Doug Brunk

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interplay between the sleep disorder and comorbid dual diagnoses,” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians.

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. They assessed the severity of obstructive sleep apnea, attention deficit problems, depression, and insomnia with a battery of standardized tests.

All patients had treatment, including continuous positive airway pressure (CPAP) for obstructive sleep apnea, cognitive behavior therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

Thus there were serious neurologic or rheumatologic diseases causing their insomnia, Dr. Risk said. “If they slept through the night, we found that they were mostly in stage 1 or 2 sleep. They never got to restorative sleep stage 3 or 4. So they had a lack of restorative sleep due to a light or fragmented sleep.”

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interplay between the sleep disorder and comorbid dual diagnoses,” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians.

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. They assessed the severity of obstructive sleep apnea, attention deficit problems, depression, and insomnia with a battery of standardized tests.

All patients had treatment, including continuous positive airway pressure (CPAP) for obstructive sleep apnea, cognitive behavior therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

Thus there were serious neurologic or rheumatologic diseases causing their insomnia, Dr. Risk said. “If they slept through the night, we found that they were mostly in stage 1 or 2 sleep. They never got to restorative sleep stage 3 or 4. So they had a lack of restorative sleep due to a light or fragmented sleep.”

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interplay between the sleep disorder and comorbid dual diagnoses,” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians.

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. They assessed the severity of obstructive sleep apnea, attention deficit problems, depression, and insomnia with a battery of standardized tests.

All patients had treatment, including continuous positive airway pressure (CPAP) for obstructive sleep apnea, cognitive behavior therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

Thus there were serious neurologic or rheumatologic diseases causing their insomnia, Dr. Risk said. “If they slept through the night, we found that they were mostly in stage 1 or 2 sleep. They never got to restorative sleep stage 3 or 4. So they had a lack of restorative sleep due to a light or fragmented sleep.”

SEATTLE — The long-term use of β‐blockers in heart failure patients with chronic obstructive pulmonary disease and/or asthma did not increase the risk of respiratory complications, results from a large retrospective study have shown.

“Although a history of asthma and/or COPD is still considered a relative contraindication to the use of β‐blockers in the management of [heart failure], our study found that long‐term use did not increase the risk for respiratory complications,” Jay I. Peters, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “We did not see any differences in outcome with the use of cardioselective vs. noncardioselective β‐blockers. The proven mortality benefit of β‐blocking medication in [heart failure] mandates their use whenever possible.”

During the 1960s, physicians viewed β‐blockers as contraindicated in patients with HF. “Subsequent research revealed that the use of cardioselective β‐blockers upregulated the β‐receptor and was useful” in patients with HF, said Dr. Peters of the division of pulmonary diseases and critical care medicine at the University of Texas Health Science Center at San Antonio.

In fact, studies have shown improved survival among HF patients on β‐blockers: For every 20 patients treated with these drugs, one life is saved (Ann. Intern. Med. 2001;134:550‐60; N. Engl. J. Med. 2001;344:1711‐2).

“Unfortunately, many review articles and guidelines often list asthma and COPD as relative contraindications to using β‐blockers. Many physicians in the community are hesitant to use these medications if the patient has any history of obstructive lung disease,” he noted.

A recent metaanalysis of data on 141 patients concluded that cardioselective β‐blockers are not associated with increased respiratory symptoms or inhaler use, and that β‐blockers may enhance the effect of inhaled β‐agonist (Cochrane Database Syst. Rev. 2002;4:CD002992). But “the duration of the studies was only 3 days to 4 weeks, and only 46 patients had pulmonary function tests,” Dr. Peters said.

In a study funded by the U.S. Department of Defense, he and his associates evaluated the prevalence of β‐blocker use and the prevalence of respiratory events in patients with COPD and/or asthma. Their retrospective analysis of prospectively collected data included 1,067 patients with HF who were followed over 18 months. Investigators reviewed every nonroutine office visit, ER visit, and hospitalization over the 18‐month period to evaluate respiratory symptoms and cardiac symptoms.

The prevalence of asthma was 5.9%, and that of COPD was 11.2%; 2.5% of patients had both COPD and asthma. “Overall, 19.6% of patients had obstructive lung disease and could have benefited from β‐blockers,” he said.

Only 39% of patients with asthma and COPD were on β‐blockers. About 45% of asthmatics and 35% of patients with COPD were on β‐blockers. In addition, 49% of the patients were prescribed cardioselective β‐blockers “that are felt to be safer in patients with obstructive lung disease.”

Patients with HF and any respiratory diagnosis had a threefold increase in respiratory encounters, compared with patients who had a diagnosis of HF alone.

Overall, the use of β‐blockers in patients with asthma and/or COPD did not increase the number of respiratory encounters in terms of unscheduled office visits, ER visits, or hospitalizations.

β‐Blocker use in patients with asthma and COPD statistically lowered the rate of respiratory events, he noted, “but the number of patients in this group was small, and larger studies will be needed to confirm this finding.”

