Study: Treated sleep apnea reduces hospital readmission rate in cardiac patients

A study claims that the hospital readmission rate for hospitalized cardiac patients is lower if their sleep apnea is treated.

A study of hospitalized cardiac patients is the first to show that effective treatment with positive airway pressure therapy reduces 30-day hospital readmission rates and emergency department visits in patients with both heart disease and sleep apnea. The results underscore the importance of the "Stop the Snore" campaign of the National Healthy Sleep Awareness Project, a collaboration between the Centers for Disease Control and Prevention, American Academy of Sleep Medicine, Sleep Research Society and other partners.

Results show that none of the cardiac patients with sleep apnea who had adequate adherence to PAP therapy were readmitted to the hospital or visited the emergency department for a heart problem within 30 days from discharge. In contrast, hospital readmission or emergency department visits occurred in 30 percent of cardiac patients with sleep apnea who had partial PAP use and 29 percent who did not use PAP therapy.

"Finding a reduced 30-day cardiac readmission rate in PAP-adherent patients is important for improving both patient care and hospital finances," said principal investigator and senior author Dr. Richard J. Schwab, Professor in the Department of Medicine and co-director of the Penn Sleep Center at the University of Pennsylvania Medical Center in Philadelphia.

The study results are published in the Oct. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

"Severe sleep apnea is solidly associated with serious cardiovascular outcomes, such as heart failure, heart attacks, and heart-related deaths," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "This study is a clarion call to detect, diagnose, and especially to treat sleep apnea in patients who are hospitalized for heart problems. Doing so is a win-win-win move; it improves the patient's quality of life, improves health outcomes, and reduces the resources used to manage heart diseases."

The "Stop the Snore" campaign was launched recently to encourage people to talk to a doctor about the warning signs for obstructive sleep apnea, which afflicts at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. Pledge to stop the snore athttp://www.stopsnoringpledge.org.

The study involved 104 consecutive patients who reported symptoms of sleep apnea while being hospitalized for a cardiac condition such as heart failure, arrhythmias or myocardial infarction. They were evaluated for sleep apnea using an in-hospital, portable sleep study. Results show that 78 percent of the cardiac patients had sleep apnea (81/104). Eighty percent of sleep apnea cases were predominantly obstructive sleep apnea (65/81), and 20 percent were predominantly central sleep apnea (16/81).

Participants who were diagnosed with sleep apnea were started on PAP therapy, and compliance data were collected via modem or data card. Adequate treatment adherence was defined as using PAP therapy four or more hours per night on at least 70 percent of nights. Thirty-day hospital readmission was defined as a hospitalization or visit to the emergency department for a cardiac cause more than 48 hours after discharge.

According to the authors, reducing hospital readmission rates for cardiac patients is essential for the provision of cost-effective care. They noted that the average total cost per heart failure hospitalization ranges from $13,000 to $18,000. Furthermore, the Centers for Medicare and Medicaid Services (CMS) withholds hospital reimbursement for the care of patients readmitted within 30 days after hospital discharge.

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When to go to the hospital for a migraine

This article explains when it is appropriate to go to the hospital for a migraine headache.

Headache is one of the most common reasons for an emergency room visit. Some people go due chronic headache or Migraine problems that do not go away with treatment, and in other cases, headache is a symptom of another medical problem.

The best reason for an ER visit is for unusual symptoms that are new to you. You may seek attention to make sure there is no chance of another problem such as aneurysm or meningitis. A severe headache that starts very suddenly (within a second or two) can mean another disorder such as stroke. New symptoms such as a fever, weakness, vision loss or double vision, or confusion are some of most concerning symptoms. If you have a new symptom and serious, life-threatening medical problems such as liver, heart or kidney disease, are pregnant, or have a disorder which affects your immune system such as HIV infection, an ER visit may be more essential.

For many patients, an ER visit for headache or Migraine happens after a long period of severe headache lasting days or weeks. After long time of experiencing severe headache, you may reach the "last straw" and no longer be able to deal with the problem. ER doctors are not specialists in headache and Migraine, and their goals are to make sure there is no serious life-threatening problem and help reduce suffering. Different ER doctors have different ways to treat acute headache and Migraine: there is no universal protocol for emergency treatment of headache disorders.

When going to the ER, be sure to mention:

• your symptoms, including any that are new or unusual for you;
• any medications you have taken, especially in the last few days; and
• if you have had good results from a particular medication regimen, that can be helpful to the ER.

Often ER doctors will want to order tests such as a CT scan of the head or spinal tap to make sure there is no bleeding in the brain, large stroke or meningitis. If you are having your typical severe headache or Migraine, and no new symptoms, the chance these tests will be helpful are extremely low and you have the right to refuse them. (See 5 Things Migraine and Headache Patients and Doctors Should Question.)

The majority of persons coming to an ER for severe headache or Migraine do not get lasting results from the medications given in the ER, so having a good long-term plan and relationship with an outpatient doctor who treats your headache disorder is very important. If you have even occasional long-lasting headaches or Migraines, a good preventive plan is very important, and you should have at least one rescue medication to prevent future ER visits.

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Study: Poor sleep doubles number of hospitalizations in heart failure patients

A study shows that heart failure patients have double the number of hospitalizations when they do not sleep well.

Poor sleep doubles hospitalizations in heart failure, according to new research in nearly 500 patients presented today at EuroHeartCare 2014.

EuroHeartCare is the official annual meeting of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC). This year's meeting is organized jointly with the Norwegian Society of Cardiovascular Nurses. It takes place 4-5 April in Stavanger, Norway.

Dr Peter Johansson, first author of the study and a heart failure nurse at the University Hospital of Linköping, Sweden, said: "Sleep is important for everyone and we all have to sleep to feel good. We know that sleep problems are common among patients with heart failure. But until now there was no data on whether poor sleep persists over time and how that relates to hospitalizations."

He added: "Our study shows that some patients with heart failure have chronic sleep problems and this more than doubles their risk of unplanned hospitalizations. We need to ask all our heart failure patients whether they sleep well and if not, find out why."

The current study included 499 patients hospitalized for heart failure who participated in the Co-ordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH) study. During the initial hospitalization, information was collected on physical functioning, mental health and sleep. Sleep problems were assessed using the question "Was your sleep restless?" from the Centre for Epidemiologic Studies Depression Scale (CES-D). After 12 months the researchers recorded the number and cause of unplanned hospitalizations during the follow up period and assessed sleep again.

The researchers found that 215 patients (43%) had sleep problems at discharge from the initial hospitalization and nearly one-third (30%) had continued sleep problems at 12 months. Patients with continued sleep problems were two times more likely to be hospitalized during the follow up period than those without any sleep problems. Risk was double for all-cause hospitalizations and for cardiovascular hospitalizations. The results were adjusted for physical and mental health factors to ensure that the association was real.

Of the 284 patients without sleep problems at initial discharge, 14% developed a sleep problem during the follow up period. There was a trend for these patients to have more cardiovascular hospitalizations than patients without sleep problems but the finding was not significant.

Dr Johansson said: "Our finding that consistently poor sleep leads to twice as many hospitalizations in patients with heart failure underlines the impact that sleep can have on health. In Sweden we don't generally ask our heart failure patients about sleep and this study shows that we should. If patients say their sleep is poor that may be a warning signal to investigate the reasons."

He added: "Patients may have poor sleep hygiene, which means they do things that prevent them from getting a good night's sleep. These include drinking coffee or too much alcohol late at night, having a bedroom that is too hot or too cold, or having upsetting conversations before going to bed."

Dr Johansson continued: "Patients need to have realistic expectations. One night of poor sleep is unlikely to be a cause for concern, and sleep patterns naturally change with age. But patients who say they consistently have poor sleep should be taken seriously. To help the patients, health professionals for example can look at their medications or send them to a sleep lab for a sleep apnea investigation."

There are a number of possible explanations for the observed association between poor sleep and increased hospitalizations in patients with heart failure. Previous studies have shown that poor sleep can increase inflammatory activity and levels of stress hormones, both of which accelerate the progression of heart failure. It is also known that poor sleep is related to psychological distress, and it could be that these patients worry more about changes to their health and are more likely to visit the hospital.

Dr Johansson said: "Poor sleep may itself lead to worsening heart failure and increased hospitalizations. Alternatively it could be a signal that patients have other problems like sleep apnoea or psychological distress that are keeping them awake. All heart failure patients should be asked about sleep so that if there is a problem we can find out what it is and provide treatment."

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Study: Maternal infections increase child's autism risk

A study found that a pregnant woman with a bacterial infections diagnosed in the hospital had a higher risk of the child being diagnosed with autism.

Hospital-diagnosed maternal bacterial infections during pregnancy were associated with an increased risk of autism spectrum disorders in children, according to a Kaiser Permanente study published Dec. 23 in the Journal of Autism and Developmental Disorders.

The research contributes new evidence to a body of scientific literature on the role of infection in autism risk and points to areas for further examination.

The study included 407 children with autism and 2,075 matched children who did not have autism. The study included infants born between January 1995 and June 1999 who remained members of the Kaiser Permanente health plan for at least two years following birth.

"Though infections in pregnant women are fairly common, in this study most were not associated with an increased risk of autism," said Lisa A. Croen, PhD, research scientist with the Kaiser Permanente Division of Research and senior author of the study. "Only bacterial infections diagnosed in the hospital were associated with an increased risk."

"Infections diagnosed in a hospital setting were more common among mothers of children who developed an ASD compared with mothers of children who did not develop an ASD," Croen further explained.

Women with bacterial infections diagnosed during a hospitalization (including of the genitals, urinary tract and amniotic fluid) had a 58 percent greater risk of having a child with an ASD. While not very common in any of the mothers studied (1.5 percent of mothers of a child with ASD vs. 0.5 percent of mothers of a child without ASD), infections diagnosed during a hospitalization in the second trimester were associated with children having more than a three-fold increased risk of developing ASD.

"Infections diagnosed in an inpatient setting may represent more severe infections, and these were associated with increased risk of ASD," said Ousseny Zerbo, PhD, research fellow with the Kaiser Permanente Division of Research and the study's lead author.

While the mechanism for how maternal infections may influence autism risk has not been firmly established, Zerbo said animal tests have shown that immune-system responses to infections during pregnancy may influence the neurological development of the fetus.

"Our findings indicate that although most infections during pregnancy were not associated with autism in the child, there appears to be some increased risk for autism," Zerbo said. "It would be prudent for pregnant women to contact their doctor if they suspect an infection."

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Dissolvable brain sutures may treat brain infections

A new theory claims that dissolvable brain sutures that are already used can be modified to contain antibiotics and treat brain infections thus reducing hospital stay length.

A plastic material already used in absorbable surgical sutures and other medical devices shows promise for continuous administration of antibiotics to patients with brain infections, scientists are reporting in a new study. Use of the material, placed directly on the brain's surface, could reduce the need for weeks of costly hospital stays now required for such treatment, they say in the journal ACS Chemical Neuroscience.

Shih-Jung Liu and colleagues explain that infections are life-threatening complications that occur in about 5-10 percent of patients who have brain surgery. Current treatment involves intravenous antibiotics for up to eight weeks and extended, costly hospital stays. Previous studies showed that drug-delivering plastics could release antibiotics directly into the brain. However, additional surgery was needed to remove the plastic when treatment finished. Liu's team sought to develop a biodegradable version using a dissolvable plastic called PLGA.

They describe development of PLGA fibers that release vancomycin, a powerful antibiotic that kills many microbes, including the infamous "MRSA," which shrugs off most other known antibiotics. They tested the fibers in rats, which are stand-ins for humans in these types of studies. The fibers successfully released vancomycin for more than eight weeks in the brain and did so without apparent side effects.

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New Technology: Tiny Microchip that can Detect an Epileptic Seizure

A new microchip is being developed that could result in epileptic patients staying in the hospital less. It would be especially useful for children.


A hi-tech medical patch being developed in Abu Dhabi should soon help epileptics avoid long stays in hospital.

The 50fil adhesive microchip, the work of a researcher at the Masdar Institute, monitors epileptic seizures.

It will allow doctors to keep a close eye on patients for up to two weeks without the need for them to stay in hospital attached to a cumbersome and uncomfortable electroencephalograph (EEG) machine.

It would be applied to the forehead and is expected to be smaller in size than three grains of rice.

Currently, doctors often have to rely on patients' own descriptions of their seizures. But their recollections of events under such circumstances are notoriously unreliable.

The chip, which detects rapid eye movements - the early sign of an epileptic seizure - will give doctors a far more accurate picture of what happened, from the length of an attack to its severity.

The patch is the work of Dr Jerald Yoo, a circuit designer at the Masdar Institute, jointly funded by the Massachusetts Institute of Technology in the United States.

About 50 million people worldwide suffer from epilepsy. While no exact figure exists for the UAE, it is believed to be about 2 to 3 per cent of the population - more than 100,000 people.

Dr Yoo said the patch would be especially useful for children or babies, who cannot express what they have suffered.

The chip can also record seizures while asleep, of which patients might not even be aware.

"Doctors need to see raw information and data with their own eyes so they can make the right decisions, diagnoses and treatments.

"You need to learn the patient's seizure traits as they usually have one or two, which allows a more thorough diagnosis and treatment."

The Taiwan Semiconductor Manufacturing Company and the Abu Dhabi-owned Mubadala - which owns most of the chipmaker, Global Foundries - are looking to start making the chip by the end of this year.

Dr Sarmad Al Shamma, a neurologist at the Neuro Spinal Hospital in Dubai, said home monitoring would be good for doctors and patients alike.

"In addition to the discomfort of being in a hospital for more than 24 hours, there is a reduced possibility of an attack in the hospital because patients are lying in bed the entire time," he said.

"This often means they have to stay in the hospital for an even longer time. By monitoring them outside the hospital, we can learn what is triggering the attacks."

Epileptic seizures can be triggered in different patients by lack of sleep, stress, low blood sugar and flashing lights.

Dr Taoufik Al Sadi, the head of neurology at Sheikh Khalifa Medical City, said the chip could help fill "gaps in knowledge" about the condition.

"If this proves to be scientifically solid it would be an excellent addition to better understand the frequency and severity of the seizures, their duration," he said.

"It will allow better options for treatment based on solid, objective data, rather than relying on a patient's history and recollection."

He added that the chip could help reduce the stigma associated with epilepsy.

"Many sufferers feel deprived from basic privileges, such as driving a car and in some cases, going to school," said Dr Al Sadi.

"They find it difficult to be in social situations because they never know when they're going to have the next attack.

"But what they need to know is that after six months of treatment they can drive and resume their normal life."

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