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Actigraphy and insomnia: a closer look. Part 1.

In recent years, wrist actigraphy has been scrutinized as a possible supplement to or even replacement for other methods traditionally used to assess the sleep of clinical patients and research subjects. While showing promise for some applications, its accuracy in measuring the nocturnal sleep of insomniacs remains in question. A reexamination of the relevant data indicates that with respect to estimating the total sleep time of insomnia patients, use of the actigraph does not yield significantly lower error than daily sleep logs and predicts only about a third of the variance. However, the actigraph does show some potential for assessing the night-to-night variability of a given individual's sleep, suggesting that it may be most useful for assessing longitudinal changes within a treatment program or experimental protocol.

Arousal↗

Postnatal changes in pulmonary mechanics and energetics of infants with respiratory distress syndrome following surfactant treatment.

BACKGROUND: Postnatal alterations in pulmonary mechanics, energetics and functional residual capacity (FRC) describe the structural maturation of the preterm respiratory system. OBJECTIVE: To evaluate longitudinal changes in pulmonary function in infants with respiratory distress syndrome (RDS) treated with oxygen, positive pressure ventilation and synthetic surfactant (Exosurf). METHODS: Serial pulmonary function tests were performed in surfactant-treated infants [mean +/- SD birth weight (BW) = 1,112 +/- 276 g, gestational age (GA) = 29 +/- 3 weeks] at postnatal ages: <3 days, 1, 2, 3, 4 and 6-8 weeks until term postmenstrual age (PMA). Tidal volume, pulmonary compliance (C(L)), pulmonary resistance (R(T)) and flow-resistive work were analyzed following simultaneous measurements of airflow and transpulmonary pressure signals. Serial FRC measurements were made in a randomly selected group. RESULTS: Prior to 28 weeks' PMA, C(L) was unchanged irrespective of GA. At age 1 week the likelihood ratio (LR) for bronchopulmonary dysplasia (BPD) based on C(L), R(T) and GA was predicted to be >90% for those with BW <750 g (LR >100) as compared to <10% probability (LR = 0.3) for infants >1,500 g. Significant linear increase in C(L) to PMA was evident >28 weeks' PMA (r = 0.86, p < 0.01) at 0.17 ml/cm H2O/kg/week. By term PMA, mean C(L) was 2.60 +/- 0.07 ml/cm H2O. Improvements in FRC of preterm infants with RDS who recovered occur at a more rapid rate ( approximately 25 ml/kg) compared to those who developed BPD ( approximately 20 ml/kg). CONCLUSIONS: Slow but incremental postnatal pulmonary improvement, minimal <28 weeks' PMA, were comparable for all infants. Along with diminished FRC, these changes reflect persistent deleterious effects of positive pressure ventilation, alveolar hyperoxia and unrecognized pulmonary overdistension.

Continuous Positive Airway Pressure↗

Similarity in married couples: a longitudinal study of mental abilities and rigidity-flexibility.

Longitudinal changes in couple similarity on the Primary Mental Abilities and the Test of Behavioral Rigidity were studied over 7-year intervals from 1956 to 1984 in 169 couples from the Seattle Longitudinal Study. Positive, initial intraclass spousal correlations were significant for verbal meaning, inductive reasoning, word fluency, educational aptitude, intellectual aptitude, attitudinal flexibility, psychomotor speed, and social responsibility, as well as age and education. After age and education had been controlled, significant increases in spousal similarity were found for verbal meaning and intellectual ability over 14 years and for attitudinal flexibility over 21 years. The higher functioning spouses' word fluency influenced the lower functioning spouses' verbal meaning and word fluency over time. Couples who became more similar over time involved husbands in higher occupations and wives with fewer changes in profession.

Adult↗

Calculation of cross-sectional geometry of bone from CT images with application in postmenopausal women.

