Pulmonary Health Hub

DENVER – Much of the rising prevalence of insomnia among U.S. and Canadian adults may be driven by the sharp reduction in the use of hormone replacement therapy following the 2002 report from the Women’s Health Initiative, Sheila N. Garland, PhD, said at the annual meeting of the Associated Professional Sleep Societies.

“In 2002 the Women’s Health Initiative came out with findings that hormone replacement therapy increased the risk of coronary heart disease, breast cancer, stroke, and pulmonary embolism [JAMA. 2002 Jul 17;288(3):321-33]. A lot of women on hormone replacement therapy up until 2002 stopped using it then. The increase in difficulty sleeping we found between 2002 and 2012 could perhaps represent an untreated menopausal symptom,” according to Dr. Garland, a psychologist at Memorial University of Newfoundland in St. John’s.

© Karen Winton / iStockphoto.com

She presented an analysis of data from the Canadian Community Health Survey, a national once-per-decade survey, which included 34,118 adults aged 20-80 years and older in the 2002 version and 23,089 in 2012.

The key finding from the standpoint of sleep medicine, the prevalence of self-reported trouble sleeping, increased from 15.6% in 2002 to 17.1% in 2012. And this increase was concentrated in 40- to 59-year-old women, where the prevalence of insomnia or poor sleep rose from 19% to 24.3%, the highest of any age group. Rates remained flat over time in men and women aged 20-39 years and 60-80 years and older as well as in 40- to 59-year-old men.

The sleep-related question put to survey participants in face-to-face or telephone interviews was this: “How often do you have trouble going to sleep or staying asleep?” If they answered “most of the time” or “all of the time” they were classified as having poor sleep.

When Dr. Garland saw the survey results she immediately asked herself, “What is happening with Canadian women?” She came up with two theories. They are not mutually exclusive. One hinges on the dramatic drop off in the use of hormone replacement therapy in response to the Women’s Health Initiative report. The other theory is that the increasing prevalence of insomnia in middle-aged women is a manifestation of stress among the growing population of what has been called “the sandwich generation,” people who care for their aging parents while also supporting their own children. Those responsibilities most often fall upon the mother.

She noted that a similar rise in the prevalence of insomnia or trouble sleeping is occurring south of the border – in the United States – as documented in a Centers for Disease Control and Prevention analysis. The CDC investigators examined data on 30,970 adult participants in the 2002 National Health Interview Survey, 23,344 in the 2007 survey, and 34,509 in the 2012 survey. The prevalence of insomnia or trouble sleeping increased from 17.5% in 2002 to 19.2% in 2012. That absolute 1.7% increase pairs well with the 1.5% rise over the same time frame in the Canadian survey. The prevalence was higher in U.S. women than men in all three survey years (Sleep Med. 2015 Mar;16[3]:372-8).

Dr. Garland said the Canadian national survey contains data on self-perceived stress levels. She plans to analyze those results to learn if being a member of the sandwich generation is a significant contributor to poor sleep.

Regardless of the underlying mechanism, she continued, it’s clear from these large national surveys that middle-aged women are particularly vulnerable to poor sleep.

“Increased recognition is necessary. Prevention and intervention programs may be warranted, given the individual and societal consequences of poor sleep, including increased psychiatric and medical disorders, work absenteeism, and health care costs,” she said.

One audience member rose to congratulate Dr. Garland on her detective work. He commented that her notion that the rise in insomnia can be traced to fallout from the 2002 Women’s Health Initiative is consistent with his own clinical experience.

“The most common way women over age 40 present to our sleep center with insomnia is because they’re menopausal and not on hormone replacement therapy,” he said.

The Canadian Community Health Survey is sponsored by Statistics Canada. Dr. Garland reported having no financial conflicts of interest.

[email protected]

DENVER – Much of the rising prevalence of insomnia among U.S. and Canadian adults may be driven by the sharp reduction in the use of hormone replacement therapy following the 2002 report from the Women’s Health Initiative, Sheila N. Garland, PhD, said at the annual meeting of the Associated Professional Sleep Societies.

“In 2002 the Women’s Health Initiative came out with findings that hormone replacement therapy increased the risk of coronary heart disease, breast cancer, stroke, and pulmonary embolism [JAMA. 2002 Jul 17;288(3):321-33]. A lot of women on hormone replacement therapy up until 2002 stopped using it then. The increase in difficulty sleeping we found between 2002 and 2012 could perhaps represent an untreated menopausal symptom,” according to Dr. Garland, a psychologist at Memorial University of Newfoundland in St. John’s.

© Karen Winton / iStockphoto.com

She presented an analysis of data from the Canadian Community Health Survey, a national once-per-decade survey, which included 34,118 adults aged 20-80 years and older in the 2002 version and 23,089 in 2012.

The key finding from the standpoint of sleep medicine, the prevalence of self-reported trouble sleeping, increased from 15.6% in 2002 to 17.1% in 2012. And this increase was concentrated in 40- to 59-year-old women, where the prevalence of insomnia or poor sleep rose from 19% to 24.3%, the highest of any age group. Rates remained flat over time in men and women aged 20-39 years and 60-80 years and older as well as in 40- to 59-year-old men.

The sleep-related question put to survey participants in face-to-face or telephone interviews was this: “How often do you have trouble going to sleep or staying asleep?” If they answered “most of the time” or “all of the time” they were classified as having poor sleep.

When Dr. Garland saw the survey results she immediately asked herself, “What is happening with Canadian women?” She came up with two theories. They are not mutually exclusive. One hinges on the dramatic drop off in the use of hormone replacement therapy in response to the Women’s Health Initiative report. The other theory is that the increasing prevalence of insomnia in middle-aged women is a manifestation of stress among the growing population of what has been called “the sandwich generation,” people who care for their aging parents while also supporting their own children. Those responsibilities most often fall upon the mother.

She noted that a similar rise in the prevalence of insomnia or trouble sleeping is occurring south of the border – in the United States – as documented in a Centers for Disease Control and Prevention analysis. The CDC investigators examined data on 30,970 adult participants in the 2002 National Health Interview Survey, 23,344 in the 2007 survey, and 34,509 in the 2012 survey. The prevalence of insomnia or trouble sleeping increased from 17.5% in 2002 to 19.2% in 2012. That absolute 1.7% increase pairs well with the 1.5% rise over the same time frame in the Canadian survey. The prevalence was higher in U.S. women than men in all three survey years (Sleep Med. 2015 Mar;16[3]:372-8).

Dr. Garland said the Canadian national survey contains data on self-perceived stress levels. She plans to analyze those results to learn if being a member of the sandwich generation is a significant contributor to poor sleep.

Regardless of the underlying mechanism, she continued, it’s clear from these large national surveys that middle-aged women are particularly vulnerable to poor sleep.

“Increased recognition is necessary. Prevention and intervention programs may be warranted, given the individual and societal consequences of poor sleep, including increased psychiatric and medical disorders, work absenteeism, and health care costs,” she said.

One audience member rose to congratulate Dr. Garland on her detective work. He commented that her notion that the rise in insomnia can be traced to fallout from the 2002 Women’s Health Initiative is consistent with his own clinical experience.

“The most common way women over age 40 present to our sleep center with insomnia is because they’re menopausal and not on hormone replacement therapy,” he said.

The Canadian Community Health Survey is sponsored by Statistics Canada. Dr. Garland reported having no financial conflicts of interest.

[email protected]

DENVER – Much of the rising prevalence of insomnia among U.S. and Canadian adults may be driven by the sharp reduction in the use of hormone replacement therapy following the 2002 report from the Women’s Health Initiative, Sheila N. Garland, PhD, said at the annual meeting of the Associated Professional Sleep Societies.

“In 2002 the Women’s Health Initiative came out with findings that hormone replacement therapy increased the risk of coronary heart disease, breast cancer, stroke, and pulmonary embolism [JAMA. 2002 Jul 17;288(3):321-33]. A lot of women on hormone replacement therapy up until 2002 stopped using it then. The increase in difficulty sleeping we found between 2002 and 2012 could perhaps represent an untreated menopausal symptom,” according to Dr. Garland, a psychologist at Memorial University of Newfoundland in St. John’s.

© Karen Winton / iStockphoto.com

She presented an analysis of data from the Canadian Community Health Survey, a national once-per-decade survey, which included 34,118 adults aged 20-80 years and older in the 2002 version and 23,089 in 2012.

The key finding from the standpoint of sleep medicine, the prevalence of self-reported trouble sleeping, increased from 15.6% in 2002 to 17.1% in 2012. And this increase was concentrated in 40- to 59-year-old women, where the prevalence of insomnia or poor sleep rose from 19% to 24.3%, the highest of any age group. Rates remained flat over time in men and women aged 20-39 years and 60-80 years and older as well as in 40- to 59-year-old men.

The sleep-related question put to survey participants in face-to-face or telephone interviews was this: “How often do you have trouble going to sleep or staying asleep?” If they answered “most of the time” or “all of the time” they were classified as having poor sleep.

When Dr. Garland saw the survey results she immediately asked herself, “What is happening with Canadian women?” She came up with two theories. They are not mutually exclusive. One hinges on the dramatic drop off in the use of hormone replacement therapy in response to the Women’s Health Initiative report. The other theory is that the increasing prevalence of insomnia in middle-aged women is a manifestation of stress among the growing population of what has been called “the sandwich generation,” people who care for their aging parents while also supporting their own children. Those responsibilities most often fall upon the mother.

She noted that a similar rise in the prevalence of insomnia or trouble sleeping is occurring south of the border – in the United States – as documented in a Centers for Disease Control and Prevention analysis. The CDC investigators examined data on 30,970 adult participants in the 2002 National Health Interview Survey, 23,344 in the 2007 survey, and 34,509 in the 2012 survey. The prevalence of insomnia or trouble sleeping increased from 17.5% in 2002 to 19.2% in 2012. That absolute 1.7% increase pairs well with the 1.5% rise over the same time frame in the Canadian survey. The prevalence was higher in U.S. women than men in all three survey years (Sleep Med. 2015 Mar;16[3]:372-8).

