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Two SNPs linked to survival in R-CHOP–treated DLBCL
Two variations of the BCL2 gene are linked with the survival prospects of patients with diffuse large B-cell lymphoma (DLBCL) who are treated with the R-CHOP regimen, based on a study published in Haematologica.
In the population-based, case-control study of patients with non-Hodgkin’s lymphoma across the British Columbia province, Morteza Bashash, PhD, of the Dalla Lana School of Public Health, Toronto, and researchers at the British Columbia Cancer Agency analyzed 217 germline DLBCL samples, excluding those with primary mediastinal large B-cell lymphoma, specifically looking at nine single nucleotide polymorphisms (SNPs).
Patients receiving R-CHOP who had the AA genotype at rs7226979 had a risk of death that was four times higher than that of those with a G allele, researchers said (P less than .01). The same pattern was seen for PFS, with AA carriers having twice the risk of an event, compared with the other genotypes (P less than .05).
For those with rs4456611, patients with the GG genotype had a risk of death that was 3 times greater than that of those with an A allele (P less than .01), but there was no association with PFS for that SNP.
In an analysis of an independent cohort, only the associations that were seen with rs7226979 – and not those with rs4456611 – were able to be replicated.
The researchers noted that, while most predictive markers that are used to guide clinical treatment are drawn from actual tumor material, host-related factors could also be important.
“Compared to genetic analysis of the tumor, the patient’s constitutional genetic profile is relatively easy to obtain and can be assessed before treatment is started,” they wrote. “Our result has the potential to be useful as a complementary tool to predict the outcome of patients treated with R-CHOP and enhance clinical decision-making after confirmation by further studies.”
Two variations of the BCL2 gene are linked with the survival prospects of patients with diffuse large B-cell lymphoma (DLBCL) who are treated with the R-CHOP regimen, based on a study published in Haematologica.
In the population-based, case-control study of patients with non-Hodgkin’s lymphoma across the British Columbia province, Morteza Bashash, PhD, of the Dalla Lana School of Public Health, Toronto, and researchers at the British Columbia Cancer Agency analyzed 217 germline DLBCL samples, excluding those with primary mediastinal large B-cell lymphoma, specifically looking at nine single nucleotide polymorphisms (SNPs).
Patients receiving R-CHOP who had the AA genotype at rs7226979 had a risk of death that was four times higher than that of those with a G allele, researchers said (P less than .01). The same pattern was seen for PFS, with AA carriers having twice the risk of an event, compared with the other genotypes (P less than .05).
For those with rs4456611, patients with the GG genotype had a risk of death that was 3 times greater than that of those with an A allele (P less than .01), but there was no association with PFS for that SNP.
In an analysis of an independent cohort, only the associations that were seen with rs7226979 – and not those with rs4456611 – were able to be replicated.
The researchers noted that, while most predictive markers that are used to guide clinical treatment are drawn from actual tumor material, host-related factors could also be important.
“Compared to genetic analysis of the tumor, the patient’s constitutional genetic profile is relatively easy to obtain and can be assessed before treatment is started,” they wrote. “Our result has the potential to be useful as a complementary tool to predict the outcome of patients treated with R-CHOP and enhance clinical decision-making after confirmation by further studies.”
Two variations of the BCL2 gene are linked with the survival prospects of patients with diffuse large B-cell lymphoma (DLBCL) who are treated with the R-CHOP regimen, based on a study published in Haematologica.
In the population-based, case-control study of patients with non-Hodgkin’s lymphoma across the British Columbia province, Morteza Bashash, PhD, of the Dalla Lana School of Public Health, Toronto, and researchers at the British Columbia Cancer Agency analyzed 217 germline DLBCL samples, excluding those with primary mediastinal large B-cell lymphoma, specifically looking at nine single nucleotide polymorphisms (SNPs).
Patients receiving R-CHOP who had the AA genotype at rs7226979 had a risk of death that was four times higher than that of those with a G allele, researchers said (P less than .01). The same pattern was seen for PFS, with AA carriers having twice the risk of an event, compared with the other genotypes (P less than .05).
For those with rs4456611, patients with the GG genotype had a risk of death that was 3 times greater than that of those with an A allele (P less than .01), but there was no association with PFS for that SNP.