OBJECTIVE: The objectives of this study were to develop a software program that calculates bone cross-sectional area (CSA) and moments of inertia from digital images, test the computations for accuracy, and implement the software in a study of longitudinal changes in bone properties in a large group of postmenopausal women. MATERIALS AND METHODS: A program called SLICE was adapted to use computed tomography (CT) bone images as input. The main outcome variables of the resulting program, SLICE_CT, were bone CSA, areal moments of inertia, and mass-weighted moments of inertia. SLICE_CT was tested for accuracy using representative arrays of CT numbers that approximate cross-sections of cortical bone. Then the technique was applied to images from a 3 year longitudinal study of the radius in 86 postmenopausal women who underwent quantitative CT of the dominant radius at 30% the distance from the wrist to the elbow. The mean age of the subjects at entry into the study was 57 years. Images at baseline and at 3 years were analyzed, and the null hypothesis of no change in cross-sectional geometry was tested by a paired difference two-tailed t test. RESULTS: The error of SLICE_CT was < 1% with proper segmentation, using half-maximal height as the threshold. In the longitudinal study of postmenopausal women, the mean change of CSA of the radius was -1.4% (SD = 3.0%; p < 0.001). However, there was a compensatory 2.4% increase in the cross-sectional second polar moment of inertia (SD = 3.7%; p < 0.001). CONCLUSION: SLICE_CT is an accurate method with which to determine cross-sectional geometry of digital images and can be used to detect changes in cross-sectional geometry of the radius with age in postmenopausal women. The results indicate that the radius remodels to compensate for bone loss and decreasing material properties of bone associated with aging.

Bone and Bones↗

Body mass index and coronary heart disease risk score: the Tromsø study, 1979 to 2001.

PURPOSE: The purpose of the study is to examine the association between longitudinal change in body mass index (BMI) and change in coronary heart disease (CHD) risk score by using the Framingham risk score equation. METHODS: A general adult population in the municipality of Tromsø, Norway, was invited to four consecutive examinations in 1979 to 1980, 1986 to 1987, 1994 to 1995, and 2001. A total of 10,214 men and women aged 20 to 61 years at baseline attended at least three times. Associations were examined by using fixed-effects regression methods for longitudinal data. RESULTS: We observed a significant association between BMI change and risk score change in all baseline age groups. The association was significantly strengthened by age in women, but not men. A BMI increase of 3 kg/m(2) in subjects aged 40 to 49 years was associated with risk score increases of 0.45 points (95% confidence interval [CI], 0.29-0.62) in men and 0.66 points (95% CI, 0.52-0.80) in women. CONCLUSIONS: The well-known increase in body weight is associated with adverse CHD risk in both men and women.

Adult↗

[Computed tomographic appearances of pulmonary alveolar proteinosis].

We evaluated longitudinal changes in chest CT images in six cases (5 males and one female, age: 35-57 yr) of pulmonary alveolar proteinosis treated with bronchopulmonary lavage. Chest CT images on admission showed a mixed pattern of air-space consolidation and reticular or reticulonodular shadows in most cases and showed a peripheral clear zone in all cases. These shadows gradually diminished after bronchopulmonary lavage. Some cases revealed early improvement in the hilar zone while others had equal improvement in all lung lesions. In one case, consolidation was changed into reticular shadows by treatment. Previous reports have indicated that "interstitial shadows which disappeared with lavage" reflect edematous thickening of interlobular septa. However, our longitudinal evaluation suggests that interstitial shadows on CT images may reflect not only real interstitial infiltration but also inhomogeneous distribution of intralobular deposits.

Adult↗

Statistical measures were proposed for identifying longitudinal patterns of change in quantitative health indicators.

OBJECTIVE: To propose statistical measures to identify different longitudinal patterns of change in quantitative health indicators. METHODS: The authors propose several simple measures to discriminate between stable-unstable, increasing-decreasing, linear-nonlinear, monotonic-nonmonotonic patterns of change. They then suggest using factor analysis to select the subset of nonredundant measures, and cluster analysis, based on the selected measures, to identify subgroups of patients with similar longitudinal trajectories. The proposed approach is illustrated using data on osteoarthritis disability from a longitudinal study undertaken in Toronto, Ontario, in 1996-2001. Disability was measured at four points in time for 835 patients, using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. RESULTS: The proposed measures allowed the detection of individual patients with specific patterns of change and identification of four different groups of patients with WOMAC scores that are (1) regularly increasing, (2) regularly decreasing, (3) stable over time, or (4) highly unstable, with abrupt changes or short-term fluctuations. CONCLUSION: The proposed approach may be used to (1) screen even large databases to identify particular patterns of change; or (2) summarize different patterns of change by classifying patients into groups with similar trajectories. Once identified, the groups can be investigated to determine whether there are differences in patient characteristics or outcomes.

