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Sleep Quality: A Key to Good Health

Sleep Quality: A Key to Good Health

A good night’s sleep is a key component of good health, but patients’ sleep history often receives little attention among clinicians. When a patient complains of sleep problems, practitioners often reflexively prescribe sleeping medications without in­quiring further. When academic sleep pioneers first performed sleep studies in the 1970s, it was soon evident that sleep is multifactorial and complex. More recent studies have revealed that cyclic alternating patterns intrude into deep sleep, thereby reducing its restorative quality. Practitioners who pose questions about sleep problems and sleep quality often find that patients will have difficulty falling and staying asleep, thus necessitating a two-pronged approach. Patients’ self-descriptions may suggest either a sleep disturbance or a systemic disease. A patient’s partner can be helpful in providing further history, such as snoring, periods of apnea, or restless legs. Impactful Consequences Many cases of disrupted sleep lead to fatigue, irritability, and depression. Normal worries and concerns can trigger insomnia, while PTSD can cause severe night terrors and vivid dreams, leading to major disruptions in quality of life. For some, blood pressure remains difficult to control until patients start sleeping more soundly. Sleep disturbance can also cause fibromyalgia and an increase in pain in other conditions, such as rheumatoid arthritis, osteo­arthritis, and systemic lupus erythematosis. Many patients fall asleep reasonably easily but then wake up a few hours later and are unable to fall back asleep. This leaves them feeling exhausted in the morning. To date, there are no prescription medications approved by the FDA to deepen sleep, though many physicians use a variety of medications “off-label” for this purpose. Encourage Good Sleep Hygiene The cornerstone...
Insomnia & Healthcare Use in Older Adults

Insomnia & Healthcare Use in Older Adults

Insomnia affects approxi­mately half of all older adults. Research suggests that insomnia may be underdetected and undertreated in clinical settings. While many older adults report difficulty sleeping, only about 10% are actually treated for a sleep disorder. In addition, older adults are high consumers of health services, with a substantial proportion of spending coming from hospitalizations, home healthcare services, and nursing home use. Focusing on Older Patients Previous studies have explored the relationship between insomnia and healthcare services use, but most have used clinical samples or focused on younger individuals. My colleagues and I, led by doctoral student Christopher Kaufmann, MHS, published a study in the Journal of Gerontology: Medical Sciences that examined the association between insomnia and the subsequent use of three different health services in a representative sample of middle-aged and older people. The study involved 14,355 participants in the Health and Retirement Study who were asked about their insomnia symptoms in 2006 and responded to questions about health service use 2 years later, including whether or not they had been hospitalized, used home healthcare, or used nursing home services. Specific insomnia symptoms included trouble falling asleep, waking during the night, waking early and not falling asleep again, and not feeling rested when wakening. We found that insomnia symptoms were associated with greater odds of subsequently using costly health services. Those with two or more insomnia symptoms were more likely to be hospitalized and to use home healthcare services. Even after accounting for common medical conditions and depressive symptoms, we observed an association between insomnia symptoms and use of any of the three health services assessed in...
Key Factors in Weight Gain After Pediatric Tonsillectomy

Key Factors in Weight Gain After Pediatric Tonsillectomy

Studies have indicated that adenotonsillectomy may be associated with significant weight gain after surgery, a problem that can be concerning for both parents and patients. Previous research also suggests that the postoperative weight gain associated with adenotonsillectomy occurs mostly in children who undergo the procedure as treatment for diagnosed obstructive sleep apnea (OSA). “Potentially worrisome weight gains following adenotonsillectomy occurred primarily in children under the age of 6 years who were underweight or normal weight to begin with.” At the 2012 annual meeting of the American Academy of Otolaryngology–Head and Neck Surgeons, my colleagues and I presented data from a study involving a large population of children undergoing adenotonsillectomy and the demographic factors that may contribute to weight gain. We analyzed medical records of children aged 6 months to 18 years who had their tonsils removed between 2008 and 2011. These data were then refined to only include medical records for children who were routinely examined for at least 6 months after their surgery and had recorded height and weight measurements. All patients in the study had a history of OSA or recurrent tonsillitis. Who’s At Risk for Weight Gain? Results of our analysis showed that, on average, patients had a weight gain of 0.5 to 2.0 lbs— equivalent to a 0.4- to 0.6-point increase in BMI scores—after their surgery. Importantly, the gains that were observed were not dependent on whether the children had OSA or recurrent tonsillitis. In a multiple linear regression analysis that controlled for gender and height, only age was significantly and negatively associated with changes in BMI. Potentially worrisome weight gains following adenotonsillectomy occurred primarily...

Cardiovascular Mortality in OSA Among the Elderly

Severe obstructive sleep apnea (OSA) that is not treated with continuous positive airway pressure (CPAP) appears to be associated with cardiovascular death in the elderly, according to Spanish research. When compared with a control group, those with untreated severe OSA had a hazard ratio of 2.25 for cardiovascular mortality, compared with 0.93 for those treated with CPAP and 1.38 for those with untreated mild to moderate OSA. Abstract: American Journal of Respiratory & Critical Care Medicine, November 1,...

Overnight Admissions After Younger Pediatric Tonsillectomy

In 1996, the American Academy of Pediatrics and the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) released guidelines indicating that children younger than 3 be admitted overnight for postoperative observation. Studies had shown that young patients were at greater risk for postoperative complications that required readmission and inpatient care. Newer surgical techniques for tonsillectomy have helped to decrease the incidence of primary hemorrhage and shorten recovery time. More recent studies looking at complications with tonsillectomy in the very young—in addition to institutional and personal experiences in the operative setting—have caused some clinicians to question the need for overnight admission in these patients. In our experience, many patients who were electively admitted overnight met all of the criteria to be discharged home within 6 hours of their surgery.  A New Retrospective Review of Tonsillectomy More data are needed to establish an evidence-based justification for challenging the longstanding guidelines from AAOHNS. In the March 19, 2012 Archives of Otolaryngology—Head & Neck Surgery, my colleagues and I had a study published in which we retrospectively examined the outcomes of tonsillectomy performed in children under the age of 3. We recorded the complications they experienced. Among the 86 patients whose medical records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Complications after tonsillectomies were generally mild and typically linked to dehydration. Our study’s overall complication rate was beneath the 10% ceiling that has been deemed acceptable for ambulatory procedures by some in the field. Results from another study have reinforced our findings. Key Contributors for Success in Young Children Several factors likely contributed to the low rate of...
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