Sleep 2014

MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.

That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.

There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.

There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.

Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.

Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.

She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.

The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.

The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.

There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.

There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).

Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.

"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.

She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.

Dr. Koren and her colleagues hope to replicate the study in a larger cohort.

Dr. Koren reported no relevant financial conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.

That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.

There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.

There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.

Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.

Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.

She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.

The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.

The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.

There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.

There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).

Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.

"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.

She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.

Dr. Koren and her colleagues hope to replicate the study in a larger cohort.

Dr. Koren reported no relevant financial conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.

That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.

There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.

There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.

Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.

Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.

She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.

The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.

The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.

There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.

There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).

Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.

"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.

She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.

Dr. Koren and her colleagues hope to replicate the study in a larger cohort.

Dr. Koren reported no relevant financial conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.

The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.

The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.

The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). In May, the two congressmen introduced a bill (H.R. 4695) that would do just that.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign. The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). In May, the two congressmen introduced a bill (H.R. 4695) that would do just that.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign. The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.

Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.

An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.

The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). In May, the two congressmen introduced a bill (H.R. 4695) that would do just that.

"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.

Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.

The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign. The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish, including durable medical equipment such as continuous positive airway pressure devices.

Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.

The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said.

Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.

aault@frontlinemedcom.com

MINNEAPOLIS – People who report feeling more sleepy and less rested have elevated levels of amyloid in regions of the brain commonly involved in Alzheimer’s disease, according to a cohort study presented at the annual meeting of the Associated Professional Sleep Societies.

Researchers studied 98 asymptomatic, cognitively healthy late- to middle-age adults from the WRAP (Wisconsin Registry for Alzheimer’s Prevention) program, the majority of whom were at elevated risk for the disease because of family history.

Self-reported somnolence, poorer sleep quality, and sleep problems were significantly correlated with higher levels of amyloid deposition in the cortex overall and in four subregions typically affected in Alzheimer’s disease.

"It does appear that there is an association between amyloid burden and sleepiness, and that relationship is present in adults who are cognitively healthy but who are at risk of developing Alzheimer’s disease in the future. They are fairly young in terms of amyloid pathology," said first author Kate Sprecher, a PhD candidate in the neuroscience training program at the University of Wisconsin–Madison. She acknowledged that the findings may differ in a cohort not enriched for people at elevated risk.

"We can’t say from these data whether sleep is driving amyloid deposition or whether amyloid deposition is disrupting sleep," she said. "Nonetheless, it’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology. We may be able to intervene early in the disease, when people are actually able to respond to treatment, because typically, current drugs are targeting later disease, when a great deal of neurodegeneration has already taken place. So sleep may be something that we can target really early."

The researchers plan to investigate the observed association using objective measures of sleep and obstructive sleep apnea (OSA), according to Ms. Sprecher. "And we’ll do some longitudinal follow-up as well in our cohort to see how sleep changes might relate to actual progression of the disease."

Study participants completed the Medical Outcomes Study (MOS) Sleep Scale and the Epworth Sleepiness Scale (ESS). Amyloid deposition in the brain was measured by positron-emission tomography performed with Pittsburgh Compound B.

The participants were 63 years old, on average, and two-thirds were female. Overall, 76% had a family history of Alzheimer’s, and 34% were positive for the APOE4 allele, which is associated with risk of this disease.

‘It’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology.’

Analyses adjusted for these and other confounders showed a correlation (P less than or equal to .05) between somnolence on the MOS Sleep Scale – the average of scores for drowsiness, trouble staying awake, and napping – and the burden of amyloid in the left supramarginal gyrus (correlation [r] = 0.22), the left frontal medial orbital cortex (r = 0.21), and the left frontal inferior orbital cortex (r = 0.21).

Poorer quality of sleep was significantly correlated with amyloid burden in the cortex overall (r = 0.25) as well as in the left and right precuneus (r = 0.23 and 0.25), the right supramarginal gyrus (r = 0.23), the left and right frontal medial orbital cortex (r = 0.29 and 0.29), and the left and right frontal inferior orbital cortex (r = 0.26 and 0.25). Scores on the Sleep Problem Index were also linked to greater burden in some of these cortical areas.

Although ESS scores were significantly correlated with MOS scores, they were not directly correlated with amyloid burden in any of the regions studied. "This could be because the two questionnaires probe slightly different aspects of sleepiness," Ms. Sprecher said in an interview. "The ESS asks how likely you are to fall asleep in several common situations such as while watching TV or driving a car. The MOS asks whether you take naps, feel sleepy during the day, or feel that you get enough sleep at night. Therefore, the MOS may be better at probing how adequate your sleep is, even if you are managing to stay awake during the day."

Ms. Sprecher had no disclosures.

MINNEAPOLIS – People who report feeling more sleepy and less rested have elevated levels of amyloid in regions of the brain commonly involved in Alzheimer’s disease, according to a cohort study presented at the annual meeting of the Associated Professional Sleep Societies.

Researchers studied 98 asymptomatic, cognitively healthy late- to middle-age adults from the WRAP (Wisconsin Registry for Alzheimer’s Prevention) program, the majority of whom were at elevated risk for the disease because of family history.

Self-reported somnolence, poorer sleep quality, and sleep problems were significantly correlated with higher levels of amyloid deposition in the cortex overall and in four subregions typically affected in Alzheimer’s disease.

"It does appear that there is an association between amyloid burden and sleepiness, and that relationship is present in adults who are cognitively healthy but who are at risk of developing Alzheimer’s disease in the future. They are fairly young in terms of amyloid pathology," said first author Kate Sprecher, a PhD candidate in the neuroscience training program at the University of Wisconsin–Madison. She acknowledged that the findings may differ in a cohort not enriched for people at elevated risk.

"We can’t say from these data whether sleep is driving amyloid deposition or whether amyloid deposition is disrupting sleep," she said. "Nonetheless, it’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology. We may be able to intervene early in the disease, when people are actually able to respond to treatment, because typically, current drugs are targeting later disease, when a great deal of neurodegeneration has already taken place. So sleep may be something that we can target really early."

The researchers plan to investigate the observed association using objective measures of sleep and obstructive sleep apnea (OSA), according to Ms. Sprecher. "And we’ll do some longitudinal follow-up as well in our cohort to see how sleep changes might relate to actual progression of the disease."

Study participants completed the Medical Outcomes Study (MOS) Sleep Scale and the Epworth Sleepiness Scale (ESS). Amyloid deposition in the brain was measured by positron-emission tomography performed with Pittsburgh Compound B.

The participants were 63 years old, on average, and two-thirds were female. Overall, 76% had a family history of Alzheimer’s, and 34% were positive for the APOE4 allele, which is associated with risk of this disease.

‘It’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology.’

Analyses adjusted for these and other confounders showed a correlation (P less than or equal to .05) between somnolence on the MOS Sleep Scale – the average of scores for drowsiness, trouble staying awake, and napping – and the burden of amyloid in the left supramarginal gyrus (correlation [r] = 0.22), the left frontal medial orbital cortex (r = 0.21), and the left frontal inferior orbital cortex (r = 0.21).

