Mild cognitive impairment in a community sample: The Sydney Memory and Ageing Study

BackgroundMild cognitive impairment (MCI) is associated with an increased dementia risk. This study reports incidence of MCI subtypes, rates of progression to dementia, and stability of MCI classification.MethodsWe examined 873 community-dwelling adults aged 70 to 90 years over 2 years as part of an ongoing population-based longitudinal study, the Sydney Memory and Ageing Study. Neuropsychological testing assessed five cognitive domains, and a diagnosis of no cognitive impairment, MCI, or dementia (follow-up only) was made according to published criteria.ResultsThe incidence of MCI was 104.6 (95% confidence interval: 81.6–127.7) per 1000 person-years, with higher incidence in men (men, 156.8; women, 70.3). Incidence rates for single-domain amnestic, multiple-domain amnestic, single-domain nonamnestic, and multiple-domain nonamnestic MCI were 47.7, 7.9, 45.0, and 3.9 per 1000 person-years, respectively. The 2-year rate of progression from MCI at baseline to dementia was 4.8%, being highest for multidomain amnestic MCI (9.1%). Of those with MCI at baseline, 28.2% reverted to no cognitive impairment at follow-up. Sensitivity analyses by redefining criteria for cognitive impairment did not affect stability of diagnosis, although changing the threshold of domain impairment reduced baseline MCI prevalence from 36.7% to 5.7% and incidence to 23.5, and increased 2-year progression rate from MCI to dementia to 14.3%.ConclusionsIncidence rates for MCI are higher than previously reported, particularly in men and for single-domain MCI; rates for amnestic and nonamnestic MCI were comparable. Multidomain amnestic MCI was the most likely subtype to progress to dementia, but overall, the diagnosis of MCI, particularly single-domain MCI, shows considerable instability.     

Mild cognitive impairment is associated with passive suicidal ideation in older adults: A population-based study

Objective

To investigate the association between MCI and passive/active suicidal ideation in a population-based sample of older adults.

Method

The sample included 916 participants without dementia acquired from the two population-based studies Prospective Population Study of Women (PPSW) and the H70-study. Cognitive status was assessed using a comprehensive neuropsychiatric examination and classified according to the Winblad et al. criteria: 182 participants were classified as cognitively intact, 448 had cognitive impairment but did not fulfill MCI criteria and 286 were diagnosed with MCI. Passive/active suicidal ideation was assessed using the Paykel questions.

Results

Passive or active suicidal ideation (any level) was reported by 16.0% of those with MCI and 1.1% of those who were cognitively intact. MCI was associated with past year life-weariness (OR 18.32, 95% CI 2.44–137.75) and death wishes (OR 5.30, 95% CI 1.19–23.64) in regression models adjusted for covariates including major depression. Lifetime suicidal ideation was reported more frequently in MCI (35.7%) than in cognitively intact participants (14.8%). MCI was associated with lifetime life-weariness (OR 2.90, 95% CI 1.67–5.05). Among individuals with MCI, impairments in memory and visuospatial ability were associated with both past year and lifetime life-weariness.

Conclusion

Our findings suggest reports of past year as well as lifetime passive suicidal ideation to be more frequent among individuals with MCI compared to those cognitively intact, indicating that individuals with MCI may constitute a high-risk group for suicidal behavior.     

Association of diabetes with amnestic and nonamnestic mild cognitive impairment

BackgroundType 2 diabetes may increase the risk of amnestic mild cognitive impairment (aMCI) through Alzheimer's disease (AD)-related and vascular pathology and may also increase the risk of nonamnestic MCI (naMCI) through vascular disease mechanisms. We examined the association of type 2 diabetes with mild cognitive impairment (MCI) and MCI subtype (aMCI and naMCI) overall and by sex.MethodsParticipants were Olmsted County, Minnesota residents (70 years and older) enrolled in a prospective, population-based study. At baseline and every 15 months thereafter, participants were evaluated using the Clinical Dementia Rating scale, a neurological evaluation, and neuropsychological testing for a diagnosis of normal cognition, MCI, and dementia by a consensus panel. Type 2 diabetes was ascertained from the medical records of participants at baseline.ResultsOver a median 4.0 years of follow-up, 348 of 1450 subjects developed MCI. Type 2 diabetes was associated (hazard ratio [95% confidence interval]) with MCI (1.39 [1.08–1.79]), aMCI (1.58 [1.17–2.15]; multiple domain: 1.58 [1.01–2.47]; single domain: 1.49 [1.09–2.05]), and the hazard ratio for naMCI was elevated (1.37 [0.84–2.24]). Diabetes was strongly associated with multiple-domain aMCI in men (2.42 [1.31–4.48]) and an elevated risk of multiple domain naMCI in men (2.11 [0.70–6.33]), and with single domain naMCI in women (2.32 [1.04–5.20]).ConclusionsDiabetes was associated with an increased risk of MCI in elderly persons. The association of diabetes with MCI may vary with subtype, number of domains, and sex. Prevention and control of diabetes may reduce the risk of MCI and Alzheimer's disease.     

