Sharon Worcester

SALT LAKE CITY — The prevalence of obstructive sleep apnea in patients with coronary heart disease may be higher than previously thought, according to data presented at the annual meeting of the Associated Professional Sleep Societies.

In a study of 132 patients who had a history of myocardial infarction or angiographically verified coronary artery disease, the prevalence of obstructive sleep apnea was 70%, Robert M. Carney, Ph.D., reported in a poster presentation.

Some previous studies have suggested prevalence rates in the 50% range in this population, he noted.

Patients in the current study underwent 2 nights of polysomnography. Obstructive sleep apnea was defined as at least five episodes of obstructive apnea or hypopnea per hour, noted Dr. Carney, professor of psychiatry and director of the Behavioral Medicine Center at Washington University, St. Louis.

The finding underscores the importance of screening heart disease patients for obstructive sleep apnea, which has been shown to increase the risk of myocardial infarction in this population, he concluded.

SALT LAKE CITY — The prevalence of obstructive sleep apnea in patients with coronary heart disease may be higher than previously thought, according to data presented at the annual meeting of the Associated Professional Sleep Societies.

In a study of 132 patients who had a history of myocardial infarction or angiographically verified coronary artery disease, the prevalence of obstructive sleep apnea was 70%, Robert M. Carney, Ph.D., reported in a poster presentation.

Some previous studies have suggested prevalence rates in the 50% range in this population, he noted.

Patients in the current study underwent 2 nights of polysomnography. Obstructive sleep apnea was defined as at least five episodes of obstructive apnea or hypopnea per hour, noted Dr. Carney, professor of psychiatry and director of the Behavioral Medicine Center at Washington University, St. Louis.

The finding underscores the importance of screening heart disease patients for obstructive sleep apnea, which has been shown to increase the risk of myocardial infarction in this population, he concluded.

SALT LAKE CITY — The prevalence of obstructive sleep apnea in patients with coronary heart disease may be higher than previously thought, according to data presented at the annual meeting of the Associated Professional Sleep Societies.

In a study of 132 patients who had a history of myocardial infarction or angiographically verified coronary artery disease, the prevalence of obstructive sleep apnea was 70%, Robert M. Carney, Ph.D., reported in a poster presentation.

Some previous studies have suggested prevalence rates in the 50% range in this population, he noted.

Patients in the current study underwent 2 nights of polysomnography. Obstructive sleep apnea was defined as at least five episodes of obstructive apnea or hypopnea per hour, noted Dr. Carney, professor of psychiatry and director of the Behavioral Medicine Center at Washington University, St. Louis.

The finding underscores the importance of screening heart disease patients for obstructive sleep apnea, which has been shown to increase the risk of myocardial infarction in this population, he concluded.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

HOLLYWOOD, FLA. — A search of more than 100 Web sites that provide information about labor epidurals yielded very few with reliable information, Dr. Edgar M. Wayne reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Of 117 sites reviewed by two experienced obstetric anesthesiologists using two popular search engines and a Microsoft Accuracy rating tool that was shown to be reliable, only 33 were rated as accurate, and only 13 of those were deemed relevant and acceptable as educational tools for patients. An additional 36 sites were rated as inaccurate, and 33 were rated as misleading, reported Dr. Wayne of the University of Michigan Health System, Ann Arbor.

The remaining 15 were peer-reviewed articles only and were not included in the analysis.

Sites based on information from peer-reviewed sources such as textbooks or journals were significantly more likely to be accurate, relevant, and reliable; inaccurate Web sites were significantly more likely than the others to be based on nonscientific sources such as anecdotes or human interest stories. In addition, the inaccurate sites were more often written or sponsored by special interest groups.

Dr. Wayne emphasized that it is important to direct patients to Web sites that provide accurate, reliable information, because the Internet is widely and increasingly used by patients for medical information and the information they find there could influence them to decline safe and potentially beneficial labor pain management.

Interdisciplinary, hospital-based antepartum educational programs could help address the need for accurate patient education regarding neuraxial labor analgesia, he said.

BOSTON — Gastroesophageal reflux disease is common, but often goes undiagnosed in children with severe generalized cerebral palsy, Dr. Rob Rieken reported at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In a cross-sectional study of 29 children with intellectual and severe motor disability (IQ less than 55 and Gross Motor Function Classification System levels I-IV), the prevalence of Gastroesophageal reflux disease (GERD)—based on 24-hour pH monitoring—was 59%, Dr. Rieken reported in a poster.

The mean duration of reflux periods was 10% of the total recording time, compared with a normal percentage of less than 4%.