Aged↗

Changes in health-related quality of life from 6 months to 2 years after discharge from intensive care.

BACKGROUND: Intensive care patients have, both before and after the ICU stay, a health-related quality of life (HRQOL) that differs from that of the normal population. Studies have described changes in HRQOL in the period from before the ICU stay and up to 12 months after. The aim of this study was to investigate possible longitudinal changes in HRQOL in adult patients (>18 years) from 6 months to 2 years after discharge from a general, mixed intensive care unit (ICU) in a university hospital. METHODS: This is a prospective cohort study. Follow-up patients were found using the ICU database and the Peoples Registry. HRQOL was measured with the Short Form 36 (SF-36) questionnaire. Answers at 6 months and 2 years were compared for all patients, surgical and medical patients, and different admission cohorts.Differences are presented with 95% confidence intervals. The SF-36 data were scored according to designed equations. SPSS 11.0 was used to perform t-tests and Mann-Whitney tests. RESULTS: A total of 100 patients (26 medical and 74 surgical) answered the SF-36 after 6 months and again after 2 years. There was overall moderate improvement in 6 out of 8 dimensions of the SF-36, and the average increase in score was + 4.0 for all 8 dimensions. The changes for surgical and medical patients were similar. Neurological and respiratory patients reported increased average HRQOL scores, while cardiovascular patients did not. Patients with worsening of scores from 6 months to 2 years were insignificantly older than patients with improved scores (55.3 vs. 49.7 years), and both groups had comparable severity scores (simplified acute physiology score, SAPS II, 37.2 vs. 36.3) and length of ICU stay (2.7 vs. 3.2 days). The statistically significant changes in HRQOL (in the Role Physical and Social Functioning dimensions) were, due to sample size, barely clinically relevant. CONCLUSION: In a mixed ICU population we found moderate increases in HRQOL both for medical and surgical patients from 6 months to 2 years after ICU discharge, but the sample size is a limitation in this study.

Adult↗

Changes in bone mineral density and bone-specific alkaline phosphatase in ovariectomized ewes.

An animal model of human osteoporosis which adequately meets many of the criteria needed to test new therapeutic agents is currently unavailable. The old ewe may serve this purpose, as changes in bone remodeling occur within 3 months, and a difference in bone mass has been indicated 6 months after ovariectomy. In the current study, we have measured longitudinal changes in bone mass and bone-specific alkaline phosphatase (BSAP) for six months in 7-9 year old ovariectomized (OVX) ewes. Thirty ewes were divided into three groups: sham-treated (n = 9), OVX (n = 12) and OVX with estrogen implants (OVXE, n = 9). Bone mineral density (BMD) was determined at 0, 3 and 6 months in the vertebrae (L4-L6/L5-L7), calcaneus (CAL) and distal radius (DR) using dual-energy X-ray absorptiometry (DEXA). Bone-Specific Alkaline Phosphatase (Tandem-R Ostase; Hybritech) was determined at monthly intervals. Body weight did not significantly change in any group during treatment compared to sham, although a trend of increasing body weight at 3 and 6 months was apparent in both OVX groups. Luteinizing hormone increased in all OVX ewes as a function of time as expected, demonstrating successful ovariectomies. Uterine weight was significantly increased (p < 0.01) in the OVXE animals compared to Sham and OVX groups. BMD did not change significantly during the 6-month treatment period in the CAL or DR. BMD in the vertebrae (L4-L6/L5-L7) was significantly lower in the OVX group compared to sham (p < 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

Cardiovascular reactivity to and recovery from psychological challenge as predictors of 3-year change in blood pressure.

