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Personalized snoring video boosts CPAP adherence
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
BOSTON – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
AT SLEEP 2017
Key clinical point: Showing patients videos of themselves having an apneic event during CPAP initiation resulted in greater treatment adherence over 3 months, compared to standard ways of initiating CPAP therapy.
Major finding: Patients who watched personalized sleep videos used their CPAP devices more than 2 hours per night longer, compared with those who were not shown a personalized video.
Data source: Randomized controlled trial with 3-month data on 24 individuals out of a planned enrollment of 300 patients.
Disclosures: This ongoing study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.
Mild OSA linked to hypertension
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
BOSTON – Sleep apnea doesn’t have to be severe or even symptomatic to increase the risk of hypertension and diabetes, according to a pair of new studies.
“We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by four times, compared to individuals without sleep apnea,” said principal investigator and top sleep researcher Alexandros N. Vgontzas, MD, of Pennsylvania State University College of Medicine in a SLEEP press release. “Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost three times, compared to individuals without sleep apnea.”
Dr. Vgontzas presented his team’s results on the link between mild to moderate OSA and hypertension at the annual meeting of the American Academy of Sleep Medicine. In a separate session, his colleague at Penn State, Yun Li, MD, presented the diabetes-related findings of the same study.
After multivariate adjustment, including controlling for change in body mass index over time, both mild and moderate OSA were significantly associated with increased odds for developing hypertension, compared with controls without OSA (odds ratios, 4.36 and 3.46, respectively.).
The researchers found their test for an age interaction was also significant, indicating that younger adults with nonsevere OSA were at increased risk of hypertension, while those over 60 years of age were not.
[polldaddy:9792720]
“In young and middle-aged adults, our findings suggest that early detection and treatment of mild to moderate sleep apnea is warranted in order to prevent future cardiometabolic disease,” said Dr. Li in a press release. “Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management.”
For diabetes, moderate OSA was significantly associated with an almost threefold increased odds for developing diabetes after adjusting for a range of baseline and follow-up variables (OR, 2.78), but mild OSA was not associated with incident diabetes (OR, 0.47).
Both studies utilized data from the Penn State Adult Cohort, a random general population sample of 1,741 adults who underwent an overnight polysomnography sleep study and had a detailed medical history interview at baseline. Mild and moderate OSA were defined as an apnea hypopnea index from 5 to 14.9 and from 15 to 29.9, respectively. The presence of hypertension or diabetes at baseline and follow-up was defined by a self-report of receiving treatment for or having a physician diagnosis of either condition.
The age range of the studied population was wide (20-84 years), with a mean age of about 47 years. The incidence of diabetes was 10.2% at follow-up, while hypertension was found in 34.2% of patients. Dr. Vgontzas said the percentage of patients with hypertension was roughly what he had expected for this population.
“Our conclusion is that, the younger a person is, the stronger is the need for detection and treatment of sleep apnea,” said Dr. Vgontzas, though he acknowledged that putting these millions of people on continuous positive airway pressure therapy is not an easy proposition.
The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
AT SLEEP 2017
Key clinical point: In a random sample of adults, the presence of mild to moderate OSA was associated with a significantly higher risk of hypertension and diabetes.
Major finding: Individuals with mild to moderate OSA had more than a fourfold increased risk of hypertension over 10 years of follow-up (OR, 4.36). Moderate OSA was significantly associated with incident diabetes risk (OR, 2.78), but mild OSA was not.
Data source: An observational study including a random sample of 1,741 adults between the ages of 20 and 84 years.
Disclosures: The study was supported by National Institutes of Health grants. Dr. Vgontzas reported no conflicts of interest.
Loud, frequent snoring increases preterm delivery risk
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
BOSTON – Women who were prepregnancy, frequent, and loud snorers during pregnancy had a significantly higher risk of preterm or early term delivery, in a study presented at the annual meeting of the Associated Professional Sleep Societies.
“The fact that there is an association between snoring and time to delivery in a cohort which is not hypertensive is alarming, and I think that treatment for snoring earlier on in pregnancy may alleviate some of these outcomes,” reported Galit Levi Dunietz, PhD, MPH, of the University of Michigan in a session at the meeting.
Compared with nonsnorers, frequently loud snorers had about a 60% increased risk of preterm delivery even after adjusting for baseline body mass index, smoking, education, race, and parity. Pregnancy-onset snoring and infrequent or quiet snoring were not associated with preterm birth.
A limitation on the findings was that only a small number of women (4% of the sample) fell into the chronic, frequent, and loud snoring category. These women, however, had significantly lower mean gestational age, mean baseline BMI, and were more likely to be smokers, as compared with nonsnorers and quiet frequent or infrequent snorers.
“I think this is excellent work because it’s a big question,” said Dr. Omavi Gbodossou Bailey, MD, MPH from the University of Arizona, Pheonix, in a Q&A session at the conference. “As a primary care physician, I deliver babies and I also deal with sleep and when I ask the ob.gyns. about sleep apnea in this patient population, they’re not usually interested.”
Dr. Bailey noted in an interview that, often, women who had uncomplicated first pregnancies return with later pregnancies heavier, more sleep deprived, and snoring. “Then, they have higher risk for complications in the second or third pregnancy,” he said.
Snoring is common in pregnancy, affecting about 35% of women, and pregnancy itself is a risk factor for snoring. Previous studies have associated snoring with key pregnancy morbidities including hypertension, preeclampsia, and gestational diabetes, but, prior to this research, the few studies that had looked at snoring and preterm delivery had shown inconsistent results.
The researchers recruited 904 pregnant women in their third trimester and without hypertension or diabetes from prenatal clinics at the University of Michigan cared for between 2008 and 2011. The women were queried on the frequency of their snoring (from never to three or more times per week) along with its intensity (from nonsnoring to loud or very loud snoring). They were also categorized, based on self-report, as either chronic/prepregnancy snorers or incident/pregnancy-onset snorers.
In this low-risk cohort, 25% of the women reported incident snoring and 9% reported chronic prepregnancy snoring.
“The combination of snoring frequency and intensity may be a clinically useful marker to identify otherwise low-risk women who are likely to deliver earlier,” said Dr. Dunietz.
This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Compared with those who were nonloud, nonfrequent, or pregnancy-onset snorers, chronic, loud, and frequent snorers were at significantly greater risk for preterm delivery.
Major finding: Of women determined to be chronic, prepregnancy, frequent, and loud snorers, 25% had preterm delivery.
Data source: An observational study including 904 pregnant women in the third trimester.
Disclosures: This study was funded by the Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research, and the National Heart, Lung, and Blood Institute. Dr. Dunietz reported having no financial disclosures.
Late-to-bed adolescents may be early-to-diabetes
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
BOSTON – Late chronotype may have a deleterious impact on glucose homeostasis independent of obesity in preadolescents aged 10-13 years, according to a small study.
Late chronotype – or an individual’s preference for later sleep and food intake – is associated with higher body mass index (BMI), risk incidence of type 2 diabetes mellitus, hemoglobin A1c, and risk of hypertension in adults. It is also associated with higher BMI, lower dietary restraint, and lower HDL cholesterol in adolescents. This study was the first to focus on chronotype and glycemic control in children on the cusp of or in early puberty.
In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days – an objective measure of chronotype – was associated positively with fasting plasma glucose (P = 0.048). “This is an important point because it highlights the objective measure of chronotype, whereas questionnaires can be more subjective,” said Magdalena Dumin, MD, at the annual meeting of Associated Professional Sleep Societies.
The researcher also noted that higher sleep fragmentation and lower sleep efficiency were both associated with hyperglycemia and hyperinsulinemia, independent of obesity.
“Our preliminary findings suggest that having a late chronotype and less efficient and more fragmented sleep in pre- and early adolescence may have a deleterious glycemic impact independent of obesity and pubertal stage,” she said.
“Advancing bedtimes may reduce glucose levels in preadolescents and adolescents,” Dr. Dumin surmised.