There was no significant difference in the percentage reflux times between upright and supine periods (perhaps because of the high use of anti-Trendelenburg's positioning of the bed in children with cerebral palsy), but compared with upright periods, the percentage reflux time postprandially was significantly greater. This is likely explained by a higher frequency of transient relaxation of the lower esophageal sphincter, decreased lower esophageal sphincter tone, and/or delayed gastric emptying in the study population, explained Dr. Rieken, of Erasmus University Medical Center, Rotterdam, the Netherlands.

In more than half of the children with GERD, the diagnosis following the recording was new, and only half of those with a prior GERD diagnosis were receiving treatment. But 40% of those who were shown in this study not to have GERD were being treated for the disease, he noted.

The findings suggest that the diagnosis of GERD is frequently missed in children with cerebral palsy, and they show that pH measurement is a feasible method for assessing this population, Dr. Rieken concluded.

BOSTON — Gastroesophageal reflux disease is common, but often goes undiagnosed in children with severe generalized cerebral palsy, Dr. Rob Rieken reported at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In a cross-sectional study of 29 children with intellectual and severe motor disability (IQ less than 55 and Gross Motor Function Classification System levels I-IV), the prevalence of Gastroesophageal reflux disease (GERD)—based on 24-hour pH monitoring—was 59%, Dr. Rieken reported in a poster.

The mean duration of reflux periods was 10% of the total recording time, compared with a normal percentage of less than 4%.

There was no significant difference in the percentage reflux times between upright and supine periods (perhaps because of the high use of anti-Trendelenburg's positioning of the bed in children with cerebral palsy), but compared with upright periods, the percentage reflux time postprandially was significantly greater. This is likely explained by a higher frequency of transient relaxation of the lower esophageal sphincter, decreased lower esophageal sphincter tone, and/or delayed gastric emptying in the study population, explained Dr. Rieken, of Erasmus University Medical Center, Rotterdam, the Netherlands.

In more than half of the children with GERD, the diagnosis following the recording was new, and only half of those with a prior GERD diagnosis were receiving treatment. But 40% of those who were shown in this study not to have GERD were being treated for the disease, he noted.

The findings suggest that the diagnosis of GERD is frequently missed in children with cerebral palsy, and they show that pH measurement is a feasible method for assessing this population, Dr. Rieken concluded.

BOSTON — Gastroesophageal reflux disease is common, but often goes undiagnosed in children with severe generalized cerebral palsy, Dr. Rob Rieken reported at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In a cross-sectional study of 29 children with intellectual and severe motor disability (IQ less than 55 and Gross Motor Function Classification System levels I-IV), the prevalence of Gastroesophageal reflux disease (GERD)—based on 24-hour pH monitoring—was 59%, Dr. Rieken reported in a poster.

The mean duration of reflux periods was 10% of the total recording time, compared with a normal percentage of less than 4%.

There was no significant difference in the percentage reflux times between upright and supine periods (perhaps because of the high use of anti-Trendelenburg's positioning of the bed in children with cerebral palsy), but compared with upright periods, the percentage reflux time postprandially was significantly greater. This is likely explained by a higher frequency of transient relaxation of the lower esophageal sphincter, decreased lower esophageal sphincter tone, and/or delayed gastric emptying in the study population, explained Dr. Rieken, of Erasmus University Medical Center, Rotterdam, the Netherlands.

In more than half of the children with GERD, the diagnosis following the recording was new, and only half of those with a prior GERD diagnosis were receiving treatment. But 40% of those who were shown in this study not to have GERD were being treated for the disease, he noted.

The findings suggest that the diagnosis of GERD is frequently missed in children with cerebral palsy, and they show that pH measurement is a feasible method for assessing this population, Dr. Rieken concluded.

SALT LAKE CITY — Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, data from the Nurses' Health Study suggest.

Data from more than 68,000 women show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night. The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel said at the annual meeting of the Associated Professional Sleep Societies. The relative risk for obesity (BMI over 30 kg/m

SALT LAKE CITY — Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, data from the Nurses' Health Study suggest.

Data from more than 68,000 women show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night. The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel said at the annual meeting of the Associated Professional Sleep Societies. The relative risk for obesity (BMI over 30 kg/m

SALT LAKE CITY — Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, data from the Nurses' Health Study suggest.

Data from more than 68,000 women show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night. The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel said at the annual meeting of the Associated Professional Sleep Societies. The relative risk for obesity (BMI over 30 kg/m

SALT LAKE CITY — Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia, defined in this study as a self-report of having difficulty falling asleep on all or most nights during the previous year, said Ms. Roane, a doctoral student in psychology at the University of North Texas at Dallas.

