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"Weingarten, A. J"
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Metoprolol for the Prevention of Acute Exacerbations of COPD
Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.
In this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All the patients had a clinical history of COPD, along with moderate airflow limitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending on the adjusted dose of metoprolol.
A total of 532 patients underwent randomization. The mean (±SD) age of the patients was 65.0±7.8 years; the mean forced expiratory volume in 1 second (FEV
) was 41.1±16.3% of the predicted value. The trial was stopped early because of futility with respect to the primary end point and safety concerns. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days in the metoprolol group and 222 days in the placebo group (hazard ratio for metoprolol vs. placebo, 1.05; 95% confidence interval [CI], 0.84 to 1.32; P = 0.66). Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group.
Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol. (Funded by the Department of Defense; BLOCK COPD ClinicalTrials.gov number, NCT02587351.).
Journal Article
Sharing the past : the reinvention of history in Canadian poetry since 1960
\"Sharing the Past is an unprecedentedly detailed account of the intertwining discourses of Canadian history and creative literature. When social history emerged as its own field of study in the 1960s, it promised new stories that would bring readers away from the elite writing of academics and closer to the everyday experiences of people. Yet, the academy's continued emphasis on professional distance and objectivity made it difficult for historians to connect with the experiences of those about whom they wrote, and those same emphases made it all but impossible for non-academic experts to be institutionally recognized as historians. Drawing on interviews and new archival materials to construct a history of Canadian poetry written since 1960, Sharing the Past argues that the project of social history has achieved its fullest expression in lyric poetry, a genre in which personal experiences anchor history. Developing this genre since 1960, Canadian poets have provided an inclusive model for a truly social history that indiscriminately shares the right to speak authoritatively of the past. \"-- Provided by publisher.
Book
0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures
Abstract
Introduction
Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA.
Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p<0.1 criterion. AHI and SpO2nadir were forced into the models.
Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2<1%), lower total arousal index (TAI, p=0.006, R2<1%), higher total sleep time (TST, p=0.003, R2<1%), higher PSQI (p<0.001, R2=5%), and higher CESD (p=0.001, R2<1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2<1%), lower TAI (p<0.001, R2=1%), higher PSQI (p<0.001, R2=3%, and higher CESD (p<0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men.
Conclusion
On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables.
Support
none
Journal Article
0736 Self-reported Sleep In OSA Patients: Roles Of Polysomnographic Measures And Depressive Symptoms
Abstract
Introduction
Sleep fragmentation is typical in OSA, which is commonly co-morbid with insomnia and depression. A complex interaction between these conditions may be also gender-dependent. Moreover, self-report measures of sleep quality and insomnia, such as PSQI and ISI, may relate to depression symptoms more than polysomnographic sleep disturbance. The present aim is to ascertain relative contributions of polysomnographic variables and depression symptoms to PSQI and ISI in a large sample of OSA patients. The interaction between depressive symptomatology and gender in their relationships with subjective sleep is also analyzed.
Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI and PSQI. ISI and PSQI were separately regressed onto age, sex and BMI, followed by PSG variables meeting p<0.1 criterion when tested individually, followed by CESDR and CESDR-by-sex interaction.
Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% of patients had AHI≥5. The PSQI final model included total sleep time (TST), sleep efficiency (SEF), WASO, PLM index, CESDR and CESDR-by-sex. Only CESDR and CESDR-by-sex were significant (p<0.001, p=0.023, respectively). Higher CESDR predicted higher PSQI in both sexes (both p<0.001), accounting for a greater portion of PSQI variance in men (R2=39%) than in women (R2=29%). The ISI final model included TST, N3%, REM%, SEF, WASO, total arousal index, AHI, PLM index, CESDR and CESDR-by-sex. Higher ISI related to lower TST (p=0.042, R2<1%), higher REM% (p=0.016, R2<1%), and higher CESDR (p<0.001, R2=42%). CESDR-by-sex was not significant.
Conclusion
In this large sample, after controlling for demographic variables, PSG parameters had only minimal relationship with self-report insomnia and sleep quality measures. Higher depressive symptomatology was associated with higher subjective sleep disturbance on PSQI and worse insomnia symptoms on ISI in both sexes, accounting for 29-42% of the variance.
Support
none
Journal Article
0576 Self-reported Pain Experience In Obstructive Sleep Apnea Patients: The Role Of Depressive Symptoms
Abstract
Introduction
Several studies suggested that OSA may change pain experience. However, in some studies OSA was associated with hyperalgesia while in others, with hypoalgesia, and opposing effects of sleep fragmentation and hypoxemia on pain perception in OSA were proposed. Further, depressive symptomatology may be elevated in OSA, and pain perception may be altered in depression. We aimed to determine relative contributions of PSG variables and depressive symptomatology to retrospective pain measures in patients undergoing OSA evaluation.
