Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

Wieling, Wouter; Raj, Satish R.; Thijs, Roland D.

doi:10.1007/s10286-009-0522-3

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…Because the restoration of normal blood volume after acute blood loss involves the effects of the RAAS to maintain intravascular sodium levels, further evaluation of interventions that would support the role of salt in restoring intravascular volume may be in order. Future research may lead to the development of simple nonpharmacologic interventions to reduce the risk of donor injury, for example, providing information pamphlets that describe the risk factors for different types of reactions and which educate donors about the need to drink fluids after donation, establishing different recommended canteen times based on sex, starting the volume replacement process early by providing an electrolyte‐rich drink and/or salty snacks, and/or positioning donors in a head‐up sleeping position, a mechanism shown to improve orthostatic tolerance 34,35 …”

Section: Discussionmentioning

confidence: 99%

BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation

Kamel

Tomasulo²,

Bravo³

et al. 2010

Transfusion

112

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Section: Discussionmentioning

confidence: 99%

BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation

Kamel

Tomasulo²,

Bravo³

et al. 2010

Transfusion

112

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“…However, although mental disorders were associated with unhealthy lifestyles compared to the general population, comparisons between disorders indicate that an even higher risk in people with schizophrenia of smoking, sedentary behaviour and diet. 83,[85][86][87] This may be partially mediated by socio-economic factors, as the incidence of schizophrenia is higher in socially deprived communities, 88 that also have higher rates of behavioural risk factors. 89 However, behavioural risk factors are still greater in schizophrenia than other disorders even when controlling for socioeconomic factors.…”

Section: Overview Of the Evidence: Lifestyle Risk Factors Across Varimentioning

confidence: 99%

“…[26][27][28][29][55][56][57][66][67][68][69][70][71][72][73]82 Along with side-effects of psychotropic medications (covered in Part 3), reasons for the increased cardiometabolic morbidity and mortality in people with mental illness can be divided into patient-related and provider/system-level factors. 25 Clear modifiable patient-related factors known to heavily influence cardiometabolic diseases are 'lifestyle risk factors' such as smoking, poor diet, and inactivity 35,[83][84][85] ; adverse health behaviours which also influence many other aspects of physical health. [26][27][28][29][66][67][68][69][70][71][72][73] However, the extent to which lifestyle-related risk factors across various mental disorders differs from the general population across is not fully established.…”

Section: Introductionmentioning

confidence: 99%

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Firth

Siddiqi

Koyanagi

et al. 2019

The Lancet Psychiatry

996

1,093

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Executive SummaryThe poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle-and high-income countries. This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare. The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan.This Commission has brought together an international team of researchers, clinicians, and key stakeholders from various backgrounds and professionally / personally-relevant experience, in order to summarize advances in understanding on this topic, and present clear directions for health promotion, clinical care and future research. The breadth and multifactorial nature of physical health disparities across the range of mental health diagnoses poses an almost limitless number of potential considerations. Therefore, rather than attempting to cover all of the different possible combinations of physical-mental comorbidities individually, the aim of this Commission was to: (i) establish highlypertinent aspects of physical health-related morbidity and mortality which apply transdiagnostically, (ii) highlight the common modifiable factors driving these disparities, (iii) present actions and initiatives for health policy and clinical services to address these issues, and (iv) identify promising areas for future research towards discovering novel solutions. This was addressed across 5 different Parts of the Commission: Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Leaders and contributors for each Part are shown in the Appendix (pg.1) . Part 1: 'Its more than premature mortality'Part 1 identified almost 100 systematic reviews/meta-analyses examining the prevalence of physical comorbidities in mental illness. Around 70% of the meta-research focused on cardiometabolic diseases; consistently reporting that mental illnesses were associated with 1.4-to 2-fold increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Although mostly studied in 'severe mental illness' ('SMI', and particularly psychotic disorders), the prevalence of cardiometabolic diseases was similarly elevated across a broad range of other diagnoses, including substance use disorders (SUDs), and 'common mental disorders' ('CMDs', such as depression and anxiety). Part 2: Key modifiable factors in health behaviours and health servicesPart 2 built on the findings of Part 1 with a hierarchal evidence synthesis of modifiable risk factors for physical diseases in mental illness. The bu...

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“…37 The proposed mechanism is a reduction in overnight diuresis and natriuresis due to reduced nocturnal BP and renal perfusion. 37 The proposed mechanism is a reduction in overnight diuresis and natriuresis due to reduced nocturnal BP and renal perfusion.…”

Section: Other Measuresmentioning

confidence: 99%

“…Elevating the head of the bed by 6-9 inches (approximately 15-20 cm) during sleep has been shown to be effective in small observational studies in autonomic failure. 37 The proposed mechanism is a reduction in overnight diuresis and natriuresis due to reduced nocturnal BP and renal perfusion. However, the efficacy of this intervention has been challenged by a recent randomised controlled trial (RCT).…”

Section: Other Measuresmentioning

confidence: 99%

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension

Chisholm

Anpalahan

2017

Internal Medicine Journal

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Both hypertension and orthostatic hypotension (OH) are strongly age-associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well-established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension and older hypertensive patients.

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Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

Abstract: Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years EDITORIAL

Cited by 18 publications

References 33 publications

BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation

BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension

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