Those reporting insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting each of the findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years after the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those who did not report insomnia during adolescence. These findings also were statistically significant.

Further analysis to control for gender and baseline levels of variables such as depression are planned, she said.

SALT LAKE CITY — Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia, defined in this study as a self-report of having difficulty falling asleep on all or most nights during the previous year, said Ms. Roane, a doctoral student in psychology at the University of North Texas at Dallas.

Those reporting insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting each of the findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years after the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those who did not report insomnia during adolescence. These findings also were statistically significant.

Further analysis to control for gender and baseline levels of variables such as depression are planned, she said.

SALT LAKE CITY — Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia, defined in this study as a self-report of having difficulty falling asleep on all or most nights during the previous year, said Ms. Roane, a doctoral student in psychology at the University of North Texas at Dallas.

Those reporting insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting each of the findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years after the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those who did not report insomnia during adolescence. These findings also were statistically significant.

Further analysis to control for gender and baseline levels of variables such as depression are planned, she said.

SALT LAKE CITY — Patients with sleep-related eating disorder may benefit from treatment with topiramate, data from a small study suggest.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 stopped treatment due to lack of efficacy and 2 stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients stayed on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes and 10 of them losing a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested it helps control SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; the other 8 received topiramate as first-line therapy, said Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. They had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate treatment was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

SALT LAKE CITY — Patients with sleep-related eating disorder may benefit from treatment with topiramate, data from a small study suggest.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 stopped treatment due to lack of efficacy and 2 stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients stayed on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes and 10 of them losing a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested it helps control SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; the other 8 received topiramate as first-line therapy, said Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. They had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate treatment was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

SALT LAKE CITY — Patients with sleep-related eating disorder may benefit from treatment with topiramate, data from a small study suggest.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 stopped treatment due to lack of efficacy and 2 stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients stayed on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes and 10 of them losing a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested it helps control SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; the other 8 received topiramate as first-line therapy, said Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. They had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate treatment was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

SALT LAKE CITY — Sleep disturbances that occur in the weeks immediately after a stressor may predict later development of posttraumatic stress symptoms, data from a post-Sept. 11, 2001, survey suggest.

A total of 782 subjects from an ongoing Web-based research panel completed a measure of acute stress (the Stanford Acute Stress Reaction Questionnaire) 2 weeks after the Sept. 11 attacks, and also completed a posttraumatic stress questionnaire at 2 and 6 months after the attacks, Elaine T. Bailey, a graduate student in psychology at the University of Arizona, Tucson, reported at the annual meeting of the Associated Professional Sleep Societies.

Sleep disturbances, including trouble falling or staying asleep at 2 weeks after the attacks, had a small, but significant predictive value for development of posttraumatic stress symptoms at both 2 and 6 months after controlling for potential effects of preexisting anxiety, depression, and insomnia. Data on these preexisting conditions were available for participants from their ongoing involvement on the Web-based research panel, for which they had completed a health questionnaire before Sept. 11.

However, after controlling for the effects of acute stress symptoms in the early period after the attacks, the findings remained significant only for development of PTS symptoms at 6 months, Ms. Bailey said. The average age of the group was 49 years. About half of the members were men. Demographic distribution of the group closely matches current U.S. census counts in terms of age, sex, race, and geographical region.

These findings raise the possibility that sleep disturbance in the period immediately after a stressor might exacerbate or contribute to the development of PTS symptoms, particularly in those who develop symptoms later in the posttrauma period, she said.

SALT LAKE CITY — Sleep disturbances that occur in the weeks immediately after a stressor may predict later development of posttraumatic stress symptoms, data from a post-Sept. 11, 2001, survey suggest.

A total of 782 subjects from an ongoing Web-based research panel completed a measure of acute stress (the Stanford Acute Stress Reaction Questionnaire) 2 weeks after the Sept. 11 attacks, and also completed a posttraumatic stress questionnaire at 2 and 6 months after the attacks, Elaine T. Bailey, a graduate student in psychology at the University of Arizona, Tucson, reported at the annual meeting of the Associated Professional Sleep Societies.

Sleep disturbances, including trouble falling or staying asleep at 2 weeks after the attacks, had a small, but significant predictive value for development of posttraumatic stress symptoms at both 2 and 6 months after controlling for potential effects of preexisting anxiety, depression, and insomnia. Data on these preexisting conditions were available for participants from their ongoing involvement on the Web-based research panel, for which they had completed a health questionnaire before Sept. 11.

