RESPIRATORY CARE
Nasal obstruction causes snoring and sleepiness
Hiraki N, et al. Snoring, daytime sleepiness, and nasal obstruction with or without allergic rhinitis. Arch Otolaryngol Head Neck Surg. 2008;134(12):1254-1257.
Recent Scottish research has found that snoring, poor sleep and daytime sleepiness are caused by nasal obstruction, not allergies. The December 2008 issue of the Archives of Otolaryngology-Head and Neck Surgery reports the findings.
In this investigation, 1,459 Japanese industrial plant workers responded to a questionnaire that included six questions about nasal obstruction, allergies, snoring, and medications, in addition to the eight-item Epworth Sleepiness Scale. Of these participants, 250 answered that they had both nasal obstruction and allergies; 359 had nasal obstruction with no allergies; 111 had allergies but no nasal obstruction; and 739 had neither condition, and thus were the control group.
The investigation found that both groups with nasal obstructions were snorers, had more excessive daytime sleepiness, and had higher average scores on the Epworth Sleepiness Scale (7.4 and 7.8, compared with 6.7 in the control group) than the control group. There was not a noteworthy difference between the group with allergies alone and the control group.
The investigation was not without limitations, however. One question on the survey asked whether or not the participants' significant other has noticed snoring; nevertheless, it was filled out by the participants themselves, not their significant others. In addition, the participants were primarily middle-aged men; who, researchers say, are more likely to snore. Lastly, not all risk factors for snoring were taken into consideration, such as age, smoking, alcohol consumption, and craniofacial abnormalities.
ADOLESCENT CARE
Bariatric surgery fights diabetes in overweight teens
Inge T, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents. Pediatrics. 2009;123:214-222.
Gastric bypass surgery has more benefits to morbidly obese teens than just weight loss; it also halts, and in some cases, actually reverses type 2 diabetes, an innovative study shows. Previous studies have uncovered these same findings in the middle-aged adult population. The new research can be found in the January 2009 issue of Pediatrics.
This study involved 11 morbidly obese adolescents with type 2 diabetes who underwent Roux-en-Y gastric bypass surgery. They were aged 14 to 21 years. Before the surgery, their mean body mass index (BMI) was 50.4, and their weight was a median of 313 lbs. One year after the bariatric surgery, the mean BMI dropped to 33.1, and the median weight decreased to 215.6 lbs. The patients' glycated hemoglobin fell from 7.33% at baseline to 5.58% at 1 year. Additionally, the patients also had mean declines of 29% to 61% in serum triglycerides, total and low-density lipoprotein cholesterol, and alanine and aspartate aminotransferase levels.
Out of these 11 patients, 10 of them no longer met the criteria for type 2 diabetes at 1 year. They were able to cease taking their antidiabetic medications. The one other patient had a more severe case of diabetes before the surgery took place, and was taking insulin, in addition to oral antidiabetic medication. One year after the surgery, this patient did show some progress in glycemic control, and was able to discontinue the oral medications, and be managed on much lower insulin doses.
CARDIOVASCULAR CARE
Lack of sleep may increase risk of heart disease
King C, et al. Short sleep duration and incident coronary artery calcification. JAMA. 2008: 300:2859-2866.
Recent research suggests a correlation between sleep duration and cardiovascular health. JAMA reports the findings of this observational cohort study of middle-aged participants.
The Coronary Artery Risk Development in Young Adults study calculated the 5-year prevalence of coronary artery calcification in 495 participants aged 35 to 47. These participants were free of calcifications at the beginning of the study, according to computed tomography scan. Over 5 years, sleep duration and quality were assessed using a wrist activity monitor. In addition, the participants were surveyed about their daytime sleepiness, overall sleep quality, and duration of sleep. The mean sleep duration was only 6.1 hours. During the next 5 years, 12.3% of participants showed signs of coronary artery calcification.
After adjusting for age, sex, race, education, smoking, and apnea risk, the researchers found that the risk of calcified plaque accumulation declined notably with each additional hour of objectively measured sleep.
WOMEN'S HEALTHCARE
Multiple corticosteroids may impair fetal growth
Murphy KE, et al. Multiple courses of antenatal corticosteroids for preterm birth (MACS): A randomized controlled trial. Lancet. 2008;372:2143-2151.
Many pregnant women who are at risk for preterm delivery are administered multiple courses of corticosteroids. However, the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) indicates that multiple courses offer no benefit in preventing preterm deliveries. In fact, it was shown to actually hinder fetal growth.
The MACS incorporated 1,858 women from 20 countries who were at risk for preterm delivery at 25 to 32 weeks of gestation. These women received a single course of corticosteroids 14 to 21 days prior to the study. The women were randomized into two groups. The first group was administered intramuscular betamethasone (Celestone) in two doses 24 hours apart, every 14 days until 33 weeks of gestation or delivery. The second group received placebo at the same intervals. Most of the women in the trial received the multiple courses of corticosteroids.
The babies born to the women who received the multiple courses of corticosteroids had lower birth weight, length, and head circumference than those born to the placebo group. The researchers said that these results are concerning, and that these children should be followed long-term to assess possible problem areas. The MACS study is currently collecting data from the secondary outcomes that were measured at 18 to 24 months of age.
MUSCULOSKELETAL CARE
Supplements of no benefit to knee osteoarthritis
Sawitzke A, et al. The effect of glucosamine and/or chondroitin sulfate on the progression on knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008;58:3183-3191.
The supplements glucosamine and chondroitin sulfate have been very trendy remedies for those suffering from knee osteoarthritis. However, the results from the large, randomized Glucosamine-chondroitin Arthritis Intervention Trial (GAIT), published in the October 2008 issue of Arthritis & Rheumatism, showed that these supplements were ineffective in reducing long-term X-ray progression of knee osteoarthritis.
In actuality, the combination of these popular supplements may be less effective than using each one individually. Patients in GAIT were randomly divided into five study groups: 1,500 mg of glucosamine hydrochloride, 1,200 mg of chondroitin sulfate, a combination of glucosamine and chondroitin, 200 mg of celecoxib (Celebrex), or placebo for up to 2 years.
The mean 2-year joint-space width losses were:
* glucosamine: 0.013 mm
* chondroitin: 0.107 mm
* glucosamine plus chondroitin: 0.194 mm
* celecoxib: 0.111 mm
* placebo: 0.166 mm.
These results provided radiographic evidence that there is no structural benefit for the use of glucosamine or chondroitin sulfate-either individually, or in combination-in decreasing progressive cartilage loss in knee osteoarthritis.
ACL surgery may not be necessary after knee ligament injury
Ageberg E, et al. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year follow up. Arthritis Rheum. 2008;59:1773-1779.
Nearly 90% of anterior cruciate ligament (ACL) injuries are treated with surgical reconstruction. However, the latest research specifies that surgical reconstruction does not lead to greater recuperation than rehabilitative exercise after an injury to the ACL. The findings of a recent randomized study can be found in the December 15, 2008 issue of Arthritis and Rheumatism.
This study includes 54 patients who had complete ACL rupture, and began treatment within 4 weeks of injury. The study followed them for 2 to 5 years after injury. Thirty-six of the 54 patients had surgical reconstruction with either patellar or hamstring tendons. All patients underwent a reasonably aggressive supervised training program for 4 months.
After 3 years, the patients were given three hop/jump tests and three tests of muscle power. The scores for both groups were virtually the same on all tests.