Treatment for obstructive sleep apnoea: effect on peripheral nerve function

Background and objective

Obstructive sleep apnoea (OSA) is suggested to be associated with peripheral nerve damage. A case–control study was conducted to provide further support to this observation. In a longitudinal intervention study, it was examined whether treatment for OSA has a possible beneficial effect on peripheral nerve function.

Methods

Participants were 23 patients with OSA and 23 controls matched for age and body mass index (BMI), all without any known cause of peripheral nerve damage. The sensory nerve action potential (SNAP) amplitudes of both sural nerves were determined. After 6 months of treatment for OSA, treatment compliance was evaluated and nerve conduction studies were repeated.

Results

Patients with OSA had significantly lower mean (standard deviation) sural SNAP amplitudes than controls (6.3 (3.5) v 11.2 (5.0), p<0.001). Multivariate regression analysis including the variables age, BMI and Apnoea–Hypopnea Index (AHI) showed that both age (p<0.01) and AHI (p<0.05) were inversely related to the SNAP amplitude. On follow‐up, the sural SNAP showed an increase of 2.6 mV on average (p<0.001). Multivariate regression analysis including the variables age, BMI, AHI, pretreatment SNAP and treatment compliance identified only treatment compliance as being significantly related to the SNAP increase (p⩽0.005).

Conclusion

OSA is an independent risk factor for axonal dysfunction of peripheral sensory nerves. Impaired neural function is at least partly reversible with treatment for sleep apnoea.Obstructive sleep apnoea (OSA) is a common disorder with an estimated prevalence in the general population of 2–5%.¹ Its main clinical features are loud snoring and breathing stoppage during sleep. Owing to non‐restful sleep, patients with OSA experience excessive daytime sleepiness and related neuropsychological impairments.² By different pathophysiological mechanisms, OSA is known to be associated with arterial hypertension,³ a hypercoagulable state,⁴ decreased cerebral perfusion,⁵ arteriosclerosis⁶ and severe cardiac arrhythmias,⁷ all of which potentially contribute to the increased mortality and cerebrocardiovascular morbidity of patients with OSA.^8,9Apart from that, an association of OSA with damage to the peripheral nervous system has been described only recently.^10,11 Thus, we reported an increased prevalence of axonal sensory polyneuropathy in patients with OSA.¹¹ This study found a decreased sural sensory nerve action potential (SNAP) in patients with OSA compared with controls. Additionally, a correlation of axonal dysfunction with the extent of oxygen desaturation was observed. We hypothesised that intermittent hypoxaemia is an independent risk factor for axonal dysfunction of peripheral nerves.¹¹This study had two aims: (1) to replicate our previous results in another case–control study, thereby providing further support to the assumed pathophysiology; and (2) to examine a possible, beneficial effect of treatment for OSA on peripheral nerve function in a longitudinal intervention study.     

Evaluation of obstructive sleep apnea in pediatric patients with facio-craniostenosis: a brief communication

Purpose

This study aimed to evaluate our experience in treating cranio-maxillo-mandibular malformations with hypoplasia of the upper and middle third of the face. We wished to determine a new diagnostic path involving a new clinical questionnaire for obstructive sleep apnea (OSA) evaluation, which we have developed by merging existing tests, literature findings, and our clinical experience to obtain a high level of information with minimal cost. This questionnaire is an improvement of the other anamnestic tests in the literature.

Methods

The study was carried out on 17 pediatric patients affected by syndromic craniofacial malformations and treated with surgical advancement of the middle third of the face, associated with or without upper third advancement, through osteodistraction. We used the obstructive airway child test (OACT) for clinical evaluation. The OACT is an OSA assessment test based on questions proposed to the patient’s relatives. All patients underwent polysomnography for instrumental assessment of OSA. These patients were also required to have a computed tomography scan for surgical planning. At the start of the treatment, 11 patients had severe OSA, 4 patients had moderate OSA, and 2 patients had slight OSA.

