Sleep apnea gets worse in the winter

Reuters – 13 hrs ago NEW YORK (Reuters Health) - The breathing problems caused by sleep apnea appear to worsen during the colder months of the year, according to a new study from Brazil.

People with the common sleep disorder stop breathing multiple times throughout the night, each bout lasting from seconds to minutes.

Jerome Dempsey, who studies breathing problems at the University of Wisconsin and was not involved in the new study, said it makes sense that airway infections and weather would have an effect on sleep apnea.

But the changes in sleep apnea across seasons are small, Dempsey added, and the study does not prove that winter weather in itself makes sleep apnea worse.

According to the National Heart, Lung, and Blood Institute, one in 10 adults over age 65 has sleep apnea.

Seasonal changes in weight and allergies can affect sleep apnea, and the Brazilian researchers, led by Cristiane Maria Cassol at Universidade Federal do Rio Grande do Sul, wanted to see if weather changes might also have any impact on the disorder.

They used data from patients who came in for testing at a sleep clinic on how many times their sleep was disturbed by breaks in breathing. The study included one night of sleep for more than 7,500 patients over a 10-year period.

The researchers then compared the severity of the patients' apnea to the weather conditions at the time, including humidity, temperature and air pollution.

Patients who came in during the colder months had more nighttime breaks in breathing than those who sought treatment during the warmer months. For instance, during the winter, patients stopped breathing an average of 18 times per hour, compared to 15 times an hour during the summer.

Similarly, the sleep clinic was more likely to see the most severe cases - people who stopped breathing more than 30 times an hour - in the colder months.

About 34 percent of patients who came in during cold weather had severe apnea, while 28 percent of patients during warm weather had severe apnea.

The team found that certain weather conditions - high atmospheric pressure and humidity and high levels of the air pollutant carbon monoxide - were tied to worse cases of apnea.

But the study could not determine whether it's the weather that's responsible for the more severe sleep apneas.

The researchers write in their report, published in the journal Chest, that more severe apnea in the winter "can be due to several circumstances, including winter-related upper-airway problems that intensify the severity of (sleep apnea) symptoms."

Another possibility is that wood burning to heat homes during the winter can cause irritation in the airways and aggravate sleep apnea.

"There are so many things that affect sleep apnea, including the decision of when to come visit" a sleep clinic, Dempsey told Reuters Health.

In other words, it might not be the weather, but the time of year that makes it more convenient for patients to take the time to seek treatment.

Dempsey said researchers would have to follow patients for at least a year and observe how their conditions change in order to say whether sleep apnea really does worsen in the winter.

While winter-related conditions such as colds or allergies might intensify sleep apnea, Dempsey said the biggest risk factor is obesity.

SOURCE: http://bit.ly/MqNmmE Chest, online June 14, 2012.

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Sleep apnea gets worse in the winter: study

Reuters – 3 hrs ago (Reuters) - Respiration problems in sleep apnea - which causes people to momentarily stop breathing multiple times throughout the night, for seconds to minutes at a time - appear to worsen during the colder months of the year, according to a study from Brazil.

Changes in weight and seasonal allergies can affect sleep apnea, and researchers writing in the journal Chest wanted to see if weather changes might also have an impact.

"More sleep disordered breathing events were recorded in wintertime than in other seasons," wrote study leader Cristiane Maria Cassol from the Universidade Federal do Rio Grande do Sul.

Cassol and her team said it could be due to several causes, including winter-related upper-airway problems that intensify the severity of symptoms and the use of burning wood to heat homes during the winter.

The team utilized data from sleep clinic patients and looked at how many times their rest was disturbed by breaks in breathing. The study included one night of sleep for more than 7,500 patients over a 10-year-period.

Researchers then compared the severity of the patients' apnea to the weather conditions at the time, including humidity, temperature and air pollution.

Patients who came in during colder months had more nighttime breaks in breathing than those who sought treatment during warmer months. During the winter, patients stopped breathing an average of 18 times an hour compared to 15 times an hour during the summer.

Similarly, the sleep clinic was more likely to see the most severe cases - people who stopped breathing more than 30 times an hour - during the colder months.

About 34 percent of patients who came in during cold weather had severe apnea, compared to 28 percent of patients during warmer weather.

The team found that certain weather conditions, such as high atmospheric pressure and humidity and high levels of the air pollutant carbon monoxide - were tied to worse cases of apnea.

But the study could not determine whether it was the weather itself that was responsible for the more severe apneas.

Jerome Dempsey, who studies breathing problems at the University of Wisconsin and wasn't involved in the study, said it makes sense that airway infections and weather could have an effect on sleep apnea, but that the changes across the seasons were small.

"There are so many things that affect sleep apnea, including the decision of when to come visit" a sleep clinic, Dempsey told Reuters Health.

In other words, it might not be the weather but the time of year that makes it more convenient for patients to take the time to seek treatment.

He added that while winter-related conditions such as colds or allergies might intensify sleep apnea, the biggest risk factor is obesity. SOURCE: http://bit.ly/MqNmmE

(Reporting from New York by Kerry Grens at Reuters Health; editing by Elaine Lies and Bob Tourtellotte)

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Poisoning at Afghan Girls School Proof that Violence Against Women Will Get Worse

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Scleroderma Complications Worse in Blacks Than Whites: Study

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Breast cancer is rare in men, but they fare worse

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Patients leaving hospital against advice fare worse

Reuters – 14 hrs ago NEW YORK (Reuters Health) - Hospital patients who leave against medical advice may have an increased risk of being readmitted or dying within a month, a study at one New York medical center finds.

In the U.S., about 500,000 hospital patients a year sign themselves out against medical advice.

Studies have suggested that decision can be unwise: patients hospitalized for asthma, HIV or a heart attack, for example, have been found to have an increased risk of readmission when they leave contrary to doctors' recommendations.

But the new study, reported in the American Journal of Medicine, suggests patients are also at increased risk of dying within 30 days of leaving against medical advice.

Researchers found that of 84,000 patients treated at their medical center, those who left against doctors' advice were more likely be readmitted within the next month: one-quarter of them ended up back in the hospital, versus 11 percent of patients who went home after a planned discharge.

They were also twice as likely to die: 1.3 percent died during the month after leaving the hospital, compared with 0.7 percent of patients with a planned discharge.

"That's the really sobering finding," said lead researcher Dr. William N. Southern, of Montefiore Medical Center and Albert Einstein College of Medicine in New York.

"These patients are not only at greater risk of readmission," he said, "they are also more likely to die in the next 30 days."

The exact reasons are not certain, Southern told Reuters Health.

Patients who signed out against medical advice tended to have a shorter hospital stay than patients with a planned discharge.

"So it may be that they aren't staying long enough to complete a course of treatment," Southern said in an interview. "But it may also be that they are not getting the follow-up care they may need."

The bottom line, according to Southern, is that people should be aware of the risks of leaving the hospital early.

That does not mean they have to follow "doctor's orders."

"Refusal of care is a patient's fundamental right," Southern said.

But, he added, patients do not always sign out because they don't want treatment. Often, it's for a personal obligation like work or caring for a family member.

The findings are based on 84,000 patients treated at Montefiore Medical Center between 2002 and 2008. That included 3,544 patients who signed out against medical advice.

Patients who checked out early were different from their counterparts in other ways too. For example, they were more likely to have a history of substance abuse or psychiatric conditions or to be on Medicaid, the government health insurance program for the poor.

But even when the researchers accounted for those differences, as well as factors like age and race, patients who left the hospital against advice still had twice the risk of dying.

Of course, the specific risks to any one person would depend on the illness being treated, overall health and other factors. "Our findings suggest that whatever your baseline (death) risk is -- whether it's high or low -- it would be twice as high if you leave the hospital against medical advice," Southern said.

A limitation of the study, though, is that it reflects a single medical center -- one located in a high-poverty area of New York. Southern said it's not known whether the results would be the similar at all hospitals.

But he said the findings do give hospital staff something to communicate to patients. Until now, it had not been clear whether discharge against medical advice was associated with death risk specifically.

"Now we know that it is," Southern said.

SOURCE: http://bit.ly/JcvCbG American Journal of Medicine, online April 17, 2012.

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