Sleep in special needs children: The challenge

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Sleep in special needs children: The challenge

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Teen Vaccines

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
CE Available

This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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Keep Your Kids Moving

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
CE Available

This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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Sleep-dependent memory consolidation in patients with sleep disorders

Sleep can improve the off-line memory consolidation of new items of declarative and non-declarative information in healthy subjects, whereas acute sleep loss, as well as sleep restriction and fragmentation, impair consolidation. This suggests that, by modifying the amount and/or architecture of sleep, chronic sleep disorders may also lead to a lower gain in off-line consolidation, which in turn may be responsible for the varying levels of impaired performance at memory tasks usually observed in sleep-disordered patients.

The experimental studies conducted to date have shown specific impairments of sleep-dependent consolidation overall for verbal and visual declarative information in patients with primary insomnia, for verbal declarative information in patients with obstructive sleep apnoeas, and for visual procedural skills in patients with narcolepsy-cataplexy.

These findings corroborate the hypothesis that impaired consolidation is a consequence of the chronically altered organization of sleep. Moreover, they raise several novel questions as to: a) the reversibility of consolidation impairment in the case of effective treatment, b) the possible negative influence of altered prior sleep also on the encoding of new information, and c) the relationships between altered sleep and memory impairment in patients with other (medical, psychiatric or neurological) diseases associated with quantitative and/or qualitative changes of sleep architecture.

Table 1. Methodological characteristics and results of the experimental studies on memory consolidation during sleep in patients with chronic sleep disorders.

Abbreviations: DM = declarative memory; NC = narcolepsy with cataplexy; NDM = non declarative memory; OSA = obstructive sleep apnoea; PI = primary insomnia; REM = rapid eye movement (sleep); REMD = REM density; SE = sleep efficiency; SWS = slow wave sleep; SPT = sleep period time; SFI = sleep fragmentation index; SOA= stimulus onset asynchrony; TST = total sleep time; WASO = wake after sleep onset.

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Copyright © 2012 Elsevier Ltd. All rights reserved.

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Sleep-dependent memory consolidation in patients with sleep disorders

Sleep can improve the off-line memory consolidation of new items of declarative and non-declarative information in healthy subjects, whereas acute sleep loss, as well as sleep restriction and fragmentation, impair consolidation. This suggests that, by modifying the amount and/or architecture of sleep, chronic sleep disorders may also lead to a lower gain in off-line consolidation, which in turn may be responsible for the varying levels of impaired performance at memory tasks usually observed in sleep-disordered patients.

The experimental studies conducted to date have shown specific impairments of sleep-dependent consolidation overall for verbal and visual declarative information in patients with primary insomnia, for verbal declarative information in patients with obstructive sleep apnoeas, and for visual procedural skills in patients with narcolepsy-cataplexy.

These findings corroborate the hypothesis that impaired consolidation is a consequence of the chronically altered organization of sleep. Moreover, they raise several novel questions as to: a) the reversibility of consolidation impairment in the case of effective treatment, b) the possible negative influence of altered prior sleep also on the encoding of new information, and c) the relationships between altered sleep and memory impairment in patients with other (medical, psychiatric or neurological) diseases associated with quantitative and/or qualitative changes of sleep architecture.

Table 1. Methodological characteristics and results of the experimental studies on memory consolidation during sleep in patients with chronic sleep disorders.

Abbreviations: DM = declarative memory; NC = narcolepsy with cataplexy; NDM = non declarative memory; OSA = obstructive sleep apnoea; PI = primary insomnia; REM = rapid eye movement (sleep); REMD = REM density; SE = sleep efficiency; SWS = slow wave sleep; SPT = sleep period time; SFI = sleep fragmentation index; SOA= stimulus onset asynchrony; TST = total sleep time; WASO = wake after sleep onset.

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High Blood Pressure in Pregnancy May Threaten Kids' Heart Health

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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- Preeclampsia, a dangerous spike in a woman's blood pressure during pregnancy, may predispose offspring to high blood pressure in childhood and young adulthood, a new study finds.

From early in life, these children have distinct cardiovascular risk factors that may put them at risk for health problems later on, the British researchers said.

"A pregnancy complicated by preeclampsia is an early warning sign that both the mother and offspring are going to be at greater risk of developing high blood pressure later in life," said lead researcher Dr. Paul Leeson, from the department of cardiovascular medicine at the University of Oxford in England.

The findings suggest a need to monitor these children, the authors said. "There is likely to be value in considering a history of preeclampsia to understand better a person's risk of developing high blood pressure," Leeson said.

High blood pressure, also called hypertension, can lead to stroke, heart attack and kidney failure.

Research into the biology underlying this association may also help identify new ways to prevent high blood pressure, Leeson added.

The report, published May 21 online, appears in the June print issue of Pediatrics.

For the study, Leeson's team reviewed 18 studies published between 1948 and 2011 that dealt with cardiovascular risk factors of children and young adults exposed to preeclampsia and those not exposed.

This type of study, which involved more than 45,000 individuals, is called a meta-analysis and is designed to look for common patterns in unrelated studies.

In their analysis, the researchers found that kids exposed to preeclampsia had higher blood pressure readings in childhood and as young adults, compared with those who were not exposed.

Systolic blood pressure of those exposed to preeclampsia was 2.39 mm Hg higher on average than that of those whose moms had healthy pregnancies, and diastolic pressure was 1.35 mm Hg higher on average, the researchers noted. In a blood pressure reading of 120/80, the first number -- 120 -- is the systolic pressure.

Over time, this difference in systolic blood pressure would increase a person's risk of death from heart disease by about 8 percent and stroke by 12 percent, the authors said.

Children and young adults exposed to preeclampsia also had a higher body mass index (BMI) than children not exposed, the researchers say. BMI, a calculation of body size based on height and weight, is another risk factor for cardiovascular disease.

The study does not prove that preeclampsia causes cardiovascular disease, however. It merely shows an association between the two.

Dr. Natalie Meirowitz, chief of maternal-fetal medicine in the department of obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., said this study points to a major public health issue.

"This study really says the intrauterine environment affects a child's vascular function as an adult," Meirowitz said.

"It may be obesity that is driving this," added Meirowitz. More pregnant women are obese, which is a risk factor for preeclampsia.

"We really need to consider cardiovascular disease that comes from the intrauterine environment and understand it better so we can prevent future cardiovascular disease," she said.

Obesity in pregnancy is a modifiable risk factor, Meirowitz said. "There isn't enough attention paid to it and the effect it can have on children later in life," she said.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Paul Leeson, M.B., Ph.D.,department of cardiovascular medicine, University of Oxford, England; Natalie Meirowitz, M.D., chief, maternal-fetal medicine, department of obstetrics and gynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; June 2012 Pediatrics

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High Blood Pressure in Pregnancy May Threaten Kids' Heart Health

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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- Preeclampsia, a dangerous spike in a woman's blood pressure during pregnancy, may predispose offspring to high blood pressure in childhood and young adulthood, a new study finds.

From early in life, these children have distinct cardiovascular risk factors that may put them at risk for health problems later on, the British researchers said.

"A pregnancy complicated by preeclampsia is an early warning sign that both the mother and offspring are going to be at greater risk of developing high blood pressure later in life," said lead researcher Dr. Paul Leeson, from the department of cardiovascular medicine at the University of Oxford in England.

The findings suggest a need to monitor these children, the authors said. "There is likely to be value in considering a history of preeclampsia to understand better a person's risk of developing high blood pressure," Leeson said.

High blood pressure, also called hypertension, can lead to stroke, heart attack and kidney failure.

Research into the biology underlying this association may also help identify new ways to prevent high blood pressure, Leeson added.

The report, published May 21 online, appears in the June print issue of Pediatrics.

For the study, Leeson's team reviewed 18 studies published between 1948 and 2011 that dealt with cardiovascular risk factors of children and young adults exposed to preeclampsia and those not exposed.

This type of study, which involved more than 45,000 individuals, is called a meta-analysis and is designed to look for common patterns in unrelated studies.

In their analysis, the researchers found that kids exposed to preeclampsia had higher blood pressure readings in childhood and as young adults, compared with those who were not exposed.

Systolic blood pressure of those exposed to preeclampsia was 2.39 mm Hg higher on average than that of those whose moms had healthy pregnancies, and diastolic pressure was 1.35 mm Hg higher on average, the researchers noted. In a blood pressure reading of 120/80, the first number -- 120 -- is the systolic pressure.

Over time, this difference in systolic blood pressure would increase a person's risk of death from heart disease by about 8 percent and stroke by 12 percent, the authors said.

Children and young adults exposed to preeclampsia also had a higher body mass index (BMI) than children not exposed, the researchers say. BMI, a calculation of body size based on height and weight, is another risk factor for cardiovascular disease.

The study does not prove that preeclampsia causes cardiovascular disease, however. It merely shows an association between the two.

Dr. Natalie Meirowitz, chief of maternal-fetal medicine in the department of obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., said this study points to a major public health issue.

"This study really says the intrauterine environment affects a child's vascular function as an adult," Meirowitz said.

"It may be obesity that is driving this," added Meirowitz. More pregnant women are obese, which is a risk factor for preeclampsia.

"We really need to consider cardiovascular disease that comes from the intrauterine environment and understand it better so we can prevent future cardiovascular disease," she said.

Obesity in pregnancy is a modifiable risk factor, Meirowitz said. "There isn't enough attention paid to it and the effect it can have on children later in life," she said.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Paul Leeson, M.B., Ph.D.,department of cardiovascular medicine, University of Oxford, England; Natalie Meirowitz, M.D., chief, maternal-fetal medicine, department of obstetrics and gynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; June 2012 Pediatrics

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Stop Bathroom Breaks

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
CE Available

This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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Strokes More Common in Southern States: CDC

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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- While fewer people in the United States are dying from strokes, the number of strokes has remained about the same, health officials report. And their findings bear out the South's reputation as the nation's so-called "stroke belt."

According to the report on stroke prevalence from 2006 to 2010, the number of self-reported strokes dipped slightly from 2.7 percent to 2.6 percent during that time. However, disparities still exist by geography, race and ethnicity, says the U.S. Centers for Disease Control and Prevention.

"Overall, there is not much change in these five years," said lead report author Dr. Jing Fang, an epidemiologist in CDC's Division of Heart Disease and Stroke Prevention.

Only two states -- Georgia and South Dakota -- showed a significant decrease, she added.

However, deaths from stroke decreased significantly, with the CDC reporting a 3.6 percent decline from 2007 to 2008. More people survive strokes primarily because of better treatment.

Since this report is based on people reporting they had a stroke, it's no surprise that reported strokes did not drop significantly, and actually an increase in reported stroke would be expected, Fang said.

"Since mortality has decreased it means that more people say: 'yes, they had a stroke,'" she said.

The report was published in the May 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Geographically, there continues to be high incidence of stroke in Southeastern states, although some other states had high rates.

States with the highest rates of stroke include South Carolina, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Tennessee, Kentucky, Missouri and Nevada.

Those with the lowest rates include New York, Michigan, Colorado, Minnesota, Wisconsin, Wyoming and the New England states.

Older people, American Indians/Alaska Natives, blacks and people with lower levels of education had more strokes than younger people, whites and those with higher levels of education, the researchers found.

The disparities in stroke, a leading cause of long-term disability, are largely due to lifestyle factors including obesity, high blood pressure and smoking, Fang said.

"Southern states have higher rates of obesity, smoking and hypertension, which are all risk factors for stroke," she said.

This is also true for blacks and American Indians/Alaska Natives, and people with lower levels of education, Fang said.

Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine, said it is "reassuring that some of our stroke prevention efforts seem to be working."

However, he said, "The disparities in stroke prevalence by age, race and education continue to highlight the importance of stroke in certain segments of our population who need more intensive stroke prevention and treatment efforts."

Sacco noted that with an aging U.S. population, better data and monitoring will be needed to avoid higher rates of stroke in the future.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jing Fang, M.D., epidemiologist, Division of Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention; Ralph Sacco, M.D., professor and chairman, neurology, professor and chairman, stroke and clinical cerebral vascular diseases, University of Miami Miller School of Medicine; May 25, 2012, Morbidity and Mortality Weekly Report

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Strokes More Common in Southern States: CDC

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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- While fewer people in the United States are dying from strokes, the number of strokes has remained about the same, health officials report. And their findings bear out the South's reputation as the nation's so-called "stroke belt."

According to the report on stroke prevalence from 2006 to 2010, the number of self-reported strokes dipped slightly from 2.7 percent to 2.6 percent during that time. However, disparities still exist by geography, race and ethnicity, says the U.S. Centers for Disease Control and Prevention.

"Overall, there is not much change in these five years," said lead report author Dr. Jing Fang, an epidemiologist in CDC's Division of Heart Disease and Stroke Prevention.

Only two states -- Georgia and South Dakota -- showed a significant decrease, she added.

However, deaths from stroke decreased significantly, with the CDC reporting a 3.6 percent decline from 2007 to 2008. More people survive strokes primarily because of better treatment.

Since this report is based on people reporting they had a stroke, it's no surprise that reported strokes did not drop significantly, and actually an increase in reported stroke would be expected, Fang said.

"Since mortality has decreased it means that more people say: 'yes, they had a stroke,'" she said.

The report was published in the May 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Geographically, there continues to be high incidence of stroke in Southeastern states, although some other states had high rates.

States with the highest rates of stroke include South Carolina, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Tennessee, Kentucky, Missouri and Nevada.

Those with the lowest rates include New York, Michigan, Colorado, Minnesota, Wisconsin, Wyoming and the New England states.

Older people, American Indians/Alaska Natives, blacks and people with lower levels of education had more strokes than younger people, whites and those with higher levels of education, the researchers found.

The disparities in stroke, a leading cause of long-term disability, are largely due to lifestyle factors including obesity, high blood pressure and smoking, Fang said.

"Southern states have higher rates of obesity, smoking and hypertension, which are all risk factors for stroke," she said.

This is also true for blacks and American Indians/Alaska Natives, and people with lower levels of education, Fang said.

Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine, said it is "reassuring that some of our stroke prevention efforts seem to be working."

However, he said, "The disparities in stroke prevalence by age, race and education continue to highlight the importance of stroke in certain segments of our population who need more intensive stroke prevention and treatment efforts."

Sacco noted that with an aging U.S. population, better data and monitoring will be needed to avoid higher rates of stroke in the future.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jing Fang, M.D., epidemiologist, Division of Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention; Ralph Sacco, M.D., professor and chairman, neurology, professor and chairman, stroke and clinical cerebral vascular diseases, University of Miami Miller School of Medicine; May 25, 2012, Morbidity and Mortality Weekly Report

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Keeping Kids Safe

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
CE Available

This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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Migraine: They are triggered by weather changes?

Some people who have headaches seem to be more sensitive to changes in time. Weather related triggers include:

Bright cold temperaturesHigh SunlightHot or humidityDry airWindy or weatherBarometric stormy pressure changes

For some people, weather changes can cause imbalance in brain chemicals, including serotonin, which can take a headache. Weather triggers can also worsen a headache caused by other triggers.

