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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_346"
                     title="Daytime Sleepiness More Common in Young (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/PrimaryCare/SleepDisorders/tb/18221?impressionId=1265774039363"
                     
      &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="20100101_19_320"
                     title="Low Vitamin D Worsens Asthma (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/Pulmonology/Asthma/tb/18187?impressionId=1265774039363"
                     
      &lt;p&gt;Low levels of vitamin D correlated with poorer lung function, increased airway reactivity, and reduced response to steroid treatment in adult asthmatics, researchers said.&lt;/p&gt;
&lt;p&gt;For every 1-ng/mL increase in serum levels of 25-hydroxyvitamin D (25-OH-D), forced one-second expiratory volume (FEV&lt;sub&gt;1&lt;/sub&gt;) increased by 21 mL (&lt;em&gt;P&lt;/em&gt;=0.03, &lt;em&gt;r&lt;/em&gt;=0.8), reported E. Rand Sutherland, MD, MPH, of National Jewish Health in Denver, and colleagues online in the &lt;em&gt;American Journal of Respiratory and Critical Care Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study of 54 adult patients with asthma also showed that airway hyperreactivity in those with serum 25-OH-D levels below 30 ng/mL  --  defined as vitamin D insufficiency  --  measured at almost twice the average levels seen in those with normal levels of 25-OH-D.&lt;/p&gt;
&lt;p&gt;The dose of methacholine required to induce a 20% drop in FEV&lt;sub&gt;1&lt;/sub&gt; was 1.03 mg/mL (SE 0.2) in those with low 25-OH-D levels, compared with 1.92 mg/mL (SD 0.2) in patients with higher serum vitamin D levels (&lt;em&gt;P&lt;/em&gt;=0.01), Sutherland and colleagues reported.&lt;/p&gt;
&lt;p&gt;Cellular responses in vitro to dexamethasone were also significantly correlated with 25-OH-D levels (&lt;em&gt;r&lt;/em&gt;=0.05, &lt;em&gt;P&lt;/em&gt;=0.02). Peripheral blood mononuclear cells from those with higher 25-OH-D levels demonstrated greater MAP kinase phosphatase expression after dexamethasone stimulation than cells from individuals with lower vitamin D levels.&lt;/p&gt;
&lt;p&gt;The effects observed were greater in those who had not received steroid treatment.&lt;/p&gt;
&lt;p&gt;&quot;In adults with persistent asthma, there is a significant and deleterious association between reduced serum vitamin D levels and lung function, airway hyperresponsiveness, and glucocorticoid sensitivity, which together constitute three important biomarkers of asthma severity, impairment, and prognosis,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues added that the findings suggest that vitamin D supplements might improve symptoms in some asthma patients, although they did not test the hypothesis.&lt;/p&gt;
&lt;p&gt;Their cross-sectional study included 54 patients with persistent asthma, mean age 38 and with FEV&lt;sub&gt;1&lt;/sub&gt; levels that were a mean 83% of predictions. Participants underwent a round of standard tests for lung function and asthma symptoms as well as laboratory measurements of 25-OH-D.&lt;/p&gt;
&lt;p&gt;Serum 25-OH-D levels averaged 28.1 ng/mL (SE 10.2), with 32 participants having levels below the insufficiency threshold of 30 ng/mL.&lt;/p&gt;
&lt;p&gt;The researchers found that vitamin D levels did not correlate only with asthma symptoms. Body mass index was also significantly and inversely associated with 25-OH-D.&lt;/p&gt;
&lt;p&gt;Each unit increase of BMI was associated with a decrease of 0.56 ng/mL (SE 0.18) in serum 25-OH-D (&lt;em&gt;r&lt;/em&gt;=0.4, &lt;em&gt;P&lt;/em&gt;=0.002) after adjusting for age, sex, and physical impairment.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues noted that earlier research had linked obesity with asthma risk, and also with reduced responses to corticosteroid treatment in asthmatic patients.&lt;/p&gt;
&lt;p&gt;They suggested that vitamin D &quot;may be one pathway by which obesity and reduced steroid response are related.&quot;&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;Funding for the study came from the National Institutes of Health.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_148"
                     title="SCCM: Sedating Drugs May Slow Elders&apos; Recovery (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SCCM/tb/17973?impressionId=1265774039363"
                     
      &lt;p&gt;MIAMI BEACH  --  Elderly patients sedated with morphine or haloperidol (Haldol) in surgical intensive care units were less likely to to be discharged to their homes and more likely to be discharged to a nursing facility than patients given other sedatives, often resulting in a poorer quality of life, researchers reported here.&lt;/p&gt;