This study included 24 adolescents, 13 of whom were normal weight and 11 of whom were obese. They all underwent anthropometric measurements with fasting glucose, insulin, C-peptide, HbA1c, and lipid levels. Exclusion criteria included a clinical diagnosis of sleep, behavioral, or dietary problems. The obese subjects also underwent a 180-minute glucose tolerance test.
Chronotype was assessed via actigraphy over 1 week to provide mid-sleep time on free days, and secondarily through administration to chronotype questionnaires – the Children’s ChronoType Questionnaire and the Morningness-Eveningness Scale for Children.
Among the normal-weight participants, 31% were morning and 23% evening chronotype (the rest being neutral chronotype), and, in the obese subjects, 27% were morning and 36% were evening chronotype.
The obese subjects were more likely to be in puberty, and had higher systolic blood pressures, higher fasting plasma insulin and levels of insulin resistance, as measured by Homeostatic Model Assessment of Insulin Resistance. Hemoglobin A1c tended to be higher in the obese subjects (P = .06), but fasting plasma glucose did not differ significantly between the obese and normal-weight participants (P = .68).
“We chose this population due to the shift from morningness to eveningness that occurs during adolescence followed by a progressive return to an intermediate or early chronotype at the end of adolescence,” Dr. Dumin said.
Bedtime, wake time, and total sleep time were nearly identical between the two groups (7.84 hours and 7.62 hours; P = .49), although sleep efficiency was numerically lower in the obese subjects (87.0 vs. 89.8; P = .14), while sleep fragmentation was somewhat greater (20.16 vs. 17.38; P = .18).
Dr. Dumin suggested that a continuation of her research with more patients would be useful.
This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine. Dr. Dumin reported having no financial disclosures.
AT SLEEP 2017
Key clinical point: Preadolescents with a late chronotype show impaired glucose homeostasis independent of obesity.
Major finding: In participants tested during the summer months, the actigraphy-derived mid-sleep time on free days was positively associated with fasting plasma glucose (P = .048).
Data source: Observational study including 24 adolescents between 10 and 13 years of age. Thirteen were normal weight and 11 were obese.
Disclosures: Dr. Dumin reported having no financial disclosures. This study is supported by the Endocrine Fellows Foundation and the University of Chicago Institute of Translational Medicine.
Later school start tied to more sleep
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
BOSTON – Teenagers slept more hours when they started school later, a new study found.
With 73% of high schoolers reporting receiving less than the recommended 8 hours of sleep per night, teens are among the most sleep-deprived members of society.
In this study, the later a teenager started school, the later he or she woke up, with average wake-up times having been just after 6:00 a.m. for those starting school between 7:00 and 7:30 a.m. and about 7:00 a.m. for those starting school after 8:30 a.m. But only those teens who started after 8:30 a.m. achieved the 8-hour recommended sleep duration, said Nicole Nahmod, during a presentation at the annual meeting of the Associated Professional Sleep Societies.
The students with the later school start times averaged 32 minutes of extra sleep, when compared with their early-rising colleagues, noted Ms. Nahmod, who is one of the study’s authors, a research technician, and study coordinator at Pennsylvania State University, Hershey. Specifically, adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, while those who started school earlier slept for only 7.5 hours a night.*
Acknowledging the importance of adequate sleep on teen health, mood, and school performance, the American Academy of Pediatrics recommends that middle schools and high schools begin at 8:30 a.m. or later. However, most school days start earlier than that, as evidenced by this dataset. While 72% of the study’s participants started school between 7:00 a.m. and 8:30 a.m., as many as 15% of the study participants began school during the narrower 7:00-7:30 a.m. window.
In this study, researchers from Penn State used data from 413 adolescents (mean age, 15.4 years; 46% male), who participated in a substudy of the Fragile Families & Child Wellbeing Study conducted across 20 large American cities. The study oversampled nonmarried pregnant mothers, resulting in a racially diverse sample and a high proportion of low-income families. The household income for 29% of the sample was below the poverty line.*
For this substudy, sleep duration was calculated from app-based daily diary reports of bed times, wake times, and school start times on days when a teen attended school.
The study was limited by its cross-sectional nature, but was enriched by a diverse range of school start times sampled from 20 U.S. cities, the high proportion of at-risk teens, and the use of a daily sleep diary.
“Current literature shows associations between later school start times and academic success, mood, and health. It also shows a decrease in motor vehicle accidents, tardiness, school dropout, and daytime sleepiness,” Ms. Nahmod noted.
Her continued research in this area involves analyzing the relationships between actigraphically assessed sleep measures in students and school start times.
Ms. Nahmod reported having no financial disclosures.
*This article was updated on June 6, 2017.
AT SLEEP 2017
Key clinical point: Teenage students who start school after 8:30 a.m. are more likely to get the recommended 8 hours of sleep than are their counterparts with earlier start times.
Major finding: Adolescents who started school after 8:30 a.m. had a mean sleep duration of 8.1 hours, compared with 7.5 hours for students who started school earlier.
Data source: A national longitudinal birth cohort study of 413 adolescents.
Disclosures: Ms. Nahmod reported having no financial disclosures.
APA: Initial response to buprenorphine-naloxone predicts effectiveness at 12 weeks
TORONTO – Whether they had relapsed in the first 2 weeks strongly predicted a successful long-term outcome in patients with prescription opioid dependence undergoing treatment with buprenorphine-naloxone, according to findings presented at the annual meeting of the American Psychiatric Association.
“People either need to hit the ground running and do well quickly, or you need to cage something within a couple of weeks,” said Dr. Roger D. Weiss, chief of the division of alcohol and drug abuse at McLean Hospital in Belmont, Mass. The typical time course of response to buprenorphine-naloxone in the treatment of prescription opioid dependence is not known, and given the overall studies’ fairly poor success rate (<10% at completion), knowing this information could help guide clinical practice in the treatment of this population, Dr. Weiss said.
Most studies of buprenorphine have focused on heroin users, who differ from prescription opioid users on socioeconomic and compliance measures.
The researchers looked at both positive predictive value – the degree to which initial opioid abstinence predicted final successful outcome at the end of 12 weeks, along with negative predictive value – the degree to which initial opioid use predicted final unsuccessful outcome.
“So, does getting off to a good start predict a good outcome and does getting off to a bad start predict a bad outcome?” Dr. Weiss asked.
Turns out, that if people were abstinent in week 1, the likelihood they would be absent at weeks 9-12 was 49%, “essentially a coin flip,” he said. If abstinence were maintained for the first 2 weeks, the PPV went up to 56%, rising a few more points out to week 4.
“Two weeks gave you as good a prediction as you’re going to get, but it’s not a great prediction,” explained Dr. Weiss, also a professor of psychiatry at Harvard Medical School in Boston.
However, looking at the negative predictive value offered more information. If the patients used opioids in week 1, the likelihood of a bad outcome was 80%, and this rose to 94% if they used in the first 2 weeks and 97% if they used in the first 4 weeks.
“So if they don’t do well in 2 weeks, the likelihood that, if you just wait a little while, they’ll do better, was almost nil,” Dr. Weiss said.
The Prescription Opioid Addiction Treatment Study (POATS) compared treatments for prescription opioid dependence, using buprenorphine-naloxone of different durations and counseling of varying intensities. The trial was conducted as part of the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) at 10 participating sites across the United States.
With 653 patients, POATS was the largest study ever conducted for prescription opioid dependence and sought to determine the value of added drug counseling to buprenorphine-naloxone treatment, and determine the optimal length of buprenorphine-naloxone treatment for these particular patients. To be eligible for enrollment, patients had to have a DSM-IV diagnosis of opioid dependence, not just physical dependence.
In POATS, patients began with 1-2 weeks of buprenorphine-naloxone treatment followed by a 4-week taper and were then randomly assigned to regular or more intensive drug counseling.
