Background: High C-reactive protein (CRP) and homocysteine levels are risk factors for cardiovascular disease. Some, but not all, previous studies have reported increased levels of CRP and homocysteine in patients with obstructive sleep apnoea syndrome (OSAS). A study was undertaken to investigate the levels of these factors in carefully selected patients with OSAS and matched normal controls. Methods: CRP and homocysteine levels were measured in 110 subjects following polysomnography (PSG). Non-OSAS patients (group 1) were compared with two patient groups (mild/moderate OSAS (group 2) and severe OSAS (group 3)) group-matched for body mass index (BMI), and a fourth group of patients with severe OSAS who were more obese (group 4). All were free of other disease and similar in age, smoking habits and cholesterol levels. 50 suitable patients were commenced on continuous positive airway pressure (CPAP) treatment after PSG and 49 were reassessed 6 weeks later. Results: CRP levels were similar in groups 1, 2 and 3 (median (interquartile range (IQR)) 1.11 (0.76-2.11) mg/l vs 1.82 (1.20-3.71) mg/l vs 2.20 (1.16-3.59) mg/l; p = 0.727, Kruskal-Wallis test), but were significantly higher in group 4 than in the other groups (5.36 (2.42-9.17) mg/l, p,0.05 by individual group comparisons). In multivariate analysis of all subjects, BMI was an independent predictor for CRP levels (b = 0.221; p = 0.006) but apnoea-hypopnoea index and other measures of OSAS were not. There was no difference in homocysteine levels between all four groups (p = 0.1). CPAP did not alter CRP (2.29 (1.32-4.10) vs 2.84 (1.13-5.40) mg/l; p = 0.145) or homocysteine levels (8.49 (3.66) vs 9.90 (4.72) mmol/l; p = 0.381). Conclusion: CRP and homocysteine levels are not associated with OSAS severity in men but CRP is independently associated with obesity.
Objective: The first health and lifestyle survey of Irish adults was carried out in 1998 and aimed to describe the health-related lifestyle behaviours of a cross-section of various population strata residing in the Republic of Ireland. This paper reports on the social variation in nutrient intake. Design: A self-administered postal questionnaire, including a 149 food item semiquantitative food frequency section, from which nutrient intakes were estimated based on McCance and Widdowson food composition tables. Setting: Community-based adults aged 18 years and over residing in the Republic of Ireland on the Register of Electors. Subjects: A stratified sample of adults on the Register of Electors received the questionnaire, of which 6539 (62%) were returned. Results: The contribution of fat to total energy intake increased with decreasing socioeconomic grouping, a finding reflective of the higher consumption levels of foods high in fat by respondents from socially disadvantaged groups. Energy from carbohydrates was greatest among those from socially advantaged groups, and was close to the recommended 50% of the total energy intake. Conversely, energy from protein decreased with increasing social status group. The mean intake of vitamins and minerals was generally close to or above the recommended values. Significant variation was observed among females across the different levels of education, whereas living with someone appeared to influence the micronutrient intake of males. The reported diets of males and females over the age of 65 years were lacking in vitamin D. Mean calcium levels among males were borderline and females over the age of 65 years had mean dietary iron levels below the recommended intake. Conclusions: For the first time, quantification of nutrient intake in the different social groups in Ireland has been undertaken. A healthy balance of energy derived from fat, protein and carbohydrate is best achieved among respondents from higher social positions. The positive relation observed with healthy food intake and increasing education level was also present in macronutrient intake and a clear gender and social support interplay was seen in the nutrient intake levels.