However, after controlling for the effects of acute stress symptoms in the early period after the attacks, the findings remained significant only for development of PTS symptoms at 6 months, Ms. Bailey said. The average age of the group was 49 years. About half of the members were men. Demographic distribution of the group closely matches current U.S. census counts in terms of age, sex, race, and geographical region.

These findings raise the possibility that sleep disturbance in the period immediately after a stressor might exacerbate or contribute to the development of PTS symptoms, particularly in those who develop symptoms later in the posttrauma period, she said.

SALT LAKE CITY — Sleep disturbances that occur in the weeks immediately after a stressor may predict later development of posttraumatic stress symptoms, data from a post-Sept. 11, 2001, survey suggest.

A total of 782 subjects from an ongoing Web-based research panel completed a measure of acute stress (the Stanford Acute Stress Reaction Questionnaire) 2 weeks after the Sept. 11 attacks, and also completed a posttraumatic stress questionnaire at 2 and 6 months after the attacks, Elaine T. Bailey, a graduate student in psychology at the University of Arizona, Tucson, reported at the annual meeting of the Associated Professional Sleep Societies.

Sleep disturbances, including trouble falling or staying asleep at 2 weeks after the attacks, had a small, but significant predictive value for development of posttraumatic stress symptoms at both 2 and 6 months after controlling for potential effects of preexisting anxiety, depression, and insomnia. Data on these preexisting conditions were available for participants from their ongoing involvement on the Web-based research panel, for which they had completed a health questionnaire before Sept. 11.

However, after controlling for the effects of acute stress symptoms in the early period after the attacks, the findings remained significant only for development of PTS symptoms at 6 months, Ms. Bailey said. The average age of the group was 49 years. About half of the members were men. Demographic distribution of the group closely matches current U.S. census counts in terms of age, sex, race, and geographical region.

These findings raise the possibility that sleep disturbance in the period immediately after a stressor might exacerbate or contribute to the development of PTS symptoms, particularly in those who develop symptoms later in the posttrauma period, she said.

SALT LAKE CITY — Use of continuous positive airway pressure may help prevent preeclampsia in pregnant women at risk for the condition, a study suggests.

In 9 of 12 women with risk factors for preeclampsia who used continuous positive airway pressure (CPAP) and medical therapy beginning before 9 weeks' gestation, blood pressure remained stable and pregnancy was normal, Dr. Christian Guilleminault reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Sleep-disordered breathing has been suggested by several studies as a possible contributor to preeclampsia. In one study, snoring was linked with preeclampsia, with the disorder occurring in 10% of snorers compared with 4% of nonsnorers. In another study, snoring was shown to be a significant predictor of hypertension and fetal growth retardation, even after controlling for maternal weight, age, and smoking status.

Based on such findings, some researchers have recommended polysomnography and/or CPAP use in pregnant women with risk factors—including snoring—for preeclampsia. In the current study, all 12 participants had risk factors for preeclampsia: All were snorers; seven had hypertension; two had prior preeclampsia; and three were obese, with a body mass index (kg/m

The women, who had a mean age of 29 years, underwent polysomnography at a mean of 7.5 weeks' gestation, and all had flow limitations at the nasal cannula without apnea or hypopnea. Nasal CPAP was used in all participants at an initial pressure of 5–6 cm H₂O, and in eight women the pressure was increased to 6–9 cm H₂O at between 5 and 6 months' gestation.

Of the seven women with hypertension at baseline, diastolic blood pressure below 90 mm Hg was maintained without a change in medication. All seven delivered healthy, full-term infants, as did one of the women with a history of preeclampsia, reported Dr. Guilleminault, of the department of psychiatry at Stanford (Calif.) University. One of the obese women miscarried at near 14 weeks' gestation and the other delivered at 34 weeks, but did not develop preeclampsia.

The third obese patient and the second woman with prior preeclampsia developed clinical features of preeclampsia, and both underwent cesarean section at 7.5 months' gestation.

Systematic treatment with nasal CPAP initiated prior to 9 weeks' gestation was associated with stable blood pressure and normal pregnancy in most women with risk factors for preeclampsia, Dr. Guilleminault concluded.

SALT LAKE CITY — Use of continuous positive airway pressure may help prevent preeclampsia in pregnant women at risk for the condition, a study suggests.

In 9 of 12 women with risk factors for preeclampsia who used continuous positive airway pressure (CPAP) and medical therapy beginning before 9 weeks' gestation, blood pressure remained stable and pregnancy was normal, Dr. Christian Guilleminault reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Sleep-disordered breathing has been suggested by several studies as a possible contributor to preeclampsia. In one study, snoring was linked with preeclampsia, with the disorder occurring in 10% of snorers compared with 4% of nonsnorers. In another study, snoring was shown to be a significant predictor of hypertension and fetal growth retardation, even after controlling for maternal weight, age, and smoking status.