The authors examined whether cardiovascular reactivity to and recovery from psychological challenge predict 3-year change in blood pressure (BP) among 216 initially normotensive, community-dwelling adults. Clinic BP assessments were conducted at baseline and follow-up. BP and heart rate (HR) readings were obtained before, during, and after 5 psychological tasks at baseline. Following adjustment for traditional predictors of BP and lifestyle factors, poorer systolic BP recovery across the tasks was associated with greater 3-year increases in clinic systolic and diastolic BP. Both diastolic BP recovery and HR recovery were also related to 3-year change in clinic BP, though cardiovascular reactivity measures were not. These findings suggest that the duration of stress-related cardiovascular responses may be important for predicting longitudinal changes in BP.

Aged↗

Imaging markers of mild cognitive impairment: multivariate analysis of CBF SPECT.

This study aimed to investigate cross-sectional and longitudinal changes of regional cerebral blood flow (rCBF) in preclinical dementia using single photon emission computed tomography (SPECT). SPECT and cognitive function were investigated in 39 mild cognitive impairment (MCI) subjects and 20 age-matched controls. All subjects were followed longitudinally 19 months on average, 16 MCI subjects progressed to Alzheimer's disease (AD), who were retrospectively defined as progressive mild cognitive impairment (PMCI) at baseline and 23 MCI subjects remained stable and were defined as stable mild cognitive impairment (SMCI) at baseline. SPECT was performed both at the initial investigation and at follow-up. Image data were analyzed using multivariate analysis, SPM and volume of interest (VOI)-based analysis. Significant covariate patterns were derived, which differentiate among PMCI, SMCI and controls at baseline as well as describe the longitudinal progression of PMCI. The combined SPECT and neuropsychology increased the diagnostic accuracy of PMCI at baseline. SPECT and neuropsychological testing can be used objectively for both baseline diagnosis and to monitor changes in brain function during very early AD.

Aged↗

Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems.

BACKGROUND: MRI findings are used in several staging systems to help determine appropriate treatment. The purposes of this study were to evaluate longitudinal changes in MRI characteristics of osteochondral lesions of the talus (OLT) and to evaluate published staging systems in a cohort of nonoperatively treated patients. METHODS: Twenty-nine patients were identified; MR images were reviewed for location, size, and interface signal of OLT as well as cysts, marrow edema and osteoarthritis. Lesions were classified as unchanged, progressed, or improved based on changes in size or interface signal. Each lesion was assigned a stage based on four different staging systems. RESULTS: Of the 29 lesions, 13 progressed, seven improved, and nine were unchanged over an average followup of 13.7 months. In the 13 that progressed, marrow edema remained present in ten and developed in two. Four had persistent cysts and four developed new cysts. Two had progression of osteoarthritis and two developed it anew. In the seven that improved, six had some degree of marrow edema that persisted and one had a persistent cyst. Initial staging changed for at least one classification system in 16 (55%) of the 29 lesions at followup. Change in stage was primarily due to development (four of 16) or disappearance of cysts or progression of the lesion in the extent of bone marrow edema (five of 16). CONCLUSIONS: OLT did not invariably progress over the short-term without operative intervention. Because some cysts and bone marrow edema resolved on MRI, they may not be reliable signs of lesion severity nor show progression of degenerative changes. Since these findings determine the stage and severity of OLT in some staging systems, they may require reconsideration and adjustment of the current staging systems.

Adolescent↗

Change in bronchial responsiveness and cough reflex sensitivity in patients with cough variant asthma: effect of inhaled corticosteroids.

BACKGROUND: Cough variant asthma (CVA) is a cause of chronic cough and a precursor of typical asthma. We retrospectively examined the longitudinal change in bronchial responsiveness and cough reflex sensitivity in CVA patients with respect to the effect of long-term inhaled corticosteroids (ICS). METHODS: Provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (PC20-FEV1) and provocative concentration of capsaicin eliciting 5 or more coughs (C5) were measured before treatment and during a follow up period following relief of cough (median; 2.0 (range; 0.5 to 8.0) years after the initial visit) in a total of 20 patients with CVA (7 males and 13 females, mean +/- SD age of 49.9 +/- 12.9 years). RESULTS: Three of 8 patients not taking long-term ICS developed typical asthma compared to none of 12 patients taking ICS (p = 0.0171). PC20-FEV1 significantly (p < 0.0001) increased from 1.80 (GSEM, 1.35) to 10.7 (GSEM, 1.63) mg/ml in patients taking ICS but did not change in patients not taking ICS [2.10 (GSEM, 1.47) compared to 2.13 (GSEM, 1.52) mg/ml]. Cough threshold did not change in patients whether taking or not taking ICS. CONCLUSION: Long-term ICS reduces bronchial hyperresponsiveness in CVA as recognized in typical asthma. Cough reflex sensitivity is not involved in the mechanism of cough in CVA.