&lt;p&gt;Patients who received morphine were 2.57 times more likely to be discharged to a nursing home, rehabilitation center, or a skilled nursing facility (&lt;em&gt;P&lt;/em&gt;=0.029), Carrie Miller, MS, CRNP of the Hospital of the University of Pennsylvania in Philadelphia, told attendees at the annual meeting of the Society of Critical Care Medicine.&lt;/p&gt;
&lt;p&gt;Patients who were given haloperidol were 12.46 times more likely to be discharged to one of those facilities rather than to their home.&lt;/p&gt;
&lt;p&gt;Similarly, the risk of having a significantly reduced function from baseline admission was five times greater if the patient had received haloperidol (&lt;em&gt;P&lt;/em&gt;=0.044) and 2.76 times more likely if the patient had received morphine (&lt;em&gt;P&lt;/em&gt;=0.011), Miller said.&lt;/p&gt;
&lt;p&gt;&quot;While older adults frequently require medications to treat pain, anxiety, and delirium, little is know about the effects these medication have on older adults&apos; functional ability or quality of life,&quot; Miller said.&lt;/p&gt;
&lt;p&gt;To shed some light on the question, she and her colleagues evaluated 114 patients in three surgical ICUs. Mean age was about 75, some 60% were men, and 85% were white. Overall, 37% were undergoing general surgical procedures, while 35% had undergone vascular procedures and 16% were trauma patients.&lt;/p&gt;
&lt;p&gt;Patients&apos; level of consciousness and delirium status were assessed daily and information about medication use was gleaned from the ICU flow sheet and the computerized administration record.&lt;/p&gt;
&lt;p&gt;The most frequently used narcotic in the surgical ICU was fentanyl (Duragesic), administered to 77 patients; the most frequently used sedative was midazolam (Versed); and the most frequently used antipsychotic was haloperidol.&lt;/p&gt;
&lt;p&gt;Miller and her colleagues noted that use of propofol (Diprivan) appeared to be associated with better outcomes as far as discharge to one&apos;s home was concerned.&lt;/p&gt;
&lt;p&gt;They noted that there was &quot;considerable discrepancy&quot; between medication usage and dosage recorded on the patients&apos; flow sheet and medication administration record. &quot;Researchers and clinicians should consider that administered prn medications may not always be recorded on the nursing flow sheet,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;The study did not control for confounding variables such as the severity of illness or comorbidities that may have affected outcomes, Miller said.&lt;/p&gt;
&lt;p&gt;&quot;This is an interesting study,&quot; said Suzan Streichenwein, MD, a private practice geriatric psychiatrist in West Palm Beach, Fla. &quot;It would be valuable for future studies to include the severity of illness or more specific details about the type of surgery relative to the dosages of morphine used and its influence on the discharge functional outcomes.&lt;/p&gt;
&lt;p&gt;&quot;Tests diagnosing mild cognitive impairment and/or dementia preop versus postop as well as the time period under anesthesia in relation to outcomes would also be helpful,&quot; said Streichenwein, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;Streichenwein told &lt;em&gt;MedPage Today&lt;/em&gt; that other possible confounding factors require further studies in this area.&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;None of the clinicians had relevant financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_641"
                     title="Too Much TV in Early Childhood May Elevate Asthma Risk"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pulmonary/Asthma/tb/13094?impressionId=1265774039363"
                     
      GLASGOW, Scotland, March 3 -- Young children who watch more than two hours of television a day may have an increased risk of developing asthma in the coming years than those who watch less TV, a study showed.
              &lt;p&gt; 
              &lt;p&gt;Kids who watched the most TV as 3-year-olds were nearly twice as likely as those who watched less than two hours a day to have asthma when they reached 11 (OR 1.8, 95% CI 1.2 to 2.6), Andrea Sherriff, Ph.D., of the University of Glasgow, and colleagues reported online in &lt;em&gt;Thorax&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The prospective longitudinal cohort study was not designed to examine children&apos;s viewing habits, but instead used duration of TV watching as a proxy for sedentary behavior, they said.