Based on such findings, some researchers have recommended polysomnography and/or CPAP use in pregnant women with risk factors—including snoring—for preeclampsia. In the current study, all 12 participants had risk factors for preeclampsia: All were snorers; seven had hypertension; two had prior preeclampsia; and three were obese, with a body mass index (kg/m

The women, who had a mean age of 29 years, underwent polysomnography at a mean of 7.5 weeks' gestation, and all had flow limitations at the nasal cannula without apnea or hypopnea. Nasal CPAP was used in all participants at an initial pressure of 5–6 cm H₂O, and in eight women the pressure was increased to 6–9 cm H₂O at between 5 and 6 months' gestation.

Of the seven women with hypertension at baseline, diastolic blood pressure below 90 mm Hg was maintained without a change in medication. All seven delivered healthy, full-term infants, as did one of the women with a history of preeclampsia, reported Dr. Guilleminault, of the department of psychiatry at Stanford (Calif.) University. One of the obese women miscarried at near 14 weeks' gestation and the other delivered at 34 weeks, but did not develop preeclampsia.

The third obese patient and the second woman with prior preeclampsia developed clinical features of preeclampsia, and both underwent cesarean section at 7.5 months' gestation.

Systematic treatment with nasal CPAP initiated prior to 9 weeks' gestation was associated with stable blood pressure and normal pregnancy in most women with risk factors for preeclampsia, Dr. Guilleminault concluded.

SALT LAKE CITY — Use of continuous positive airway pressure may help prevent preeclampsia in pregnant women at risk for the condition, a study suggests.

In 9 of 12 women with risk factors for preeclampsia who used continuous positive airway pressure (CPAP) and medical therapy beginning before 9 weeks' gestation, blood pressure remained stable and pregnancy was normal, Dr. Christian Guilleminault reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Sleep-disordered breathing has been suggested by several studies as a possible contributor to preeclampsia. In one study, snoring was linked with preeclampsia, with the disorder occurring in 10% of snorers compared with 4% of nonsnorers. In another study, snoring was shown to be a significant predictor of hypertension and fetal growth retardation, even after controlling for maternal weight, age, and smoking status.

Based on such findings, some researchers have recommended polysomnography and/or CPAP use in pregnant women with risk factors—including snoring—for preeclampsia. In the current study, all 12 participants had risk factors for preeclampsia: All were snorers; seven had hypertension; two had prior preeclampsia; and three were obese, with a body mass index (kg/m

The women, who had a mean age of 29 years, underwent polysomnography at a mean of 7.5 weeks' gestation, and all had flow limitations at the nasal cannula without apnea or hypopnea. Nasal CPAP was used in all participants at an initial pressure of 5–6 cm H₂O, and in eight women the pressure was increased to 6–9 cm H₂O at between 5 and 6 months' gestation.

Of the seven women with hypertension at baseline, diastolic blood pressure below 90 mm Hg was maintained without a change in medication. All seven delivered healthy, full-term infants, as did one of the women with a history of preeclampsia, reported Dr. Guilleminault, of the department of psychiatry at Stanford (Calif.) University. One of the obese women miscarried at near 14 weeks' gestation and the other delivered at 34 weeks, but did not develop preeclampsia.

The third obese patient and the second woman with prior preeclampsia developed clinical features of preeclampsia, and both underwent cesarean section at 7.5 months' gestation.

Systematic treatment with nasal CPAP initiated prior to 9 weeks' gestation was associated with stable blood pressure and normal pregnancy in most women with risk factors for preeclampsia, Dr. Guilleminault concluded.

BOSTON — Pain frequently interferes with sleep in children and adolescents with physical disabilities, results of a study suggest.

Pain should be routinely assessed and managed to minimize the adverse effects it can have on patients and their caregivers, said Marilyn Wright of McMaster University and McMaster Children's Hospital, Hamilton, Ont.

The cross-sectional survey of 178 caregivers of children and adolescents with physical disabilities showed that up to half of those with certain disabilities experienced nighttime pain, and that this pain—and its effects on sleep—was associated with a number of sequelae in both patients and caregivers, she reported in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

For example, 50% of the children and adolescents in the study with muscular dystrophy, 48% of those with cerebral palsy, 15% of those with developmental delay, and 15% of those with spina bifida experienced nighttime pain. The most common types of pain reported were muscle pain (18% of patients), joint pain (10% of patients), muscle spasms (9% of patients), and growing pains (7% of patients).