Dr. Garland said the Canadian national survey contains data on self-perceived stress levels. She plans to analyze those results to learn if being a member of the sandwich generation is a significant contributor to poor sleep.

Regardless of the underlying mechanism, she continued, it’s clear from these large national surveys that middle-aged women are particularly vulnerable to poor sleep.

“Increased recognition is necessary. Prevention and intervention programs may be warranted, given the individual and societal consequences of poor sleep, including increased psychiatric and medical disorders, work absenteeism, and health care costs,” she said.

One audience member rose to congratulate Dr. Garland on her detective work. He commented that her notion that the rise in insomnia can be traced to fallout from the 2002 Women’s Health Initiative is consistent with his own clinical experience.

“The most common way women over age 40 present to our sleep center with insomnia is because they’re menopausal and not on hormone replacement therapy,” he said.

The Canadian Community Health Survey is sponsored by Statistics Canada. Dr. Garland reported having no financial conflicts of interest.

[email protected]

Patients who have survived sepsis or septic shock do not receive any significant benefit in the quality of their mental health by receiving primary care management intervention, according to a new study published by JAMA.

“Many survivors of sepsis have multiple medical comorbidities that are typically managed in primary care [but] interventions for managing sepsis sequelae in primary care have not been developed,” states the study, which was led by Jochen Gensichen, MD, of the Institute of General Practice & Family Medicine at Jena (Germany) University Hospital.

©invisioner/thinkstockphotos.com

“To our knowledge, this is the first large-scale, randomized controlled clinical trial of an intervention to improve outcomes in survivors of sepsis in primary care,” Dr. Gensichen and his coinvestigators added.

The study recruited sepsis and septic shock survivors from nine ICUs across Germany between February 2011 and December 2014, excluding any patients with cognitive impairment, defined as a Telephone Interview of Cognitive Status score no greater than 27. Ultimately, 291 patients aged 18 years or older (mean age of 61.6 years) were selected for inclusion and randomized into cohorts receiving either primary care–based intervention (n = 148) or usual care (n = 143) (JAMA. 2016;315:2703-11. doi: 10.1001/jama.2016.7207).

Those assigned to the usual care cohort received the standard care that their primary care providers would normally carry out, which included “periodic contacts, referrals to specialists, and prescription of medication and therapeutic aids at quantities comparable with those for other populations with multiple chronic conditions.” Those in the other cohort were given active monitoring of symptoms from providers who had been given evidence-based care training and clinical decision support from nurses who underwent training to become case managers. Case managers would take patients through an hour-long face-to-face training on sepsis sequelae within 2-20 days of ICU discharge, along with subsequent follow-up conversations over the phone.

“Case managers monitored patients’ symptoms using validated screening tools to assess critical illness polyneuropathy/myopathy, wasting, neurocognitive deficits, [posttraumatic stress disorder], depressive and pain symptoms, as well as patient self-management behaviors focusing on physical activity and individual self-management goals,” the authors said, noting that case managers would report their results to a consulting physician who “supervised the case managers and provided clinical decision support to the [primary care physicians].”

Baseline Mental Component Summary (MCS) scores were taken for subjects in both cohorts to determine mental health-based quality of life, which averaged 49.1 for the intervention cohort and 49.3 for the control. MCS scores at 6 months’ follow-up were 52.9 for the intervention group (95% confidence interval, 1.05-6.54) and 51.0 for the control group (95% CI, –1.22-4.51), for a mean change of 3.8 in the intervention cohort and 1.6 for the control group. The mean treatment effect was 2.15 (95% CI, –1.79-6.09; P = .28), indicating no significant difference between the two.

“There was no evidence for a differential treatment effect on the study’s primary outcome, postsepsis MCS scores,” the authors concluded. “This finding is similar to those from previous trials of care management interventions following critical illness.”

The authors added that “further research is needed to determine if modified approaches to primary care management may be more effective.”

The study was funded by the Center for Sepsis Control and Care, the German Federal Ministry of Education and Research, and the German Sepsis Society. Dr. Gensichen reported receiving personal fees from the Primary Health Care Foundation and receiving a grant from the German Federal Ministry of Education and Research.

[email protected]

Patients who have survived sepsis or septic shock do not receive any significant benefit in the quality of their mental health by receiving primary care management intervention, according to a new study published by JAMA.

“Many survivors of sepsis have multiple medical comorbidities that are typically managed in primary care [but] interventions for managing sepsis sequelae in primary care have not been developed,” states the study, which was led by Jochen Gensichen, MD, of the Institute of General Practice & Family Medicine at Jena (Germany) University Hospital.

©invisioner/thinkstockphotos.com

“To our knowledge, this is the first large-scale, randomized controlled clinical trial of an intervention to improve outcomes in survivors of sepsis in primary care,” Dr. Gensichen and his coinvestigators added.

The study recruited sepsis and septic shock survivors from nine ICUs across Germany between February 2011 and December 2014, excluding any patients with cognitive impairment, defined as a Telephone Interview of Cognitive Status score no greater than 27. Ultimately, 291 patients aged 18 years or older (mean age of 61.6 years) were selected for inclusion and randomized into cohorts receiving either primary care–based intervention (n = 148) or usual care (n = 143) (JAMA. 2016;315:2703-11. doi: 10.1001/jama.2016.7207).

Those assigned to the usual care cohort received the standard care that their primary care providers would normally carry out, which included “periodic contacts, referrals to specialists, and prescription of medication and therapeutic aids at quantities comparable with those for other populations with multiple chronic conditions.” Those in the other cohort were given active monitoring of symptoms from providers who had been given evidence-based care training and clinical decision support from nurses who underwent training to become case managers. Case managers would take patients through an hour-long face-to-face training on sepsis sequelae within 2-20 days of ICU discharge, along with subsequent follow-up conversations over the phone.

“Case managers monitored patients’ symptoms using validated screening tools to assess critical illness polyneuropathy/myopathy, wasting, neurocognitive deficits, [posttraumatic stress disorder], depressive and pain symptoms, as well as patient self-management behaviors focusing on physical activity and individual self-management goals,” the authors said, noting that case managers would report their results to a consulting physician who “supervised the case managers and provided clinical decision support to the [primary care physicians].”

Baseline Mental Component Summary (MCS) scores were taken for subjects in both cohorts to determine mental health-based quality of life, which averaged 49.1 for the intervention cohort and 49.3 for the control. MCS scores at 6 months’ follow-up were 52.9 for the intervention group (95% confidence interval, 1.05-6.54) and 51.0 for the control group (95% CI, –1.22-4.51), for a mean change of 3.8 in the intervention cohort and 1.6 for the control group. The mean treatment effect was 2.15 (95% CI, –1.79-6.09; P = .28), indicating no significant difference between the two.

“There was no evidence for a differential treatment effect on the study’s primary outcome, postsepsis MCS scores,” the authors concluded. “This finding is similar to those from previous trials of care management interventions following critical illness.”

The authors added that “further research is needed to determine if modified approaches to primary care management may be more effective.”

The study was funded by the Center for Sepsis Control and Care, the German Federal Ministry of Education and Research, and the German Sepsis Society. Dr. Gensichen reported receiving personal fees from the Primary Health Care Foundation and receiving a grant from the German Federal Ministry of Education and Research.

[email protected]

Patients who have survived sepsis or septic shock do not receive any significant benefit in the quality of their mental health by receiving primary care management intervention, according to a new study published by JAMA.

“Many survivors of sepsis have multiple medical comorbidities that are typically managed in primary care [but] interventions for managing sepsis sequelae in primary care have not been developed,” states the study, which was led by Jochen Gensichen, MD, of the Institute of General Practice & Family Medicine at Jena (Germany) University Hospital.

©invisioner/thinkstockphotos.com

“To our knowledge, this is the first large-scale, randomized controlled clinical trial of an intervention to improve outcomes in survivors of sepsis in primary care,” Dr. Gensichen and his coinvestigators added.

The study recruited sepsis and septic shock survivors from nine ICUs across Germany between February 2011 and December 2014, excluding any patients with cognitive impairment, defined as a Telephone Interview of Cognitive Status score no greater than 27. Ultimately, 291 patients aged 18 years or older (mean age of 61.6 years) were selected for inclusion and randomized into cohorts receiving either primary care–based intervention (n = 148) or usual care (n = 143) (JAMA. 2016;315:2703-11. doi: 10.1001/jama.2016.7207).

Those assigned to the usual care cohort received the standard care that their primary care providers would normally carry out, which included “periodic contacts, referrals to specialists, and prescription of medication and therapeutic aids at quantities comparable with those for other populations with multiple chronic conditions.” Those in the other cohort were given active monitoring of symptoms from providers who had been given evidence-based care training and clinical decision support from nurses who underwent training to become case managers. Case managers would take patients through an hour-long face-to-face training on sepsis sequelae within 2-20 days of ICU discharge, along with subsequent follow-up conversations over the phone.

“Case managers monitored patients’ symptoms using validated screening tools to assess critical illness polyneuropathy/myopathy, wasting, neurocognitive deficits, [posttraumatic stress disorder], depressive and pain symptoms, as well as patient self-management behaviors focusing on physical activity and individual self-management goals,” the authors said, noting that case managers would report their results to a consulting physician who “supervised the case managers and provided clinical decision support to the [primary care physicians].”

Baseline Mental Component Summary (MCS) scores were taken for subjects in both cohorts to determine mental health-based quality of life, which averaged 49.1 for the intervention cohort and 49.3 for the control. MCS scores at 6 months’ follow-up were 52.9 for the intervention group (95% confidence interval, 1.05-6.54) and 51.0 for the control group (95% CI, –1.22-4.51), for a mean change of 3.8 in the intervention cohort and 1.6 for the control group. The mean treatment effect was 2.15 (95% CI, –1.79-6.09; P = .28), indicating no significant difference between the two.

“There was no evidence for a differential treatment effect on the study’s primary outcome, postsepsis MCS scores,” the authors concluded. “This finding is similar to those from previous trials of care management interventions following critical illness.”

The authors added that “further research is needed to determine if modified approaches to primary care management may be more effective.”

