Key clinical point: Disgust sensitivity may act as a potential trigger or predisposition factor for irritable bowel syndrome (IBS), particularly in women.

Major finding: Disgust sensitivity was positively correlated with IBS (correlation coefficient [r] 0.251; P = .014), with the correlation being significant in women (P = .021) but not in men (P = .505). No correlation was observed between IBS and disgust propensity (P = .911) or total disgust score (P = .115).

Study details: This study included 105 healthy participants who completed the Disgust Propensity and Sensitivity Scale-Revised, IBS-Quality of Life Measure, and Chronic Urticaria-Quality of Life Measure questionnaires.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Formica S et al. Relationship between sensitivity to disgust and irritable bowel syndrome: A study on healthy individuals. Clin Neuropsychiatry. 2022;19(4):230-235 (Aug). Doi: 10.36131/cnfioritieditore20220405

Key clinical point: Disgust sensitivity may act as a potential trigger or predisposition factor for irritable bowel syndrome (IBS), particularly in women.

Major finding: Disgust sensitivity was positively correlated with IBS (correlation coefficient [r] 0.251; P = .014), with the correlation being significant in women (P = .021) but not in men (P = .505). No correlation was observed between IBS and disgust propensity (P = .911) or total disgust score (P = .115).

Study details: This study included 105 healthy participants who completed the Disgust Propensity and Sensitivity Scale-Revised, IBS-Quality of Life Measure, and Chronic Urticaria-Quality of Life Measure questionnaires.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Formica S et al. Relationship between sensitivity to disgust and irritable bowel syndrome: A study on healthy individuals. Clin Neuropsychiatry. 2022;19(4):230-235 (Aug). Doi: 10.36131/cnfioritieditore20220405

Key clinical point: Disgust sensitivity may act as a potential trigger or predisposition factor for irritable bowel syndrome (IBS), particularly in women.

Major finding: Disgust sensitivity was positively correlated with IBS (correlation coefficient [r] 0.251; P = .014), with the correlation being significant in women (P = .021) but not in men (P = .505). No correlation was observed between IBS and disgust propensity (P = .911) or total disgust score (P = .115).

Study details: This study included 105 healthy participants who completed the Disgust Propensity and Sensitivity Scale-Revised, IBS-Quality of Life Measure, and Chronic Urticaria-Quality of Life Measure questionnaires.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Formica S et al. Relationship between sensitivity to disgust and irritable bowel syndrome: A study on healthy individuals. Clin Neuropsychiatry. 2022;19(4):230-235 (Aug). Doi: 10.36131/cnfioritieditore20220405

Key clinical point: Cimetropium, drotaverine, and acupuncture were more effective in improving abdominal pain than placebo in patients with irritable bowel syndrome (IBS), with acupuncture being more effective than pinaverium in relieving global IBS symptoms and causing fewer adverse events than other antispasmodics.

Major finding: Cimetropium (standardized mean difference [SMD] −3.00; 95% CI −4.47 to −1.53) was the most effective for relieving abdominal pain, with drotaverine, acupuncture, and pinaverium being superior to placebo. Acupuncture vs pinaverium more effectively relieved global IBS symptoms (SMD −1.11; 95% CI −1.94 to −0.28). The adverse event rate was lower with acupuncture vs most antispasmodics.

Study details: The data come from an adjusted indirect treatment comparison meta-analysis of 35 randomized control trials including 5190 participants.

Disclosures: This study was supported by the National Key Research and Development Program of the Ministry of Science and Technology of the People’s Republic of China and others. The authors declared no conflicts of interest.

Source: Shi YZ et al. Acupuncture vs antispasmodics in the treatment of irritable bowel syndrome: An adjusted indirect treatment comparison meta-analysis. Front Physiol. 2022; 13:1001978 (Oct 6). Doi: 10.3389/fphys.2022.1001978

Key clinical point: Cimetropium, drotaverine, and acupuncture were more effective in improving abdominal pain than placebo in patients with irritable bowel syndrome (IBS), with acupuncture being more effective than pinaverium in relieving global IBS symptoms and causing fewer adverse events than other antispasmodics.

Major finding: Cimetropium (standardized mean difference [SMD] −3.00; 95% CI −4.47 to −1.53) was the most effective for relieving abdominal pain, with drotaverine, acupuncture, and pinaverium being superior to placebo. Acupuncture vs pinaverium more effectively relieved global IBS symptoms (SMD −1.11; 95% CI −1.94 to −0.28). The adverse event rate was lower with acupuncture vs most antispasmodics.