              &lt;p&gt; 
              &lt;p&gt;There are some reports suggesting that breathing patterns associated with sedentary behavior could cause changes in airway responsiveness, &quot;and this mechanism has been proposed as a potential contributor to the recent rise in the prevalence of asthma,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;But the environmental exposures associated with increased asthma rates are not entirely clear, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;Some studies have linked increased TV watching to obesity, and others have found a relationship between obesity and asthma. Also, excessive TV watching has been associated with cognitive and physical deficits. But no studies have previously connected TV watching with asthma, they said.
              &lt;p&gt; 
              &lt;p&gt;The researchers used data from 3,065 youngsters tracked from birth to age 11-1/2 as part of the Avon Longitudinal Study of Parents and Children (ALSPAC).
              &lt;p&gt; 
              &lt;p&gt;All of the participants for the current analysis were free from wheezing until they were at least 3-1/2, which minimized &quot;the possibility that any observed association was due to wheezy children electing to be more sedentary as a result of their condition,&quot; the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Once the kids reached this age, the parents were asked about the number of hours their children spent watching TV on a typical weekday.
              &lt;p&gt; 
              &lt;p&gt;Overall, 28.3% watched less than one hour, 46.4% watched one to two hours, and 22.6% watched more than two hours.
              &lt;p&gt; 
              &lt;p&gt;At age 11-1/2, some 6% of the kids had asthma, but the prevalence increased with the amount of TV watched (&lt;em&gt;P&lt;/em&gt;=0.0003 for trend).
              &lt;p&gt; 
              &lt;p&gt;Adjusting for body mass index and other potential confounders had little effect on the association.
              &lt;p&gt; 
              &lt;p&gt;Rates of sedentary behavior at age 11-1/2 that were objectively measured by accelerometry were not related to TV watching at age 3-1/2 and did not differ between those who had asthma and those who did not.
              &lt;p&gt; 
              &lt;p&gt;A potential mechanism for the association between sedentary behavior (indicated by hours spent watching TV) and asthma is the failure to stretch smooth muscle in the airway by taking regular deep breaths during physical activity. This could lead to increased airway responsiveness, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;However, they said, bronchial hyper-responsiveness following methacholine (Provocholine) challenge did not modify the association of TV watching and asthma in this study (&lt;em&gt;P&lt;/em&gt;=0.9).
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was funded by a grant from the U.K. Medical Research Council to Dr. Sherriff.
              &lt;p&gt; 
              &lt;p&gt;The authors reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1784"
                     title="Obesity Constricts Corticosteroids&apos; Benefit for Asthma"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pulmonary/Asthma/tb/14562?impressionId=1265774039363"
                     
      SAN FRANCISCO, June 4 -- Extra girth may impair treatment response to some asthma medications but does not worsen overall disease severity, researchers found.
              &lt;br&gt;&lt;br&gt;Lung function and use of rescue medication was not different to a clinically relevant degree between normal weight or underweight asthma patients and those who were overweight or obese, E. Rand Sutherland, M.D., M.P.H., of National Jewish Health in Denver, and colleagues reported.
              &lt;br&gt;&lt;br&gt;But overweight and obesity reduced the effectiveness of inhaled corticosteroids by 55% and blunted lung-function improvements with inhaled corticosteroids plus long-acting beta-agonist treatment (&lt;em&gt;P&lt;/em&gt;=0.02 to 0.04).
              &lt;br&gt;&lt;br&gt;These findings in the June issue of the &lt;em&gt;Journal of Allergy and Clinical Immunology&lt;/em&gt; may aid clinical decision-making on dosing and use of alternatives to steroids, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Earlier epidemiologic studies, based largely on self-reported data, have suggested that being overweight or obese increases the risk of incident asthma and has an impact on treatment response.
              &lt;p&gt; 
              &lt;p&gt;So Dr. Sutherland&apos;s group looked at data from a total of 1,265 patients with mild-to-moderate persistent asthma who participated in prospective clinical trials connected with the National Heart, Lung, and Blood Institute-funded Asthma Clinical Research Network. 
