Risks and benefits of optimised medical and revascularisation therapy in elderly patients with angina--on-treatment analysis of the TIME trial.

AIM: To assess treatment effects of optimised medical therapy and PCI or CABG surgery on one-year outcome in patients 75 years old with chronic angina. METHODS AND RESULTS: On-treatment analysis of the TIME data: all re-vascularised patients (REVASC n=174: 112 randomised to revascularisation and 62 to drugs with late revascularisation) were compared to all patients on continued drug therapy (MED n=127: 86 randomised to drugs and 41 to revascularisation only). Baseline characteristics of both groups were similar (age 80 +/- 4 years). Risk of death at one year (adjusted hazard ratio (HR)=1.31; 95%-CI: 0.58-2.99; P=0.52) and of death/infarction (adjusted hazard RATIO=1.77; 95%-CI 0.91-3.41; P=0.09) were comparable between REVASC and MED patients. Furthermore, the risk of death within 30 days was even slightly lower among REVASC patients (unadjusted hazard RATIO=0.73; 95%-CI: 0.21-2.53; P=0.98). Overall, REVASC patients had greater improvements in symptoms and well-being than MED patients (P<0.01). Surgical patients had similar mortality rates as angioplasty patients, but they also had greater symptomatic improvements (P<0.01). CONCLUSION: Treated medically, elderly patients with chronic angina have a similarly high 30-day and one-year mortality as patients of the same age being re-vascularised; however, they can expect lower improvements in symptoms and well being.     

The prevalence of REM-related obstructive sleep apnoea is reduced by the AASM 2012 hypopnoea criteria

Purpose

The variations in reported prevalence of rapid eye movement-related obstructive sleep apnoea (REM-OSA) have been attributed to different definitions, although the effect of hypopnoea criteria has not been previously investigated.

Methods

Within this retrospective study, 134 of 382 consecutive patients undertaking polysomnography (PSG) for the suspicion of OSA met the inclusion criteria. PSGs were scored using both the 2007 AASM recommended hypopnoea criteria (AASM_2007Rec) and the 2012 AASM recommended hypopnoea criteria (AASM_2012Rec). For each hypopnoea criteria, REM-OSA patients were grouped as REM-related [either as REM-predominant OSA (rpOSA) or REM-isolated OSA (riOSA)] or non-stage-specific OSA (nssOSA). Outcome measures (SF-36, FOSQ and DASS-21) were also compared between groups.

Results

Incorporation of the AASM_2012Rec criteria compared to the AASM_2007Rec criteria increased the apnoea-hypopnoea index (AHI) for NREM and REM sleep but decreased the AHI_REM/AHI_NREM ratio from 1.9 to 1.3 (p < 0.001). It also decreased the prevalence of riOSA [15.7 vs 2.2% (p < 0.001) for AASM_2007Rec and AASM_2012Rec, respectively]. The prevalence of rpOSA remained the same for each hypopnoea criteria although the prevalence of nssOSA increased with the AASM_2012Rec hypopnoea criteria [53.0 vs 66.4% (p < 0.006) for AASM_2007Rec and AASM_2012Rec, respectively]. There were no differences in clinical symptoms between the groups, irrespective of hypopnoea criteria used.

Conclusions

This study demonstrates that in comparison with AASM_2007Rec, the AASM_2012Rec hypopnoea criteria reduce the prevalence of riOSA but not rpOSA by reducing the ratio of REM respiratory events and NREM respiratory events.

     

Simple Sequence Repeats in the National Longitudinal Study of Adolescent Health: An Ethnically Diverse Resource for Genetic Analysis of Health and Behavior

Simple sequence repeats (SSRs) are one of the earliest available forms of genetic variation available for analysis and have been utilized in studies of neurological, behavioral, and health phenotypes. Although findings from these studies have been suggestive, their interpretation has been complicated by a variety of factors including, among others, limited power due to small sample sizes. The current report details the availability, diversity, and allele and genotype frequencies of six commonly examined SSRs in the ethnically diverse, population-based National Longitudinal Study of Adolescent Health. A total of 106,743 genotypes were generated across 15,140 participants that included four microsatellites and two di-nucleotide repeats in three dopamine genes (DAT1, DRD4, DRD5), the serotonin transporter, and monoamine oxidase A. Allele and genotype frequencies showed a complex pattern and differed significantly between populations. For both di-nucleotide repeats we observed a greater allelic diversity than previously reported. The availability of these six SSRs in a large, ethnically diverse sample with extensive environmental measures assessed longitudinally offers a unique resource for researchers interested in health and behavior.     

Diagnostic specificity and familiality of early versus late evoked potentials to auditory paired stimuli across the schizophrenia‐bipolar psychosis spectrum

Disrupted sensory processing is a core feature of psychotic disorders. Auditory paired stimuli (PS) evoke a complex neural response, but it is uncertain which aspects reflect shared and/or distinct liability for the most common severe psychoses, schizophrenia (SZ) and psychotic bipolar disorder (BDP). Evoked time‐voltage/time‐frequency domain responses quantified with EEG during a typical PS paradigm (S1‐S2) were compared among proband groups (SZ [n = 232], BDP [181]), their relatives (SZrel [259], BDPrel [220]), and healthy participants (H [228]). Early S1‐evoked responses were reduced in SZ and BDP, while later/S2 abnormalities showed SZ/SZrel and BDP/BDPrel specificity. Relatives' effects were absent/small despite significant familiality of the entire auditorineural response. This pattern suggests general and divergent biological pathways associated with psychosis, yet may reflect complications with conditioning solely on clinical phenomenology.