If you feel your migraines are triggered by time, you may be understandably frustrated. After all, you can't change the time. However, you can learn what changes weather forecast initiate a migraine and take measures to reduce the effects:

Keep a diary of migraine headaches, migraine, list each when it happened, how long it lasted, and what might have caused. This can help determine if you have triggers specific forecasts.Monitor changes to climate and to avoid the trigger if possible. For example, staying indoors during the very cold and windy weather if these factors seem to trigger your headache.Take the migraine medicine at the first sign of a migraine.Make healthy lifestyle — eating healthy foods, exercise regularly, get enough sleep and keeping your stress under control. These factors may help to reduce the number and severity of your migraines.Next question references environmental and physical factors. National Foundation of headaches. http://www.headaches.org/education/Tools_for_Sufferers/Headache_-_Frequently_Asked_Questions/Environmental_and_Physical_Factors. The 21 February, 2012. Friedman DI, et al., migraines and the environment. Headaches. 2009; 49: 941. Migraine headaches. American Academy of Neurology. http://www.aan.com/Professionals/Practice/Guidelines/migraine/Migraine_Guide_Patients.pdf. Accessed February 29, 2012. Hoffman J, et al., weather sensitivity in migraine sufferers. Journal of Neurology. 2011; 258: 596. Migraine. National Foundation of headaches. http://www.headaches.org/education/Headache_Topic_Sheets/migraine. Accessed 1 March 2012.

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Migraine: They are triggered by weather changes?

Some people who have headaches seem to be more sensitive to changes in time. Weather related triggers include:

Bright cold temperaturesHigh SunlightHot or humidityDry airWindy or weatherBarometric stormy pressure changes

For some people, weather changes can cause imbalance in brain chemicals, including serotonin, which can take a headache. Weather triggers can also worsen a headache caused by other triggers.

If you feel your migraines are triggered by time, you may be understandably frustrated. After all, you can't change the time. However, you can learn what changes weather forecast initiate a migraine and take measures to reduce the effects:

Keep a diary of migraine headaches, migraine, list each when it happened, how long it lasted, and what might have caused. This can help determine if you have triggers specific forecasts.Monitor changes to climate and to avoid the trigger if possible. For example, staying indoors during the very cold and windy weather if these factors seem to trigger your headache.Take the migraine medicine at the first sign of a migraine.Make healthy lifestyle — eating healthy foods, exercise regularly, get enough sleep and keeping your stress under control. These factors may help to reduce the number and severity of your migraines.Next question references environmental and physical factors. National Foundation of headaches. http://www.headaches.org/education/Tools_for_Sufferers/Headache_-_Frequently_Asked_Questions/Environmental_and_Physical_Factors. The 21 February, 2012. Friedman DI, et al., migraines and the environment. Headaches. 2009; 49: 941. Migraine headaches. American Academy of Neurology. http://www.aan.com/Professionals/Practice/Guidelines/migraine/Migraine_Guide_Patients.pdf. Accessed February 29, 2012. Hoffman J, et al., weather sensitivity in migraine sufferers. Journal of Neurology. 2011; 258: 596. Migraine. National Foundation of headaches. http://www.headaches.org/education/Headache_Topic_Sheets/migraine. Accessed 1 March 2012.

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Protecting Babies from Flu

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
CE Available

This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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Is obstructive sleep apnea associated with cortisol levels? A systematic review of the research evidence

a San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, UCSD Mail Code 0804, La Jolla, CA, United Statesb Department of Psychiatry, University of California, San Diego, CA, United StatesReceived 8 March 2011. Revised 21 May 2011. Accepted 23 May 2011. Available online 30 July 2011.View full text The pathophysiology of obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis; however a relationship between OSA and altered cortisol levels has not been conclusively established. We conducted a systematic review using the PRISMA Guidelines based on comprehensive database searches for 1) studies of OSA patients compared to controls in whom cortisol was measured and 2) studies of OSA patients treated with continuous positive airway pressure (CPAP) in whom cortisol was measured pre and post treatment. Five electronic databases were searched along with the reference lists of retrieved studies. The primary outcomes were 1) differences in cortisol between OSA and control subjects and 2) differences in cortisol pre-post CPAP treatment. Sampling methodology, sample timing and exclusion criteria were evaluated. Fifteen studies met the inclusion criteria. Heterogeneity of studies precluded statistical pooling. One study identified differences in cortisol between OSA patients and controls. Two studies showed statistically significant differences in cortisol levels pre-post CPAP. The majority of studies were limited by assessment of cortisol at a single time point. The available studies do not provide clear evidence that OSA is associated with alterations in cortisol levels or that treatment with CPAP changes cortisol levels. Methodological concerns such as infrequent sampling, failure to match comparison groups on demographic factors known to impact cortisol levels (age, body mass index; BMI), and inconsistent control of variables known to influence HPA function may have limited the results.