SEATTLE — The long-term use of β‐blockers in heart failure patients with chronic obstructive pulmonary disease and/or asthma did not increase the risk of respiratory complications, results from a large retrospective study have shown.

“Although a history of asthma and/or COPD is still considered a relative contraindication to the use of β‐blockers in the management of [heart failure], our study found that long‐term use did not increase the risk for respiratory complications,” Jay I. Peters, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “We did not see any differences in outcome with the use of cardioselective vs. noncardioselective β‐blockers. The proven mortality benefit of β‐blocking medication in [heart failure] mandates their use whenever possible.”

During the 1960s, physicians viewed β‐blockers as contraindicated in patients with HF. “Subsequent research revealed that the use of cardioselective β‐blockers upregulated the β‐receptor and was useful” in patients with HF, said Dr. Peters of the division of pulmonary diseases and critical care medicine at the University of Texas Health Science Center at San Antonio.

In fact, studies have shown improved survival among HF patients on β‐blockers: For every 20 patients treated with these drugs, one life is saved (Ann. Intern. Med. 2001;134:550‐60; N. Engl. J. Med. 2001;344:1711‐2).

“Unfortunately, many review articles and guidelines often list asthma and COPD as relative contraindications to using β‐blockers. Many physicians in the community are hesitant to use these medications if the patient has any history of obstructive lung disease,” he noted.

A recent metaanalysis of data on 141 patients concluded that cardioselective β‐blockers are not associated with increased respiratory symptoms or inhaler use, and that β‐blockers may enhance the effect of inhaled β‐agonist (Cochrane Database Syst. Rev. 2002;4:CD002992). But “the duration of the studies was only 3 days to 4 weeks, and only 46 patients had pulmonary function tests,” Dr. Peters said.

In a study funded by the U.S. Department of Defense, he and his associates evaluated the prevalence of β‐blocker use and the prevalence of respiratory events in patients with COPD and/or asthma. Their retrospective analysis of prospectively collected data included 1,067 patients with HF who were followed over 18 months. Investigators reviewed every nonroutine office visit, ER visit, and hospitalization over the 18‐month period to evaluate respiratory symptoms and cardiac symptoms.

The prevalence of asthma was 5.9%, and that of COPD was 11.2%; 2.5% of patients had both COPD and asthma. “Overall, 19.6% of patients had obstructive lung disease and could have benefited from β‐blockers,” he said.

Only 39% of patients with asthma and COPD were on β‐blockers. About 45% of asthmatics and 35% of patients with COPD were on β‐blockers. In addition, 49% of the patients were prescribed cardioselective β‐blockers “that are felt to be safer in patients with obstructive lung disease.”

Patients with HF and any respiratory diagnosis had a threefold increase in respiratory encounters, compared with patients who had a diagnosis of HF alone.

Overall, the use of β‐blockers in patients with asthma and/or COPD did not increase the number of respiratory encounters in terms of unscheduled office visits, ER visits, or hospitalizations.

β‐Blocker use in patients with asthma and COPD statistically lowered the rate of respiratory events, he noted, “but the number of patients in this group was small, and larger studies will be needed to confirm this finding.”

SEATTLE — The long-term use of β‐blockers in heart failure patients with chronic obstructive pulmonary disease and/or asthma did not increase the risk of respiratory complications, results from a large retrospective study have shown.

“Although a history of asthma and/or COPD is still considered a relative contraindication to the use of β‐blockers in the management of [heart failure], our study found that long‐term use did not increase the risk for respiratory complications,” Jay I. Peters, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “We did not see any differences in outcome with the use of cardioselective vs. noncardioselective β‐blockers. The proven mortality benefit of β‐blocking medication in [heart failure] mandates their use whenever possible.”

During the 1960s, physicians viewed β‐blockers as contraindicated in patients with HF. “Subsequent research revealed that the use of cardioselective β‐blockers upregulated the β‐receptor and was useful” in patients with HF, said Dr. Peters of the division of pulmonary diseases and critical care medicine at the University of Texas Health Science Center at San Antonio.

In fact, studies have shown improved survival among HF patients on β‐blockers: For every 20 patients treated with these drugs, one life is saved (Ann. Intern. Med. 2001;134:550‐60; N. Engl. J. Med. 2001;344:1711‐2).

“Unfortunately, many review articles and guidelines often list asthma and COPD as relative contraindications to using β‐blockers. Many physicians in the community are hesitant to use these medications if the patient has any history of obstructive lung disease,” he noted.

A recent metaanalysis of data on 141 patients concluded that cardioselective β‐blockers are not associated with increased respiratory symptoms or inhaler use, and that β‐blockers may enhance the effect of inhaled β‐agonist (Cochrane Database Syst. Rev. 2002;4:CD002992). But “the duration of the studies was only 3 days to 4 weeks, and only 46 patients had pulmonary function tests,” Dr. Peters said.

