) underwent scans, sleep studies, and had their oral temperature and saliva melatonin measured.

The study found 15 of the 42 patients, or 36 percent, had a CRSD. Of those, eight people had a delayed sleep phase syndrome with problems falling asleep and waking up, and seven people had irregular sleep-wake patterns.

Increased habitual alcohol consumption among men is associated with an increased risk of a mild or worse sleep-related breathing disorder (SRBD), according to a study published in the April 15th issue of the Journal of Clinical Sleep Medicine (JCSM).

The study, authored by Paul E. Peppard, PhD, and colleagues at the University of Wisconsin-Madison, focused on 775 men and 645 women, who were evaluated for alcohol consumption and a sleep-related breathing disorder.

It was discovered that, relative to men who consumed less alcohol, for each increment of one drink per day, men who consumed more alcohol had 25 percent greater odds of a mild or worse SRBD.

Among women, minimal to moderate alcohol consumption was not significantly associated with an increased risk of an SRBD.

According to Peppard, possible explanations for this include the limited range of alcohol consumption reported by women in the study sample, reducing the ability to detect clinically important moderate associations.

The testosterone levels of healthy men decline as they get older. As sleep quality and quantity typically decrease with age, objectively measured differences in the amount of sleep a healthy older man gets can affect his level of testosterone in the morning, according to a study published in the April 1st issue of the journal SLEEP

The study, conducted by Plamen Penev, MD, PhD, of the University of Chicago, focused on 12 healthy men between the ages of 64 and 74. Three morning blood samples were pooled for the measurement of total and free testosterone.

In addition to overnight laboratory polysomnography, wrist activity monitoring for six-to-nine days were used to determine the amount of nighttime sleep of the participants in everyday life settings.

The main outcome levels were total sleep time and morning testosterone levels. Analyses revealed that the amount of nighttime sleep measured by polysomnography was an independent predictor of the subjects’ morning total and free testosterone levels.

Sleep continuity disturbance impairs endogenous pain-inhibitory function and increases spontaneous pain in women. This supports a possible pathophysiologic role of sleep disturbance in chronic pain, according to a study published in the April 1st issue of the journal SLEEP.

The study, conducted by Michael T. Smith, PhD, and colleagues at John’s Hopkins University, focused on 32 healthy females, who were studied polysomnographically for seven nights.

On the first two nights, the subjects slept undisturbed for eight hours. Then, the women were assigned to one of three groups: “Control”, “Forced Awakening” (FA) and “Restricted Sleep Opportunity” (RSO).

From nights three-to-five, the “Control” group continued to sleep undisturbed, while the “Forced Awakening” group underwent eight forced awakenings, one per hour, and the “Restricted Sleep Opportunity” group received partial sleep deprivation by delayed bedtime. On night six, both the FA and RSO groups underwent 36 hours of total sleep deprivation, followed by 11-hour recovery sleep.

Older Americans are convinced that a good night’s sleep is necessary to maintaining their health. A survey by the Gallup Poll found that seventy-two percent of seniors have discussed poor sleep with their doctors.

The study also found no clear consensus on the safety of sleep medications such as Ambien and Lunesta - also known as hypnotics.

In another study from the National Institutes of Health (NIH) titled “The Treatment of Sleep Disorders of Older People”, NIH estimates that disturbances of sleep affect more than half of people aged 65 and older.

They advise hypnotic medications should not be the mainstay treatment of insomnia as “they are overused and have habit forming potential”. Some of their recommendations include exercise, avoidance of alcohol and caffeine, and reduced fluid intake in the evening.

Actigraphy, the use of a portable device that records movement over extended periods of time, and has been used extensively in the study of sleep and circadian rhythms, provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and in-patients suspected of certain sleep disorders, according to practice parameters published in the April 1st issue of the journal SLEEP.

The practice parameters, authored by the American Academy of Sleep Medicine’s (AASM) Standards of Practice Committee, were developed as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations.

Actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome, delayed sleep phase syndrome, and shift work disorder.

Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24 hour sleep/wake syndrome.

Further, when polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea.