Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome

OBJECTIVE: To assess changes in response to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) concerning excessive daytime sleepiness (EDS), depressive state, and quality of life (QOL). PATIENTS AND METHODS: We assessed for EDS using the Epworth sleepiness scale (ESS), for mood using The Zung self-depression scale (SDS), and for QOL using Short-Form 36 (SF-36) in 132 patients with obstructive sleep apnea syndrome (OSAS) and control subjects. Patients had severe OSAS (apnea-hypopnea index, 59.4+/-23.8/h) and were more hypersomnolent and depressed, and had poorer QOL than 38 age- and gender-matched controls. RESULTS: Before treatment most QOL domains in the SF-36 were significantly associated with patients' SDS scores. With nasal CPAP, ESS and SDS scores were respectively decreased from 9.7+/-4.5 to 4.0+/-2.4 (p<0.0001) and from 49.2+/-10.4 to 45.1+/-9.6 (p<0.0005). Total SF-36 score and scores for seven of eight domains were increased significantly with treatment. Thus, nasal CPAP lessens EDS and depression, and improves QOL, in patients with severe OSAS. Further, magnitudes of changes in total SF-36 scores and in five of eight domains correlated significantly with magnitude of change in SDS score upon nasal CPAP treatment. No relationship was evident between treatment-associated score changes in SF-36 domains and ESS score change. CONCLUSION: Although patients with severe OSAS have poorer QOL than control subjects, nasal CPAP appears to improve QOL by alleviating depression.     

Is a Type A behavior pattern associated with falling among the community-dwelling elderly?

The aim of this report is to investigate the relationship between Type A behavior patterns and the likelihood of falling among community-dwelling elderly, and to compare differences in the prevalence, reasons, locations, injuries and frequency of falls between Type A and non-Type A personalities. Persons aged 60 or older living in 3 communities of Nanjing, China participated in a baseline survey conducted in 2000 (n=879), and falling incidents were followed for 1 year. The survey employed a self-administered questionnaire designed to elicit demographic data, current health problems and medications taken, intake of alcohol, exercise habits, physical function, environmental hazards and Type A behavior patterns. Several factors associated with falling such as health condition, physical function and environmental factors did not differ between the Type A and non-Type A groups except in the male tendency toward heart disease and their inability to walk fast. The results of logistic regression analyses showed that a Type A behavior pattern was independently associated with falling in males but not in females. Findings in the present study suggest that a Type A behavior pattern might play an important role in the rate of falling incidents in elderly males, since some characteristics of this personality pattern might lead to risk-taking behavior. More studies are needed to evaluate the association of certain behavior patterns with falling incidents.     

Home BP Monitoring Using a Telemonitoring System is Effective for Controlling BP in a Remote Island in Japan

The purpose of this study was to assess whether a home blood pressure (HBP) telemonitoring system could improve BP control and overcome the problems of HBP monitoring in a remote location. The authors enrolled 60 subjects and randomized them to either a Telemonitoring group or a Control group. The outcomes were changes in HBP level, adherence to HBP monitoring, and visual analog scale (VAS; score 0–100) as a measure of the motivation to perform HBP measurements. The reductions in morning systolic BP (−5.5±0.9 mm Hg vs 0.7±0.7 mm Hg, P<.001) and evening systolic BP (−4.6±1.0 mm Hg vs 1.0±1.1 mm Hg, P<.001) and the change in VAS (12.8±3.3 vs −1.6±2.2, P=.001) were significantly greater in the Telemonitoring group than in the Control group. The measure of the adherence to HBP monitoring tended to be better (P=.064) in the Telemonitoring group than in the Control group. These results indicate that an HBP telemonitoring system would be a beneficial healthcare measure in remote geographical locations.

Hypertension is one of the most common risk factors for cardiovascular disease, with a prevalence of approximately 30% to 45% of the general population.¹ Niijima, a small island located 160 km south of Tokyo, has 2933 residents (1410 men and 1523 women), 37% of whom are elderly (older than 65 years). In the 2013 health examination, the prevalence of hypertension was 35% among those older than 40 years. There has been an increasing number of elderly people living alone or living with elderly spouses on Niijima as a result of out‐migration of the young. In cases of acute illness, such as myocardial infarction or cerebral infarction, patients must be transported to a specialized medical center in Tokyo via 3‐hour flight by helicopter. In addition, there is no way off the island in the case of typhoons or other severe storms. Therefore, primary prevention by aggressive control of cardiovascular risk factors, especially hypertension, is of paramount importance.Home blood pressure (HBP) monitoring has been reported to be superior to office BP monitoring in predicting future cardiovascular events or mortality.², ³, ⁴, ⁵ When there is a discrepancy between the levels of HBP and office BP, HBP is superior to office BP in predicting cardiovascular risk.⁶, ⁷ However, in clinical practice, HBP monitoring is sometimes difficult to carry out adequately, especially in the elderly. With regard to HBP measurements, the biggest concern is the limited accuracy of the measurement techniques reporting by the subjects. With respect to the reporting of HBP measurements, the major problems are excess reports, insufficient reports, and reports of phantom records.⁸ In addition, patients sometimes forget to bring their log books in which the results of HBP measurements are written. On Niijima Island, it has been estimated that only 10% to 20% of hypertensive outpatients measure their HBP correctly.To overcome these shortcomings of HBP, the HBP telemonitoring system was developed.⁹ In the HBP telemonitoring system, HBP data are stored and transmitted to a secure Web site and doctors can check them in real time. Subjects do not need to manually record their BP data and physicians can check all of their data on the Web site. Studies have shown that the HBP telemonitoring system improves BP control, self‐efficacy, and adherence to antihypertensive medication.¹⁰, ¹¹, ¹², ¹³, ¹⁴, ¹⁵ However, it has not been established whether an HBP telemonitoring system would be effective in an elderly population, most of whom are living alone or with elderly spouses, in a remote geographical location.In this study, we hypothesized that an HBP telemonitoring system would improve BP control and solve the problems of HBP monitoring related to adherence and motivation in the population of Niijima Island, a very remote location off the east coast of Japan.     

Discovery of Surfactant-Like Peptides from a Phage-Displayed Peptide Library

Peptides with specific affinities for various materials have been identified in the past three decades and utilized in materials science and engineering. A peptide’s capability to specifically interact with materials is not naturally derived but screened from a biologically constructed peptide library displayed on phages or cells. To date, due to limitations in the screening procedure, the function of screened peptides has been primarily limited to the affinity for target materials. Herein, we demonstrated the screening of surfactant-like peptides from a phage-displayed peptide library. A screened phage clone displaying a peptide showed high activity for accumulating at emulsion surfaces with certain assembled structures, resulting in stable emulsions. The surface tension for the solution of the chemically synthesized peptide decreased with increasing peptide concentration, demonstrating certain surface activity, which corresponded to the ability to decrease the surface tension of liquids (e.g., water), owing to the accumulation of molecules at the air–liquid or liquid–liquid interface. Peptides with a randomized sequence did not lower the surface tension, indicating the essential role of amino acid sequences in surface activity. Our strategy for identifying novel functional peptides from a phage-displayed peptide library can be used to expand the applicability of peptidyl materials and biosurfactants.