Heidi Splete

MINNEAPOLIS – Metabolic changes and comorbid conditions are just a few of the factors that challenge clinicians when they treat insomnia in older adults.

“The predictability of your giving drug X to patient A and knowing what is going to happen goes way down. That's the bottom line,” said Dr. Daniel Buysse, a professor of psychiatry and the director of the Clinical Neuroscience Research Center at the University of Pittsburgh.

The physiologic changes that occur with aging affect how the body absorbs medication, he said at the annual meeting of the Associated Professional Sleep Societies.

“As we get older, our lean body mass decreases and our adipose tissue increases,” he noted. Because the drugs used to treat insomnia are lipid soluble, older adults who have a greater proportion of adipose tissue will store the drug longer before processing it through the body, Dr. Buysse explained. Consequently, older patients may have more residual sleepiness the next day after taking a sleep medication the previous night, and their dosages may need adjustment.

Hypnotics have shown effectiveness in treating insomnia in adults, but be aware that the measured blood concentrations of drugs are much more variable in an older population, Dr. Buysse said. In addition, some studies have shown that hypnotics are associated with cognitive and psychomotor problems in older patients.

Antidepressants such as trazodone may be helpful for some patients; but be aware of the risks of dizziness, which could lead to falls, and the risk of oversedation because of older adults' slower metabolisms.

Choosing insomnia medications for older adults is tricky, said Dr. Alon Avidan, a neurologist at the University of California, Los Angeles. Drugs have their risks, but untreated insomnia can be just as risky, because it has been linked to an increased risk of falls in older adults. Elderly people who wake up at night are likely to get out of bed, which means that they are at greater risk for falls than older adults who are able to sleep longer.

In fact, hypnotics may be protective in preventing falls in older adults with insomnia, Dr. Avidan said, based on data from his study of more than 34,000 nursing home residents with an average age of 84 years (J. Am. Geriatr. Soc. 2005;53:955–62).

The patients with untreated insomnia were 30% more likely to fall, compared with those who were treated with hypnotics. But treating insomnia had no measurable effect on the patients' risk for hip fractures, Dr. Avidan noted.

Dr. Buysse shared his top clinical considerations when choosing drug therapies for elderly patients with insomnia.

First, keep expectations realistic, he advised. “The fact that older adults have comorbidities may limit how well we can do with our treatments,” he noted.

Second, remind patients that insomnia medication is not a general anesthesia. “Some older adults look at sleep as a behavioral alternative when they run out of things to do,” Dr. Buysse said.

In addition, remember that no evidence-based treatment guidelines exist to direct treatment of insomnia in older adults.

“We have not the least idea how to match a particular treatment to a patient, and we don't really know what constitutes a clinically significant response,” Dr. Buysse said. Findings from a recent meta-analysis suggest that many of the drugs currently available for treating insomnia have not shown consistent effectiveness in improving sleep in older adults (Ann. Clin. Psychiatry 2006;18:49–56).

Dr. Buysse recommended starting with a benzodiazepine receptor agonist, and then switching to a sedating antidepressant if the benzodiazepine doesn't help. “When people still don't improve, you could start moving to other methods such as behavioral therapy,” he said.

More research is needed to understand how to combine drug therapy with behavior therapy to treat insomnia in older adults, he added.

The measured blood concentrations of drugs might be more variable in older populations. DR. BUYSSE

MINNEAPOLIS – Metabolic changes and comorbid conditions are just a few of the factors that challenge clinicians when they treat insomnia in older adults.

“The predictability of your giving drug X to patient A and knowing what is going to happen goes way down. That's the bottom line,” said Dr. Daniel Buysse, a professor of psychiatry and the director of the Clinical Neuroscience Research Center at the University of Pittsburgh.

The physiologic changes that occur with aging affect how the body absorbs medication, he said at the annual meeting of the Associated Professional Sleep Societies.

