Topics of the week:
8. RES: A Randomized Controlled Trial on the Effectiveness of Mild Water-filtered Near Infrared Whole-body Hyperthermia as an Adjunct to a Standard Multimodal Rehabilitation in the Treatment of Fibromyalgia
[Return to digest index] --------------------------------------------- This is a special digest of Co-Cure Research & Medical posts only Problems? Write to mailto:email@example.com --------------------------------------------- ---------------------------------------------------------------------- Date: Tue, 6 Feb 2007 17:24:17 -0500 From: Co-Cure Moderator <ray CO-CURE.ORG> Subject: NOT,MED: March 10, 2007 NJCFSA Spring Conference & CAA's "kNOw MORE CFS" seminar There is a new, professionally rendered announcement for the March 10, 2007 conference co-hosted by the New Jersey CFS Association and the CFIDS Association of America available in PDF at http://www.co-cure.org/NJ.pdf [AOL: <a href="http://www.co-cure.org/NJ.pdf">Here</a>] We urge you to take a moment to look at it. The main points of the announcement are as follows: In March the New Jersey Chronic Fatigue Syndrome Association and the CFIDS Association of America will join forces to bring you a special event that combines the spring conference of the NJCFSA with the CFIDS Association’s popular kNOw MORE CFS seminar series. Date: Saturday, March 10, 2007 Place: Robert Wood Johnson University Hospital Time: 11:00 a.m. to 5:15 p.m. The conference will include three key sessions: 1) The CFS Public Awareness Campaign session. This session will include a showing of the campaign public service announcements, video clips of key media coverage and an overview of campaign goals and highlights from CFIDS Association president and CEO Kimberly McCleary. In addition, Jacqueline Niederle and Brian Bernard, two photo exhibit participants, will share their personal experiences as patients and advocates. 2) Research session. Dr. Nancy Klimas, University of Miami 3) Clinical session. Dr. Alan Pocinki, internal medicine practice The new traveling CFS photo exhibit, “The Faces of Chronic Fatigue Syndrome,” will be displayed from March 9-12 in the Arline and Henry Schwartzman Courtyard (atrium) at Robert Wood Johnson University Hospital, in New Brunswick, New Jersey. It can be viewed by conference participants on March 10. The compelling exhibit features portraits and stories of patients (including three past and present NJCFSA members), family members and health care professionals. It’s part of the national CFS Public Awareness Campaign sponsored by the CDC and the CFIDS Association of America. Mark your calendars and save the date! Additional information is available on the NJCFSA website at www.njcfsa.org and on the CFIDS Association of America’s website at www.cfids.org. Early registration is recommended as seating is limited. [Thanks to Eileen Holderman, Chair of the NJCFSA Publicity Committee for providing us with the PDF document.] [Return to top] ------------------------------ Date: Tue, 6 Feb 2007 19:45:20 -0500 From: "Diane Rose <diane dianerose.com> via Co-Cure Moderator" Subject: NOT,RES: Boston-based medical study seeks POTS subjects [US] Permission to re-post: Roy Freeman, MD and his research staff at the Center for Autonomic and Peripheral Nerve Disorders at Boston's Beth Israel Deaconess Medical Center (a teaching hospital of Harvard Medical School) are conducting a number of studies of patients with POTS (Postural Tachycardia Syndrome) and they are actively seeking subjects (who have postural tachycardia syndrome). This is how they describe the studies: "The aim of our research project is to identify the possible pathophysiological mechanisms of the postural tachycardia syndrome by applying an integrated physiological-experimental approach. The approach includes carotid artery and brachial artery ultrasound examination, different autonomic evaluation techniques such as arterial baroreflex assessment, cardiovascular response monitoring to different stress tests, calf blood flow measurement and sympathetic nerve activity recording. The research study also includes pharmacological assessment of the arterial baroreflex function and the increase of this parasympathetic control by low dose atropine and losartan. Using all of these techniques, our research study provides information simultaneously about several aspects of the cardiovascular autonomic control mechanisms in postural tachycardia syndrome and facilitates our understanding of the sympathetic vascular and cardiac autonomic controls in this disorder. The research study consists of a screening visit and 4 study visits [to