Patients who had a successful outcome in phase 1 (defined as 4 days or fewer of use per month, no positive urine screens for 2 consecutive weeks, no injection of opioids, no other formal substance abuse treatment, and not more than one missing urine sample) were considered finished with the study.
Those who relapsed had the option of going to phase 2, where they received 3 months of buprenorphine-naloxone stabilization and were rerandomized to standard care or standard care plus extra drug counseling. They also received 12 weeks of buprenorphine-naloxone treatment, followed by a taper period until week 16.
Dr. Weiss disclosed that he has consulted to Reckitt Benckiser Pharmaceuticals, maker of the drug, but vowed to “present the content in a fair and balanced manner.”
TORONTO – Whether they had relapsed in the first 2 weeks strongly predicted a successful long-term outcome in patients with prescription opioid dependence undergoing treatment with buprenorphine-naloxone, according to findings presented at the annual meeting of the American Psychiatric Association.
“People either need to hit the ground running and do well quickly, or you need to cage something within a couple of weeks,” said Dr. Roger D. Weiss, chief of the division of alcohol and drug abuse at McLean Hospital in Belmont, Mass. The typical time course of response to buprenorphine-naloxone in the treatment of prescription opioid dependence is not known, and given the overall studies’ fairly poor success rate (<10% at completion), knowing this information could help guide clinical practice in the treatment of this population, Dr. Weiss said.
Most studies of buprenorphine have focused on heroin users, who differ from prescription opioid users on socioeconomic and compliance measures.
The researchers looked at both positive predictive value – the degree to which initial opioid abstinence predicted final successful outcome at the end of 12 weeks, along with negative predictive value – the degree to which initial opioid use predicted final unsuccessful outcome.
“So, does getting off to a good start predict a good outcome and does getting off to a bad start predict a bad outcome?” Dr. Weiss asked.
Turns out, that if people were abstinent in week 1, the likelihood they would be absent at weeks 9-12 was 49%, “essentially a coin flip,” he said. If abstinence were maintained for the first 2 weeks, the PPV went up to 56%, rising a few more points out to week 4.
“Two weeks gave you as good a prediction as you’re going to get, but it’s not a great prediction,” explained Dr. Weiss, also a professor of psychiatry at Harvard Medical School in Boston.
However, looking at the negative predictive value offered more information. If the patients used opioids in week 1, the likelihood of a bad outcome was 80%, and this rose to 94% if they used in the first 2 weeks and 97% if they used in the first 4 weeks.
“So if they don’t do well in 2 weeks, the likelihood that, if you just wait a little while, they’ll do better, was almost nil,” Dr. Weiss said.
The Prescription Opioid Addiction Treatment Study (POATS) compared treatments for prescription opioid dependence, using buprenorphine-naloxone of different durations and counseling of varying intensities. The trial was conducted as part of the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) at 10 participating sites across the United States.
With 653 patients, POATS was the largest study ever conducted for prescription opioid dependence and sought to determine the value of added drug counseling to buprenorphine-naloxone treatment, and determine the optimal length of buprenorphine-naloxone treatment for these particular patients. To be eligible for enrollment, patients had to have a DSM-IV diagnosis of opioid dependence, not just physical dependence.
In POATS, patients began with 1-2 weeks of buprenorphine-naloxone treatment followed by a 4-week taper and were then randomly assigned to regular or more intensive drug counseling.
Patients who had a successful outcome in phase 1 (defined as 4 days or fewer of use per month, no positive urine screens for 2 consecutive weeks, no injection of opioids, no other formal substance abuse treatment, and not more than one missing urine sample) were considered finished with the study.
Those who relapsed had the option of going to phase 2, where they received 3 months of buprenorphine-naloxone stabilization and were rerandomized to standard care or standard care plus extra drug counseling. They also received 12 weeks of buprenorphine-naloxone treatment, followed by a taper period until week 16.
Dr. Weiss disclosed that he has consulted to Reckitt Benckiser Pharmaceuticals, maker of the drug, but vowed to “present the content in a fair and balanced manner.”
TORONTO – Whether they had relapsed in the first 2 weeks strongly predicted a successful long-term outcome in patients with prescription opioid dependence undergoing treatment with buprenorphine-naloxone, according to findings presented at the annual meeting of the American Psychiatric Association.
“People either need to hit the ground running and do well quickly, or you need to cage something within a couple of weeks,” said Dr. Roger D. Weiss, chief of the division of alcohol and drug abuse at McLean Hospital in Belmont, Mass. The typical time course of response to buprenorphine-naloxone in the treatment of prescription opioid dependence is not known, and given the overall studies’ fairly poor success rate (<10% at completion), knowing this information could help guide clinical practice in the treatment of this population, Dr. Weiss said.
Most studies of buprenorphine have focused on heroin users, who differ from prescription opioid users on socioeconomic and compliance measures.
The researchers looked at both positive predictive value – the degree to which initial opioid abstinence predicted final successful outcome at the end of 12 weeks, along with negative predictive value – the degree to which initial opioid use predicted final unsuccessful outcome.
“So, does getting off to a good start predict a good outcome and does getting off to a bad start predict a bad outcome?” Dr. Weiss asked.
Turns out, that if people were abstinent in week 1, the likelihood they would be absent at weeks 9-12 was 49%, “essentially a coin flip,” he said. If abstinence were maintained for the first 2 weeks, the PPV went up to 56%, rising a few more points out to week 4.
“Two weeks gave you as good a prediction as you’re going to get, but it’s not a great prediction,” explained Dr. Weiss, also a professor of psychiatry at Harvard Medical School in Boston.
However, looking at the negative predictive value offered more information. If the patients used opioids in week 1, the likelihood of a bad outcome was 80%, and this rose to 94% if they used in the first 2 weeks and 97% if they used in the first 4 weeks.
“So if they don’t do well in 2 weeks, the likelihood that, if you just wait a little while, they’ll do better, was almost nil,” Dr. Weiss said.
The Prescription Opioid Addiction Treatment Study (POATS) compared treatments for prescription opioid dependence, using buprenorphine-naloxone of different durations and counseling of varying intensities. The trial was conducted as part of the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) at 10 participating sites across the United States.
With 653 patients, POATS was the largest study ever conducted for prescription opioid dependence and sought to determine the value of added drug counseling to buprenorphine-naloxone treatment, and determine the optimal length of buprenorphine-naloxone treatment for these particular patients. To be eligible for enrollment, patients had to have a DSM-IV diagnosis of opioid dependence, not just physical dependence.
In POATS, patients began with 1-2 weeks of buprenorphine-naloxone treatment followed by a 4-week taper and were then randomly assigned to regular or more intensive drug counseling.
Patients who had a successful outcome in phase 1 (defined as 4 days or fewer of use per month, no positive urine screens for 2 consecutive weeks, no injection of opioids, no other formal substance abuse treatment, and not more than one missing urine sample) were considered finished with the study.
Those who relapsed had the option of going to phase 2, where they received 3 months of buprenorphine-naloxone stabilization and were rerandomized to standard care or standard care plus extra drug counseling. They also received 12 weeks of buprenorphine-naloxone treatment, followed by a taper period until week 16.
Dr. Weiss disclosed that he has consulted to Reckitt Benckiser Pharmaceuticals, maker of the drug, but vowed to “present the content in a fair and balanced manner.”
AT THE APA ANNUAL MEETING
Key clinical point: Early response to buprenorphine-naloxone treatment predicts outcome in prescription opioid dependence.
Major finding: Patients who abstain from opioids in the first 2 weeks of buprenorphine-naloxone treatment have a better chance of a good outcome at 9-12 weeks Conversely, those who used opioids in each of the first 2 weeks have very little chance of abstaining in weeks 9-12.
Data source: The Prescription Opioid Addiction Treatment Study (POATS), a multisite, randomized, controlled outpatient study of 653 participants.
Disclosures: Dr. Weiss disclosed that he has consulted for Reckitt Benckiser Pharmaceuticals, maker of the drug, but vowed to “present the content in a fair and balanced manner.”