Study details: The data come from an adjusted indirect treatment comparison meta-analysis of 35 randomized control trials including 5190 participants.

Disclosures: This study was supported by the National Key Research and Development Program of the Ministry of Science and Technology of the People’s Republic of China and others. The authors declared no conflicts of interest.

Source: Shi YZ et al. Acupuncture vs antispasmodics in the treatment of irritable bowel syndrome: An adjusted indirect treatment comparison meta-analysis. Front Physiol. 2022; 13:1001978 (Oct 6). Doi: 10.3389/fphys.2022.1001978

Key clinical point: Cimetropium, drotaverine, and acupuncture were more effective in improving abdominal pain than placebo in patients with irritable bowel syndrome (IBS), with acupuncture being more effective than pinaverium in relieving global IBS symptoms and causing fewer adverse events than other antispasmodics.

Major finding: Cimetropium (standardized mean difference [SMD] −3.00; 95% CI −4.47 to −1.53) was the most effective for relieving abdominal pain, with drotaverine, acupuncture, and pinaverium being superior to placebo. Acupuncture vs pinaverium more effectively relieved global IBS symptoms (SMD −1.11; 95% CI −1.94 to −0.28). The adverse event rate was lower with acupuncture vs most antispasmodics.

Study details: The data come from an adjusted indirect treatment comparison meta-analysis of 35 randomized control trials including 5190 participants.

Disclosures: This study was supported by the National Key Research and Development Program of the Ministry of Science and Technology of the People’s Republic of China and others. The authors declared no conflicts of interest.

Source: Shi YZ et al. Acupuncture vs antispasmodics in the treatment of irritable bowel syndrome: An adjusted indirect treatment comparison meta-analysis. Front Physiol. 2022; 13:1001978 (Oct 6). Doi: 10.3389/fphys.2022.1001978

Key clinical point: Treatment with anaerobically cultivated human intestinal microbiota (ACHIM) suspension or donor fecal microbiota transplantation (donor-FMT) but not placebo changed gut microbiota profiles in patients with irritable bowel syndrome (IBS) to those measured in healthy control individuals along with significant changes in bacterial strain signal.

Major finding: Patients receiving donor-FMT vs placebo had more significant bacterial strain signals for Actinobacteria spp. and Bifidobacteria spp., whereas those receiving ACHIM or donor-FMT vs placebo had more significant signals for Alistipes onderdonkii (all P < .05). After receiving ACHIM suspension or donor-FMT, but not placebo, the bacterial signal in patients resembled more that in healthy controls. No post-transplant complications were reported.

Study details: The data come from a randomized controlled study including 43 patients with IBS-D who received ACHIM suspension (n = 17), donor-FMT (n = 11), or placebo (patient’s own feces; n = 15).

Disclosures: This study was funded by Helse Vest, Norway. The authors declared no conflicts of interest.

Source: Mazzawi T et al. The effect of anaerobically cultivated human intestinal microbiota compared to fecal microbiota transplantation on gut microbiota profile and symptoms of irritable bowel syndrome, a double-blind placebo-controlled study. Microorganisms. 2022;10(9):1819 (Sep 11). Doi: 10.3390/microorganisms10091819

Key clinical point: Treatment with anaerobically cultivated human intestinal microbiota (ACHIM) suspension or donor fecal microbiota transplantation (donor-FMT) but not placebo changed gut microbiota profiles in patients with irritable bowel syndrome (IBS) to those measured in healthy control individuals along with significant changes in bacterial strain signal.

Major finding: Patients receiving donor-FMT vs placebo had more significant bacterial strain signals for Actinobacteria spp. and Bifidobacteria spp., whereas those receiving ACHIM or donor-FMT vs placebo had more significant signals for Alistipes onderdonkii (all P < .05). After receiving ACHIM suspension or donor-FMT, but not placebo, the bacterial signal in patients resembled more that in healthy controls. No post-transplant complications were reported.

Study details: The data come from a randomized controlled study including 43 patients with IBS-D who received ACHIM suspension (n = 17), donor-FMT (n = 11), or placebo (patient’s own feces; n = 15).

Disclosures: This study was funded by Helse Vest, Norway. The authors declared no conflicts of interest.

Source: Mazzawi T et al. The effect of anaerobically cultivated human intestinal microbiota compared to fecal microbiota transplantation on gut microbiota profile and symptoms of irritable bowel syndrome, a double-blind placebo-controlled study. Microorganisms. 2022;10(9):1819 (Sep 11). Doi: 10.3390/microorganisms10091819

Key clinical point: Treatment with anaerobically cultivated human intestinal microbiota (ACHIM) suspension or donor fecal microbiota transplantation (donor-FMT) but not placebo changed gut microbiota profiles in patients with irritable bowel syndrome (IBS) to those measured in healthy control individuals along with significant changes in bacterial strain signal.