Results

At the end of the treatment, 6 patients had slight OSA and 11 patients had no OSA; these data were confirmed with OACT and polysomnography.

Conclusions

Based on our results, we suggest the following flowchart: OACT for OSA clinical evaluation; CT scan for evaluation of the volume of the rhinoropharyngeal air column, anatomical obstruction detection, and surgical planning; and polysomnography for diagnostic confirmation.     

Predictors of prescribed medication use for depression,anxiety, stress,and sleep problems in mid-aged Australian women

Objective

The study examined prevalence of self-reported use of medication recommended or prescribed by a doctor for depression, anxiety, stress, and sleep problems; and modelled baseline factors that predicted use over 3 years for each condition.

Methods

Analyses were undertaken on the 2001 and 2004 surveys of mid-aged women in the Australian Longitudinal Study on Women’s Health. Dependent variables were self-reported use in past 4 weeks of medications recommended or prescribed by a doctor for depression, anxiety, stress, or sleep problems in 2001 and 2004. Generalized Estimating Equations (GEE) were used to predict medication use for each condition over 3 years.

Results

Prevalence of prescribed medication use (2001, 2004) for each condition was depression (7.2, 8.9 %), anxiety (7.4, 9.0 %), stress (4.8, 5.7 %), and sleep problems (8.7, 9.5 %). Multivariable analyses revealed that odds of medication use across 3 years in all four conditions were higher for women with poorer mental and physical health, using hormone replacement therapy (HRT), or having seen a counsellor; and increased over time for depression, anxiety, and stress models. Medication use for depression was also higher for overweight/obese women, ex-smokers, and unmarried. Medication use for anxiety was higher for unmarried and non-working/low occupational women. Medication use for stress was higher for non-working women. Additional predictors of medication for sleep were surgical menopause, and area of residence.

Conclusions

Self-reported use of prescribed medication for four mental health conditions is increased over time after controlling for mental and physical health and other variables. Research needs to explore decision-making processes influencing differential rates of psychoactive medication use and their relationship with health outcomes.     

Randomized Controlled Trial of a Behavior Change Intervention to Increase Physical Activity and Quality of Life in Prostate Cancer Survivors

Background

Physical activity improves health in prostate cancer survivors; however, participation rates are low.

Purpose

This study aims to determine the effects of an implementation intention intervention on physical activity and quality of life in prostate cancer survivors.

Methods

Prostate cancer survivors (N?=?423) were randomly assigned to a standard physical activity recommendation, a self-administered implementation intention, or a telephone-assisted implementation intention. Physical activity and quality of life were assessed at baseline, 1, and 3 months.

Results

Analyses of covariance using multiple imputation showed that physical activity at 1 month increased by 86 min/week in the standard physical activity recommendation group compared with 168 min/week in the self-administered implementation intention group (P?=?0.023) and 105 min/week in the telephone-assisted implementation intention group (P?=?0.35).

Conclusions

A self-administered implementation intention intervention resulted in a meaningful short-term increase in physical activity. Supplementation with additional intervention strategies and more frequent intervention may improve longer-term exercise. (ClinicalTrials.gov number NCT01410656).     

The association between obstructive sleep apnea and dietary choices among obese individuals during middle to late childhood

Objective

Determine whether obstructive sleep apnea (OSA) is associated with the dietary choices of obese individuals during middle- to late-childhood. It was hypothesized that OSA would be associated with increased caloric content of a dinner order, particularly with high carbohydrate food choices. Secondarily, we examined the relationships between sleep duration and dietary choices.

Methods

42 obese subjects aged 10–16.9 years participated in a cross-sectional study that involved systematic collection of sleep duration (based on actigraphy), presence and severity of obstructive sleep apnea (obstructive apnea + hypopnea index [AHI] from inpatient polysomnography) and the macronutrient content of dinners ordered from a standardized hospital menu the evening before the polysomnogram.