APA: Transcranial near-infrared light could be useful in depression
TORONTO – Transcranial near-infrared light is a promising treatment for depression, Dr. Andrew A. Nierenberg said at the annual meeting of the American Psychiatric Association. The therapy is noninvasive and cheap, and enhances the brain’s bioenergetic metabolism, potentially offering a treatment alternative to patients with refractory symptoms of depression.
“It’s too early for prime time,” said Dr. Nierenberg, a psychiatrist at Massachusetts General Hospital and Harvard Medical School, both in Boston. “You can buy these devices on Amazon, but I wouldn’t recommend it.”
Transcranial near-infrared (NIR) light passes through the skull and stimulates cytochrome c oxidase within the mitochondria, which increases energy production and is anti-inflammatory. “It turns out that transcranial near-infrared light is extremely neuroprotective,” reported Dr. Nierenberg, explaining that it has shown real promise in the treatment of traumatic brain injury and is being studied in mood disorders. “My chairman likes it for his joints,” he added.
A pilot study of the therapy in 10 patients with major depression, including 9 with anxiety, showed a good response at 2 weeks after a single treatment (Brain Funct. 2009;5:46). Patients experienced highly significant reductions in both Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores following treatment, with the greatest reductions occurring at 2 weeks. However, a fair amount of regression was seen at 4 weeks post treatment. “One question is whether you can do repeated exposures,” Dr. Nierenberg said.The sham-controlled, randomized ELATED trial (Transcranial Laser Therapy for Major Depressive Disorder) is ongoing and plans to include 30 patients with structured clinical interview for DSM (SCID) diagnosis of major depressive disorder. Findings could be released as early as this summer.
“We’ll see what happens with this over time, but I think it’s a wonderful example of a technology that may actually help people over time,” Dr. Nierenberg said. He added that near infrared therapy isn’t related to sunlight exposure, since there isn’t enough of the near infrared spectrum in regular sunlight to have an effect.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
TORONTO – Transcranial near-infrared light is a promising treatment for depression, Dr. Andrew A. Nierenberg said at the annual meeting of the American Psychiatric Association. The therapy is noninvasive and cheap, and enhances the brain’s bioenergetic metabolism, potentially offering a treatment alternative to patients with refractory symptoms of depression.
“It’s too early for prime time,” said Dr. Nierenberg, a psychiatrist at Massachusetts General Hospital and Harvard Medical School, both in Boston. “You can buy these devices on Amazon, but I wouldn’t recommend it.”
Transcranial near-infrared (NIR) light passes through the skull and stimulates cytochrome c oxidase within the mitochondria, which increases energy production and is anti-inflammatory. “It turns out that transcranial near-infrared light is extremely neuroprotective,” reported Dr. Nierenberg, explaining that it has shown real promise in the treatment of traumatic brain injury and is being studied in mood disorders. “My chairman likes it for his joints,” he added.
A pilot study of the therapy in 10 patients with major depression, including 9 with anxiety, showed a good response at 2 weeks after a single treatment (Brain Funct. 2009;5:46). Patients experienced highly significant reductions in both Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores following treatment, with the greatest reductions occurring at 2 weeks. However, a fair amount of regression was seen at 4 weeks post treatment. “One question is whether you can do repeated exposures,” Dr. Nierenberg said.The sham-controlled, randomized ELATED trial (Transcranial Laser Therapy for Major Depressive Disorder) is ongoing and plans to include 30 patients with structured clinical interview for DSM (SCID) diagnosis of major depressive disorder. Findings could be released as early as this summer.
“We’ll see what happens with this over time, but I think it’s a wonderful example of a technology that may actually help people over time,” Dr. Nierenberg said. He added that near infrared therapy isn’t related to sunlight exposure, since there isn’t enough of the near infrared spectrum in regular sunlight to have an effect.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
TORONTO – Transcranial near-infrared light is a promising treatment for depression, Dr. Andrew A. Nierenberg said at the annual meeting of the American Psychiatric Association. The therapy is noninvasive and cheap, and enhances the brain’s bioenergetic metabolism, potentially offering a treatment alternative to patients with refractory symptoms of depression.
“It’s too early for prime time,” said Dr. Nierenberg, a psychiatrist at Massachusetts General Hospital and Harvard Medical School, both in Boston. “You can buy these devices on Amazon, but I wouldn’t recommend it.”
Transcranial near-infrared (NIR) light passes through the skull and stimulates cytochrome c oxidase within the mitochondria, which increases energy production and is anti-inflammatory. “It turns out that transcranial near-infrared light is extremely neuroprotective,” reported Dr. Nierenberg, explaining that it has shown real promise in the treatment of traumatic brain injury and is being studied in mood disorders. “My chairman likes it for his joints,” he added.
A pilot study of the therapy in 10 patients with major depression, including 9 with anxiety, showed a good response at 2 weeks after a single treatment (Brain Funct. 2009;5:46). Patients experienced highly significant reductions in both Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores following treatment, with the greatest reductions occurring at 2 weeks. However, a fair amount of regression was seen at 4 weeks post treatment. “One question is whether you can do repeated exposures,” Dr. Nierenberg said.The sham-controlled, randomized ELATED trial (Transcranial Laser Therapy for Major Depressive Disorder) is ongoing and plans to include 30 patients with structured clinical interview for DSM (SCID) diagnosis of major depressive disorder. Findings could be released as early as this summer.
“We’ll see what happens with this over time, but I think it’s a wonderful example of a technology that may actually help people over time,” Dr. Nierenberg said. He added that near infrared therapy isn’t related to sunlight exposure, since there isn’t enough of the near infrared spectrum in regular sunlight to have an effect.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
EXPERT ANALYSIS FROM THE APA ANNUAL MEETING
APA: Honest talk about opioid dependence encouraged
TORONTO – More than half of patients in a random sample of individuals seeking treatment for opioid dependence started their journey to addiction with a legitimate medical need for painkillers, according to Dr. Christopher Chiodo.
With the rising morbidity, mortality, and costs associated with opioid dependence, it’s time for physicians to take a closer look at their prescribing habits, said Dr. Chiodo, an orthopedic surgeon at the Brigham and Women’s Faulkner Hospital, Boston.
“You guys are on the back end, taking care of these poor individuals,” Dr. Chiodo told a room full of addiction specialists. “I’m on the front end. I’m the one giving out the prescriptions to patients who are becoming addicted.”
The journey to dependence
In an effort to better understand the role physicians play in the origins of patients’ addiction, Dr. Chiodo and his colleagues at the Brigham and Women’s hospital studied 50 consecutive patients (64% male; mean age, 40 years) being treated for opioid addiction at the hospital’s outpatient center.
Based on an anonymous written survey, the investigators found that 58% of patients received their first opioids from a doctor’s prescription, an additional 28% got the drugs from family and friends, and 14% got them from dealers or other sources.
“There are a lot of patients, for whom we are starting this process. … I’m certainly not going to use the word ‘responsible’ for it, but we’re starting the process,” Dr. Chiodo said at the annual meeting of the American Psychiatric Association.
Orthopedic surgeons weren’t actually the biggest prescribers: 36% of patients reported getting the prescription from a primary care doctor, 7% from a dentist, 7% from an orthopedic surgeon, 14% from general surgeons, and the remaining 36% from other clinicians or from multiple physicians (for example, through doctor shopping).
Perhaps of most concern, at the time the patients reported first considering themselves addicted to opioids, 45% were still getting their drugs from doctors.
The pressures to overprescribe
Many doctors overprescribe just to avoid being called in the middle of the night by a patient in pain. “It’s the low road,” he said.
Other pressures that increase prescribing include patient expectations, increasing surgical volume, and the lack of a longitudinal relationship with patients who are often being treated for acute problems.
“Typical orthopedic office encounters involve patients in pain, quick visits, and we don’t have a longitudinal relationship with these patients – we don’t know who they are, what their personal values are, or their coping or anxiety scores,” Dr. Chiodo said.