In a study funded by the U.S. Department of Defense, he and his associates evaluated the prevalence of β‐blocker use and the prevalence of respiratory events in patients with COPD and/or asthma. Their retrospective analysis of prospectively collected data included 1,067 patients with HF who were followed over 18 months. Investigators reviewed every nonroutine office visit, ER visit, and hospitalization over the 18‐month period to evaluate respiratory symptoms and cardiac symptoms.

The prevalence of asthma was 5.9%, and that of COPD was 11.2%; 2.5% of patients had both COPD and asthma. “Overall, 19.6% of patients had obstructive lung disease and could have benefited from β‐blockers,” he said.

Only 39% of patients with asthma and COPD were on β‐blockers. About 45% of asthmatics and 35% of patients with COPD were on β‐blockers. In addition, 49% of the patients were prescribed cardioselective β‐blockers “that are felt to be safer in patients with obstructive lung disease.”

Patients with HF and any respiratory diagnosis had a threefold increase in respiratory encounters, compared with patients who had a diagnosis of HF alone.

Overall, the use of β‐blockers in patients with asthma and/or COPD did not increase the number of respiratory encounters in terms of unscheduled office visits, ER visits, or hospitalizations.

β‐Blocker use in patients with asthma and COPD statistically lowered the rate of respiratory events, he noted, “but the number of patients in this group was small, and larger studies will be needed to confirm this finding.”

SAN DIEGO — Patients diagnosed with hematologic malignancies seem to want information from physicians about treatment options and recommendations but less information about the likely course of their disease, preliminary results from an ongoing study suggest.

Many studies in the medical literature have explored ways to break bad news during end-of-life care, but “much less has been done in the middle, when patients facing an acute illness are really looking for guidance and information and are seeing a subspecialist for the first time,” Stephanie J. Lee, M.D., said in an interview prior to the annual meeting of the American Society of Hematology.

“While physicians appear to be communicating with patients in ways that result in high degrees of satisfaction, maintain hope, and do not diminish patients' sense of depression or anxiety, patients are retaining overoptimistic prognostic expectations after their consultation,” Dr. Lee said.

She and her associates interviewed 83 patients with hematologic malignancies at the Dana-Farber Cancer Institute, Boston, between September 2002 and September 2003. Prior to coming to Dana-Farber, the patients had been seen by 15 physicians in six different states. Investigators interviewed the patients before and after their consultation with a cancer subspecialist at Dana-Farber, and all consultations were tape recorded.

Of the 83 patients, 83% were white, and 54% were men. The average age was 58, and the median time from diagnosis to study enrollment was 69 days.

The main diagnoses were non-Hodgkin's lymphoma (31%) and multiple myeloma (29%).

Overall, 41% of the patients wanted to be an equal partner in decision making, while 36% wanted to take primary responsibility for the decision, said Dr. Lee of Harvard Medical School, Boston.

“Almost everyone wanted to discuss treatment options, treatment goals, and physician treatment recommendations, but fewer wanted to discuss average patient survival, likelihood of treatment success, likelihood of cure, or clinical trials,” she said.

Most patients (70%) wanted prognostic information in percentages, and 64% wanted to hear how previous patients fared; only 44% wanted to hear qualitative expressions of probability.

“We didn't ask the patients, 'How would you like to be told if the news was bad?' We did ask, 'If you were going to hear about prognosis, how would you like your doctor to tell you about prognosis?' Most said they wanted to hear percentages,” Dr. Lee said.

When patients were asked to estimate their chance of cure or life expectancy prior to their subspecialist consultation, they “were much more optimistic, compared with their physicians,” she said. “After the consultation, most patients' prognostic estimates were unchanged.”

She added that most patients were “very satisfied” with their consultations, and most reported the same or improved depression, anxiety, and hope after.

Patient optimism “is a pretty universal finding,” Dr. Lee concluded. “They were accessing a lot of different sources of information when we talked to them—even before they saw the subspecialist. And yet they were still quite optimistic, compared with what the doctor was saying in terms of what might be out there in the literature. There's this sort of human optimism that surrounds all kinds of diseases—not just cancers.”

She and her associates plan to enroll a total of 240 patients in the study to explore other components of patient-physician communication. For example, “is there something specific about the way the doctors communicate with patients that make the outcomes better or worse? Better or worse outcomes can result from one communication method. If you're brutally honest with someone, they might get the actual information, but you can cause a lot of depression and anxiety, poor coping, and bad outcomes, as well.”

SAN DIEGO — Patients diagnosed with hematologic malignancies seem to want information from physicians about treatment options and recommendations but less information about the likely course of their disease, preliminary results from an ongoing study suggest.

Many studies in the medical literature have explored ways to break bad news during end-of-life care, but “much less has been done in the middle, when patients facing an acute illness are really looking for guidance and information and are seeing a subspecialist for the first time,” Stephanie J. Lee, M.D., said in an interview prior to the annual meeting of the American Society of Hematology.