Results

Primary analyses using Spearman rank-order correlations found that AHI was significantly associated with total calories, as well as grams of fat and carbohydrate, but not protein. These macronutrient variables did not correlate with sleep duration across a week, nor the night before the meal. Findings were unchanged after correcting for age- and sex-adjusted BMI.

Conclusions

More severe OSA appears to be associated with an increased preference for calorie-dense foods that are high in fat and carbohydrates in a manner that is independent of degree of obesity. Although this novel finding awaits replication, it has potential implications for the clinical care of obese youth and individuals with OSA, adds to the limited data that relate sleep to dietary choices and may have implications for OSA-related morbidity.     

Validation of Clinical Prediction Scores in Patients with Primary Intracerebral Hemorrhage

Background

Initial reports of the FUNC score suggest that it may accurately identify those patients suffering from intracerebral hemorrhage (ICH) with an ultra low chance of functional neurologic recovery. This study’s aim is to validate the FUNC score and determine if it accurately identifies the cohort of patients with an ultra low chance of survival with good neurologic recovery.

Methods

Retrospective review of 501 consecutive primary ICH patients admitted from the Emergency Department to a large healthcare system. Performance of the FUNC, ICH-GS, and oICH scores was determined by calculating areas under the receiver-operator-characteristic curves. Patients with a predicted 100 % chance of poor neurologic outcome (PNO) (FUNC <4 and ICH-GS >10) scores were evaluated to determine if DNR impacted 90 day survival or rate of survival with a Glasgow Outcome Score of <3.

Results

In 366 cases of primary ICH who presented during the study period, 222(61 %) survived to discharge. Both the FUNC (AUC: 0.873) and ICH-GS (AUC: 0.888) outperformed the oICH (AUC: 0.743) in predicting 90-day mortality (p = <0.001). Of 68 patients with a FUNC score <4, 67 (98.5 %) had PNO at discharge. The presence of DNR was not associated with a significant difference in the rate of PNO at discharge (40/40 = 100 % vs. 27/28 = 96.4 % p = 0.42) or 90-day mortality (40/40 = 100 % vs. 21/28 = 75 %, p = 0.06).

Conclusion

The FUNC and ICH-GS appear superior to the oICH in predicting outcome in patients with primary ICH. In addition, the FUNC score appears to accurately identify patients with low chance of functional neurologic recovery at discharge.     

Six-Month Outcomes from Living Well with Diabetes: A Randomized Trial of a Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control

Background

Intensive lifestyle intervention trials in type 2 diabetes contribute evidence on what can be achieved under optimal conditions, but are less informative for translation in applied settings.

Purpose

Living Well with Diabetes is a telephone-delivered weight loss intervention designed for real-world delivery.

Methods

This study is a randomized controlled trial of telephone counseling (n?=?151) versus usual care (n?=?151); 6-month primary outcomes of weight, physical activity, HbA1c; secondary diet outcomes; analysis was by adjusted generalized linear models.

Results

Relative to usual care, telephone counseling participants had small but significantly better weight loss [?1.12 % of initial body weight; 95 % confidence interval (CI) ?1.92, ?0.33 %]; physical activity [relative rate (RR)?=?1.30; 95 % CI, 1.08, 1.57]; energy intake reduction (?0.63 MJ/day; 95 % CI, ?1.01, ?0.25); and diet quality (3.72 points; 95 % CI, 1.77, 5.68), with no intervention effect for HbA1c (RR?=?0.99; 95 % CI, 0.96, 1.01).

Conclusions

Results are discussed in light of challenges to intervention delivery.     

Physical Activity Disparities in Heterosexual and Sexual Minority Youth Ages 12–22 Years Old: Roles of Childhood Gender Nonconformity and Athletic Self-Esteem

Background

Physical activity is an important health determinant. Little is known about sexual orientation differences in physical activity and their psychosocial determinants.

