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Patients with Asthma are more likely to have Insomnia

asthma and sleep

New research out of the University of Pittsburgh shows that patients with asthma are highly likely to suffer from insomnia, which puts them at greater risk of decreased asthma control, anxiety, depression, and other health problems or quality of life issues.  The research and findings were published and discussed in the journal, CHEST.

Asthma patients frequently report trouble sleeping, but the burden on quality of life from insomnia in asthma patients is unknown.  Asthma is a chronic disease marked by narrowed, swollen, or inflamed airways leading to difficulty breathing because of muscle spasms that happen in the airways as a result of trying to keep the airways open.  There are no previous studies to look at how insomnia affects asthma control and the utilization of the healthcare system by asthma patients.

This study reports the following:

  • About 37% of asthma patients also had clinically significant insomnia.
  • Patients with insomnia had worse lung function, lower household income, and higher BMI than those who did not have insomnia.
  • Almost 25% of asthma patients met diagnostic criteria for insomnia, despite not having nighttime asthma symptoms.
  • Patients with insomnia reported more frequent use of the healthcare system within a 12-month period than those who did not have insomnia.
  • Asthma patients with insomnia reported more episodes of depression and anxiety, as well as lower quality of life due to asthma-related problems. This is suggestive of higher risk of adverse outcomes in asthma patients who have an associated insomnia disorder.

Researchers note that these findings indicate a significant impact of an insomnia disorder in patients with asthma, and their well-being and quality of life are severely affected.  Their treatment interventions and action plan should include evaluation and treatment of insomnia symptoms.

Lead author of the study, Dr. Faith Luyster, notes that these results suggest that difficulty sleeping may not be solely due to asthma-related awakenings, but instead may be due to insomnia as a comorbid condition.  Further, the insomnia can inadvertently affect asthma symptoms and treatments by decreasing quality of life and increasing their use of the healthcare system.

As with all new findings, further study is warranted to understand the link between asthma control and insomnia, even though it is clear that insomnia is prevalent in asthma patients who also have adverse outcomes.  Future studies can be done to look at interventions like cognitive behavioral therapy for insomnia.

Reference:  https://www.eurekalert.org/pub_releases/2016-12/ehs-sac120716.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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Pulmonary Embolisms May Recur in Patients with Sleep Apnea

lungs chest xray

Venous thromboembolism (VTE) often comes with the risk of pulmonary embolism (PE), which can be fatal.  Blood clots are common in people who live sedentary lifestyles, are obese, and/or are advanced in age; however, recent research indicates that obstructive sleep apnea (OSA) may also be contributing to blood clots that lead to PE.  VTE is a chronic disease marked by recurring episodes of PE, but scientists wanted to review the OSA risk of developing PE.  Findings show that after initial PE, patients with OSA are at increased risk of developing another.

This study is published in the December issue of CHEST.

Recurrent PE comes with a 9% chance of mortality, and patients who have had one PE are 30% more likely to have another.  Generally, anticoagulant medications can help prevent the recurrence of PE, but they also come with a higher risk of bleeding.  The need for blood thinners can be reduced by properly identifying risk factors and making changes as a preventative measure.  One of the biggest risk factors is sleep apnea, which shares many other risk factors with PE like obesity, decreased physical activity, and advancing age.

Lead investigator, Alberto Alonso-Fernandez, MD, PhD, from Hospital Universitario Son Espases in Spain notes that the evidence in longitudinal and cross-sectional studies shows that there is a link between PE and OSA.  The link indicates there is a major health burden, especially since both disorders are prevalent and there is a high fatality rate for PE.  To their knowledge, there are no studies to investigate how OSA contributes to recurrent thromboembolisms.

The current research trailed 120 people for five to eight years post PE initial occurrence.  Scientists monitored sleep to determine if there were any signs or symptoms of OSA.  It was noted that 19 patients had recurrent episodes of PE, and 16 of those 19 patients had OSA.

The primary finding is that patients who had an initial PE and an OSA diagnosis were at increased risk of experiencing a recurrent PE than those who did not have OSA.  Furthermore, even without an OSA diagnosis, patients whose oxygen saturations consistently stayed below 90% were also at risk for PE recurrence.  Many of these patients were started on anticoagulation due to new blood clot formation.