Methods
On the evening of PSG, 107 patients (18-89y.o., 64 women, 70 minorities) used Center for Epidemiologic Studies Depression Scale-Revised (CESDR) and Chronic Pain Grade Scale to report depressive symptoms, and pain intensity (PI, range 0–10) and its functional effects (FE, range 0–10) for the preceding 6 months. PI and FE scores were hierarchically regressed on age, sex, BMI in the 1st step, and on total sleep time, sleep stage percentages, sleep latency, sleep efficiency, WASO, awakenings, arousal index, REM latency, AHI, SpO2% nadir, time spent below SpO2 90%, desaturation index, time above ETCO2 50mmHg, CESDR and CESDR-by-OSA(AHI≥5) interaction in the 2nd step, using step-wise entry.
Results
Group means: AHI=12.5 ± 20.8 (61 patients had OSA, AHI≥5); PI=3.7 ± 2.6; FE=2.8 ± 2.9; CESDR=14.6 ± 11.9. Higher PI was related to lower N1% (p=0.009, R2=7%) and higher CESDR (p=0.001, R2=12%). Higher FE was related only to higher CESDR (p=0.001, R2=12%). The CESDR-by-OSA interaction terms were not significant; mean PI and FE were similar in patients with and without OSA (p values>0.6). CESDR was marginally elevated in patients with OSA (17.2 ± 12.3 vs. 12.9 ± 11.4, t=1.9, p=0.07).
Conclusion
In this sample, there was no evidence of the effect of OSA on pain experience. Elevated depressive symptomatology plays a significant role in the retrospectively reported intensity and functional effects of pain, accounting for 12% of the variance, similarly in patients with and without the OSA diagnosis.
Support (If Any)
None.
Journal Article
0578 Self-reported Sleep Quality And Daytime Sleepiness In Obstructive Sleep Apnea Patients: The Role Of Depressive Symptoms
Abstract
Introduction
Self-report measures of sleep and daytime sleepiness, including Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS), are used to evaluate OSA patients. However, OSA has been associated with depression, and self-report sleep measures have been shown to relate to symptoms of depression in non-clinical samples and in OSA patients. We aimed to determine relative contributions of PSG variables and depressive symptomatology to PSQI, ISI and ESS in patients undergoing OSA evaluation.
Methods
On the evening of PSG, 107 patients (18-89y.o., 64 women, 70 minorities) completed PSQI (normal range: PSQI<6), ISI (normal range: ISI<8), ESS (normal range: ESS<9), and Center for Epidemiologic Studies Depression Scale-Revised (normal range: CESDR<16). PSQI, ISI and ESS scores were hierarchically regressed on age, sex, BMI in the 1st step, and on total sleep time, sleep stage percentages, sleep latency, sleep efficiency, WASO, awakenings, arousal index, REM latency, AHI, SpO2% nadir, time spent below SpO2 90%, desaturation index, time above ETCO2 50mmHg, CESDR and CESDR-by-OSA(AHI≥5) interaction in the 2nd step, using step-wise entry.
Results
Group means: AHI=12.5 ± 20.8 (61 patients had OSA, AHI≥5); PSQI=9.0 ± 3.9; ISI=11.8 ± 6.6; ESS=7.5 ± 4.6, CESDR=14.6 ± 11.9. Higher PSQI was related to lower N2% (p=0.001, R2=7%), lower N1% (p=0.003, R2=6%), and higher CESDR (p<0.001, R2=26%). Higher ISI was related to higher REM% (p=0.002, R2=6%) and higher CESDR (p<0.001, R2=34%). Higher ESS was related to higher sleep efficiency (p=0.007, R2=7%) and higher CESDR (p<0.001, R2=18%). CESDR was marginally elevated in patients with OSA (17.2 ± 12.3 vs. 12.9 ± 11.4, t=1.9, p=0.07). The CESDR-by-OSA interaction terms were not significant.
Conclusion
Elevated depressive symptomatology plays a significant role in subjective sleep disturbance and daytime sleepiness, accounting for 18–34% of the variance in self-report sleep measures, similarly in patients with and without the OSA diagnosis. The OSA diagnosis was associated with only a marginal elevation of depressive symptoms.
Support (If Any)
None.
Journal Article
