Sleep 2014

MINNEAPOLIS – Increased exposure to ozone appeared to increase cardiorespiratory events in healthy sleeping infants, based on preliminary data.

Dr. Chana I.C. Chin, a pediatric pulmonology fellow at the Children’s Hospital Los Angeles, and her associates found that for each 10-part-per-billion (ppb) elevation in ozone, there was a 22% higher risk of an apneic or bradycardic event (P = .0012), after adjustment for seasonality, weekday, and individual random effects.

"Air pollution likely increases infant mortality and likely impacts infants to a greater degree than adults," said Dr. Chin. "Infants have small body mass ratio, narrower airways, higher particulate deposition rates, greater volume of air breathed per body weight, and underdeveloped defense mechanisms."

"Infant sleep offers a great way to study the impact of air pollutants. And [infants] sleep 16-18 hours a day and depend on healthy sleep for appropriate growth and development," she added.

Disturbed sleep has been seen in rats exposed to ozone (O₃), but human data are scant. Dr. Chin and her associates studied the association between air pollution and sleep-associated cardiopulmonary events in the hopes of elucidating a novel pathway linking early-life exposure to adverse health effects in childhood.

Researchers studied 196 healthy term infants, preterm infants, siblings of SIDS infants, and infants experiencing apparent life-threatening events who were residing in Southern California and recruited in 1994-1998 for the Collaborative Home Infant Monitoring Evaluation Study (CHIME). Home-based monitoring of sleep measured central, obstructive, and mixed apnea and bradycardia aggregated over a 24-hour period.

About 60% of the cohort were preterm, with an overall median gestational age of 33.7 weeks. Historical Environmental Protection Agency air quality data on daily O₃, nitrogen dioxide, and particulate matter exposure was assigned to each residential zip code.

A greater adverse effect for ozone was found in the term babies (odds ratio, 1.35), compared with the preterm babies (OR, 1.01; P=.0005 for between-group difference), Dr. Chin reported at the annual meeting of the Associated Professional Sleep Societies.

Nitrogen dioxide and particulate matter exposure were not significantly associated with sleep apnea or bradycardia in these infants.

"We speculate that the observed O₃ apnea and bradycardia association implies a possible mechanistic pathway for subsequent adverse morbidity and mortality and merits further investigation," Dr. Chin said.

In response to a query on the relative age of the data (1994-1998), she commented that the CHIME data are so valuable since "we don’t really monitor healthy infants anymore."

"There’s no large trial now where a parent would say, "Yes, put my infant on an apnea monitor when there’s no indication," Dr. Chin added.

This study was supported by a pilot project grant from the National Institute of Environmental Health Sciences–funded USC/UCLA Southern Environmental Health Sciences Center and a seed grant from the American Medical Association. Dr. Chin reported having no disclosures.

MINNEAPOLIS – Increased exposure to ozone appeared to increase cardiorespiratory events in healthy sleeping infants, based on preliminary data.

Dr. Chana I.C. Chin, a pediatric pulmonology fellow at the Children’s Hospital Los Angeles, and her associates found that for each 10-part-per-billion (ppb) elevation in ozone, there was a 22% higher risk of an apneic or bradycardic event (P = .0012), after adjustment for seasonality, weekday, and individual random effects.

"Air pollution likely increases infant mortality and likely impacts infants to a greater degree than adults," said Dr. Chin. "Infants have small body mass ratio, narrower airways, higher particulate deposition rates, greater volume of air breathed per body weight, and underdeveloped defense mechanisms."

"Infant sleep offers a great way to study the impact of air pollutants. And [infants] sleep 16-18 hours a day and depend on healthy sleep for appropriate growth and development," she added.

Disturbed sleep has been seen in rats exposed to ozone (O₃), but human data are scant. Dr. Chin and her associates studied the association between air pollution and sleep-associated cardiopulmonary events in the hopes of elucidating a novel pathway linking early-life exposure to adverse health effects in childhood.

Researchers studied 196 healthy term infants, preterm infants, siblings of SIDS infants, and infants experiencing apparent life-threatening events who were residing in Southern California and recruited in 1994-1998 for the Collaborative Home Infant Monitoring Evaluation Study (CHIME). Home-based monitoring of sleep measured central, obstructive, and mixed apnea and bradycardia aggregated over a 24-hour period.

About 60% of the cohort were preterm, with an overall median gestational age of 33.7 weeks. Historical Environmental Protection Agency air quality data on daily O₃, nitrogen dioxide, and particulate matter exposure was assigned to each residential zip code.

A greater adverse effect for ozone was found in the term babies (odds ratio, 1.35), compared with the preterm babies (OR, 1.01; P=.0005 for between-group difference), Dr. Chin reported at the annual meeting of the Associated Professional Sleep Societies.

Nitrogen dioxide and particulate matter exposure were not significantly associated with sleep apnea or bradycardia in these infants.

"We speculate that the observed O₃ apnea and bradycardia association implies a possible mechanistic pathway for subsequent adverse morbidity and mortality and merits further investigation," Dr. Chin said.

In response to a query on the relative age of the data (1994-1998), she commented that the CHIME data are so valuable since "we don’t really monitor healthy infants anymore."

"There’s no large trial now where a parent would say, "Yes, put my infant on an apnea monitor when there’s no indication," Dr. Chin added.

This study was supported by a pilot project grant from the National Institute of Environmental Health Sciences–funded USC/UCLA Southern Environmental Health Sciences Center and a seed grant from the American Medical Association. Dr. Chin reported having no disclosures.

MINNEAPOLIS – Increased exposure to ozone appeared to increase cardiorespiratory events in healthy sleeping infants, based on preliminary data.

