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.

Genetic Link between Insomnia, Restless Legs Syndrome, Schizophrenia, and Obesity

sleep research

For the first time, scientists have found a genetic connection between sleep disturbance and medical disorders like schizophrenia, restless legs syndrome, and obesity.

The team of researchers include:

  • Jacqueline Lane, PhD, first author of the study and fellow at Massachusetts General Hospital
  • Richa Saxena, PhD, joint senior author and assistant Anesthesia professor at MGH and Harvard Medical School
  • Martin K Rutter, MD, FRCP, joint senior author and lecturer for cardiometabolic medicine at the University of Manchester

Study findings were published in Nature Genetics.

 There were more than 112,000 people analyzed in this research, who were all part of the UK Biobank Study.  This research looked at insomnia, daytime sleepiness, and sleep duration controllers and tried to find the connection with their life histories and health.  Participants were asked to report the degree of insomnia, daytime sleepiness issues, and sleep duration.  They also had gene mapping performed.  Additional data were collected, including height, weight, and past diseases.

Researchers found the areas of the genome responsible for sleep disturbance, especially excessive daytime sleepiness and insomnia.  In addition to this finding, they identified genetic links to other medical problems like schizophrenia, obesity, and restless legs syndrome.

Interestingly, the strongest genetic link for sleep disturbance and insomnia were associated with the gene that has been linked to restless legs syndrome.  RLS is a nervous system condition affecting 1 in 20 people and is characterized by incessantly strong urges to move the legs, especially at night.

Additional findings include a genetic link between schizophrenia and longer sleep durations, as well as higher obesity rates in association with excessive daytime sleepiness.  Research also suggests that insomnia may be directly linked to abnormal glucose metabolism and major depression disorder.

This study marks a major advancement in understanding sleep biology.  The University of Manchester’s Research Innovation Fund and the U.S. National Institutes of Health funded this research.

According to the U.N. Food and Agriculture Organization, one in four British citizens are obese, and the National Health Service treats approximately 280,000 people for schizophrenia at any given time.  Statistics show that 1 in 10 schizophrenia patients will commit suicide within the first 10 years of diagnosis.

Dr. Rutter notes that these findings are significant advancements that will help doctors and scientists understand the biology of sleep and these medical conditions.  The connections between sleep disorders and health issues have been observed for many years, but now this study gives a direct link to genetic predispositions at a molecular level.

The original study, UK Biobank, is focused on the advancement of identifying, preventing, diagnosing, and treating a number of life-threatening illnesses, so this team of researchers is confident their sample from this study will be accurate and an excellent resource for data collection.

Dr. Saxena noted that it is important to remember there are currently no tests to target the molecular structures of conditions that affect sleep.  Right now, all they can use are sedatives, so the hope is that this current research will allow them to find new ways to treat these conditions fundamentally.  Further study is needed, but the current findings offer the key to advancement in understanding one of the most prevalent influencers on our health and behavior:  sleep.

Reference:  https://www.eurekalert.org/pub_releases/2016-12/mgh-gls121616.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.

Adolescents Benefit from Later School Start Times

Teaching sleep

A group of researchers from the Centers for Disease Control and Prevention, Sleep Research Society, American Academy of Sleep Medicine, and the American Academy of Dental Sleep Medicine performed an analysis of scientific literature around high school students’ sleep habits and performance.  They found that the later the high school start time, the better performance in teens, including fewer car accidents and longer sleep durations during the week.

This research was conducted to look at 18 peer-reviewed medical studies that were published before April 2016.  The goal was to evaluate sleep duration during the week in adolescents.  They found that duration increased by about 19 minutes when school started an hour later than usual.  Additionally, with the later start time, regular sleep time on school nights was about 53 minutes longer.  Furthermore, increased sleep because of later school start times led to fewer car accidents, less fluctuation in sleep duration between weekdays and weekends, and less daytime sleepiness.