prs.rt("abs_end");Obstructive sleep apnea; Cortisol; Continuous positive airway pressure; Systematic review

Figures and tables from this article:

Fig. 1. PRISMA trial flow used to identify studies for detailed analysis of cortisol in 1) patients with obstructive sleep apnea and healthy controls and 2) patients with obstructive sleep apnea before and after treatment with continuous positive airway pressure. AHI = Apnea hypopnea index; CPAP = Continuous positive airway pressure.

View Within ArticleTable 1. The 7 included studies of cortisol in patients with OSA versus controls.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; w = with; wo = without.

View Within ArticleTable 2. The 8 included studies of cortisol in patients with OSA treated with CPAP.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; SE = Standard error of the mean; w = with; wo = without.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

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Is obstructive sleep apnea associated with cortisol levels? A systematic review of the research evidence

a San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, UCSD Mail Code 0804, La Jolla, CA, United Statesb Department of Psychiatry, University of California, San Diego, CA, United StatesReceived 8 March 2011. Revised 21 May 2011. Accepted 23 May 2011. Available online 30 July 2011.View full text The pathophysiology of obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic pituitary adrenal (HPA) axis; however a relationship between OSA and altered cortisol levels has not been conclusively established. We conducted a systematic review using the PRISMA Guidelines based on comprehensive database searches for 1) studies of OSA patients compared to controls in whom cortisol was measured and 2) studies of OSA patients treated with continuous positive airway pressure (CPAP) in whom cortisol was measured pre and post treatment. Five electronic databases were searched along with the reference lists of retrieved studies. The primary outcomes were 1) differences in cortisol between OSA and control subjects and 2) differences in cortisol pre-post CPAP treatment. Sampling methodology, sample timing and exclusion criteria were evaluated. Fifteen studies met the inclusion criteria. Heterogeneity of studies precluded statistical pooling. One study identified differences in cortisol between OSA patients and controls. Two studies showed statistically significant differences in cortisol levels pre-post CPAP. The majority of studies were limited by assessment of cortisol at a single time point. The available studies do not provide clear evidence that OSA is associated with alterations in cortisol levels or that treatment with CPAP changes cortisol levels. Methodological concerns such as infrequent sampling, failure to match comparison groups on demographic factors known to impact cortisol levels (age, body mass index; BMI), and inconsistent control of variables known to influence HPA function may have limited the results.

prs.rt("abs_end");Obstructive sleep apnea; Cortisol; Continuous positive airway pressure; Systematic review

Figures and tables from this article:

Fig. 1. PRISMA trial flow used to identify studies for detailed analysis of cortisol in 1) patients with obstructive sleep apnea and healthy controls and 2) patients with obstructive sleep apnea before and after treatment with continuous positive airway pressure. AHI = Apnea hypopnea index; CPAP = Continuous positive airway pressure.

View Within ArticleTable 1. The 7 included studies of cortisol in patients with OSA versus controls.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; w = with; wo = without.

View Within ArticleTable 2. The 8 included studies of cortisol in patients with OSA treated with CPAP.

Na = No information; OSA = Obstructive sleep apnea; BMI = Body mass index; AHI = Apnea hypopnea index; EDS = Excessive daytime sleepiness; SE = Standard error of the mean; w = with; wo = without.

View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

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Restrain Your Children

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April 6, 2012 / Vol. 61 / No. RR–2
Good Laboratory Practices for Biochemical Genetic Testing and Newborn Screening for Inherited Metabolic Disorders
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This report provides recommendations for good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process, confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations.

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