In an analysis of an independent cohort, only the associations that were seen with rs7226979 – and not those with rs4456611 – were able to be replicated.
The researchers noted that, while most predictive markers that are used to guide clinical treatment are drawn from actual tumor material, host-related factors could also be important.
“Compared to genetic analysis of the tumor, the patient’s constitutional genetic profile is relatively easy to obtain and can be assessed before treatment is started,” they wrote. “Our result has the potential to be useful as a complementary tool to predict the outcome of patients treated with R-CHOP and enhance clinical decision-making after confirmation by further studies.”
FROM HAEMATOLOGICA
Key clinical point: Two SNPs were found to be linked to survival prospects in patients with diffuse large B-cell lymphoma who receive primary R-CHOP therapy.
Major finding: For the rs7226979 SNP, those with the AA genotype had a four times higher risk of death than those with a G allele.
Data source: A population-based, case-control study of patients with non-Hodgkin’s lymphoma in British Columbia, with DNA samples analyzed for 9nine SNPs among the DLBCL patients, excluding those with primary mediastinal large B-cell lymphoma.
Disclosures: Some of the study authors reported institutional research funding from Roche; honoraria from Roche/Genentech, Janssen Pharmaceuticals and Celgene; and/or consultant or advisory roles with Roche/Genentech, Janssen Pharmaceuticals, Celgene, and NanoString Technologies.
Prescribing Patterns Shift After Detailing-Policy Change
In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.
The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.
At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.
The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.
In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.
The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.
At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.
The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.
In the past decade, medical institutions have begun to check the practice of detailing—pharmaceutical reps promoting medications during sales visits to physicians. This NIH study is one of the first to document the effect of these restrictions. The researchers compared prescribing at 19 academic medical centers (AMCs) that, between 2006 and 2012 instituted policies restricting detailing.
The study compared prescribing by 2,126 physicians at AMCs with that by 24,593 physicians from a pharmacy benefits database. The analysis covered 16.1 million prescriptions in 8 major drug classes: lipid lowering, gastroesophageal reflux disease, diabetes, hypertension, sleep, attention deficit hyperactivity disorder, depression, and antipsychosis.
At the centers with restrictions, physicians prescribed fewer of the promoted drugs and more nonpromoted drugs in the same drug classes. The mean market share of detailed drugs (across all the drug classes) in AMCs before the policy changes was 19.3%. Over the study period, the market share of detailed drugs prescribed by AMC physicians declined by 1.67 percentage point, an 8.7% decrease relative to the prechange level. The comparison group of physicians saw a slight decline over the same period. Although the drop was “modest,” NIH notes, proportionally small changes can represent thousands of prescriptions. The market share of nondetailed drugs increased by a relative 5.6%.
The changes were statistically significant for 6 of the 8 drug classes and for all drugs in the aggregate. The magnitude of changes differed across AMCs, the researchers found. The decline was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas. In 8 of 11 AMCs with more stringent policies, the changes in prescribing were significant, compared with only 1 of 8 AMCs with more limited measures.
OSA in pregnancy linked to congenital anomalies
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
BOSTON – Newborns exposed to obstructive sleep apnea (OSA) in utero are at a higher risk of being diagnosed with congenital anomalies, according to a new study presented at the annual meeting of the Associated Professional Sleep Societies.
The researchers’ analysis covered data from more than 1.4 million births during 2010-2014. Circulatory, musculoskeletal, and central nervous systems were among the types of anomalies they saw in the 17.3% of babies born to mothers who had OSA during pregnancy. These babies were also more likely to require intensive care at birth, compared with those born to mothers who had not been diagnosed with OSA.
Additionally, the investigators found that the 0.1% of women who had a diagnosis of OSA were 2.76 times more likely to have babies that required some kind of resuscitative effort at birth. Specifically, 0.5% of the newborns of the mothers with OSA required resuscitation, compared with 0.1% of the other group’s babies. The newborns of women with OSA were also 2.25 times more likely to have a longer hospital stay.
Mothers with OSA were older and more likely to be non-Hispanic black and have a diagnosis of obesity, tobacco use, and drug use but not alcohol use.