“While physicians appear to be communicating with patients in ways that result in high degrees of satisfaction, maintain hope, and do not diminish patients' sense of depression or anxiety, patients are retaining overoptimistic prognostic expectations after their consultation,” Dr. Lee said.

She and her associates interviewed 83 patients with hematologic malignancies at the Dana-Farber Cancer Institute, Boston, between September 2002 and September 2003. Prior to coming to Dana-Farber, the patients had been seen by 15 physicians in six different states. Investigators interviewed the patients before and after their consultation with a cancer subspecialist at Dana-Farber, and all consultations were tape recorded.

Of the 83 patients, 83% were white, and 54% were men. The average age was 58, and the median time from diagnosis to study enrollment was 69 days.

The main diagnoses were non-Hodgkin's lymphoma (31%) and multiple myeloma (29%).

Overall, 41% of the patients wanted to be an equal partner in decision making, while 36% wanted to take primary responsibility for the decision, said Dr. Lee of Harvard Medical School, Boston.

“Almost everyone wanted to discuss treatment options, treatment goals, and physician treatment recommendations, but fewer wanted to discuss average patient survival, likelihood of treatment success, likelihood of cure, or clinical trials,” she said.

Most patients (70%) wanted prognostic information in percentages, and 64% wanted to hear how previous patients fared; only 44% wanted to hear qualitative expressions of probability.

“We didn't ask the patients, 'How would you like to be told if the news was bad?' We did ask, 'If you were going to hear about prognosis, how would you like your doctor to tell you about prognosis?' Most said they wanted to hear percentages,” Dr. Lee said.

When patients were asked to estimate their chance of cure or life expectancy prior to their subspecialist consultation, they “were much more optimistic, compared with their physicians,” she said. “After the consultation, most patients' prognostic estimates were unchanged.”

She added that most patients were “very satisfied” with their consultations, and most reported the same or improved depression, anxiety, and hope after.

Patient optimism “is a pretty universal finding,” Dr. Lee concluded. “They were accessing a lot of different sources of information when we talked to them—even before they saw the subspecialist. And yet they were still quite optimistic, compared with what the doctor was saying in terms of what might be out there in the literature. There's this sort of human optimism that surrounds all kinds of diseases—not just cancers.”

She and her associates plan to enroll a total of 240 patients in the study to explore other components of patient-physician communication. For example, “is there something specific about the way the doctors communicate with patients that make the outcomes better or worse? Better or worse outcomes can result from one communication method. If you're brutally honest with someone, they might get the actual information, but you can cause a lot of depression and anxiety, poor coping, and bad outcomes, as well.”

SAN DIEGO — Patients diagnosed with hematologic malignancies seem to want information from physicians about treatment options and recommendations but less information about the likely course of their disease, preliminary results from an ongoing study suggest.

Many studies in the medical literature have explored ways to break bad news during end-of-life care, but “much less has been done in the middle, when patients facing an acute illness are really looking for guidance and information and are seeing a subspecialist for the first time,” Stephanie J. Lee, M.D., said in an interview prior to the annual meeting of the American Society of Hematology.

“While physicians appear to be communicating with patients in ways that result in high degrees of satisfaction, maintain hope, and do not diminish patients' sense of depression or anxiety, patients are retaining overoptimistic prognostic expectations after their consultation,” Dr. Lee said.

She and her associates interviewed 83 patients with hematologic malignancies at the Dana-Farber Cancer Institute, Boston, between September 2002 and September 2003. Prior to coming to Dana-Farber, the patients had been seen by 15 physicians in six different states. Investigators interviewed the patients before and after their consultation with a cancer subspecialist at Dana-Farber, and all consultations were tape recorded.

Of the 83 patients, 83% were white, and 54% were men. The average age was 58, and the median time from diagnosis to study enrollment was 69 days.

The main diagnoses were non-Hodgkin's lymphoma (31%) and multiple myeloma (29%).

Overall, 41% of the patients wanted to be an equal partner in decision making, while 36% wanted to take primary responsibility for the decision, said Dr. Lee of Harvard Medical School, Boston.

“Almost everyone wanted to discuss treatment options, treatment goals, and physician treatment recommendations, but fewer wanted to discuss average patient survival, likelihood of treatment success, likelihood of cure, or clinical trials,” she said.

Most patients (70%) wanted prognostic information in percentages, and 64% wanted to hear how previous patients fared; only 44% wanted to hear qualitative expressions of probability.

“We didn't ask the patients, 'How would you like to be told if the news was bad?' We did ask, 'If you were going to hear about prognosis, how would you like your doctor to tell you about prognosis?' Most said they wanted to hear percentages,” Dr. Lee said.

When patients were asked to estimate their chance of cure or life expectancy prior to their subspecialist consultation, they “were much more optimistic, compared with their physicians,” she said. “After the consultation, most patients' prognostic estimates were unchanged.”

She added that most patients were “very satisfied” with their consultations, and most reported the same or improved depression, anxiety, and hope after.

