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Patients with Muscular Dystrophy Benefit from Sleep Disorder Therapy

Most patients with myotonic dystrophy type 1 (DM1) also suffer from respiratory and sleep disorders.  DM1 is the most common form of muscular dystrophy found in adults.  Recent research published in the Journal of Neuromuscular Diseases notes that due to the variety of sleep difficulties in DM1 patients, the treatments often do not work on a one-size-fits-all model.

Sophie D. West, MD, lead investigator of the study from Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals in the UK, notes that patients with myotonic dystrophy type 1 frequently suffer from severe daytime sleepiness, with anywhere between 33% and 80% of patients reporting problems.  She notes that there may be other contributing problems leading to the sleepiness like obstructive sleep apnea (OSA), periodic limb movements in sleep, poor sleep patterns, respiratory failure, or narcolepsy.

Overnight sleep studies were given to all DM1 patients who showed signs of severe daytime sleepiness in their annual follow-up visits between May 2011 and May 2015 at John Walton Muscular Dystrophy Research Center in Newcastle upon Tyne.  In 120 DM1 patients, scientists found that 30% showed intrinsic sleepiness on the Epworth Sleepiness Score (ESS), 27% experienced respiratory failure, and 18% suffered from OSA.

Patients were put into one of four groups:

  1. Those with intrinsic sleepiness on ESS
  2. Those with respiratory failure during the day
  3. Those with OSA symptoms
  4. A control group for those who had no sleep-related problems

Treatments were administered for the individual symptoms, including use of the drug modafinil for daytime sleepiness, non-invasive ventilation for respiratory failure, and continuous positive airway pressure (CPAP) for OSA patients.

The study showed that only 29% of patients continued the therapies and reported benefits.  This was an unexpectedly lower result than what would be seen in other patient populations, suggesting that additional research is needed to identify if DM1 patients are more likely to benefit from targeted therapy.  Additional research is also needed to find the most effective way to deliver targeted therapies to these patients.

To improve target therapies for DM1 patients, researchers recommend classifying these patients in three types of sleep disturbances, as listed above.  Those with high ESS scores, light use of sedatives, and no restless leg syndrome, modafinil showed good results for daytime sleepiness.  For those with OSA without respiratory failure, the standard CPAP treatment would be beneficial.  For patients with daytime respiratory failure and abnormalities on sleep studies, providers should try noninvasive ventilation techniques.

There are varying levels of muscular and respiratory impairment, as well as sleepiness in all muscular dystrophy patients.  The disease is heterogeneous in nature.  Dr. Sophia West notes that this data is extremely valuable for those who are working toward better treatment methods for DM1 patients with excessive daytime sleepiness.  These findings support their efforts with detailed sleep tests and targeted therapies that will, hopefully, improve symptoms in the long-run.

Reference:  https://www.eurekalert.org/pub_releases/2017-01/ip-ttf011317.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.

 

Sleep Education Reduces Risk of Injury and Disability in Firefighters

firefighter sleep

Long workweeks and extended shifts have contributed to a high number of firefighters suffering from acute and chronic sleep deprivation, as well as disrupted circadian rhythms, or sleep-wake cycles.  Previous studies have shown a link between long shifts and risk of burnout, sleepiness, errors, and injuries, especially when compared to shorter shifts in first responders, ER physicians, and EMTs.  Furthermore, sleep disorders in firefighters often go undiagnosed, increasing their risk of injury and deteriorating health.

Researchers at Brigham and Women’s Hospital theorized that a workplace-based Sleep Health Program (SHP) would benefit firefighters by increasing their knowledge about health and safety compared to standard practices.  The SHP was created to incorporate education and a sleep disorder screening.  In the mid-sized fire departments that were tested, half of the employees participated in the SHP, while the other half continued as they had been.  Injuries, disability days, and other measures were watched and recorded over the next 12 months.  This study is the first randomized trial to demonstrate the reduction in injury and disability risk with an SHP in place.

The research found an almost 50% reduction in disability days among those who had the SHP.  Additionally, the firefighters who attended the sleep health education sessions were less likely to be injured over the 12-month period.  These findings are published in the online journal, SLEEP.

Dr. Steven W. Lockley, senior author of the study and neuroscientist at the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, notes that this indicates a wellness and sleep health education program held in workplace setting for firefighters, along with free screenings and information about sleep disorders, resulted in fewer injuries and disability days.  Sleep disorders are prevalent in firefighters and are comparable to those found in a large nationwide cohort study.  When this is coupled with 24-hour shifts and chronic sleep loss, risks for on-the-job sleepiness and injury become a real problem.  This SHP program showed that to reduce injury and disability, implementation of a thorough and well-maintained educational program would be beneficial in all fire departments.

The scientists emphasize that there is a definite and well-defined connection between higher risk of health problems like heart disease and metabolic syndromes and untreated sleep conditions.  It is also well established that sleep deprivation leads to higher rates of automobile accidents, so a Sleep Health Program could help identify and treat these disorders and reduce that risk, which would benefit firefighters’ long-term health and short-term safety.  Many occupational health programs that offer sleep health education and sleep disorder diagnosis and treatment can be promoted as well.

Reference:  https://www.eurekalert.org/pub_releases/2017-01/bawh-shp011217.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.

Gestational Diabetes Linked to Insufficient Sleep

diabetes and sleep

New research out of Singapore found a link between gestational diabetes mellitus (GDM) and short sleep duration during pregnancy.  For the first time, this study looked at the relationship between GDM and sleep duration in an Asian population across multiple ethnic groups.  Published in the journal, SLEEP, findings suggested that risk of GDM could be reduced by addressing any sleep problems during pregnancy.

