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Abstract Background Beta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts. Methods We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use. Results Overall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time. Conclusion We found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.

The aim of this project was construction of a universal platform for rapid development and implementation of interactive computer-based collection of clinical data. A TabletPC was used to pilot-test the platform and to implement two self-administered questionnaires: SF-12 Health Survey (SF-12) and Health Utilities Index (HUI). Qualitative analysis of the system acceptance in 12 patients showed that computer-assisted data collection in elderly patients with no previous computer experience can be successfully implemented using a TabletPC.

Abstract  Asthma has been identified as a possible risk factor for Obstructive Sleep Apnea (OSA) in children. It is not known whether parent-reported asthma increases the likelihood of the diagnosis of OSA in snoring children. We hypothesized that snoring children with asthma are more likely to have OSA than snoring children without asthma. This study is a 1-year retrospective review of polysomnogram and questionnaire data collected on 236 patients referred to the University of Maryland Pediatric Sleep laboratory for evaluation of snoring. Of the 236 patients, 58% (137/236) were boys, and 79% (173/219 reporting race) were African-American (AA). The age at referral was 7.2 ± 3.7 years (mean ± S.D.). Mean body mass index (BMI) percentile was 73.4 ± 32.3%, with 43.2% (54/125) >95th percentile. A history of asthma was reported by 31.4% (74/236); no subject was symptomatic on the night of the study. We found no increased risk for polysomnographically diagnosed OSA for asthmatics. To the contrary, by logistic regression analysis, a parent/guardian report of asthma decreased the odds of having OSA by 34% (p = 0.027), controlling for individual and socioeconomic factors and assessment results. Polysomnographic (PSG) differences between asthmatic and non-asthmatic children were found in only the arousal index (11.0 vs.9.3 ± 6.5/h, p = 0.099) and total sleep time (337.1 ± 64.3 vs. 347 ± 65.2 min, p = 0.1) In a referral-based group of predominantly AA inner-city snoring children, asymptomatic asthma decreased the likelihood of OSA. [ABSTRACT FROM AUTHOR]

Abstract  We utilized well-established and validated quality of life (QoL) measures to test the validity of the Health Utilities Index (HUI) in patients with untreated sleep disorders in a cross-sectional study. We submitted a 66-question survey to 86 patients presenting to the University of Maryland Sleep Disorders Center (68 with sleep apnea, 18 with other sleep disorders). HUI mark 2 (HUI2) and HUI mark 3 (HUI3) were compared with other indices of QoL: medical short form 12 (SF-12), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleepiness Questionnaire (FOSQ). The participants of this study were eighty-six patients presenting with untreated sleep disorders to the University Medical Center. There were no interventions. The mean age in our patients was 50.7 � 14.2 years with a mean body mass index of 32.9 � 7.6. For patients with sleep apnea, the mean respiratory disturbance index was 32.6 � 29.1. For all patients, the mean HUI2 score was 0.73  0.23, and the mean HUI3 score was 0.6 � 0.35 (p = 0.0066 for difference from HUI2). The mean SF-12 physical components (PC) score was 43.6 � 12.1, and the mean SF-12 mental components (MC) score was 49.8 ≡ 40.1. The mean ESS score was 10.5  5.2, and the mean FOSQ score was 16.4 � 3.5. Significant bivariate correlations were found between HUI2 and HUI3 as well as between both of these and age, SF-12, SF-12 PC score, ESS, and FOSQ. Stepwise multivariate regression revealed significant independent correlations between HUI2 and age, SF-12 PC and the FOSQ, and between HUI3, SF-12 PC, and the FOSQ. There were no differences in HUI scores between obstructive sleep apnea (OSA) and non-OSA patients: (1) HUI3 scores are lower than HUI2 scores, (2) both HUI2 and HUI3 are correlated with other indices of QoL in sleep patients, and (3) the HUI surveys should be considered in QoL and economic impact studies in patients with sleep disorders. [ABSTRACT FROM AUTHOR]

Abstract  Obstructive sleep apnea (OSA) affects a large portion of the population and is associated with repeated airway collapse leading to chronic intermittent hypoxia, exaggerated swings in intrathoracic pressure and post apneic arousal. OSA is associated with heightened sympathoadrenal tone and is a risk factor for cardiovascular mortality and morbidity. In addition to well-known mechanical and autonomic effects, OSA appears to be associated with systemic inflammation. This could provide one mechanism leading to cardiovascular disease (CVD). A central factor in the inflammatory cascade is nuclear factor kappa B (NF-κB), which is involved in the transcription of numerous genes involved in the inflammatory cascade. The object of this article is to review recent literature on some of the aspects of OSA related to a proinflammatory state and the possible role of NF-κB as one mechanism providing a link between sleep apnea and CVD. [ABSTRACT FROM AUTHOR]