Boston's Beth Israel Deaconess Medical Center]. it is optional to stay in the hospital before [or during] the study days. Discontinuation of medications may be necessary for the study but you may discontinue any medication only with the approval of your Primary Care Physician and Dr. Freeman." The studies appear to be quite flexible and you can choose to do some, all or none of the pieces of it. There is modest compensation for your time. If you would like to find out more about the study, please contact Dr. Bonyhay (MD, PhD Research Fellow) at 617-632-0646. [Return to top] ------------------------------ Date: Wed, 7 Feb 2007 12:45:13 +0000 From: Maggie Wallace <zen38947 ZEN.CO.UK> Subject: RES,MED: IACFS Prof Conf I: Cardiovascular and Exercise Studies Posted on behalf of cort johnson <phoenixcfs yahoo.com> Welcome to another Special Edition of Phoenix Rising. This issue begins the coverage of the Professional Section of the exciting 8th IACFS Conferrence held in Fort Lauderdale, Florida from Jan 12th-14. This section provides an overview of the Introduction to the Fatigue Section and to studies on Cardiovascular/Vascular and Exercise Testing . These studies appear to indicate that some things are starting to come together in CFS reserach, Keep your eye open for studies implicating the cardiovascular sytem, infllammation and the mitochondria. The next section will be on the Brain and Genetics You can access this section by clicking on the below URL http://phoenix-cfs.org/PR%20Sp%20Ed%20IACFS%20I%20Cardio%20Exercise.htm Please subscribe to Phoenix Rising! Happy reading! Cort [Return to top] ------------------------------ Date: Wed, 7 Feb 2007 14:53:29 -0500 From: Co-Cure Moderator <ray CO-CURE.ORG> Subject: NOT,RES: Neurobiological Differences Found in CFS Neurobiological Differences Found in CFS At the recent IACFS conference, researcher Paul Nestadt described findings from a study of neurometabolites in CFS undertaken by a team of researchers led by Dr. Dikoma Shungu and funded by the CFIDS Association. In an attempt to understand the neurobiological effects of CFS and to discern potential biomarkers for the illness, these researchers used cross-sectional neuroimaging to compare regional brain metabolite levels and to examine the association of the neurochemical findings with the symptomology of the illness. Read the complete article at http://www.cfids.org/cfidslink/2007/neurobiological.asp [Return to top] ------------------------------ Date: Wed, 7 Feb 2007 15:22:35 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Enhanced feedback sensitivity to prednisolone in chronic fatigue syndrome Enhanced feedback sensitivity to prednisolone in chronic fatigue syndrome. Journal: Psychoneuroendocrinology. 2007 Feb 2; [Epub ahead of print] Authors: Jerjes WK, Taylor NF, Wood PJ, Cleare AJ. Affiliation: Department of Clinical Biochemistry, Guy's, King's and St Thomas' School of Medicine, Bessemer Road, London SE5 9RS, UK. NLM Citation: PMID: 17276605 Objective: Enhancement of negative feedback control of the HPA axis in patients with chronic fatigue syndrome (CFS) has been reported using the low dose dexamethasone suppression test. We have developed the use of prednisolone (5mg) as a more physiologically appropriate alternative to dexamethasone in the investigation of mild degrees of glucocorticoid resistance or supersensitivity. The objective of the study was to use this test to look for alterations in negative feedback control of the HPA axis in CFS patients. Methods: Fifteen patients with CFS were recruited after fulfilling strict criteria including the absence of comorbid psychiatric diagnosis. They collected urine between 0900 and 1800h and saliva at 0900h pre-prednisolone. At midnight, they took prednisolone (5mg) orally and then collected urine and saliva at the same intervals the following day. Results: Salivary cortisol was lower in CFS subjects pre-prednisolone than controls. Urinary cortisol metabolites were lower in CFS subjects pre-prednisolone, but did not reach significance. Both measures were significantly lower in CFS subjects post-dose. Mean percentage suppression of both salivary cortisol and urinary cortisol metabolites was significantly higher in CFS compared to controls. Conclusion: There is enhanced sensitivity of the HPA axis to negative feedback in CFS as demonstrated using the prednisolone suppression test. This provides further evidence of alterations in the control of the HPA axis in patients with established CFS. [Return to top] ------------------------------ Date: Thu, 8 Feb 2007 13:53:04 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: An 'Overwhelming Illness': Women's Experiences of Learning to Live with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis An 'Overwhelming Illness': Women's Experiences of Learning to Live with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Journal: J Health Psychol. 