Among the factors significantly associated with pain in the children were waking during the night (9% reportedly wake up three or more times per night), the necessity of position change during the night, daytime irritability attributed to lack of sleep, and interference with school and social activities.

Caregivers also were affected. Nighttime pain experienced by a child was shown to be associated with caregiver daytime irritability and exhaustion attributed to lack of sleep; negative effects on caregivers' work outside the home; caregiver concern about the child's sleeping position; and concern about the negative effect of poor sleep on the general health of the child.

Furthermore, the children and adolescents who were reported as having nighttime pain that interfered with sleep were more compromised in their independent mobility, Ms. Wright reported.

Self-reports by 25 children and adolescents who were interviewed about nighttime pain, its effects on sleep, and sequelae of poor sleep showed trends similar to those seen with the data provided by caregivers, she noted.

The current study was undertaken following a prior finding that pain had a negative effect on sleep quality in children and adolescents with physical disabilities more often than in children without such disabilities (30% vs. 3%). With increasing attention to the effects of pain on sleep in this population, there has been greater awareness of the need for early intervention.

“Early and ongoing orthopedic surveillance is an integral part of preventing secondary impairments that can contribute to pain and interruption of sleep,” Ms. Wright concluded.

Attention to positioning throughout the day also can help reduce pain. At McMaster Children's Hospital, a “24-hour positioning program” is offered to parents and caregivers through workshops and home visits, as well as through educational materials. It addresses issues like pain, muscle integrity, muscle contracture, and mobility, she said in an interview.

The program focuses on positioning throughout the day and promotes supportive, safe, well-aligned, and comfortable sleep positioning in an effort to reduce pain and promote optimal sleep throughout the night, she said.

BOSTON — Pain frequently interferes with sleep in children and adolescents with physical disabilities, results of a study suggest.

Pain should be routinely assessed and managed to minimize the adverse effects it can have on patients and their caregivers, said Marilyn Wright of McMaster University and McMaster Children's Hospital, Hamilton, Ont.

The cross-sectional survey of 178 caregivers of children and adolescents with physical disabilities showed that up to half of those with certain disabilities experienced nighttime pain, and that this pain—and its effects on sleep—was associated with a number of sequelae in both patients and caregivers, she reported in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

For example, 50% of the children and adolescents in the study with muscular dystrophy, 48% of those with cerebral palsy, 15% of those with developmental delay, and 15% of those with spina bifida experienced nighttime pain. The most common types of pain reported were muscle pain (18% of patients), joint pain (10% of patients), muscle spasms (9% of patients), and growing pains (7% of patients).

Among the factors significantly associated with pain in the children were waking during the night (9% reportedly wake up three or more times per night), the necessity of position change during the night, daytime irritability attributed to lack of sleep, and interference with school and social activities.

Caregivers also were affected. Nighttime pain experienced by a child was shown to be associated with caregiver daytime irritability and exhaustion attributed to lack of sleep; negative effects on caregivers' work outside the home; caregiver concern about the child's sleeping position; and concern about the negative effect of poor sleep on the general health of the child.

Furthermore, the children and adolescents who were reported as having nighttime pain that interfered with sleep were more compromised in their independent mobility, Ms. Wright reported.

Self-reports by 25 children and adolescents who were interviewed about nighttime pain, its effects on sleep, and sequelae of poor sleep showed trends similar to those seen with the data provided by caregivers, she noted.

The current study was undertaken following a prior finding that pain had a negative effect on sleep quality in children and adolescents with physical disabilities more often than in children without such disabilities (30% vs. 3%). With increasing attention to the effects of pain on sleep in this population, there has been greater awareness of the need for early intervention.

“Early and ongoing orthopedic surveillance is an integral part of preventing secondary impairments that can contribute to pain and interruption of sleep,” Ms. Wright concluded.

Attention to positioning throughout the day also can help reduce pain. At McMaster Children's Hospital, a “24-hour positioning program” is offered to parents and caregivers through workshops and home visits, as well as through educational materials. It addresses issues like pain, muscle integrity, muscle contracture, and mobility, she said in an interview.

The program focuses on positioning throughout the day and promotes supportive, safe, well-aligned, and comfortable sleep positioning in an effort to reduce pain and promote optimal sleep throughout the night, she said.

BOSTON — Pain frequently interferes with sleep in children and adolescents with physical disabilities, results of a study suggest.

Pain should be routinely assessed and managed to minimize the adverse effects it can have on patients and their caregivers, said Marilyn Wright of McMaster University and McMaster Children's Hospital, Hamilton, Ont.