“As we get older, our lean body mass decreases and our adipose tissue increases,” he noted. Because the drugs used to treat insomnia are lipid soluble, older adults who have a greater proportion of adipose tissue will store the drug longer before processing it through the body, Dr. Buysse explained. Consequently, older patients may have more residual sleepiness the next day after taking a sleep medication the previous night, and their dosages may need adjustment.

Hypnotics have shown effectiveness in treating insomnia in adults, but be aware that the measured blood concentrations of drugs are much more variable in an older population, Dr. Buysse said. In addition, some studies have shown that hypnotics are associated with cognitive and psychomotor problems in older patients.

Antidepressants such as trazodone may be helpful for some patients; but be aware of the risks of dizziness, which could lead to falls, and the risk of oversedation because of older adults' slower metabolisms.

Choosing insomnia medications for older adults is tricky, said Dr. Alon Avidan, a neurologist at the University of California, Los Angeles. Drugs have their risks, but untreated insomnia can be just as risky, because it has been linked to an increased risk of falls in older adults. Elderly people who wake up at night are likely to get out of bed, which means that they are at greater risk for falls than older adults who are able to sleep longer.

In fact, hypnotics may be protective in preventing falls in older adults with insomnia, Dr. Avidan said, based on data from his study of more than 34,000 nursing home residents with an average age of 84 years (J. Am. Geriatr. Soc. 2005;53:955–62).

The patients with untreated insomnia were 30% more likely to fall, compared with those who were treated with hypnotics. But treating insomnia had no measurable effect on the patients' risk for hip fractures, Dr. Avidan noted.

Dr. Buysse shared his top clinical considerations when choosing drug therapies for elderly patients with insomnia.

First, keep expectations realistic, he advised. “The fact that older adults have comorbidities may limit how well we can do with our treatments,” he noted.

Second, remind patients that insomnia medication is not a general anesthesia. “Some older adults look at sleep as a behavioral alternative when they run out of things to do,” Dr. Buysse said.

In addition, remember that no evidence-based treatment guidelines exist to direct treatment of insomnia in older adults.

“We have not the least idea how to match a particular treatment to a patient, and we don't really know what constitutes a clinically significant response,” Dr. Buysse said. Findings from a recent meta-analysis suggest that many of the drugs currently available for treating insomnia have not shown consistent effectiveness in improving sleep in older adults (Ann. Clin. Psychiatry 2006;18:49–56).

Dr. Buysse recommended starting with a benzodiazepine receptor agonist, and then switching to a sedating antidepressant if the benzodiazepine doesn't help. “When people still don't improve, you could start moving to other methods such as behavioral therapy,” he said.

More research is needed to understand how to combine drug therapy with behavior therapy to treat insomnia in older adults, he added.

The measured blood concentrations of drugs might be more variable in older populations. DR. BUYSSE

MINNEAPOLIS – Metabolic changes and comorbid conditions are just a few of the factors that challenge clinicians when they treat insomnia in older adults.

“The predictability of your giving drug X to patient A and knowing what is going to happen goes way down. That's the bottom line,” said Dr. Daniel Buysse, a professor of psychiatry and the director of the Clinical Neuroscience Research Center at the University of Pittsburgh.

The physiologic changes that occur with aging affect how the body absorbs medication, he said at the annual meeting of the Associated Professional Sleep Societies.

“As we get older, our lean body mass decreases and our adipose tissue increases,” he noted. Because the drugs used to treat insomnia are lipid soluble, older adults who have a greater proportion of adipose tissue will store the drug longer before processing it through the body, Dr. Buysse explained. Consequently, older patients may have more residual sleepiness the next day after taking a sleep medication the previous night, and their dosages may need adjustment.

Hypnotics have shown effectiveness in treating insomnia in adults, but be aware that the measured blood concentrations of drugs are much more variable in an older population, Dr. Buysse said. In addition, some studies have shown that hypnotics are associated with cognitive and psychomotor problems in older patients.