Patient optimism “is a pretty universal finding,” Dr. Lee concluded. “They were accessing a lot of different sources of information when we talked to them—even before they saw the subspecialist. And yet they were still quite optimistic, compared with what the doctor was saying in terms of what might be out there in the literature. There's this sort of human optimism that surrounds all kinds of diseases—not just cancers.”

She and her associates plan to enroll a total of 240 patients in the study to explore other components of patient-physician communication. For example, “is there something specific about the way the doctors communicate with patients that make the outcomes better or worse? Better or worse outcomes can result from one communication method. If you're brutally honest with someone, they might get the actual information, but you can cause a lot of depression and anxiety, poor coping, and bad outcomes, as well.”

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

“Iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology. “We need to look in more detail at transfused vs. nontransfused patients and see whether the iron overload story holds out.”

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

For the study, the investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had previously been transfused or were currently on a transfusion program. The investigators also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah, of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two had osteoporosis and two were osteopenic). Liver iron concentrations were higher among osteopenic females than in their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males in the study, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of the serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia.

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

“Iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology. “We need to look in more detail at transfused vs. nontransfused patients and see whether the iron overload story holds out.”

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

For the study, the investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had previously been transfused or were currently on a transfusion program. The investigators also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah, of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two had osteoporosis and two were osteopenic). Liver iron concentrations were higher among osteopenic females than in their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males in the study, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of the serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia.

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

“Iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology. “We need to look in more detail at transfused vs. nontransfused patients and see whether the iron overload story holds out.”

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

For the study, the investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had previously been transfused or were currently on a transfusion program. The investigators also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah, of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two had osteoporosis and two were osteopenic). Liver iron concentrations were higher among osteopenic females than in their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males in the study, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of the serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases. The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35–37 weeks does not appear to be predictive of BV at admission for labor.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases. The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35–37 weeks does not appear to be predictive of BV at admission for labor.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases. The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35–37 weeks does not appear to be predictive of BV at admission for labor.

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The sleep specialist isn't done when he says, 'It's sleep apnea. Use continuous positive airway pressure,' or 'It's insomnia; take a sleeping pill,'” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “He has to work out what the concurrent conditions are at the same time he's trying to improve the insomnia or sleep apnea. The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interlay between the sleep disorder and comorbid dual diagnoses.”

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. Investigators administered a wide battery of standardized tests to assess the severity of obstructive sleep apnea, attention-deficit problems, depression, and insomnia.

All patients received treatment for their respective conditions, including continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea, cognitive-behavioral therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

There were serious rheumatologic and neurologic diseases causing sleep disturbances in patients with insomnia, Dr. Risk said.

He concluded that a multidisciplinary approach to patients with sleep difficulties “may be necessary in order to isolate additional comorbidities that are causing persistent impairment.

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The sleep specialist isn't done when he says, 'It's sleep apnea. Use continuous positive airway pressure,' or 'It's insomnia; take a sleeping pill,'” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “He has to work out what the concurrent conditions are at the same time he's trying to improve the insomnia or sleep apnea. The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interlay between the sleep disorder and comorbid dual diagnoses.”

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. Investigators administered a wide battery of standardized tests to assess the severity of obstructive sleep apnea, attention-deficit problems, depression, and insomnia.

All patients received treatment for their respective conditions, including continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea, cognitive-behavioral therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

There were serious rheumatologic and neurologic diseases causing sleep disturbances in patients with insomnia, Dr. Risk said.

He concluded that a multidisciplinary approach to patients with sleep difficulties “may be necessary in order to isolate additional comorbidities that are causing persistent impairment.

SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.

“The sleep specialist isn't done when he says, 'It's sleep apnea. Use continuous positive airway pressure,' or 'It's insomnia; take a sleeping pill,'” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “He has to work out what the concurrent conditions are at the same time he's trying to improve the insomnia or sleep apnea. The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interlay between the sleep disorder and comorbid dual diagnoses.”

He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. Investigators administered a wide battery of standardized tests to assess the severity of obstructive sleep apnea, attention-deficit problems, depression, and insomnia.

All patients received treatment for their respective conditions, including continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea, cognitive-behavioral therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.

Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.

Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.

There were serious rheumatologic and neurologic diseases causing sleep disturbances in patients with insomnia, Dr. Risk said.

He concluded that a multidisciplinary approach to patients with sleep difficulties “may be necessary in order to isolate additional comorbidities that are causing persistent impairment.

SAN FRANCISCO — Fluconazole prophylaxis twice weekly during the first 6 weeks of life is similar to the previously studied schedule of more frequent doses in preventing invasive fungal infection in high-risk preterm infants who weigh less than 1,000 g at birth, David Kaufman, M.D., reported at the annual meeting of the Pediatric Academic Societies.

