Sleep Disorders

ATLANTA -- A rabies-therapy protocol that saved an unvaccinated Wisconsin teenager from death in 2004 has not rescued two other youngsters, the CDC reported.

MONTRÉAL -- Restless legs syndrome may boost nocturnal blood pressure and exacerbate cardiovascular disease risks, particularly among older patients, investigators here suggested.

BALTIMORE -- Sleep disturbance may set up a vicious cycle of spontaneous and chronic pain, which in turn can contribute to sleep loss, investigators here have found.

KANSAS CITY, Kan. -- For patients with Parkinson's disease poorly controlled by levodopa alone, the addition of ropinirole (Requip) both reduced "off" time and allowed for lower doses of levodopa.

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A 38-year-old secretary has had right wrist pain for the past 6 months. It was initially relievedby ibuprofen but is now persistent and makes it difficult for her to type. The pain is worse atnight.

Sleep complaints are common in patients with chronic obstructive pulmonary disease (COPD). Many patients complain of morning tiredness, early awakenings, difficulty in falling asleep, restlessness, and daytime sleepiness. Functional status may eventually be impaired by the resulting chronic fatigue that is compounded by dyspnea.

CHAPEL HILL, N.C. -- Major depression severity is much the same in a psychiatric clinic as it is in the practice of a generalist, reported investigators in a multicenter study.

LIVERPOOL, England -- Lamotrigine (Lamictal) should be the drug of choice for patients with partial-onset epileptic seizures while valproate (Depacon) heads the list for generalized and unclassifiable seizures, two major studies have found.

TOKYO -- Bystander CPR without mouth-to-mouth ventilation doubled the chance that those in cardiac arrest would have a good neurologic outcome, researchers here reported.

TOKYO -- Obstructive sleep apnea patients have a high rate of silent brain infarctions that can be seen by magnetic resonance imaging, according to researchers here.

ROCKVILLE, Md -- The FDA has taken steps to ensure that clinicians and patients are aware of rare bizarre effects associated with sedative hypnotics, including driving or eating while sleeping.

STANFORD, Calif. -- Despite hopes that selective serotonin reuptake inhibitors can help control kleptomania, a small randomized trial of one agent yielded no more than a placebo response.

GRENOBLE, France -- Nearly 60% of patients with pacemakers have undiagnosed sleep apnea, according to a small European study.

ROCKVILLE, Md. -- The FDA has warned all hospitals about a possible unanticipated fallout from an act of Congress -- the three-week-early shift to daylight savings time. All medical events triggered by computer clocks could chime an hour out of whack on Sunday.

UTRECHT, The Netherlands -- IVF rates for term live births after "mild" ovarian stimulation with single-embryo transfer equaled the rates for standard stimulation with two-embryo transfer, Dutch researchers reported.

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abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

MELBOURNE, Australia -- For children with intermittent asthma, a short course of Singulair (montelukast), a leukotriene antagonist, given at the first sign of an episode may reduce acute care visits, reported Australian investigators.

ATHENS, Greece -- Greek men and women who took a midday nap at least occasionally had a 12% lower risk of coronary mortality, according to a study here, and those who napped for at least three times per week did three times as well.

EVANSTON, Ill. -- Children who get less sleep than recommended are significantly more likely to be overweight or obese than their peers who get the right amount of sleep.

PITTSBURGH -- Common symptoms of depression such as fatigue, sleep disturbances, and anhedonia may trigger initima-media thickness changes associated with subclinical atherosclerosis, researchers here reported.

GLASGOW, Scotland -- About half of patients with newly diagnosed epilepsy will have good control of their seizures with the first medication tried, and a majority of responders will be seizure-free at the lowest dose, reported European investigators.

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

ABSTRACT: Heel pain that occurs with the first several steps in the morning and diminishes as walking continues is the classic symptom of plantar fasciitis. Assessment of risk factors, such as improper footwear, a change in physical activities, and a new running surface, is important. Radiographs are rarely useful. Plantar fasciitis is generally self-limited; symptoms typically take 6 to 18 months to resolve. Conservative measures may include relative rest, stretching, strengthening, shoe modifications, orthoses, night splints, NSAIDs, and ice therapy. A corticosteroid injection may be warranted in resistant cases. If extensive conservative treatment is unsuccessful, referral to an orthopedic surgeon may be indicated.

For several days, the left eye and eyelids of a 60-year-old obese man had been red and irritated. The symptoms were worse in the morning after waking. The patient had recently started wearing a nighttime continuous positive airway pressure mask for obstructive sleep apnea (OSA). He slept exclusively on his left side.

BETHESDA, Md. -- Nearly three million Americans are living after a stroke, reported government researchers. There are more than two million patients with epilepsy, and migraine affects more than 35 million lives.

CHAPEL HILL, N.C. -- Intracranial bleeding in newborns has been found common after a vaginal birth, although the bleeding is limited and apparently has no effect, according to researchers here.

OXFORD, England -- Efforts to quit smoking with Chantix (varenicline), the nicotine-receptor partial agonist, may be more successful than with Zyban (bupropion), according to a Cochrane review.