“We can’t say for sure that sleep apnea is causing these outcomes,” said abstract presenter and principal investigator Ghada Bourjeily, MD, of Brown University and Miriam Hospital, both in Providence, R.I., in an interview.
“We know that women who have sleep apnea also often have other morbidities, so we don’t know what might have contributed to the congenital outcomes,” said Dr. Bourjeily. “We also don’t know if treating sleep apnea can reverse or prevent birth complications or even maternal complications, like preeclampsia or gestational diabetes.”
Ongoing studies are looking at maternal continuous positive airway pressure therapy use and neonatal outcomes, but “they are nothing to write home about yet,” she said.
“This is an underdiagnosed condition and it’s probably undercoded too, but we know from another study that the prevalence of OSA in the first trimester in an all-comers population that was screened for the condition is 4%,” said Dr. Bourjeily. “If another 3% of [the study participants] actually had OSA, then all of these findings are potentially underestimated.”
The majority of OSA in pregnant women that has been identified in prospective studies is mild and not necessarily something that most physicians would treat, she noted. “In our study, the ones who were diagnosed were those who probably went to their doctors and complained of sleepiness or loud snoring.”
The researchers also determined that the newborns of mothers with sleep apnea were more likely to be admitted to an intensive care unit (25.3% vs. 8.1%) or a special care nursery (34.9% vs. 13.6%).
A diagnosis of OSA was established when a diagnosis code for OSA was present on the delivery discharge record. Maternal and infant outcomes were collected for ICD-9 and procedural codes.
Dr. Bourjeily received research equipment support from Respironics.
AT SLEEP 2017
Key clinical point: This large cohort study is the first study to show an increased risk of congenital anomalies and resuscitation at birth in newborns born to mothers with diagnosed obstructive sleep apnea (OSA).
Major finding: Of babies born to a mother with OSA, 17.3% had a congenital anomaly, compared with 10.6% of those born to mothers without OSA (P less than .001). This difference remained significant after adjusting for potential confounders.
Data source: A national cohort study including more than 1.4 million linked maternal and newborn records with a delivery hospitalization during 2010-2014.
Disclosures: Dr. Bourjeily received research equipment support from Respironics.
Supportive parenting program reduced African American teen smoking
Particularly in high-risk populations, participation in a family-centered parenting intervention can reduce adolescent and early adult smoking, according to results of a randomized controlled trial of the Strong African American Families (SAAF) program published in Pediatrics June 14.
African Americans have the “highest mortality rates for coronary heart disease and stroke,” compared with other racial groups, and the high rate of smoking among young adult African Americans is of concern, wrote Yi-fu Chen, PhD, of National Taipei University, New Taipei City, Taiwan, and his coinvestigators.
In a study of 424 African American adolescents from small towns in nine rural counties of southern Georgia, the 257 who were randomized to SAAF at age 11 years overall displayed significantly lower cotinine scores a
The SAAF families each attended seven meetings that consisted of both a separate session for the youth and the parent, and a joint session in which they practiced the skills they learned separately. The parents focused on “consistent provision of instrumental and emotional support, along with high levels of monitoring, consistent discipline that is not harsh, predictable family routines, and the establishment of clear norms and expectations for the use of drugs,” while the youth focused on “the importance of having and abiding by household rules, adaptive behaviors to use when encountering racism, and the importance of forming goals for the future and making plans to attain them,” the researchers explained.
These results “may provide a strategy for reducing health vulnerabilities associated with smoking among African American youth who grow up in challenging rural contexts,” the authors wrote.
Read more in Pediatrics (doi: 10.1542/peds.2016-4162).
Particularly in high-risk populations, participation in a family-centered parenting intervention can reduce adolescent and early adult smoking, according to results of a randomized controlled trial of the Strong African American Families (SAAF) program published in Pediatrics June 14.
African Americans have the “highest mortality rates for coronary heart disease and stroke,” compared with other racial groups, and the high rate of smoking among young adult African Americans is of concern, wrote Yi-fu Chen, PhD, of National Taipei University, New Taipei City, Taiwan, and his coinvestigators.
