Daily Archives: 31 July 2024

Blood Analysis May Forecast Likelihood of Obstructive Sleep Apnea

Measuring the level of homocysteine, an amino acid in the blood, can provide predictive insights into an individual’s risk of developing obstructive sleep apnea, a disorder characterized by repeated interruptions in breathing during sleep due to the relaxation of throat muscles. Researchers at the Sleep Institute and the Federal University of São Paulo (UNIFESP) in Brazil, with the support of FAPESP, have determined that this simple blood test not only predicts the likelihood of the disorder but also assesses whether a patient with mild or moderate apnea is likely to progress to severe apnea. These findings were published in the European Archives of Oto-Rhino-Laryngology.

Monica Levy Andersen, a professor at UNIFESP and the study’s senior author, noted the uncertainty about whether apnea causes the rise in homocysteine levels or vice versa. She suggests that the relationship might be bidirectional and recommends including the homocysteine test in routine medical examinations for people over 40. This simple and cost-effective test, especially under Brazil’s public health system (SUS), could provide crucial data on this correlation.

Cardiologists have long been concerned with homocysteine due to its potential to cause cardiovascular problems. Elevated levels of this amino acid, known as hyperhomocysteinemia (more than 15 micromoles per litre), can lead to blood vessel damage and increase the risk of coronary diseases, thrombosis, and strokes. Vanessa Cavalcante-Silva, a postdoctoral researcher at UNIFESP and first author of the study, explains that a deficiency in B-complex vitamins—specifically B6, B9, and B12—can predispose individuals to high homocysteine levels. Therefore, dietary intake of these vitamins or supplementation could be a strategy to regulate these levels.

The data for this study was derived from the Epidemiological Study of Sleep (Episono), led by Sergio Tufik, a professor at UNIFESP, which has been examining the sleep quality and the effects of sleep disorders on the residents of São Paulo for over fifteen years. Preliminary findings from 2007 showed that a significant portion of the population experienced frequent snoring and sleep apnea. These conditions not only disrupt domestic peace but also impair memory, accelerate cellular ageing, and increase the risk of several severe health issues like hypertension, diabetes, and heart failure.

In their analysis, Andersen’s team used a sample of volunteers from the Episono project who underwent polysomnography tests to measure their apnea-hypopnea index (AHI), a diagnostic tool for sleep apnea severity based on the number of breathing disruptions per hour. Initially, they diagnosed varying degrees of apnea among participants and correlated these with different blood levels of homocysteine, revealing that higher homocysteine levels were associated with higher AHI scores.

A follow-up study conducted in 2015 aimed to investigate if homocysteine levels could predict the development of apnea in participants who initially did not have the condition. The results indicated a modest but existing risk: a slight increase in homocysteine levels correlated with a slightly higher risk of developing sleep apnea over the years. Andersen highlights the clinical relevance of this finding, suggesting that regular monitoring of homocysteine could provide valuable predictive information for managing and potentially mitigating the progression of sleep apnea. This novel approach underscores the potential of routine blood tests for risk assessment and guiding effective interventions in sleep medicine.

More information: Vanessa Cavalcante-Silva et al, Homocysteine as a predictor of apnea–hypopnea index in obstructive sleep apnea: a longitudinal epidemiological study (EPISONO), European Archives of Oto-Rhino-Laryngology. DOI: 10.1007/s00405-024-08614-z

Journal information: European Archives of Oto-Rhino-Laryngology Provided by Fundação de Amparo à Pesquisa do Estado de São Paulo

Senior Citizens Consider Reducing Medication, Research Advises Caution

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Over 82% of Americans aged between 50 and 80 regularly take prescription medications, and a significant 80% of these individuals are open to discontinuing one or more of these drugs if their healthcare providers agree, according to a new study from the University of Michigan. The research, however, highlights the complexities involved in such decisions. The study’s authors advocate for health care professionals, including prescribers and pharmacists, to engage deeply with older adults to determine whether reducing medication—commonly referred to as “deprescribing”—is appropriate based on individual circumstances.

The research in the Journal of General Internal Medicine draws on data from the University of Michigan’s National Poll on Healthy Aging. This recent study expands on a report from April 2023, focusing mainly on individuals who use medication to manage cardiovascular diseases or diabetes. About 30% of these individuals expressed a strong interest in deprescribing, primarily because the medicines they use target asymptomatic conditions like high blood pressure, cholesterol, and blood sugar—critical factors in preventing severe health crises if unmanaged.

Despite these medications’ essential role in preventing future health problems, the lack of immediate benefits can lead patients to question their necessity. On the other hand, the study found that those suffering from conditions with immediate symptoms, such as arthritis, mental health issues, and respiratory disorders, were less inclined to stop their medications. This suggests a clear preference for continuing treatments that directly relieve distressing symptoms.

Sarah Vordenberg, Pharm.D., M.P.H., the study’s lead author and a clinical associate professor at the U-M College of Pharmacy, emphasizes the importance of comprehensive medication reviews. These reviews are critical as they assess all medications and supplements a person is taking, aiming to safely reduce dosages, costs, and frequency of intake. While Medicare covers such reviews for eligible enrollees, uptake is surprisingly low, as shown by data from a 2020 National Poll on Healthy Aging report.

The study further explores the specific conditions reported by poll respondents, revealing varying degrees of openness to deprescribing: 84% of those on prescription drugs have a cardiovascular condition, with 35% open to stopping at least one medication; 29% have diabetes, with 30% considering deprescribing; nearly half report having arthritis, but only 17% would consider stopping such medications; 22% have brain-related conditions affecting mental health or cognition, with 19% open to deprescribing; and 11% taking medication for lung diseases like asthma or chronic obstructive pulmonary disease, with a similar percentage open to stopping treatment.

Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and a researcher at the VA Ann Arbor Healthcare System, comments on the changing guidelines for the use of cardiovascular and diabetes medications and emphasizes the need for ongoing, tailored discussions between patients and providers. The rise of direct-to-consumer services, particularly for medicines like GLP-1 inhibitors, highlights the critical need for healthcare providers to be fully informed about all substances their patients use, regardless of the source. This approach ensures that treatment decisions best suit individual health needs and circumstances.

More information: Sarah E. Vordenberg et al, Interest in Medication Deprescribing Among US Adults Aged 50–80, Journal of General Internal Medicine. DOI: 10.1007/s11606-024-08945-x

Journal information: Journal of General Internal Medicine Provided by Michigan Medicine – University of Michigan

Evaluation of the Economic Effects of Alternative Healthcare Delivery Methods for Elderly Patients in Emergency Departments

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Overcrowding and long waiting times in emergency departments (EDs) are pressing issues in Ireland and across the globe, negatively impacting healthcare outcomes and patient satisfaction. Addressing this, a novel study conducted by researchers at Trinity College Dublin and the University of Limerick has scrutinised the economic benefits of incorporating a specialised, dedicated team of health and social care professionals (HSCPs) into existing care frameworks for elderly patients. The findings, which reveal significant potential cost savings and enhancements in patient quality of life, were published on 25th June 2024 in the journal PLOS ONE.

The OPTI-MEND trial, led by Professor Dominic Trépel of Trinity College Dublin and Professor Rose Galvin of the University of Limerick and funded by the Health Research Board, was initiated in 2023. It introduced a dedicated ED team specialising in prompt assessment and intervention for patients aged 65 and over. The study of 353 older adults demonstrated that this team’s early interventions reduced the length of ED stays, minimised hospital readmission risk, and improved patient satisfaction overall.

This innovative service ensures that even patients with less severe conditions—those less likely to suffer from serious diseases or complications—receive comprehensive care from senior occupational therapists, physiotherapists, medical social workers, and ED care. The OPTI-MEND trial’s primary clinical findings suggested that many elderly patients could be safely discharged from the ED following early assessment and intervention by the HSCP team, avoiding costly inpatient hospital stays and motivating the hypothesis of significant economic benefits.