              &lt;p&gt; 
              &lt;p&gt;Among these asthmatic patients, 53% were overweight or obese (body mass index 25.0 kg/m&lt;sup&gt;2&lt;/sup&gt; or higher).
              &lt;p&gt; 
              &lt;p&gt;Compared with their leaner counterparts, those patients had a lower absolute mean forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;, 2.91 versus 3.05 L, adjusted &lt;em&gt;P&lt;/em&gt;=0.001), but without any difference in percent-predicted FEV&lt;sub&gt;1&lt;/sub&gt; (&lt;em&gt;P&lt;/em&gt;=0.1).
              &lt;p&gt; 
              &lt;p&gt;They also showed a slight reduction in FEV&lt;sub&gt;1&lt;/sub&gt;-to-forced vital capacity ratio (71.3% versus 72.6%, adjusted &lt;em&gt;P&lt;/em&gt;=0.01) and asthma-specific quality of life (5.59 versus 5.77, adjusted &lt;em&gt;P&lt;/em&gt;=0.004), and had higher rescue albuterol use (1.2 versus 1.08 puffs/day, adjusted &lt;em&gt;P&lt;/em&gt;=0.03).
              &lt;p&gt; 
              &lt;p&gt;But Dr. Sutherland called these small differences of little clinical significance when taken with the lack of divergence in other measures of asthma impairment, including:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Morning peak expiratory flow rate 
                &lt;li&gt;Airway hyperresponsiveness to methacholine 
                &lt;li&gt;Exhaled nitric oxide level 
                &lt;li&gt;Total number of positive allergen skin test responses 
                &lt;li&gt;Score on the mini-Asthma Control Questionnaire
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Being obese or overweight did not appear to influence the short-term clinical course of asthma either. 
              &lt;p&gt; 
              &lt;p&gt;In the placebo arms of trials included in Dr. Sutherland&apos;s study, elevated BMI had had no impact over the eight to 48 week duration of these studies on lung function, airway hyperresponsiveness or inflammation, or clinical status. 
              &lt;p&gt; 
              &lt;p&gt;Asthma exacerbations, though, were no different between BMI groups with either treatment regimen.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;However, being overweight or obese did have an impact on medication response.
              &lt;p&gt; 
              &lt;p&gt;In patients treated with inhaled corticosteroids only, the reduction in inflammation associated with treatment -- measured by fraction of exhaled nitric oxide -- was substantially lower at high BMIs (-3.57 versus -6.54, adjusted &lt;em&gt;P&lt;/em&gt;=0.04).
              &lt;p&gt; 
              &lt;p&gt;Likewise, overweight and obese patients with asthma showed less lung function improvement when given the combination of inhaled glucocorticoid and long-acting beta agonist. 
              &lt;p&gt; 
              &lt;p&gt;Their improvement in FEV&lt;sub&gt;1&lt;/sub&gt;-to-forced vital capacity ratio averaged 1.77% less than their leaner peers (adjusted &lt;em&gt;P&lt;/em&gt;=0.02) while FEV&lt;sub&gt;1&lt;/sub&gt; improved a mean of 80 mL less (adjusted &lt;em&gt;P&lt;/em&gt;=0.04).
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;Nor were there any differences by BMI in response to leukotriene modifiers.
              &lt;p&gt; 
              &lt;p&gt;The researchers cautioned that their analyses were all post-hoc without BMI as an a priori stratification variable in any of the individual trials.
              &lt;p&gt; 
              &lt;p&gt;They also noted that the small effects suggested the study may have been underpowered and subject to confounding by dietary and other factors and that the results might not generalize to severe asthma patients.
              &lt;p&gt; 
              &lt;p&gt;The researchers called for prospective validation to determine whether glucocorticoid insensitivity is responsible for the reduced benefit of inhaled corticosteroid seen in the study.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by National Institutes of Health grants.
              &lt;p&gt; 
              &lt;p&gt;Dr. Sutherland reported being on advisory boards for GlaxoSmithKline and Dey; being on a data and safety monitoring board for Schering-Plough; and getting grant support from the National Institutes of Health, Novartis, and Dey. 
              &lt;p&gt;Co-authors reported conflicts of interest with AstraZeneca, Schering-Plough, Novartis, GlaxoSmithKline, Merck, Genentech, and Asthmatx.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
</recommendedContent>