The study was funded by the Center for Sepsis Control and Care, the German Federal Ministry of Education and Research, and the German Sepsis Society. Dr. Gensichen reported receiving personal fees from the Primary Health Care Foundation and receiving a grant from the German Federal Ministry of Education and Research.

[email protected]

Standardized rehabilitation therapy did not reduce hospital length of stay in patients with acute respiratory failure, based on data from a randomized trial of 300 adults published online in JAMA.

Hospital length of stay averaged 10 days for patients in the standardized rehabilitation therapy group (SRT) and 10 days in the control group that received usual ICU care, wrote Dr. Peter E. Morris of the division of pulmonary, critical care and sleep medicine at the University of Kentucky, Lexington, and his colleagues (JAMA. 2016 Jun;315:2694-702. doi: 10.1001/jama.2016.7201).

Hemera Technologies/Thinkstock

The patients were followed for 6 months; 84 patients in the SRT group and 81 in the usual group completed the study.

Patients in the SRT group received daily therapy including passive range of motion, physical therapy, and progressive-resistance exercises. The usual care group received weekday physical therapy as determined by the clinical team.

The researchers also assessed secondary outcomes related to physical function and quality of life, including ventilator days, Short Physical Performance Battery (SPPB) score, handgrip, Mini-Mental State Examination, and Functional Performance Inventory (FPI).

Overall, there was no difference in duration of ventilation or ICU care between the two groups, and score of handgrip strength and mental health also were similar at 6 months’ follow up. However, the SF-36 physical function scores were significantly higher in the SRT group (difference, 12.2; 95% confidence interval, 3.8-20.7; P = .001), and the FPI scores and SPPB scores were higher, compared with the usual care group at 6 months.

“These findings from the exploratory analysis may highlight the emerging role of placing long-term outcomes within critical care clinical trial design not only as a secondary outcome, but possibly as the primary outcome,” the researchers noted. “In view of the SPPB, SF-36 PFS, and FPI data at 6 months, the SRT group demonstrated a potential signal of improvement compared with the usual care group that was not evident at hospital discharge,” they wrote.

The study was supported by the National Institutes of Health, National Institute of Nursing Research, and National Heart, Lung, and Blood Institute. Lead author, Dr. Morris, had no financial conflicts to disclose.

Standardized rehabilitation therapy did not reduce hospital length of stay in patients with acute respiratory failure, based on data from a randomized trial of 300 adults published online in JAMA.

Hospital length of stay averaged 10 days for patients in the standardized rehabilitation therapy group (SRT) and 10 days in the control group that received usual ICU care, wrote Dr. Peter E. Morris of the division of pulmonary, critical care and sleep medicine at the University of Kentucky, Lexington, and his colleagues (JAMA. 2016 Jun;315:2694-702. doi: 10.1001/jama.2016.7201).

Hemera Technologies/Thinkstock

The patients were followed for 6 months; 84 patients in the SRT group and 81 in the usual group completed the study.

Patients in the SRT group received daily therapy including passive range of motion, physical therapy, and progressive-resistance exercises. The usual care group received weekday physical therapy as determined by the clinical team.

The researchers also assessed secondary outcomes related to physical function and quality of life, including ventilator days, Short Physical Performance Battery (SPPB) score, handgrip, Mini-Mental State Examination, and Functional Performance Inventory (FPI).

Overall, there was no difference in duration of ventilation or ICU care between the two groups, and score of handgrip strength and mental health also were similar at 6 months’ follow up. However, the SF-36 physical function scores were significantly higher in the SRT group (difference, 12.2; 95% confidence interval, 3.8-20.7; P = .001), and the FPI scores and SPPB scores were higher, compared with the usual care group at 6 months.

“These findings from the exploratory analysis may highlight the emerging role of placing long-term outcomes within critical care clinical trial design not only as a secondary outcome, but possibly as the primary outcome,” the researchers noted. “In view of the SPPB, SF-36 PFS, and FPI data at 6 months, the SRT group demonstrated a potential signal of improvement compared with the usual care group that was not evident at hospital discharge,” they wrote.

The study was supported by the National Institutes of Health, National Institute of Nursing Research, and National Heart, Lung, and Blood Institute. Lead author, Dr. Morris, had no financial conflicts to disclose.

Standardized rehabilitation therapy did not reduce hospital length of stay in patients with acute respiratory failure, based on data from a randomized trial of 300 adults published online in JAMA.

Hospital length of stay averaged 10 days for patients in the standardized rehabilitation therapy group (SRT) and 10 days in the control group that received usual ICU care, wrote Dr. Peter E. Morris of the division of pulmonary, critical care and sleep medicine at the University of Kentucky, Lexington, and his colleagues (JAMA. 2016 Jun;315:2694-702. doi: 10.1001/jama.2016.7201).

Hemera Technologies/Thinkstock

The patients were followed for 6 months; 84 patients in the SRT group and 81 in the usual group completed the study.

Patients in the SRT group received daily therapy including passive range of motion, physical therapy, and progressive-resistance exercises. The usual care group received weekday physical therapy as determined by the clinical team.

The researchers also assessed secondary outcomes related to physical function and quality of life, including ventilator days, Short Physical Performance Battery (SPPB) score, handgrip, Mini-Mental State Examination, and Functional Performance Inventory (FPI).

Overall, there was no difference in duration of ventilation or ICU care between the two groups, and score of handgrip strength and mental health also were similar at 6 months’ follow up. However, the SF-36 physical function scores were significantly higher in the SRT group (difference, 12.2; 95% confidence interval, 3.8-20.7; P = .001), and the FPI scores and SPPB scores were higher, compared with the usual care group at 6 months.

“These findings from the exploratory analysis may highlight the emerging role of placing long-term outcomes within critical care clinical trial design not only as a secondary outcome, but possibly as the primary outcome,” the researchers noted. “In view of the SPPB, SF-36 PFS, and FPI data at 6 months, the SRT group demonstrated a potential signal of improvement compared with the usual care group that was not evident at hospital discharge,” they wrote.

The study was supported by the National Institutes of Health, National Institute of Nursing Research, and National Heart, Lung, and Blood Institute. Lead author, Dr. Morris, had no financial conflicts to disclose.

DENVER – The surgically implanted Inspire system for controlled upper airway stimulation as therapy for moderate to severe obstructive sleep apnea demonstrated sustained benefit at 42 months of prospective follow-up in the STAR trial, Dr. Patrick J. Strollo Jr. reported at the annual meeting of the Associated Professional Sleep Societies.

STAR was the pivotal trial whose previously reported 12-month outcomes led to Food and Drug Administration clearance of the device. Dr. Strollo was first author of that paper (N Engl J Med. 2014 Jan 9;370:139-49). At SLEEP 2016, he presented patient- and partner-reported outcomes at 42 months. Bottom line: The device had continued safety and no loss in efficacy.

“So far it seems to be a useful option for people who frequently didn’t have an option. And the technology is improving and will only get better,” said Dr. Strollo, professor of medicine and clinical and translational science, director of the Sleep Medicine Center, and codirector of the Sleep Medicine Institute at the University of Pittsburgh.

The Inspire system consists of three parts implanted by an otolaryngologist in an outpatient procedure: a small impulse generator, a breathing sensor lead inserted in the intercostal muscle, and a stimulator lead attached to the distal branch of the 10th cranial nerve, the hypoglossal nerve controlling the tongue muscles.

The device is programmed to discharge at the end of expiration and continue through the inspiratory phase, causing the tongue to move forward and the retrolingual and retropalatal airways to open, he explained in an interview.

Upper airway stimulation is approved for commercial use in patients such as those enrolled in the STAR trial on the basis of pilot studies that identified most likely responders. The key selection criteria include moderate to severe obstructive sleep apnea as defined by an apnea-hypopnea index of 20-50, nonadherence to continuous positive airway pressure (CPAP), a body mass index of 32 kg/m² or less, and absence of concentric collapse of the airway at the level of the palate during sedated endoscopy.

STAR included 126 participants who received the upper airway stimulation device. There have been two explants: one from septic arthritis, the other elective.

A total of 97 STAR participants had 42-month follow-up data available. Among the key findings were that:

• Mean scores on the Epworth Sleepiness Scale decreased from 11.6 at baseline to 7 at 12 months and 7.1 at 42 months.

• Scores on the Functional Outcomes of Sleep Questionnaire improved from 14.3 at baseline to 17.3 at 12 months and 17.5 at 42 months.

• The scores on both the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire were abnormal at baseline and converted to normal range at both 12 and 42 months of follow-up.

• At baseline, 29% of the patients’ sleeping partners characterized the snoring as loud, 24% rated it ‘very intense,’ and 30% left the bedroom. At 32 months, 11% of partners called the snoring loud, 3% deemed it very intense, and only 4% left the room.

• At 42 months, 81% of patients reported using the device nightly. That’s consistent with the objective evidence of adherence Dr. Strollo and his coinvestigators obtained in a study of postmarketing device implants in which they found device usage averaged about 7 hours per night.

“That’s much better than we see with CPAP in patients who can tolerate that therapy,” Dr. Strollo observed.

The planned 5-year follow-up of STAR participants includes a full laboratory polysomnography study to obtain objective apnea-hypopnea index figures.

The other major development is the launch of a comprehensive registry of patients who receive a post-marketing commercial implant. Roughly 1,000 implants have been done worldwide to date, but now that the device is approved, that number will quickly grow. The registry should prove a rich source for research.

“The goal is to try to refine the selection criteria,” according to Dr. Strollo.

Given that only about 50% of patients with moderate to severe sleep apnea are able to tolerate CPAP long term, where does the Inspire system fit into today’s practice of sleep medicine?

“Upper airway stimulation is another tool, another option for patients,” he said. “In my practice, normally I’d let patients try positive pressure first. I want to make sure they’ve tried CPAP, and they’ve tried more advanced therapy like autotitrating bilevel positive airway pressure, which is more comfortable than CPAP. Bilevel positive airway pressure allows you to salvage a fair number of patients who can’t tolerate CPAP. And I also offer an oral appliance, although the robustness of an oral appliance is not great as apnea becomes more severe.”

The STAR trial is supported by Inspire Medical Systems. Dr. Strollo reported receiving a research grant from the company.