Antidepressants such as trazodone may be helpful for some patients; but be aware of the risks of dizziness, which could lead to falls, and the risk of oversedation because of older adults' slower metabolisms.

Choosing insomnia medications for older adults is tricky, said Dr. Alon Avidan, a neurologist at the University of California, Los Angeles. Drugs have their risks, but untreated insomnia can be just as risky, because it has been linked to an increased risk of falls in older adults. Elderly people who wake up at night are likely to get out of bed, which means that they are at greater risk for falls than older adults who are able to sleep longer.

In fact, hypnotics may be protective in preventing falls in older adults with insomnia, Dr. Avidan said, based on data from his study of more than 34,000 nursing home residents with an average age of 84 years (J. Am. Geriatr. Soc. 2005;53:955–62).

The patients with untreated insomnia were 30% more likely to fall, compared with those who were treated with hypnotics. But treating insomnia had no measurable effect on the patients' risk for hip fractures, Dr. Avidan noted.

Dr. Buysse shared his top clinical considerations when choosing drug therapies for elderly patients with insomnia.

First, keep expectations realistic, he advised. “The fact that older adults have comorbidities may limit how well we can do with our treatments,” he noted.

Second, remind patients that insomnia medication is not a general anesthesia. “Some older adults look at sleep as a behavioral alternative when they run out of things to do,” Dr. Buysse said.

In addition, remember that no evidence-based treatment guidelines exist to direct treatment of insomnia in older adults.

“We have not the least idea how to match a particular treatment to a patient, and we don't really know what constitutes a clinically significant response,” Dr. Buysse said. Findings from a recent meta-analysis suggest that many of the drugs currently available for treating insomnia have not shown consistent effectiveness in improving sleep in older adults (Ann. Clin. Psychiatry 2006;18:49–56).

Dr. Buysse recommended starting with a benzodiazepine receptor agonist, and then switching to a sedating antidepressant if the benzodiazepine doesn't help. “When people still don't improve, you could start moving to other methods such as behavioral therapy,” he said.

More research is needed to understand how to combine drug therapy with behavior therapy to treat insomnia in older adults, he added.

The measured blood concentrations of drugs might be more variable in older populations. DR. BUYSSE

BALTIMORE — Obstructive sleep apnea is associated with significant morbidity among hospital inpatients, based on a review of about 60,000 hospitalized patients at a single facility during a 2-year period.

“Our goal was to characterize the frequency with which OSA patients needed acute care,” said Dr. Lisa Wolfe of the division of pulmonary medicine at Northwestern University, Chicago. She presented the results at the annual meeting of the Associated Professional Sleep Societies.

Increased morbidity has been linked with OSA in outpatients, but the impact of OSA on inpatients has not been well studied, Dr. Wolfe said. The Joint Commission has asked the medical community to comment on how to curb postoperative complications in patients with OSA, she noted.

Dr. Wolfe and her colleagues reviewed data on all patients hospitalized at Northwestern Memorial Hospital, Chicago, from September 2005 to May 2007. Acute care management was defined as rapid response team calls, code calls, or unplanned transfers to the intensive care unit. OSA was identified based on medical records.

Overall, 56 of 1,377 patients with OSA required action from a rapid response team, compared with 800 of 59,030 patients without OSA (4.1% vs. 1.4%). Significantly more patients with OSA required code calls, compared with patients without OSA (2.9% vs. 1.7%). On average, one patient with OSA underwent acute care management every 4.5 days.

“We know that OSA is a predictor for other health problems,” Dr. Wolfe said.

The study was limited by its use of medical records and by a lack of data on continuous positive airway pressure (CPAP) therapy, but the findings support results from previous studies and emphasize the need for enhanced monitoring of hospitalized patients with OSA to reduce their use of acute care resources, she noted.

The topic of OSA as a marker of increased mortality in hospitalized patients attracted national attention in the wake of a study conducted at the Mayo Clinic in Rochester, Minn., in 2001, Dr. Wolfe said. In that study, which included patients who had undergone surgeries for hip or knee replacements, patients with OSA were significantly more likely to have complications, compared with control patients without OSA. The complications often were serious and led to longer hospital stays.