Major finding: Patients receiving donor-FMT vs placebo had more significant bacterial strain signals for Actinobacteria spp. and Bifidobacteria spp., whereas those receiving ACHIM or donor-FMT vs placebo had more significant signals for Alistipes onderdonkii (all P < .05). After receiving ACHIM suspension or donor-FMT, but not placebo, the bacterial signal in patients resembled more that in healthy controls. No post-transplant complications were reported.

Study details: The data come from a randomized controlled study including 43 patients with IBS-D who received ACHIM suspension (n = 17), donor-FMT (n = 11), or placebo (patient’s own feces; n = 15).

Disclosures: This study was funded by Helse Vest, Norway. The authors declared no conflicts of interest.

Source: Mazzawi T et al. The effect of anaerobically cultivated human intestinal microbiota compared to fecal microbiota transplantation on gut microbiota profile and symptoms of irritable bowel syndrome, a double-blind placebo-controlled study. Microorganisms. 2022;10(9):1819 (Sep 11). Doi: 10.3390/microorganisms10091819

Key clinical point: Modest conformation exists between subjective reporting of the Bristol Stool Form Scale (BSFS) and fecal consistency measured by stool water content in irritable bowel syndrome (IBS), warranting caution when using BSFS reporting for subtyping IBS.

Major finding: BSFS scores significantly correlated with stool water content (correlation coefficient [r] 0.36, P < .0001); however, 77% of stool samples referred as BSFS 1-2 had a water content of ≤68.5% and 52.0% of samples referred as BSFS 6-7 had a water content of ≥78%. Sensitivity and specificity for BSFS 1-2 were 32% and 94%, respectively, and those for BSFS 6-7 were 37% and 93%, respectively.

Study details: The data come from a subanalysis of a previous randomized three-way crossover trial including 110 participants with severe-to-moderate IBS who underwent 1-week provocation with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; gluten; or placebo.

Disclosures: This study was funded by Formas and the Swedish Research Council. The authors declared no conflicts of interest.

Source: Nordin E et al. Modest conformity between self-reporting of Bristol stool form and fecal consistency measured by stool water content in irritable bowel syndrome, a FODMAP and gluten trial. Am J Gastroenterol. 2022;117(10):1668-1674 (Aug 12). Doi: 10.14309/ajg.0000000000001942

Key clinical point: Modest conformation exists between subjective reporting of the Bristol Stool Form Scale (BSFS) and fecal consistency measured by stool water content in irritable bowel syndrome (IBS), warranting caution when using BSFS reporting for subtyping IBS.

Major finding: BSFS scores significantly correlated with stool water content (correlation coefficient [r] 0.36, P < .0001); however, 77% of stool samples referred as BSFS 1-2 had a water content of ≤68.5% and 52.0% of samples referred as BSFS 6-7 had a water content of ≥78%. Sensitivity and specificity for BSFS 1-2 were 32% and 94%, respectively, and those for BSFS 6-7 were 37% and 93%, respectively.

Study details: The data come from a subanalysis of a previous randomized three-way crossover trial including 110 participants with severe-to-moderate IBS who underwent 1-week provocation with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; gluten; or placebo.

Disclosures: This study was funded by Formas and the Swedish Research Council. The authors declared no conflicts of interest.

Source: Nordin E et al. Modest conformity between self-reporting of Bristol stool form and fecal consistency measured by stool water content in irritable bowel syndrome, a FODMAP and gluten trial. Am J Gastroenterol. 2022;117(10):1668-1674 (Aug 12). Doi: 10.14309/ajg.0000000000001942

Key clinical point: Modest conformation exists between subjective reporting of the Bristol Stool Form Scale (BSFS) and fecal consistency measured by stool water content in irritable bowel syndrome (IBS), warranting caution when using BSFS reporting for subtyping IBS.

Major finding: BSFS scores significantly correlated with stool water content (correlation coefficient [r] 0.36, P < .0001); however, 77% of stool samples referred as BSFS 1-2 had a water content of ≤68.5% and 52.0% of samples referred as BSFS 6-7 had a water content of ≥78%. Sensitivity and specificity for BSFS 1-2 were 32% and 94%, respectively, and those for BSFS 6-7 were 37% and 93%, respectively.