Severe obstructive sleep apnea in patients with chronic obstructive pulmonary disease is associated with an increased prevalence of mild cognitive impairment

BackgroundChronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with mild cognitive impairment (MCI). However, this association is unclear. This study aimed to assess the prevalence of MCI in patients with overlap syndrome, determine whether OSA increases the risk of MCI in patients with COPD, and investigate the potential mechanisms for this association.MethodsParticipants with stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2–4 COPD and complaints of snoring in 2016–2018 were enrolled in this cross-sectional observational study. All were free of asthma, acute left-sided congestive heart failure, unstable coronary heart disease, uncontrolled hypertension, diabetes, encephalitis, and epilepsy. They underwent pulmonary function tests and overnight polysomnography and completed the Montreal Cognitive Assessment (MoCA). MCI was defined by an MoCA score of <23, while OSA was defined by an apnea-hypopnea index (AHI) of ≥15 per hour. The association between MCI, demographics, and comorbidities was tested by logistic regression analysis with adjustment for confounders. Sleep-disordered breathing measures were investigated as potential mechanisms underlying this relationship.ResultsMCI was significantly more common in patients with overlap syndrome than in those with COPD (40.6% [43/106] vs 24.6% [42/171]). After adjustment, severe OSA was an independent contributor to MCI (odds ratio, OR 2.27; 95% confidence interval, CI 1.12–4.62). Increased percent of night-time spent with oxygen saturation <90% (TSat₉₀) was associated with increased odds of MCI (odds ratio 4.75, 95% CI 2.73–11.13).ConclusionsMCI is more prevalent in overlap syndrome than in COPD. OSA may contribute to MCI in COPD. The mechanism may involve TSat₉₀.     

Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults

Background and purposeOlder patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition.MethodsProspective study of 591 adults ≥65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7–11) and normal cognition (score of 12–27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3–4).ResultsAmong survivors of AIS, 26.9% had pre-existing MCI (62.9% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1% had normal cognition (51.4% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95% CI, 0.43–0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95% CI, 0.56–1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95% CI, 0.95–0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95% CI, 0.31–0.94]; P=0.03).ConclusionsDifferences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care.     

Hypertension and the risk of mild cognitive impairment

OBJECTIVE: To explore whether hypertension is associated with the risk of mild cognitive impairment (MCI), an intermediate stage of dementia, because there are conflicting data relating hypertension to the risk of Alzheimer disease. DESIGN AND SETTING: Prospective community-based cohort study conducted in northern Manhattan. Multivariate proportional hazards regression analyses were used, relating hypertension to incident all-cause MCI, amnestic MCI, and nonamnestic MCI in 918 persons without prevalent MCI at baseline followed up for a mean of 4.7 years. RESULTS: There were 334 cases of incident MCI, 160 cases of amnestic MCI, and 174 cases of nonamnestic MCI during 4337 person-years of follow-up. Hypertension was associated with an increased risk of all-cause MCI (hazard ratio, 1.40; 95% confidence interval, 1.06-1.77; P = .02) and nonamnestic MCI (hazard ratio, 1.70; 95% confidence interval, 1.13-2.42; P = .009) after adjusting for age and sex. Both associations were slightly attenuated in models additionally adjusting for stroke and other vascular risk factors. There was no association between hypertension and the risk of amnestic MCI (hazard ratio, 1.10; 95% confidence interval, 0.79-1.63; P = .49). Consistent with this association, hypertension was related with the slope of change in an executive ability score, but not with memory or language score. There was no effect modification of the association between hypertension and MCI by APOEepsilon4 genotype or use of antihypertensive medication. CONCLUSIONS: A history of hypertension is related to a higher risk of MCI. The association seems to be stronger with the nonamnestic than the amnestic type of MCI in the elderly. These findings suggest that prevention and treatment of hypertension may have an important impact in lowering the risk of cognitive impairment.     