[email protected]

DENVER – The surgically implanted Inspire system for controlled upper airway stimulation as therapy for moderate to severe obstructive sleep apnea demonstrated sustained benefit at 42 months of prospective follow-up in the STAR trial, Dr. Patrick J. Strollo Jr. reported at the annual meeting of the Associated Professional Sleep Societies.

STAR was the pivotal trial whose previously reported 12-month outcomes led to Food and Drug Administration clearance of the device. Dr. Strollo was first author of that paper (N Engl J Med. 2014 Jan 9;370:139-49). At SLEEP 2016, he presented patient- and partner-reported outcomes at 42 months. Bottom line: The device had continued safety and no loss in efficacy.

“So far it seems to be a useful option for people who frequently didn’t have an option. And the technology is improving and will only get better,” said Dr. Strollo, professor of medicine and clinical and translational science, director of the Sleep Medicine Center, and codirector of the Sleep Medicine Institute at the University of Pittsburgh.

The Inspire system consists of three parts implanted by an otolaryngologist in an outpatient procedure: a small impulse generator, a breathing sensor lead inserted in the intercostal muscle, and a stimulator lead attached to the distal branch of the 10th cranial nerve, the hypoglossal nerve controlling the tongue muscles.

The device is programmed to discharge at the end of expiration and continue through the inspiratory phase, causing the tongue to move forward and the retrolingual and retropalatal airways to open, he explained in an interview.

Upper airway stimulation is approved for commercial use in patients such as those enrolled in the STAR trial on the basis of pilot studies that identified most likely responders. The key selection criteria include moderate to severe obstructive sleep apnea as defined by an apnea-hypopnea index of 20-50, nonadherence to continuous positive airway pressure (CPAP), a body mass index of 32 kg/m² or less, and absence of concentric collapse of the airway at the level of the palate during sedated endoscopy.

STAR included 126 participants who received the upper airway stimulation device. There have been two explants: one from septic arthritis, the other elective.

A total of 97 STAR participants had 42-month follow-up data available. Among the key findings were that:

• Mean scores on the Epworth Sleepiness Scale decreased from 11.6 at baseline to 7 at 12 months and 7.1 at 42 months.

• Scores on the Functional Outcomes of Sleep Questionnaire improved from 14.3 at baseline to 17.3 at 12 months and 17.5 at 42 months.

• The scores on both the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire were abnormal at baseline and converted to normal range at both 12 and 42 months of follow-up.

• At baseline, 29% of the patients’ sleeping partners characterized the snoring as loud, 24% rated it ‘very intense,’ and 30% left the bedroom. At 32 months, 11% of partners called the snoring loud, 3% deemed it very intense, and only 4% left the room.

• At 42 months, 81% of patients reported using the device nightly. That’s consistent with the objective evidence of adherence Dr. Strollo and his coinvestigators obtained in a study of postmarketing device implants in which they found device usage averaged about 7 hours per night.

“That’s much better than we see with CPAP in patients who can tolerate that therapy,” Dr. Strollo observed.

The planned 5-year follow-up of STAR participants includes a full laboratory polysomnography study to obtain objective apnea-hypopnea index figures.

The other major development is the launch of a comprehensive registry of patients who receive a post-marketing commercial implant. Roughly 1,000 implants have been done worldwide to date, but now that the device is approved, that number will quickly grow. The registry should prove a rich source for research.

“The goal is to try to refine the selection criteria,” according to Dr. Strollo.

Given that only about 50% of patients with moderate to severe sleep apnea are able to tolerate CPAP long term, where does the Inspire system fit into today’s practice of sleep medicine?

“Upper airway stimulation is another tool, another option for patients,” he said. “In my practice, normally I’d let patients try positive pressure first. I want to make sure they’ve tried CPAP, and they’ve tried more advanced therapy like autotitrating bilevel positive airway pressure, which is more comfortable than CPAP. Bilevel positive airway pressure allows you to salvage a fair number of patients who can’t tolerate CPAP. And I also offer an oral appliance, although the robustness of an oral appliance is not great as apnea becomes more severe.”

The STAR trial is supported by Inspire Medical Systems. Dr. Strollo reported receiving a research grant from the company.

[email protected]

DENVER – The surgically implanted Inspire system for controlled upper airway stimulation as therapy for moderate to severe obstructive sleep apnea demonstrated sustained benefit at 42 months of prospective follow-up in the STAR trial, Dr. Patrick J. Strollo Jr. reported at the annual meeting of the Associated Professional Sleep Societies.

STAR was the pivotal trial whose previously reported 12-month outcomes led to Food and Drug Administration clearance of the device. Dr. Strollo was first author of that paper (N Engl J Med. 2014 Jan 9;370:139-49). At SLEEP 2016, he presented patient- and partner-reported outcomes at 42 months. Bottom line: The device had continued safety and no loss in efficacy.

“So far it seems to be a useful option for people who frequently didn’t have an option. And the technology is improving and will only get better,” said Dr. Strollo, professor of medicine and clinical and translational science, director of the Sleep Medicine Center, and codirector of the Sleep Medicine Institute at the University of Pittsburgh.

The Inspire system consists of three parts implanted by an otolaryngologist in an outpatient procedure: a small impulse generator, a breathing sensor lead inserted in the intercostal muscle, and a stimulator lead attached to the distal branch of the 10th cranial nerve, the hypoglossal nerve controlling the tongue muscles.

The device is programmed to discharge at the end of expiration and continue through the inspiratory phase, causing the tongue to move forward and the retrolingual and retropalatal airways to open, he explained in an interview.

Upper airway stimulation is approved for commercial use in patients such as those enrolled in the STAR trial on the basis of pilot studies that identified most likely responders. The key selection criteria include moderate to severe obstructive sleep apnea as defined by an apnea-hypopnea index of 20-50, nonadherence to continuous positive airway pressure (CPAP), a body mass index of 32 kg/m² or less, and absence of concentric collapse of the airway at the level of the palate during sedated endoscopy.

STAR included 126 participants who received the upper airway stimulation device. There have been two explants: one from septic arthritis, the other elective.

A total of 97 STAR participants had 42-month follow-up data available. Among the key findings were that:

• Mean scores on the Epworth Sleepiness Scale decreased from 11.6 at baseline to 7 at 12 months and 7.1 at 42 months.

• Scores on the Functional Outcomes of Sleep Questionnaire improved from 14.3 at baseline to 17.3 at 12 months and 17.5 at 42 months.

• The scores on both the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire were abnormal at baseline and converted to normal range at both 12 and 42 months of follow-up.

• At baseline, 29% of the patients’ sleeping partners characterized the snoring as loud, 24% rated it ‘very intense,’ and 30% left the bedroom. At 32 months, 11% of partners called the snoring loud, 3% deemed it very intense, and only 4% left the room.

• At 42 months, 81% of patients reported using the device nightly. That’s consistent with the objective evidence of adherence Dr. Strollo and his coinvestigators obtained in a study of postmarketing device implants in which they found device usage averaged about 7 hours per night.

“That’s much better than we see with CPAP in patients who can tolerate that therapy,” Dr. Strollo observed.

The planned 5-year follow-up of STAR participants includes a full laboratory polysomnography study to obtain objective apnea-hypopnea index figures.

The other major development is the launch of a comprehensive registry of patients who receive a post-marketing commercial implant. Roughly 1,000 implants have been done worldwide to date, but now that the device is approved, that number will quickly grow. The registry should prove a rich source for research.

“The goal is to try to refine the selection criteria,” according to Dr. Strollo.

Given that only about 50% of patients with moderate to severe sleep apnea are able to tolerate CPAP long term, where does the Inspire system fit into today’s practice of sleep medicine?

“Upper airway stimulation is another tool, another option for patients,” he said. “In my practice, normally I’d let patients try positive pressure first. I want to make sure they’ve tried CPAP, and they’ve tried more advanced therapy like autotitrating bilevel positive airway pressure, which is more comfortable than CPAP. Bilevel positive airway pressure allows you to salvage a fair number of patients who can’t tolerate CPAP. And I also offer an oral appliance, although the robustness of an oral appliance is not great as apnea becomes more severe.”

The STAR trial is supported by Inspire Medical Systems. Dr. Strollo reported receiving a research grant from the company.

[email protected]

DENVER – A high degree of unwarranted practice variation exists among pediatricians and family physicians with regard to screening children for obstructive sleep apnea in accord with current evidence-based practice guidelines, Sarah M. Honaker, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies.

The American Academy of Pediatrics and American Academy of Sleep Medicine recommend that children with frequent snoring be referred for a sleep study or to a sleep specialist or otolaryngologist because of the damaging consequences of living with untreated obstructive sleep apnea (OSA). But Dr. Honaker’s study of 8,135 children aged 1-12 years seen at five university-affiliated urban primary care pediatric clinics demonstrated that the identification rate of suspected OSA was abysmally low, and physician practice on this score varied enormously.

Bruce Jancin/Frontline Medical News

“There is a critical need to develop enhanced implementation strategies to support primary care providers’ adherence to evidence-based practice for pediatric OSA,” declared Dr. Honaker of Indiana University in Indianapolis.

She and her coinvestigators have developed a computer decision support system designed to do just that. Known as CHICA, for Child Health Improvement through Computer Automation, the system works like this: While in the clinic waiting room, the parent is handed a computer tablet and asked to complete 20 yes/no items designed to identify priority areas for the primary care provider to address during the current visit. The items are individually tailored based upon the child’s age, past medical history, and previous responses.

One item asks if the child snores three or more nights per week, a well-established indicator of increased risk for OSA. If the answer is yes, CHICA instantly sends a prompt to the child’s electronic medical record noting that the parent reports the child is a frequent snorer and this might indicate OSA.

The primary care provider can either ignore the prompt or respond during or after the visit in one of three ways: “I am concerned about OSA,” “I do not suspect OSA,” or “The parent in the examining room denies hearing frequent snoring.”