Purpose

The aim of this study is to examine adolescent and young adult hours/week of moderate/vigorous physical activity (MVPA) and team sports participation by sexual orientation and investigate contributions of gender nonconformity and low athletic self-esteem to possible sexual orientation differences.

Methods

Analysis of data from 5,272 males and 7,507 females from 1999 to 2005 waves of the US Growing Up Today Study (ages 12–22 years).

Results

Sexual minorities (i.e., lesbian, gay, bisexual, mostly heterosexual) reported 1.21–2.62 h/week less MVPA (p?<?0.01) and were 46–76 % less likely to participate in team sports than same-gender heterosexuals. Gender nonconformity and athletic self-esteem accounted for 46–100 % of sexual orientation MVPA differences.

Conclusions

Physical activity contexts should be modified to welcome sexual minority males and females. Targeting intolerance of gender nonconformity and fostering athletic self-esteem may mitigate sexual orientation MVPA disparities.     

A Neurological Complication of a Uterine Fibroid

Background

Uterine leiomyoma (or fibroid) can be associated with secondary polycythemia and venous thrombosis, but there has been no report of intracranial venous thrombosis associated with leiomyoma.

Methods

We describe a case report of a cerebral venous thrombosis associated with erythrocytosis and a uterine fibroid in a non-smoking female with no history of malignancy or hormone use. The hemoglobin and erythropoietin normalized after removal of her uterine fibroid.

Results

MRI/MRV of this 60-year-old cephalalgic female revealed extensive thrombus throughout the sagittal sinus and right transverse sinus. CT of the abdomen revealed a 16 × 13 × 12 cm solid mass arising for the uterus consistent with a uterine fibroid. PET scan was negative for malignancy. Hemoglobin on admission was 18.4 g/dl. Erythropoietin was 16.6 mIU/ml. One month after hysterectomy, her hemoglobin was 12.6 g/dl and her erythropoietin was 4.7 mIU/ml.

Conclusions

Cerebral vein thrombosis is a potential complication of uterine fibroids with erythrocytosis.     

Medication Adherence Is Associated with Having a Caregiver Among Cardiac Patients

Background

Medication non-adherence is a significant contributor to suboptimal control of blood pressure and lipids.

Purpose

This study determined if having a paid and/or family caregiver was associated with medication adherence in patients hospitalized for cardiovascular disease.

Methods

Consecutive patients admitted to the cardiovascular service at a university medical center who completed a standardized questionnaire about medication adherence and caregiving (paid/professional or family member/friend) were included in this analysis (N?=?1,432; 63 % white; 63%male).

Results

Among cardiac patients, 39 % reported being prescribed ≥7 different medications, and one in four reported being non-adherent to their medication(s). Participants who reported having/planning to have a paid caregiver were 40 % less likely to be non-adherent to their medications compared to their counterparts. The association remained significant after adjustment for demographic confounders and comorbid conditions (OR?=?0.49; 95 %CI?=?0.29–0.82).

Conclusion

Cardiac patients with a paid caregiver were half as likely to be non-adherent to medications as those without caregivers.     

Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial

Background

Adherence to preventive medication is often poor, and current interventions have had limited success.

Purpose

This study was conducted to pilot a randomised controlled trial aimed at increasing adherence to preventive medication in stroke survivors using a brief, personalised intervention.

Methods

Sixty-two stroke survivors were randomly allocated to either a two-session intervention aimed at increasing adherence via (a) introducing a plan linked to environmental cues (implementation intentions) to help establish a better medication-taking routine (habit) and (b) eliciting and modifying any mistaken patient beliefs regarding medication/stroke or a control group. Primary outcome was adherence to antihypertensive medication measured objectively over 3 months using an electronic pill bottle.

Results

Fifty-eight people used the pill bottle and were analysed as allocated; 54 completed treatment. The intervention resulted in 10 % more doses taken on schedule (intervention, 97 %; control, 87 %; 95 % CI for difference (0.2, 16.2); p?=?0.048).