Poorer quality of sleep was significantly correlated with amyloid burden in the cortex overall (r = 0.25) as well as in the left and right precuneus (r = 0.23 and 0.25), the right supramarginal gyrus (r = 0.23), the left and right frontal medial orbital cortex (r = 0.29 and 0.29), and the left and right frontal inferior orbital cortex (r = 0.26 and 0.25). Scores on the Sleep Problem Index were also linked to greater burden in some of these cortical areas.

Although ESS scores were significantly correlated with MOS scores, they were not directly correlated with amyloid burden in any of the regions studied. "This could be because the two questionnaires probe slightly different aspects of sleepiness," Ms. Sprecher said in an interview. "The ESS asks how likely you are to fall asleep in several common situations such as while watching TV or driving a car. The MOS asks whether you take naps, feel sleepy during the day, or feel that you get enough sleep at night. Therefore, the MOS may be better at probing how adequate your sleep is, even if you are managing to stay awake during the day."

Ms. Sprecher had no disclosures.

MINNEAPOLIS – People who report feeling more sleepy and less rested have elevated levels of amyloid in regions of the brain commonly involved in Alzheimer’s disease, according to a cohort study presented at the annual meeting of the Associated Professional Sleep Societies.

Researchers studied 98 asymptomatic, cognitively healthy late- to middle-age adults from the WRAP (Wisconsin Registry for Alzheimer’s Prevention) program, the majority of whom were at elevated risk for the disease because of family history.

Self-reported somnolence, poorer sleep quality, and sleep problems were significantly correlated with higher levels of amyloid deposition in the cortex overall and in four subregions typically affected in Alzheimer’s disease.

"It does appear that there is an association between amyloid burden and sleepiness, and that relationship is present in adults who are cognitively healthy but who are at risk of developing Alzheimer’s disease in the future. They are fairly young in terms of amyloid pathology," said first author Kate Sprecher, a PhD candidate in the neuroscience training program at the University of Wisconsin–Madison. She acknowledged that the findings may differ in a cohort not enriched for people at elevated risk.

"We can’t say from these data whether sleep is driving amyloid deposition or whether amyloid deposition is disrupting sleep," she said. "Nonetheless, it’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology. We may be able to intervene early in the disease, when people are actually able to respond to treatment, because typically, current drugs are targeting later disease, when a great deal of neurodegeneration has already taken place. So sleep may be something that we can target really early."

The researchers plan to investigate the observed association using objective measures of sleep and obstructive sleep apnea (OSA), according to Ms. Sprecher. "And we’ll do some longitudinal follow-up as well in our cohort to see how sleep changes might relate to actual progression of the disease."

Study participants completed the Medical Outcomes Study (MOS) Sleep Scale and the Epworth Sleepiness Scale (ESS). Amyloid deposition in the brain was measured by positron-emission tomography performed with Pittsburgh Compound B.

The participants were 63 years old, on average, and two-thirds were female. Overall, 76% had a family history of Alzheimer’s, and 34% were positive for the APOE4 allele, which is associated with risk of this disease.

‘It’s kind of tantalizing that sleep may be a tool that we can use to prevent or delay Alzheimer’s pathology.’

Analyses adjusted for these and other confounders showed a correlation (P less than or equal to .05) between somnolence on the MOS Sleep Scale – the average of scores for drowsiness, trouble staying awake, and napping – and the burden of amyloid in the left supramarginal gyrus (correlation [r] = 0.22), the left frontal medial orbital cortex (r = 0.21), and the left frontal inferior orbital cortex (r = 0.21).

Poorer quality of sleep was significantly correlated with amyloid burden in the cortex overall (r = 0.25) as well as in the left and right precuneus (r = 0.23 and 0.25), the right supramarginal gyrus (r = 0.23), the left and right frontal medial orbital cortex (r = 0.29 and 0.29), and the left and right frontal inferior orbital cortex (r = 0.26 and 0.25). Scores on the Sleep Problem Index were also linked to greater burden in some of these cortical areas.

Although ESS scores were significantly correlated with MOS scores, they were not directly correlated with amyloid burden in any of the regions studied. "This could be because the two questionnaires probe slightly different aspects of sleepiness," Ms. Sprecher said in an interview. "The ESS asks how likely you are to fall asleep in several common situations such as while watching TV or driving a car. The MOS asks whether you take naps, feel sleepy during the day, or feel that you get enough sleep at night. Therefore, the MOS may be better at probing how adequate your sleep is, even if you are managing to stay awake during the day."

Ms. Sprecher had no disclosures.

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

MINNEAPOLIS – Tailoring an intervention to the particular needs of a child and his or her family can markedly improve the child’s ability to go to sleep and stay asleep, a pilot study shows.

The trial was successful enough that the National Institute of Child Health and Development has given the lead researcher, Michelle M. Garrison, Ph.D., of the Seattle Children’s Research Institute, funding to enroll 500 children in a randomized, controlled trial to validate the intervention.

Dr. Garrison undertook the pilot in part to see what would help sleep-deprived and frustrated parents, and pediatricians, who might not have a ready solution for a preschooler who persistently won’t go to bed or won’t stay in bed.

©Mykola Velychko/Fotolia.com

To recruit children for the study, Dr. Garrison sent the CSHQ (Children’s Sleep Habits Questionnaire) to parents of all children aged 2.5-5 years who had been seen at local pediatric clinics. If parents were interested, they returned the survey. If the children met the eligibility criteria for having a behavioral sleep problem, they were included. Not every parent agreed that their child had an issue, which created an initial hurdle for making the intervention work, said Dr. Garrison.

The program started with a home visit, in which parents received education and a kit that included a binder with educational handouts, the book

Take Charge of Your Child's Sleep (New York: Marlowe and Co., 2005), a bedtime routine chart with cards that can be individualized to the child, laminated passes that allow the child to step outside the routine occasionally, and a clock that glows green when it is okay to get out of bed in the morning.

Parents received three follow-up phone calls for education, to set goals, and to engage in preemptive problem solving. Parents were coached on setting bedtime routines, creating a consistent bedtime, eliminating screen time in the hour or two before bed, setting limits, and working on night waking.

The pilot enrolled 36 children with a mean age of about 4 years. Forty-four percent were female and 72% were white, 19% were Asian, 8% were black, and 6% were Hispanic. The race and ethnicity categories were not mutually exclusive, said Dr. Garrison. A total of 22% of children had been adopted after 1 year of age. The mean age of the parents was 38 years. Only 11% of children lived in a one-adult home, and 11% lived in a multigenerational home.

Sleep habits and issues were assessed at baseline and at 3 months through 7-day diaries, actigraphy, and several sleep scales. The researchers were able to perform actigraphy on only 15 children, but there was good concordance between those measures and the diaries, said Dr. Garrison.