The mean age of the patients in Dr. Honaker’s study was 5.8 years, and 83% of the 8,135 children had Medicaid coverage. Parental cooperation with CHICA was high: 98.5% of parents addressed the snoring question. They reported that 28.5% of the children snored at least 3 nights per week, generating a total of 1,094 CHICA prompts to the primary care providers. Forty-four percent of providers didn’t respond to the prompt, which Dr. Honaker said is a typical rate for this sort of computerized assist intervention. Of those who did respond, only 15.9% indicated they suspected OSA. Sixty-three percent declared they didn’t suspect OSA, and the remainder said the parent in the examining room didn’t report frequent snoring.

Although responding providers indicated they suspected OSA in 15.9% of the children, that’s a low figure for frequent snorers. Moreover, 31% of children who got the CHICA frequent snoring prompt were overweight or obese, and 17% had attention-deficit hyperactivity disorder symptoms, both known risk factors for OSA. Some of the kids had both risk factors, but 39% had at least one in addition to their frequent snoring, Dr. Honaker noted.

The investigators carried out multivariate logistic regression analyses of child, provider, and clinic characteristics in search of predictors associated with physician concern that a child might have OSA. It turned out that none of the provider characteristics had any bearing on this endpoint. It didn’t matter if a physician’s specialty was pediatrics or family medicine. Providers had been in practice for 3-42 years, with a mean of 15.1 years, but years in practice weren’t associated with a physician’s rate of identification of possible pediatric OSA. Individual provider rates varied enormously, though. Some physicians never suspected OSA, others did so in nearly 50% of children flagged by the CHICA prompt.

“It’s not clear that type of training plays a large role in this area,” she commented.

The only relevant patient factor was age: children aged 1-2.5 years were 73% less likely to generate physician suspicion of OSA.

“Surprisingly, none of the patient health factors were predictive. So having ADHD symptoms or being overweight or obese did not make it more likely that a child would elicit concern for OSA,” Dr. Honaker observed.

However, which of the five clinics the child attended turned out to make a big difference. Rates of suspected OSA in children with a CHICA snoring prompt ranged from a low of 5% at one clinic to 27% at another.

Dr. Honaker’s recent review of the literature led her to conclude that the Indiana University experience is hardly unique. Despite documented high rates of pediatric sleep disorders in primary care settings, screening and treatment rates are low. Primary care physicians receive little training in sleep medicine (Sleep Med Rev. 2016;25:31-9).

What’s next for CHICA?

Dr. Honaker and coworkers have developed a beefed up CHICA decision support system known as the CHICA OSA Module. In addition to generating a prompt in the medical record if a parent indicates the child snores three or more nights per week, additional OSA signs and symptoms, if present, will be noted on the screen, along with a comment that American Academy of Pediatrics guidelines recommend referral when OSA is suspected. Dr. Honaker plans to conduct a controlled trial in which some clinics get the CHICA OSA Module while others use the older CHICA system.

Her study was funded by the American Sleep Medicine Foundation. She reported having no financial conflicts.

[email protected]

DENVER – A high degree of unwarranted practice variation exists among pediatricians and family physicians with regard to screening children for obstructive sleep apnea in accord with current evidence-based practice guidelines, Sarah M. Honaker, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies.

The American Academy of Pediatrics and American Academy of Sleep Medicine recommend that children with frequent snoring be referred for a sleep study or to a sleep specialist or otolaryngologist because of the damaging consequences of living with untreated obstructive sleep apnea (OSA). But Dr. Honaker’s study of 8,135 children aged 1-12 years seen at five university-affiliated urban primary care pediatric clinics demonstrated that the identification rate of suspected OSA was abysmally low, and physician practice on this score varied enormously.

Bruce Jancin/Frontline Medical News

“There is a critical need to develop enhanced implementation strategies to support primary care providers’ adherence to evidence-based practice for pediatric OSA,” declared Dr. Honaker of Indiana University in Indianapolis.

She and her coinvestigators have developed a computer decision support system designed to do just that. Known as CHICA, for Child Health Improvement through Computer Automation, the system works like this: While in the clinic waiting room, the parent is handed a computer tablet and asked to complete 20 yes/no items designed to identify priority areas for the primary care provider to address during the current visit. The items are individually tailored based upon the child’s age, past medical history, and previous responses.

One item asks if the child snores three or more nights per week, a well-established indicator of increased risk for OSA. If the answer is yes, CHICA instantly sends a prompt to the child’s electronic medical record noting that the parent reports the child is a frequent snorer and this might indicate OSA.

The primary care provider can either ignore the prompt or respond during or after the visit in one of three ways: “I am concerned about OSA,” “I do not suspect OSA,” or “The parent in the examining room denies hearing frequent snoring.”

The mean age of the patients in Dr. Honaker’s study was 5.8 years, and 83% of the 8,135 children had Medicaid coverage. Parental cooperation with CHICA was high: 98.5% of parents addressed the snoring question. They reported that 28.5% of the children snored at least 3 nights per week, generating a total of 1,094 CHICA prompts to the primary care providers. Forty-four percent of providers didn’t respond to the prompt, which Dr. Honaker said is a typical rate for this sort of computerized assist intervention. Of those who did respond, only 15.9% indicated they suspected OSA. Sixty-three percent declared they didn’t suspect OSA, and the remainder said the parent in the examining room didn’t report frequent snoring.

Although responding providers indicated they suspected OSA in 15.9% of the children, that’s a low figure for frequent snorers. Moreover, 31% of children who got the CHICA frequent snoring prompt were overweight or obese, and 17% had attention-deficit hyperactivity disorder symptoms, both known risk factors for OSA. Some of the kids had both risk factors, but 39% had at least one in addition to their frequent snoring, Dr. Honaker noted.

The investigators carried out multivariate logistic regression analyses of child, provider, and clinic characteristics in search of predictors associated with physician concern that a child might have OSA. It turned out that none of the provider characteristics had any bearing on this endpoint. It didn’t matter if a physician’s specialty was pediatrics or family medicine. Providers had been in practice for 3-42 years, with a mean of 15.1 years, but years in practice weren’t associated with a physician’s rate of identification of possible pediatric OSA. Individual provider rates varied enormously, though. Some physicians never suspected OSA, others did so in nearly 50% of children flagged by the CHICA prompt.

“It’s not clear that type of training plays a large role in this area,” she commented.

The only relevant patient factor was age: children aged 1-2.5 years were 73% less likely to generate physician suspicion of OSA.

“Surprisingly, none of the patient health factors were predictive. So having ADHD symptoms or being overweight or obese did not make it more likely that a child would elicit concern for OSA,” Dr. Honaker observed.

However, which of the five clinics the child attended turned out to make a big difference. Rates of suspected OSA in children with a CHICA snoring prompt ranged from a low of 5% at one clinic to 27% at another.

Dr. Honaker’s recent review of the literature led her to conclude that the Indiana University experience is hardly unique. Despite documented high rates of pediatric sleep disorders in primary care settings, screening and treatment rates are low. Primary care physicians receive little training in sleep medicine (Sleep Med Rev. 2016;25:31-9).

What’s next for CHICA?

Dr. Honaker and coworkers have developed a beefed up CHICA decision support system known as the CHICA OSA Module. In addition to generating a prompt in the medical record if a parent indicates the child snores three or more nights per week, additional OSA signs and symptoms, if present, will be noted on the screen, along with a comment that American Academy of Pediatrics guidelines recommend referral when OSA is suspected. Dr. Honaker plans to conduct a controlled trial in which some clinics get the CHICA OSA Module while others use the older CHICA system.

Her study was funded by the American Sleep Medicine Foundation. She reported having no financial conflicts.

[email protected]

DENVER – A high degree of unwarranted practice variation exists among pediatricians and family physicians with regard to screening children for obstructive sleep apnea in accord with current evidence-based practice guidelines, Sarah M. Honaker, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies.

The American Academy of Pediatrics and American Academy of Sleep Medicine recommend that children with frequent snoring be referred for a sleep study or to a sleep specialist or otolaryngologist because of the damaging consequences of living with untreated obstructive sleep apnea (OSA). But Dr. Honaker’s study of 8,135 children aged 1-12 years seen at five university-affiliated urban primary care pediatric clinics demonstrated that the identification rate of suspected OSA was abysmally low, and physician practice on this score varied enormously.

Bruce Jancin/Frontline Medical News

“There is a critical need to develop enhanced implementation strategies to support primary care providers’ adherence to evidence-based practice for pediatric OSA,” declared Dr. Honaker of Indiana University in Indianapolis.

She and her coinvestigators have developed a computer decision support system designed to do just that. Known as CHICA, for Child Health Improvement through Computer Automation, the system works like this: While in the clinic waiting room, the parent is handed a computer tablet and asked to complete 20 yes/no items designed to identify priority areas for the primary care provider to address during the current visit. The items are individually tailored based upon the child’s age, past medical history, and previous responses.

One item asks if the child snores three or more nights per week, a well-established indicator of increased risk for OSA. If the answer is yes, CHICA instantly sends a prompt to the child’s electronic medical record noting that the parent reports the child is a frequent snorer and this might indicate OSA.

The primary care provider can either ignore the prompt or respond during or after the visit in one of three ways: “I am concerned about OSA,” “I do not suspect OSA,” or “The parent in the examining room denies hearing frequent snoring.”

The mean age of the patients in Dr. Honaker’s study was 5.8 years, and 83% of the 8,135 children had Medicaid coverage. Parental cooperation with CHICA was high: 98.5% of parents addressed the snoring question. They reported that 28.5% of the children snored at least 3 nights per week, generating a total of 1,094 CHICA prompts to the primary care providers. Forty-four percent of providers didn’t respond to the prompt, which Dr. Honaker said is a typical rate for this sort of computerized assist intervention. Of those who did respond, only 15.9% indicated they suspected OSA. Sixty-three percent declared they didn’t suspect OSA, and the remainder said the parent in the examining room didn’t report frequent snoring.

Although responding providers indicated they suspected OSA in 15.9% of the children, that’s a low figure for frequent snorers. Moreover, 31% of children who got the CHICA frequent snoring prompt were overweight or obese, and 17% had attention-deficit hyperactivity disorder symptoms, both known risk factors for OSA. Some of the kids had both risk factors, but 39% had at least one in addition to their frequent snoring, Dr. Honaker noted.