Perhaps one of the strongest issues in overprescribing is the desire to avoid complaints, he said.
“You’re doing everything you can to avoid having to confront the patients, so you take the easier road and give them a prescription, and hope they give you a better review in the hospital and on the Internet,” said Dr. Chiodo.
Recent studies have estimated the total annual cost in the United States of opioid abuse to be between $18 billion and $72 billion per year. As well, the United States consumes 80% of the global opioid supply and 99% of global hydrocodone. Studies have shown that patients are more likely to complain about doctors who don’t give them pain medications.
Have the talk
Just prescribing fewer opioids isn’t the only answer, said Dr. Chiodo. What is needed is more dialogue with patients about their pain expectations and their need for opioids.
“I give them 2 weeks [after surgery], and maybe one more prescription to carry them through the third week, but when you get that call, you need to tell your patient that it’s OK to be having some pain,” Dr. Chiodo said. “Half of the time, that’s enough for them; they sigh and say they don’t want the prescription for another week.”
Sometime what is needed – and this is a harder talk to have, said Dr. Chiodo – is an honest suggestion to patients that they are at risk for addiction. “You’re prescribing something very powerful for pain that is affecting their life, and I think we need to talk to our patients more.”
During the Q&A period, Dr. Stephen Frye, a psychiatrist from Las Vegas, suggested that much of this musculoskeletal pain can be better managed with medicinal marijuana.
“Let me assure you that marijuana, which is medically now allowed in 24 states, is really valuable medicine, remarkably safe, you cannot die from it, you cannot OD from it. … This is excellent medication for these problems,” Dr. Frye said.
Dr. Chiodo reported no relevant financial disclosures.
TORONTO – More than half of patients in a random sample of individuals seeking treatment for opioid dependence started their journey to addiction with a legitimate medical need for painkillers, according to Dr. Christopher Chiodo.
With the rising morbidity, mortality, and costs associated with opioid dependence, it’s time for physicians to take a closer look at their prescribing habits, said Dr. Chiodo, an orthopedic surgeon at the Brigham and Women’s Faulkner Hospital, Boston.
“You guys are on the back end, taking care of these poor individuals,” Dr. Chiodo told a room full of addiction specialists. “I’m on the front end. I’m the one giving out the prescriptions to patients who are becoming addicted.”
The journey to dependence
In an effort to better understand the role physicians play in the origins of patients’ addiction, Dr. Chiodo and his colleagues at the Brigham and Women’s hospital studied 50 consecutive patients (64% male; mean age, 40 years) being treated for opioid addiction at the hospital’s outpatient center.
Based on an anonymous written survey, the investigators found that 58% of patients received their first opioids from a doctor’s prescription, an additional 28% got the drugs from family and friends, and 14% got them from dealers or other sources.
“There are a lot of patients, for whom we are starting this process. … I’m certainly not going to use the word ‘responsible’ for it, but we’re starting the process,” Dr. Chiodo said at the annual meeting of the American Psychiatric Association.
Orthopedic surgeons weren’t actually the biggest prescribers: 36% of patients reported getting the prescription from a primary care doctor, 7% from a dentist, 7% from an orthopedic surgeon, 14% from general surgeons, and the remaining 36% from other clinicians or from multiple physicians (for example, through doctor shopping).
Perhaps of most concern, at the time the patients reported first considering themselves addicted to opioids, 45% were still getting their drugs from doctors.
The pressures to overprescribe
Many doctors overprescribe just to avoid being called in the middle of the night by a patient in pain. “It’s the low road,” he said.
Other pressures that increase prescribing include patient expectations, increasing surgical volume, and the lack of a longitudinal relationship with patients who are often being treated for acute problems.
“Typical orthopedic office encounters involve patients in pain, quick visits, and we don’t have a longitudinal relationship with these patients – we don’t know who they are, what their personal values are, or their coping or anxiety scores,” Dr. Chiodo said.
Perhaps one of the strongest issues in overprescribing is the desire to avoid complaints, he said.
“You’re doing everything you can to avoid having to confront the patients, so you take the easier road and give them a prescription, and hope they give you a better review in the hospital and on the Internet,” said Dr. Chiodo.
Recent studies have estimated the total annual cost in the United States of opioid abuse to be between $18 billion and $72 billion per year. As well, the United States consumes 80% of the global opioid supply and 99% of global hydrocodone. Studies have shown that patients are more likely to complain about doctors who don’t give them pain medications.
Have the talk
Just prescribing fewer opioids isn’t the only answer, said Dr. Chiodo. What is needed is more dialogue with patients about their pain expectations and their need for opioids.
“I give them 2 weeks [after surgery], and maybe one more prescription to carry them through the third week, but when you get that call, you need to tell your patient that it’s OK to be having some pain,” Dr. Chiodo said. “Half of the time, that’s enough for them; they sigh and say they don’t want the prescription for another week.”
Sometime what is needed – and this is a harder talk to have, said Dr. Chiodo – is an honest suggestion to patients that they are at risk for addiction. “You’re prescribing something very powerful for pain that is affecting their life, and I think we need to talk to our patients more.”
During the Q&A period, Dr. Stephen Frye, a psychiatrist from Las Vegas, suggested that much of this musculoskeletal pain can be better managed with medicinal marijuana.
“Let me assure you that marijuana, which is medically now allowed in 24 states, is really valuable medicine, remarkably safe, you cannot die from it, you cannot OD from it. … This is excellent medication for these problems,” Dr. Frye said.
Dr. Chiodo reported no relevant financial disclosures.
TORONTO – More than half of patients in a random sample of individuals seeking treatment for opioid dependence started their journey to addiction with a legitimate medical need for painkillers, according to Dr. Christopher Chiodo.
With the rising morbidity, mortality, and costs associated with opioid dependence, it’s time for physicians to take a closer look at their prescribing habits, said Dr. Chiodo, an orthopedic surgeon at the Brigham and Women’s Faulkner Hospital, Boston.
“You guys are on the back end, taking care of these poor individuals,” Dr. Chiodo told a room full of addiction specialists. “I’m on the front end. I’m the one giving out the prescriptions to patients who are becoming addicted.”
The journey to dependence
In an effort to better understand the role physicians play in the origins of patients’ addiction, Dr. Chiodo and his colleagues at the Brigham and Women’s hospital studied 50 consecutive patients (64% male; mean age, 40 years) being treated for opioid addiction at the hospital’s outpatient center.
Based on an anonymous written survey, the investigators found that 58% of patients received their first opioids from a doctor’s prescription, an additional 28% got the drugs from family and friends, and 14% got them from dealers or other sources.
“There are a lot of patients, for whom we are starting this process. … I’m certainly not going to use the word ‘responsible’ for it, but we’re starting the process,” Dr. Chiodo said at the annual meeting of the American Psychiatric Association.
Orthopedic surgeons weren’t actually the biggest prescribers: 36% of patients reported getting the prescription from a primary care doctor, 7% from a dentist, 7% from an orthopedic surgeon, 14% from general surgeons, and the remaining 36% from other clinicians or from multiple physicians (for example, through doctor shopping).
Perhaps of most concern, at the time the patients reported first considering themselves addicted to opioids, 45% were still getting their drugs from doctors.
The pressures to overprescribe
Many doctors overprescribe just to avoid being called in the middle of the night by a patient in pain. “It’s the low road,” he said.
Other pressures that increase prescribing include patient expectations, increasing surgical volume, and the lack of a longitudinal relationship with patients who are often being treated for acute problems.
“Typical orthopedic office encounters involve patients in pain, quick visits, and we don’t have a longitudinal relationship with these patients – we don’t know who they are, what their personal values are, or their coping or anxiety scores,” Dr. Chiodo said.
Perhaps one of the strongest issues in overprescribing is the desire to avoid complaints, he said.
“You’re doing everything you can to avoid having to confront the patients, so you take the easier road and give them a prescription, and hope they give you a better review in the hospital and on the Internet,” said Dr. Chiodo.