In a study of 424 African American adolescents from small towns in nine rural counties of southern Georgia, the 257 who were randomized to SAAF at age 11 years overall displayed significantly lower cotinine scores a
The SAAF families each attended seven meetings that consisted of both a separate session for the youth and the parent, and a joint session in which they practiced the skills they learned separately. The parents focused on “consistent provision of instrumental and emotional support, along with high levels of monitoring, consistent discipline that is not harsh, predictable family routines, and the establishment of clear norms and expectations for the use of drugs,” while the youth focused on “the importance of having and abiding by household rules, adaptive behaviors to use when encountering racism, and the importance of forming goals for the future and making plans to attain them,” the researchers explained.
These results “may provide a strategy for reducing health vulnerabilities associated with smoking among African American youth who grow up in challenging rural contexts,” the authors wrote.
Read more in Pediatrics (doi: 10.1542/peds.2016-4162).
Particularly in high-risk populations, participation in a family-centered parenting intervention can reduce adolescent and early adult smoking, according to results of a randomized controlled trial of the Strong African American Families (SAAF) program published in Pediatrics June 14.
African Americans have the “highest mortality rates for coronary heart disease and stroke,” compared with other racial groups, and the high rate of smoking among young adult African Americans is of concern, wrote Yi-fu Chen, PhD, of National Taipei University, New Taipei City, Taiwan, and his coinvestigators.
In a study of 424 African American adolescents from small towns in nine rural counties of southern Georgia, the 257 who were randomized to SAAF at age 11 years overall displayed significantly lower cotinine scores a
The SAAF families each attended seven meetings that consisted of both a separate session for the youth and the parent, and a joint session in which they practiced the skills they learned separately. The parents focused on “consistent provision of instrumental and emotional support, along with high levels of monitoring, consistent discipline that is not harsh, predictable family routines, and the establishment of clear norms and expectations for the use of drugs,” while the youth focused on “the importance of having and abiding by household rules, adaptive behaviors to use when encountering racism, and the importance of forming goals for the future and making plans to attain them,” the researchers explained.
These results “may provide a strategy for reducing health vulnerabilities associated with smoking among African American youth who grow up in challenging rural contexts,” the authors wrote.
Read more in Pediatrics (doi: 10.1542/peds.2016-4162).
FROM PEDIATRICS
Personalized snoring video boosts CPAP adherence
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
AT SLEEP 2017
Key clinical point: Showing patients videos of themselves having an apneic event during CPAP initiation resulted in greater treatment adherence over 3 months, compared to standard ways of initiating CPAP therapy.
Major finding: Patients who watched personalized sleep videos used their CPAP devices more than 2 hours per night longer, compared with those who were not shown a personalized video.
Data source: Randomized controlled trial with 3-month data on 24 individuals out of a planned enrollment of 300 patients.
Disclosures: This ongoing study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
Relieving PTSD Symptoms May Cut Risk of Myocardial Infarction and Stroke
Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.
The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.
Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.
Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.
A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.
Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.
Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.
Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.
The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.
Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.
Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.
A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.
Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.
Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.
Women with severe posttraumatic stress disorder (PTSD) symptoms have a nearly 70% increase in the incidence of cardiovascular disease (CVD), according to a study by researchers from Harvard and Brigham and Women’s Hospital in Boston, Massachusetts, Columbia University in New York, and University of California in San Francisco.
The researchers analyzed data from 49,859 women in the Nurses’ Health Study II. Over 20 years, there were 552 confirmed cases of myocardial infarction or stroke.
Women with 6 to 7 symptoms of trauma and PTSD had the highest risk. Women with trauma but no PTSD symptoms had a 30% higher risk. When women who said illness was their worst trauma were excluded, the risk of CVD doubled among those with trauma and severe PTSD symptoms and increased by 88% in women with trauma and moderate PTSD symptoms.
Strikingly, the researchers also found that when the PTSD symptoms declined so did the CVD risk. The researchers note that CVD risk due to other well-known risk factors, such as smoking, increases with exposure duration declines once the risk factor is eliminated. In this study, for every 5 additional years PTSD symptoms lasted, the odds of CVD were 9% higher.
A “more nuanced understanding” of the role of health behaviors could add insight into how PTSD influences the risk of CVD, the researchers say. They point to studies that have found a link between PTSD and cardiotoxic behaviors such as smoking, drinking, and diet. Physiologic alterations that occur with PTSD symptoms also may play an important role, they suggest, such as changes in neuropeptide Y in response to stress, which might contribute to metabolic syndrome.