The cross-sectional survey of 178 caregivers of children and adolescents with physical disabilities showed that up to half of those with certain disabilities experienced nighttime pain, and that this pain—and its effects on sleep—was associated with a number of sequelae in both patients and caregivers, she reported in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

For example, 50% of the children and adolescents in the study with muscular dystrophy, 48% of those with cerebral palsy, 15% of those with developmental delay, and 15% of those with spina bifida experienced nighttime pain. The most common types of pain reported were muscle pain (18% of patients), joint pain (10% of patients), muscle spasms (9% of patients), and growing pains (7% of patients).

Among the factors significantly associated with pain in the children were waking during the night (9% reportedly wake up three or more times per night), the necessity of position change during the night, daytime irritability attributed to lack of sleep, and interference with school and social activities.

Caregivers also were affected. Nighttime pain experienced by a child was shown to be associated with caregiver daytime irritability and exhaustion attributed to lack of sleep; negative effects on caregivers' work outside the home; caregiver concern about the child's sleeping position; and concern about the negative effect of poor sleep on the general health of the child.

Furthermore, the children and adolescents who were reported as having nighttime pain that interfered with sleep were more compromised in their independent mobility, Ms. Wright reported.

Self-reports by 25 children and adolescents who were interviewed about nighttime pain, its effects on sleep, and sequelae of poor sleep showed trends similar to those seen with the data provided by caregivers, she noted.

The current study was undertaken following a prior finding that pain had a negative effect on sleep quality in children and adolescents with physical disabilities more often than in children without such disabilities (30% vs. 3%). With increasing attention to the effects of pain on sleep in this population, there has been greater awareness of the need for early intervention.

“Early and ongoing orthopedic surveillance is an integral part of preventing secondary impairments that can contribute to pain and interruption of sleep,” Ms. Wright concluded.

Attention to positioning throughout the day also can help reduce pain. At McMaster Children's Hospital, a “24-hour positioning program” is offered to parents and caregivers through workshops and home visits, as well as through educational materials. It addresses issues like pain, muscle integrity, muscle contracture, and mobility, she said in an interview.

The program focuses on positioning throughout the day and promotes supportive, safe, well-aligned, and comfortable sleep positioning in an effort to reduce pain and promote optimal sleep throughout the night, she said.

SALT LAKE CITY — Restless legs syndrome is common yet rarely diagnosed in children and teens, Dr. Daniel Picchietti reported at the annual meeting of the Associated Professional Sleep Societies.

Multiple case reports, practice-based study findings, and adult studies showing that more than a third of patients report symptom onset prior to age 20 have hinted at a relatively high prevalence in the pediatric population. Findings from the Peds REST Study—a large population-based study—provides confirmation of that, said Dr. Picchietti of the University of Illinois, Urbana.

In that study of children from more than 10,500 families in the United States and United Kingdom, the prevalence of definite restless legs syndrome (RLS) by the National Institutes of Health consensus criteria definition was 1.9% in children ages 8–11 years, and 2.0% in those ages 12–17 years, suggesting RLS occurs more often than epilepsy or diabetes in this population, he said.

To meet the official diagnosis, patients must meet these NIH criteria:

▸ A strong urge to move the legs, which patients may not be able to resist.

▸ RLS symptoms start or become worse when resting.

▸ Symptoms improve when patients move their legs. The relief can be complete or only partial, but generally starts very soon after activity.

▸ Symptoms are worse in the evening, especially when patients are lying down.

In the study, moderately to severely distressing symptoms that occurred more than twice weekly were reported by 0.5% of those ages 8–11 years, and by 1.0% of those ages 12–17 years. Furthermore, sleep disturbance and growing pains were significantly more common in those with RLS than in controls, 50% of those with RLS reported the condition had a negative effect on mood, and several medical diagnoses were reported more commonly in RLS patients than would be expected in the general population.

In the U.S. population, for example, RLS patients were commonly diagnosed with ADHD (27%), anxiety disorder (11%), and depression (12%).

Data were collected randomly via Internet survey in April 2005 from a large volunteer research panel. Participants were initially blinded to the survey topic. Responses were provided by the parents of those participants in the 8- to 11-year-old range, and by either parents or the teens themselves in the 12- to 17-year-old range.

Descriptions of RLS symptoms that were provided by children in their own words were convincing in regard to whether they were truly affected by RLS.

“I really got the sense that this was restless legs syndrome—that we got exactly what we were measuring,” Dr. Picchietti said, explaining that there was concern about discerning RLS symptoms from other common arthralgias and cramps of childhood.

