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    <recommendedItem id="20100101_19_346"
                     title="Daytime Sleepiness More Common in Young (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/PrimaryCare/SleepDisorders/tb/18221?impressionId=1265769385598"
                     
      &lt;p&gt;Compared with 20-somethings and seniors, middle-age adults are less likely to suffer daytime sleepiness when they don&apos;t get a good night&apos;s sleep, according to a small study.&lt;/p&gt;
&lt;p&gt;When three groups of healthy adults  --  young (20 to 30 years old), middle-age (40 to 55) and older (66 to 83)  --  were studied over four nights, slow wave sleep decreased and the number of nocturnal awakenings progressively increased with age, wrote Derk-Jan Dijk, PhD, of the Surrey Sleep Center at the University of Surrey in Guildford, England, and colleagues in the Feb. 1 issue of &lt;em&gt;Sleep.&lt;/em&gt;&lt;/p&gt;

&lt;p&gt;As the likelihood for eight hours of uninterrupted deep sleep decreased with age, there was no increase in the likelihood of daytime sleepiness, which led Dijk and colleagues to conclude that as people age there may be a change in the &quot;sleep (duration and depth) required to maintain alertness.&quot;&lt;/p&gt;
&lt;p&gt;Based on that observation, the authors wrote that it could be argued that &quot;an eight-hour episode rich in [slow wave sleep] is insufficient for young adults but that an eight-hour sleep episode with less [slow wave sleep] is sufficient for older adults.&quot;&lt;/p&gt;
&lt;p&gt;As a result, middle-age and older adults are less likely to build up &quot;sleep debt&quot; during the daylight hours, so they manage with less time in deep sleep at night, less homeostatic sleep pressure.&lt;/p&gt;
&lt;p&gt;The authors hypothesized that this apparent need for less sleep may be a factor in age-related insomnia.&lt;/p&gt;
&lt;p&gt;If older adults are unaware of the need for less sleep, &quot;their self-selected time in bed, which provides an input to the sleep homeostat, may become maladaptive and lead to reduced sleep consolidation and associated complaints.&quot;&lt;/p&gt;
&lt;p&gt;Dijk and colleagues recruited 44 young adults, 35 middle-age adults, and 31 older adults for their study. All were healthy at baseline and all were initially assessed for an eight-hour nocturnal sleep episode.&lt;/p&gt;
&lt;p&gt;They were then randomized to two nights of either selective short wave sleep interruption by acoustic stimuli or sleep without disruption, followed by one night of recovery sleep.&lt;/p&gt;
&lt;p&gt;Two standardized measurement tools, the Multiple Sleep Latency Test (MSLT) and the Karolinska Sleepiness Scale (KSS), were used to assess objective and subjective sleep propensity.&lt;/p&gt;
&lt;p&gt;&quot;Total sleep time per eight hour time in bed decreased significantly and progressively across the age groups such that older adults slept approximately 20 minutes less than middle-aged, who slept 23 minutes less than young adults,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The reduction in total sleep time &quot;was primarily related to an increase in the number of awakenings and the duration of wakefulness after sleep onset, rather than an increase in latency to sleep onset.&quot;&lt;/p&gt;
&lt;p&gt;As a result, sleep efficiency decreased significantly from 92.1% for the youngest group, to 82% for the older group (effect of age, &lt;em&gt;P&amp;lt;&lt;/em&gt;0.0001).&lt;/p&gt;
&lt;p&gt;The subjective sleep propensity tests revealed that &quot;young people were significantly sleepier than the middle-age people, who were the least sleepy of the three groups.&quot; Daytime sleepiness for the oldest group &quot;fell in between the other two groups [and] was not significantly different from either.&quot;&lt;/p&gt;
&lt;p&gt;All three groups, regardless of age, demonstrated increased daytime sleepiness following a night of experimental disruption of slow wave sleep, but when the participants had an uninterrupted eight hours of deep sleep, it was only the youngest group that was drowsy during the daytime hours.&lt;/p&gt;
&lt;p&gt;The authors noted that although there was less daytime sleepiness among middle-age and older adults in this study, sleep propensity was not measured during the evening hours, so it was possible that the age-related difference might diminish at twilight.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by H. Lundbeck A/S.&lt;/p&gt;&lt;p&gt;Dijk reported receiving research support from the Air Force Office of Scientific Research, the Biotechnology and Biological Sciences Research Council, GlaxoSmithKline, H. Lundbeck A/S, Merck, Pfizer, Philips Lighting, sanofi-aventis, and Takeda.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3346"
                     title="Heart Disease Raises Hip Fracture Risk (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Cardiology/CoronaryArteryDisease/tb/16546?impressionId=1265769385598"
                     