Conclusions

A simple, brief intervention increased medication adherence in stroke survivors, over and above any effect of increased patient contact or mere measurement. (http://controlled-trials.com, number ISRCTN38274953.)     

Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults

Background

Sleep problems may lead to, or be symptomatic of, depression and other mental illnesses yet few studies have investigated their association with suicide risk.

Design

Prospective cohort study.

Setting

Taiwan.

Participants

393,983 men and women aged 20 or above participating in the MJ health check-up programme.

Results

There were 335 suicides over a mean of 7.4 years follow-up. There was a reverse J-shaped association between sleep duration and suicide risk. When compared with those sleeping 6–8 h per night the adjusted hazard ratios (95 % confidence intervals) for suicide associated with 0–4, 4–6 and >8 h sleep were 3.5 (2.0–6.1), 1.5 (1.1–1.9) and 1.5 (1.1–2.0), respectively. People requiring sleeping pills to get to sleep (1.2 % participants) were at over 11-fold increased risk; difficulty falling asleep (11.5 % participants), frequent dreaming (16.7 %) and being easily awoken (30.6 %) were associated with a 2.0-, 1.6- and 1.3-fold increased risk of suicide, respectively.

Conclusions

Less than 6 h sleep duration, sleep disturbances and reported use of sleep medicines are markers of suicide risk. Sleep problems should be assessed when evaluating suicide risk.     

Depression and Anxiety Following Myocardial Infarction and Their Inverse Associations with Future Health Behaviors and Quality of Life

Background

Post-myocardial infarction (MI) depression and anxiety were found to predict prognosis and quality of life.

Purpose

The purpose of this study was to test a behavioral pathway from post-MI depression/anxiety to future quality of life.

Methods

This is a longitudinal cohort study. Five hundred forty patients (≤65 years old) filled out questionnaires after a first MI, including socio-demographics, pre-MI health status and behaviors, MI severity, social support, sense of coherence, depression, and anxiety. Reports of health behaviors were obtained 5 years and of quality of life 10 years later.

Results

A structural equations model confirmed that depression and anxiety were directly related to poorer quality of life 10 years later. These relationships were partly mediated by a positive association between anxiety and health behaviors at 5 years and a negative one between depression and health behaviors.

Conclusions

The opposite effects of anxiety and depression underscore the need to attend to both emotional reactions to MI while encouraging preventive health behaviors.     

Intra-hospital Transport of Brain-Injured Patients: A Prospective, Observational Study

Introduction

Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients.

Methods

We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans.

Results

Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36 %) of all transports (p = n.s scheduled vs. unscheduled) necessitating the deployment of interventions designed to treat changes in arterial pressure (2) despite the presence of trained medical personnel and availability of specialized equipment, intra-cranial pressure was not adequately monitored during transports (especially in patients with intra-cranial hypertension prior to transport) (3) intra-hospital transfer was associated with minor but statistically significant clinical changes, including a reduction in arterial partial pressure of oxygen ( $ {\text{Pa}}_{{{\text{O}}_{ 2} }} $ )/inspired oxygen fraction ( $ {\text{Fi}}_{{{\text{O}}_{ 2} }} $ ) (only in the scheduled transport population), decreased arterial lactate levels (scheduled transport population), lowered body temperature (scheduled transport population), and increased arterial partial pressure of carbon dioxide ( $ {\text{Pa}}_{{{\text{CO}}_{ 2} }} $ ) (scheduled transport population).

Conclusions

Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO₂ ( $ {\text{ET}}_{{{\text{CO}}_{ 2} }} $ )] during transport is recommended.     

Sleep quality,obstructive sleep apnea,and psychological distress in truck drivers: a cross-sectional study

Purpose

Sleep disorders are highly prevalent in truck drivers. The aim of this study is to evaluate the prevalence of self-reported obstructive sleep apnea (OSA) and poor sleep quality in truck drivers, and to analyze the relationship between sleep problems and mental health.