Overall, on average, children slept an additional 36 minutes a night. According to the diaries, 14% slept 10-30 minutes more, a third slept 30-60 minutes more, and 25% slept an additional hour. The actigraphy showed that 14% of children gained 10-30 minutes sleep, 36% gained 30-60 minutes, and 7% gained more than an hour. The average onset latency decreased by 10 minutes.

Dr. Garrison said the intervention could be tailored to children and parents with varying needs. For instance, adopted and nonadopted children did equally well with the program. She and her colleagues also worked with co-sleepers. She split them into "reactive" co-sleepers – that is, parents who felt like they had no choice – and "lifestyle" co-sleepers, who saw it as a way to bond. Reactive co-sleepers were coached on getting children to sleep in their own beds. Lifestyle parents were taught how to get children to get to sleep first, before the adults joined them in bed. There was a significant increase in sleep duration in those children of lifestyle co-sleepers, said Dr. Garrison.

Overall, there were no differences observed by age, sex, or comorbid conditions such as asthma.

The things that seemed to help the most included the number of contacts with the families, the tailored bedtime routine, and anticipatory problem solving around bedtime consistency. Parents who were the most skeptical about the benefits of sleep benefited the most from the program, said Dr. Garrison.

She will now take her methods into a larger trial that is being funded by the NICHD and has begun enrolling children. It will include 500 children and families will get monthly phone follow-ups for 9 months. Children will be analyzed for 3 years, in part to see if improving sleep has any impact on body mass index, learning, and cognitive function, she said.

The study was funded by the Sleep Research Society Foundation’s J. Christian Gillin, M.D., Research Grant; the Institution of Translational Health Sciences; and Seattle Children’s Research Institute. Dr. Garrison reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Tailoring an intervention to the particular needs of a child and his or her family can markedly improve the child’s ability to go to sleep and stay asleep, a pilot study shows.

The trial was successful enough that the National Institute of Child Health and Development has given the lead researcher, Michelle M. Garrison, Ph.D., of the Seattle Children’s Research Institute, funding to enroll 500 children in a randomized, controlled trial to validate the intervention.

Dr. Garrison undertook the pilot in part to see what would help sleep-deprived and frustrated parents, and pediatricians, who might not have a ready solution for a preschooler who persistently won’t go to bed or won’t stay in bed.

©Mykola Velychko/Fotolia.com

To recruit children for the study, Dr. Garrison sent the CSHQ (Children’s Sleep Habits Questionnaire) to parents of all children aged 2.5-5 years who had been seen at local pediatric clinics. If parents were interested, they returned the survey. If the children met the eligibility criteria for having a behavioral sleep problem, they were included. Not every parent agreed that their child had an issue, which created an initial hurdle for making the intervention work, said Dr. Garrison.

The program started with a home visit, in which parents received education and a kit that included a binder with educational handouts, the book

Take Charge of Your Child's Sleep (New York: Marlowe and Co., 2005), a bedtime routine chart with cards that can be individualized to the child, laminated passes that allow the child to step outside the routine occasionally, and a clock that glows green when it is okay to get out of bed in the morning.

Parents received three follow-up phone calls for education, to set goals, and to engage in preemptive problem solving. Parents were coached on setting bedtime routines, creating a consistent bedtime, eliminating screen time in the hour or two before bed, setting limits, and working on night waking.

The pilot enrolled 36 children with a mean age of about 4 years. Forty-four percent were female and 72% were white, 19% were Asian, 8% were black, and 6% were Hispanic. The race and ethnicity categories were not mutually exclusive, said Dr. Garrison. A total of 22% of children had been adopted after 1 year of age. The mean age of the parents was 38 years. Only 11% of children lived in a one-adult home, and 11% lived in a multigenerational home.

Sleep habits and issues were assessed at baseline and at 3 months through 7-day diaries, actigraphy, and several sleep scales. The researchers were able to perform actigraphy on only 15 children, but there was good concordance between those measures and the diaries, said Dr. Garrison.

Overall, on average, children slept an additional 36 minutes a night. According to the diaries, 14% slept 10-30 minutes more, a third slept 30-60 minutes more, and 25% slept an additional hour. The actigraphy showed that 14% of children gained 10-30 minutes sleep, 36% gained 30-60 minutes, and 7% gained more than an hour. The average onset latency decreased by 10 minutes.

Dr. Garrison said the intervention could be tailored to children and parents with varying needs. For instance, adopted and nonadopted children did equally well with the program. She and her colleagues also worked with co-sleepers. She split them into "reactive" co-sleepers – that is, parents who felt like they had no choice – and "lifestyle" co-sleepers, who saw it as a way to bond. Reactive co-sleepers were coached on getting children to sleep in their own beds. Lifestyle parents were taught how to get children to get to sleep first, before the adults joined them in bed. There was a significant increase in sleep duration in those children of lifestyle co-sleepers, said Dr. Garrison.

Overall, there were no differences observed by age, sex, or comorbid conditions such as asthma.

The things that seemed to help the most included the number of contacts with the families, the tailored bedtime routine, and anticipatory problem solving around bedtime consistency. Parents who were the most skeptical about the benefits of sleep benefited the most from the program, said Dr. Garrison.

She will now take her methods into a larger trial that is being funded by the NICHD and has begun enrolling children. It will include 500 children and families will get monthly phone follow-ups for 9 months. Children will be analyzed for 3 years, in part to see if improving sleep has any impact on body mass index, learning, and cognitive function, she said.

The study was funded by the Sleep Research Society Foundation’s J. Christian Gillin, M.D., Research Grant; the Institution of Translational Health Sciences; and Seattle Children’s Research Institute. Dr. Garrison reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Tailoring an intervention to the particular needs of a child and his or her family can markedly improve the child’s ability to go to sleep and stay asleep, a pilot study shows.

The trial was successful enough that the National Institute of Child Health and Development has given the lead researcher, Michelle M. Garrison, Ph.D., of the Seattle Children’s Research Institute, funding to enroll 500 children in a randomized, controlled trial to validate the intervention.

Dr. Garrison undertook the pilot in part to see what would help sleep-deprived and frustrated parents, and pediatricians, who might not have a ready solution for a preschooler who persistently won’t go to bed or won’t stay in bed.

©Mykola Velychko/Fotolia.com

To recruit children for the study, Dr. Garrison sent the CSHQ (Children’s Sleep Habits Questionnaire) to parents of all children aged 2.5-5 years who had been seen at local pediatric clinics. If parents were interested, they returned the survey. If the children met the eligibility criteria for having a behavioral sleep problem, they were included. Not every parent agreed that their child had an issue, which created an initial hurdle for making the intervention work, said Dr. Garrison.

The program started with a home visit, in which parents received education and a kit that included a binder with educational handouts, the book

Take Charge of Your Child's Sleep (New York: Marlowe and Co., 2005), a bedtime routine chart with cards that can be individualized to the child, laminated passes that allow the child to step outside the routine occasionally, and a clock that glows green when it is okay to get out of bed in the morning.