The investigators carried out multivariate logistic regression analyses of child, provider, and clinic characteristics in search of predictors associated with physician concern that a child might have OSA. It turned out that none of the provider characteristics had any bearing on this endpoint. It didn’t matter if a physician’s specialty was pediatrics or family medicine. Providers had been in practice for 3-42 years, with a mean of 15.1 years, but years in practice weren’t associated with a physician’s rate of identification of possible pediatric OSA. Individual provider rates varied enormously, though. Some physicians never suspected OSA, others did so in nearly 50% of children flagged by the CHICA prompt.

“It’s not clear that type of training plays a large role in this area,” she commented.

The only relevant patient factor was age: children aged 1-2.5 years were 73% less likely to generate physician suspicion of OSA.

“Surprisingly, none of the patient health factors were predictive. So having ADHD symptoms or being overweight or obese did not make it more likely that a child would elicit concern for OSA,” Dr. Honaker observed.

However, which of the five clinics the child attended turned out to make a big difference. Rates of suspected OSA in children with a CHICA snoring prompt ranged from a low of 5% at one clinic to 27% at another.

Dr. Honaker’s recent review of the literature led her to conclude that the Indiana University experience is hardly unique. Despite documented high rates of pediatric sleep disorders in primary care settings, screening and treatment rates are low. Primary care physicians receive little training in sleep medicine (Sleep Med Rev. 2016;25:31-9).

What’s next for CHICA?

Dr. Honaker and coworkers have developed a beefed up CHICA decision support system known as the CHICA OSA Module. In addition to generating a prompt in the medical record if a parent indicates the child snores three or more nights per week, additional OSA signs and symptoms, if present, will be noted on the screen, along with a comment that American Academy of Pediatrics guidelines recommend referral when OSA is suspected. Dr. Honaker plans to conduct a controlled trial in which some clinics get the CHICA OSA Module while others use the older CHICA system.

Her study was funded by the American Sleep Medicine Foundation. She reported having no financial conflicts.

[email protected]

Updated guidelines from the National Institute of Allergy and Infectious Diseases for the early introduction of peanut-containing foods to children at increased risk for peanut allergies are on the horizon, pending final approval.

“Two studies recently showed that infants at high risk of developing peanut allergy [infants with egg allergy and or severe eczema] were much less likely to have peanut allergy at age 5 years if they were able to incorporate peanut regularly into the diet between 4 and 11 months of age,” said Dr. Scott H. Sicherer, the Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology, and chief of the division of allergy and immunology in the department of pediatrics at the Icahn School of Medicine at Mount Sinai, New York.

©mates/Fotolia.com

“However, adding peanut to the diet at this age requires caution because these infants may already be allergic to peanut, and so allergy testing and care in adding peanut to the diet with medical supervision is needed in this high-risk group,” noted Dr. Sicherer, a member of the expert panel that worked on the guidelines.

The draft guidelines include 43 clinical recommendations for the diagnosis and management of food allergies in children, according to the NIAID website. In particular, the draft guidelines recommend introducing peanut-containing foods to infants aged 4-6 months who are at increased risk for peanut allergy because of severe eczema and/or egg allergies, after an evaluation with skin prick testing or peanut-specific IgE testing.

“Peanut allergy is relatively common and often persistent, and so a strategy that could prevent the allergy is very important,” Dr. Sicherer said in an interview. “However, peanut can be a choking hazard as peanuts or peanut butter, and so families should talk to their pediatrician about how and when to incorporate peanut into the diet, and whether allergy testing and referral to an allergist is needed.”

Support for the guidelines comes from several large studies with promising results, notably the LEAP (Learning Early about Peanut Allergy) trial. A recent extension of that study, known as LEAP-On (Persistence of Oral Tolerance to Peanut), showed that regular consumption of peanut-containing foods from infancy to 5 years provided ongoing protection against allergies, even 6 years after peanut consumption was discontinued for a 1-year period in 550 children (N Eng J Med. 2016 Apr 14;374:1435-43).

In the original LEAP study, 640 infants aged 4-11 months with severe eczema, egg allergy, or both were randomized to dietary peanut consumption or avoidance (N Engl J Med. 2015 Feb 26;372[9]:803-13). The prevalence of peanut allergy at 5 years of age was approximately 2% in the peanut-consumption group, compared with 14% in the peanut-avoidance group.

Another significant randomized trial, the EAT study (Enquiring About Tolerance) tested not only peanut, but also the early introduction of cooked egg, cow’s milk, sesame, wheat, and fish to 1,303 infants aged 3 months and older in the general population. The study’s strict protocol made adherence difficult, but researchers found a significant 67% reduction in the prevalence of food allergies at age 3 years among the children who followed the protocol, compared with controls, with relative risk reductions of 100% and 75%, respectively, for peanut and egg allergies (N Engl J Med. 2016 May 5;374:1733-43).

The next steps for research should make early introduction of peanut-containing foods even more effective at allergy prevention, Dr. Sicherer noted.

“We need to learn more about how much peanut should be incorporated into the diet, how long the protein has to be kept in the diet to have the best preventative effect, and whether this strategy applies to other foods,” he said.

Updated guidelines from the National Institute of Allergy and Infectious Diseases for the early introduction of peanut-containing foods to children at increased risk for peanut allergies are on the horizon, pending final approval.

“Two studies recently showed that infants at high risk of developing peanut allergy [infants with egg allergy and or severe eczema] were much less likely to have peanut allergy at age 5 years if they were able to incorporate peanut regularly into the diet between 4 and 11 months of age,” said Dr. Scott H. Sicherer, the Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology, and chief of the division of allergy and immunology in the department of pediatrics at the Icahn School of Medicine at Mount Sinai, New York.

©mates/Fotolia.com

“However, adding peanut to the diet at this age requires caution because these infants may already be allergic to peanut, and so allergy testing and care in adding peanut to the diet with medical supervision is needed in this high-risk group,” noted Dr. Sicherer, a member of the expert panel that worked on the guidelines.

The draft guidelines include 43 clinical recommendations for the diagnosis and management of food allergies in children, according to the NIAID website. In particular, the draft guidelines recommend introducing peanut-containing foods to infants aged 4-6 months who are at increased risk for peanut allergy because of severe eczema and/or egg allergies, after an evaluation with skin prick testing or peanut-specific IgE testing.

“Peanut allergy is relatively common and often persistent, and so a strategy that could prevent the allergy is very important,” Dr. Sicherer said in an interview. “However, peanut can be a choking hazard as peanuts or peanut butter, and so families should talk to their pediatrician about how and when to incorporate peanut into the diet, and whether allergy testing and referral to an allergist is needed.”

Support for the guidelines comes from several large studies with promising results, notably the LEAP (Learning Early about Peanut Allergy) trial. A recent extension of that study, known as LEAP-On (Persistence of Oral Tolerance to Peanut), showed that regular consumption of peanut-containing foods from infancy to 5 years provided ongoing protection against allergies, even 6 years after peanut consumption was discontinued for a 1-year period in 550 children (N Eng J Med. 2016 Apr 14;374:1435-43).

In the original LEAP study, 640 infants aged 4-11 months with severe eczema, egg allergy, or both were randomized to dietary peanut consumption or avoidance (N Engl J Med. 2015 Feb 26;372[9]:803-13). The prevalence of peanut allergy at 5 years of age was approximately 2% in the peanut-consumption group, compared with 14% in the peanut-avoidance group.

Another significant randomized trial, the EAT study (Enquiring About Tolerance) tested not only peanut, but also the early introduction of cooked egg, cow’s milk, sesame, wheat, and fish to 1,303 infants aged 3 months and older in the general population. The study’s strict protocol made adherence difficult, but researchers found a significant 67% reduction in the prevalence of food allergies at age 3 years among the children who followed the protocol, compared with controls, with relative risk reductions of 100% and 75%, respectively, for peanut and egg allergies (N Engl J Med. 2016 May 5;374:1733-43).

The next steps for research should make early introduction of peanut-containing foods even more effective at allergy prevention, Dr. Sicherer noted.

“We need to learn more about how much peanut should be incorporated into the diet, how long the protein has to be kept in the diet to have the best preventative effect, and whether this strategy applies to other foods,” he said.

Updated guidelines from the National Institute of Allergy and Infectious Diseases for the early introduction of peanut-containing foods to children at increased risk for peanut allergies are on the horizon, pending final approval.

“Two studies recently showed that infants at high risk of developing peanut allergy [infants with egg allergy and or severe eczema] were much less likely to have peanut allergy at age 5 years if they were able to incorporate peanut regularly into the diet between 4 and 11 months of age,” said Dr. Scott H. Sicherer, the Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology, and chief of the division of allergy and immunology in the department of pediatrics at the Icahn School of Medicine at Mount Sinai, New York.

©mates/Fotolia.com

“However, adding peanut to the diet at this age requires caution because these infants may already be allergic to peanut, and so allergy testing and care in adding peanut to the diet with medical supervision is needed in this high-risk group,” noted Dr. Sicherer, a member of the expert panel that worked on the guidelines.

The draft guidelines include 43 clinical recommendations for the diagnosis and management of food allergies in children, according to the NIAID website. In particular, the draft guidelines recommend introducing peanut-containing foods to infants aged 4-6 months who are at increased risk for peanut allergy because of severe eczema and/or egg allergies, after an evaluation with skin prick testing or peanut-specific IgE testing.

“Peanut allergy is relatively common and often persistent, and so a strategy that could prevent the allergy is very important,” Dr. Sicherer said in an interview. “However, peanut can be a choking hazard as peanuts or peanut butter, and so families should talk to their pediatrician about how and when to incorporate peanut into the diet, and whether allergy testing and referral to an allergist is needed.”

Support for the guidelines comes from several large studies with promising results, notably the LEAP (Learning Early about Peanut Allergy) trial. A recent extension of that study, known as LEAP-On (Persistence of Oral Tolerance to Peanut), showed that regular consumption of peanut-containing foods from infancy to 5 years provided ongoing protection against allergies, even 6 years after peanut consumption was discontinued for a 1-year period in 550 children (N Eng J Med. 2016 Apr 14;374:1435-43).