Objective: To assess the impact and suitability of a pilot dietary educational programme for primary school pupils. The Nutrition Education at Primary School (NEAPS) programme aimed to build awareness of the benefits of healthy eating, induce positive behaviour change and increase the children's knowledge. Design: A comparative quasi-experimental study with follow-up after 3 months. Setting: Eight primary schools in the Eastern and North Western Health Boards and three control schools in the same board regions. Subjects: Data were used from 821 Irish school children aged 8-10 years old. Methods:The education programme comprised 20 sessions over 10 weeks including circular worksheets, homework assignments and an aerobic exercise regime. At baseline and after 3 months pupils completed food diaries and a validated food pairing questionnaire on food behaviour, knowledge and preferences. Results: Significant differences were found in the intervention children's behaviour and preference levels after the NEAPS programme (P Ͻ 0.01 in both sections). Knowledge levels were very high at baseline and though some individual items improved, average change overall was not significant. Rural children appeared to benefit more in behaviour and preferences from the programme (P Ͻ 0.01). The NEAPS programme appeared to be less effective in pupils in disadvantaged areas (P Ͻ 0.01 for each of the sections: behaviour, preference and knowledge). One hundred and eighty-seven children completed food diaries. The intervention children's consumption of fruit and vegetables increased, and they consumed less salty snacks after the programme. Rural children were confirmed to have healthier diets at baseline. Conclusions: Following the NEAPS pilot programme positive changes were seen in the school children's eating behaviour and preferences for healthier foodstuffs. This suggests successful development of a culturally sensitive nutrition education programme for school children aged 8-10 years.
Obstructive sleep apnoea (OSA) is associated with significantly increased risk of cardiovascular disease. Carotid ultrasonography and retrospective, uncontrolled, coronary imaging studies have suggested an association of OSA with subclinical atherosclerosis, but there is a lack of prospective, controlled studies directly evaluating the relationship of OSA with occult coronary artery disease.We performed coronary computed tomographic angiography and inpatient-attended sleep studies on a cohort of otherwise healthy males attending our sleep laboratory, and compared coronary artery plaque volume between subjects with low and high apnoea/hypopnoea index (AHI) scores.29 subjects participated. The median AHI was 15.5 events?h -1 , with subjects who scored above this classified as high AHI. No significant differences were observed in demographic, anthropometric and clinical variables between the high-and low-AHI groups. Coronary plaque volume was significantly greater in the high-AHI group (mean plaque volume 2.6¡0.7 mm 2 versus 0.8¡0.2 mm 2 ; p50.017) and, furthermore, correlated significantly with AHI (Spearman's r50.433; p50.019). Following adjustment for dyslipidaemia and fasting plasma glucose levels, AHI remained a significant predictor of plaque volume (standardised b=0.424; p50.027).In this prospective case-control study, we found that severity of OSA may predict occult coronary atherosclerosis in otherwise healthy overweight or obese male subjects. @ERSpublications Increasing OSA severity predicts a greater burden of occult coronary artery disease in healthy overweight or obese males http://ow.ly/nSXEU
Background: Sleep is associated with important adverse effects in patients with chronic obstructive pulmonary disease (COPD), such as disturbed sleep quality and gas exchange, including hypoxemia and hypercapnia. The effects of inhaled long-acting β2-agonist therapy (LABA) on these disturbances are unclear. Objectives: The aim of the study was to assess the effect of inhaled salmeterol on nocturnal sleeping arterial oxygen saturation (SaO2) and sleep quality. Methods: In a randomized, double-blind, placebo-controlled, crossover study of moderate/severe stable COPD patients, we compared the effects of 4 weeks of treatment with salmeterol 50 µg b.d. and matching placebo on sleeping SaO2 and sleep quality. Overnight polysomnography (PSG) was performed at baseline, and after 4 and 8 weeks in addition to detailed pulmonary function testing. Of 15 patients included, 12 completed the trial (median age 69 years, forced expiratory volume in 1 s, FEV1: 39%). Results: Both mean SaO2 [salmeterol vs. placebo: 92.9% (91.2, 94.7) vs. 91.0% (88.9, 94.8); p = 0.016] and the percentage of sleep spent below 90% of SaO2 [1.8% (0.0, 10.8) vs. 25.6% (0.5, 53.5); p = 0.005] improved significantly with salmeterol. Sleep quality was similar with both salmeterol and placebo on PSG. Static lung volumes, particularly trapped gas volume, tended to improve with salmeterol. Conclusion: We conclude that inhaled LABA therapy improves sleeping SaO2 without significant change in sleep quality.
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