Parents received three follow-up phone calls for education, to set goals, and to engage in preemptive problem solving. Parents were coached on setting bedtime routines, creating a consistent bedtime, eliminating screen time in the hour or two before bed, setting limits, and working on night waking.

The pilot enrolled 36 children with a mean age of about 4 years. Forty-four percent were female and 72% were white, 19% were Asian, 8% were black, and 6% were Hispanic. The race and ethnicity categories were not mutually exclusive, said Dr. Garrison. A total of 22% of children had been adopted after 1 year of age. The mean age of the parents was 38 years. Only 11% of children lived in a one-adult home, and 11% lived in a multigenerational home.

Sleep habits and issues were assessed at baseline and at 3 months through 7-day diaries, actigraphy, and several sleep scales. The researchers were able to perform actigraphy on only 15 children, but there was good concordance between those measures and the diaries, said Dr. Garrison.

Overall, on average, children slept an additional 36 minutes a night. According to the diaries, 14% slept 10-30 minutes more, a third slept 30-60 minutes more, and 25% slept an additional hour. The actigraphy showed that 14% of children gained 10-30 minutes sleep, 36% gained 30-60 minutes, and 7% gained more than an hour. The average onset latency decreased by 10 minutes.

Dr. Garrison said the intervention could be tailored to children and parents with varying needs. For instance, adopted and nonadopted children did equally well with the program. She and her colleagues also worked with co-sleepers. She split them into "reactive" co-sleepers – that is, parents who felt like they had no choice – and "lifestyle" co-sleepers, who saw it as a way to bond. Reactive co-sleepers were coached on getting children to sleep in their own beds. Lifestyle parents were taught how to get children to get to sleep first, before the adults joined them in bed. There was a significant increase in sleep duration in those children of lifestyle co-sleepers, said Dr. Garrison.

Overall, there were no differences observed by age, sex, or comorbid conditions such as asthma.

The things that seemed to help the most included the number of contacts with the families, the tailored bedtime routine, and anticipatory problem solving around bedtime consistency. Parents who were the most skeptical about the benefits of sleep benefited the most from the program, said Dr. Garrison.

She will now take her methods into a larger trial that is being funded by the NICHD and has begun enrolling children. It will include 500 children and families will get monthly phone follow-ups for 9 months. Children will be analyzed for 3 years, in part to see if improving sleep has any impact on body mass index, learning, and cognitive function, she said.

The study was funded by the Sleep Research Society Foundation’s J. Christian Gillin, M.D., Research Grant; the Institution of Translational Health Sciences; and Seattle Children’s Research Institute. Dr. Garrison reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – People with chronic insomnia don’t have to take the sedative-hypnotic agent zolpidem every night for it to remain efficacious, a randomized trial found.

Investigators enrolled in the trial 56 patients who had had a response to a priming phase of 4 weeks of nightly zolpidem (Ambien) 10 mg and assigned them to three maintenance strategies: nightly dosing, intermittent dosing (whereby the drug was taken 3-5 nights per week of the patient’s choice), and partial reinforcement dosing (whereby a capsule was taken every night, but half were placebos).

Use of partial reinforcement after a priming phase, during which the drug is repeatedly paired with sleep, taps into the phenomenon of conditioning, explained lead author Michael Perlis, Ph.D., director of the behavioral sleep medicine program, University of Pennsylvania, Philadelphia. "In this kind of paradigm, on the nights when there is no medication, they are getting a conditioned response; on the nights when there is medication, you are reinforcing the capsule as the conditioned stimulus for that physiologic response."

Analyses based on the 41 compliant patients showed that after 1 month, the three maintenance regimens were statistically indistinguishable in terms of measures such as time to relapse, sleep latency, and waking after sleep onset.

Total sleep time was longer with nightly dosing (463 minutes) and partial reinforcement dosing (459 minutes) than with intermittent dosing (429 minutes) (P = .002 across groups). Also, sleep efficiency was better with nightly dosing (90%) and partial reinforcement (91%) than with intermittent dosing (88%) (P = .002 across groups).

The frequency of medical symptoms, possibly adverse effects, was statistically indistinguishable across groups, although they tended to be least frequent with the partial reinforcement strategy and most with the intermittent dosing strategy.

"The present findings suggest that in compliant subjects, any of the three 10-mg strategies evaluated may be used to maintain treatment response over time. If a trend is evident, it’s that subjects in the intermittent dosing group condition do not do as well as nightly dosing and as in partial reinforcement, and that’s especially and significantly true for total sleep time and sleep efficiency," Dr. Perlis commented. "The take-home message is interspersing placebos between active doses appears to be a reasonable approach for maintaining clinical gains following priming, in other words, obtention of treatment response with a full-dose strategy."

In upcoming research, the investigators plan to see how low they can go with the partial reinforcement strategy as far as nights of zolpidem – even down to zero capsules of active drug – and still maintain the benefit of nightly dosing. If this proves successful, "then it may be possible to one, maintain treatment response for long periods of time with fractional amounts of medication. Second, we have a potential to reduce tolerance and side effect risks. Third, we would massively be able to reduce the cost of maintenance therapy considering placebos are basically free," he said.

"Finally and most important..., if this approach works as applied to insomnia, it may be a powerful tool for the management of medications with narrow therapeutic indices. Put differently, the partial reinforcement approach may be a strategy for managing medications that have nearly as much risk as they do benefit. That’s where the money is," said Dr. Perlis, who disclosed no relevant conflicts of interest.

In an interview, Brandy Roane, Ph.D., one of the session cochairs and a psychologist at the University of North Texas Health Science Center in Fort Worth, noted that the study is interesting in that it sheds light on why patients on intermittent dosing might become increasingly dependent on the medication.

"You have the patient who becomes more likely to increase their use even if it’s not effective, because they end up taking that dose on the night when they do sleep better because it would be a typical what we call crash night, where their body is already so physically fatigued and their homeostatic sleep pressure is so increased that they take it and it pairs it with that [sleep], and it’s a learned response: ‘I took medication and I slept so much better.’ Whereas if you hadn’t paired it with that, they would have slept better anyway," she explained.

"So I think it does look more at that real world type of setting and starts to speak to some of that possible use actually increasing the likelihood that they are going to take the medication, whether it’s effective or not, and then not use behavioral interventions that might be more effective."

Colin A. Espie, Ph.D., the other session cochair and a professor of sleep medicine in the Nuffield Department of Clinical Neuroscience at the University of Oxford (England), commented: "This is theoretically quite an interesting study. I think there might be some ethical problems in devising a practice whereby you systematically give people placebo without their knowledge, so I’m not sure it’s a very usable clinical strategy. But I think it’s an interesting paradigm to understand more about the placebo effect."

Dr. Perlis disclosed no relevant conflicts of interest.