“This dosing seems comparable,” Dr. Kaufman said in a later interview. “Certainly, [it] offers the benefit of less cost and less patient exposure as far as potential side effects. The bigger issue is that some fungi develop resistance to fluconazole. This [dosing] is another way to reduce the possibility of resistance.”

Dr. Kaufman and his associates conducted a 2-year prospective, randomized, double-blind study of 81 high-risk preterm infants at the University of Virginia Children's Medical Center, Charlottesville.

The infants had birth weights of less than 1,000 g and either an endotracheal tube or central venous catheter. Infants were randomized to receive one of two dosing schedules. Dosing schedule A consisted of 3 mg of intravenous fluconazole per kilogram of body weight every 72 hours during weeks 1 and 2, then every 48 hours during weeks 3 and 4, and every 24 hours for weeks 5 and 6. Dosing schedule B consisted of 3 mg/kg fluconazole twice a week.

The 41 infants randomized to dosing schedule A and the 40 on dosing schedule B were similar in mean body weight (691g vs. 704 g), gestational age (25 weeks vs. 26 weeks), and risk factors for fungal infection, said Dr. Kaufman of the university's department of pediatrics. Two patients in each group had baseline fungal colonization.

During the 6-week treatment period, fungal colonization was documented in five schedule A patients (12%) and in four schedule B patients (10%). Invasive fungal infection occurred in two schedule A patients (5%) and in one schedule B patient (3%).

All these infections cleared with line removal and amphotericin treatment. All fungal isolates remained sensitive to fluconazole, and no adverse side effects were noted.

Dr. Kaufman said he and his associates would like to conduct a larger, multisite, randomized trial of 1,000-1,500 infants within the next year or 2 to confirm the findings.

“A multicenter study would better confirm the efficacy as well as further evaluate side effects and resistance,” he said. “It might also be able to show if prophylaxis would decrease mortality. Since up to 40% of extremely preterm infants who develop fungal bloodstream infections die, prevention should improve survival.”

If one assumes that each dose of fluconazole costs $50, he added, the cost difference between schedule A dosing and schedule B dosing is significant ($1,600 vs. $600, respectively).

The study was supported by a grant from Pfizer Inc., which markets fluconazole under the brand name Diflucan.

The meeting was sponsored by the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

SAN FRANCISCO — Fluconazole prophylaxis twice weekly during the first 6 weeks of life is similar to the previously studied schedule of more frequent doses in preventing invasive fungal infection in high-risk preterm infants who weigh less than 1,000 g at birth, David Kaufman, M.D., reported at the annual meeting of the Pediatric Academic Societies.

“This dosing seems comparable,” Dr. Kaufman said in a later interview. “Certainly, [it] offers the benefit of less cost and less patient exposure as far as potential side effects. The bigger issue is that some fungi develop resistance to fluconazole. This [dosing] is another way to reduce the possibility of resistance.”

Dr. Kaufman and his associates conducted a 2-year prospective, randomized, double-blind study of 81 high-risk preterm infants at the University of Virginia Children's Medical Center, Charlottesville.

The infants had birth weights of less than 1,000 g and either an endotracheal tube or central venous catheter. Infants were randomized to receive one of two dosing schedules. Dosing schedule A consisted of 3 mg of intravenous fluconazole per kilogram of body weight every 72 hours during weeks 1 and 2, then every 48 hours during weeks 3 and 4, and every 24 hours for weeks 5 and 6. Dosing schedule B consisted of 3 mg/kg fluconazole twice a week.

The 41 infants randomized to dosing schedule A and the 40 on dosing schedule B were similar in mean body weight (691g vs. 704 g), gestational age (25 weeks vs. 26 weeks), and risk factors for fungal infection, said Dr. Kaufman of the university's department of pediatrics. Two patients in each group had baseline fungal colonization.

During the 6-week treatment period, fungal colonization was documented in five schedule A patients (12%) and in four schedule B patients (10%). Invasive fungal infection occurred in two schedule A patients (5%) and in one schedule B patient (3%).

All these infections cleared with line removal and amphotericin treatment. All fungal isolates remained sensitive to fluconazole, and no adverse side effects were noted.

Dr. Kaufman said he and his associates would like to conduct a larger, multisite, randomized trial of 1,000-1,500 infants within the next year or 2 to confirm the findings.

“A multicenter study would better confirm the efficacy as well as further evaluate side effects and resistance,” he said. “It might also be able to show if prophylaxis would decrease mortality. Since up to 40% of extremely preterm infants who develop fungal bloodstream infections die, prevention should improve survival.”

If one assumes that each dose of fluconazole costs $50, he added, the cost difference between schedule A dosing and schedule B dosing is significant ($1,600 vs. $600, respectively).

The study was supported by a grant from Pfizer Inc., which markets fluconazole under the brand name Diflucan.

The meeting was sponsored by the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

SAN FRANCISCO — Fluconazole prophylaxis twice weekly during the first 6 weeks of life is similar to the previously studied schedule of more frequent doses in preventing invasive fungal infection in high-risk preterm infants who weigh less than 1,000 g at birth, David Kaufman, M.D., reported at the annual meeting of the Pediatric Academic Societies.