Cancer risk in association with Parkinson disease: A population-based study

PurposeData from large population-based studies on the association between Parkinson disease (PD) and the risk of developing cancer are scarce. We compared the risk of developing incident cancer between patients with or without PD.MethodsWe conducted a population-based follow-up study and a nested case-control analysis using data from the UK-based General Practice Research Database. We included PD patients aged ≥40 years with a first PD diagnosis between 1994 and 2005, and a matched comparison group free of PD. We assessed cancer incidence rates and relative risk estimates (odds ratios [ORs] with 95% confidence intervals [CI]).ResultsThe risk of developing cancer overall was lower in PD patients as compared to patients without PD (crude incidence rate ratio 0.77, 95% CI 0.64–0.92). In the nested case-control analysis (adj. OR for all cancers 0.72, 95% CI 0.59–0.87) the risk reduction was strongest for smoking-related cancers (adj. OR 0.47, 95% CI 0.31–0.72). The adjusted OR for hematological malignancies was 0.32 (95% CI 0.14–0.74). Due to small numbers, ORs for other cancer entities did not reach statistical significance.ConclusionsWith the exception of melanoma, PD patients were less likely to develop cancer than individuals without PD in this large observational study.     

Variants in C-reactive protein and IL-6 genes and susceptibility to obstructive sleep apnea in children: a candidate-gene association study in European American and Southeast European populations

BackgroundPreliminary evidence indicates that variants of the C-reactive protein (CRP) and IL-6 genes might be associated with the presence of obstructive sleep apnea (OSA) in childhood. Thus a candidate-gene association study was conducted to investigate the association of four variants of the CRP gene (1444C/T, −717T/C, 1861C/T, and 1919A/T) and two variants of the IL-6 gene (−174G/C and 597G/A) with OSA in a cohort of European American and Greek children.MethodsThe genetic risk effects were estimated based on the odds ratio (OR) of the allele contrast and the generalized odds ratio (OR_G), which is a model-free approach. The mode of inheritance was assessed using the degree of dominance index. The impact of haplotypes was also examined.ResultsIn the American population, the allele contrast and the model-free approach produced significant ORs for the CRP 1444C/T variant (OR, 3.82 [95% confidence interval {CI}, 1.91–7.63] and OR_G, 4.37 [95% CI, 1.96–9.76]), respectively, and the mode of inheritance was recessiveness of allele T. Significance was also shown for the CRP 1919A/T variant (OR, 2.45 [95% CI, 1.23–4.85] and OR_G, 2.76 [95% CI, 1.26–6.03]) with the mode of inheritance being nondominance of allele T. For the IL-6-174G/C variant, there was an indication of recessiveness of allele C. Finally, the IL-6-174C/IL-6 597A haplotype was associated with OSA. In the Greek population, no association was detected for any variant or haplotype.ConclusionsGenetic variation in the IL-6/CRP pathway was associated with increased risk for OSA in European American children and may account for the higher CRP levels in the context of pediatric OSA compared to Greek children.     

Association between glaucoma and sleep apnea in a large French multicenter prospective cohort

ObjectiveSeveral reports suggest that glaucoma may be linked to obstructive sleep apnea (OSA). Herein, we investigated this hypothesis in the largest reported sample to date.MethodsData were from the French multicenter prospective cohort study including OSA-suspected patients from private practice, general and teaching hospitals. Demographics, history, comorbidities and sleep studies from patients aged >50 years were analyzed. Univariate and multivariate logistic regression were used to predict the odds ratio of prevalent glaucoma depending on sleep apnea status and other potential anthropometric, metabolic, cardiovascular and respiratory confounders.ResultsA total of 9580 patients aged >50 years were included. Among these patients, 6754 had sleep apnea and 330 had glaucoma. Glaucoma prevalence was 3.55% in patients with OSA and 3.14% in patients without OSA. OSA diagnosis did not significantly influence the risk of glaucoma in univariate analysis (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.87–1.47). The variables significantly influencing the odds of glaucoma with multivariate regression were age >61.4 years (OR, 1.55; 95% CI, 1.23–1.95), body mass index <30 kg/m² (OR, 1.58; 95% CI, 1.26–1.99), female gender (OR, 1.40; 95% CI, 1.11–1.78), arterial hypertension (OR, 1.32; 95% CI, 1.05–1.67), high triglyceride levels (OR, 2.03; 95% CI, 1.43–2.88) and thyroid dysfunction (OR, 1.52; 95% CI, 1.09–2.11).ConclusionsWhen confounders are taken into account, patients with OSA do not have higher odds of glaucoma compared with patients who do not have OSA in a large multicenter prospective cohort.     