MINNEAPOLIS – People with chronic insomnia don’t have to take the sedative-hypnotic agent zolpidem every night for it to remain efficacious, a randomized trial found.

Investigators enrolled in the trial 56 patients who had had a response to a priming phase of 4 weeks of nightly zolpidem (Ambien) 10 mg and assigned them to three maintenance strategies: nightly dosing, intermittent dosing (whereby the drug was taken 3-5 nights per week of the patient’s choice), and partial reinforcement dosing (whereby a capsule was taken every night, but half were placebos).

Use of partial reinforcement after a priming phase, during which the drug is repeatedly paired with sleep, taps into the phenomenon of conditioning, explained lead author Michael Perlis, Ph.D., director of the behavioral sleep medicine program, University of Pennsylvania, Philadelphia. "In this kind of paradigm, on the nights when there is no medication, they are getting a conditioned response; on the nights when there is medication, you are reinforcing the capsule as the conditioned stimulus for that physiologic response."

Analyses based on the 41 compliant patients showed that after 1 month, the three maintenance regimens were statistically indistinguishable in terms of measures such as time to relapse, sleep latency, and waking after sleep onset.

Total sleep time was longer with nightly dosing (463 minutes) and partial reinforcement dosing (459 minutes) than with intermittent dosing (429 minutes) (P = .002 across groups). Also, sleep efficiency was better with nightly dosing (90%) and partial reinforcement (91%) than with intermittent dosing (88%) (P = .002 across groups).

The frequency of medical symptoms, possibly adverse effects, was statistically indistinguishable across groups, although they tended to be least frequent with the partial reinforcement strategy and most with the intermittent dosing strategy.

"The present findings suggest that in compliant subjects, any of the three 10-mg strategies evaluated may be used to maintain treatment response over time. If a trend is evident, it’s that subjects in the intermittent dosing group condition do not do as well as nightly dosing and as in partial reinforcement, and that’s especially and significantly true for total sleep time and sleep efficiency," Dr. Perlis commented. "The take-home message is interspersing placebos between active doses appears to be a reasonable approach for maintaining clinical gains following priming, in other words, obtention of treatment response with a full-dose strategy."

In upcoming research, the investigators plan to see how low they can go with the partial reinforcement strategy as far as nights of zolpidem – even down to zero capsules of active drug – and still maintain the benefit of nightly dosing. If this proves successful, "then it may be possible to one, maintain treatment response for long periods of time with fractional amounts of medication. Second, we have a potential to reduce tolerance and side effect risks. Third, we would massively be able to reduce the cost of maintenance therapy considering placebos are basically free," he said.

"Finally and most important..., if this approach works as applied to insomnia, it may be a powerful tool for the management of medications with narrow therapeutic indices. Put differently, the partial reinforcement approach may be a strategy for managing medications that have nearly as much risk as they do benefit. That’s where the money is," said Dr. Perlis, who disclosed no relevant conflicts of interest.

In an interview, Brandy Roane, Ph.D., one of the session cochairs and a psychologist at the University of North Texas Health Science Center in Fort Worth, noted that the study is interesting in that it sheds light on why patients on intermittent dosing might become increasingly dependent on the medication.

"You have the patient who becomes more likely to increase their use even if it’s not effective, because they end up taking that dose on the night when they do sleep better because it would be a typical what we call crash night, where their body is already so physically fatigued and their homeostatic sleep pressure is so increased that they take it and it pairs it with that [sleep], and it’s a learned response: ‘I took medication and I slept so much better.’ Whereas if you hadn’t paired it with that, they would have slept better anyway," she explained.

"So I think it does look more at that real world type of setting and starts to speak to some of that possible use actually increasing the likelihood that they are going to take the medication, whether it’s effective or not, and then not use behavioral interventions that might be more effective."

Colin A. Espie, Ph.D., the other session cochair and a professor of sleep medicine in the Nuffield Department of Clinical Neuroscience at the University of Oxford (England), commented: "This is theoretically quite an interesting study. I think there might be some ethical problems in devising a practice whereby you systematically give people placebo without their knowledge, so I’m not sure it’s a very usable clinical strategy. But I think it’s an interesting paradigm to understand more about the placebo effect."

Dr. Perlis disclosed no relevant conflicts of interest.

MINNEAPOLIS – People with chronic insomnia don’t have to take the sedative-hypnotic agent zolpidem every night for it to remain efficacious, a randomized trial found.

Investigators enrolled in the trial 56 patients who had had a response to a priming phase of 4 weeks of nightly zolpidem (Ambien) 10 mg and assigned them to three maintenance strategies: nightly dosing, intermittent dosing (whereby the drug was taken 3-5 nights per week of the patient’s choice), and partial reinforcement dosing (whereby a capsule was taken every night, but half were placebos).

Use of partial reinforcement after a priming phase, during which the drug is repeatedly paired with sleep, taps into the phenomenon of conditioning, explained lead author Michael Perlis, Ph.D., director of the behavioral sleep medicine program, University of Pennsylvania, Philadelphia. "In this kind of paradigm, on the nights when there is no medication, they are getting a conditioned response; on the nights when there is medication, you are reinforcing the capsule as the conditioned stimulus for that physiologic response."

Analyses based on the 41 compliant patients showed that after 1 month, the three maintenance regimens were statistically indistinguishable in terms of measures such as time to relapse, sleep latency, and waking after sleep onset.

Total sleep time was longer with nightly dosing (463 minutes) and partial reinforcement dosing (459 minutes) than with intermittent dosing (429 minutes) (P = .002 across groups). Also, sleep efficiency was better with nightly dosing (90%) and partial reinforcement (91%) than with intermittent dosing (88%) (P = .002 across groups).

The frequency of medical symptoms, possibly adverse effects, was statistically indistinguishable across groups, although they tended to be least frequent with the partial reinforcement strategy and most with the intermittent dosing strategy.

"The present findings suggest that in compliant subjects, any of the three 10-mg strategies evaluated may be used to maintain treatment response over time. If a trend is evident, it’s that subjects in the intermittent dosing group condition do not do as well as nightly dosing and as in partial reinforcement, and that’s especially and significantly true for total sleep time and sleep efficiency," Dr. Perlis commented. "The take-home message is interspersing placebos between active doses appears to be a reasonable approach for maintaining clinical gains following priming, in other words, obtention of treatment response with a full-dose strategy."

In upcoming research, the investigators plan to see how low they can go with the partial reinforcement strategy as far as nights of zolpidem – even down to zero capsules of active drug – and still maintain the benefit of nightly dosing. If this proves successful, "then it may be possible to one, maintain treatment response for long periods of time with fractional amounts of medication. Second, we have a potential to reduce tolerance and side effect risks. Third, we would massively be able to reduce the cost of maintenance therapy considering placebos are basically free," he said.