      &lt;p&gt;A diagnosis of cardiovascular disease (CVD) significantly increased the risk of subsequent hip fracture in both women and men, a Swedish twin study found.&lt;/p&gt;
&lt;p&gt;The crude absolute rate of hip fracture was 12.6 per 1,000 person-years among patients diagnosed with heart failure or stroke, compared with 1.2 per 1,000 person-years among those without CVD, according to Ulf Sennerby, MD, of Uppsala University in Sweden, and colleagues.&lt;/p&gt;
&lt;p&gt;The rates were 6.6 per 1,000 person-years after a diagnosis of peripheral atherosclerosis and 5.2 after a diagnosis of ischemic heart disease, respectively, the researchers reported in the Oct. 21 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Stroke has been widely recognized as a risk factor for hip fracture, in part because of resulting hemiplegia and immobility, but an underlying genetic predisposition may exist for CVD and osteoporosis.&lt;/p&gt;
&lt;p&gt;The researchers turned to the Swedish Twin Registry  --  the largest such registry in the world  --  to determine whether the risk for hip fracture is also increased in other types of CVD and to look for evidence of a genetic connection.&lt;/p&gt;
&lt;p&gt;Their analysis included 15,968 twin pairs who were 50 years old at study entry and were followed until the date of a hip fracture, death, or study conclusion in December 2005.&lt;/p&gt;
&lt;p&gt;Hip fracture was diagnosed in 1,442 patients during the course of the study, 70% of whom were women.&lt;/p&gt;
&lt;p&gt;Multivariable analysis found the following adjusted hazard ratios for hip fracture: &lt;ul&gt; &lt;li&gt;Heart failure, HR 4.40 (95% CI 3.43 to 5.63)&lt;/li&gt; &lt;li&gt;Overall stroke, HR 5.09 (95% CI 4.18 to 6.20)&lt;/li&gt; &lt;li&gt;Ischemic stroke, HR 4.95 (95% CI 4.07 to 6.02)&lt;/li&gt; &lt;li&gt;Hemorrhagic stroke, HR 5.48 (95% CI 3.68 to 8.15)&lt;/li&gt; &lt;li&gt;Peripheral atherosclerosis, HR 3.20 (95% CI 2.28 to 4.50)&lt;/li&gt; &lt;li&gt;Ischemic heart disease, HR 2.32 (95% CI 1.91 to 2.84)&lt;/li&gt; &lt;li&gt;Acute myocardial infarction, HR 2.42 (95% CI 1.85 to 3.17)&lt;/li&gt; &lt;li&gt;Hypertension, HR 1.59 (95% CI 1.36 to 1.85)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Rates were comparable between the sexes except following overall stroke, when men tended to have a higher risk (HR 6.65, 95% CI 4.82 to 9.19) compared with women (HR 4.42, 95% CI 3.49 to 5.61).&lt;/p&gt;
&lt;p&gt;The investigators also calculated 10-year absolute risks for hip fracture according to age and sex, and found that a 75-year-old woman had an 18% risk (95% CI 13 to 22) for fracture within 10 years after a diagnosis of heart failure, while the risk for a man of that age was 10% (95% CI 7 to 14).&lt;/p&gt;
&lt;p&gt;And a 75-year-old woman with a stroke had a 19% 10-year risk (95% CI 15 to 23) for fracture, while a man had a 15% risk (95% CI 12 to 19).&lt;/p&gt;
&lt;p&gt;The highest rates of hip fracture were seen during the first year after heart failure or stroke, which may relate to immobility as well as muscle and bone loss, the researchers said.&lt;/p&gt;
&lt;p&gt;They also looked at fracture risk as related to zygosity, and found that in identical twin pairs where only one sibling had heart failure, the other also had a fourfold increased risk of hip fracture. When only one had a stroke, the other had a doubled risk of hip fracture.&lt;/p&gt;
&lt;p&gt;These increases were &quot;less pronounced&quot; among dizygotic twins when only one had a cardiovascular event, supporting the likelihood of genetic influences, the investigators observed.&lt;/p&gt;
&lt;p&gt;Although the study was not designed to fully explore the shared pathophysiologic mechanisms between CVD and fractures, possible contributing factors might include telomere lengths and genes associated with matrix proteins supporting bone, blood vessel walls, and the myocardium, the researchers said.&lt;/p&gt;
&lt;p&gt;Hormones, proteins involved in lipid metabolism, and chronic inflammation also may contribute, they noted.&lt;/p&gt;
&lt;p&gt;Strengths of the study include its population-based design, inclusion of both sexes, and large number of events.&lt;/p&gt;
&lt;p&gt;Limitations include reliance on telephone interviews for information on body weight, smoking, physical activity, and medications.&lt;/p&gt;
&lt;p&gt;The investigators concluded that clinicians should be aware of the risks for fracture in patients with cardiovascular disease, particularly after hospitalization.&lt;/p&gt;
&lt;p&gt;&quot;We advocate that individuals with a recent diagnosis of CVD should have their future fracture risk evaluated with clinical risk factors and bone scans,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institutes of Health and the Swedish Research Council.&lt;/p&gt;&lt;p&gt;No financial disclosures were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_3_511"
                     title="Pre-op Breathing Therapy Halves Post-CABG Lung Risks"
                     score="-0.006"
                     href="