Journal Article↗

Impact of race and baseline PSA on longitudinal PSA.

There is an increasing debate regarding the frequency of prostate-specific antigen (PSA) testing and the current primary screening modality used to detect prostate cancer. The purpose of this study is to determine whether PSA screening intervals should be based on initial PSA. Our study explores longitudinal changes of PSA levels in black and white males separately. Study participants were 768 white and 450 black males attending an annual prostate cancer screening. We fit a longitudinal repeated measures model separately for blacks and whites and estimated the probability of PSA converting to greater than 4.0 ng/ml at a follow-up year given baseline PSA range among males without an abnormal DRE. Black and white males with a baseline PSA between 0 and 1.0 ng/ml, with a healthy or enlarged prostate, have a less than 1% chance that their PSA will increase above 4.0 ng/ml over the following 5 years. Black and white males with a PSA between 1.0 and 1.9 ng/ml have a less than 1% chance of PSA conversion to greater than 4.0 ng/ml over the next year. Our findings further support that annual screening for prostate cancer may not be necessary, specifically males with a baseline PSA less than 2.0 may not need to undergo annual screening. Our results suggest that race does not affect the longitudinal trend of PSA enough to warrant setting screening intervals based on race.

Aged↗

Body weight change since menopause and percentage body fat mass are predictors of subsequent bone mineral density change of the proximal femur in women aged 75 years and older: results of a 5 year prospective study.

Few studies have evaluated risk factors for bone loss in elderly women. We examined risk factors associated with a 5-year longitudinal change in bone mineral density (BMD) at the hip in healthy women aged 75 years and older. The BMD of 276 women from the French EPIDOS (Epidémiologie des Osteoporoses) study was assessed in Montpellier from 1992 to 1993 and again from 1997 to 1998. BMD was measured at the femoral neck, trochanter, and Ward's area using the same Lunar densitometer. We examined the relationship between clinical and behavioral factors at baseline and their variations during follow-up, with percentage BMD change adjusted for baseline BMD. Depending on the femur subregion studied, a significant decrease in BMD (exceeding the least significant difference, i.e., > 2.8 CV) was observed in 36.2% to 51.1% of women. Multivariate analysis showed that both postmenopausal weight change before baseline and baseline percentage of fat mass were positively correlated with BMD change at the Ward's triangle and the trochanter. Yearly absolute and relative weight changes over the follow-up period were significantly associated with change of trochanter and femoral neck BMD. Our results show that maintenance of body weight throughout the postmenopause period and body fat mass play protective roles against bone loss at the proximal femur in women aged 75 years and older and suggest the value in including assessment of weight change throughout postmenopause and percentage body fat mass in screening programs for elderly women who are at higher risk of accelerated bone loss.

Absorptiometry, Photon↗

The time course of pulmonary transfer factor changes following heart transplantation.