"Finally and most important..., if this approach works as applied to insomnia, it may be a powerful tool for the management of medications with narrow therapeutic indices. Put differently, the partial reinforcement approach may be a strategy for managing medications that have nearly as much risk as they do benefit. That’s where the money is," said Dr. Perlis, who disclosed no relevant conflicts of interest.

In an interview, Brandy Roane, Ph.D., one of the session cochairs and a psychologist at the University of North Texas Health Science Center in Fort Worth, noted that the study is interesting in that it sheds light on why patients on intermittent dosing might become increasingly dependent on the medication.

"You have the patient who becomes more likely to increase their use even if it’s not effective, because they end up taking that dose on the night when they do sleep better because it would be a typical what we call crash night, where their body is already so physically fatigued and their homeostatic sleep pressure is so increased that they take it and it pairs it with that [sleep], and it’s a learned response: ‘I took medication and I slept so much better.’ Whereas if you hadn’t paired it with that, they would have slept better anyway," she explained.

"So I think it does look more at that real world type of setting and starts to speak to some of that possible use actually increasing the likelihood that they are going to take the medication, whether it’s effective or not, and then not use behavioral interventions that might be more effective."

Colin A. Espie, Ph.D., the other session cochair and a professor of sleep medicine in the Nuffield Department of Clinical Neuroscience at the University of Oxford (England), commented: "This is theoretically quite an interesting study. I think there might be some ethical problems in devising a practice whereby you systematically give people placebo without their knowledge, so I’m not sure it’s a very usable clinical strategy. But I think it’s an interesting paradigm to understand more about the placebo effect."

Dr. Perlis disclosed no relevant conflicts of interest.

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

Dr. Walia disclosed no relevant conflicts of interest.

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

Dr. Walia disclosed no relevant conflicts of interest.

MINNEAPOLIS – Continuous positive airway pressure works similarly well at lowering blood pressure in real-world clinical practice as in clinical trials, according to a cohort study of 880 patients with sleep-disordered breathing and hypertension.

The patients, 598 with hypertension that responded to therapy and 282 with idiopathic resistant hypertension, were all treated at a tertiary-care sleep disorders center between 2010 and 2013.

On average, a year after starting continuous positive airway pressure (CPAP), they had a reduction of 3.0 mm Hg in systolic blood pressure, 2.2 mm Hg in diastolic blood pressure, and 2.5 mm Hg in mean arterial pressure in analyses adjusted for potential confounders, researchers reported at the annual meeting of the Associated Professional Sleep Societies.

The benefit was similar regardless of whether hypertension was resistant or not, although patients with the resistant form had higher blood pressure – especially systolic blood pressure – at this time point.

"Our real-world experience is consistent with the blood pressure reduction seen with the use of CPAP in the rigorous clinical trials," commented lead researcher Dr. Harneet K. Walia, assistant professor of family medicine with the sleep disorders center at the Cleveland Clinic. "The clinic-based effectiveness data of CPAP on blood pressure in this pragmatic clinical study were similar in the resistant hypertension and non–resistant hypertension groups."

Study findings were essentially the same when neck size was substituted for body mass index as a potential confounder (although the multivariate model had a better fit) and when analyses were restricted to the 82% of patients who were adherent to CPAP, according to self-report.

In an interview, session cochair Dr. Cathy Anne Goldstein, assistant professor of neurology at the University of Michigan, Ann Arbor, said, "This is a promising study that does show the association of treating obstructive sleep apnea with CPAP and reducing blood pressure. This was nice because it showed it wasn’t just the patients who were refractory – it was all comers with hypertension who had a benefit."

"This isn’t new, but it’s confirmatory of what some other studies have shown," she added. "The more information we can get, the better, because there have been some conflicting results."

Dr. Walia disclosed no relevant conflicts of interest.

MINNEAPOLIS – Sleep apnea is associated with neurocognitive dysfunction in adult Hispanics living in the United States, research presented at the annual meeting of the Associated Professional Sleep Societies shows.

In unadjusted models, sleep apnea, as assessed by the apnea-hypopnea index (AHI), was inversely associated with neurocognitive dysfunction in both men and women.

"However, after adjusting for covariates, these interactions were attenuated," reported Dr. Alberto R. Ramos. "In a fully adjusted model accounting for age, BMI [body mass index], tobacco use, depression and anxiety scores, stroke, diabetes, hypertension, and field center tested, this association was seen only in women, but not in men."

Dr. Ramos of the department of clinical neurology at the University of Miami and his colleagues conducted a cross-sectional analysis of 9,714 Hispanic men and women between the ages of 45 and 74 who were participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The researchers sought to determine the extent to which sleep apnea contributes to neurocognitive dysfunction in a representative sample of Hispanic men and women residing in the United States.

Subjects were administered multiple neurocognitive tests, assessing learning, recall, word fluency, and digit symbol substitution. Obstructive sleep apnea was determined objectively using the apnea risk evaluation system and defined by the apnea-hypopnea index (AHI), and subjectively using standardized sleep symptom scales.

The mean AHI was 8.9, 11.5 for men and 6.8 for women (P less than 0.001 for difference between genders). With increasing age, the AHI significantly increased, too, from 7.4 in subjects aged 45 to 54, to 11.5 in those aged 65 to 74 (P less than 0.001).

Dementia prevalence is on the rise, particularly among Hispanics/Latinos who are up to 3.3 times more likely to meet diagnostic criteria for advanced dementia, compared with non-Hispanic whites, Dr. Ramos reported.

Dr. Ramos reported having no disclosures. The study received support from multiple National Heart, Lung, and Blood Institute grants.

MINNEAPOLIS – Sleep apnea is associated with neurocognitive dysfunction in adult Hispanics living in the United States, research presented at the annual meeting of the Associated Professional Sleep Societies shows.

In unadjusted models, sleep apnea, as assessed by the apnea-hypopnea index (AHI), was inversely associated with neurocognitive dysfunction in both men and women.

"However, after adjusting for covariates, these interactions were attenuated," reported Dr. Alberto R. Ramos. "In a fully adjusted model accounting for age, BMI [body mass index], tobacco use, depression and anxiety scores, stroke, diabetes, hypertension, and field center tested, this association was seen only in women, but not in men."

Dr. Ramos of the department of clinical neurology at the University of Miami and his colleagues conducted a cross-sectional analysis of 9,714 Hispanic men and women between the ages of 45 and 74 who were participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The researchers sought to determine the extent to which sleep apnea contributes to neurocognitive dysfunction in a representative sample of Hispanic men and women residing in the United States.

Subjects were administered multiple neurocognitive tests, assessing learning, recall, word fluency, and digit symbol substitution. Obstructive sleep apnea was determined objectively using the apnea risk evaluation system and defined by the apnea-hypopnea index (AHI), and subjectively using standardized sleep symptom scales.

The mean AHI was 8.9, 11.5 for men and 6.8 for women (P less than 0.001 for difference between genders). With increasing age, the AHI significantly increased, too, from 7.4 in subjects aged 45 to 54, to 11.5 in those aged 65 to 74 (P less than 0.001).