Dr. Chana I.C. Chin, a pediatric pulmonology fellow at the Children’s Hospital Los Angeles, and her associates found that for each 10-part-per-billion (ppb) elevation in ozone, there was a 22% higher risk of an apneic or bradycardic event (P = .0012), after adjustment for seasonality, weekday, and individual random effects.

"Air pollution likely increases infant mortality and likely impacts infants to a greater degree than adults," said Dr. Chin. "Infants have small body mass ratio, narrower airways, higher particulate deposition rates, greater volume of air breathed per body weight, and underdeveloped defense mechanisms."

"Infant sleep offers a great way to study the impact of air pollutants. And [infants] sleep 16-18 hours a day and depend on healthy sleep for appropriate growth and development," she added.

Disturbed sleep has been seen in rats exposed to ozone (O₃), but human data are scant. Dr. Chin and her associates studied the association between air pollution and sleep-associated cardiopulmonary events in the hopes of elucidating a novel pathway linking early-life exposure to adverse health effects in childhood.

Researchers studied 196 healthy term infants, preterm infants, siblings of SIDS infants, and infants experiencing apparent life-threatening events who were residing in Southern California and recruited in 1994-1998 for the Collaborative Home Infant Monitoring Evaluation Study (CHIME). Home-based monitoring of sleep measured central, obstructive, and mixed apnea and bradycardia aggregated over a 24-hour period.

About 60% of the cohort were preterm, with an overall median gestational age of 33.7 weeks. Historical Environmental Protection Agency air quality data on daily O₃, nitrogen dioxide, and particulate matter exposure was assigned to each residential zip code.

A greater adverse effect for ozone was found in the term babies (odds ratio, 1.35), compared with the preterm babies (OR, 1.01; P=.0005 for between-group difference), Dr. Chin reported at the annual meeting of the Associated Professional Sleep Societies.

Nitrogen dioxide and particulate matter exposure were not significantly associated with sleep apnea or bradycardia in these infants.

"We speculate that the observed O₃ apnea and bradycardia association implies a possible mechanistic pathway for subsequent adverse morbidity and mortality and merits further investigation," Dr. Chin said.

In response to a query on the relative age of the data (1994-1998), she commented that the CHIME data are so valuable since "we don’t really monitor healthy infants anymore."

"There’s no large trial now where a parent would say, "Yes, put my infant on an apnea monitor when there’s no indication," Dr. Chin added.

This study was supported by a pilot project grant from the National Institute of Environmental Health Sciences–funded USC/UCLA Southern Environmental Health Sciences Center and a seed grant from the American Medical Association. Dr. Chin reported having no disclosures.

MINNEAPOLIS – Caffeine therapy for apnea of prematurity did not prevent the development of persistent and significant obstructive apnea in children by the time they were 9 years old.

"Apnea of prematurity occurs in more than three-quarters of infants born at under 30 weeks’ gestation, and more than half of these apneas are actually obstructive in nature," reported Dr. Carole Marcus, who is director of the sleep center at the Children’s Hospital of Philadelphia, at the annual meeting of the Associated Professional Sleep Societies. "Caffeine is now the most commonly used drug [to treat apnea of prematurity] in the NICU in infants less than 32 weeks’ gestation," she said.

Apnea of prematurity is commonly treated with therapeutic caffeine administration, but the long-term effects of caffeine on sleep in the developing brain are not well understood. In particular, it is not known whether neonatal caffeine administration has permanent adverse effects on sleep architecture and ventilatory control, perhaps increasing the risk of later sleep disorders such as insomnia and obstructive sleep apnea.

In the earlier CAP (Caffeine for Apnea of Prematurity) trial, 793 premature infants with birthweights of 500-1250 g were randomly assigned to receive either caffeine or placebo until therapy for apnea of prematurity was no longer needed.

Caffeine therapy was shown to improve the rate of survival without neurodevelopmental disability at 18 to 21 months in these babies compared to placebo (P = .008) (N. Engl. J. Med. 2007;357:1893-902).

The subsequent axillary long-term CAP-S (Sleep) trial involved 201 CAP subjects and looked at whether neonatal caffeine administration resulted in later sleep abnormalities. The investigators assessed the ex-premature children between ages 5-11 years (mean age, 9 years) using sleep questionnaires, actigraphy, and full ambulatory (home-based) polysomnography.

Of note, the patients assessed in CAP-S were from either Canada or Australia, with a high proportion of white patients, high maternal education, and high socioeconomic status, "which is relevant to our obstructive sleep apnea outcomes," noted Dr. Marcus (SLEEP 2014 abstract supplement;37:abst.#0862).

No significant differences were noted in children who had received caffeine, compared with those who did not in terms of subjective measures of sleep quality or quantity. Total recording time and total sleep time on polysomnography were somewhat longer in the caffeine arm, but there was no difference seen in sleep efficiency between groups (P = .91).

However, obstructive sleep apnea (apnea-hypopnea index of more than two episodes/hour) was common in both groups (8.2% of the caffeine group and 11% of the placebo group; P = .22). In contrast, the prevalence of obstructive sleep apnea in the general pediatric population is between 1%-4%.

Also, 24% of the caffeine group and 29% of the placebo group had either obstructive sleep apnea on polysomnography and/or a history of adenoidectomy/tonsillectomy, again with no difference between groups (P = .35).

A large proportion of subjects in both arms had elevated periodic limb movements (17.5% in the caffeine group and 11% in the placebo groups; P = .27), a proportion that was markedly higher than was the normal prevalence in cases in which the child had more than five episodes of periodic limb movement/hour, which lies between 5% and 8%.

