[Obstructive sleep apnea in women]. / Az obstruktív alvási apnoe jelentosége nok körében.

The prevalence of sleep disturbances and their symptomatic manifestations may be different in men and women. Women with obstructive sleep apnea are less likely to be diagnosed with sleep apnea compared to men, probably due to atypical symptoms such as morning headaches, symptoms of depression and daytime fatigue. There is a great importance of diagnosis and treatment of sleep disorders regarding quality of life, co-morbidity and mortality in both genders.

Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure.

Periodic limb movements in sleep (PLMS) is prevalent among dialysed patients and is associated with increased risk of mortality. Our study aimed to determine the prevalence of this disease in a sample of transplanted and waiting-list haemodialysed patients. One hundred transplanted and 50 waiting-list patients underwent polysomnography. Moderate and severe diseases were defined as periodic limb movements in sleep index (PLMSI) higher than 15 and 25 events h(-1), respectively. The 10-year coronary heart disease risk was estimated for all patients using the Framingham Score. Moreover, the 10-year estimated risk of stroke was calculated according to the modified version of the Framingham Stroke Risk Profile. PLMS was present in 27% of the transplanted and 42% of the waiting-list group (P = 0.094); the proportion of severe disease was twice as high in waiting-list versus transplanted patients (32 versus 16%, P = 0.024). Patients with severe disease had a higher 10-year estimated risk of stroke in the transplanted group [10 (7-17) versus 5 (4-10); P = 0.002] and a higher 10-year coronary heart disease risk in both the transplanted [18 (8-22) versus 7 (4-14); P = 0.002], and the waiting-list groups [11 (5-18) versus 4 (1-9); P = 0.032]. In multivariable linear regression models the PLMSI was associated independently with the Framingham cardiovascular and cerebrovascular scores after adjusting for important covariables. Higher PLMSI is an independent predictor of higher cardiovascular and cerebrovascular risk score in patients with chronic kidney disease. Severe PLMS is less frequent in kidney transplant recipients compared to waiting-list dialysis patients.

[Links between diabetes mellitus and sleep disorders: focusing on obstructive sleep apnea]. / A diabetes mellitus és az alvászavarok kapcsolata - fókuszban az obstruktív alvási apnoe.

During the past decades obesity and diabetes have become increasingly common in modern, industrialized societies. At the same time sleep disorders, chronic sleep loss and sleep deprivation have also become more and more prevalent. There may be a positive feed back circle between the two disorders: sleep problems may affect endocrine function and metabolic conditions, while metabolic abnormalities potentially interfere with sleep regulation. Sleep-disordered breathing, obstructive sleep apnea in particular, has the strongest association with glucose metabolism. Prevalence and severity of obstructive sleep apnea are higher among diabetic individuals compared to non-diabetic subjects. Central obesity is an important risk factor both in diabetes and sleep apnea, and recent evidence supports the direct association between them. Diabetic neuropathy and metabolic syndrome parameters correlate with the presence and severity of obstructive sleep apnea. Intermittent hypoxia may cause insulin resistance, consequently increasing the risk of diabetes and further impairing glycemic control. Specialists in both diabetology and sleep medicine need to work together to prevent the negative interactions between these two groups of disorders and to also preserve patients' quality of life and to improve outcomes.

Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario.

OBJECTIVE: Guidelines recommend home blood pressure monitoring (HBPM) to improve blood pressure control, but the attitudes of primary care physicians and their hypertensive patients towards its use are not known. METHODS: A 28-item self-administered survey about home blood pressure monitoring was mailed to a random sample of 1418 primary care physicians in Ontario and 765 (55%) were returned. Of the 478 physicians treating hypertension, 299 agreed to give surveys to their hypertensive patients. We received 149 patient surveys. RESULTS: The majority of primary care physicians (63%) often or almost always encouraged their hypertensive patients to monitor their own blood pressure at home. Only 13%, however, preferred home blood pressure monitoring to office or ambulatory readings for diagnostic purposes and 19%, to guide therapy. Physicians had concerns about patients becoming preoccupied with home monitoring (70%) and the accuracy of home devices (65%). Most patients (78%) had a device at home, and 84% indicated that their doctor encouraged them to measure blood pressure. Yet, 80% received no advice from their physician on the type of device to purchase, only 8% had specific training on proper measurement technique, 68% did not regularly take the results to the doctor and 39% did nothing specific about alarming readings. CONCLUSIONS: Primary care physicians prefer office or ambulatory to home readings to make diagnostic and therapeutic decisions. While home monitoring is popular among patients, its clinical usefulness is undermined by the lack of reliable purchasing information, standard measurement protocols, proper training on measurement technique and specific instructions on handling and interpreting results.