In the original LEAP study, 640 infants aged 4-11 months with severe eczema, egg allergy, or both were randomized to dietary peanut consumption or avoidance (N Engl J Med. 2015 Feb 26;372[9]:803-13). The prevalence of peanut allergy at 5 years of age was approximately 2% in the peanut-consumption group, compared with 14% in the peanut-avoidance group.

Another significant randomized trial, the EAT study (Enquiring About Tolerance) tested not only peanut, but also the early introduction of cooked egg, cow’s milk, sesame, wheat, and fish to 1,303 infants aged 3 months and older in the general population. The study’s strict protocol made adherence difficult, but researchers found a significant 67% reduction in the prevalence of food allergies at age 3 years among the children who followed the protocol, compared with controls, with relative risk reductions of 100% and 75%, respectively, for peanut and egg allergies (N Engl J Med. 2016 May 5;374:1733-43).

The next steps for research should make early introduction of peanut-containing foods even more effective at allergy prevention, Dr. Sicherer noted.

“We need to learn more about how much peanut should be incorporated into the diet, how long the protein has to be kept in the diet to have the best preventative effect, and whether this strategy applies to other foods,” he said.

DENVER – Obstructive sleep apnea diagnosed later in life is associated with an increased likelihood of subsequent Alzheimer’s disease, Dr. Omonigho Bubu reported at the annual meeting of the Associated Professional Sleep Societies.

He presented a retrospective cohort study in which a dose-reponse relationship was apparent. The more severe an individual’s obstructive sleep apnea (OSA) as reflected in a higher apnea-hypopnea index on polysomnography, the greater the risk of later being diagnosed with Alzheimer’s disease, compared with matched controls during up to 13 years of follow-up.

Bruce Jancin/Frontline Medical News

The study also identified several possible contributing factors for the observed OSA/Alzheimer’s relationship. Those OSA patients with more severe sleep fragmentation, nocturnal hypoxia, and abnormal sleep duration were significantly more likely to subsequently develop Alzheimer’s disease than were OSA patients with less severely disrupted sleep measures, added Dr. Bubu of the University of South Florida, Tampa.

The study included 756 patients aged 65 years and older with no history of cognitive decline when diagnosed with OSA by polysomnography at Tampa General Hospital during 2001-2005. They were matched by age, race, sex, body mass index, and zip code to two control groups totaling 3,780 subjects. The controls, drawn from outpatient medical clinics at the hospital, had a variety of medical problems but no sleep disorders or cognitive impairment.

During a mean 10.5-year follow-up period, 513 subjects were diagnosed with Alzheimer’s disease, according to Medicare data. In a Cox proportional hazards analysis adjusted for age, sex, race, body mass index, and education level, OSA was independently associated with a 2.2-fold increased risk. Further adjustment for alcohol intake, smoking, use of sleep medications, and chronic medical conditions didn’t substantially change the results.

However, the investigators were not able to control for apolipoprotein E (APOE)–epsilon 4 allele status, which is a known risk factor for both OSA and Alzheimer’s disease, so it makes one wonder whether the association is “all related to APOE,” said Dr. Richard J. Caselli, professor of neurology at the Mayo Clinic, Scottsdale, Ariz., when asked to comment on the study.

Time to onset of Alzheimer’s disease was shorter in the OSA patients: The mean time to diagnosis was 60.8 months after diagnosis of OSA, compared with 73 and 78 months in members of the two control groups who developed the dementia.

When the risk of developing Alzheimer’s disease was stratified according to baseline OSA severity, a dose-response effect was seen. Mild OSA, defined as 5-14 apnea-hypopnea events per hour of sleep, was associated with a 1.67-fold greater risk than in controls. The moderate OSA group, who had 15-29 events per hour, had a 1.81-fold increased risk. Patients with severe OSA, with 30 or more events per hour, had a 2.63-fold increased risk.

Gender, race, and education modified the relationship between OSA and Alzheimer’s disease, Dr. Bubu said. Women with OSA had a 2.28-fold greater risk of later developing the disease, compared with controls; men had a 1.42-fold increased risk. African-Americans with OSA were at 2.56-fold greater risk than were controls, while Hispanics with OSA were at 1.8-fold increased risk and non-Hispanic whites were at 1.87-fold increased risk. OSA patients with a high school education or less were at 2.73 times greater risk of Alzheimer’s disease than were controls, those with at least some college or technical school were at 1.82-fold risk, and OSA patients who’d been to graduate school had a 1.31-fold increased risk.

“Our results definitely show that OSA precedes the onset of Alzheimer’s disease. But we cannot say that’s causation. That will be left to future research examining the potential mechanisms we’ve identified,” Dr. Bubu said in an interview.

A key missing link in establishing a causal relationship is the lack of data on how many of the older patients diagnosed with OSA accepted treatment for the condition, and what their response rates were. In other words, it remains to be seen whether OSA occurring later in life is a modifiable risk factor for Alzheimer’s disease as opposed to an early expression of the dementing disease process whereby treatment of the sleep disorder doesn’t affect the progressive cognitive decline.

Both short sleep duration of less than 6 hours as well as a mean total sleep time greater than 9 hours in patients with OSA were associated with significantly increased risk of Alzheimer’s disease, compared with a sleep time of 6-9 hours. Patients with a high sleep-onset latency in the sleep lab, a high REM latency from sleep onset, a low percentage of time spent in REM, an oxygen saturation level of less than 90% for at least 1% of sleep time, and/or a high number of arousals per hour of sleep were also at increased risk of subsequent Alzheimer’s disease.

The study was supported by the Byrd Alzheimer’s Institute. Dr. Bubu reported having no financial conflicts.

[email protected]

DENVER – Obstructive sleep apnea diagnosed later in life is associated with an increased likelihood of subsequent Alzheimer’s disease, Dr. Omonigho Bubu reported at the annual meeting of the Associated Professional Sleep Societies.

He presented a retrospective cohort study in which a dose-reponse relationship was apparent. The more severe an individual’s obstructive sleep apnea (OSA) as reflected in a higher apnea-hypopnea index on polysomnography, the greater the risk of later being diagnosed with Alzheimer’s disease, compared with matched controls during up to 13 years of follow-up.

Bruce Jancin/Frontline Medical News

The study also identified several possible contributing factors for the observed OSA/Alzheimer’s relationship. Those OSA patients with more severe sleep fragmentation, nocturnal hypoxia, and abnormal sleep duration were significantly more likely to subsequently develop Alzheimer’s disease than were OSA patients with less severely disrupted sleep measures, added Dr. Bubu of the University of South Florida, Tampa.

The study included 756 patients aged 65 years and older with no history of cognitive decline when diagnosed with OSA by polysomnography at Tampa General Hospital during 2001-2005. They were matched by age, race, sex, body mass index, and zip code to two control groups totaling 3,780 subjects. The controls, drawn from outpatient medical clinics at the hospital, had a variety of medical problems but no sleep disorders or cognitive impairment.

During a mean 10.5-year follow-up period, 513 subjects were diagnosed with Alzheimer’s disease, according to Medicare data. In a Cox proportional hazards analysis adjusted for age, sex, race, body mass index, and education level, OSA was independently associated with a 2.2-fold increased risk. Further adjustment for alcohol intake, smoking, use of sleep medications, and chronic medical conditions didn’t substantially change the results.

However, the investigators were not able to control for apolipoprotein E (APOE)–epsilon 4 allele status, which is a known risk factor for both OSA and Alzheimer’s disease, so it makes one wonder whether the association is “all related to APOE,” said Dr. Richard J. Caselli, professor of neurology at the Mayo Clinic, Scottsdale, Ariz., when asked to comment on the study.

Time to onset of Alzheimer’s disease was shorter in the OSA patients: The mean time to diagnosis was 60.8 months after diagnosis of OSA, compared with 73 and 78 months in members of the two control groups who developed the dementia.

When the risk of developing Alzheimer’s disease was stratified according to baseline OSA severity, a dose-response effect was seen. Mild OSA, defined as 5-14 apnea-hypopnea events per hour of sleep, was associated with a 1.67-fold greater risk than in controls. The moderate OSA group, who had 15-29 events per hour, had a 1.81-fold increased risk. Patients with severe OSA, with 30 or more events per hour, had a 2.63-fold increased risk.

Gender, race, and education modified the relationship between OSA and Alzheimer’s disease, Dr. Bubu said. Women with OSA had a 2.28-fold greater risk of later developing the disease, compared with controls; men had a 1.42-fold increased risk. African-Americans with OSA were at 2.56-fold greater risk than were controls, while Hispanics with OSA were at 1.8-fold increased risk and non-Hispanic whites were at 1.87-fold increased risk. OSA patients with a high school education or less were at 2.73 times greater risk of Alzheimer’s disease than were controls, those with at least some college or technical school were at 1.82-fold risk, and OSA patients who’d been to graduate school had a 1.31-fold increased risk.

“Our results definitely show that OSA precedes the onset of Alzheimer’s disease. But we cannot say that’s causation. That will be left to future research examining the potential mechanisms we’ve identified,” Dr. Bubu said in an interview.

A key missing link in establishing a causal relationship is the lack of data on how many of the older patients diagnosed with OSA accepted treatment for the condition, and what their response rates were. In other words, it remains to be seen whether OSA occurring later in life is a modifiable risk factor for Alzheimer’s disease as opposed to an early expression of the dementing disease process whereby treatment of the sleep disorder doesn’t affect the progressive cognitive decline.

Both short sleep duration of less than 6 hours as well as a mean total sleep time greater than 9 hours in patients with OSA were associated with significantly increased risk of Alzheimer’s disease, compared with a sleep time of 6-9 hours. Patients with a high sleep-onset latency in the sleep lab, a high REM latency from sleep onset, a low percentage of time spent in REM, an oxygen saturation level of less than 90% for at least 1% of sleep time, and/or a high number of arousals per hour of sleep were also at increased risk of subsequent Alzheimer’s disease.

The study was supported by the Byrd Alzheimer’s Institute. Dr. Bubu reported having no financial conflicts.

[email protected]

DENVER – Obstructive sleep apnea diagnosed later in life is associated with an increased likelihood of subsequent Alzheimer’s disease, Dr. Omonigho Bubu reported at the annual meeting of the Associated Professional Sleep Societies.