"We think that this study further supports the use of caffeine for apnea of prematurity as it has been shown to have quite a number of beneficial effects and no long-term adverse effects," said Dr. Marcus. "However, further study is needed on the mechanisms underlying the high prevalence of sleep disorders, both [obstructive sleep apnea] and [periodic limb movement syndrome], in ex-preterm infants."

In response to a comment, Dr. Marcus added that there is also a long-term behavioral and neurocognitive outcomes study ongoing on the CAP cohort, but they were unable to combine those results with the sleep study results because the data were collected too far apart.

The study was supported by an National Institutes of Health R01 grant and by the Canadian Institute for Health Research. Philips Respironics provided actigraphy equipment. Dr. Marcus reported that she gets unrelated research support from Philips Respironics and Ventus.

MINNEAPOLIS – Caffeine therapy for apnea of prematurity did not prevent the development of persistent and significant obstructive apnea in children by the time they were 9 years old.

"Apnea of prematurity occurs in more than three-quarters of infants born at under 30 weeks’ gestation, and more than half of these apneas are actually obstructive in nature," reported Dr. Carole Marcus, who is director of the sleep center at the Children’s Hospital of Philadelphia, at the annual meeting of the Associated Professional Sleep Societies. "Caffeine is now the most commonly used drug [to treat apnea of prematurity] in the NICU in infants less than 32 weeks’ gestation," she said.

Apnea of prematurity is commonly treated with therapeutic caffeine administration, but the long-term effects of caffeine on sleep in the developing brain are not well understood. In particular, it is not known whether neonatal caffeine administration has permanent adverse effects on sleep architecture and ventilatory control, perhaps increasing the risk of later sleep disorders such as insomnia and obstructive sleep apnea.

In the earlier CAP (Caffeine for Apnea of Prematurity) trial, 793 premature infants with birthweights of 500-1250 g were randomly assigned to receive either caffeine or placebo until therapy for apnea of prematurity was no longer needed.

Caffeine therapy was shown to improve the rate of survival without neurodevelopmental disability at 18 to 21 months in these babies compared to placebo (P = .008) (N. Engl. J. Med. 2007;357:1893-902).

The subsequent axillary long-term CAP-S (Sleep) trial involved 201 CAP subjects and looked at whether neonatal caffeine administration resulted in later sleep abnormalities. The investigators assessed the ex-premature children between ages 5-11 years (mean age, 9 years) using sleep questionnaires, actigraphy, and full ambulatory (home-based) polysomnography.

Of note, the patients assessed in CAP-S were from either Canada or Australia, with a high proportion of white patients, high maternal education, and high socioeconomic status, "which is relevant to our obstructive sleep apnea outcomes," noted Dr. Marcus (SLEEP 2014 abstract supplement;37:abst.#0862).

No significant differences were noted in children who had received caffeine, compared with those who did not in terms of subjective measures of sleep quality or quantity. Total recording time and total sleep time on polysomnography were somewhat longer in the caffeine arm, but there was no difference seen in sleep efficiency between groups (P = .91).

However, obstructive sleep apnea (apnea-hypopnea index of more than two episodes/hour) was common in both groups (8.2% of the caffeine group and 11% of the placebo group; P = .22). In contrast, the prevalence of obstructive sleep apnea in the general pediatric population is between 1%-4%.

Also, 24% of the caffeine group and 29% of the placebo group had either obstructive sleep apnea on polysomnography and/or a history of adenoidectomy/tonsillectomy, again with no difference between groups (P = .35).

A large proportion of subjects in both arms had elevated periodic limb movements (17.5% in the caffeine group and 11% in the placebo groups; P = .27), a proportion that was markedly higher than was the normal prevalence in cases in which the child had more than five episodes of periodic limb movement/hour, which lies between 5% and 8%.

"We think that this study further supports the use of caffeine for apnea of prematurity as it has been shown to have quite a number of beneficial effects and no long-term adverse effects," said Dr. Marcus. "However, further study is needed on the mechanisms underlying the high prevalence of sleep disorders, both [obstructive sleep apnea] and [periodic limb movement syndrome], in ex-preterm infants."

In response to a comment, Dr. Marcus added that there is also a long-term behavioral and neurocognitive outcomes study ongoing on the CAP cohort, but they were unable to combine those results with the sleep study results because the data were collected too far apart.

The study was supported by an National Institutes of Health R01 grant and by the Canadian Institute for Health Research. Philips Respironics provided actigraphy equipment. Dr. Marcus reported that she gets unrelated research support from Philips Respironics and Ventus.

MINNEAPOLIS – Caffeine therapy for apnea of prematurity did not prevent the development of persistent and significant obstructive apnea in children by the time they were 9 years old.

"Apnea of prematurity occurs in more than three-quarters of infants born at under 30 weeks’ gestation, and more than half of these apneas are actually obstructive in nature," reported Dr. Carole Marcus, who is director of the sleep center at the Children’s Hospital of Philadelphia, at the annual meeting of the Associated Professional Sleep Societies. "Caffeine is now the most commonly used drug [to treat apnea of prematurity] in the NICU in infants less than 32 weeks’ gestation," she said.

Apnea of prematurity is commonly treated with therapeutic caffeine administration, but the long-term effects of caffeine on sleep in the developing brain are not well understood. In particular, it is not known whether neonatal caffeine administration has permanent adverse effects on sleep architecture and ventilatory control, perhaps increasing the risk of later sleep disorders such as insomnia and obstructive sleep apnea.

In the earlier CAP (Caffeine for Apnea of Prematurity) trial, 793 premature infants with birthweights of 500-1250 g were randomly assigned to receive either caffeine or placebo until therapy for apnea of prematurity was no longer needed.