2007 Mar;12(2):203-14. Edwards CR, Thompson AR, Blair A. Barnsley Primary Care Trust, UK. firstname.lastname@example.org. NLM Citation: PMID: 17284485 The processes through which people learn to live with CFS/ME are poorly understood and have not been rigorously explored within the literature. Semi- structured interviews were conducted with eight women and analysed using interpretative phenomenological analysis. Participants initially described being 'overwhelmed' by CFS/ME. Attempts at seeking help were unsatisfactory and participants described feeling let down and disbelieved. Participants reacted to this by identifying types of 'self-help' and assertively taking more responsibility for their illness and its treatment. Acquiring social support and greater knowledge were key mediating factors in the emergence of control and acceptance. The relevance of the themes to existing research and the implications for clinical practice are considered. [Return to top] ------------------------------ Date: Thu, 8 Feb 2007 14:14:25 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Fibromyalgia treatment update Fibromyalgia treatment update. Curr Opin Rheumatol. 2007 Mar;19(2):111-7. Rooks DS. Division of Rheumatology and the Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. PMID: 17278924 PURPOSE OF REVIEW: Fibromyalgia is a common chronic pain disorder characterized by complex symptomatology and few consistently effective treatments. The purpose of this review is to highlight the recent literature from April 2005 through September 2006 involving treatment options. RECENT FINDINGS: Prior evidence suggests that medication and self-management approaches to care can improve symptoms, function and well-being in this patient population. Recent studies examining the efficacy of two serotonin and norepinephrine-reuptake inhibitors - duloxetine and milnacipran - and the anticonvulsant pregabalin are encouraging. Studies evaluating different forms of exercise continue to support the belief that increased physical activity is an essential component of any treatment plan for the patient with fibromyalgia. Three studies added to the understanding of treatment adherence. Finally, three studies evaluating the efficacy of acupuncture in the treatment of fibromyalgia showed conflicting results, but added to the knowledge needed for clinicians to have substantive conversations with patients. SUMMARY: Recent studies support the recommendation of a multimodal approach to treatment involving individualized, evidence-based pharmacotherapy and self-management. Treatment goals should include the improvement of symptoms, primarily pain and sleep, and the promotion of positive health behaviors with the aim of improving physical function and emotional well-being. [Return to top] ------------------------------ Date: Thu, 8 Feb 2007 14:11:37 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: A Randomized Controlled Trial on the Effectiveness of Mild Water-filtered Near Infrared Whole-body Hyperthermia as an Adjunct to a Standard Multimodal Rehabilitation in the Treatment of Fibromyalgia A Randomized Controlled Trial on the Effectiveness of Mild Water-filtered Near Infrared Whole-body Hyperthermia as an Adjunct to a Standard Multimodal Rehabilitation in the Treatment of Fibromyalgia. Clin J Pain. 2007 Jan;23(1):67-75. Brockow T, Wagner A, Franke A, Offenbacher M, Resch KL. *Spa Medicine Research Institute Bad Elster, Lindenstr. 5, 08645 Bad Elster, Germany daggerRehabilitation Hospital Hoher Meissner, Hardtstr. 36, 37242 Bad Sooden-Allendorf double daggerDepartment of Medical Psychology at the University of Munich, 80336 Munchen. PMID: 17277647 OBJECTIVES: To evaluate whether mild water-filtered near infrared whole-body hyperthermia (NI-WBH) produces an additional benefit when applied as an adjunct to a standard multimodal rehabilitation (MR) compared with MR only in patients with fibromyalgia (FM). METHODS: One hundred thirty-nine patients of a German inpatient rehabilitation hospital meeting the ACR 1990 criteria for FM were randomly allocated to NI-WBH (heating-up to 38.1 degrees C body core temperature followed by a 15 min heat retention period) and MR or MR only, twice a week over 3 weeks. Main outcome measures were affective and sensory pain assessed by a German version of the McGill