New and Noteworthy Information—December 2015
Nonpharmacologic sleep interventions may help optimize outcomes in patients with chronic pain, according to data published in the November issue of Sleep. Investigators analyzed 11 randomized controlled trials, involving 1,066 participants, that evaluated the effect of nonpharmacologic sleep treatments on self-reported sleep quality, pain, and well-being in patients with long-term pain. They extracted means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, and physical and psychologic functioning for the treatment and control groups at baseline, post treatment, and final follow-up. Nonpharmacologic sleep treatments in patients with chronic pain were associated with a large improvement in sleep quality, a small reduction in pain, and moderate improvement in fatigue at post treatment. The effects on sleep quality and fatigue were maintained for as long as one year, when a moderate reduction in depression also was observed.
CSF biomarkers of angiogenesis are increased in Parkinson’s disease and associated with gait difficulties, blood–brain barrier dysfunction, white matter lesions, and cerebral microbleeds, according to a study published online ahead of print October 28 in Neurology. This cross-sectional analysis included 38 elderly controls and 100 patients with Parkinson’s disease. Patients with Parkinson’s disease without dementia displayed higher CSF levels of vascular endothelial growth factor, placental growth factor, and vascular endothelial growth factor 2, and lower levels of angiopoietin 2, compared with controls. Similar alterations in vascular endothelial growth factor, placental growth factor, and angiopoietin 2 levels were observed in patients with Parkinson’s disease with dementia. Abnormal angiogenesis may be important in Parkinson’s disease pathogenesis and contribute to dopa-resistant symptoms, said the researchers.
Despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood, according to a study published in the November issue of Sleep. Participants were randomized to receive three consecutive nights of sleep continuity disruption by forced nocturnal awakenings, or one of the following two control conditions: restricted sleep opportunity or uninterrupted sleep. Compared with controls with restricted sleep opportunity, participants who underwent forced awakenings had significantly less slow wave sleep after the first night of sleep deprivation, and significantly lower positive mood after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood.
Among patients who underwent transcatheter atrial septal defect closure (ASD), the use of clopidogrel and aspirin, compared with aspirin plus placebo, resulted in a lower monthly frequency of migraine attacks over three months, according to a study published online ahead of print November 9 in JAMA. A total of 171 patients without migraine were randomized to receive dual antiplatelet therapy or single antiplatelet therapy (ie, aspirin and placebo) for three months following transcatheter ASD closure. The mean age of the participants was 49, and 62% were women. Among patients with migraines following the procedure, those who received clopidogrel had less-severe migraine attacks. No patients who received clopidogrel had moderately or severely disabling migraine attacks, and 37% of the placebo group had such attacks.
The Consortium of Multiple Sclerosis Centers (CMSC) has issued a statement asserting that prescribers must retain the right to decide on the best treatment and medication for each patient with MS. “The varied and individualized course of MS mandates full access to symptomatic management as well as disease-modifying therapies, which, in the best judgment of the prescriber, offer optimal treatment outcomes. Medications to treat symptoms are carefully decided on an individual basis and by best-practice regimens,” said the CMSC. “Lack of understanding of the disease course and the challenges of MS treatment result in poor decision making practices by the insurance plans and specialty pharmacies and subsequent denial of prescribed medications.... CMSC proposes a collaborative care model in which providers, patients, and insurers work together to address these concerns.”
APOE4 greatly increases the likelihood of microbleeds in some men, according to a study published online ahead of print October 16 in Neurobiology of Aging. These microbleeds contribute to memory loss. Investigators examined brain scans of 658 participants (ages 48 to 91) in the Alzheimer’s Disease Neuroimaging Initiative. Of those subjects, 402 had mild cognitive impairment (MCI), 90 had early-stage Alzheimer’s disease, and 166 were cognitively normal. Researchers also analyzed scans of 448 other subjects (ages 36 to 88). Of those people, 152 had MCI, 152 had Alzheimer’s disease, and 144 were cognitively normal. Male carriers of APOE4 with MCI or Alzheimer’s disease had twice as many microbleeds in their brains as women with similar diagnoses. Researchers should evaluate whether sex steroids can reduce the microbleeds, said the authors.