Cardiovascular disease and health-care utilization in snorers: a population survey.

STUDY OBJECTIVES: We assessed the prevalence of self-reported snoring in the Hungarian population and established whether different types of snoring are associated with cardiovascular disorders and increased health-care utilization. DESIGN: Cross-sectional study. Door-to-door survey. SETTING: Nationally representative population in Hungary. PARTICIPANTS: Interviews were carried out in the homes of 12,643 persons. We used the Hungarian National Population Register as the sampling frame and implemented a clustered, stratified sampling procedure. The study population represented 0.16% of the population over the age of 18 years according to age, sex, and 150 subregions of the country. INTERVENTIONS: Not applicable. MEASUREMENTS AND RESULTS: Thirty-seven percent of men and 21% of women reported loud snoring with breathing pauses. Hypertension, myocardial infarction, and stroke were reported by 26%, 3%, and 4% of the respondents, respectively. There was a significant increase in the prevalence of hypertension, myocardial infarction, and stroke in quiet and loud snorers, as compared with nonsnorers. Multivariate analysis showed an association between loud snoring and hypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.24-1.58), myocardial infarction (OR: 1.34, CI: 1.04-1.73), and stroke (OR: 1.67, CI: 1.32-2.11) after statistical adjustment for age, sex, body mass index, diabetes, level of education, smoking, and alcohol consumption. Loud snoring was also associated with measures of health-care use in both sexes. CONCLUSIONS: Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization.

Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.

BACKGROUND: Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care. METHODS: Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system's development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements. RESULTS: The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians' reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (+/-13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective. CONCLUSIONS: The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.

Primary-care physicians' views about the use of home/self blood pressure monitoring: nationwide survey in Hungary.

OBJECTIVE: To obtain unbiased views of primary-care physicians about home blood pressure monitoring (HBPM). METHODS: A mail survey was conducted in a random sample (n = 700) of all Hungarian primary-care physicians (n = 5112). Items in the questionnaire related to the extent and indications for use of HBPM, to the significance attributed to its results, to the methods of its use, and to concerns physicians had with HBPM. RESULTS: Of the 700 questionnaires, 405 (58%) could be analysed. HBPM was popular among the respondents: 60% of them had more then 50 patients on HBPM, 90% of them were recommending its use either 'often' or 'almost all the time', and 75% of them considered the results of HBPM of either 'considerable' or of 'extreme importance'. The most frequent indications for use were white-coat hypertension (97%), assessing 24-h drug effects (87%), improving compliance (82%), suspicion of hypotension (63%), and resistant hypertension (61%). Physicians actively recommended devices with an upper-arm cuff (83%), equipped with a built in memory (63%). Most respondents (67%) had someone in their offices to teach the patient the correct measurement technique. Surprisingly, 65% of the physicians only reviewed the data to obtain a 'general picture' and did not analyse the data. Most of the respondents (78%) encouraged their patients to call their offices, and 90% of them did receive a call. Main concerns with HBPM were the use of non-validated devices (75%), and patient preoccupation with blood pressure (55%). Areas for suggested improvements were the need for patient training facilities (48%), established measurement protocols (44%) and better methods of displaying readings (30%). CONCLUSIONS: We found an unexpected popularity in the use of HBPM among primary-care physicians. In order to fully exploit the benefits of HBPM, the concerns raised (validated devices, patient preoccupation) and areas to be improved upon (patient training, better methods of displaying results) will have to be addressed by researchers, societies and the industry.