Methods

A total of 526 male truck drivers (mean age 45.9; DS 9.4) responded to a questionnaire about risk factors for OSA (STOP-Bang), sleep quality perception (Pittsburg sleep questionnaire inventory, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS), and psychological disorders (general health questionnaire, GHQ-12).

Results

It was found that 51.1% of the drivers were at risk of OSA, 17.3% had bad sleep quality, and 8.9% had excessive daytime sleepiness (EDS). The association between psychological distress, OSA (OR?=?1.67; CI 95% 0.99–2.83; p?=?0.057), bad sleep quality (OR?=?2.58; CI 95% 1.52–4.37; p?<?0.001), and EDS (OR?=?1.65; CI 95% 0.83–3.30; p?=?0.151) was assessed.

Conclusions

The high prevalence of sleep problems, especially suspected OSA, and low quality of sleep in truck drivers can worsen the general and psychological wellbeing of the workers. Educational programs focusing on sleep hygiene and behavioral interventions are needed to promote adequate sleep habits and improve individual and public health.

     

Traumatic basal ganglia hematoma following closed head injuries in children

Purpose

High-velocity trauma with acceleration/deceleration forces turns into shear stress over lenticulostriate or anterior choroidal arteries that lead to basal ganglia hemorrhage. Traumatic basal ganglia hematoma has rarely been described in pediatric population. The aim of this study was to present our clinical series of pediatric patients with traumatic basal ganglia hematoma and to analyze the prognostic indicators of traumatic basal ganglia hematoma.

Methods

In this retrospective case series, emergency admissions of pediatric patients with traumatic basal ganglia hematoma due to closed head injury were analyzed. Demographic, clinical, and radiographical data of the patients were retrieved from patients’ charts and picture archiving and communication system.

Results

There were four children with traumatic basal ganglia hematoma (TBGH). All patients were male. Median age was 8 years (range = 7–16 years). Road accident (three) and fall (one) were the causes of the traumas. Basal ganglia hematoma was present on the right side in one patient and on the left side in three patients. Hematoma volumes ranged from 0.9 to 8.94 ml. All patients were treated conservatively. One patient recovered fully; two patients were moderately disabled at their last clinical follow-ups. The last patient with diffuse subarachnoidal hemorrhage and edema died despite all interventions.

Conclusions

Traumatic basal ganglia hematomas are unique and different from other kind of intracerebral hematomas. The eloquent nature of basal ganglia makes it more vulnerable to head trauma. Mechanism of injury, energy and velocity of injury are the most important prognostic criteria. Post-traumatic phase of injury should be carefully observed in patients with TBGH, especially when mechanism and velocity of injury are severe and high.

     

Value of Transcranial Doppler,Perfusion-CT and Neurological Evaluation to Forecast Secondary Ischemia after Aneurysmal SAH

Introduction

This study was conducted to prospectively evaluate the diagnostic value of detailed neurological evaluation, transcranial Doppler sonography (TCD) and Perfusion-CT (PCT) to predict delayed vasospasm (DV) and delayed cerebral infarction (DCI) within the following 3 days in patients with aneurysmal subarachnoid hemorrhage (SAH).

Methods

A total of 61 patients with aneurysmal SAH were included in the study. All patients were amenable for neurological evaluation throughout the critical phase to develop secondary ischemia after SAH. The neurological status was assessed three times a day according to a detailed examination protocol. Mean flow velocities (MFV) in intracranial vessel trunks were measured daily by TCD. Native CT and PCT were routinely acquired at 3-day intervals and, in addition, whenever it was thought to be of diagnostic relevance. The predictive values of abnormal PCT and accelerations in TCD (MFV > 140 cm/s) to detect angiographic DV and DCI within the following 2 days were calculated and compared to the predictive value of delayed ischemic neurological deficits (DIND).