Study details: The data come from a subanalysis of a previous randomized three-way crossover trial including 110 participants with severe-to-moderate IBS who underwent 1-week provocation with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; gluten; or placebo.

Disclosures: This study was funded by Formas and the Swedish Research Council. The authors declared no conflicts of interest.

Source: Nordin E et al. Modest conformity between self-reporting of Bristol stool form and fecal consistency measured by stool water content in irritable bowel syndrome, a FODMAP and gluten trial. Am J Gastroenterol. 2022;117(10):1668-1674 (Aug 12). Doi: 10.14309/ajg.0000000000001942

Key clinical point: Bowel symptoms and psychosocial features were not significantly different among patients with irritable bowel syndrome (IBS) who experienced only pain (Rome IV criteria) or discomfort (seen in Rome III but not Rome IV criteria) as the predominant abdominal symptom associated with defecation.

Major finding: Overall, 33.8% of patients who met the Rome III criteria for IBS failed to meet the Rome IV criteria. Bowel habits, coexisting extragastrointestinal pain, comorbid anxiety, depression, and IBS quality-of-life scores were not significantly different between patients with pain and those with discomfort.

Study details: This study included 367 patients who met the Rome III criteria for IBS; patients were categorized into the only pain (n = 233), only discomfort (n = 83), or pain and discomfort (n = 51) group according to the predominant abdominal symptom associated with defecation.

Disclosures: This study was supported by the Program of International S & T Cooperation, the National Natural Science Foundation of China, and others. The authors declared no conflicts of interest.

Source: Fang XC et al. Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain? World J Gastroenterol. 2022;28(33):4861-4874 (Sep 7). Doi: 10.3748/wjg.v28.i33.4861

Key clinical point: Bowel symptoms and psychosocial features were not significantly different among patients with irritable bowel syndrome (IBS) who experienced only pain (Rome IV criteria) or discomfort (seen in Rome III but not Rome IV criteria) as the predominant abdominal symptom associated with defecation.

Major finding: Overall, 33.8% of patients who met the Rome III criteria for IBS failed to meet the Rome IV criteria. Bowel habits, coexisting extragastrointestinal pain, comorbid anxiety, depression, and IBS quality-of-life scores were not significantly different between patients with pain and those with discomfort.

Study details: This study included 367 patients who met the Rome III criteria for IBS; patients were categorized into the only pain (n = 233), only discomfort (n = 83), or pain and discomfort (n = 51) group according to the predominant abdominal symptom associated with defecation.

Disclosures: This study was supported by the Program of International S & T Cooperation, the National Natural Science Foundation of China, and others. The authors declared no conflicts of interest.

Source: Fang XC et al. Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain? World J Gastroenterol. 2022;28(33):4861-4874 (Sep 7). Doi: 10.3748/wjg.v28.i33.4861

Key clinical point: Bowel symptoms and psychosocial features were not significantly different among patients with irritable bowel syndrome (IBS) who experienced only pain (Rome IV criteria) or discomfort (seen in Rome III but not Rome IV criteria) as the predominant abdominal symptom associated with defecation.

Major finding: Overall, 33.8% of patients who met the Rome III criteria for IBS failed to meet the Rome IV criteria. Bowel habits, coexisting extragastrointestinal pain, comorbid anxiety, depression, and IBS quality-of-life scores were not significantly different between patients with pain and those with discomfort.

Study details: This study included 367 patients who met the Rome III criteria for IBS; patients were categorized into the only pain (n = 233), only discomfort (n = 83), or pain and discomfort (n = 51) group according to the predominant abdominal symptom associated with defecation.

Disclosures: This study was supported by the Program of International S & T Cooperation, the National Natural Science Foundation of China, and others. The authors declared no conflicts of interest.

Source: Fang XC et al. Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain? World J Gastroenterol. 2022;28(33):4861-4874 (Sep 7). Doi: 10.3748/wjg.v28.i33.4861

Key clinical point: A gluten-free diet influenced bowel habits and had significant positive effects on irritable bowel syndrome (IBS) symptom severity, abdominal pain intensity, and daily life interference.

Major finding: In patients with IBS, the IBS-severity scoring system total score (P = .02), abdominal pain intensity (P = .02), and daily life interference (P = .04) improved significantly after the gluten-free intervention but not after the gluten-containing intervention. Patients with IBS reported fewer loose stools during the gluten-free vs gluten-containing intervention (19.2% vs 27.4%; P = .01).

Study details: The data come from a randomized controlled trial (PROT-IBS) including 20 patients with IBS and 21 healthy control individuals who were challenged with gluten (14 g/day) or rice flour during two 14-day interventions, while adhering to a strict gluten-free diet.