Pain Questionnaire, measured at baseline, postintervention, 3 and 6 months postintervention and analyzed by intention to treat. RESULTS: Repeated measures analysis of covariance showed significant differences between groups for both primary outcome measures in favor of NI-WBH and MR compared with MR only (P<0.001 for affective pain, P=0.001 for sensory pain). Secondary analyses on pain intensity, FM-related quality of life and tender point assessment yielded similar results. Moderate effect sizes were observed for all outcome measures considered (range, 0.41 to 0.75). NI-WBH related side effects were observed in 14 of 69 participants (20%) but all disappeared in less than 30 minutes. DISCUSSION: The study indicates that NI-WBH is a worthwhile adjunct to MR in the treatment of FM. [Return to top] ------------------------------ Date: Thu, 8 Feb 2007 14:17:33 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Pool exercise for individuals with fibromyalgia Pool exercise for individuals with fibromyalgia. Curr Opin Rheumatol. 2007 Mar;19(2):168-73. Gowans SE, Dehueck A. Allied Health, University Health Network; Department of Physical Therapy, University of Toronto; Therapy Services Department, Joseph Brant Memorial Hospital, Toronto, Ontario, Canada. PMID: 17278933 PURPOSE OF REVIEW: The benefits of general aerobic exercise for individuals with fibromyalgia have been established. Recently, there have been a number of randomized controlled trials that evaluate the benefits of pool exercise for fibromyalgia. This review will integrate the results of eight pool exercise studies that have been published in the last 7 years. RECENT FINDINGS: Pool exercise has been evaluated against sedentary control groups, land-based exercise and immersion in a warm, mineralized pool. Pool exercise has been shown to be as effective as land-based exercise and may have greater benefits with respect to mood and sleep duration. Based on follow-up studies, exercise-induced improvements in physical function, pain and mood may persist for up to 2 years. Pool exercise may be better tolerated as an initial means of exercise by individuals with arthritis in weight-bearing joints (because of water buoyancy) or by individuals who fear exercise will exacerbate their pain. SUMMARY: Pool exercise can be an effective intervention for individuals with fibromyalgia. Future studies should reassess subjects at multiple time points to determine the time course of exercise-induced improvements and further explore the effects of pool exercise on mood and sleep quality. [Return to top] ------------------------------ Date: Fri, 9 Feb 2007 11:59:21 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Cortisol and severe fatigue: A longitudinal study in adolescent girls Cortisol and severe fatigue: A longitudinal study in adolescent girls. Journal: Psychoneuroendocrinology. 2007 Feb 5; [Epub ahead of print] Authors: Ter Wolbeek M, van Doornen LJ, Coffeng LE, Kavelaars A, Heijnen CJ. Affiliations: Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Office KC03.068.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands; Department of Health Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands. NLM Citation: PMID: 17287088 Fatigue is a common complaint among adolescents, especially in girls, and is associated with high rates of school absenteeism. Severe fatigue is often accompanied by psychological and physical symptoms. In the chronic fatigue syndrome (CFS) functioning of the hypothalamic-pituitary-adrenal (HPA)-axis has previously been found to be altered. The aim of the present study was to investigate whether cortisol production is deviant in fatigued adolescent girls from the general population and to study longitudinal changes in fatigue in association with possible changes in HPA-axis functioning. In the cross-sectional part of the study the cortisol response to awakening (CAR) and to a low-dose oral dexamethasone were examined in a group of fatigued adolescent girls (n=87) in comparison to a non-fatigued control group (n=77). Questionnaires regarding fatigue, depression, anxiety, sleep quality, somatic symptoms and CFS-related symptoms were filled out. Follow up measurements were performed after 6 and 12 months. While the fatigued and non-fatigued group differed remarkably on all symptom self-reports, no differences between groups in CAR and response to dexamethasone were observed. Girls in the fatigued group remained fatigued over time and reported high levels of other psychological and physical symptoms during the whole year of the study. The CAR varied between time points but correlated non-systematically with situational characteristics or symptom reports. We conclude that trait-like fatigue, as measured in a sample of adolescent girls from a high school population, is not reflected in a dysregulation as assessed on the level of salivary cortisol after awakening. [Return to top] ------------------------------ Date: Fri, 9 Feb 2007 12:00:06 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Treatment approaches for painful bladder syndrome/interstitial cystitis Treatment approaches for painful bladder syndrome/interstitial cystitis. Drugs. 