Results

The accuracy of TCD and PCT to predict DV or DCI was 0.65 and 0.63, respectively. In comparison, DIND predicted DV or DCI with an accuracy of 0.96. Pathological PCT findings had a higher sensitivity (0.93) and negative predictive value (0.98) than TCD (0.81 and 0.96).

Conclusion

Neurological assessment at close intervals is the most accurate parameter to detect DV and DCI in the following 3 days. However, DIND may not be reversible. The routine acquisition of PCT in addition to daily TCD examinations seems reasonable, particularly in patients who are not amenable to a detailed neurological examination since it has a higher sensitivity and negative predictive value than TCD and leaves a lower number of undetected cases of vasospasm and infarction.     

Healthy for Life: A Randomized Trial Examining Physical Activity Outcomes and Psychosocial Mediators

Background

Researchers theorize that interventions increase physical activity by influencing key theory-based mediators (e.g., behavioral processes). However, few studies have been adequately powered to examine the importance of mediators.

Purpose

This study examined both physical activity behavior and psychosocial mediators in a randomized trial specifically powered to detect mediation.

Methods

Healthy, sedentary adults (n?=?448; 70 % Caucasian, 87 % women, mean age was 43) were randomly assigned to either a 6-month print-based theory tailored physical activity intervention (n?=?224) or a 6-month health/wellness contact control arm (n?=?224).

Results

The print intervention arm exhibited greater increases in physical activity than the control arm at 6 and 12 months (p?<?.05). Additionally, behavioral processes were found to be an important mediator of physical activity behavior.

Conclusions

It is important for researchers and practitioners to focus on increasing behavioral strategies for physical activity adoption. Future studies should examine other potential mediators of physical activity.     

Increased serum levels of advanced glycation end-products is associated with severity of sleep disordered breathing but not insulin sensitivity in non-diabetic men with obstructive sleep apnoea

Background

Patients with diabetes mellitus are known to have increased serum levels of advanced glycation end-products (AGEs), and this is also associated with insulin resistance. This study aimed to investigate the relationship between serum AGEs and insulin sensitivity in non-diabetic subjects with obstructive sleep apnoea (OSA).

Methods

Adult males with no known comorbidities were recruited from the sleep clinic of a university teaching hospital. They underwent overnight in-laboratory polysomnography. Fasting blood was taken to measure serum AGE and plasma glucose levels. Insulin sensitivity was estimated using the short insulin tolerance test.

Results

In total, 105 subjects with a mean age of 43.5 (standard deviation [SD] 9.2) years, mean body mass index of 27.1 (SD 4.0) kg/m², and median apnoea-hypopnoea index (AHI) of 17 (interquartile range 5-46) were analysed. Serum AGE levels were significantly higher in subjects with OSA (AHI ?5), compared with those without OSA (AHI <5) (3.9 [SD 1.2] vs. 3.2 [SD 0.8] μg/ml, respectively; P = 0.037) after adjusting for confounders. AGE levels were positively correlated with AHI (r = 0.318, P = 0.001), but not with insulin sensitivity. AGE levels decreased in subjects with moderate-to-severe OSA who received continuous positive airway pressure (CPAP) treatment for three months (n = 18, P = 0.017).

Conclusions

Serum AGE levels correlate with AHI in non-diabetic adult males. This relationship cannot be explained by insulin sensitivity. Supporting the hypothesis of a direct relationship between AHI and AGEs, AGE levels were found to decline with CPAP therapy.     

Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Risks, Lay Beliefs, and Informed Decisions

Background

Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test.

Purpose

This study aims to identify classes of reasons guiding men’s decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour.

Methods

First-degree relatives of men with prostate cancer (n?=?207) and men from the general population (n?=?239) of Australia listed reasons they considered when deciding whether to have a PSA test.

Results

Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men.

Conclusion

Understanding the reasons underlying men’s screening decisions may lead to a more effective information provision and decision support.