Citing “particularly intriguing” findings from a study that found symptoms eventually remitted in 44% of individuals with PTSD, the researchers say providing treatment shortly after PTSD symptoms begin could limit the risk of CVD and, potentially, other disease-related risk.
Source:
Gilsanz P, Winning A, Koenen KC, et al. Psychol Med. 2017;47(8):1370-1378.
doi: 10.1017/S0033291716003378.
Unique Military and VA Nurse Collaboration to Teach and Learn
When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.
The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”
Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”
Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."
When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.
The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”
Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”
Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."
When military and VA nurses work side by side—learning from and teaching each other—they benefit and so do their patients. A “unique partnership” between the DoD and VA is proving that at Captain James A. Lovell Federal Health Care Center outside Chicago, Illinois.
The first of its kind facility serves nearly 67,000 active-duty military, military retirees, family members, and veterans. In an article for Health.mil News, U.S. Navy Lt. Nathan Aranas, an active-duty registered nurse (RN) and assistant nurse manager in the emergency department (ED), says, “We learn from local trauma, mental health, and pediatrics and birthing centers, exposing me more to how medicine outside of the military is practiced. It gives me a bigger perspective of how the rest of the country operates as a health care institution.”
Christine Barassi-Jackson, a VA civilian RN, nurse manager in the ED, says “having a combined organization is a great balance that pulls out the best parts of both the Navy and VA.” She leans on Aranas, the article says, to serve as an interpreter with some of the patients. “Knowing more of the Navy culture helps break down walls with the patients and other providers.” Aranas also believes that former active-duty patients may be more at ease with a uniformed nurse “because they understand the lingo.”
Overall, Aranas says, “It’s a great experience for young, active-duty clinicians to have."
Mild OSA linked to hypertension
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
AT SLEEP 2017
Key clinical point: In a random sample of adults, the presence of mild to moderate OSA was associated with a significantly higher risk of hypertension and diabetes.
Major finding: Individuals with mild to moderate OSA had more than a fourfold increased risk of hypertension over 10 years of follow-up (OR, 4.36). Moderate OSA was significantly associated with incident diabetes risk (OR, 2.78), but mild OSA was not.
Data source: An observational study including a random sample of 1,741 adults between the ages of 20 and 84 years.
Disclosures: The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
Loud, frequent snoring increases preterm delivery risk
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Compared with those who were nonloud, nonfrequent, or pregnancy-onset snorers, chronic, loud, and frequent snorers were at significantly greater risk for preterm delivery.
Major finding: Of women determined to be chronic, prepregnancy, frequent, and loud snorers, 25% had preterm delivery.
Data source: An observational study including 904 pregnant women in the third trimester.
Disclosures: This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
Avastin and Eylea: Comparison Shows Similar Success
A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.
In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.
On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”
Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.
Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.
A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.
In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.
On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”
Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.
Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.
A head-to-head comparison of 2 widely used drugs for macular edema due to central retinal vein occlusion—bevacizumab (Avastin) and aflibercept (Eylea)—found that both improved visual acuity (VA) similarly. But Eylea does it for $1,850 per dose, versus $60 per dose for Avastin.
In the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), National Eye Institute (NEI) researchers randomly assigned 362 patients to either Eylea or Avastin by eye injection every 4 weeks for 6 months. At 6 months, the researchers assessed VA, retinal thickness, and side effects.
On average, VA improved about 4 lines on an eye chart, from 20/100 to 20/40, more than doubling the ability to resolve fine detail, said Frederick Ferris, MD, director of the Division of Epidemiology and Clinical Applications at NEI. “For some patients it restores their ability to drive.”
Both drugs prevent the release of vascular endothelial growth factor, which causes swelling. The researchers found that macular edema declined significantly in both groups. The rates of adverse events, such as elevated intraocular pressure, were low and similar in both groups.
Retinal vein occlusion is associated with diabetes mellitus and hypertension. It is the second most common retinal vascular disease after diabetic retinopathy, according to NIH, and affects more than 16 million adults worldwide.