Sleep apnea in end-stage renal disease patients: Impact on cardiovascular and neurological outcomes.

INTRODUCTION: Sleep apnea (SA) is an important comorbidity in end-stage renal disease (ESRD) patients. The association between SA and cardiac and neurological disease is known. This study investigates the relationship between SA and cardiovascular and cerebrovascular outcomes in the ESRD population. METHODS: In a retrospective cohort study, the United States Renal Data System was queried to identify ESRD patients aged 18-100 years in whom hemodialysis had been initiated between 2005 and 2013. Diagnoses of SA and clinical comorbidities were determined from International Classification of Disease-9 codes. Demographic variables were obtained from Centers for Medicare and Medicaid Services Form-2728. Logistic regression was used to examine the association of SA with myocardial infarction (MI) or with stroke, controlling for demographic and clinical variables. RESULTS: Of 858,131 subjects meeting the inclusion criteria, 587 had central SA, and 22,724 had obstructive SA. The SA cohort was younger, more likely to be male and Caucasian compared to the non-SA cohort. Patients with SA also had more tobacco and alcohol use, hypertension, heart failure, and diabetes. Central SA (aRR = 1.69, 95% CI = 1.28-2.23) and obstructive SA (aRR = 1.15, 95% CI = 1.09-1.21) were associated with an increased risk of stroke but not MI. CONCLUSION: In the ESRD population, a diagnosis of central SA or obstructive SA increased the risk of stroke, but not MI. Early identification and treatment of SA in the ESRD population may help reduce the risk of stroke in these patients.

Assessment of self-reported anger expression in youth.

Internal consistency, temporal stability, and principal components structures of two self-report anger expression scales used in pediatric health research were examined in 415 youth (216 White, 199 Black; 191 boys, 224 girls; mean age 14.7 years). Participants completed the Anger Expression Scale (AXS) and the Pediatric Anger Expression Scale (PAES) on two occasions separated by approximately 1 year. Psychometric properties of the two scales were examined and compared with those reported by the scale authors. For both the AXS and the PAES, estimates of internal consistency (Cronbach s alpha) were acceptable and comparable to values reported by scale authors. Temporal stability of both scales was significant over 1 year. Principal components structures for both scales were similar to those reported by scale authors. Results were generally consistent for age groupings (<13, 13 years), ethnicity, and gender. It is concluded that further research using the AXS and PAES is warranted. The stability of anger expression over time and the assessment of anger suppression is discussed.

Suicidal behaviors in young adolescents.

A two-stage epidemiologic study investigated the frequency of suicidal behavior in children 12-14 years of age. In the first stage, the Center for Epidemiologic Studies Depression Scale, a three-item suicide scale, a life-event schedule, and a family environment scale were administered during 1986 to a southeastern US community sample of 1,542 seventh and eighth grade students. In the second stage, 226 mother-child pairs were interviewed utilizing the Schedule for Schizophrenia and Affective Disorders in School Age Children (K-SADS). Subjects interviewed included students with high depression scores and a random sample of the remaining students. Prevalence estimates for moderate to severe suicidal ideation (K-SADS score greater than or equal to 4) were 4.0% (95% confidence interval (CI) 0.6-16.4%) in males and 8.7% (95% CI 2.4-23.3%) in females. The prevalences of suicide attempts were 1.9% (95% CI 0.0-13.2%) in males and 1.5% (95% CI 0.6-12.7%) in females. Significant relations were found between major depression and both suicide ideation (odds ratio = 6.19, 95% CI 1.53-24.94) and suicide attempts (odds ratio = 9.80, 95% CI 1.89-50.86). The undesirable life-events score was also a significant predictor of suicide ideation and suicide attempts.