Dr. Alonso-Fernandez is working to determine how OSA contributes the susceptibility of a repeat PE event.  He believes OSA may affect the three components of Vichow’s risk triad: vascular endothelial impairment, blood flow stasis, and/or higher ability to coagulate.  There is an increased inflammatory response and oxidative stress when hypoxia is present, both of which impair endothelial function.  OSA may slow intravenous flow with sedentary position and hemodynamic alternations.  Finally, it is possible that OSA patients have increased coagulability, decreased fibrinolytic capacity, and better platelet activity, which are often improved with the use of CPAP.

A lot of research has been dedicated to determining the origin of PE, there are only a few known factors identified in recurrent PE, including things like continued use of estrogen, vena cava filters, high D-dimer after anticoagulation, cancer, obesity, and male gender.  OSA is now labeled as an independent risk factor for experiencing another PE, even after researchers adjusted for factors like BMI and gender.  OSA is more prevalent in obese men, so researchers believe that the higher risk of recurrent PE in obese patients is likely related to OSA as well.

It is notable that obesity is directly linked to a sedentary lifestyle, as well as venous stasis; however, there is also research connecting obesity to higher concentrations of clotting factors, putting an individual in a prothrombotic state and increasing his or her risk of clots because of the increased estrogen and inflammation that are associated with obesity.

These findings will help physicians determine better treatment interventions for those who have had PE and a history of OSA.  CPAP is the usual treatment for OSA, and these patients may also need longer-term anticoagulation to reduce PE risk.  Given the prevalence of OSA in patients with thromboembolic events, further study circling around procoagulability states caused by hypoxia and treated with CPAP would be greatly beneficial for further interventions.

Reference:  https://www.eurekalert.org/pub_releases/2016-12/ehs-sac120716.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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The Link Between Pain and Sleep

Sleep and dreams

New Studies Underway to Link Sleep and Chronic Pain

As part of a nationwide effort to address the widespread overuse and abuse of opioid pain relievers while simultaneously expanding knowledge on non-drug interventions, Washington State University has decided to lead a study to look at the relationship between chronic pain and sleep.

Marian Wilson, lead investigator and assistant professor in the College of Nursing at WSU, notes that physicians are being pressured to stop prescribing so many painkillers.  New guidelines for prescribing medications, issued in 2016 by the Centers for Disease Control and Prevention recommend limiting the use of opioids in chronic pain patients.

Ms. Wilson began the research, noting that it is not fair to cut off pain relievers in chronic pain patients without having effective alternatives available.

While there is medical literature about sleep and pain, the topic has not been adequately studied.  Previous research suggests there is a correlation, linking poor sleep to higher amounts of pain, but it is not clear which comes first.  Is the pain worse because of sleep loss, or is sleep disrupted because of the pain?

The new grant given by the National Center for Complementary and Integrative Health (part of the National Institutes of Health) allows Dr. Wilson and colleagues from WSU Health Sciences in Spokane and the Department of Rehabilitation Medicine to study the topic over a two-year period.

The study will be part of a larger NIH-funded project focused on a veteran hypnosis-pain study.  Dr. Wilson and team will collaborate with pain experts Mark Jensen and Rhonda Williams from University of Washington and the U.S. Veterans Administration Puget Sound Healthcare System.  Additional sleep expertise will come from Dr. Hans Van Dongen, a professor at Elson S. Floyd College of Medicine and the director of the Sleep and Performance Research Center.

The parent study will focus on how effective self-hypnosis and mindful meditation interventions are in 240 veterans with chronic pain.

Ms. Wilson’s subproject about sleep and pain will review 135 veterans from the parent study.  Each vet will do a sleep survey and wear monitoring devices for one week at three different times: before the intervention, immediately after, and then again three months after intervention.

Scientists will pair pain data with sleep data from the parent study to determine if improvements in pain are followed by or preceded by improvements in sleep, or if they happen simultaneously.  This will serve as the first step toward developing treatments for sleep that will help with chronic pain.

Dr. Wilson has a passion for pain management.  As a nurse scientist, while pursuing her Ph.D. in nursing, she reviewed a program that addressed the abuse of the emergency department by chronic pain patients seeking opioids.  The program, instead of providing the prescriptions, referred patients back to their primary doctor, and it was considered successful in reducing the use of the emergency department in this patient population.

Wilson felt there was more that could be done to address the need for opioids in chronic pain patients, especially with regard to finding new ways to manage symptoms without drugs.  She wrote her dissertation on the efficacy of self-management programs online for those with chronic pain, with the added benefit of reduced use of opioids.