2007;67(2):215-35. Theoharides TC. Departments of Pharmacology and Experimental Therapeutics, Biochemistry and Internal Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA. PMID: 17284085 Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disease of unknown aetiology, characterised by severe pressure and pain in the bladder area or lower pelvis that is frequently or typically relieved by voiding, along with urgency or frequency of urination in the absence of urinary tract infections. PBS/IC occurs primarily in women, is increasingly recognised in young adults, and may affect as many as 0.1-1% of adult women. PBS/IC is often comorbid with allergies, endometriosis, fibromyalgia, irritable bowel syndrome and panic syndrome, all of which are worsened by stress. As a result, patients may visit as many as five physicians, including family practitioners, internists, gynaecologists, urologists and pain specialists, leading to confusion and frustration. There is no curative treatment; intravesical dimethyl sulfoxide, as well as oral amitriptyline, pentosan polysulfate and hydroxyzine have variable results, with success more likely when these drugs are given together. Pilot clinical trials suggest that the flavonoid quercetin may be helpful. Lack of early diagnosis and treatment can affect outcomes and leads to the development of hyperalgesia/allodynia. [Return to top] ------------------------------ Date: Fri, 9 Feb 2007 12:05:38 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Fibromylagia,Chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study Fibromylagia,Chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study. Psychopharmacol Bull. 2007 Winter;40(1):118-26. Young JL, Redmond JC. Rochester Center for Behavioral Medicine, Rochester Hills, MI. PMID: 17285103 Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints. [Return to top] ------------------------------ Date: Fri, 9 Feb 2007 12:33:46 -0500 From: "David Axford <axford worldonline.co.uk> via Co-Cure Moderator" Subject: NOT,RES: Latest ME Research The latest ME & CFS References are now available at: < http://freespace.virgin.net/david.axford/melist.htm> Click on the: "Latest Research" button which is in the left-hand column. You'll then see the "ME/CFS References " clearly marked 1st March 2007 in the right hand frame. This has a "NEW" graphic alongside. Click on the button (microscope on top of the globe). You may also find the article using the SEARCH tool which is on the home page. It is possible that your browser won't log on first time due to the large number of people who are accessing the web-site. Please be patient and try again at different times when it's less busy. [Return to top] ------------------------------ Date: Sat, 10 Feb 2007 18:17:58 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels? Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels? Growth Horm IGF Res. 2007 Feb 5; [Epub ahead of print] Yuen KC, Bennett RM, Hryciw CA, Cook MB, Rhoads SA, Cook DM. Department of Endocrinology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailcode L607, Portland, OR 97239-3098, USA. PMID: 17289417 OBJECTIVE: Fibromyalgia (FM) is characterized by diffuse pain, fatigue, and sleep disturbances; symptoms that resemble the adult growth hormone (GH) deficiency syndrome. Many FM patients have low serum GH levels, with a hypothesized aetiology of dysregulated GH/insulin-like growth factor (IGF)-I axis. The aim of this study was to assess the GH reserve in FM patients with low serum IGF-I levels using the GH-releasing hormone (GHRH)-arginine test. DESIGN: We retrospectively reviewed the GHRH-arginine data of 77 FM patients with low serum IGF-I levels referred to our tertiary unit over a 4-year period. RESULTS: Of the 77 FM patients, 13 patients (17%) failed the GHRH-arginine test. Further evaluation with pituitary imaging revealed normal pituitary glands (n=7), coincident microadenomas (n=4), empty sella (n=1) and pituitary cyst (n=1), and relevant medical histories such as previous head injury (n=4), Sheehan's