“This dosing seems comparable,” Dr. Kaufman said in a later interview. “Certainly, [it] offers the benefit of less cost and less patient exposure as far as potential side effects. The bigger issue is that some fungi develop resistance to fluconazole. This [dosing] is another way to reduce the possibility of resistance.”

Dr. Kaufman and his associates conducted a 2-year prospective, randomized, double-blind study of 81 high-risk preterm infants at the University of Virginia Children's Medical Center, Charlottesville.

The infants had birth weights of less than 1,000 g and either an endotracheal tube or central venous catheter. Infants were randomized to receive one of two dosing schedules. Dosing schedule A consisted of 3 mg of intravenous fluconazole per kilogram of body weight every 72 hours during weeks 1 and 2, then every 48 hours during weeks 3 and 4, and every 24 hours for weeks 5 and 6. Dosing schedule B consisted of 3 mg/kg fluconazole twice a week.

The 41 infants randomized to dosing schedule A and the 40 on dosing schedule B were similar in mean body weight (691g vs. 704 g), gestational age (25 weeks vs. 26 weeks), and risk factors for fungal infection, said Dr. Kaufman of the university's department of pediatrics. Two patients in each group had baseline fungal colonization.

During the 6-week treatment period, fungal colonization was documented in five schedule A patients (12%) and in four schedule B patients (10%). Invasive fungal infection occurred in two schedule A patients (5%) and in one schedule B patient (3%).

All these infections cleared with line removal and amphotericin treatment. All fungal isolates remained sensitive to fluconazole, and no adverse side effects were noted.

Dr. Kaufman said he and his associates would like to conduct a larger, multisite, randomized trial of 1,000-1,500 infants within the next year or 2 to confirm the findings.

“A multicenter study would better confirm the efficacy as well as further evaluate side effects and resistance,” he said. “It might also be able to show if prophylaxis would decrease mortality. Since up to 40% of extremely preterm infants who develop fungal bloodstream infections die, prevention should improve survival.”

If one assumes that each dose of fluconazole costs $50, he added, the cost difference between schedule A dosing and schedule B dosing is significant ($1,600 vs. $600, respectively).

The study was supported by a grant from Pfizer Inc., which markets fluconazole under the brand name Diflucan.

The meeting was sponsored by the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases.

The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35-37 weeks does not appear to be predictive of BV at admission for labor.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases.

The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35-37 weeks does not appear to be predictive of BV at admission for labor.

SAN DIEGO — Repeat screening for lower genital tract infections in pregnant adolescents is reasonable because of high recurrence and persistence rate of infections in this patient population, Andrea Ries Thurman, M.D., reported in a poster session at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“Universal screening of adolescents for common genital tract infections will improve their obstetric outcomes,” said Dr. Thurman of the department of ob.gyn. at Medical University of South Carolina, Charleston. “They're a different population than pregnant adults in their risk of problems, particularly in their risk of lower genital tract infections.”

In an ongoing study, pregnant adolescents were screened for bacterial vaginosis (BV), yeast vaginitis, trichomoniasis, gonorrhea, and chlamydia at their intake obstetric visit and at their 35- to 37-week visit. A Gram stain of the vaginal secretions was obtained upon admission to labor and delivery.

Dr. Thurman reported on complete data available for 69 patients at the intake obstetric visit and 31 patients at the 35- to 37-week visit. At the intake visit, 33% of patients had BV, 15% had chlamydia, 13% had yeast vaginitis, 4% had gonorrhea, and 4% had trichomoniasis.

At the 35- to 37-week visit, 19% of patients had chlamydia, 16% had BV, 13% had yeast vaginitis, 3% had trichomoniasis, and no patients had gonorrhea.

Of the lower genital tract infections identified at the 35- to 37-week visit, the following were new diagnoses: 100% of the trichomoniasis cases, 80% of the BV cases, 75% of the yeast infections, and 50% of the chlamydia cases.

The rest were recurrent infections from the intake visit, despite receiving treatment.

Gram stains were obtained from 94 pregnant teens on admission for labor and delivery. Investigators observed that Nugent scores for vaginal flora did not differ between mothers who delivered preterm and those who delivered at term. They also found that screening for BV at 35-37 weeks does not appear to be predictive of BV at admission for labor.

NEW ORLEANS — Sleep apnea and hypoxia are rarely associated with gastroesophageal reflux and probably are not important causes of increased acid exposure, Anthony DiMarino Jr., M.D., reported at the annual Digestive Disease Week.

“The cause of nocturnal acid reflux events is presumably due to transient lower esophageal sphincter relaxation,” said Dr. DiMarino, chief of the division of gastroenterology and hepatology at Thomas Jefferson University Hospital, Philadelphia. “It is not related to nocturnal respiratory changes of apnea or hypoxia.”