Recent studies have estimated the total annual cost in the United States of opioid abuse to be between $18 billion and $72 billion per year. As well, the United States consumes 80% of the global opioid supply and 99% of global hydrocodone. Studies have shown that patients are more likely to complain about doctors who don’t give them pain medications.
Have the talk
Just prescribing fewer opioids isn’t the only answer, said Dr. Chiodo. What is needed is more dialogue with patients about their pain expectations and their need for opioids.
“I give them 2 weeks [after surgery], and maybe one more prescription to carry them through the third week, but when you get that call, you need to tell your patient that it’s OK to be having some pain,” Dr. Chiodo said. “Half of the time, that’s enough for them; they sigh and say they don’t want the prescription for another week.”
Sometime what is needed – and this is a harder talk to have, said Dr. Chiodo – is an honest suggestion to patients that they are at risk for addiction. “You’re prescribing something very powerful for pain that is affecting their life, and I think we need to talk to our patients more.”
During the Q&A period, Dr. Stephen Frye, a psychiatrist from Las Vegas, suggested that much of this musculoskeletal pain can be better managed with medicinal marijuana.
“Let me assure you that marijuana, which is medically now allowed in 24 states, is really valuable medicine, remarkably safe, you cannot die from it, you cannot OD from it. … This is excellent medication for these problems,” Dr. Frye said.
Dr. Chiodo reported no relevant financial disclosures.
AT THE APA ANNUAL MEETING
Key clinical point: Physicians are overprescribing opioids, starting many patients on the road to opioid dependence.
Major finding: In a random sample of patients receiving treatment for opioid dependence, 58% received their first opioids from a doctor’s prescription. At the time they considered themselves addicted, 45% were still being prescribed opioids.
Data source: An observational study of 50 people.
Disclosures: Dr. Chiodo reported no relevant financial disclosures.
APA: Predictive analytics and big data hold promise in mood disorders
TORONTO – “What if we could detect a mood episode before it happened?” It was with this question that Dr. Andrew A. Nierenberg began his talk on new advances in mood disorders research at the annual meeting of the American Psychiatric Association.
From predictive analytics to big data collaboration to therapeutic apps, Dr. Nierenberg led the audience through a tour of the now and near future.
One company in this space, Ginger.io, uses behavioral analytics to better understand patients’ changing social, mental, and physical health status. The data can then be fed quickly back to clinicians when intervention is warranted. The company’s app collects passive sensor data from patients’ smartphones about their movement, communication, and sleep patterns. Sophisticated analytical methods detect changes in behavior and predict people’s moods and actions.
“It’s a little creepy in some ways, but maybe not,” he said. “If you think about it, when people come to us in distress, it’s not at the very edge or beginning of a mood episode, but they’re deep into it [and that is] when we tend to intervene.”
When a patient is evaluated, he explained, the strength of the evaluation is dependent on accurate self-observation, and accurate storage and recall of the patient’s observations about their emotional states.
“Those are all problems for people with mood disorders,” Dr. Nierenberg said. “So, when we ask someone how they have been in the past week, we’re really getting a window into the past 3-6 hours. What these predictive analytics allow is real time data to look at what is actually happening with people.”
The question really being asked here, said Dr. Nierenberg, is whether it’s possible to see objective changes that are not among the information people are likely to report to their clinicians, that can predict a mood episode.
Harnessing technology
Big data also has come to mood disorders care in a big way. Large registries are being compiled for research purposes, and patient communities are growing that help patients cope with their conditions and help researchers collect huge amounts of data. Based on cognitive-behavioral therapy combined with relaxation and wellness techniques, we believe in holistic daily tools aimed at breaking the anxiety cycle. We’re not about quick fixes or false promises. We are about real progress, a day at a time.
According to its website, Big White Wall is an online community of people “who are anxious, down, or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.”
Other examples of these tech-based solutions are therapeutic apps and websites. Dr. Nierenberg mentioned just three: MoodGYM, Now Matters Now, and Pacifica, all of which are “cutting edge and evidence-based” and help patients manage their conditions.
• MoodGym is a free, interactive self-help program that provides cognitive-behavior therapy (CBT) training to help users prevent and cope with depression and anxiety.
• Now Matters Now is an online video-based program that uses “real” people, including suicide prevention researchers and clinicians, to teach coping skills such as mindfulness, paced breathing, and opposite action to individuals having suicidal thoughts. The skills taught are part of dialectical behavior therapy, or DBT, proven to be helpful for people considering suicide. Dr. Nierenberg called this community “quite extraordinary” and uniquely valuable, “because the majority of people who are having suicidal thoughts don’t have them when they’re in your office …”
• Pacifica is a self-help app for anxiety that uses CBT combined with relaxation and wellness techniques aimed at “breaking the anxiety cycle,” the company says.
‘A game changer’
The Patient Centered Outcomes Research Network (PCORnet.org) is “a game changer,” said Dr. Nierenberg. It is part of the Patient-Centered Outcomes Research Institute (PCORI), which is part of the Affordable Care Act, funded at about $500 million a year. One part of PCORnet.org is the Patient-Powered Research Networks, including a mood-focused network, moodnetwork.org.
“It allows the patients to choose how they want to be monitored, through self-report, but also gives them a voice in prioritizing research and research questions.” A goal is to transform research and mood disorder care by creating an infrastructure for both research and clinicians wanting to follow their patients and through prospective comparative effectiveness trials embedded within routine care.
The organizers hope to gather 50,000 patients in the network, a “wild and audacious goal,” admitted Dr. Nierenberg, who is the principal investigator of moodnetwork.org. PCORnet.org ultimately might cover 90 million people and truly be able to answer real-world questions in a way that most research today does not address, he added.
Dr. Nierenberg is a top researcher and educator from Massachusetts General Hospital and Harvard Medical School, Boston. In 2013, he won the prestigious Colvin Prize given by the Brain & Behavior Research Foundation for Outstanding Achievement in Mood Disorders Research.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
TORONTO – “What if we could detect a mood episode before it happened?” It was with this question that Dr. Andrew A. Nierenberg began his talk on new advances in mood disorders research at the annual meeting of the American Psychiatric Association.
From predictive analytics to big data collaboration to therapeutic apps, Dr. Nierenberg led the audience through a tour of the now and near future.
One company in this space, Ginger.io, uses behavioral analytics to better understand patients’ changing social, mental, and physical health status. The data can then be fed quickly back to clinicians when intervention is warranted. The company’s app collects passive sensor data from patients’ smartphones about their movement, communication, and sleep patterns. Sophisticated analytical methods detect changes in behavior and predict people’s moods and actions.
“It’s a little creepy in some ways, but maybe not,” he said. “If you think about it, when people come to us in distress, it’s not at the very edge or beginning of a mood episode, but they’re deep into it [and that is] when we tend to intervene.”
When a patient is evaluated, he explained, the strength of the evaluation is dependent on accurate self-observation, and accurate storage and recall of the patient’s observations about their emotional states.
“Those are all problems for people with mood disorders,” Dr. Nierenberg said. “So, when we ask someone how they have been in the past week, we’re really getting a window into the past 3-6 hours. What these predictive analytics allow is real time data to look at what is actually happening with people.”
The question really being asked here, said Dr. Nierenberg, is whether it’s possible to see objective changes that are not among the information people are likely to report to their clinicians, that can predict a mood episode.
Harnessing technology
Big data also has come to mood disorders care in a big way. Large registries are being compiled for research purposes, and patient communities are growing that help patients cope with their conditions and help researchers collect huge amounts of data. Based on cognitive-behavioral therapy combined with relaxation and wellness techniques, we believe in holistic daily tools aimed at breaking the anxiety cycle. We’re not about quick fixes or false promises. We are about real progress, a day at a time.
According to its website, Big White Wall is an online community of people “who are anxious, down, or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.”
Other examples of these tech-based solutions are therapeutic apps and websites. Dr. Nierenberg mentioned just three: MoodGYM, Now Matters Now, and Pacifica, all of which are “cutting edge and evidence-based” and help patients manage their conditions.