Dementia prevalence is on the rise, particularly among Hispanics/Latinos who are up to 3.3 times more likely to meet diagnostic criteria for advanced dementia, compared with non-Hispanic whites, Dr. Ramos reported.

Dr. Ramos reported having no disclosures. The study received support from multiple National Heart, Lung, and Blood Institute grants.

MINNEAPOLIS – Sleep apnea is associated with neurocognitive dysfunction in adult Hispanics living in the United States, research presented at the annual meeting of the Associated Professional Sleep Societies shows.

In unadjusted models, sleep apnea, as assessed by the apnea-hypopnea index (AHI), was inversely associated with neurocognitive dysfunction in both men and women.

"However, after adjusting for covariates, these interactions were attenuated," reported Dr. Alberto R. Ramos. "In a fully adjusted model accounting for age, BMI [body mass index], tobacco use, depression and anxiety scores, stroke, diabetes, hypertension, and field center tested, this association was seen only in women, but not in men."

Dr. Ramos of the department of clinical neurology at the University of Miami and his colleagues conducted a cross-sectional analysis of 9,714 Hispanic men and women between the ages of 45 and 74 who were participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The researchers sought to determine the extent to which sleep apnea contributes to neurocognitive dysfunction in a representative sample of Hispanic men and women residing in the United States.

Subjects were administered multiple neurocognitive tests, assessing learning, recall, word fluency, and digit symbol substitution. Obstructive sleep apnea was determined objectively using the apnea risk evaluation system and defined by the apnea-hypopnea index (AHI), and subjectively using standardized sleep symptom scales.

The mean AHI was 8.9, 11.5 for men and 6.8 for women (P less than 0.001 for difference between genders). With increasing age, the AHI significantly increased, too, from 7.4 in subjects aged 45 to 54, to 11.5 in those aged 65 to 74 (P less than 0.001).

Dementia prevalence is on the rise, particularly among Hispanics/Latinos who are up to 3.3 times more likely to meet diagnostic criteria for advanced dementia, compared with non-Hispanic whites, Dr. Ramos reported.

Dr. Ramos reported having no disclosures. The study received support from multiple National Heart, Lung, and Blood Institute grants.

A free app to help patients with obstructive sleep apnea become accustomed to using continuous positive airway pressure improved adherence during the first 11 weeks of therapy in a randomized, controlled trial with 61 patients.

The mean percentage of nights in which patients used continuous positive airway pressure (CPAP) for at least 4 hours was significantly higher in the 30 patients randomized to usual care plus use of the SleepMapper app (54%), compared with the 31 patients in the control group who got usual care alone (37%), Karen Sheikh reported at the annual meeting of the Associated Professional Sleep Societies in Minneapolis.

Courtesy of Philips Respironics, Murrysville, Penn.

Patients in the app group also used the CPAP device for significantly more nights, compared with the control group – an average of 78% of nights vs. 55%, respectively, said Ms. Sheikh of the research arm of Linthicum, Md.–based Respira, a durable medical equipment company that sponsored the study. Dr. Jordanna M. Hostler of Walter Reed National Medical Center, Bethesda, Md., led the study, which was conducted at Walter Reed (Sleep 2014;37:A106-7).

All patients used the same kind of CPAP equipment and were introduced to the therapy through a 4-hour group session, lectures giving an overview of obstructive sleep apnea, CPAP, and good sleep habits, and a follow-up appointment with a respiratory therapist 30 days later, according to Ms. Sheikh.

The 17% improvement in the SleepMapper group, compared with the control group, in nights in which CPAP was used for at least 4 hours was seen after the influences of maximum PAP pressure and sleep efficiency were controlled for, she reported.

The app can be used with any CPAP equipment made by Philips, the company that developed SleepMapper, according to Mark S. Aloia, Ph.D. In addition to providing information about PAP devices, the app individualizes feedback for patients about their adherence using algorithms based on psychological theories of behavior change.

SleepMapper also performed well in a separate retrospective study of 15,242 patients released by Philips. Compared with 7,601 patients who received standard care without the app, the 7,641 patients using SleepMapper were significantly more likely to be adhering to CPAP therapy in the first 90 days of therapy (78% vs. 56%, respectively).

Among the 12% of app users and 32% of the control group who were considered "struggling users" because they used CPAP an average of fewer than 2 hours per night during the first 2 weeks, 33% of strugglers in the app group and 11% of strugglers in the control group went on to meet CPAP adherence criteria set by the Centers for Medicare & Medicaid Services, according to Philips.

"We are confident that our study demonstrates that SleepMapper can improve patient lives at a population level," Dr. Aloia of Denver, who is senior director of global clinical research for Philips Healthcare, said in an e-mail interview.

Other sleep-related apps – and there are thousands – may not be as effective.

Pulmonologist Ambra Ferraris reported in a separate presentation at the Sleep 2014 meeting that results from the Sleep Time app (by Azumio) for iPhones did not correlate with in-laboratory polysomnography results in a pilot trial in 12 healthy volunteers. The Sleep Time app is not accurate enough for clinical use, suggested Dr. Ferraris of the New Jersey Neuroscience Institute at JFK Medical Center, Seton Hall University, South Orange, N.J.

The Sleep Time app (free or $1.99 version) uses the iPhone’s accelerometer to detect the sleeper’s movements during the night and claims to adjust the wake-up time that the user has set in the phone’s alarm clock so that the alarm goes off during the lightest sleep phase and the person wakes up refreshed instead of groggy.

In the study, volunteers simultaneously used the app and underwent polysomnography in the lab. There was no correlation between the two sets of results for sleep efficiency, percentage of light or deep sleep, or sleep latency, according to Dr. Ferraris's abstract. The app’s overall accuracy was 46% (Sleep 2014;37:A367-8), though it’s unclear whether the app or the smartphones were to blame for the poor accuracy, she said in an e-mail interview.

Ms. Sheikh reported that the investigators in the SleepMapper study had no disclosures. Dr. Aloia works for Philips Healthcare, which markets SleepMapper. Dr. Ferraris reported having no disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

A free app to help patients with obstructive sleep apnea become accustomed to using continuous positive airway pressure improved adherence during the first 11 weeks of therapy in a randomized, controlled trial with 61 patients.

The mean percentage of nights in which patients used continuous positive airway pressure (CPAP) for at least 4 hours was significantly higher in the 30 patients randomized to usual care plus use of the SleepMapper app (54%), compared with the 31 patients in the control group who got usual care alone (37%), Karen Sheikh reported at the annual meeting of the Associated Professional Sleep Societies in Minneapolis.

Courtesy of Philips Respironics, Murrysville, Penn.

Patients in the app group also used the CPAP device for significantly more nights, compared with the control group – an average of 78% of nights vs. 55%, respectively, said Ms. Sheikh of the research arm of Linthicum, Md.–based Respira, a durable medical equipment company that sponsored the study. Dr. Jordanna M. Hostler of Walter Reed National Medical Center, Bethesda, Md., led the study, which was conducted at Walter Reed (Sleep 2014;37:A106-7).