Disclosures: This study was funded by the Swedish Research Council and other sources. Some authors declared receiving consulting fees or research grants or serving on advisory boards for various sources.

Source: Algera JP et al. Randomised controlled trial: Effects of gluten-free diet on symptoms and the gut microenvironment in irritable bowel syndrome. Aliment Pharmacol Ther. 2022;56(9):1318-1327 (Sep 29). Doi: 10.1111/apt.17239

Key clinical point: A gluten-free diet influenced bowel habits and had significant positive effects on irritable bowel syndrome (IBS) symptom severity, abdominal pain intensity, and daily life interference.

Major finding: In patients with IBS, the IBS-severity scoring system total score (P = .02), abdominal pain intensity (P = .02), and daily life interference (P = .04) improved significantly after the gluten-free intervention but not after the gluten-containing intervention. Patients with IBS reported fewer loose stools during the gluten-free vs gluten-containing intervention (19.2% vs 27.4%; P = .01).

Study details: The data come from a randomized controlled trial (PROT-IBS) including 20 patients with IBS and 21 healthy control individuals who were challenged with gluten (14 g/day) or rice flour during two 14-day interventions, while adhering to a strict gluten-free diet.

Disclosures: This study was funded by the Swedish Research Council and other sources. Some authors declared receiving consulting fees or research grants or serving on advisory boards for various sources.

Source: Algera JP et al. Randomised controlled trial: Effects of gluten-free diet on symptoms and the gut microenvironment in irritable bowel syndrome. Aliment Pharmacol Ther. 2022;56(9):1318-1327 (Sep 29). Doi: 10.1111/apt.17239

Key clinical point: A gluten-free diet influenced bowel habits and had significant positive effects on irritable bowel syndrome (IBS) symptom severity, abdominal pain intensity, and daily life interference.

Major finding: In patients with IBS, the IBS-severity scoring system total score (P = .02), abdominal pain intensity (P = .02), and daily life interference (P = .04) improved significantly after the gluten-free intervention but not after the gluten-containing intervention. Patients with IBS reported fewer loose stools during the gluten-free vs gluten-containing intervention (19.2% vs 27.4%; P = .01).

Study details: The data come from a randomized controlled trial (PROT-IBS) including 20 patients with IBS and 21 healthy control individuals who were challenged with gluten (14 g/day) or rice flour during two 14-day interventions, while adhering to a strict gluten-free diet.

Disclosures: This study was funded by the Swedish Research Council and other sources. Some authors declared receiving consulting fees or research grants or serving on advisory boards for various sources.

Source: Algera JP et al. Randomised controlled trial: Effects of gluten-free diet on symptoms and the gut microenvironment in irritable bowel syndrome. Aliment Pharmacol Ther. 2022;56(9):1318-1327 (Sep 29). Doi: 10.1111/apt.17239

Cardiovascular health (CVH) scores that include sleep predicted CV disease risk among older U.S. adults, supporting the American Heart Association’s recent inclusion of sleep in its own checklist.

Sleep duration is now considered “an essential component for ideal heart and brain health,” according to the AHA’s updated checklist, now called Life’s Essential 8. “Our study is the first to show that sleep metrics add independent predictive value for CVD events over and above the original seven cardiovascular health metrics, providing support for updating the guidelines from Life’s Simple 7 (LS7) to Life’s Essential 8,” lead author Nour Makarem, PhD, of the Mailman School of Public Health at Columbia University Irving Medical Center, New York, said in an interview.

For the study, her team compared four versions of LS7 checklists that included sleep in relation to cardiovascular disease (CVD) risk.

“CVH scores that included sleep duration alone as a measure of overall sleep health, as well as scores that included multiple dimensions of sleep health (that is, sleep duration, efficiency, and regularity, daytime sleepiness, and sleep disorders), were both predictive of future CVD,” she said.

Study participants scoring in the highest tertile of the CVH checklists that included sleep had up to a 47% lower CVD risk.

Sleeping 7 hours or more but less than 9 hours nightly was considered “ideal,” according to the study, which was published online  in the Journal of the American Heart Association.
 

Lower the odds

Dr. Makarem and colleagues analyzed data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) sleep study using overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and outcomes. They used the data to evaluate the four iterations of an expanded LS7 score:

• Score 1 included sleep duration;
• Score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea [OSA]);
• Score 3 included sleep characteristics associated with CVD in MESA (sleep duration and efficiency, daytime sleepiness, and OSA); and
• Score 4, also based on CVD in MESA, included sleep regularity.

