CHEST 2011: Embargoed studies highlight new sleep disorder research

The presence of rhythmic limb movements when sleeping, which may vary in intensity, may be an indicator of periodic limb movement disorder (PLMD). In a study of 100 patients with PMLD, researchers from Toledo, Ohio divided the patients into those who were right-handed and those who were left-handed. Of the 84 right-handed and 16 left-handed patients, 69% of right-handed patients had bilateral limb movements compared with 94% of left-handed patients, irrespective of age, sex, and race. Their findings indicate that left-handed people have significantly higher chances of having bilateral limb movements, indicating the potential for PLMD.

Weight Gain Common After CPAP Therapy
(#1119750, Wednesday, October 26, 7:45 PM Eastern)

Obesity is causally linked to obstructive sleep apnea (OSA). Researchers from Baylor College of Medicine in Houston, Texas studied electronic medical records of veterans diagnosed with OSA and treated with continuous positive airway pressure (CPAP) from January 2005 through May 2005, for baseline data. They examined sleep apnea severity, weight, blood pressure, and blood glucose levels before and after initiation of CPAP. Of the 61 patients studied, including 61 men and three women, with an average age of 63.8 years, the researchers found a trend toward weight gain at 1 year and a statistically significant weight gain at 2 years compared with baseline. This study shows that individuals using CPAP are prone to weight gain due to decreased energy expenditure from a reduction in an active need to breathe.

Women Pregnant With Multiples Experience Higher Rates of Sleep Apnea
(#1120102, Tuesday, October 25, 3:00 PM Eastern)

Researchers at Winthrop-University Hospital in Mineola, New York found that a greater risk of obstructive sleep apnea (OSA) exists for female patients who carry more than one child at a time. This study, which included 100 women between the ages of 18 and 86 years who had no pregnancies or up to 12 pregnancies, took place between December 2010 and April 2011. The study showed a higher prevalence of rapid eye movement (REM)-related OSA in women pregnant with two, three, or more babies than in women who either were not pregnant or carried only one child at a time. They attributed the REM-related OSA to structural and/or functional changes in the upper airway induced by repetitive exposure to pregnancy hormones. Identifying a tendency to carry multiples allows for earlier diagnosis and intervention in this group of women, possibly preventing the long-term OSA aftereffects.

Sleep Disorders Common Among Soldiers With Brain Injury, PTSD
(#1119758, Monday, October 24, 7:30 PM Eastern)

Soldiers with combat-related injuries, including traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), experience a high incidence of sleep disorders. Researchers from Walter Reed Army Medical Center in Washington, DC, studied 261 patients including 135 with PTSD, 116 of whom had a TBI, and 66 with both conditions. Of these patients (90.4% men, mean age 35 years), soldiers with combat-related TBI and PTSD were found to have high rates of disordered sleep. Of those with TBI blunt trauma, more experienced obstructive sleep apnea (OSA) (54.3% vs 25.9%, p=0.003), while, of those with blast injuries, more experienced insomnia (63.0% vs 40.0%, p=0.022). Overall, insomnia rates were similar among all patients with PTSD; however, PTSD appears to predispose soldiers to OSA. An increased awareness of the prevalence of sleep disorders is important in order for adequate treatment to be provided, especially beyond soldiers' military commitment.

Veterans With PTSD Often Report Dream Enactment
(#1119176, Monday, October 24, 7:30PM Eastern)

Dream enactment is very often reported in veterans with posttraumatic stress disorder (PTSD). Researchers from Baylor in Houston, Texas reviewed the histories of 23 veterans, 12 with PTSD and 11 without PTSD, who were referred to a sleep center for polysomnographic studies. Of the veterans who had PTSD, 10 reported dream enactments compared with none of the veterans without PTSD. Dream enactments were tied to phasic electromyogram (EMG) augmentation during rapid eye movement (REM). Researchers concluded that sleep or augmented REM-related EMG activity should prompt a thorough evaluation for PTSD and dream enactment in combat veterans.

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