syndrome (n=1), and whiplash injury (n=1). In contrast, the remaining 64 patients (83%) that responded to the GHRH-arginine test demonstrated higher peak GH levels compared to age and BMI-matched controls (n=24). CONCLUSION: Our data shows that a subpopulation of FM patients with low serum IGF-I levels will fail the GHRH-arginine test. We, thus, recommend that the GH reserve of these patients should be evaluated further, as GH replacement may potentially improve the symptomatology of those with true GH deficiency. Additionally, the increased GH response rates to GHRH-arginine stimulation in the majority of FM patients with low serum IGF-I levels further supports the hypothesis of a dysregulated GH/IGF-I axis in the pathophysiology of FM. [Return to top] ------------------------------ Date: Sun, 11 Feb 2007 00:56:36 +0000 From: Maggie Wallace <zen38947 ZEN.CO.UK> Subject: NOT,MED: Zolpidem, sold under the brand names Ambien, Stilnoct and Stilnox May be of interest to readers and subscribers taking sleep medication. Sleep medication linked to bizarre behaviour * 12:44 06 February 2007 * NewScientist.com news service * Roxanne Khamsi New evidence has linked a commonly prescribed sleep medication with bizarre behaviours, including a case in which a woman painted her front door in her sleep. UK and Australian health agencies have released information about 240 cases of odd occurrences, including sleepwalking, amnesia and hallucinations among people taking the drug zolpidem. http://www.newscientist.com/article/dn11115?DCMP=NLC-nletter&nsref=dn11115 The US Food and Drug Administration says it is continuing to "actively investigate" and collect information about cases linking zolpidem to unusual side effects. The Ambien label currently lists strange behaviour as a “special concern” for people taking the drug. “It’s a possible rare adverse event,” says Sanofi-Aventis spokesperson Melissa Feltmann, adding that the strange sleepwalking behaviours “may not necessarily be caused by the drug” but instead result from an underlying disorder. She says that “the safety profile [of zolpidem] is well established”. The drug received approval in the US in 1993. [Return to top] ------------------------------ Date: Sun, 11 Feb 2007 00:13:59 -0500 From: "Barbara Soliday <bsoliday miami.edu> via Co-Cure Moderator" Subject: NOT,MED: Sleep diagnosis without going to a sleep center This study may be good news if people want to try out a C-PAP machine without the expense and difficulty of going to a sleep center. Barbara Soliday ********* New York Times February 6, 2007 Vital Signs Diagnosis: An Easier Path to the Treatment of Sleep Apnea By ERIC NAGOURNEY http://www.nytimes.com/2007/02/06/health/06diag.html?adxnnl=1&adxnnlx=1171170213-L4bbR2JorCKutR4Mj6s0Rg People who have obstructive sleep apnea know how hard it can be to adjust to the breathing apparatus used to treat it. But just getting a diagnosis poses its own challenges, generally requiring two nights hooked up to wires in a sleep laboratory. Now researchers say there is an easier way that allows some patients to stay at home. Instead of going to a laboratory, patients who are good candidates for an apnea diagnosis are given treatment right away, with portable equipment being used to assess their response. Writing in the current Annals of Internal Medicine, the researchers say the method can speed up diagnoses and treatment for those with the disorder, which causes people to wake up repeatedly when they stop breathing. The condition can lead to fatigue, high blood pressure and other health problems. Patients thought to have sleep apnea are usually sent to specialized centers to be evaluated. Only after that are they given machines that send air into the lungs while they sleep, known as C-PAPs. But the visits are expensive, the waiting lists are long, and many people do not live near a sleep center. For the study (see http://www.annals.org/cgi/content/abstract/146/3/157 ), the researchers screened patients to come up with a group they considered at least 90 percent likely to have the condition. The patients were then given either a standard evaluation at a laboratory or an at-home one, with C-PAP use beginning immediately. When the patients were re-examined, researchers found that those who went to the laboratory did no better than the other patients, said Dr. C. Frank Ryan of the University of British Columbia, the senior author of the study. The lead author was Alan T. Mulgrew of the Vancouver Public Health System in Canada. [Return to top] ------------------------------
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