[Obstructive sleep apnea and cardiovascular disease]. / Az obstruktív alvási apnoe hatása a cardiovascularis betegségek kialakulására es prognózisára.

Obstructive sleep apnea is an increasingly common disorder and it is a novel cardiovascular disease risk factor. Repetitive apneas and hypopneas during sleep are accompanied by hypoxia, increased sympathetic activity and frequent arousals. Sleep apnea has clearly been demonstrated to be an independent risk factor for development of hypertension and it has also been implicated in the pathogenesis of atherosclerosis, congestive heart failure, pulmonary hypertension, cardiac arrhythmias and stroke. Several studies showed that obstructive sleep apnea is associated with an increased risk of cardiovascular morbidity and mortality. However, a number of trials that assessed the effect of continuous positive airway pressure treatment have shown a reduction in blood pressure, decrease in cardiac arrhythmias, improvement in left ventricular function and reduction in incidence and mortality of cardiovascular diseases. Despite the available effective therapy the majority of individuals with obstructive sleep apnea and cardiovascular disease remains underdiagnosed and untreated.

[Obstructive sleep apnea and cardiovascular disease]. / Az obstruktív alvási apnoe epidemiológiája, diagnosztikája, kezelése és cardiovascularis következményei.

Sleep-related breathing disorders are prevalent in the general population and are associated with a wide range of cardiovascular diseases. Obstructive sleep apnea is the most common form of sleep-related breathing disorders and is characterized by repetitive episodes of partial or complete upper airway obstruction, followed by oxygen-desaturation and arousals. These apneic events disrupt normal sleep and lead to various acute and chronic cardiovascular consequences. The current standard treatment with nasal continuous positive airway pressure eliminates apneas, improves sleep fragmentation and prevents consequent hemodynamic changes during sleep. Every patient with hypertension, obesity or heart disease should be asked routinely about symptoms of sleep apnea and referred for a sleep study if necessary.

Acute effects of cigarette smoking on the QT interval in healthy smokers.

This study assesses the effect of a first cigarette smoked in the morning on the QT interval duration in healthy habitual smokers after not smoking overnight. This study demonstrates that although after cigarette smoking the QT(Bc) values increase, the QT(Fc) and QT(Lc) values remained unchanged, and an increased sympathetic response was evident. The discrepancies between the results seen by different QT correction formulas emphasize the importance of selecting an accurate method for heart rate correction when evaluating and interpreting alterations in QT values.

Obstructive sleep apnea and heart rate variability in male patients with metabolic syndrome: cross-sectional study.

BACKGROUND: Obstructive sleep apnea (OSA) is often accompanied by the metabolic syndrome. Because both conditions are associated with depressed heart rate variability (HRV) separately, our aim was to study whether co-morbid OSA is associated with more reduced HRV in male patients with the metabolic syndrome. METHODS: In this cross-sectional study, 35 men (age, 57±11 years) with the metabolic syndrome (according to International Diabetes Federation criteria) were included. OSA severity was defined by the apnea-hypopnea index (AHI). HRV was assessed by 24-hr ambulatory electrocardiographic monitoring. Standard deviation of all normal-to-normal RR intervals (SDNN), the high frequency power (HFP), and the ratio of low- to high-frequency power (LF/HF) were measured. RESULTS: There were 14, 6, and 8 cases of severe (AHI ≥30/hr), moderate (15/hr≤AHI <30/hr), and mild (5/hr ≤AHI <15/hr) OSA, respectively. Seven patients had no OSA. Patients with mild-moderate or severe OSA had reduced SDNN and HFP values compared to those without OSA. Increasing OSA severity was associated significantly with lower daytime LF/HF ratio [standardized ß regression coefficient (ß)=-0.362, P=0.043] and higher night/day LF/HF ratio (ß=0.377, P=0.023) after controlling for age, duration of diabetes, and severity of metabolic syndrome. CONCLUSIONS: Co-morbid OSA is associated with decreased overall HRV, parasympathetic loss, and impaired diurnal pattern of sympathovagal balance that may further increase the cardiovascular vulnerability of male patients with the metabolic syndrome. The role of the HRV analysis in the risk assessment of these patients warrants further studies.