Among 1,920 participants (mean age 69 years; 54% women; 40%, White individuals), the mean LS7 score was 7.3, and the means of the alternate CVH scores that included sleep ranged from 7.4 to 7.8 (scores range from 0 to 14, with higher scores indicating better CVH).

On actigraphy, 63% of participants slept less than 7 hours; 30% slept less than 6 hours; 39% had high night-to-night variability in sleep duration; and 25% had high variability in sleep onset timing.

Overall, 10% had sleep efficiency less than 85%; 14% had excessive daytime sleepiness; 36% had high insomnia symptoms; and 47% had moderate to severe OSA. Short-duration sleepers also had a higher prevalence of overweight/obesity, diabetes, and hypertension and had lower mean LS7 scores.

During a mean follow-up of 4.4 years, 95 prevalent CVD events and 93 incident cases occurred.

Higher scores on all four expanded versions were related to lower odds of having CVD. Participants in the highest versus the lowest tertile of the LS7 score had 75% lower CVD odds (odds ratio, 0.25). Similarly, those in the highest versus the lowest tertile of CVH scores 1 and 2 had 71% and 80% lower odds of prevalent CVD (OR, 0.29 and OR, 0.20), respectively.

Overall, participants in the highest versus lowest tertile of the LS7 score and all CVH scores had up to 80% lower odds of prevalent CVD; those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratios, 0.57 and 0.53), respectively.

The LS7 score alone was not significantly associated with CVD incidence (HR, 0.62).

“Clinicians should ask patients about their sleep health and emphasize the importance of prioritizing sleep for heart disease prevention,” Dr. Makarem said.
 

Sleep ‘devalued’

“The sleep field has been fighting to get more sleep education into medical education for decades,” AHA volunteer expert Michael A. Grandner, PhD, Director of the Sleep & Health Research Program and of the Behavioral Sleep Medicine Clinic at the University of Arizona College of Medicine, Tucson, said in an interview.

“To my knowledge, there still is not a lot of attention given to it, partly because the culture in medical school and among residents is one of not sleeping,” said Dr. Grandner, who was not involved in the study. “The culture among physicians is ‘Who needs sleep? I function fine without it.’ ”

“Sleep made it to the checklist because it is a biological requirement for human life,” he noted. “We sleep for the same reason we breathe and drink. It’s an imperative. Yet we live in a society that devalues sleep.”

It’s “extremely unusual” for a doctor to ask a patient how they’re sleeping, he said. “It’s also pretty unusual to have sleep-related conversations between doctors and patients, especially in the context of health, not just, ‘Hey, doc, I can’t sleep, throw me a pill.’”

Clinicians should be asking every patient about how they’re sleeping at every visit, Dr. Grandner said. “It’s now part of the official definition of heart health. Just like you would be remiss if you didn’t ask about smoking or test blood pressure, you’d be missing something important by not asking about sleep – something that has similar billing to diet, exercise, blood pressure, and all the other ‘essentials.’ ”

No commercial funding or conflicts of interest were declared.

A version of this article first appeared on Medscape.com.

Cardiovascular health (CVH) scores that include sleep predicted CV disease risk among older U.S. adults, supporting the American Heart Association’s recent inclusion of sleep in its own checklist.

Sleep duration is now considered “an essential component for ideal heart and brain health,” according to the AHA’s updated checklist, now called Life’s Essential 8. “Our study is the first to show that sleep metrics add independent predictive value for CVD events over and above the original seven cardiovascular health metrics, providing support for updating the guidelines from Life’s Simple 7 (LS7) to Life’s Essential 8,” lead author Nour Makarem, PhD, of the Mailman School of Public Health at Columbia University Irving Medical Center, New York, said in an interview.

For the study, her team compared four versions of LS7 checklists that included sleep in relation to cardiovascular disease (CVD) risk.

“CVH scores that included sleep duration alone as a measure of overall sleep health, as well as scores that included multiple dimensions of sleep health (that is, sleep duration, efficiency, and regularity, daytime sleepiness, and sleep disorders), were both predictive of future CVD,” she said.

Study participants scoring in the highest tertile of the CVH checklists that included sleep had up to a 47% lower CVD risk.

Sleeping 7 hours or more but less than 9 hours nightly was considered “ideal,” according to the study, which was published online  in the Journal of the American Heart Association.
 