• MoodGym is a free, interactive self-help program that provides cognitive-behavior therapy (CBT) training to help users prevent and cope with depression and anxiety.
• Now Matters Now is an online video-based program that uses “real” people, including suicide prevention researchers and clinicians, to teach coping skills such as mindfulness, paced breathing, and opposite action to individuals having suicidal thoughts. The skills taught are part of dialectical behavior therapy, or DBT, proven to be helpful for people considering suicide. Dr. Nierenberg called this community “quite extraordinary” and uniquely valuable, “because the majority of people who are having suicidal thoughts don’t have them when they’re in your office …”
• Pacifica is a self-help app for anxiety that uses CBT combined with relaxation and wellness techniques aimed at “breaking the anxiety cycle,” the company says.
‘A game changer’
The Patient Centered Outcomes Research Network (PCORnet.org) is “a game changer,” said Dr. Nierenberg. It is part of the Patient-Centered Outcomes Research Institute (PCORI), which is part of the Affordable Care Act, funded at about $500 million a year. One part of PCORnet.org is the Patient-Powered Research Networks, including a mood-focused network, moodnetwork.org.
“It allows the patients to choose how they want to be monitored, through self-report, but also gives them a voice in prioritizing research and research questions.” A goal is to transform research and mood disorder care by creating an infrastructure for both research and clinicians wanting to follow their patients and through prospective comparative effectiveness trials embedded within routine care.
The organizers hope to gather 50,000 patients in the network, a “wild and audacious goal,” admitted Dr. Nierenberg, who is the principal investigator of moodnetwork.org. PCORnet.org ultimately might cover 90 million people and truly be able to answer real-world questions in a way that most research today does not address, he added.
Dr. Nierenberg is a top researcher and educator from Massachusetts General Hospital and Harvard Medical School, Boston. In 2013, he won the prestigious Colvin Prize given by the Brain & Behavior Research Foundation for Outstanding Achievement in Mood Disorders Research.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
TORONTO – “What if we could detect a mood episode before it happened?” It was with this question that Dr. Andrew A. Nierenberg began his talk on new advances in mood disorders research at the annual meeting of the American Psychiatric Association.
From predictive analytics to big data collaboration to therapeutic apps, Dr. Nierenberg led the audience through a tour of the now and near future.
One company in this space, Ginger.io, uses behavioral analytics to better understand patients’ changing social, mental, and physical health status. The data can then be fed quickly back to clinicians when intervention is warranted. The company’s app collects passive sensor data from patients’ smartphones about their movement, communication, and sleep patterns. Sophisticated analytical methods detect changes in behavior and predict people’s moods and actions.
“It’s a little creepy in some ways, but maybe not,” he said. “If you think about it, when people come to us in distress, it’s not at the very edge or beginning of a mood episode, but they’re deep into it [and that is] when we tend to intervene.”
When a patient is evaluated, he explained, the strength of the evaluation is dependent on accurate self-observation, and accurate storage and recall of the patient’s observations about their emotional states.
“Those are all problems for people with mood disorders,” Dr. Nierenberg said. “So, when we ask someone how they have been in the past week, we’re really getting a window into the past 3-6 hours. What these predictive analytics allow is real time data to look at what is actually happening with people.”
The question really being asked here, said Dr. Nierenberg, is whether it’s possible to see objective changes that are not among the information people are likely to report to their clinicians, that can predict a mood episode.
Harnessing technology
Big data also has come to mood disorders care in a big way. Large registries are being compiled for research purposes, and patient communities are growing that help patients cope with their conditions and help researchers collect huge amounts of data. Based on cognitive-behavioral therapy combined with relaxation and wellness techniques, we believe in holistic daily tools aimed at breaking the anxiety cycle. We’re not about quick fixes or false promises. We are about real progress, a day at a time.
According to its website, Big White Wall is an online community of people “who are anxious, down, or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals.”
Other examples of these tech-based solutions are therapeutic apps and websites. Dr. Nierenberg mentioned just three: MoodGYM, Now Matters Now, and Pacifica, all of which are “cutting edge and evidence-based” and help patients manage their conditions.
• MoodGym is a free, interactive self-help program that provides cognitive-behavior therapy (CBT) training to help users prevent and cope with depression and anxiety.
• Now Matters Now is an online video-based program that uses “real” people, including suicide prevention researchers and clinicians, to teach coping skills such as mindfulness, paced breathing, and opposite action to individuals having suicidal thoughts. The skills taught are part of dialectical behavior therapy, or DBT, proven to be helpful for people considering suicide. Dr. Nierenberg called this community “quite extraordinary” and uniquely valuable, “because the majority of people who are having suicidal thoughts don’t have them when they’re in your office …”
• Pacifica is a self-help app for anxiety that uses CBT combined with relaxation and wellness techniques aimed at “breaking the anxiety cycle,” the company says.
‘A game changer’
The Patient Centered Outcomes Research Network (PCORnet.org) is “a game changer,” said Dr. Nierenberg. It is part of the Patient-Centered Outcomes Research Institute (PCORI), which is part of the Affordable Care Act, funded at about $500 million a year. One part of PCORnet.org is the Patient-Powered Research Networks, including a mood-focused network, moodnetwork.org.
“It allows the patients to choose how they want to be monitored, through self-report, but also gives them a voice in prioritizing research and research questions.” A goal is to transform research and mood disorder care by creating an infrastructure for both research and clinicians wanting to follow their patients and through prospective comparative effectiveness trials embedded within routine care.
The organizers hope to gather 50,000 patients in the network, a “wild and audacious goal,” admitted Dr. Nierenberg, who is the principal investigator of moodnetwork.org. PCORnet.org ultimately might cover 90 million people and truly be able to answer real-world questions in a way that most research today does not address, he added.
Dr. Nierenberg is a top researcher and educator from Massachusetts General Hospital and Harvard Medical School, Boston. In 2013, he won the prestigious Colvin Prize given by the Brain & Behavior Research Foundation for Outstanding Achievement in Mood Disorders Research.
Dr. Nierenberg reported working with several pharmaceutical companies in drug development.
EXPERT ANALYSIS FROM THE APA ANNUAL MEETING
APA: Botox tied to lifting of refractory depression
TORONTO – A single injection of Botox in the forehead area may be an effective adjuvant treatment in patient with treatment-resistant depression, according to a meta-analysis presented at the annual meeting of the American Psychiatric Association.
“Botulinum toxin A injection in the glabellar region appears to induce a significant and sustained antidepressant effect when used as an adjunctive treatment for major depressive disorder,” said principal investigator Dr. Ajay K. Parsaik.
Dr. Parsaik, a resident in psychiatry at the University of Texas, Houston, conducted a meta-analysis of eligible randomized controlled trials comparing the efficacy of botulinum toxin A (onabotulinumtoxinA) with placebo in subjects with major depressive disorder. The results painted a consistent picture of efficacy: Treated patients had an average 9.8-point decrease on their primary depression scores compared to placebo, were 8 times more likely to respond to treatment (defined as a 50% or more reduction in primary depression score), and were about 4.5 times more likely to go into remission (a score ≤10 in one study and ≤7 in the other two). All findings were statistically significant in favor of botulinum toxin A.
However, the data remain limited: From 639 articles screened, the researchers found 3 RCTs and 2 more non-RCT studies. Two of the three RCTs were published in 2014 (the third in 2012), showing just how new this concept is. The RCTs data included 134 patients in total, more than 80% of whom were female. Mean age was 49 years. Follow-up varied from 6 weeks to 24 weeks, but results tended to be seen in about 2 weeks, Dr. Parsaik said.Not just for wrinkles anymore, botulinum toxin A (Botox) is used to treat muscle contractions and spasms, chronic migraine, hyperhidrosis, and urinary incontinence in adults with multiple sclerosis and spinal cord injury. But it’s actually Botox’s wrinkle-smoothing advantages that play a part in its use in major depression. The agent works by preventing the release of acetylcholine from nerve endings leading to muscle paralysis that continues until the nerve develops new endings to communicate with the muscles. Injected into the muscle above and between the eyebrows, Botox cosmetically improves the appearance of vertical frown lines between the eyebrows. It is this use that has appeared promising as an adjuvant therapy in the treatment of depression.