Lead author of the research, Dr. Timothy Morgenthaler, professor of medicine at Mayo Clinic in Rochester, Minnesota and past president at AASM notes that the review was done to highlight the importance of evaluating the connection between high school student health and performance and later school start times.  There is a common belief that early school start times are a big reason students do not get enough sleep.  To add to that, the CDC did a study that found over 85% of American high schools had a start time before 8:30 a.m., which is the earliest time recommended by the AAP (American Academy of Pediatrics).

The analysis results were published in the December issue of the Journal of Clinical Sleep Medicine.

AASM recommends regularly getting 8 to 10 hours of sleep each night for teens between 13 and 18 years of age.  On the other hand, CDC studies show that more than 69% of teens get less than 8 hours of sleep on school nights.  AASM notes there is a natural circadian or biological “clock” shift that happens during pubescent years, leading to a preference for later nights, which clearly can conflict with early school times.

Dr. Morgenthaler reminds us that this nation’s future depends greatly on the mental, educational, and physical excellence of our youth, but the most recent surveys show that less than 1/3 of teens are getting enough sleep each night as recommended by leading medical authorities.  This is so concerning because sleep deprivation is directly linked to declining mental health, learning disabilities, focus problems, higher obesity rates, greater car accident rates, and even increased use of alcohol and drugs.

Ten of the 18 studies were cross-sectional, seven were prospective, and one was retrospective and historical; this qualifies the meta-analysis for systematic review, making the findings even more important and significant.  The majority of the studies looked at public schools, with just two being boarding schools.

There was mixed support that these findings show delayed start times at high school may improve grades or standardized test scores; however, further information in the study suggests that later school start times decreased school absences and tardiness.  Furthermore, having later school times may improve behavioral health as well.

Authors note that more studies are necessary to better examine the effects of later school start times.

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 reading, traveling, and cooking.

Sleep May Help with Traumatic Experiences

night terror nightmare

There is always a question of whether sleep worsens or improves how we process a traumatic event.  Does it help, or are emotions and memories intensified because of sleep disturbance?  This question is asked frequently to determine how best to treat trauma-related conditions like PTSD (post-traumatic stress disorder).

Development of treatment courses for PTSD is highly influenced by how we process the distressing event immediately after it happens.  Many PTSD patients often experience flashbacks, or other distressing emotions caused by memories of the event; these flashbacks and memories make them feel as if they are experiencing the trauma all over again.  New research suggests that sleep may be playing a role in how an individual processes that suffering.

A team from the University of Zurich Department of Psychology and the Psychiatric University Hospital Zurich has conducted a study to look at whether sleep in those initial 24 hours after a traumatic event plays a role in an individual’s processing of the event.  Also, they wanted to see if quality sleep has a positive effect on the emotional distress and flashbacks.

Test subjects were shown a traumatic video in a lab, and anything that they recounted in memory over the next few days was recorded in a diary.  Essentially, it was noted that out of nowhere, subjects would experience an image or memory of what they saw, which would reawaken initial fearful and unpleasant thoughts and feelings.  The visual and experiential quality of these memories were similar to those recorded by PTSD patients.  However, the scientists noted that aside from the traumatic event, the memory recalls disappeared after just a few days.

Each participant was separated into one of two groups.  One group remained awake throughout the night, while the other group slept in the lab connected to an EEG (electroencephalograph) to measure and record sleep patterns.  Author Birgit Kleim from University of Zurich’s Department of Experimental Psychopathology and Psychotherapy notes that these results suggest that subjects who went to sleep right after the film had fewer episodes of memory recall that caused distressing emotions than those who stayed awake.  This theory supports the one that suggests sleep plays a protective role in the aftermath of trauma.

On one side of the coin, sleep can weaken the emotions associated with an already existing trauma memory; on the other side of the coin, however, sleep can help process and contextualize the memories, allowing the brain to store them as informational memories only.  This process likely takes several nights of good quality sleep, though.

The authors of this study note that early preventive treatments for those suffering from traumatic events are not as common as one might believe.  This approach offers a unique opportunity to expand early interventions and non-invasive alternatives to attempt to head off PTSD related disorders without medication.  Sleep may prove to be a natural preventive measure.

Reference: https://www.eurekalert.org/pub_releases/2016-12/uoz-shp121316.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.

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.

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.

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.