Association between sleep disturbances and falls among the elderly: results from the German Cooperative Health Research in the Region of Augsburg-Age study

ObjectiveWe aimed to examine the association between various sleep disturbances and falls among older individuals from the general population while considering the influence of age and dizziness.MethodsData were derived from the population-based cross-sectional KORA (Cooperative Health Research in the Region of Augsburg)-Age study, whereby information was conducted in standardized telephone interviews with 4127 men and women aged ⩾65 years in 2008 and 2009. Unstratified and stratified (by age and dizziness) multivariable logistic regression model analyses were performed.ResultsThe multivariable analysis showed a marginally significant association between trouble staying asleep and ⩾1 fall in the previous year (odds ratio [OR], 1.23 [95% confidence interval (CI), 1.01–1.50]). This association was more pronounced in participants older than the age of 75 years (OR, 1.58 [95% CI, 1.16–2.16]) and in individuals without dizziness (OR, 1.35 [95% CI, 1.04–1.76]). There was no association between daytime sleepiness and falls in the fully-adjusted models, but the odds of falls in the previous year in individuals older than the age of 75 years were significantly higher for individuals with difficulty falling asleep. Although sleep duration was not associated with falls in multivariable analyses when stratified by dizziness, sleep duration of 9 h daily was significantly associated with higher odds of experiencing at least one fall in the previous year.ConclusionsOur study suggested that the positive relationship between a trend towards longer sleep duration, trouble falling and staying asleep, and falls is strongest in older individuals and in individuals who did not experience dizziness in the previous year.     

Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment

ObjectiveExamine the association between neuropsychiatric symptoms (NPS) and clinical outcome in memory clinic patients with vascular brain injury.Design/SettingTRACE-VCI prospective memory clinic cohort with follow-up (2.1 ± 0.5 years).ParticipantsFive hundred and seventy-five memory clinic patients with vascular brain injury on MRI (i.e. possible Vascular Cognitive Impairment [VCI]). Severity of cognitive impairment ranged from no objective cognitive impairment to mild cognitive impairment (MCI) and dementia.MeasurementsWe used Neuropsychiatric Inventory (total score and score on hyperactive, psychotic, affective, and apathetic behavior domains) to measure NPS. We assessed the association between NPS and institutionalization, mortality and cognitive deterioration (increase ≥0.5 on Clinical Dementia Rating scale) with Cox proportional hazards models and logistic regression analyses.ResultsNPS were present in 89% of all patients, most commonly in the hyperactive and apathetic behavior domain. Across the whole cohort, affective behavior was associated with institutionalization (HR: 1.98 [1.01-3.87]), mainly driven by the dementia subgroup (HR: 2.06 [1.00–4.21]). Apathetic behavior was associated with mortality and cognitive deterioration (HR: 2.07 [1.10–3.90],OR: 1.67 [1.12–2.49], respectively), mainly driven by the MCI subgroup (HR: 4.93 [1.07–22.86],OR: 3.25 [1.46–7.24], respectively). Conversely, hyperactive behavior was related to lower mortality (HR: 0.54 [0.29–0.98]), again particularly driven by the MCI subgroup (HR:0.17 [0.04–0.75]). Psychotic behavior was associated with cognitive deterioration in patients with no objective cognitive impairment (OR: 3.10 [1.09–8.80]) and with institutionalization in MCI (HR: 12.45 [1.28–121.14]).ConclusionNPS are common and have prognostic value in memory clinic patients with possible VCI. This prognostic value depends on the severity of cognitive impairment.     