Lower the odds

Dr. Makarem and colleagues analyzed data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) sleep study using overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and outcomes. They used the data to evaluate the four iterations of an expanded LS7 score:

• Score 1 included sleep duration;
• Score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea [OSA]);
• Score 3 included sleep characteristics associated with CVD in MESA (sleep duration and efficiency, daytime sleepiness, and OSA); and
• Score 4, also based on CVD in MESA, included sleep regularity.

Among 1,920 participants (mean age 69 years; 54% women; 40%, White individuals), the mean LS7 score was 7.3, and the means of the alternate CVH scores that included sleep ranged from 7.4 to 7.8 (scores range from 0 to 14, with higher scores indicating better CVH).

On actigraphy, 63% of participants slept less than 7 hours; 30% slept less than 6 hours; 39% had high night-to-night variability in sleep duration; and 25% had high variability in sleep onset timing.

Overall, 10% had sleep efficiency less than 85%; 14% had excessive daytime sleepiness; 36% had high insomnia symptoms; and 47% had moderate to severe OSA. Short-duration sleepers also had a higher prevalence of overweight/obesity, diabetes, and hypertension and had lower mean LS7 scores.

During a mean follow-up of 4.4 years, 95 prevalent CVD events and 93 incident cases occurred.

Higher scores on all four expanded versions were related to lower odds of having CVD. Participants in the highest versus the lowest tertile of the LS7 score had 75% lower CVD odds (odds ratio, 0.25). Similarly, those in the highest versus the lowest tertile of CVH scores 1 and 2 had 71% and 80% lower odds of prevalent CVD (OR, 0.29 and OR, 0.20), respectively.

Overall, participants in the highest versus lowest tertile of the LS7 score and all CVH scores had up to 80% lower odds of prevalent CVD; those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratios, 0.57 and 0.53), respectively.

The LS7 score alone was not significantly associated with CVD incidence (HR, 0.62).

“Clinicians should ask patients about their sleep health and emphasize the importance of prioritizing sleep for heart disease prevention,” Dr. Makarem said.
 

Sleep ‘devalued’

“The sleep field has been fighting to get more sleep education into medical education for decades,” AHA volunteer expert Michael A. Grandner, PhD, Director of the Sleep & Health Research Program and of the Behavioral Sleep Medicine Clinic at the University of Arizona College of Medicine, Tucson, said in an interview.

“To my knowledge, there still is not a lot of attention given to it, partly because the culture in medical school and among residents is one of not sleeping,” said Dr. Grandner, who was not involved in the study. “The culture among physicians is ‘Who needs sleep? I function fine without it.’ ”

“Sleep made it to the checklist because it is a biological requirement for human life,” he noted. “We sleep for the same reason we breathe and drink. It’s an imperative. Yet we live in a society that devalues sleep.”

It’s “extremely unusual” for a doctor to ask a patient how they’re sleeping, he said. “It’s also pretty unusual to have sleep-related conversations between doctors and patients, especially in the context of health, not just, ‘Hey, doc, I can’t sleep, throw me a pill.’”

Clinicians should be asking every patient about how they’re sleeping at every visit, Dr. Grandner said. “It’s now part of the official definition of heart health. Just like you would be remiss if you didn’t ask about smoking or test blood pressure, you’d be missing something important by not asking about sleep – something that has similar billing to diet, exercise, blood pressure, and all the other ‘essentials.’ ”

No commercial funding or conflicts of interest were declared.

A version of this article first appeared on Medscape.com.

Cardiovascular health (CVH) scores that include sleep predicted CV disease risk among older U.S. adults, supporting the American Heart Association’s recent inclusion of sleep in its own checklist.

Sleep duration is now considered “an essential component for ideal heart and brain health,” according to the AHA’s updated checklist, now called Life’s Essential 8. “Our study is the first to show that sleep metrics add independent predictive value for CVD events over and above the original seven cardiovascular health metrics, providing support for updating the guidelines from Life’s Simple 7 (LS7) to Life’s Essential 8,” lead author Nour Makarem, PhD, of the Mailman School of Public Health at Columbia University Irving Medical Center, New York, said in an interview.

For the study, her team compared four versions of LS7 checklists that included sleep in relation to cardiovascular disease (CVD) risk.

“CVH scores that included sleep duration alone as a measure of overall sleep health, as well as scores that included multiple dimensions of sleep health (that is, sleep duration, efficiency, and regularity, daytime sleepiness, and sleep disorders), were both predictive of future CVD,” she said.

Study participants scoring in the highest tertile of the CVH checklists that included sleep had up to a 47% lower CVD risk.

Sleeping 7 hours or more but less than 9 hours nightly was considered “ideal,” according to the study, which was published online  in the Journal of the American Heart Association.
 

