Somatic Disorders

People who have sleep-disordered breathing are less likely to experience a normal nighttime decrease in systolic blood pressure, and they are at increased risk of adverse cardiac and other outcomes, according to the results of a new prospective study.

Most people experience a 10%-20% dip in their blood pressure at nighttime (Hypertension 1995;26:60-9). Previously, researchers showed an association between sleep apnea syndrome and a failure to experience that beneficial nighttime decrease in blood pressure, but evidence so far is limited to cross-sectional studies (Am. J. Hypertens. 2001;14:887-92; Chest 2002;122:1148-55).

The new study's findings are important because “nocturnal nondipping” associated with sleep-disordered breathing (SDB) has been linked to target organ damage and to a poor cardiovascular prognosis (Can. J. Cardiol. 2007;23:132-8; JAMA 1999;282:539-46).

Dr. Khin Mae Hla and her associates assessed 328 adults in the ongoing Wisconsin Sleep Cohort Study. All of the participants had a baseline polysomnography study and at least two 24-hour ambulatory blood pressure monitoring assessments during an average of 7.2 years of follow-up. Dr. Hla and her colleagues of the departments of medicine and population health sciences at the University of Wisconsin, Madison, reported their findings in Sleep (2008;31:795-800).

A total of 18% of participants developed systolic nondipping, and 11% developed diastolic nondipping. Although the researchers did not find an association between SDB and diastolic nondipping, the longitudinal association with systolic BP alterations was significant.

“This failure to experience normal dipping adds to the amassing evidence that sleep-disordered breathing has a causal role in cardiovascular disease, possibly via multiple pathways [JAMA 2003;290:1906-14; J. Clin. Sleep Med. 2007;3:409-15],” the researchers wrote.

The chances of developing systolic nondipping were significantly correlated with baseline severity of SDB in a dose-response fashion.

Patients who scored less than 5 on the Apnea-Hypopnea Index (no or minimal SDB) were used as a reference group. In comparison, those with mild SDB (score from 5 to 15) were three times as likely to develop systolic nondipping (adjusted odds ratio, 3.1). In addition, patients with moderate to severe SDB (score of 15 or greater) were more than four times as likely to develop systolic nondipping (OR, 4.4).

Mean patient age was 49 years, 63% were men, and the mean body mass index was 29 kg/m

Grants from the National Institutes of Health helped to fund the study. The authors had no financial relationships to disclose.

Patients using CPAP were included because researchers were unable to determine whether treatment was optimal. That was a possible limitation of the study, the researchers noted, as was a failure to follow all participants who had a baseline 24-hour blood pressure study.

“Our findings of a strong longitudinal association of SDB with nocturnal systolic nondipping of BP have clinical and public health relevance, since SDB and hypertension both are very prevalent in the general population,” the authors wrote.

“The development of systolic BP nondipping, a well-established cardiovascular disease risk, in those with mild to moderate SDB underscores the importance of diagnosing SDB even in its milder forms,” they said.

People who have sleep-disordered breathing are less likely to experience a normal nighttime decrease in systolic blood pressure, and they are at increased risk of adverse cardiac and other outcomes, according to the results of a new prospective study.

Most people experience a 10%-20% dip in their blood pressure at nighttime (Hypertension 1995;26:60-9). Previously, researchers showed an association between sleep apnea syndrome and a failure to experience that beneficial nighttime decrease in blood pressure, but evidence so far is limited to cross-sectional studies (Am. J. Hypertens. 2001;14:887-92; Chest 2002;122:1148-55).

The new study's findings are important because “nocturnal nondipping” associated with sleep-disordered breathing (SDB) has been linked to target organ damage and to a poor cardiovascular prognosis (Can. J. Cardiol. 2007;23:132-8; JAMA 1999;282:539-46).

Dr. Khin Mae Hla and her associates assessed 328 adults in the ongoing Wisconsin Sleep Cohort Study. All of the participants had a baseline polysomnography study and at least two 24-hour ambulatory blood pressure monitoring assessments during an average of 7.2 years of follow-up. Dr. Hla and her colleagues of the departments of medicine and population health sciences at the University of Wisconsin, Madison, reported their findings in Sleep (2008;31:795-800).

A total of 18% of participants developed systolic nondipping, and 11% developed diastolic nondipping. Although the researchers did not find an association between SDB and diastolic nondipping, the longitudinal association with systolic BP alterations was significant.

“This failure to experience normal dipping adds to the amassing evidence that sleep-disordered breathing has a causal role in cardiovascular disease, possibly via multiple pathways [JAMA 2003;290:1906-14; J. Clin. Sleep Med. 2007;3:409-15],” the researchers wrote.

The chances of developing systolic nondipping were significantly correlated with baseline severity of SDB in a dose-response fashion.

Patients who scored less than 5 on the Apnea-Hypopnea Index (no or minimal SDB) were used as a reference group. In comparison, those with mild SDB (score from 5 to 15) were three times as likely to develop systolic nondipping (adjusted odds ratio, 3.1). In addition, patients with moderate to severe SDB (score of 15 or greater) were more than four times as likely to develop systolic nondipping (OR, 4.4).

Mean patient age was 49 years, 63% were men, and the mean body mass index was 29 kg/m

Grants from the National Institutes of Health helped to fund the study. The authors had no financial relationships to disclose.

Patients using CPAP were included because researchers were unable to determine whether treatment was optimal. That was a possible limitation of the study, the researchers noted, as was a failure to follow all participants who had a baseline 24-hour blood pressure study.

“Our findings of a strong longitudinal association of SDB with nocturnal systolic nondipping of BP have clinical and public health relevance, since SDB and hypertension both are very prevalent in the general population,” the authors wrote.

“The development of systolic BP nondipping, a well-established cardiovascular disease risk, in those with mild to moderate SDB underscores the importance of diagnosing SDB even in its milder forms,” they said.

People who have sleep-disordered breathing are less likely to experience a normal nighttime decrease in systolic blood pressure, and they are at increased risk of adverse cardiac and other outcomes, according to the results of a new prospective study.

Most people experience a 10%-20% dip in their blood pressure at nighttime (Hypertension 1995;26:60-9). Previously, researchers showed an association between sleep apnea syndrome and a failure to experience that beneficial nighttime decrease in blood pressure, but evidence so far is limited to cross-sectional studies (Am. J. Hypertens. 2001;14:887-92; Chest 2002;122:1148-55).

The new study's findings are important because “nocturnal nondipping” associated with sleep-disordered breathing (SDB) has been linked to target organ damage and to a poor cardiovascular prognosis (Can. J. Cardiol. 2007;23:132-8; JAMA 1999;282:539-46).

Dr. Khin Mae Hla and her associates assessed 328 adults in the ongoing Wisconsin Sleep Cohort Study. All of the participants had a baseline polysomnography study and at least two 24-hour ambulatory blood pressure monitoring assessments during an average of 7.2 years of follow-up. Dr. Hla and her colleagues of the departments of medicine and population health sciences at the University of Wisconsin, Madison, reported their findings in Sleep (2008;31:795-800).

A total of 18% of participants developed systolic nondipping, and 11% developed diastolic nondipping. Although the researchers did not find an association between SDB and diastolic nondipping, the longitudinal association with systolic BP alterations was significant.

“This failure to experience normal dipping adds to the amassing evidence that sleep-disordered breathing has a causal role in cardiovascular disease, possibly via multiple pathways [JAMA 2003;290:1906-14; J. Clin. Sleep Med. 2007;3:409-15],” the researchers wrote.

The chances of developing systolic nondipping were significantly correlated with baseline severity of SDB in a dose-response fashion.

Patients who scored less than 5 on the Apnea-Hypopnea Index (no or minimal SDB) were used as a reference group. In comparison, those with mild SDB (score from 5 to 15) were three times as likely to develop systolic nondipping (adjusted odds ratio, 3.1). In addition, patients with moderate to severe SDB (score of 15 or greater) were more than four times as likely to develop systolic nondipping (OR, 4.4).

Mean patient age was 49 years, 63% were men, and the mean body mass index was 29 kg/m

Grants from the National Institutes of Health helped to fund the study. The authors had no financial relationships to disclose.

Patients using CPAP were included because researchers were unable to determine whether treatment was optimal. That was a possible limitation of the study, the researchers noted, as was a failure to follow all participants who had a baseline 24-hour blood pressure study.

“Our findings of a strong longitudinal association of SDB with nocturnal systolic nondipping of BP have clinical and public health relevance, since SDB and hypertension both are very prevalent in the general population,” the authors wrote.

“The development of systolic BP nondipping, a well-established cardiovascular disease risk, in those with mild to moderate SDB underscores the importance of diagnosing SDB even in its milder forms,” they said.

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

PHOENIX – Preliminary data on the off-label use of sodium oxybate suggest that it improved sleep in a randomized, placebo-controlled study of 151 patients with fibromyalgia who completed 8 weeks of treatment at 21 medical centers.

The study enrolled 195 patients who started with a drug washout period and were randomized to continue for 8 weeks on sodium oxybate 4.5 g/day or 6 g/day or placebo. Doses were split; patients took a half-dose at bedtime, then awoke 4 hours later for the other half.

Forty-four patients (23%) withdrew before completion, mostly from the higher-dose group and primarily because of side effects, including headache, dizziness, and nausea, Dr. Harvey Moldofsky reported at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Both objective and subjective measures of sleep improved in the drug groups, compared with placebo–for those who finished the study–more so with the 6-g/day dose, said Dr. Moldofsky, president and director of the Centre for Sleep and Chronobiology, Toronto, and emeritus professor of medicine at the University of Toronto.

The study was funded by Jazz Pharmaceuticals, the company that makes sodium oxybate. Dr. Moldofsky is a consultant to and an advisory board member for the company.

Many patients with fibromyalgia have sleep disturbances, he noted.

Sleep polysomnography showed significant objective improvements in the high-dose group in the following areas: amount of time spent sleeping; sleep efficiency (the proportion of time spent sleeping, compared with time in bed); and the amount of deep, or slow-wave, sleep, he reported.

Subjective results from patient self-reports on several scales showed that they experienced improvements with either dose, compared with placebo, in pain and fatigue (Visual Analog Scale), daytime sleepiness (Epworth Sleepiness Scale), impaired sleep (Jenkins Scale), and daytime functioning (Functional Outcome of Sleep Questionnaire, SF-36 Vitality scale, and Fibromyalgia Impact Questionnaire).

The study provides a proof of concept, but more research is needed before the drug is used by patients with fibromyalgia, he said.

Besides headache, dizziness, and nausea, other side effects that occurred more frequently in the drug groups than in the placebo group included vomiting, nasopharyngitis, extremity pain, muscle cramp, nervous system disorders, restlessness, and incontinence or other renal/urinary disorders.

In 2002 sodium oxybate was approved in the United States to reduce cataplexy attacks in patients with narcolepsy, but the drug is under tightly restricted distribution from Jazz Pharmaceuticals alone – not from pharmacies.

The agent, more commonly known as gamma hydroxybutyrate, or GHB, entered the U.S. market as a dietary supplement in the early 1990s. It subsequently gained favor as a party drug, was used to perpetrate date rape because of its intoxicating effects, and caused many serious adverse events and some deaths from its use and misuse.

More research would be needed to determine whether the improvements in sleep seen in the current study were independent of subjective improvements in pain and functionality, Dr. Moldofsky said.

PHOENIX – Preliminary data on the off-label use of sodium oxybate suggest that it improved sleep in a randomized, placebo-controlled study of 151 patients with fibromyalgia who completed 8 weeks of treatment at 21 medical centers.

The study enrolled 195 patients who started with a drug washout period and were randomized to continue for 8 weeks on sodium oxybate 4.5 g/day or 6 g/day or placebo. Doses were split; patients took a half-dose at bedtime, then awoke 4 hours later for the other half.

Forty-four patients (23%) withdrew before completion, mostly from the higher-dose group and primarily because of side effects, including headache, dizziness, and nausea, Dr. Harvey Moldofsky reported at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Both objective and subjective measures of sleep improved in the drug groups, compared with placebo–for those who finished the study–more so with the 6-g/day dose, said Dr. Moldofsky, president and director of the Centre for Sleep and Chronobiology, Toronto, and emeritus professor of medicine at the University of Toronto.

The study was funded by Jazz Pharmaceuticals, the company that makes sodium oxybate. Dr. Moldofsky is a consultant to and an advisory board member for the company.

Many patients with fibromyalgia have sleep disturbances, he noted.

Sleep polysomnography showed significant objective improvements in the high-dose group in the following areas: amount of time spent sleeping; sleep efficiency (the proportion of time spent sleeping, compared with time in bed); and the amount of deep, or slow-wave, sleep, he reported.

Subjective results from patient self-reports on several scales showed that they experienced improvements with either dose, compared with placebo, in pain and fatigue (Visual Analog Scale), daytime sleepiness (Epworth Sleepiness Scale), impaired sleep (Jenkins Scale), and daytime functioning (Functional Outcome of Sleep Questionnaire, SF-36 Vitality scale, and Fibromyalgia Impact Questionnaire).

The study provides a proof of concept, but more research is needed before the drug is used by patients with fibromyalgia, he said.

Besides headache, dizziness, and nausea, other side effects that occurred more frequently in the drug groups than in the placebo group included vomiting, nasopharyngitis, extremity pain, muscle cramp, nervous system disorders, restlessness, and incontinence or other renal/urinary disorders.

In 2002 sodium oxybate was approved in the United States to reduce cataplexy attacks in patients with narcolepsy, but the drug is under tightly restricted distribution from Jazz Pharmaceuticals alone – not from pharmacies.

The agent, more commonly known as gamma hydroxybutyrate, or GHB, entered the U.S. market as a dietary supplement in the early 1990s. It subsequently gained favor as a party drug, was used to perpetrate date rape because of its intoxicating effects, and caused many serious adverse events and some deaths from its use and misuse.

More research would be needed to determine whether the improvements in sleep seen in the current study were independent of subjective improvements in pain and functionality, Dr. Moldofsky said.

PHOENIX – Preliminary data on the off-label use of sodium oxybate suggest that it improved sleep in a randomized, placebo-controlled study of 151 patients with fibromyalgia who completed 8 weeks of treatment at 21 medical centers.

The study enrolled 195 patients who started with a drug washout period and were randomized to continue for 8 weeks on sodium oxybate 4.5 g/day or 6 g/day or placebo. Doses were split; patients took a half-dose at bedtime, then awoke 4 hours later for the other half.

Forty-four patients (23%) withdrew before completion, mostly from the higher-dose group and primarily because of side effects, including headache, dizziness, and nausea, Dr. Harvey Moldofsky reported at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Both objective and subjective measures of sleep improved in the drug groups, compared with placebo–for those who finished the study–more so with the 6-g/day dose, said Dr. Moldofsky, president and director of the Centre for Sleep and Chronobiology, Toronto, and emeritus professor of medicine at the University of Toronto.

The study was funded by Jazz Pharmaceuticals, the company that makes sodium oxybate. Dr. Moldofsky is a consultant to and an advisory board member for the company.

Many patients with fibromyalgia have sleep disturbances, he noted.

Sleep polysomnography showed significant objective improvements in the high-dose group in the following areas: amount of time spent sleeping; sleep efficiency (the proportion of time spent sleeping, compared with time in bed); and the amount of deep, or slow-wave, sleep, he reported.

Subjective results from patient self-reports on several scales showed that they experienced improvements with either dose, compared with placebo, in pain and fatigue (Visual Analog Scale), daytime sleepiness (Epworth Sleepiness Scale), impaired sleep (Jenkins Scale), and daytime functioning (Functional Outcome of Sleep Questionnaire, SF-36 Vitality scale, and Fibromyalgia Impact Questionnaire).

The study provides a proof of concept, but more research is needed before the drug is used by patients with fibromyalgia, he said.

Besides headache, dizziness, and nausea, other side effects that occurred more frequently in the drug groups than in the placebo group included vomiting, nasopharyngitis, extremity pain, muscle cramp, nervous system disorders, restlessness, and incontinence or other renal/urinary disorders.

In 2002 sodium oxybate was approved in the United States to reduce cataplexy attacks in patients with narcolepsy, but the drug is under tightly restricted distribution from Jazz Pharmaceuticals alone – not from pharmacies.

The agent, more commonly known as gamma hydroxybutyrate, or GHB, entered the U.S. market as a dietary supplement in the early 1990s. It subsequently gained favor as a party drug, was used to perpetrate date rape because of its intoxicating effects, and caused many serious adverse events and some deaths from its use and misuse.

More research would be needed to determine whether the improvements in sleep seen in the current study were independent of subjective improvements in pain and functionality, Dr. Moldofsky said.

KYOTO, JAPAN – Prolactin may be a key mediator in the pathway by which psychological stress triggers and exacerbates psoriasis, Dr. Ewan A. Langan said at an international investigative dermatology meeting.

This raises the intriguing prospect that prolactin may offer a novel future therapeutic target in psoriasis and other skin diseases that worsen in response to psychological distress, said Dr. Langan, who is with the University of Manchester (England).

Prolactin is a “remarkably versatile” neurohormone for which more than 300 distinct biologic actions have been identified. Several of these involve the skin, he noted.

For example, prolactin has been shown to promote keratinocyte proliferation and differentiation, angiogenesis, and a Th1 proinflammatory local cutaneous milieu marked by a T-cell-predominant infiltrate.

These just happen to be among the hallmarks of psoriasis, Dr. Langan observed at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology.

Dr. Langan presented what he described as the first-ever study to demonstrate that prolactin levels and prolactin receptor expression are increased in chronic psoriatic plaques, compared with the normal photo-protected skin of healthy controls.

The study involved 10 patients with early-onset chronic plaque psoriasis and 10 controls, all of whom surrendered skin biopsies that were subsequently analyzed immunohistochemically.

Both prolactin and prolactin receptors were detected in epidermal keratinocytes, dermal fibroblasts, and sweat glands of healthy controls.

By comparison, however, expression of prolactin and prolactin receptors was markedly upregulated throughout the epidermis in psoriasis plaques, especially in the basal layer, probably because of local cutaneous production.

No significant difference was noted between expression in the uninvolved skin of psoriasis patients and samples from normal controls.

The most likely scenario is that prolactin enhances interferon-?-induced chemokine production in keratinocytes, thereby facilitating cutaneous T-cell infiltration, according to Dr. Langan.

Planned future studies will attempt to pin down the factors that regulate cutaneous prolactin and prolactin receptor production, he added.

KYOTO, JAPAN – Prolactin may be a key mediator in the pathway by which psychological stress triggers and exacerbates psoriasis, Dr. Ewan A. Langan said at an international investigative dermatology meeting.

This raises the intriguing prospect that prolactin may offer a novel future therapeutic target in psoriasis and other skin diseases that worsen in response to psychological distress, said Dr. Langan, who is with the University of Manchester (England).

Prolactin is a “remarkably versatile” neurohormone for which more than 300 distinct biologic actions have been identified. Several of these involve the skin, he noted.

For example, prolactin has been shown to promote keratinocyte proliferation and differentiation, angiogenesis, and a Th1 proinflammatory local cutaneous milieu marked by a T-cell-predominant infiltrate.

These just happen to be among the hallmarks of psoriasis, Dr. Langan observed at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology.

Dr. Langan presented what he described as the first-ever study to demonstrate that prolactin levels and prolactin receptor expression are increased in chronic psoriatic plaques, compared with the normal photo-protected skin of healthy controls.

The study involved 10 patients with early-onset chronic plaque psoriasis and 10 controls, all of whom surrendered skin biopsies that were subsequently analyzed immunohistochemically.

Both prolactin and prolactin receptors were detected in epidermal keratinocytes, dermal fibroblasts, and sweat glands of healthy controls.

By comparison, however, expression of prolactin and prolactin receptors was markedly upregulated throughout the epidermis in psoriasis plaques, especially in the basal layer, probably because of local cutaneous production.

No significant difference was noted between expression in the uninvolved skin of psoriasis patients and samples from normal controls.

The most likely scenario is that prolactin enhances interferon-?-induced chemokine production in keratinocytes, thereby facilitating cutaneous T-cell infiltration, according to Dr. Langan.

Planned future studies will attempt to pin down the factors that regulate cutaneous prolactin and prolactin receptor production, he added.

KYOTO, JAPAN – Prolactin may be a key mediator in the pathway by which psychological stress triggers and exacerbates psoriasis, Dr. Ewan A. Langan said at an international investigative dermatology meeting.

This raises the intriguing prospect that prolactin may offer a novel future therapeutic target in psoriasis and other skin diseases that worsen in response to psychological distress, said Dr. Langan, who is with the University of Manchester (England).

Prolactin is a “remarkably versatile” neurohormone for which more than 300 distinct biologic actions have been identified. Several of these involve the skin, he noted.

For example, prolactin has been shown to promote keratinocyte proliferation and differentiation, angiogenesis, and a Th1 proinflammatory local cutaneous milieu marked by a T-cell-predominant infiltrate.

These just happen to be among the hallmarks of psoriasis, Dr. Langan observed at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology.

Dr. Langan presented what he described as the first-ever study to demonstrate that prolactin levels and prolactin receptor expression are increased in chronic psoriatic plaques, compared with the normal photo-protected skin of healthy controls.

The study involved 10 patients with early-onset chronic plaque psoriasis and 10 controls, all of whom surrendered skin biopsies that were subsequently analyzed immunohistochemically.

Both prolactin and prolactin receptors were detected in epidermal keratinocytes, dermal fibroblasts, and sweat glands of healthy controls.

By comparison, however, expression of prolactin and prolactin receptors was markedly upregulated throughout the epidermis in psoriasis plaques, especially in the basal layer, probably because of local cutaneous production.

No significant difference was noted between expression in the uninvolved skin of psoriasis patients and samples from normal controls.

The most likely scenario is that prolactin enhances interferon-?-induced chemokine production in keratinocytes, thereby facilitating cutaneous T-cell infiltration, according to Dr. Langan.

Planned future studies will attempt to pin down the factors that regulate cutaneous prolactin and prolactin receptor production, he added.

BALTIMORE – Moderate to severe sleep apnea significantly increased the risk of all-cause mortality, according to 14 years of follow-up data from a large community sample.

“Sleep apnea is a disease of public health significance,” said Nathaniel Marshall, Ph.D., of the University of Sydney, who presented results from the Busselton Health Study at the annual meeting of the Associated Professional Sleep Societies.

Previous studies have suggested that obstructive sleep apnea (OSA) increases the risk of death from cardiovascular disease, Dr. Marshall said. Until recently, however, the role of sleep apnea as an independent predictor of all-cause mortality has not been well studied, he added.

The Busselton Health Study is an ongoing community-based study in Busselton, Western Australia.

For the study, the researchers analyzed data from 400 community-dwelling adults aged 45-60 years. All of the participants were tested for OSA using a home sleep apnea monitoring device. Sleep apnea was quantified using the respiratory disturbance index (RDI), and moderate to severe apnea was defined as an RDI score of 15 or more respiratory disruptions per hour of sleep.

Complete data were available from 380 participants (278 men and 102 women) after an average of 13.4 years. The mortality rate was significantly higher (33.3%) among the 18 participants who had moderate to severe apnea (six deaths), compared with 6.5% among the 77 participants with mild OSA (five deaths) and 7.7% among the 285 participants without OSA (22 deaths).

Compared with people who did not have sleep apnea, the mortality hazard ratio was 6.24 for people with moderate to severe sleep apnea, after the researchers controlled for risk factors including age, gender, body mass index, mean arterial pressure (as a measure of blood pressure), smoking status, total cholesterol, HDL cholesterol, diabetes status, and physician-diagnosed angina.

“I was suspicious of the size of this effect,” Dr. Marshall said. “If you put this same model into an odds ratio, you get an odds ratio of about 10.” To put it another way, “sleep apnea has about the same effect on mortality as getting 18 years older,” he said.

But the results reflect similar recent findings from two studies in the United States–the multicenter Sleep Heart Health Study and the Wisconsin Sleep Study–that also show significant independent associations between OSA and all-cause mortality.

The association between moderate to severe OSA and all-cause mortality in the Busselton Health Study persisted even in a partly adjusted model that did not control for blood pressure. That model was used for comparison because OSA is a known cause of hypertension, Dr. Marshall noted. However, the researchers found no significant association between mild sleep apnea and an increased risk of death, which is good news, he said.

The study was limited by a lack of information about any treatment of sleep apnea in the study group, but the community-based format of the study kept it free of clinical referral bias, Dr. Marshall explained.

The results suggest that sleep apnea could be added to the list of standard mortality risk factors. But the findings also emphasize the need for randomized controlled trials of sleep apnea treatments that are designed to identify reductions in mortality risk, Dr. Marshall noted.

Dr. Marshall reported that he had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

BALTIMORE – Moderate to severe sleep apnea significantly increased the risk of all-cause mortality, according to 14 years of follow-up data from a large community sample.

“Sleep apnea is a disease of public health significance,” said Nathaniel Marshall, Ph.D., of the University of Sydney, who presented results from the Busselton Health Study at the annual meeting of the Associated Professional Sleep Societies.

Previous studies have suggested that obstructive sleep apnea (OSA) increases the risk of death from cardiovascular disease, Dr. Marshall said. Until recently, however, the role of sleep apnea as an independent predictor of all-cause mortality has not been well studied, he added.

The Busselton Health Study is an ongoing community-based study in Busselton, Western Australia.

For the study, the researchers analyzed data from 400 community-dwelling adults aged 45-60 years. All of the participants were tested for OSA using a home sleep apnea monitoring device. Sleep apnea was quantified using the respiratory disturbance index (RDI), and moderate to severe apnea was defined as an RDI score of 15 or more respiratory disruptions per hour of sleep.

Complete data were available from 380 participants (278 men and 102 women) after an average of 13.4 years. The mortality rate was significantly higher (33.3%) among the 18 participants who had moderate to severe apnea (six deaths), compared with 6.5% among the 77 participants with mild OSA (five deaths) and 7.7% among the 285 participants without OSA (22 deaths).

Compared with people who did not have sleep apnea, the mortality hazard ratio was 6.24 for people with moderate to severe sleep apnea, after the researchers controlled for risk factors including age, gender, body mass index, mean arterial pressure (as a measure of blood pressure), smoking status, total cholesterol, HDL cholesterol, diabetes status, and physician-diagnosed angina.

“I was suspicious of the size of this effect,” Dr. Marshall said. “If you put this same model into an odds ratio, you get an odds ratio of about 10.” To put it another way, “sleep apnea has about the same effect on mortality as getting 18 years older,” he said.

But the results reflect similar recent findings from two studies in the United States–the multicenter Sleep Heart Health Study and the Wisconsin Sleep Study–that also show significant independent associations between OSA and all-cause mortality.

The association between moderate to severe OSA and all-cause mortality in the Busselton Health Study persisted even in a partly adjusted model that did not control for blood pressure. That model was used for comparison because OSA is a known cause of hypertension, Dr. Marshall noted. However, the researchers found no significant association between mild sleep apnea and an increased risk of death, which is good news, he said.

The study was limited by a lack of information about any treatment of sleep apnea in the study group, but the community-based format of the study kept it free of clinical referral bias, Dr. Marshall explained.

The results suggest that sleep apnea could be added to the list of standard mortality risk factors. But the findings also emphasize the need for randomized controlled trials of sleep apnea treatments that are designed to identify reductions in mortality risk, Dr. Marshall noted.

Dr. Marshall reported that he had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

BALTIMORE – Moderate to severe sleep apnea significantly increased the risk of all-cause mortality, according to 14 years of follow-up data from a large community sample.

“Sleep apnea is a disease of public health significance,” said Nathaniel Marshall, Ph.D., of the University of Sydney, who presented results from the Busselton Health Study at the annual meeting of the Associated Professional Sleep Societies.

Previous studies have suggested that obstructive sleep apnea (OSA) increases the risk of death from cardiovascular disease, Dr. Marshall said. Until recently, however, the role of sleep apnea as an independent predictor of all-cause mortality has not been well studied, he added.

The Busselton Health Study is an ongoing community-based study in Busselton, Western Australia.

For the study, the researchers analyzed data from 400 community-dwelling adults aged 45-60 years. All of the participants were tested for OSA using a home sleep apnea monitoring device. Sleep apnea was quantified using the respiratory disturbance index (RDI), and moderate to severe apnea was defined as an RDI score of 15 or more respiratory disruptions per hour of sleep.

Complete data were available from 380 participants (278 men and 102 women) after an average of 13.4 years. The mortality rate was significantly higher (33.3%) among the 18 participants who had moderate to severe apnea (six deaths), compared with 6.5% among the 77 participants with mild OSA (five deaths) and 7.7% among the 285 participants without OSA (22 deaths).

Compared with people who did not have sleep apnea, the mortality hazard ratio was 6.24 for people with moderate to severe sleep apnea, after the researchers controlled for risk factors including age, gender, body mass index, mean arterial pressure (as a measure of blood pressure), smoking status, total cholesterol, HDL cholesterol, diabetes status, and physician-diagnosed angina.

“I was suspicious of the size of this effect,” Dr. Marshall said. “If you put this same model into an odds ratio, you get an odds ratio of about 10.” To put it another way, “sleep apnea has about the same effect on mortality as getting 18 years older,” he said.

But the results reflect similar recent findings from two studies in the United States–the multicenter Sleep Heart Health Study and the Wisconsin Sleep Study–that also show significant independent associations between OSA and all-cause mortality.