He and his associates studied 16 patients with self-described insomnia on two separate nights in the Jefferson Sleep Disorders Center using simultaneous polysomnography and esophageal pH monitoring. The researchers noted each episode of sleep apnea, central sleep apnea, obstructive sleep apnea, hypopnea, hypoxia, and awakening (a period of wakefulness lasting for at least 15 seconds), and determined their relationship with gastroesophageal reflux events.

A decrease in the esophageal pH below 4·0 was considered a significant reflux event. Reflux events were associated with arousals if they occurred 5 minutes prior to the sleep event.

The average age of patients was 41·3 years and their mean body mass index was 25 kg/m2. Ten of the 16 patients were men.

The researchers recorded 240 apnea episodes, of which 13 were associated with reflux. Of the 27 obstructive apnea episodes, 1 was associated with reflux.

“The majority of reflux events were not associated with apnea, and there was no consistent relationship of the reflux events to the type of apnea or hypopnea,” Dr. DiMarino said.

The researchers recorded 44 hypoxia events, of which 9 were associated with reflux. In addition, there were 61 awakenings associated with the 240 apnea episodes, and 27 awakenings associated with the 44 hypoxia events. This suggests that sleep awakenings are related to apnea and hypoxia, but they do not cause reflux as a secondary event, he said.

NEW ORLEANS — Sleep apnea and hypoxia are rarely associated with gastroesophageal reflux and probably are not important causes of increased acid exposure, Anthony DiMarino Jr., M.D., reported at the annual Digestive Disease Week.

“The cause of nocturnal acid reflux events is presumably due to transient lower esophageal sphincter relaxation,” said Dr. DiMarino, chief of the division of gastroenterology and hepatology at Thomas Jefferson University Hospital, Philadelphia. “It is not related to nocturnal respiratory changes of apnea or hypoxia.”

He and his associates studied 16 patients with self-described insomnia on two separate nights in the Jefferson Sleep Disorders Center using simultaneous polysomnography and esophageal pH monitoring. The researchers noted each episode of sleep apnea, central sleep apnea, obstructive sleep apnea, hypopnea, hypoxia, and awakening (a period of wakefulness lasting for at least 15 seconds), and determined their relationship with gastroesophageal reflux events.

A decrease in the esophageal pH below 4·0 was considered a significant reflux event. Reflux events were associated with arousals if they occurred 5 minutes prior to the sleep event.

The average age of patients was 41·3 years and their mean body mass index was 25 kg/m2. Ten of the 16 patients were men.

The researchers recorded 240 apnea episodes, of which 13 were associated with reflux. Of the 27 obstructive apnea episodes, 1 was associated with reflux.

“The majority of reflux events were not associated with apnea, and there was no consistent relationship of the reflux events to the type of apnea or hypopnea,” Dr. DiMarino said.

The researchers recorded 44 hypoxia events, of which 9 were associated with reflux. In addition, there were 61 awakenings associated with the 240 apnea episodes, and 27 awakenings associated with the 44 hypoxia events. This suggests that sleep awakenings are related to apnea and hypoxia, but they do not cause reflux as a secondary event, he said.

NEW ORLEANS — Sleep apnea and hypoxia are rarely associated with gastroesophageal reflux and probably are not important causes of increased acid exposure, Anthony DiMarino Jr., M.D., reported at the annual Digestive Disease Week.

“The cause of nocturnal acid reflux events is presumably due to transient lower esophageal sphincter relaxation,” said Dr. DiMarino, chief of the division of gastroenterology and hepatology at Thomas Jefferson University Hospital, Philadelphia. “It is not related to nocturnal respiratory changes of apnea or hypoxia.”

He and his associates studied 16 patients with self-described insomnia on two separate nights in the Jefferson Sleep Disorders Center using simultaneous polysomnography and esophageal pH monitoring. The researchers noted each episode of sleep apnea, central sleep apnea, obstructive sleep apnea, hypopnea, hypoxia, and awakening (a period of wakefulness lasting for at least 15 seconds), and determined their relationship with gastroesophageal reflux events.

A decrease in the esophageal pH below 4·0 was considered a significant reflux event. Reflux events were associated with arousals if they occurred 5 minutes prior to the sleep event.

The average age of patients was 41·3 years and their mean body mass index was 25 kg/m2. Ten of the 16 patients were men.

The researchers recorded 240 apnea episodes, of which 13 were associated with reflux. Of the 27 obstructive apnea episodes, 1 was associated with reflux.

“The majority of reflux events were not associated with apnea, and there was no consistent relationship of the reflux events to the type of apnea or hypopnea,” Dr. DiMarino said.

The researchers recorded 44 hypoxia events, of which 9 were associated with reflux. In addition, there were 61 awakenings associated with the 240 apnea episodes, and 27 awakenings associated with the 44 hypoxia events. This suggests that sleep awakenings are related to apnea and hypoxia, but they do not cause reflux as a secondary event, he said.