Treatment with melatonin significantly improved subjective sleep quality in 12 women with mild to moderate asthma, as compared with 10 asthmatic women who took placebo. Although the investigators found improved sleep quality in the melatonin-treated women, their results showed no change in asthma symptoms, use of relief medication, or daily peak expiratory flow rate. (Melatonin is a hormone secreted by the human pineal gland, a tiny endocrine gland situated in the center of the brain. It is believed to play an important role in the regulation of sleep cycles.) Even when asthma is well-controlled, the investigators said that the drugs used for the disease such as oral steroids had been shown to disrupt sleep. The study subjects consisted of 22 consecutive female patients aged 18 to 60 years who had mild to moderate asthma. Those who had a history of asthma exacerbations within the prior 4 weeks, respiratory disease other than asthma, sleep disorders, use of hypnotic or sedative drugs, smoking, shift-work, or were pregnant or breastfeeding were excluded. Throughout the 4-week treatment period, participants were asked to record their morning and evening peak expiratory flow rate, the presence of asthma symptoms, and the frequency of their beta2-agonist inhalation use. According to the authors, no adverse effects were reported by participants who took melatonin. The study is published in the first issue for November 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
ACCIDENT RISK FACTORS ASSOCIATED WITH SLEEPY TRUCK DRIVERS
In a large study, Australian researchers found a high prevalence of sleep-disordered breathing and excessive sleepiness among drivers of commercial vehicles in their country. The investigators measured excessive sleepiness and sleep-disordered breathing and assessed accident risk factors in 2,342 respondents who were Australian commercial truck drivers. In addition, another 161 from a group of selected professional truck drivers underwent a polysomnographic sleep test. According to the investigators, about 60 percent of the drivers had sleep-disordered breathing and 16 percent had obstructive sleep apnea syndrome. Those figures contrasted sharply with data associated with the normal civilian population that showed a 24 percent sleep-disordered breathing rate and a 4 percent sleep apnea level. (For the study, sleep-disordered breathing was defined as 5 temporary pauses (apneas) or more in breathing per hour during sleep. Obstructive sleep apnea was characterized as 5 breathing pauses or more per hour, plus a high Epworth Sleepiness Scale score.) In addition to the accident problems shown by the drivers who suffered from increased sleepiness as demonstrated by the index, the authors saw an increased accident risk through narcotic analgesic and antihistamine use. These substances were used by 4 percent of the drivers. Of the 2,342 respondents who answered the study questionnaire, 739 drivers (35.5 percent) had a total of 1,407 accidents in the prior 3 years, with almost half of these truckers (48.3 percent) having had more than one accident. The study appears in the first issue for November 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
HUGE STUDY REVEALS CRITICAL CARE USE IN SERIOUS ILLNESS
In results from a huge study of Medicare patients who were seriously ill, researchers found that use of critical care was less likely the older an individual got; yet, regardless of age, about 3 percent of the patients who repeatedly entered intensive care accounted for 23 percent of the hospitalizations, totaling over $3 billion in costs. The investigator analyzed the records of 1,108,060 Medicare beneficiaries. These persons were at least 60 years of age, and newly diagnosed with serious illness. Their health problems included 1 of 9 malignancies, stroke, congestive heart failure, hip fracture, or heart attack. Of the total cohort, almost 55 percent used critical care at some time after their diagnosis. Much older patients (90 years of age) had one-third the odds of using critical care as those who were 68 to 70 years of age. In addition, a total of 31,348 patients (2.8 percent) were repeated users of the intensive care unit (ICU). They accounted for $3.6 billion in hospital charges and $1.4 billion in Medicare reimbursement. The median age of those analyzed in the study was 79. Of this group, almost 42 percent were male, 88.3 percent were white, and 15.8 percent also received Medcaid benefits given to those who have either low or no income. The repeated users of critical care were defined as those who had 5 or more distinct hospitalizations in which the ICU was used between the time of their diagnosis and death. Cardiac patients were disproportionately represented. The investigator concluded that critical care use is common in serious chronic illness and is not associated with hospitalization for a preterminal illness. The study appears in the first issue for November 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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