The association between moderate to severe OSA and all-cause mortality in the Busselton Health Study persisted even in a partly adjusted model that did not control for blood pressure. That model was used for comparison because OSA is a known cause of hypertension, Dr. Marshall noted. However, the researchers found no significant association between mild sleep apnea and an increased risk of death, which is good news, he said.

The study was limited by a lack of information about any treatment of sleep apnea in the study group, but the community-based format of the study kept it free of clinical referral bias, Dr. Marshall explained.

The results suggest that sleep apnea could be added to the list of standard mortality risk factors. But the findings also emphasize the need for randomized controlled trials of sleep apnea treatments that are designed to identify reductions in mortality risk, Dr. Marshall noted.

Dr. Marshall reported that he had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

CHICAGO – Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment, The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome, hot flash score, was measured with a daily diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10 mg, 20 mg, and 30 mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20- mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

The authors reported no conflicts of interest.

Mean reductions in hot flash frequency were 46%–50% for citalopram and 20% for placebo. DR. BARTON

CHICAGO – Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment, The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome, hot flash score, was measured with a daily diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10 mg, 20 mg, and 30 mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20- mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

The authors reported no conflicts of interest.

Mean reductions in hot flash frequency were 46%–50% for citalopram and 20% for placebo. DR. BARTON

CHICAGO – Citalopram may be an effective option for reducing hot flashes, having performed twice as well as placebo in a randomized, placebo-controlled phase III trial conducted by the North Central Cancer Treatment Group.

“Hot flash relief can be obtained with as little as 10 mg/day citalopram,” Debra Barton, Ph.D., of the Mayo Clinic in Rochester, Minn., and her coauthors concluded in a poster reporting results of the trial at the annual meeting of the American Society of Clinical Oncology.

A selective serotonin reuptake inhibitor (SSRI), citalopram (Celexa) is approved for depression, but is also used for some other disorders.

Postmenopausal women who had a history of breast cancer or wanted to avoid hormones due to breast cancer risk were enrolled in the study. They had to have at least 14 hot flashes per week for at least 1 month. Endocrine therapy was allowed, if the woman was on a stable dose for at least 1 month. No other antidepressants or hot flash therapies were permitted.

All 254 participants kept a record of their hot flashes for 1 week before starting treatment, The investigators randomized the women into four groups that received either (group 1) 10 mg/day of citalopram on weeks 2–7, (group 2) 10 mg/day of citalopram during week 2 followed by 20 mg/day of citalopram for weeks 3–7, (group 3) 10 mg/day of citalopram during week 2 followed by 20 mg/day for week 3 and 30 mg/day for weeks 4–7, or (group 4) placebo.

The placebo group comprised 83 women; each citalopram arm had 57 women. Most participants were 50 years or older (81%) and white (89%). A third of the women (34%) had a history of breast cancer. Nearly half the women (48%) had 4–9 hot flashes per day, another 38% had 10 or more per day, and 13% had less than 4 per day (13%). Mean baseline hot flash score and frequency were comparable between the groups.

The primary outcome, hot flash score, was measured with a daily diary. Secondary outcomes included data from Hot Flash Daily Interference and Profile of Mood States measures and from a symptom experience diary.

Women in the placebo group had a mean hot flash score reduction of 23%. Women in the 10 mg, 20 mg, and 30 mg citalopram groups had mean reductions of 49%, 50%, and 55%, respectively, with the differences relative to placebo being statistically significant for all three citalopram groups.

The mean reduction in hot flash frequency was 20% for the placebo group. The mean reductions for the 10-mg, 20- mg, and 30-mg citalopram groups were 46%, 43%, and 50%, respectively. Again all three comparisons to placebo were statistically significant.

The researchers also looked at quality of life measures. On the Profile of Mood States measure, women in the citalopram arms had greater improvement from baseline than did those in the placebo group on the tension/anxiety subscale, though the difference was only significant for the 20-mg citalopram group. Likewise, women in the citalopram arms had greater improvements from baseline than did those in the placebo group on the anger/hostility subscale, though the difference was only significant for the 10-mg arm.

On the Hot Flash Daily Interference Scale, women in the citalopram arms generally had greater improvements from baseline than did those in the placebo group on measures of work, social, leisure, sleep, mood, concentration, relationships, sexuality, enjoyment of life, and overall quality of life.

Women on any dose of citalopram also had significantly greater improvements in abnormal sweating, hot flash distress, and hot flash control than did women in the placebo group.

The authors reported no conflicts of interest.

Mean reductions in hot flash frequency were 46%–50% for citalopram and 20% for placebo. DR. BARTON

WASHINGTON – Even though the sleeping aid zolpidem does cross the placenta, use of the drug during pregnancy does not appear to significantly affect outcomes, a study of 45 women shows.

The study, presented as a poster at the annual meeting of the American Psychiatric Association, included pregnant women who were enrolled in a prospective study of the pharmacokinetics of psychotropic drugs during pregnancy and who were treated with zolpidem (Ambien) during pregnancy. Maternal diagnoses were determined using the Structured Clinical Interview for DSM-IV (SCID). Maternal and cord blood were obtained at delivery when possible.