All patients used the same kind of CPAP equipment and were introduced to the therapy through a 4-hour group session, lectures giving an overview of obstructive sleep apnea, CPAP, and good sleep habits, and a follow-up appointment with a respiratory therapist 30 days later, according to Ms. Sheikh.

The 17% improvement in the SleepMapper group, compared with the control group, in nights in which CPAP was used for at least 4 hours was seen after the influences of maximum PAP pressure and sleep efficiency were controlled for, she reported.

The app can be used with any CPAP equipment made by Philips, the company that developed SleepMapper, according to Mark S. Aloia, Ph.D. In addition to providing information about PAP devices, the app individualizes feedback for patients about their adherence using algorithms based on psychological theories of behavior change.

SleepMapper also performed well in a separate retrospective study of 15,242 patients released by Philips. Compared with 7,601 patients who received standard care without the app, the 7,641 patients using SleepMapper were significantly more likely to be adhering to CPAP therapy in the first 90 days of therapy (78% vs. 56%, respectively).

Among the 12% of app users and 32% of the control group who were considered "struggling users" because they used CPAP an average of fewer than 2 hours per night during the first 2 weeks, 33% of strugglers in the app group and 11% of strugglers in the control group went on to meet CPAP adherence criteria set by the Centers for Medicare & Medicaid Services, according to Philips.

"We are confident that our study demonstrates that SleepMapper can improve patient lives at a population level," Dr. Aloia of Denver, who is senior director of global clinical research for Philips Healthcare, said in an e-mail interview.

Other sleep-related apps – and there are thousands – may not be as effective.

Pulmonologist Ambra Ferraris reported in a separate presentation at the Sleep 2014 meeting that results from the Sleep Time app (by Azumio) for iPhones did not correlate with in-laboratory polysomnography results in a pilot trial in 12 healthy volunteers. The Sleep Time app is not accurate enough for clinical use, suggested Dr. Ferraris of the New Jersey Neuroscience Institute at JFK Medical Center, Seton Hall University, South Orange, N.J.

The Sleep Time app (free or $1.99 version) uses the iPhone’s accelerometer to detect the sleeper’s movements during the night and claims to adjust the wake-up time that the user has set in the phone’s alarm clock so that the alarm goes off during the lightest sleep phase and the person wakes up refreshed instead of groggy.

In the study, volunteers simultaneously used the app and underwent polysomnography in the lab. There was no correlation between the two sets of results for sleep efficiency, percentage of light or deep sleep, or sleep latency, according to Dr. Ferraris's abstract. The app’s overall accuracy was 46% (Sleep 2014;37:A367-8), though it’s unclear whether the app or the smartphones were to blame for the poor accuracy, she said in an e-mail interview.

Ms. Sheikh reported that the investigators in the SleepMapper study had no disclosures. Dr. Aloia works for Philips Healthcare, which markets SleepMapper. Dr. Ferraris reported having no disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

A free app to help patients with obstructive sleep apnea become accustomed to using continuous positive airway pressure improved adherence during the first 11 weeks of therapy in a randomized, controlled trial with 61 patients.

The mean percentage of nights in which patients used continuous positive airway pressure (CPAP) for at least 4 hours was significantly higher in the 30 patients randomized to usual care plus use of the SleepMapper app (54%), compared with the 31 patients in the control group who got usual care alone (37%), Karen Sheikh reported at the annual meeting of the Associated Professional Sleep Societies in Minneapolis.

Courtesy of Philips Respironics, Murrysville, Penn.

Patients in the app group also used the CPAP device for significantly more nights, compared with the control group – an average of 78% of nights vs. 55%, respectively, said Ms. Sheikh of the research arm of Linthicum, Md.–based Respira, a durable medical equipment company that sponsored the study. Dr. Jordanna M. Hostler of Walter Reed National Medical Center, Bethesda, Md., led the study, which was conducted at Walter Reed (Sleep 2014;37:A106-7).

All patients used the same kind of CPAP equipment and were introduced to the therapy through a 4-hour group session, lectures giving an overview of obstructive sleep apnea, CPAP, and good sleep habits, and a follow-up appointment with a respiratory therapist 30 days later, according to Ms. Sheikh.

The 17% improvement in the SleepMapper group, compared with the control group, in nights in which CPAP was used for at least 4 hours was seen after the influences of maximum PAP pressure and sleep efficiency were controlled for, she reported.

The app can be used with any CPAP equipment made by Philips, the company that developed SleepMapper, according to Mark S. Aloia, Ph.D. In addition to providing information about PAP devices, the app individualizes feedback for patients about their adherence using algorithms based on psychological theories of behavior change.

SleepMapper also performed well in a separate retrospective study of 15,242 patients released by Philips. Compared with 7,601 patients who received standard care without the app, the 7,641 patients using SleepMapper were significantly more likely to be adhering to CPAP therapy in the first 90 days of therapy (78% vs. 56%, respectively).

Among the 12% of app users and 32% of the control group who were considered "struggling users" because they used CPAP an average of fewer than 2 hours per night during the first 2 weeks, 33% of strugglers in the app group and 11% of strugglers in the control group went on to meet CPAP adherence criteria set by the Centers for Medicare & Medicaid Services, according to Philips.

"We are confident that our study demonstrates that SleepMapper can improve patient lives at a population level," Dr. Aloia of Denver, who is senior director of global clinical research for Philips Healthcare, said in an e-mail interview.

Other sleep-related apps – and there are thousands – may not be as effective.

Pulmonologist Ambra Ferraris reported in a separate presentation at the Sleep 2014 meeting that results from the Sleep Time app (by Azumio) for iPhones did not correlate with in-laboratory polysomnography results in a pilot trial in 12 healthy volunteers. The Sleep Time app is not accurate enough for clinical use, suggested Dr. Ferraris of the New Jersey Neuroscience Institute at JFK Medical Center, Seton Hall University, South Orange, N.J.

The Sleep Time app (free or $1.99 version) uses the iPhone’s accelerometer to detect the sleeper’s movements during the night and claims to adjust the wake-up time that the user has set in the phone’s alarm clock so that the alarm goes off during the lightest sleep phase and the person wakes up refreshed instead of groggy.

In the study, volunteers simultaneously used the app and underwent polysomnography in the lab. There was no correlation between the two sets of results for sleep efficiency, percentage of light or deep sleep, or sleep latency, according to Dr. Ferraris's abstract. The app’s overall accuracy was 46% (Sleep 2014;37:A367-8), though it’s unclear whether the app or the smartphones were to blame for the poor accuracy, she said in an e-mail interview.

Ms. Sheikh reported that the investigators in the SleepMapper study had no disclosures. Dr. Aloia works for Philips Healthcare, which markets SleepMapper. Dr. Ferraris reported having no disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert