Wednesday, June 17, 2015

Insomnia and empathy

Insomnia can significantly affect your daytime functioning - most with chronic insomnia report daytime tiredness, concentration problems, and irritability. Here is an article about research presented at the annual Sleep meeting in Seattle. Researchers studied how insomnia levels affect healthcare workers ability to feel empathy for their patients. Workers with a sufficiently high insomnia scored demonstrated less empathy than those with lower insomnia scores. The article doesn't specify whether the healthcare workers had temporary insomnia, long term insomnia, or just sleep deprivation from rotating work and call schedules.

Wednesday, June 10, 2015


I've been asked by multiple patients in the past few weeks about this tiny CPAP, the Airing. I don't know anything about it other than what is in this article. It looks interesting, but I have many questions about it. If it gets FDA approval, we will learn much more.

Wednesday, June 3, 2015

Natural history of excessive daytime sleepiness

This article examines the natural history of excessive daytime sleepiness (EDS). In the article, the authors explain that EDS affects about 30% of the general public. They also explain that EDS is associated with certain psychiatric, metabolic, and sleep disorders. I would add that EDS is also a result of insufficient amount of sleep and sedating medications.

In this study, participants had a comprehensive sleep history and physical exam along with an in-lab overnight sleep study at baseline. No daytime sleepiness study, called the Multiple Sleep Latency Test (MSLT), was performed - sleepiness was only determined subjectively. Sleep apnea was defined at a cutoff that is standard for moderate severity - it's not explained why they did not include those with mild sleep apnea, who could be just as sleepy as more severe levels. Finally, follow up was only through telephone interview - no repeat sleep study or physical examination was done. The follow up was 7.5 years after the baseline evaluation, on average. Therefore, there are some important limitations to this study.

Incident EDS was defined as those who had no EDS at baseline but did have it at follow up. Remitted EDS meant those that had EDS at baseline, but not at follow up. And persistent EDS meant those that had EDS at both baseline and follow up. Results showed that incident EDS was 8.2%, and was more commonly associated with male gender, non-Caucasian race, and younger and older age. Depression, sleep apnea, obesity, and diabetes were also associated with incident EDS. Sleep duration less than 5 hours or more than 8 hours was associated with incident EDS. However, insomnia was not associated with incident EDS. Snoring was related to incident EDS, especially in those with sleep apnea.

The persistent EDS rate was 38%, whereas 62% had remitted EDS. Persistent EDS was associated strongest with anemia and insomnia. Individuals with incident or persistent EDS gained significantly more weight when compared to those without EDS. Also, individuals with remitted EDS gained significantly less weight compared to those without EDS.

The authors concluded that obesity, depression, and sleep disorders should be a public health priority to improve EDS.

Wednesday, May 27, 2015

CPAP therapy and cognitive performance in elderly patients with severe obstructive sleep apnea

Obstructive sleep apnea (OSA) is more common with age, regardless of weight. OSA in elderly patients can contribute to daytime sleepiness and impair cognitive performance. OSA has even been associated with development of early dementia, called mild cognitive impairment. There is not a lot of data showing the effects of CPAP use on cognitive functioning in elderly patients. But that is just what this study sought to do.

The study population was a subset of a larger study, and participants were at least 65 years old. Participants received extensive neuropsychological testing at the start and end of the study period (6-10 years between the two time points). Participants had a sleep study at the beginning of the study and only those with severe OSA were included. The researchers then divided the participants into those that used CPAP therapy and those that did not. This was a smaller study, with only 126 subjects included, 33 of which used CPAP. Also, note that CPAP use was determined by the patient's self-report. In other words, CPAP use was not determined objectively by checking what the CPAP machine had recorded. So it's possible that CPAP use may have been over-estimated. The researchers also did not separate out CPAP use into the number of hours per night - participants either did or did not report CPAP use. Interestingly, all of the CPAP users reported using CPAP for the minimal 4 hours per night. Finally, participants who used CPAP tended to have more severe OSA, were more overweight, and had more daytime sleepiness. There was no difference in age, gender, or level of education in those that used CPAP versus those that did not.