Further studies are needed to explore ways to ensure patient safety and to assess the implications of improved monitoring strategies for hospitalized patients with OSA, Dr. Wolfe added. She reported that she had no financial conflicts to disclose.

BALTIMORE — Obstructive sleep apnea is associated with significant morbidity among hospital inpatients, based on a review of about 60,000 hospitalized patients at a single facility during a 2-year period.

“Our goal was to characterize the frequency with which OSA patients needed acute care,” said Dr. Lisa Wolfe of the division of pulmonary medicine at Northwestern University, Chicago. She presented the results at the annual meeting of the Associated Professional Sleep Societies.

Increased morbidity has been linked with OSA in outpatients, but the impact of OSA on inpatients has not been well studied, Dr. Wolfe said. The Joint Commission has asked the medical community to comment on how to curb postoperative complications in patients with OSA, she noted.

Dr. Wolfe and her colleagues reviewed data on all patients hospitalized at Northwestern Memorial Hospital, Chicago, from September 2005 to May 2007. Acute care management was defined as rapid response team calls, code calls, or unplanned transfers to the intensive care unit. OSA was identified based on medical records.

Overall, 56 of 1,377 patients with OSA required action from a rapid response team, compared with 800 of 59,030 patients without OSA (4.1% vs. 1.4%). Significantly more patients with OSA required code calls, compared with patients without OSA (2.9% vs. 1.7%). On average, one patient with OSA underwent acute care management every 4.5 days.

“We know that OSA is a predictor for other health problems,” Dr. Wolfe said.

The study was limited by its use of medical records and by a lack of data on continuous positive airway pressure (CPAP) therapy, but the findings support results from previous studies and emphasize the need for enhanced monitoring of hospitalized patients with OSA to reduce their use of acute care resources, she noted.

The topic of OSA as a marker of increased mortality in hospitalized patients attracted national attention in the wake of a study conducted at the Mayo Clinic in Rochester, Minn., in 2001, Dr. Wolfe said. In that study, which included patients who had undergone surgeries for hip or knee replacements, patients with OSA were significantly more likely to have complications, compared with control patients without OSA. The complications often were serious and led to longer hospital stays.

Further studies are needed to explore ways to ensure patient safety and to assess the implications of improved monitoring strategies for hospitalized patients with OSA, Dr. Wolfe added. She reported that she had no financial conflicts to disclose.

BALTIMORE — Obstructive sleep apnea is associated with significant morbidity among hospital inpatients, based on a review of about 60,000 hospitalized patients at a single facility during a 2-year period.

“Our goal was to characterize the frequency with which OSA patients needed acute care,” said Dr. Lisa Wolfe of the division of pulmonary medicine at Northwestern University, Chicago. She presented the results at the annual meeting of the Associated Professional Sleep Societies.

Increased morbidity has been linked with OSA in outpatients, but the impact of OSA on inpatients has not been well studied, Dr. Wolfe said. The Joint Commission has asked the medical community to comment on how to curb postoperative complications in patients with OSA, she noted.

Dr. Wolfe and her colleagues reviewed data on all patients hospitalized at Northwestern Memorial Hospital, Chicago, from September 2005 to May 2007. Acute care management was defined as rapid response team calls, code calls, or unplanned transfers to the intensive care unit. OSA was identified based on medical records.

Overall, 56 of 1,377 patients with OSA required action from a rapid response team, compared with 800 of 59,030 patients without OSA (4.1% vs. 1.4%). Significantly more patients with OSA required code calls, compared with patients without OSA (2.9% vs. 1.7%). On average, one patient with OSA underwent acute care management every 4.5 days.

“We know that OSA is a predictor for other health problems,” Dr. Wolfe said.