SALT LAKE CITY — Restless legs syndrome is common yet rarely diagnosed in children and teens, Dr. Daniel Picchietti reported at the annual meeting of the Associated Professional Sleep Societies.

Multiple case reports, practice-based study findings, and adult studies showing that more than a third of patients report symptom onset prior to age 20 have hinted at a relatively high prevalence in the pediatric population. Findings from the Peds REST Study—a large population-based study—provides confirmation of that, said Dr. Picchietti of the University of Illinois, Urbana.

In that study of children from more than 10,500 families in the United States and United Kingdom, the prevalence of definite restless legs syndrome (RLS) by the National Institutes of Health consensus criteria definition was 1.9% in children ages 8–11 years, and 2.0% in those ages 12–17 years, suggesting RLS occurs more often than epilepsy or diabetes in this population, he said.

To meet the official diagnosis, patients must meet these NIH criteria:

▸ A strong urge to move the legs, which patients may not be able to resist.

▸ RLS symptoms start or become worse when resting.

▸ Symptoms improve when patients move their legs. The relief can be complete or only partial, but generally starts very soon after activity.

▸ Symptoms are worse in the evening, especially when patients are lying down.

In the study, moderately to severely distressing symptoms that occurred more than twice weekly were reported by 0.5% of those ages 8–11 years, and by 1.0% of those ages 12–17 years. Furthermore, sleep disturbance and growing pains were significantly more common in those with RLS than in controls, 50% of those with RLS reported the condition had a negative effect on mood, and several medical diagnoses were reported more commonly in RLS patients than would be expected in the general population.

In the U.S. population, for example, RLS patients were commonly diagnosed with ADHD (27%), anxiety disorder (11%), and depression (12%).

Data were collected randomly via Internet survey in April 2005 from a large volunteer research panel. Participants were initially blinded to the survey topic. Responses were provided by the parents of those participants in the 8- to 11-year-old range, and by either parents or the teens themselves in the 12- to 17-year-old range.

Descriptions of RLS symptoms that were provided by children in their own words were convincing in regard to whether they were truly affected by RLS.

“I really got the sense that this was restless legs syndrome—that we got exactly what we were measuring,” Dr. Picchietti said, explaining that there was concern about discerning RLS symptoms from other common arthralgias and cramps of childhood.

SALT LAKE CITY — Restless legs syndrome is common yet rarely diagnosed in children and teens, Dr. Daniel Picchietti reported at the annual meeting of the Associated Professional Sleep Societies.

Multiple case reports, practice-based study findings, and adult studies showing that more than a third of patients report symptom onset prior to age 20 have hinted at a relatively high prevalence in the pediatric population. Findings from the Peds REST Study—a large population-based study—provides confirmation of that, said Dr. Picchietti of the University of Illinois, Urbana.

In that study of children from more than 10,500 families in the United States and United Kingdom, the prevalence of definite restless legs syndrome (RLS) by the National Institutes of Health consensus criteria definition was 1.9% in children ages 8–11 years, and 2.0% in those ages 12–17 years, suggesting RLS occurs more often than epilepsy or diabetes in this population, he said.

To meet the official diagnosis, patients must meet these NIH criteria:

▸ A strong urge to move the legs, which patients may not be able to resist.

▸ RLS symptoms start or become worse when resting.

▸ Symptoms improve when patients move their legs. The relief can be complete or only partial, but generally starts very soon after activity.

▸ Symptoms are worse in the evening, especially when patients are lying down.

In the study, moderately to severely distressing symptoms that occurred more than twice weekly were reported by 0.5% of those ages 8–11 years, and by 1.0% of those ages 12–17 years. Furthermore, sleep disturbance and growing pains were significantly more common in those with RLS than in controls, 50% of those with RLS reported the condition had a negative effect on mood, and several medical diagnoses were reported more commonly in RLS patients than would be expected in the general population.

In the U.S. population, for example, RLS patients were commonly diagnosed with ADHD (27%), anxiety disorder (11%), and depression (12%).

Data were collected randomly via Internet survey in April 2005 from a large volunteer research panel. Participants were initially blinded to the survey topic. Responses were provided by the parents of those participants in the 8- to 11-year-old range, and by either parents or the teens themselves in the 12- to 17-year-old range.

Descriptions of RLS symptoms that were provided by children in their own words were convincing in regard to whether they were truly affected by RLS.

“I really got the sense that this was restless legs syndrome—that we got exactly what we were measuring,” Dr. Picchietti said, explaining that there was concern about discerning RLS symptoms from other common arthralgias and cramps of childhood.