Recently, Wilson performed a study that provided the online self-management program to chronic pain patients who receive methadone in place of an opioid drug.  She performed extensive interviews with patients to get a better understanding of why they ended up addicted to the opioids and what they felt could be done to self-manage their pain and addiction symptoms.

 Those study results have not been fully reviewed; however, Wilson still notes that something has to change with regards to the overuse of opioids in pain patients.

People are being sent home with a month’s supply of opioids after minor surgeries and tooth extractions, and it only takes two weeks of consistent opioid use to lead to dependence.  This means that almost every household in America has opioids in the cabinet, and people are becoming addicts at rapid rates, leading to the need for methadone interventions.  The idea of this new study is to start to find ways to prevent opioid overuse and dependence by concentrating on sleep.

 Reference:  https://www.eurekalert.org/pub_releases/2016-12/wsu-nst120516.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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Crash Risk Doubles with Sleep Deprivation

Sleepy driving and drowsy behind the wheel

One to two hours can make a difference when it comes to sleep.  A new study out of the AAA Foundation for Traffic Safety has found that drivers who get one to two hours less than the recommended seven to eight hours each night double their risk of accident.  About 35% of American drivers get less than the recommended amount of sleep, according to the Centers for Disease Control and Prevention.

AAA warns that getting less than the recommended number of hours for sleep may come with deadly consequences, especially since drowsiness is reported in one out of every five fatal crashes every year in the U.S. alone.

Executive Director at the AAA Foundation for Traffic Safety, Dr. David Yang, reports that losing sleep, especially getting less than five hours every night, has a comparable risk to someone who drives drunk.  You cannot lose a couple of hours of sleep and expect not to have consequences, Dr. Yang notes.  Sleep loss means you cannot safely be able to function behind the wheel.

The report from AAA, Acute Sleep Deprivation and Risk of Motor Vehicle Crash Involvement, compared drivers who got seven hours of sleep and those who got four to five hours of sleep each night.  They found that those who got fewer than five hours of sleep quadrupled their risk of crash compared to those who got the recommended amount of sleep.  The National Highway Traffic Safety Administration gives the same risk for someone driving over the legal limit of alcohol.

When compared to drivers who got enough sleep, those who were sleep deprived had progressively increased risk of crash, with the following findings noted from the AAA Foundation:

  • Four hours of sleep or less were at 11.5 times the crash risk
  • Four to five hours of sleep were at 4.3 times the crash risk
  • Five to six hours of sleep were at 1.9 times the crash risk
  • Six to seven hours of sleep were at 1.3 times the crash risk

About 97% of AAA surveyed drivers viewed drowsy driving as a completely unsafe and unacceptable behavior; however, one in three admit to drowsy driving at least once a month, admitting they could hardly keep their eyes open behind the wheel.

Jake Nelson, AAA director of Traffic Safety Advocacy and Research, notes that many of us sacrifice sleep for our careers and lifestyles, but maintaining a healthy work-life balance is necessary for safety and health.  Not creating a healthy bedtime routine and getting adequate sleep means you are putting yourself and others at risk while driving.

Symptoms to look out for with drowsy driving include:

  • Difficulty keeping your eyes open
  • Lane drifting
  • Not remembering the last few miles

However, it is notable that more than half the drivers that were involved in sleepiness-related crashes did not report experiencing any symptoms before falling asleep behind the wheel.  Researchers and experts at AAA urge drivers not to wait for physical symptoms to occur, but instead to prioritize their sleep as a preventive measure.  For those who take longer road trips, they should:

  • Take scheduled breaks every two hours or 100 miles
  • Avoid heavy meals; eat several smaller meals throughout the day
  • Travel during normal wake times
  • Avoid taking any medications that may cause drowsiness or impairment
  • Travel with someone who is awake and alert during driving

A total sample of 7234 drivers involved in 4571 crashes was analyzed in this AAA Foundation report.  All the information came from the National Motor Vehicle Crash Causation Survey from NHTSA, which included a sample of reported crashes involving at least one party sent for emergency medical treatment and at least one vehicle towed from the scene.

Reference:  https://www.eurekalert.org/pub_releases/2016-12/a-m1h120116.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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Upcoming Events
Sleep Apnea Awareness Week October 1 – 7 www.SleepApneaAwarenessWeek.com
Narcolepsy Awareness Week December 1 – 7 www.NarcolepysAwarenessWeek.com
Restless Legs (RLS) Awareness Week February 1 – 7 www.RLSAwarenessWeek.com
Insomnia Awareness Week April 1 – 7 www.InsomniaAwarenessWeek.com
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