The study was limited by its use of medical records and by a lack of data on continuous positive airway pressure (CPAP) therapy, but the findings support results from previous studies and emphasize the need for enhanced monitoring of hospitalized patients with OSA to reduce their use of acute care resources, she noted.

The topic of OSA as a marker of increased mortality in hospitalized patients attracted national attention in the wake of a study conducted at the Mayo Clinic in Rochester, Minn., in 2001, Dr. Wolfe said. In that study, which included patients who had undergone surgeries for hip or knee replacements, patients with OSA were significantly more likely to have complications, compared with control patients without OSA. The complications often were serious and led to longer hospital stays.

Further studies are needed to explore ways to ensure patient safety and to assess the implications of improved monitoring strategies for hospitalized patients with OSA, Dr. Wolfe added. She reported that she had no financial conflicts to disclose.

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members. The results were presented last month in a teleconference.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“We are still seeing some infection control professionals struggling to get the support they need,” said Kathy Warye, CEO of APIC. But the overall trend of the poll is encouraging, she said.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the APIC's Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members. The results were presented last month in a teleconference.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“We are still seeing some infection control professionals struggling to get the support they need,” said Kathy Warye, CEO of APIC. But the overall trend of the poll is encouraging, she said.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the APIC's Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members. The results were presented last month in a teleconference.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“We are still seeing some infection control professionals struggling to get the support they need,” said Kathy Warye, CEO of APIC. But the overall trend of the poll is encouraging, she said.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the APIC's Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Complications including gestational diabetes, placenta previa, and hypertension occurred in 41% of assisted reproductive technology pregnancies, based on data from 293 pregnancies.

“Increased fetal and maternal surveillance is warranted in these pregnancies,” wrote Dr. Elena Chinea and colleagues from the Centro de Asistencia a la Reproducción Humana de Canarias S.L., Santa Cruz de Tenerife, Spain, in a poster presented at the annual meeting of the American Society for Reproductive Medicine.

To determine the nature and incidence of adverse events for assisted reproductive technology (ART) pregnancies, as well as the effect of increasing maternal age, the researchers analyzed the rates of preexisting maternal conditions, pregnancy complications, labor and delivery complications, and perinatal outcomes in pregnancies from 1,056 cycles of in vitro fertilization with intracytoplasmic sperm injection.

Preexisting maternal conditions were noted in 15% of the women, and the incidence increased consistently from 10% in women under 31 years to 28% in women over 40 years. Gestational diabetes occurred in 18% overall (16% of singleton and 25% of twin pregnancies). But no age-related increases in rates of gestational diabetes or pregnancy-induced hypertension were seen.

As for labor and delivery complications, the overall incidence of premature labor was 13%, and the rate for twin pregnancies was double the rate for singleton pregnancies (20% vs. 10%). The average overall cesarean section rate was 49%, with an average of 40% in singleton pregnancies and an average of 77% for twin pregnancies.

Low birth weights occurred in 30% of the infants overall (11% of singletons, 51% of twins). Very low birth weights occurred in 4.5% of the infants overall (2% of singletons and 7% of twins).

WASHINGTON — Complications including gestational diabetes, placenta previa, and hypertension occurred in 41% of assisted reproductive technology pregnancies, based on data from 293 pregnancies.

“Increased fetal and maternal surveillance is warranted in these pregnancies,” wrote Dr. Elena Chinea and colleagues from the Centro de Asistencia a la Reproducción Humana de Canarias S.L., Santa Cruz de Tenerife, Spain, in a poster presented at the annual meeting of the American Society for Reproductive Medicine.

To determine the nature and incidence of adverse events for assisted reproductive technology (ART) pregnancies, as well as the effect of increasing maternal age, the researchers analyzed the rates of preexisting maternal conditions, pregnancy complications, labor and delivery complications, and perinatal outcomes in pregnancies from 1,056 cycles of in vitro fertilization with intracytoplasmic sperm injection.