While the exact mechanism of Botox’s benefit in depression remains unclear, Dr. Parsaik said the facial feedback hypothesis remains a lead candidate: Facial movements can influence the emotional experience. Smiling makes you happy; frowning makes you sad.
Since the expression of negative emotions (fear, anger, sadness) involves contraction of corrugator muscles located on the medial end of the eyebrows, paralysis of these muscles blocks neuromuscular transmission and interrupts this facial feedback loop. Blinding is difficult to maintain in these studies, admitted Dr. Parsaik, and more study is certainly needed, including, he suggested, testing botulinum toxin A as a monotherapy in depressed patients.
Other possible mechanisms include that the treatment improved self-perception, which in turn, improved mood, or that happier facial expressions may facilitate better social interaction leading to better mood, he said. In response to this, a physician in the audience asked (tongue in cheek) whether it might be appropriate to buy patients tickets to comedy shows or offer penile and breast enlargements in an effort to increase happiness and self-perception.
Dr. Parsaik reported having no conflict of interest.
TORONTO – A single injection of Botox in the forehead area may be an effective adjuvant treatment in patient with treatment-resistant depression, according to a meta-analysis presented at the annual meeting of the American Psychiatric Association.
“Botulinum toxin A injection in the glabellar region appears to induce a significant and sustained antidepressant effect when used as an adjunctive treatment for major depressive disorder,” said principal investigator Dr. Ajay K. Parsaik.
Dr. Parsaik, a resident in psychiatry at the University of Texas, Houston, conducted a meta-analysis of eligible randomized controlled trials comparing the efficacy of botulinum toxin A (onabotulinumtoxinA) with placebo in subjects with major depressive disorder. The results painted a consistent picture of efficacy: Treated patients had an average 9.8-point decrease on their primary depression scores compared to placebo, were 8 times more likely to respond to treatment (defined as a 50% or more reduction in primary depression score), and were about 4.5 times more likely to go into remission (a score ≤10 in one study and ≤7 in the other two). All findings were statistically significant in favor of botulinum toxin A.
However, the data remain limited: From 639 articles screened, the researchers found 3 RCTs and 2 more non-RCT studies. Two of the three RCTs were published in 2014 (the third in 2012), showing just how new this concept is. The RCTs data included 134 patients in total, more than 80% of whom were female. Mean age was 49 years. Follow-up varied from 6 weeks to 24 weeks, but results tended to be seen in about 2 weeks, Dr. Parsaik said.Not just for wrinkles anymore, botulinum toxin A (Botox) is used to treat muscle contractions and spasms, chronic migraine, hyperhidrosis, and urinary incontinence in adults with multiple sclerosis and spinal cord injury. But it’s actually Botox’s wrinkle-smoothing advantages that play a part in its use in major depression. The agent works by preventing the release of acetylcholine from nerve endings leading to muscle paralysis that continues until the nerve develops new endings to communicate with the muscles. Injected into the muscle above and between the eyebrows, Botox cosmetically improves the appearance of vertical frown lines between the eyebrows. It is this use that has appeared promising as an adjuvant therapy in the treatment of depression.
While the exact mechanism of Botox’s benefit in depression remains unclear, Dr. Parsaik said the facial feedback hypothesis remains a lead candidate: Facial movements can influence the emotional experience. Smiling makes you happy; frowning makes you sad.
Since the expression of negative emotions (fear, anger, sadness) involves contraction of corrugator muscles located on the medial end of the eyebrows, paralysis of these muscles blocks neuromuscular transmission and interrupts this facial feedback loop. Blinding is difficult to maintain in these studies, admitted Dr. Parsaik, and more study is certainly needed, including, he suggested, testing botulinum toxin A as a monotherapy in depressed patients.
Other possible mechanisms include that the treatment improved self-perception, which in turn, improved mood, or that happier facial expressions may facilitate better social interaction leading to better mood, he said. In response to this, a physician in the audience asked (tongue in cheek) whether it might be appropriate to buy patients tickets to comedy shows or offer penile and breast enlargements in an effort to increase happiness and self-perception.
Dr. Parsaik reported having no conflict of interest.
TORONTO – A single injection of Botox in the forehead area may be an effective adjuvant treatment in patient with treatment-resistant depression, according to a meta-analysis presented at the annual meeting of the American Psychiatric Association.
“Botulinum toxin A injection in the glabellar region appears to induce a significant and sustained antidepressant effect when used as an adjunctive treatment for major depressive disorder,” said principal investigator Dr. Ajay K. Parsaik.
Dr. Parsaik, a resident in psychiatry at the University of Texas, Houston, conducted a meta-analysis of eligible randomized controlled trials comparing the efficacy of botulinum toxin A (onabotulinumtoxinA) with placebo in subjects with major depressive disorder. The results painted a consistent picture of efficacy: Treated patients had an average 9.8-point decrease on their primary depression scores compared to placebo, were 8 times more likely to respond to treatment (defined as a 50% or more reduction in primary depression score), and were about 4.5 times more likely to go into remission (a score ≤10 in one study and ≤7 in the other two). All findings were statistically significant in favor of botulinum toxin A.
However, the data remain limited: From 639 articles screened, the researchers found 3 RCTs and 2 more non-RCT studies. Two of the three RCTs were published in 2014 (the third in 2012), showing just how new this concept is. The RCTs data included 134 patients in total, more than 80% of whom were female. Mean age was 49 years. Follow-up varied from 6 weeks to 24 weeks, but results tended to be seen in about 2 weeks, Dr. Parsaik said.Not just for wrinkles anymore, botulinum toxin A (Botox) is used to treat muscle contractions and spasms, chronic migraine, hyperhidrosis, and urinary incontinence in adults with multiple sclerosis and spinal cord injury. But it’s actually Botox’s wrinkle-smoothing advantages that play a part in its use in major depression. The agent works by preventing the release of acetylcholine from nerve endings leading to muscle paralysis that continues until the nerve develops new endings to communicate with the muscles. Injected into the muscle above and between the eyebrows, Botox cosmetically improves the appearance of vertical frown lines between the eyebrows. It is this use that has appeared promising as an adjuvant therapy in the treatment of depression.
While the exact mechanism of Botox’s benefit in depression remains unclear, Dr. Parsaik said the facial feedback hypothesis remains a lead candidate: Facial movements can influence the emotional experience. Smiling makes you happy; frowning makes you sad.
Since the expression of negative emotions (fear, anger, sadness) involves contraction of corrugator muscles located on the medial end of the eyebrows, paralysis of these muscles blocks neuromuscular transmission and interrupts this facial feedback loop. Blinding is difficult to maintain in these studies, admitted Dr. Parsaik, and more study is certainly needed, including, he suggested, testing botulinum toxin A as a monotherapy in depressed patients.
Other possible mechanisms include that the treatment improved self-perception, which in turn, improved mood, or that happier facial expressions may facilitate better social interaction leading to better mood, he said. In response to this, a physician in the audience asked (tongue in cheek) whether it might be appropriate to buy patients tickets to comedy shows or offer penile and breast enlargements in an effort to increase happiness and self-perception.
Dr. Parsaik reported having no conflict of interest.
AT THE APA ANNUAL MEETING
Key clinical point: Botulinum toxin A injected into the forehead area is associated with an ease in depression.
Major finding: Based on pooled data, Botox reduced mean depression score by 9.8 points (over placebo), and meaningfully increased response and remission rates in patients with treatment-resistant depression.
Data source: Meta-analysis of three randomized, controlled trials including 134 patients with depression.
Disclosures: Dr. Parsaik reported having no conflict of interest.