OBJECTIVE: The pulmonary transfer factor for carbon monoxide (TLCO) has been reported to decline following heart transplantation, but the time course of this decline is not well documented. The aim of this study was to define the longitudinal changes in TLCO after heart transplantation. METHODS: Single breath TLCO, lung volumes and expiratory flow rates were prospectively measured in 57 patients (mean age 49 years, range 19-61) before and at least once after heart transplantation. Thirty seven of the 57 patients had four post-transplant assessment which were performed at 6 weeks, 3, 6 and 12 months in 26 patients and at 12, 18, 24 and 36 months in 11 patients. Results were compared with data from 28 normal subjects (mean age 40 years, range 19-61). RESULTS: Before transplantation there was a mild impairment of lung volumes and expiratory flow rates. At 6 weeks after transplantation, there was a further reduction in the forced expiratory volume in one second, forced vital capacity, residual volume and total lung capacity, but all of these increased in the subsequent measurements to exceed their pre-transplant values at about 1 year after transplantation. Haemoglobin-corrected TLCO was also reduced before transplantation compared to normal controls (74.3% and 98.6% of predicted respectively, P < 0.001). Although TLCO per unit alveolar volume (KCO) was relatively preserved in heart transplant candidates, it was still significantly lower than that of normal controls (92.6% and 105.3% of predicted respectively, P < 0.05). After transplantation, mean haemoglobin-corrected TLCO and KCO declined by 12% and 20% of predicted respectively) with the majority of patients having reductions greater than 10% of predicted. The decline in TLCO and KCO was evident at 6 weeks after transplantation with no further changes in the subsequent measurements. CONCLUSIONS: TLCO is reduced in heart transplant candidates and declines further after heart transplantation despite improvement in lung volumes and airway function. The early and non-progressive nature of TLCO decline suggests an aetiology exerting its effect on TLCO within the first 6 weeks after transplantation.

Adult↗

Three year longitudinal study for out-of-hospital cardiac arrest in Osaka Prefecture.

OBJECTIVE: To analyze the longitudinal changes in the treatment of out-of-hospital cardiac arrests. These analyses have focused on the time interval from the receipt of call until defibrillation of patients with ventricular fibrillation. DESIGN: Population-based, prospective longitudinal study according to the Utstein style. SETTING: Osaka Prefecture (population 8, 800, 000), served by 36 municipal fire and emergency departments. PATIENTS: Consecutive, out-of-hospital cardiac arrests occurring between May 1998 and April 2001. MAIN OUTCOME MEASURES: Change in the interval to defibrillation, and one-year survival from cardiac arrest. RESULTS: Of the 15,211 cases of confirmed cardiac arrests during the three years, resuscitation was attempted in 14,609 subjects. Of the 2957 cases of cardiac origin and witnessed by bystanders, 90 cases (3.0%) were alive 1 year following the episode. In 383 cases of defibrillation, the interval from receipt of call to defibrillation was evaluated annually. This interval decreased significantly during the three year course (14.5, 13.0, and 11.5 min expressed by the median), suggesting that this project to report the data of out-of-hospital arrests was an effective campaign for EMT. However, the outcome did not improve significantly during this period (3.0%, 2.6%, and 3.6% alive 1 year in witnessed arrests with cardiac etiology). This may be because the third year median duration of 11.5 min, is still insufficient to indicate a significant improvement in the outcome. CONCLUSIONS: This project to report the data of out-of-hospital cardiac arrest might have contributed to the reduction of the interval for defibrillation, as a campaign for the EMTs; although the decrease in this interval was still insufficient to result in a significant increase in the number of cases who are alive one year later.

Electric Countershock↗

The influence of training intensity, airway infections and environmental conditions on seasonal variations in bronchial responsiveness in cross-country skiers.

The influence of physical training, airway infections and environmental conditions on changes in bronchial responsiveness to methacholine during a training and competitive season was studied in 19 high-performance male cross-country skiers 19-21 years old. The longitudinal changes in the methacholine concentration required for a 10% fall in FEV1 (PC10) were negatively correlated with the changes in the volume of physical activity at an intensity level above 90% of maximal heart rate. The variation in physical activity at this intensity level accounted for 54.8% of the change in PC10. No association was found, however, with regard to physical activity at lower intensity levels. Seasonal variation in PC10 was not associated with the changes in occurrence or duration of airway infections provided that the PC10 measurement was postponed for 3-6 weeks after the onset of a recent infection. Seasonal variation in PC10 seemed not to be associated with variations in ambient levels of air pollutants or aeroallergens. PC10 was lowest at the end of the coldest part of the year. In conclusion, seasonal variation in bronchial responsiveness in high-performance cross-country skiers could to a great extent be explained by changes in the volume of physical activity at a very high intensity level.

Adult↗