The results showed that subjects with OSA had a more severe deterioration of cognitive function and memory over time. Also, CPAP therapy helped preserve some cognitive functions like memory, attention, and decision making ability. The authors concluded that long term CPAP use is associated with a protective effect on cognitive performance in elderly patients with severe OSA. They suggest that physicians who treat elderly patients consider screening for and treating OSA to help maintain cognitive performance.

Wednesday, May 20, 2015

CPAP and blood sugar levels in Prediabetes

Prediabetes is a condition in which blood sugar levels are elevated above normal, but not high enough to meet criteria for diabetes. Here is a study that measured blood sugar levels (and other parameters) during two weeks of CPAP use versus an oral placebo in patients diagnosed with obstructive sleep apnea. I only have access to the abstract and an article about the study. In this study, researchers ensured that those randomized to CPAP used it for 8 hours a night for two weeks straight. The results showed that the CPAP users had lower blood sugar levels as the main outcome. A secondary outcome measure showed lower blood pressure levels in the CPAP users when compared to the controls.

Wednesday, May 13, 2015

Bedtime routines and children's sleep

In my practice, I recommend that all parents follow a regular bedtime routine with their younger children. Research has shown that a consistent bedtime routine is linked to better sleep in kids. However, there are no studies that have looked at whether a bedtime routine works better if done every night or just once a week. This study did just that. It involved a questionnaire of over 10,000 moms who had children up to 5 years old. Results showed that less than half of all families had a consistent bedtime routine every night. In those families with a consistent bedtime routine, the children had earlier bedtimes, shorter time to fall asleep, fewer number and duration of awakenings, and more total sleep per 24 hours. Also, there was a linear relationship between number of nights per week of bedtime routine and sleep outcomes - meaning that the more times per week there was a bedtime routine, the better the sleep outcomes. Perceived sleep problems also went up as the number of bedtime routine nights per week went down. Finally, there was a relationship between daytime behaviors (including hyperactivity, attention deficit, and difficult behaviors) and consistent bedtime routine. Again, the relationship was such that a more frequent bedtime routine meant less problematic daytime behaviors.

The authors conclude that pediatricians could easily recommend a consistent bedtime routine to all of their patients. Pediatricians could explain that a bedtime routine is a set of the same activities done in the same order on a nightly basis prior to turning the lights out. For example, brushing teeth, putting on pajamas, and then reading a story before turning out the lights.

Wednesday, May 6, 2015

Pictures of infants' sleeping positions in media

Here is an interesting abstract presented at the Pediatric Academic Societies annual meeting in San Diego. I didn't attend this meeting, but saw a write-up about this abstract here. The abstract is about a study designed to evaluate images in popular stock photograph websites and pictures of infants in magazines published for women of childbearing age. The study authors were attempting to determine if the pictures were in compliance with the American Academy of Pediatrics guidelines for safe infant sleep practices - meaning having your infant sleep on its back to prevent Sudden Infant Death Syndrome (SIDS).

The results showed that just over half (50.3%) of the stock photos from websites showed the baby sleeping on its back. And only 15.7% of all infant sleep environments were compliant with American Academy of Pediatrics recommendations - meaning that the infant was not bed-sharing and the crib did not have soft objects like pillows, blankets, or bumper pads. With regard to the magazine pictures, there were 4 out of 12 pictures showing an infant sleeping on its stomach, which may raise the risk of SIDS. And only 7 of 24 magazine pictures properly demonstrated a safe infant sleep environment.

The study authors are concerned that stock photo websites and magazine pictures of infants sleeping in positions and environments not recommended by the American Academy of Pediatrics could confuse some women, causing them to think it's ok to let their infant sleep on its stomach, for example.