Association of elevated neutrophil-to-lymphocyte ratio with increased intracranial aneurysm stability scores and aneurysm growth

Background and purposeInflammation involves in the progression of intracranial aneurysms (IAs). However, whether the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker links to IAs stability is unidentified. This study was performed to assess the association of the NLR with IAs stability.MethodsWe retrospectively reviewed the medical records of patients diagnosed with unruptured IAs from January 2014 to June 2018. According to the quartiles of the NLR, patients with unruptured IAs were categorized into four groups. We evaluated the association between the NLR and IAs stability scores and IAs growth. Multiple logistic regression models were used in the analysis.ResultsA significant dose-response association was found between the NLR with IAs stability scores and IAs growth. After adjustment for potential confounders, an elevated NLR (fourth quartile) was associated with increased PHASES score (>5) (adjusted odds ratio [OR], 2.007; 95% confidence interval [CI], 1.361–2.960; p<0.001 [p for trend <0.001]), increased ELAPSS score (>15) (adjusted OR, 1.581; 95% CI, 1.074–2.328; p=0.020 [p for trend =0.001]), increased JAPAN 3-year rupture risk score (>5) (adjusted OR, 1.512; 95% CI, 1.033–2.215; p=0.034 [p for trend <0.001]), and IAs growth (adjusted OR, 16.759; 95% CI, 3.022–92.928; p=0.001 [p for trend <0.001]).ConclusionAn elevated NLR was associated with increased IAs stability scores and IAs growth. The association between NLR and IAs stability need further investigate.     

Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study

ObjectivePharmacological treatment of older adults with cognitive impairment represents a challenge for prescribing physicians, and polypharmacy is common in these complex patients. The aim of the current study is to assess prevalence and factors related to polypharmacy in a sample of nursing home (nursing home) residents with advanced cognitive impairment.MethodsWe conducted a cross-sectional analysis of 1449 nursing home residents with advanced cognitive impairment participating to the Services and Health for Elderly in Long Term Care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in eight countries. Data were collected using the International Resident Assessment Instrument (InterRAI) for long-term care facilities. Polypharmacy status was categorized into three groups: nonpolypharmacy (zero to four drugs), polypharmacy (five to nine drugs), and excessive polypharmacy (≥10 drugs).ResultsPolypharmacy was observed in 735 residents (50.7%) and excessive polypharmacy was seen in 245 (16.9%). Compared with nonpolypharmacy, excessive polypharmacy was associated directly with ischemic heart disease (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.01–6.74), diabetes mellitus (OR, 2.66; 95% CI; 1.46–4.84), Parkinson's disease (OR, 2.84; 95% CI, 1.36–5.85), gastrointestinal symptoms (OR, 1.20; 95% CI, 1.43–3.39), pain (OR, 3.12; 95% CI, 1.99–4.89), dyspnea (OR, 2.57; 95% CI, 1.31–5.07), and recent hospitalization (OR, 2.56; 95% CI, 1.36–5.85). An inverse relation with excessive polypharmacy was shown for age (OR, 0.74; 95% CI, 0.59–0.93), activities of daily living disability (OR, 0.79; 95% CI, 0.63–0.99) and presence of a geriatrician on the nursing home staff (OR, 0.36; 95% CI, 0.20–0.64).ConclusionPolypharmacy and excessive polypharmacy are common among nursing home residents with advanced cognitive impairment. Determinants of polypharmacy status includes not only comorbidities, but also specific symptoms, age, and functional status. A geriatrician in the facility is associated with lower prevalence of excessive polypharmacy.     

Cognitive impairment in nondemented oldest-old: prevalence and relationship to cardiovascular risk factors

ObjectiveTo determine the prevalence and types of cognitive impairment in a sample of nondemented participants aged ≥90 (the oldest-old) and to examine the relationships between cognitive impairment and cardiovascular risk factors.ParticipantsThe participants were 420 nondemented individuals from The 90+ Study, a study of aging and dementia in the oldest-old. These participants were categorized into four nonoverlapping groups: normal cognition, amnestic mild cognitive impairment (aMCI), nonamnestic MCI (naMCI), and other cognitive impairment (OCI). History of cardiovascular risk factors was assessed through self-report.ResultsThe overall prevalence of cognitive impairment in nondemented participants was 34.0% (95% CI: 29.5–38.5). The prevalence of OCI was highest (17.4%; 95% CI: 13.9–21.4), followed by aMCI (8.3%; 95% CI: 5.9–11.4) and naMCI (8.3%; 95% CI: 5.9–11.4). Normal cognition was present in 66.0% (95% CI: 61.2–70.5) of participants. History of hypertension and stroke were the only risk factors that varied between the groups, occurring more frequently in participants with naMCI (χ² = 3.82; P < .05) and OCI (χ² = 5.51; P < .05).ConclusionsThis study found a high prevalence of cognitive impairment in a sample of nondemented oldest-old. We did not find a strong relationship between cardiovascular risk factors and the cognitive impairment groups, other than between hypertension and naMCI and stroke and OCI. Future studies comparing the incidence of dementia in these groups will ultimately determine their predictive utility in the oldest-old.     

Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis

BackgroundObstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder which could impair someone's quality of life and is also associated with poor outcomes from many diseases. Currently, the evidence regarding the link between OSA and coronavirus disease 2019 (COVID-19) is still conflicting. This study aims to analyze the relationship between OSA and poor outcomes of COVID-19.Materials and methodsWe systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 10th, 2020. All articles published on COVID-19 and OSA were retrieved. The quality of the study was assessed using the Newcastle–Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software.ResultsA total of 21 studies with 54,276 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that OSA was associated with composite poor outcome [OR 1.72 (95% CI 1.55–1.91), p < 0.00001, I² = 36%, random-effect modeling] and its subgroup which comprised of severe COVID-19 [OR 1.70 (95% CI 1.18–2.45), p = 0.005], ICU admissions [OR 1.76 (95% CI 1.51–2.05), p < 0.00001], the need for mechanical ventilation [OR 1.67 (95% CI 1.48–1.88), p < 0.00001], and mortality [OR 1.74 (95% CI 1.39–2.19), p < 0.00001].ConclusionsExtra care and close monitoring should be provided to patients with OSA to minimize the risk of infections. Simple questionnaires such as STOP-Bang questionnaire can be used for screening patients who may be at risk for severe adverse outcomes.     

Sleep apnea-plus: prevalence, risk factors, and association with cardiovascular diseases using United States population-level data

ObjectivesThe purpose of this study was to estimate the prevalence of, to identify sociodemographic risk factors for, and to examine the association of cardiovascular diseases with sleep apnea-plus (i.e., comorbid insomnia and sleep apnea) in the general United States population.MethodsA population-based multi-year cross-sectional study design was used with data from the 2005–2008 United States National Health and Nutrition Examination Surveys (NHANES) (n = 12,593).ResultsThe prevalence of insomnia among individuals with sleep apnea (n = 236/546 or 43%) was higher compared to individuals without sleep apnea (n = 3550/12,047 or 30%). Among individuals with sleep apnea, women (OR 2.19, 95% CI 1.07–4.48) and individuals with symptoms of depression (OR 3.53, 95% CI 1.49–8.35) were significantly more likely, and individuals ages 60+ years (OR 0.43, 95% CI 0.20–0.94) and individuals with morbid obesity (OR 0.27, 95% CI 0.09–0.75) were significantly less likely, to have sleep apnea-plus. After controlling for confounders, the odds of health professional-diagnosed self-reported hypertension (OR 0.64, 95% CI 0.29–1.44), diabetes (OR 1.02, 95% CI 0.33–3.11), congestive heart failure (OR 0.67, 95% CI 0.19–2.44), myocardial infarction (OR 1.80, 95% CI 0.49–6.67), and stroke (OR 0.82, 95% CI 0.18–3.77), as well as objectively measured risk factors for these conditions, were not significantly different between individuals with sleep apnea-plus and individuals with sleep apnea-alone.ConclusionsThe prevalence of insomnia in sleep apnea is high, and substantially greater than in the general population, and this has important implications for the management of sleep apnea patients. Similar to sleep apnea-alone, individuals with sleep apnea-plus have elevated rates of cardiovascular diseases compared to the general population. Given the elevated rates of cardiovascular diseases among individuals with sleep apnea-plus, along with their known poor CPAP compliance, identification of individuals with sleep apnea-plus and treatment of their concomitant insomnia is important.     

Sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorders in British Columbia,Canada

Purpose

This study aimed at determining to what extent sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorder diagnosis in British Columbia (BC), Canada, using a population-based survey.