All around the world, diabetes has become a major health concern, with growing numbers in Asia.  The International Diabetes Foundation (IDF) reported in 2015 that Singapore had the second highest number of diabetes patients in developed countries.  Furthermore, it has the most cases of GDM, increasing the risk of subsequent type 2 DM.

GDM is one of the most common problems in pregnancy, characterized by excessively high glucose levels in the blood.  If left untreated, it could lead to birth and delivery complications like obstructed labor, high blood pressure, birth trauma, and mortality.  This is why it is vital to identify the risks of GDM and determine what may be contributing to the condition.

As we have seen in previous studies, glucose metabolism is affected by sleep.  Some studies note that sleep deprivation, or short sleep duration, is a major risk factor for type 2 diabetes mellitus as well.  Unfortunately, however, few clinical trials look at the relationship between GDM and sleep in Asian populations.

This recent research finds that Singapore adults are one of the most sleep deprived populations in the world.  With their higher rate of GDM, it was theorized that sleep deprivation might be contributing to the development of the condition in Asian women, who are already at increased risk due to ethnicity.

Researchers from Duke-NUS Medical School and the National University of Singapore Yong Loo Lin School of medicine set out to analyze the glucose levels and sleep patterns of people within the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study.

They chose 686 women who had their glucose levels measured at 26 and 28 weeks’ gestation and completed a sleep questionnaire.  Approximately 19% of these women had GDM.

When this was determined, researchers performed an analysis on whether short sleep duration (less than 6 hours each night) put them at higher risk of GDM.  It was noted that there was a link between GDM patients and short sleep duration, even after adjusting for age, history of GDM, and BMI.  Furthermore, women who reported getting between seven to eight hours of sleep each night were at decreased risk of GDM (16.8%), while women who had six or fewer hours were at higher risk (27.3%).

This is consistent with previous studies that linked type 2 diabetes mellitus with sleep deprivation in the general adult populations.

This suggests that good sleep hygiene and habits could reduce the risk of GDM and hyperglycemia in pregnant women.  Singapore has recently launched a ‘war on diabetes,’ so the importance of healthy sleep is being emphasized around the country, along with initiating measures aimed at changing lifestyle behaviors that contribute to short sleep.

This study offers an opportunity to develop better treatment methods for a potentially serious disease that affects women and unborn children.  Further research will be necessary to determine which modifiable factors can be addressed.

All participants in this study came from GUSTO, which is long-term research analyzing the effects of lifestyle on maternal health, the growth of the fetus, and the development of the child after birth.

Reference:  https://www.eurekalert.org/pub_releases/2017-01/dms-sfa010917.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.

 

Traumatic Brain Injury Recovery Related to Better Sleep

Sleep and brain

Many traumatic brain injury (TBI) patients also experience sleep disturbances, especially with regard to their sleep-wake cycle.  New research reports that these two conditions should be treated simultaneously for optimum recovery.  These findings are published in the online journal, Neurology, from the American Academy of Neurology.

One of the lead authors of the study, Nadia Gosselin, PhD, from the University of Montreal in Canada notes that the results indicate monitoring sleep cycles may be a good tool for evaluating the recovery from TBI.  It was noted that people who suffered a brain injury and were not able to gain a specific level of consciousness that allowed them to stay aware of their surroundings were more likely to have sleep-wake cycle disruptions.  However, researchers note that as those patients recovered, their sleep quality got better.

Having a good sleep-wake or circadian sleep cycle means that one is alert, awake, and active throughout the day and have uninterrupted sleep throughout the night.

There were 30 participants in this study, all aged between 17 and 58 years.  All participants were hospitalized in the intensive care unit for moderate to severe TBI, and most were comatose on admission.  Injuries were the result of car accidents in 20 of the participants, falls for seven people, sports or recreational injuries two, and a head injury by a blow from an external object for the last person.  Average hospital admission lasted 45 days, and monitoring for this study started approximately 21 days into their admission.

Scientists used the Rancho Los Amigos scale to monitor each person for approximately 11 days to evaluate thinking abilities and level of consciousness.  The scale has scores ranging from 1 to 8.  In addition, each participant wore an activity device on their wrist that monitored and measured their sleep.

Findings showed a linear relationship between quality sleep and thinking abilities and increased levels of consciousness.

The daytime activity ratio is one of the measures the researchers used, which showed percentage of activity throughout the day.  It showed that right after the injury, a lot of activity was happening during both day and night.  The results found that once participants came out of the minimally conscious state, they had a daytime activity ratio of 80% and they had a decent sleep-wake cycle.

Unfortunately, though, many participants still had a poor cycle with a score of 5 on the Rancho Los Amigos scale, meaning they were often confused and gave incorrect or inappropriate responses to commands and stimuli.  The sleep-wake cycles normalized and improved at the same time that the participants scored at least a 6 on the Rancho Los Amigos scale.  This measurement indicates that the person could give adequate responses with a little outside help and direction.  At the 6 level, participants could remember and relearn tasks; however, they still were unable to remember new ones.

Adjustments were made for time passed since the injury and the types of medications used on them in the ICU; however, the results remained the same.

Dr. Gosselin notes that there may be similar brain mechanisms involved in the recovery from sleep deprivation and TBI.  Additional studies will be performed to examine how the hospital setting, like lighting and noise, plays a role in sleep quality in TBI patients.

 Reference:  https://www.eurekalert.org/pub_releases/2016-12/aaon-rfb121616.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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