Caffeine therapy was shown to improve the rate of survival without neurodevelopmental disability at 18 to 21 months in these babies compared to placebo (P = .008) (N. Engl. J. Med. 2007;357:1893-902).

The subsequent axillary long-term CAP-S (Sleep) trial involved 201 CAP subjects and looked at whether neonatal caffeine administration resulted in later sleep abnormalities. The investigators assessed the ex-premature children between ages 5-11 years (mean age, 9 years) using sleep questionnaires, actigraphy, and full ambulatory (home-based) polysomnography.

Of note, the patients assessed in CAP-S were from either Canada or Australia, with a high proportion of white patients, high maternal education, and high socioeconomic status, "which is relevant to our obstructive sleep apnea outcomes," noted Dr. Marcus (SLEEP 2014 abstract supplement;37:abst.#0862).

No significant differences were noted in children who had received caffeine, compared with those who did not in terms of subjective measures of sleep quality or quantity. Total recording time and total sleep time on polysomnography were somewhat longer in the caffeine arm, but there was no difference seen in sleep efficiency between groups (P = .91).

However, obstructive sleep apnea (apnea-hypopnea index of more than two episodes/hour) was common in both groups (8.2% of the caffeine group and 11% of the placebo group; P = .22). In contrast, the prevalence of obstructive sleep apnea in the general pediatric population is between 1%-4%.

Also, 24% of the caffeine group and 29% of the placebo group had either obstructive sleep apnea on polysomnography and/or a history of adenoidectomy/tonsillectomy, again with no difference between groups (P = .35).

A large proportion of subjects in both arms had elevated periodic limb movements (17.5% in the caffeine group and 11% in the placebo groups; P = .27), a proportion that was markedly higher than was the normal prevalence in cases in which the child had more than five episodes of periodic limb movement/hour, which lies between 5% and 8%.

"We think that this study further supports the use of caffeine for apnea of prematurity as it has been shown to have quite a number of beneficial effects and no long-term adverse effects," said Dr. Marcus. "However, further study is needed on the mechanisms underlying the high prevalence of sleep disorders, both [obstructive sleep apnea] and [periodic limb movement syndrome], in ex-preterm infants."

In response to a comment, Dr. Marcus added that there is also a long-term behavioral and neurocognitive outcomes study ongoing on the CAP cohort, but they were unable to combine those results with the sleep study results because the data were collected too far apart.

The study was supported by an National Institutes of Health R01 grant and by the Canadian Institute for Health Research. Philips Respironics provided actigraphy equipment. Dr. Marcus reported that she gets unrelated research support from Philips Respironics and Ventus.

MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.

"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.

Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "

Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.

He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.

They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.

They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.

A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.

The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.

At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.

"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)

It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.

As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."

Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."

Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.

The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.

"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.

Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "

Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.

He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.

They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.

They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.

A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.

The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.

At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.

"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)

It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.

As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."

Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."

Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.

The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.

"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.

Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "

Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.

He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.

They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.

They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.

A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.

The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.

At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.

"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)

It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.

As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."

Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."

Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.

The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – Using the adult treatment threshold for serum ferritin to guide treatment in children with restless sleep may lead to inappropriate iron supplementation.

In both adults and children, iron deficiency has been linked to the presence and severity of restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS). For adults, a serum ferritin less than 50 mcg/L is the threshold commonly used to guide iron supplementation for patients with RLS or PLMS. A threshold of 40-50 mcg/L also has been used in pediatric studies.

For children, however, a far lower level of 20 mcg/L appears more appropriate, Alyson Connor and her colleagues reported at the annual meeting of the Associated Professional Sleep Societies.

"Our findings raise a question about the best serum ferritin threshold to use when seeing a child with evidence of sleep restlessness, in particular with elevated" periodic limb movement index, Ms. Connor said, adding a caution that, "while many children may benefit from iron supplementation for these disorders, this area is worthy of further study as investigation in animals suggests that treatment of iron deficiency with high-dose iron supplementation in early development may differentially effect the development of the brain."

Ms. Connor, a student in the biomedical research program at the University of Michigan, Ann Arbor, and her colleagues conducted a review of 537 children between the ages of 12 months and 18 years who were referred to the University of Michigan pediatric sleep clinic.

In this young cohort (mean age was 8.9 years; 62% were male), a median serum ferritin level of 23.6 mcg/L was associated with polysomnographic measures of periodic limb movement index (PLMI) per hour of total sleep time of 5 or more, while a median level of 30 mcg/L was associated with PLMI less than 5. Overall, about 26% of the subjects had a PLMI of 5 or more.

"There was a significant association between serum ferritin and periodic limb movement index such that, for every 10 mcg/L increase in serum ferritin, it decreased the odds of having an elevated PLMI by 11%, with a P value of .01," Ms Connor said.

Boys, younger patients, those with lower serum ferritin levels, and those with a shorter time between hematology and polysomnography all had significantly increased odds of a PLMI of 5 or more.

Only 19% of patients studied had a serum ferritin above 50 mcg/L, while 50% had a serum ferritin below 30 mcg/L.

"Essentially, the cutoff of 50 is very sensitive, giving few false negatives, but not very specific, whereas a lower cutoff improves specificity," Ms. Connor said.

Future studies are needed to assess the association between iron status and sleep measures in a general pediatric population and to determine the best iron dose, timing, and method of delivery for optimal developmental outcomes, she said.

The study was supported by the Charles Woodson Fund for Clinical Research.

MINNEAPOLIS – Using the adult treatment threshold for serum ferritin to guide treatment in children with restless sleep may lead to inappropriate iron supplementation.

In both adults and children, iron deficiency has been linked to the presence and severity of restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS). For adults, a serum ferritin less than 50 mcg/L is the threshold commonly used to guide iron supplementation for patients with RLS or PLMS. A threshold of 40-50 mcg/L also has been used in pediatric studies.

For children, however, a far lower level of 20 mcg/L appears more appropriate, Alyson Connor and her colleagues reported at the annual meeting of the Associated Professional Sleep Societies.

"Our findings raise a question about the best serum ferritin threshold to use when seeing a child with evidence of sleep restlessness, in particular with elevated" periodic limb movement index, Ms. Connor said, adding a caution that, "while many children may benefit from iron supplementation for these disorders, this area is worthy of further study as investigation in animals suggests that treatment of iron deficiency with high-dose iron supplementation in early development may differentially effect the development of the brain."

Ms. Connor, a student in the biomedical research program at the University of Michigan, Ann Arbor, and her colleagues conducted a review of 537 children between the ages of 12 months and 18 years who were referred to the University of Michigan pediatric sleep clinic.

In this young cohort (mean age was 8.9 years; 62% were male), a median serum ferritin level of 23.6 mcg/L was associated with polysomnographic measures of periodic limb movement index (PLMI) per hour of total sleep time of 5 or more, while a median level of 30 mcg/L was associated with PLMI less than 5. Overall, about 26% of the subjects had a PLMI of 5 or more.

"There was a significant association between serum ferritin and periodic limb movement index such that, for every 10 mcg/L increase in serum ferritin, it decreased the odds of having an elevated PLMI by 11%, with a P value of .01," Ms Connor said.

Boys, younger patients, those with lower serum ferritin levels, and those with a shorter time between hematology and polysomnography all had significantly increased odds of a PLMI of 5 or more.

Only 19% of patients studied had a serum ferritin above 50 mcg/L, while 50% had a serum ferritin below 30 mcg/L.

"Essentially, the cutoff of 50 is very sensitive, giving few false negatives, but not very specific, whereas a lower cutoff improves specificity," Ms. Connor said.

Future studies are needed to assess the association between iron status and sleep measures in a general pediatric population and to determine the best iron dose, timing, and method of delivery for optimal developmental outcomes, she said.

The study was supported by the Charles Woodson Fund for Clinical Research.

MINNEAPOLIS – Using the adult treatment threshold for serum ferritin to guide treatment in children with restless sleep may lead to inappropriate iron supplementation.

In both adults and children, iron deficiency has been linked to the presence and severity of restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS). For adults, a serum ferritin less than 50 mcg/L is the threshold commonly used to guide iron supplementation for patients with RLS or PLMS. A threshold of 40-50 mcg/L also has been used in pediatric studies.

For children, however, a far lower level of 20 mcg/L appears more appropriate, Alyson Connor and her colleagues reported at the annual meeting of the Associated Professional Sleep Societies.

"Our findings raise a question about the best serum ferritin threshold to use when seeing a child with evidence of sleep restlessness, in particular with elevated" periodic limb movement index, Ms. Connor said, adding a caution that, "while many children may benefit from iron supplementation for these disorders, this area is worthy of further study as investigation in animals suggests that treatment of iron deficiency with high-dose iron supplementation in early development may differentially effect the development of the brain."

Ms. Connor, a student in the biomedical research program at the University of Michigan, Ann Arbor, and her colleagues conducted a review of 537 children between the ages of 12 months and 18 years who were referred to the University of Michigan pediatric sleep clinic.

In this young cohort (mean age was 8.9 years; 62% were male), a median serum ferritin level of 23.6 mcg/L was associated with polysomnographic measures of periodic limb movement index (PLMI) per hour of total sleep time of 5 or more, while a median level of 30 mcg/L was associated with PLMI less than 5. Overall, about 26% of the subjects had a PLMI of 5 or more.

"There was a significant association between serum ferritin and periodic limb movement index such that, for every 10 mcg/L increase in serum ferritin, it decreased the odds of having an elevated PLMI by 11%, with a P value of .01," Ms Connor said.

Boys, younger patients, those with lower serum ferritin levels, and those with a shorter time between hematology and polysomnography all had significantly increased odds of a PLMI of 5 or more.

Only 19% of patients studied had a serum ferritin above 50 mcg/L, while 50% had a serum ferritin below 30 mcg/L.

"Essentially, the cutoff of 50 is very sensitive, giving few false negatives, but not very specific, whereas a lower cutoff improves specificity," Ms. Connor said.

Future studies are needed to assess the association between iron status and sleep measures in a general pediatric population and to determine the best iron dose, timing, and method of delivery for optimal developmental outcomes, she said.

The study was supported by the Charles Woodson Fund for Clinical Research.

MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.

That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.

Courtesy of Faith Luyster

The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.

Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).

Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.

Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.

CPAP use was recorded by the device itself.

At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).

"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."

Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.

And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.

The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.

That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.

Courtesy of Faith Luyster

The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.

Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).

Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.

Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.

CPAP use was recorded by the device itself.

At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).

"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."

Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.

And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.

The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.

aault@frontlinemedcom.com

On Twitter @aliciaault

MINNEAPOLIS – People with obstructive sleep apnea who have spouses or supportive partners tend to use their continuous positive airway pressure devices for longer periods of time.

That’s according to a study to be presented at the annual meeting of the Associated Professional Sleep Societies on June 2 by researchers at the University of Pittsburgh School of Nursing and at National Jewish Health in Denver.

Courtesy of Faith Luyster

The findings indicate that patients who live alone or do not have a supportive family might benefit from a group setting during the initial use of the CPAP. New, single users could also be paired off with peer "buddies" who can share experience and offer advice, according to principal investigator Faith Luyster, Ph.D.

Dr. Luyster performed a subanalysis of patients enrolled in a larger randomized, controlled trial conducted by Mark Aloia, Ph.D., associate professor of medicine at National Jewish Health, when he was a resident at Brown University in Providence, R.I. That larger study enrolled patients with obstructive sleep apnea (OSA) to determine whether motivational interviewing or intensive education might increase the use of continuous positive airway pressure (CPAP).

Data were analyzed from 253 patients (100 women and 153 men), just starting CPAP. At the start of the study, 185 were part of a couple and 68 were never married; divorced or separated; or widowed. The quality of the relationship was assessed at baseline using the 12-item General Functioning subscale of the McMaster Family Assessment Device.

Study participants used a four-point Likert scale – rating the 12 statements as "strongly agree", "agree," "disagree," and "strongly disagree" to answer statements that included: "In times of crisis we can turn to each other for support;" "We can express feelings to each other;" and "We confide in each other." A high score is associated with poor relationship quality.

CPAP use was recorded by the device itself.

At 3 months, single patients had average CPAP use of 3.3 hours plus or minus 2.5 hours per night, and coupled patients had 4.3 hours plus or minus 2.6 hours per night (P less than .01). Patients who had a higher relationship quality also had better adherence (P less than .05).

"Ideally, physicians want patients to wear [the CPAP mask] all night," said Dr. Luyster. There are "some data to suggest that wearing it 6 to 7 hours a night can improve cognitive functioning and daytime sleepiness."

Having a supportive partner or family member can help, especially in the beginning of CPAP use. The mask may need to be adjusted, and the user needs to get acclimated to sleeping with a mask. "It’s very helpful for patients to have cheerleaders," who can encourage and assist them, remind them to use the device, and help them to clean the CPAP device daily.

And it helps to have someone who’s accepting of the patient when wearing the CPAP mask. In focus groups, men were very concerned about how they would look to their partners, said Dr. Luyster. Women were more concerned that everyone was sleeping well again.

The authors reported no financial conflicts. The study was funded by the National Heart, Lung and Blood Institute.

aault@frontlinemedcom.com

On Twitter @aliciaault

A novel agent for symptoms of excessive daytime sleepiness in narcolepsy patients has shown evidence of efficacy, according to researchers who will report their results as a late-breaking abstract at Sleep 2014.

ADX-N05, a wake-promoting agent with dopaminergic and noradrenergic activity, reduced symptoms in a 12-week, placebo-controlled, double-blind study of nearly 100 patients with narcolepsy, according to Dr. Jed Black of Jazz Pharmaceuticals and Stanford (Calif.) Sleep Medicine Center, and his colleagues.

Efficacy was based on improvements at 4 and 12 weeks from baseline in average sleep-onset latency on the Maintenance of Wakefulness Test and Clinical Global Impression-Change scale. A secondary endpoint was change on the Epworth Sleepiness Scale.

For the study, 49 patients were randomized to placebo and 44 to the active drug. The active drug was initiated at 150 mg/day for 4 weeks and increased to 300 mg/day for weeks 5-12.

At week 4, average sleep-onset latency on the Maintenance of Wakefulness Test was 9.5 minutes in those on the active drug and 1.4 minutes in those on placebo, a difference that was statistically significant (P less than .0001). Improvements on the Clinical Global Impression-Change scale were 80% vs. 51%; (P = .0066), and Epworth Sleepiness Scale scores had decreased (5.6 points vs. 2.4 points; P = 0.0038).

Further improvements were noted at 12 weeks, with average sleep-onset latency on the Maintenance of Wakefulness Test of 12.8 minutes vs. 2.1 minutes; (P less than .0001). Epworth Sleepiness Scale scores were 8.5 points vs. 2.5 points (P less than .0001), and the proportion of patients with Clinical Global Impression-Change scale improvements was 86% vs. 38% (P less than .0001), according to the researchers, who will present their complete study results at the annual meeting of the Associated Professional Sleep Societies.

Adverse events were more common with the active drug and included headache, nausea, diarrhea, insomnia, decreased appetite, and anxiety. Three study subjects halted active therapy because of adverse events. Two serious events—conversion disorder and acute cholecystitis—occurred in the active treatment group and were probably unrelated to drug therapy, according to the researchers.

The study was supported by Aerial BioPharma. Dr. Black is with Jazz Pharmaceuticals, which has acquired ADX-N05 from Aerial BioPharma.

A novel agent for symptoms of excessive daytime sleepiness in narcolepsy patients has shown evidence of efficacy, according to researchers who will report their results as a late-breaking abstract at Sleep 2014.

ADX-N05, a wake-promoting agent with dopaminergic and noradrenergic activity, reduced symptoms in a 12-week, placebo-controlled, double-blind study of nearly 100 patients with narcolepsy, according to Dr. Jed Black of Jazz Pharmaceuticals and Stanford (Calif.) Sleep Medicine Center, and his colleagues.

Efficacy was based on improvements at 4 and 12 weeks from baseline in average sleep-onset latency on the Maintenance of Wakefulness Test and Clinical Global Impression-Change scale. A secondary endpoint was change on the Epworth Sleepiness Scale.

For the study, 49 patients were randomized to placebo and 44 to the active drug. The active drug was initiated at 150 mg/day for 4 weeks and increased to 300 mg/day for weeks 5-12.

At week 4, average sleep-onset latency on the Maintenance of Wakefulness Test was 9.5 minutes in those on the active drug and 1.4 minutes in those on placebo, a difference that was statistically significant (P less than .0001). Improvements on the Clinical Global Impression-Change scale were 80% vs. 51%; (P = .0066), and Epworth Sleepiness Scale scores had decreased (5.6 points vs. 2.4 points; P = 0.0038).

Further improvements were noted at 12 weeks, with average sleep-onset latency on the Maintenance of Wakefulness Test of 12.8 minutes vs. 2.1 minutes; (P less than .0001). Epworth Sleepiness Scale scores were 8.5 points vs. 2.5 points (P less than .0001), and the proportion of patients with Clinical Global Impression-Change scale improvements was 86% vs. 38% (P less than .0001), according to the researchers, who will present their complete study results at the annual meeting of the Associated Professional Sleep Societies.

Adverse events were more common with the active drug and included headache, nausea, diarrhea, insomnia, decreased appetite, and anxiety. Three study subjects halted active therapy because of adverse events. Two serious events—conversion disorder and acute cholecystitis—occurred in the active treatment group and were probably unrelated to drug therapy, according to the researchers.

The study was supported by Aerial BioPharma. Dr. Black is with Jazz Pharmaceuticals, which has acquired ADX-N05 from Aerial BioPharma.

A novel agent for symptoms of excessive daytime sleepiness in narcolepsy patients has shown evidence of efficacy, according to researchers who will report their results as a late-breaking abstract at Sleep 2014.

ADX-N05, a wake-promoting agent with dopaminergic and noradrenergic activity, reduced symptoms in a 12-week, placebo-controlled, double-blind study of nearly 100 patients with narcolepsy, according to Dr. Jed Black of Jazz Pharmaceuticals and Stanford (Calif.) Sleep Medicine Center, and his colleagues.

Efficacy was based on improvements at 4 and 12 weeks from baseline in average sleep-onset latency on the Maintenance of Wakefulness Test and Clinical Global Impression-Change scale. A secondary endpoint was change on the Epworth Sleepiness Scale.

For the study, 49 patients were randomized to placebo and 44 to the active drug. The active drug was initiated at 150 mg/day for 4 weeks and increased to 300 mg/day for weeks 5-12.

At week 4, average sleep-onset latency on the Maintenance of Wakefulness Test was 9.5 minutes in those on the active drug and 1.4 minutes in those on placebo, a difference that was statistically significant (P less than .0001). Improvements on the Clinical Global Impression-Change scale were 80% vs. 51%; (P = .0066), and Epworth Sleepiness Scale scores had decreased (5.6 points vs. 2.4 points; P = 0.0038).

Further improvements were noted at 12 weeks, with average sleep-onset latency on the Maintenance of Wakefulness Test of 12.8 minutes vs. 2.1 minutes; (P less than .0001). Epworth Sleepiness Scale scores were 8.5 points vs. 2.5 points (P less than .0001), and the proportion of patients with Clinical Global Impression-Change scale improvements was 86% vs. 38% (P less than .0001), according to the researchers, who will present their complete study results at the annual meeting of the Associated Professional Sleep Societies.

Adverse events were more common with the active drug and included headache, nausea, diarrhea, insomnia, decreased appetite, and anxiety. Three study subjects halted active therapy because of adverse events. Two serious events—conversion disorder and acute cholecystitis—occurred in the active treatment group and were probably unrelated to drug therapy, according to the researchers.

The study was supported by Aerial BioPharma. Dr. Black is with Jazz Pharmaceuticals, which has acquired ADX-N05 from Aerial BioPharma.

Pupil response to light differs in people with seasonal affective disorder and is affected by their total exposure to light, researchers will report at Sleep 2014 in Minneapolis.

"We speculate that low light levels in SAD [seasonal affective disorder] trigger downstream changes in mood and behavior, and that the link between light and SAD may be mediated by the PIPR [postillumination pupil response]," Kathryn A. Roecklein, Ph.D., of the University of Pittsburgh and her colleagues wrote in a late-breaker abstract to be presented at the annual meeting of the Associated Professional Sleep Societies.

For their study, the researchers examined postillumination pupil response during summer and winter in 33 people with SAD and 17 controls. One-second light exposures to red light and to blue light were used for testing. Actigraphy was used to measure light exposure in the days before the tests.

In the study subjects with SAD, most of the variance in postillumination pupil response was associated with total photon exposures on the day of testing. In the controls, however, postillumination pupil response was independent of total photon exposures on the day of testing. Blue total photon exposures accounted for the greatest proportion of variance in postillumination pupil response (P = .013) and were predictive of SAD independent of the subject’s gender, time since waking, and whether they were early risers or night owls (P = .013).

The postillumination pupil response was lower in subjects with SAD than in controls (P less than .05), especially among those with SAD who were night owls (P less than .001).

The data, which are the first to link light exposure and the postillumination pupil response in SAD, will be presented in their entirety at the meeting.

The study was funded by a grant from the National Institutes of Health. The authors reported having no financial disclosures.

Pupil response to light differs in people with seasonal affective disorder and is affected by their total exposure to light, researchers will report at Sleep 2014 in Minneapolis.

"We speculate that low light levels in SAD [seasonal affective disorder] trigger downstream changes in mood and behavior, and that the link between light and SAD may be mediated by the PIPR [postillumination pupil response]," Kathryn A. Roecklein, Ph.D., of the University of Pittsburgh and her colleagues wrote in a late-breaker abstract to be presented at the annual meeting of the Associated Professional Sleep Societies.

For their study, the researchers examined postillumination pupil response during summer and winter in 33 people with SAD and 17 controls. One-second light exposures to red light and to blue light were used for testing. Actigraphy was used to measure light exposure in the days before the tests.

In the study subjects with SAD, most of the variance in postillumination pupil response was associated with total photon exposures on the day of testing. In the controls, however, postillumination pupil response was independent of total photon exposures on the day of testing. Blue total photon exposures accounted for the greatest proportion of variance in postillumination pupil response (P = .013) and were predictive of SAD independent of the subject’s gender, time since waking, and whether they were early risers or night owls (P = .013).

The postillumination pupil response was lower in subjects with SAD than in controls (P less than .05), especially among those with SAD who were night owls (P less than .001).

The data, which are the first to link light exposure and the postillumination pupil response in SAD, will be presented in their entirety at the meeting.

The study was funded by a grant from the National Institutes of Health. The authors reported having no financial disclosures.

Pupil response to light differs in people with seasonal affective disorder and is affected by their total exposure to light, researchers will report at Sleep 2014 in Minneapolis.

"We speculate that low light levels in SAD [seasonal affective disorder] trigger downstream changes in mood and behavior, and that the link between light and SAD may be mediated by the PIPR [postillumination pupil response]," Kathryn A. Roecklein, Ph.D., of the University of Pittsburgh and her colleagues wrote in a late-breaker abstract to be presented at the annual meeting of the Associated Professional Sleep Societies.

For their study, the researchers examined postillumination pupil response during summer and winter in 33 people with SAD and 17 controls. One-second light exposures to red light and to blue light were used for testing. Actigraphy was used to measure light exposure in the days before the tests.

In the study subjects with SAD, most of the variance in postillumination pupil response was associated with total photon exposures on the day of testing. In the controls, however, postillumination pupil response was independent of total photon exposures on the day of testing. Blue total photon exposures accounted for the greatest proportion of variance in postillumination pupil response (P = .013) and were predictive of SAD independent of the subject’s gender, time since waking, and whether they were early risers or night owls (P = .013).

The postillumination pupil response was lower in subjects with SAD than in controls (P less than .05), especially among those with SAD who were night owls (P less than .001).

The data, which are the first to link light exposure and the postillumination pupil response in SAD, will be presented in their entirety at the meeting.

The study was funded by a grant from the National Institutes of Health. The authors reported having no financial disclosures.

Teens who miss sleep are more likely to set their metabolism in motion for insulin resistance.

Based on a pilot study of 10 lean and obese adolescents, sleep duration was the primary predictor of abnormal 90-minute glucose values on oral glucose tolerance tests, Dr. Dorit Koren and her colleagues will report at the annual meeting of the Associated Professional Sleep Societies in Minneapolis. The finding was independent of the teens’ body weights.

The University of Chicago researchers wrote in their late-breaking abstract that the pilot study is "the first to our knowledge to examine potential interrelationships between home sleep duration and dynamic insulin and glucose homeostasis in adolescents." Previous studies in children have associated short sleep with insulin resistance, but have not examined the relationship between home sleep and postprandial glucose metabolism. Studies in adults have linked type 2 diabetes risks and experimental sleep restriction to acute insulin resistance and glucose intolerance.

For the study, the 13- to 18-year-olds had oral glucose tolerance tests, evaluations of body weight, an overnight polysomnogram, and home sleep assessments based on actigraphy and sleep diaries. Sleep duration was linearly correlated with 90-minute oral glucose tolerance test results (r = –0.66, P = .036). There were trends toward negative associations between home sleep duration, obesity, and insulin resistance.

The study was supported by a grant from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health.

mdales@frontlinemedcom.com

Teens who miss sleep are more likely to set their metabolism in motion for insulin resistance.

Based on a pilot study of 10 lean and obese adolescents, sleep duration was the primary predictor of abnormal 90-minute glucose values on oral glucose tolerance tests, Dr. Dorit Koren and her colleagues will report at the annual meeting of the Associated Professional Sleep Societies in Minneapolis. The finding was independent of the teens’ body weights.

The University of Chicago researchers wrote in their late-breaking abstract that the pilot study is "the first to our knowledge to examine potential interrelationships between home sleep duration and dynamic insulin and glucose homeostasis in adolescents." Previous studies in children have associated short sleep with insulin resistance, but have not examined the relationship between home sleep and postprandial glucose metabolism. Studies in adults have linked type 2 diabetes risks and experimental sleep restriction to acute insulin resistance and glucose intolerance.

For the study, the 13- to 18-year-olds had oral glucose tolerance tests, evaluations of body weight, an overnight polysomnogram, and home sleep assessments based on actigraphy and sleep diaries. Sleep duration was linearly correlated with 90-minute oral glucose tolerance test results (r = –0.66, P = .036). There were trends toward negative associations between home sleep duration, obesity, and insulin resistance.

The study was supported by a grant from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health.

mdales@frontlinemedcom.com

Teens who miss sleep are more likely to set their metabolism in motion for insulin resistance.

Based on a pilot study of 10 lean and obese adolescents, sleep duration was the primary predictor of abnormal 90-minute glucose values on oral glucose tolerance tests, Dr. Dorit Koren and her colleagues will report at the annual meeting of the Associated Professional Sleep Societies in Minneapolis. The finding was independent of the teens’ body weights.

The University of Chicago researchers wrote in their late-breaking abstract that the pilot study is "the first to our knowledge to examine potential interrelationships between home sleep duration and dynamic insulin and glucose homeostasis in adolescents." Previous studies in children have associated short sleep with insulin resistance, but have not examined the relationship between home sleep and postprandial glucose metabolism. Studies in adults have linked type 2 diabetes risks and experimental sleep restriction to acute insulin resistance and glucose intolerance.

For the study, the 13- to 18-year-olds had oral glucose tolerance tests, evaluations of body weight, an overnight polysomnogram, and home sleep assessments based on actigraphy and sleep diaries. Sleep duration was linearly correlated with 90-minute oral glucose tolerance test results (r = –0.66, P = .036). There were trends toward negative associations between home sleep duration, obesity, and insulin resistance.

The study was supported by a grant from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health.

mdales@frontlinemedcom.com