Lower the odds

Dr. Makarem and colleagues analyzed data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) sleep study using overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and outcomes. They used the data to evaluate the four iterations of an expanded LS7 score:

• Score 1 included sleep duration;
• Score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea [OSA]);
• Score 3 included sleep characteristics associated with CVD in MESA (sleep duration and efficiency, daytime sleepiness, and OSA); and
• Score 4, also based on CVD in MESA, included sleep regularity.

Among 1,920 participants (mean age 69 years; 54% women; 40%, White individuals), the mean LS7 score was 7.3, and the means of the alternate CVH scores that included sleep ranged from 7.4 to 7.8 (scores range from 0 to 14, with higher scores indicating better CVH).

On actigraphy, 63% of participants slept less than 7 hours; 30% slept less than 6 hours; 39% had high night-to-night variability in sleep duration; and 25% had high variability in sleep onset timing.

Overall, 10% had sleep efficiency less than 85%; 14% had excessive daytime sleepiness; 36% had high insomnia symptoms; and 47% had moderate to severe OSA. Short-duration sleepers also had a higher prevalence of overweight/obesity, diabetes, and hypertension and had lower mean LS7 scores.

During a mean follow-up of 4.4 years, 95 prevalent CVD events and 93 incident cases occurred.

Higher scores on all four expanded versions were related to lower odds of having CVD. Participants in the highest versus the lowest tertile of the LS7 score had 75% lower CVD odds (odds ratio, 0.25). Similarly, those in the highest versus the lowest tertile of CVH scores 1 and 2 had 71% and 80% lower odds of prevalent CVD (OR, 0.29 and OR, 0.20), respectively.

Overall, participants in the highest versus lowest tertile of the LS7 score and all CVH scores had up to 80% lower odds of prevalent CVD; those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratios, 0.57 and 0.53), respectively.

The LS7 score alone was not significantly associated with CVD incidence (HR, 0.62).

“Clinicians should ask patients about their sleep health and emphasize the importance of prioritizing sleep for heart disease prevention,” Dr. Makarem said.
 

Sleep ‘devalued’

“The sleep field has been fighting to get more sleep education into medical education for decades,” AHA volunteer expert Michael A. Grandner, PhD, Director of the Sleep & Health Research Program and of the Behavioral Sleep Medicine Clinic at the University of Arizona College of Medicine, Tucson, said in an interview.

“To my knowledge, there still is not a lot of attention given to it, partly because the culture in medical school and among residents is one of not sleeping,” said Dr. Grandner, who was not involved in the study. “The culture among physicians is ‘Who needs sleep? I function fine without it.’ ”

“Sleep made it to the checklist because it is a biological requirement for human life,” he noted. “We sleep for the same reason we breathe and drink. It’s an imperative. Yet we live in a society that devalues sleep.”

It’s “extremely unusual” for a doctor to ask a patient how they’re sleeping, he said. “It’s also pretty unusual to have sleep-related conversations between doctors and patients, especially in the context of health, not just, ‘Hey, doc, I can’t sleep, throw me a pill.’”

Clinicians should be asking every patient about how they’re sleeping at every visit, Dr. Grandner said. “It’s now part of the official definition of heart health. Just like you would be remiss if you didn’t ask about smoking or test blood pressure, you’d be missing something important by not asking about sleep – something that has similar billing to diet, exercise, blood pressure, and all the other ‘essentials.’ ”

No commercial funding or conflicts of interest were declared.

A version of this article first appeared on Medscape.com.

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: In patients receiving atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC), alpha-fetoprotein (AFP) responses of 50% and 20% served as predictors of overall response rate (ORR) and disease control rate (DCR), respectively, with both responses being associated with progression-free survival (PFS).

Major finding: An AFP relative decrease of ≥50% was associated with ORR (odds ratio 5.7; 95% CI 1.9-17) and PFS (hazard ratio [HR] 5.60; P  =  .006), whereas that of ≥20% was associated with DCR (positive predictive value 100%; sensitivity 52.0%) and PFS (HR 4.44; P < .001).

Study details: This multicenter prospective study included 91 patients with unresectable HCC and AFP ≥10 ng/mL who were treated with atezolizumab and bevacizumab.

Disclosures: This study was supported by the Japan Agency for Medical Research and Development. Two authors declared receiving lecture fees from a pharmaceutical company.

Source: Tamaki N et al. Optimal threshold of alpha-fetoprotein response in patients with unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab. Invest New Drugs. 2022 (Sep 24). Doi: 10.1007/s10637-022-01303-w

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6