Subsequent analysis by the Trépel Lab at Trinity involved thoroughly scrutinising the trial data, assessing changes in quality of life and calculating both the direct costs of HSCP and the downstream costs to the Irish Health Service. The results indicated that integrating HSCP teams into standard ED care significantly enhances patient quality of life while potentially saving the national healthcare system approximately €2.4 billion. These savings are not just numbers but a beacon of hope for the future of Irish healthcare, primarily driven by the timely discharge of elderly patients from the ED. This suggests that if this model were adopted nationwide, it could allow patients to return to their homes sooner and more efficiently, ushering in a new era of healthcare efficiency and patient-centred care.

Professor Dominic Trépel highlighted the importance of including economic evaluations in clinical trials. These evaluations are not just numbers but powerful tools that aid in making informed decisions and managing limited healthcare budgets effectively. He underscored that a small investment in HSCP teams across Ireland’s 27 Emergency Departments could free up to €2.4 billion for other healthcare services while significantly improving health-related quality of life. Professor Rose Galvin echoed these sentiments, noting the surprising amount of funds that could be freed up by deploying HSCP teams, which significantly improve the health of older ED patients.

Building on these findings, Professors Trépel and Galvin are now collaborating on a new research program funded under the HRB Leaders Award to explore the value of home-based comprehensive geriatric assessments. Like the OPTI-MEND trial, this latest research aims to demonstrate the clinical and cost-effectiveness of service improvements, potentially shaping the future of Irish healthcare for generations to come.

More information: Dominic Trépel et al, The cost effectiveness of early assessment and intervention by a dedicated health and social care professional team for older adults in the emergency department compared to treatment-as-usual: Economic evaluation of the OPTI-MEND trial, PLoS ONE. DOI: 0.1371/journal.pone.0298162

Journal information: PLoS ONE Provided by Trinity College Dublin

Weight Reduction Affects Risk-Taking Behaviour in Obese Individuals

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Individuals with severe obesity experience not only altered risk behaviours but also significant changes in their metabolism and psychological state. Historically, it was believed that individuals with severe obesity are more impulsive and have a greater inclination towards risk-taking. Researchers from the DZD partner, the German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), have delved into whether substantial weight loss can lessen these metabolic and psychological disturbances and enhance decision-making abilities. Their comprehensive study and findings have been documented in the journal Clinical Nutrition.

Many factors influence behaviour, including personality and internal physiological signals such as glucose metabolism and emotional state. Studies indicate that in obese individuals, these internal signals are disrupted; impaired glucose metabolism and mood disturbances fail to provide reliable bases for decision-making. In an attempt to investigate whether these conditions are reversible, Beatrix Keweloh, a doctoral candidate in the Department of Neuroscience of Decision and Nutrition, and her team initiated an intervention study. They recruited 62 participants with severe obesity, ranging in age from 18 to 75 years, and subjected them to a rigorous 10-week diet that restricted their daily caloric intake to 800 kilocalories. The study meticulously measured participants’ weight, body fat, mood through questionnaires, and risk-taking tendencies via a computer-based test before and after the diet regimen.

The intervention led to significant health improvements, as evidenced by substantial reductions in body mass index (BMI) and HbA1c levels, the latter serving as a critical marker for glucose metabolism. Alongside these metabolic enhancements, there was a marked improvement in participants’ moods. The study intriguingly revealed a shift towards more risk-averse behaviour, underscoring a strong correlation between BMI and risk behaviour in obesity. Beatrix Keweloh noted, “Our findings underscore that post-weight loss, the metabolic factor HbA1c becomes the dominant predictor of risk-taking behaviours.”

The study’s implications are profound, indicating that mood exerts less influence over decision-making after weight loss, with metabolic signals taking precedence. This shift suggests that weight loss improves physical health parameters and restores the functional integrity of glucose metabolism as a critical decision-making signal. Beatrix Keweloh summarised the outcomes, highlighting the dual benefits of weight loss on glucose metabolism and mood, ultimately restoring the reliability of physiological signals in supporting decision-making processes.

More information: Beatrix Keweloh et al, Weight loss impacts risky decisions in obesity, Clinical Nutrition. DOI: 10.1016/j.clnu.2024.04.002

Journal information: Clinical Nutrition Provided by Deutsches Zentrum für Diabetesforschung DZD