Preexisting maternal conditions were noted in 15% of the women, and the incidence increased consistently from 10% in women under 31 years to 28% in women over 40 years. Gestational diabetes occurred in 18% overall (16% of singleton and 25% of twin pregnancies). But no age-related increases in rates of gestational diabetes or pregnancy-induced hypertension were seen.

As for labor and delivery complications, the overall incidence of premature labor was 13%, and the rate for twin pregnancies was double the rate for singleton pregnancies (20% vs. 10%). The average overall cesarean section rate was 49%, with an average of 40% in singleton pregnancies and an average of 77% for twin pregnancies.

Low birth weights occurred in 30% of the infants overall (11% of singletons, 51% of twins). Very low birth weights occurred in 4.5% of the infants overall (2% of singletons and 7% of twins).

WASHINGTON — Complications including gestational diabetes, placenta previa, and hypertension occurred in 41% of assisted reproductive technology pregnancies, based on data from 293 pregnancies.

“Increased fetal and maternal surveillance is warranted in these pregnancies,” wrote Dr. Elena Chinea and colleagues from the Centro de Asistencia a la Reproducción Humana de Canarias S.L., Santa Cruz de Tenerife, Spain, in a poster presented at the annual meeting of the American Society for Reproductive Medicine.

To determine the nature and incidence of adverse events for assisted reproductive technology (ART) pregnancies, as well as the effect of increasing maternal age, the researchers analyzed the rates of preexisting maternal conditions, pregnancy complications, labor and delivery complications, and perinatal outcomes in pregnancies from 1,056 cycles of in vitro fertilization with intracytoplasmic sperm injection.

Preexisting maternal conditions were noted in 15% of the women, and the incidence increased consistently from 10% in women under 31 years to 28% in women over 40 years. Gestational diabetes occurred in 18% overall (16% of singleton and 25% of twin pregnancies). But no age-related increases in rates of gestational diabetes or pregnancy-induced hypertension were seen.

As for labor and delivery complications, the overall incidence of premature labor was 13%, and the rate for twin pregnancies was double the rate for singleton pregnancies (20% vs. 10%). The average overall cesarean section rate was 49%, with an average of 40% in singleton pregnancies and an average of 77% for twin pregnancies.

Low birth weights occurred in 30% of the infants overall (11% of singletons, 51% of twins). Very low birth weights occurred in 4.5% of the infants overall (2% of singletons and 7% of twins).

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association, which emerged both in people living in nursing homes and in those in the community, remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during one night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

After controlling for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time. The analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” they wrote. In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The authors said the study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association, which emerged both in people living in nursing homes and in those in the community, remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during one night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

After controlling for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time. The analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” they wrote. In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The authors said the study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association, which emerged both in people living in nursing homes and in those in the community, remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during one night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

After controlling for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time. The analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” they wrote. In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The authors said the study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that contains strains from both B virus lineages, noted Dr. Robert Couch, a professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that contains strains from both B virus lineages, noted Dr. Robert Couch, a professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that contains strains from both B virus lineages, noted Dr. Robert Couch, a professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from about 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association—which emerged both among people living in nursing homes and in those in the community—remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women with an average age of 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting (Sleep 2008;31:224–30).

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements.

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake, less total sleep time and nonrapid eye movement sleep, less sleep efficiency, and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless legs syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards said that “treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from about 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association—which emerged both among people living in nursing homes and in those in the community—remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women with an average age of 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting (Sleep 2008;31:224–30).

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements.

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake, less total sleep time and nonrapid eye movement sleep, less sleep efficiency, and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless legs syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards said that “treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from about 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented. But the association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established. The nature of the association—which emerged both among people living in nursing homes and in those in the community—remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women with an average age of 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function. The exam rated 7 people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment. The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting (Sleep 2008;31:224–30).

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements.

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake, less total sleep time and nonrapid eye movement sleep, less sleep efficiency, and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study revealed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities. “This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless legs syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards said that “treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).