He presented a retrospective cohort study in which a dose-reponse relationship was apparent. The more severe an individual’s obstructive sleep apnea (OSA) as reflected in a higher apnea-hypopnea index on polysomnography, the greater the risk of later being diagnosed with Alzheimer’s disease, compared with matched controls during up to 13 years of follow-up.

Bruce Jancin/Frontline Medical News

The study also identified several possible contributing factors for the observed OSA/Alzheimer’s relationship. Those OSA patients with more severe sleep fragmentation, nocturnal hypoxia, and abnormal sleep duration were significantly more likely to subsequently develop Alzheimer’s disease than were OSA patients with less severely disrupted sleep measures, added Dr. Bubu of the University of South Florida, Tampa.

The study included 756 patients aged 65 years and older with no history of cognitive decline when diagnosed with OSA by polysomnography at Tampa General Hospital during 2001-2005. They were matched by age, race, sex, body mass index, and zip code to two control groups totaling 3,780 subjects. The controls, drawn from outpatient medical clinics at the hospital, had a variety of medical problems but no sleep disorders or cognitive impairment.

During a mean 10.5-year follow-up period, 513 subjects were diagnosed with Alzheimer’s disease, according to Medicare data. In a Cox proportional hazards analysis adjusted for age, sex, race, body mass index, and education level, OSA was independently associated with a 2.2-fold increased risk. Further adjustment for alcohol intake, smoking, use of sleep medications, and chronic medical conditions didn’t substantially change the results.

However, the investigators were not able to control for apolipoprotein E (APOE)–epsilon 4 allele status, which is a known risk factor for both OSA and Alzheimer’s disease, so it makes one wonder whether the association is “all related to APOE,” said Dr. Richard J. Caselli, professor of neurology at the Mayo Clinic, Scottsdale, Ariz., when asked to comment on the study.

Time to onset of Alzheimer’s disease was shorter in the OSA patients: The mean time to diagnosis was 60.8 months after diagnosis of OSA, compared with 73 and 78 months in members of the two control groups who developed the dementia.

When the risk of developing Alzheimer’s disease was stratified according to baseline OSA severity, a dose-response effect was seen. Mild OSA, defined as 5-14 apnea-hypopnea events per hour of sleep, was associated with a 1.67-fold greater risk than in controls. The moderate OSA group, who had 15-29 events per hour, had a 1.81-fold increased risk. Patients with severe OSA, with 30 or more events per hour, had a 2.63-fold increased risk.

Gender, race, and education modified the relationship between OSA and Alzheimer’s disease, Dr. Bubu said. Women with OSA had a 2.28-fold greater risk of later developing the disease, compared with controls; men had a 1.42-fold increased risk. African-Americans with OSA were at 2.56-fold greater risk than were controls, while Hispanics with OSA were at 1.8-fold increased risk and non-Hispanic whites were at 1.87-fold increased risk. OSA patients with a high school education or less were at 2.73 times greater risk of Alzheimer’s disease than were controls, those with at least some college or technical school were at 1.82-fold risk, and OSA patients who’d been to graduate school had a 1.31-fold increased risk.

“Our results definitely show that OSA precedes the onset of Alzheimer’s disease. But we cannot say that’s causation. That will be left to future research examining the potential mechanisms we’ve identified,” Dr. Bubu said in an interview.

A key missing link in establishing a causal relationship is the lack of data on how many of the older patients diagnosed with OSA accepted treatment for the condition, and what their response rates were. In other words, it remains to be seen whether OSA occurring later in life is a modifiable risk factor for Alzheimer’s disease as opposed to an early expression of the dementing disease process whereby treatment of the sleep disorder doesn’t affect the progressive cognitive decline.

Both short sleep duration of less than 6 hours as well as a mean total sleep time greater than 9 hours in patients with OSA were associated with significantly increased risk of Alzheimer’s disease, compared with a sleep time of 6-9 hours. Patients with a high sleep-onset latency in the sleep lab, a high REM latency from sleep onset, a low percentage of time spent in REM, an oxygen saturation level of less than 90% for at least 1% of sleep time, and/or a high number of arousals per hour of sleep were also at increased risk of subsequent Alzheimer’s disease.

The study was supported by the Byrd Alzheimer’s Institute. Dr. Bubu reported having no financial conflicts.

[email protected]

DENVER – Adults with ADHD or autism spectrum disorder experience a high burden of sleep disturbances, especially insomnia, Dr. Anastasios Galanopoulos reported at the annual meeting of the Associated Professional Sleep Societies.

This has previously been established to be the case in pediatric patients with these neurodevelopmental disorders. However, sleep pathology hasn’t previously been well studied in affected adults, according to Dr. Galanopoulos, a consulting psychiatrist at Maudsley Hospital and King’s College London.

Bruce Jancin/Frontline Medical News

He presented a cross-sectional study of insomnia in a clinically representative sample comprising 164 adult patients: 98 with a DSM-5 diagnosis of ADHD, 30 with autism spectrum disorder, and 34 carrying both diagnoses.

Fully 91% of participants fell into the “poor” sleep category on the Pittsburgh Sleep Quality Index. Moreover, 44% of subjects had either moderate or severe clinical insomnia as reflected in a score of 15 or more on the Insomnia Severity Index. The rate of high sleep disruption scores was similar, regardless of whether the diagnosis was ADHD, autism spectrum disorder, or both.

Anxiety but not depression ratings on the Hospital Anxiety and Depression Scale correlated with insomnia scores, regardless of neurodevelopmental diagnosis. Insomnia scores also increased in concert with higher levels of hyperactivity symptoms as scored on the Barkley Adult ADHD Rating Scale. In contrast, inattentiveness scores were unrelated to insomnia.

Hyperactivity scores on the Barkley scale were significantly higher in adults with ADHD than in those with autism spectrum disorder. On the other hand, anxiety scores were higher in adults with autism spectrum disorder.

While the burden of sleep disturbances is similarly high in adults with ADHD and autism spectrum disorder, the underlying mechanism may well be different. For this reason, Dr. Galanopoulos and coinvestigators have begun studies systematically looking at various possible interventions for sleep disorders in adults with neurodevelopmental disorders.

He reported having no financial conflicts regarding this study, which was conducted without commercial support.

[email protected]

DENVER – Adults with ADHD or autism spectrum disorder experience a high burden of sleep disturbances, especially insomnia, Dr. Anastasios Galanopoulos reported at the annual meeting of the Associated Professional Sleep Societies.

This has previously been established to be the case in pediatric patients with these neurodevelopmental disorders. However, sleep pathology hasn’t previously been well studied in affected adults, according to Dr. Galanopoulos, a consulting psychiatrist at Maudsley Hospital and King’s College London.

Bruce Jancin/Frontline Medical News

He presented a cross-sectional study of insomnia in a clinically representative sample comprising 164 adult patients: 98 with a DSM-5 diagnosis of ADHD, 30 with autism spectrum disorder, and 34 carrying both diagnoses.

Fully 91% of participants fell into the “poor” sleep category on the Pittsburgh Sleep Quality Index. Moreover, 44% of subjects had either moderate or severe clinical insomnia as reflected in a score of 15 or more on the Insomnia Severity Index. The rate of high sleep disruption scores was similar, regardless of whether the diagnosis was ADHD, autism spectrum disorder, or both.

Anxiety but not depression ratings on the Hospital Anxiety and Depression Scale correlated with insomnia scores, regardless of neurodevelopmental diagnosis. Insomnia scores also increased in concert with higher levels of hyperactivity symptoms as scored on the Barkley Adult ADHD Rating Scale. In contrast, inattentiveness scores were unrelated to insomnia.

Hyperactivity scores on the Barkley scale were significantly higher in adults with ADHD than in those with autism spectrum disorder. On the other hand, anxiety scores were higher in adults with autism spectrum disorder.

While the burden of sleep disturbances is similarly high in adults with ADHD and autism spectrum disorder, the underlying mechanism may well be different. For this reason, Dr. Galanopoulos and coinvestigators have begun studies systematically looking at various possible interventions for sleep disorders in adults with neurodevelopmental disorders.

He reported having no financial conflicts regarding this study, which was conducted without commercial support.

[email protected]

DENVER – Adults with ADHD or autism spectrum disorder experience a high burden of sleep disturbances, especially insomnia, Dr. Anastasios Galanopoulos reported at the annual meeting of the Associated Professional Sleep Societies.

This has previously been established to be the case in pediatric patients with these neurodevelopmental disorders. However, sleep pathology hasn’t previously been well studied in affected adults, according to Dr. Galanopoulos, a consulting psychiatrist at Maudsley Hospital and King’s College London.

Bruce Jancin/Frontline Medical News

He presented a cross-sectional study of insomnia in a clinically representative sample comprising 164 adult patients: 98 with a DSM-5 diagnosis of ADHD, 30 with autism spectrum disorder, and 34 carrying both diagnoses.

Fully 91% of participants fell into the “poor” sleep category on the Pittsburgh Sleep Quality Index. Moreover, 44% of subjects had either moderate or severe clinical insomnia as reflected in a score of 15 or more on the Insomnia Severity Index. The rate of high sleep disruption scores was similar, regardless of whether the diagnosis was ADHD, autism spectrum disorder, or both.

Anxiety but not depression ratings on the Hospital Anxiety and Depression Scale correlated with insomnia scores, regardless of neurodevelopmental diagnosis. Insomnia scores also increased in concert with higher levels of hyperactivity symptoms as scored on the Barkley Adult ADHD Rating Scale. In contrast, inattentiveness scores were unrelated to insomnia.

Hyperactivity scores on the Barkley scale were significantly higher in adults with ADHD than in those with autism spectrum disorder. On the other hand, anxiety scores were higher in adults with autism spectrum disorder.

While the burden of sleep disturbances is similarly high in adults with ADHD and autism spectrum disorder, the underlying mechanism may well be different. For this reason, Dr. Galanopoulos and coinvestigators have begun studies systematically looking at various possible interventions for sleep disorders in adults with neurodevelopmental disorders.

He reported having no financial conflicts regarding this study, which was conducted without commercial support.

[email protected]