The placental passage rate was calculated as the ratio of medication concentration in the umbilical cord plasma to that in maternal plasma. When umbilical cord concentrations were below the limit of detection (less than 4.0 ng/mL), this value was used for data analysis. This approach was thought to be conservative, erring toward overestimation of fetal exposure to zolpidem. When both maternal and umbilical plasma concentrations were less than the detection limit, the pair was excluded from the analysis.

Obstetrical and neonatal outcomes among women who had given birth to a live infant after taking zolpidem during pregnancy were compared with outcomes among a group of 45 women who were matched for age, race, level of education, SCID diagnosis, and pregnancy exposure to the same classes of psychotropics.

For women who took zolpidem during pregnancy, exposure by trimester included 38% in the first trimester, 56% in the second trimester, and 38% in the third trimester. The average zolpidem exposure during pregnancy was 14 weeks, and the average dose was 9 mg.

No statistically significant differences were found between the two groups in terms of obstetrical and neonatal outcomes. However, a trend toward preterm delivery and low-birth-weight infants was seen among women on zolpidem during pregnancy. “It is unclear if these outcomes were driven by zolpidem exposure and/or sleep disturbance or other pharmacological intervention in pregnancy,” wrote Sandra Juric and her colleagues at Emory University's Women's Mental Health Program in Atlanta. Ms. Juric reported no conflicts of interest.

WASHINGTON – Even though the sleeping aid zolpidem does cross the placenta, use of the drug during pregnancy does not appear to significantly affect outcomes, a study of 45 women shows.

The study, presented as a poster at the annual meeting of the American Psychiatric Association, included pregnant women who were enrolled in a prospective study of the pharmacokinetics of psychotropic drugs during pregnancy and who were treated with zolpidem (Ambien) during pregnancy. Maternal diagnoses were determined using the Structured Clinical Interview for DSM-IV (SCID). Maternal and cord blood were obtained at delivery when possible.

The placental passage rate was calculated as the ratio of medication concentration in the umbilical cord plasma to that in maternal plasma. When umbilical cord concentrations were below the limit of detection (less than 4.0 ng/mL), this value was used for data analysis. This approach was thought to be conservative, erring toward overestimation of fetal exposure to zolpidem. When both maternal and umbilical plasma concentrations were less than the detection limit, the pair was excluded from the analysis.

Obstetrical and neonatal outcomes among women who had given birth to a live infant after taking zolpidem during pregnancy were compared with outcomes among a group of 45 women who were matched for age, race, level of education, SCID diagnosis, and pregnancy exposure to the same classes of psychotropics.

For women who took zolpidem during pregnancy, exposure by trimester included 38% in the first trimester, 56% in the second trimester, and 38% in the third trimester. The average zolpidem exposure during pregnancy was 14 weeks, and the average dose was 9 mg.

No statistically significant differences were found between the two groups in terms of obstetrical and neonatal outcomes. However, a trend toward preterm delivery and low-birth-weight infants was seen among women on zolpidem during pregnancy. “It is unclear if these outcomes were driven by zolpidem exposure and/or sleep disturbance or other pharmacological intervention in pregnancy,” wrote Sandra Juric and her colleagues at Emory University's Women's Mental Health Program in Atlanta. Ms. Juric reported no conflicts of interest.

WASHINGTON – Even though the sleeping aid zolpidem does cross the placenta, use of the drug during pregnancy does not appear to significantly affect outcomes, a study of 45 women shows.

The study, presented as a poster at the annual meeting of the American Psychiatric Association, included pregnant women who were enrolled in a prospective study of the pharmacokinetics of psychotropic drugs during pregnancy and who were treated with zolpidem (Ambien) during pregnancy. Maternal diagnoses were determined using the Structured Clinical Interview for DSM-IV (SCID). Maternal and cord blood were obtained at delivery when possible.

The placental passage rate was calculated as the ratio of medication concentration in the umbilical cord plasma to that in maternal plasma. When umbilical cord concentrations were below the limit of detection (less than 4.0 ng/mL), this value was used for data analysis. This approach was thought to be conservative, erring toward overestimation of fetal exposure to zolpidem. When both maternal and umbilical plasma concentrations were less than the detection limit, the pair was excluded from the analysis.

Obstetrical and neonatal outcomes among women who had given birth to a live infant after taking zolpidem during pregnancy were compared with outcomes among a group of 45 women who were matched for age, race, level of education, SCID diagnosis, and pregnancy exposure to the same classes of psychotropics.

For women who took zolpidem during pregnancy, exposure by trimester included 38% in the first trimester, 56% in the second trimester, and 38% in the third trimester. The average zolpidem exposure during pregnancy was 14 weeks, and the average dose was 9 mg.

No statistically significant differences were found between the two groups in terms of obstetrical and neonatal outcomes. However, a trend toward preterm delivery and low-birth-weight infants was seen among women on zolpidem during pregnancy. “It is unclear if these outcomes were driven by zolpidem exposure and/or sleep disturbance or other pharmacological intervention in pregnancy,” wrote Sandra Juric and her colleagues at Emory University's Women's Mental Health Program in Atlanta. Ms. Juric reported no conflicts of interest.