Association between lunar phase and sleep characteristics.

OBJECTIVES: Popular belief holds that the lunar cycle affects human physiology, behavior, and health, including sleep. To date, only a few and conflicting analyses have been published about the association between lunar phases and sleep. Our aim was to analyze the relationship between lunar phases and sleep characteristics. METHODS: In this retrospective, cross-sectional analysis, data from 319 patients who had been referred for sleep study were included. Individuals with apnea-hypopnea index ≥ 15/h were excluded. Socio-demographic parameters were recorded. All participants underwent one-night standard polysomnography. Associations between lunar cycle (new moon, full moon and alternate moon) and sleep parameters were examined in unadjusted and adjusted models. RESULTS: Fifty-seven percent of patients were males. Mean age for men was 45 ± 14 years and 51 ± 12 years for women. In total, 224 persons had their sleep study done during alternate moon, 47 during full moon, and 48 during new moon. Full moon was associated with lower sleep efficiency [median (%) (IQR): new moon 82 (18), full moon 74 (19), alternate moon 82 (15); P < 0.001], less deep sleep [median (%) (IQR): new moon 9 (9), full moon 6 (4), alternate moon 11 (9); P < 0.001], and increased REM latency [median (min) (IQR): new moon 98 (74), full moon 137 (152), alternate moon 97 (76); P < 0.001], even after adjustment for several covariables. CONCLUSION: The results are consistent with a recent report and the widely held belief that sleep characteristics may be associated with the full moon.

Sleep apnea is associated with cardiovascular risk factors among kidney transplant patients.

BACKGROUND AND OBJECTIVES: We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study of 100 Tx and 50 WL patients who underwent one-night polysomnography (SLeep disorders Evaluation in Patients after kidney Transplantation [SLEPT] Study). Sociodemographic information and data about medication, comorbidity, and laboratory parameters were collected. RESULTS: The prevalence of mild (apnea-hypopnea index [AHI] > or =5/h and <15/h), moderate (AHI > or =15/h and <30/h), and severe OSA (AHI > or =30/h) was 18, 11, and 14% in the Tx group and 28, 16, and 10% in the WL group, respectively. The AHI was significantly correlated with age (rho = 0.34), body mass index (rho = 0.45), neck circumference (rho = 0.4), abdominal circumference (rho = 0.51), and hemoglobin (rho = 0.24) in the Tx group. The proportion of Tx patients who were treated with three or more antihypertensive drugs was significantly higher in the OSA group (56 versus 31%; P = 0.022). Despite taking significantly more antihypertensive drugs, the average systolic BP was still higher in patients with versus without OSA (147 +/- 21 versus 139 +/- 18 mmHg; P = 0.059). CONCLUSIONS: The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.

Moderate exercise and bright light treatment in overweight and obese individuals.

OBJECTIVE: Increased physical activity is important given the concern over the growing rates of obesity. The aim of this study is to conduct a controlled investigation of the effects of bright light therapy and exercise on weight loss and body composition in overweight and obese individuals. RESEARCH METHODS AND PROCEDURES: Twenty-five overweight and obese subjects were assigned to 6 weeks of moderate exercise with or without bright light treatment. Outcome measure included changes in body mass and body composition and ratings of mood, seasonality, and sleep. RESULTS: Body weight decreased significantly with exercise in subjects in the light and non-light treatment groups, but the change was not significantly different between the groups. Similar results were found for BMI. With exercise, body fat decreased significantly only in the light treatment group. There was a significant effect of the interaction of group by time on body fat composition, but the group by time interaction failed to reach statistical significance for body weight and BMI. Mood scores improved significantly with exercise in the light group, but no significant changes were noted regarding sleep. DISCUSSION: This preliminary study is the first to show that addition of bright light treatment to a 6-week moderate exercise program can alter body composition by significantly reducing body fat. The reduction in body fat mass is of particular importance, because visceral fat has been particularly implicated as a major factor in the development of the metabolic syndrome. This study is an important step toward finding ways to maximize the effects of exercise.