Methods

This analysis was based on the cross-sectional 2013–2014 Canadian Community Health Survey. The sample was restricted to respondents in BC with valid responses to the survey items considered. A multivariable logistic model, where the behavioral HIV risk score exposure was nested into the sexual minority status modifier, estimated the odds of having a prevalent mood or an anxiety disorder. The behavioral HIV risk score (0, 1, 2, ≥ 3) included the following five measures: (1) age at first intercourse < 14 years, (2) condom use during last intercourse, (3) history of sexually transmitted infections, (5) number of sexual partners in the past 12 months (< 4, ≥ 4), and substance use in the past 12 months.

Results

Of the weighted sample (2,521,252), 97% (95% confidence interval (CI) 97–98) were heterosexual, while 3% (95% CI 2–3) were lesbian, gay, and bisexual (LGB). The prevalence of a mood or anxiety disorder diagnosis was 12% (95% CI 11–13). For every 1-level increment in the behavioral HIV risk score, the adjusted odds ratio of having a prevalent mood or anxiety disorder diagnosis was 1.29 (95% CI 1.03–1.54) for heterosexual respondents and 2.37 (95% CI 1.84–2.90) for LGB respondents.

Conclusion

Sexual minority status modified the relationship between HIV risk behavior and prevalent mood or anxiety disorders, with a stronger association among LGB respondents. Healthcare providers should prioritize integrated care that addresses the intersectionality between sexual risk, substance use, and mood or anxiety disorders.

     

Risk factors for suicide among older adults with cancer

Objective: To determine whether the increased risk of suicide for individuals with cancer may be explained by functional limitations, lack of social support, or other factors.Method: In this population-based case-control study, interviews of primary informants for suicides in the state of North Carolina were compared to interviews with participants in the Piedmont Health Study of the Elderly to estimate adjusted odds ratios for suicide and self-reported, physician diagnosed cancer, heart attack, stroke, and hip fracture.Results: Adjusting for all other factors, there was a statistically significant association of suicide and cancer (odds ratio [OR] 2.62, 95% confidence interval [CI] CI 1.84–3.73), but not heart attack, hip fracture, or stroke. The risk of suicide was also elevated for men vs. women (OR 17.15, CI 10.88–27.02), whites vs. blacks (OR 9.70, CI 6.07–15.50), and individuals with stressful life events (OR 2.75, CI 1.97–3.86) or limitations of instrumental (OR 2.93, CI 2.03–4.22) but not physical activities of daily living. Suicide cases were not more likely to be short of breath or poor sleep quality. Suicide was statistically significantly less likely for study participants who were married with spouse living vs. other (OR 0.61, CI 0.43–0.88) or who had one or more indicators of social support (OR 0.27, CI 0.19–0.39).Conclusion: After adjustment for other risk factors, suicide was strongly associated with cancer but not with other disabling, potentially fatal conditions.     

Bed-sharing and related factors in early adolescents

ObjectiveTo investigate the prevalence of bed-sharing and examine correlates of bed-sharing habits in early adolescents.MethodsParticipants were 1452 early adolescents from 10 primary schools in Shanghai, China. Children's health status and past history, family environment and parents' attitude towards bed-sharing, and children's sleep arrangements were surveyed. Sleep was assessed by the Children's Sleep Habit Questionnaire. Tanner stage was determined by the endocrinologist.ResultsThe median of age was 10.83 years (range: 9.42–12.92; 95% confidence interval [CI]: 10.79–10.83) and boys accounted for 51.17%. The prevalence of bed-sharing was 16.8%. Positive parental attitude toward bed-sharing (OR: 9.87; 95% CI: 6.57–14.83), asthma (OR: 2.15; 95% CI: 1.16–3.98), smaller residential space (OR: 1.90; 95% CI: 1.17–3.09), extended family (OR: 1.59; 95% CI: 1.16–2.18), and being physically less mature (OR: 2.39; 95% CI: 1.16–4.91) increased the likelihood of bed-sharing. Bed-sharers were more likely to have bedtime resistance (OR: 12.20; 95% CI: 8.59–17.33), sleep anxiety (OR: 3.76; 95% CI: 2.74–5.15), and poor sleep quality (OR: 3.21; 95% CI: 2.28–4.81) compared to non-bed-sharers. Furthermore, bed-sharing was associated with daytime sleepiness (OR: 1.53; 95% CI: 1.10–2.13) but not with sleep duration.ConclusionsBed-sharing is highly prevalent among Chinese early adolescents and is significantly related to sleep quality. Parental positive attitude toward bed-sharing was the most determining factor.