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“Slept like a baby” is most heard among people whose has a sound sleep,  however this sleep is lot among todays people where changing lifestyles and daily habit.

Sleep loss does more than just make us tired. It can undermine our emotional functioning, decrease positive moods and put us at higher risk for anxiety symptoms, according to a study published by the American Psychological Association that synthesized more than 50 years of research on sleep deprivation and mood.

“In our largely sleep-deprived society, quantifying the effects of sleep loss on emotion is critical for promoting psychological health,” said study lead author Cara Palmer, PhD, of Montana State University.

“This study represents the most comprehensive synthesis of experimental sleep and emotion research to date, and provides strong evidence that periods of extended wakefulness, shortened sleep duration, and nighttime awakenings adversely influence human emotional functioning.”

The study was published in the journal Psychological Bulletin.

Palmer and her colleagues, including co-lead author Joanne Bower, PhD, of East Anglia University, analyzed data from 154 studies spanning five decades, with 5,715 total participants. In all those studies, researchers disrupted participants’ sleep for one or more nights.

In some experiments, participants were kept awake for an extended period. In others, they were allowed a shorter-than-typical amount of sleep, and in others they were periodically awakened throughout the night.

Each study also measured at least one emotion-related variable after the sleep manipulation, such as participants’ self-reported mood, their response to emotional stimuli, and measures of depression and anxiety symptoms.

Overall, the researchers found that all three types of sleep loss resulted in fewer positive emotions such as joy, happiness and contentment among participants, as well as increased anxiety symptoms such as a rapid heart rate and increased worrying.

“This occurred even after short periods of sleep loss, like staying up an hour or two later than usual or after losing just a few of hours of sleep,” Palmer said. “We also found that sleep loss increased anxiety symptoms and blunted arousal in response to emotional stimuli.”

Findings for symptoms of depression were smaller and less consistent, as were those for negative emotions such as sadness, worry and stress.

One limitation to the study is that the majority of participants were young adults – the average age was 23. Future research should include a more diverse age sample to better understand how sleep deprivation affects people at different ages, according to the researchers.

Other directions for future research could include examining the effects of multiple nights of sleep loss, looking at individual differences to find out why some people may be more vulnerable than others to the effects of sleep loss, and examining the effects of sleep loss across different cultures, as most of the research in the current study was conducted in the United States and Europe, according to the researchers.

“Research has found that more than 30 percent of adults and up to 90 percent of teens don’t get enough sleep,” Palmer said.

“The implications of this research for individual and public health are considerable in a largely sleep-deprived society. Industries and sectors prone to sleep loss, such as first responders, pilots and truck drivers, should develop and adopt policies that prioritize sleep to mitigate against the risks to daytime function and well-being.”

USA: Intravenous cardio-sphere-derived cells (CDCs) are safe in both the short and long term in subjects with pulmonary arterial hypertension (PAH), according to findings from Phase I clinical trial published in eBioMedicine, a Lancet journal.

CDCs are heart-derived progenitor cells exhibiting immunomodulatory and anti-inflammatory effects, are anti-oxidative, anti-fibrotic, and anti-apoptotic to potentially impact several aspects of PAH pathobiology

“Infusions of potentially therapeutic cells derived from the heart are safe for people with pulmonary arterial hypertension, a form of high blood pressure that occurs in the blood vessels of the lungs and typically affects middle-aged women,” Cedars-Sinai investigators report. 

“Although several drugs are approved for pulmonary arterial hypertension, mortality remains high,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, the Mark S. Siegel Family Foundation Distinguished Professor and senior author of the study. “We tried a fundamentally different approach-cell therapy delivered into the pulmonary artery-and found encouraging results, in patients already on combination conventional therapy.”

Pulmonary arterial hypertension is a rare disease, affecting fewer than 100 people per million. There currently is no cure and the average median life expectancy on treatment for most patients is roughly 6.2 years after diagnosis.

Currently approved medications for the condition aim to open up blood vessels in the lungs, allowing for better blood flow; however, studies on lungs in patients on treatment still show severe occlusive vessel changes. Further, these medications don’t address many of the complex underlying mechanisms that cause the high pulmonary pressures. Even on medication, people with pulmonary arterial hypertension can develop severe dysfunction in the right ventricle of the heart, the part that pumps blood to the lungs and whose function correlates best with survival.

Cedars-Sinai investigators are experimenting with using cardiosphere-derived cells (CDCs) to address some of the biological processes involved in pulmonary arterial hypertension. CDCs were first developed and characterized by Marbán. They have been used in multiple clinical trials for a variety of diseases, most recently, Duchenne muscular dystrophy. These are cells derived from human heart tissue that Marbán and colleagues have discovered reduce inflammation in the body and exert beneficial effects on the immune system.

Called the ALPHA study, this clinical trial was conducted in two phases. In the first, six people with pulmonary arterial hypertension received an infusion of CDCs into their lungs. Three patients received an infusion of 50 million CDCs and the other three received an infusion of 100 million CDCs.

In the second phase, 10 people with pulmonary arterial hypertension were randomized to receive an infusion of 100 million CDCs and 10 people were randomized to receive infusions containing a placebo. Investigators performed right heart catheterization and cardiac MR imaging on each study participant before the infusions and four months after the infusions.

All the participants were on combination pulmonary arterial hypertension-specific medications throughout the course of the study.

The investigators tracked the health of participants for 12 months after the infusions. No adverse effects related to the infusions occurred during this time. Although this study was only designed to assess the safety of the CDC infusions, the investigators observed encouraging changes that might indicate the 16 people who had received the CDC infusions had improved cardiopulmonary health. People who received the infusions, for example, showed improved functioning in the heart’s right ventricle and, at two months post-infusion, were able to walk a greater distance during a six-minute test than people who received placebo.

“The most important takeaway is that this approach is safe and feasible to do in people with pulmonary arterial hypertension,” said Michael I. Lewis, MD, director of Respiratory Care Services at Cedars-Sinai, and first and corresponding author of the study. “These are encouraging exploratory findings that motivate moving on to more advanced studies.”

The investigators plan additional trials to study the effects of repeated infusions of CDCs given to people with pulmonary arterial hypertension.

Reference:

Michael I. Lewis, Shelley Shapiro, Ronald J. Oudiz, Mamoo Nakamura, Dael Geft, Yuri Matusov,The ALPHA phase 1 study: pulmonary ArteriaL hypertension treated with CardiosPHere-Derived allogeneic stem cells, DOI: https://doi.org/10.1016/j.ebiom.2023.104900

Peripheral artery disease (PAD) is a prevalent vascular disorder associated with atherosclerosis and reduced blood flow to the extremities. Affecting 8-10 million Americans and over 200 million people globally, it is a complex condition influenced by various risk factors like diabetes, smoking, hypertension, high cholesterol, and coronary artery disease. PAD leads to structural and functional changes in the limbs, resulting in disability, decreased quality of life, increased mortality, etc.

Post-surgery pain relief has shifted away from opioid-containing medications over the past seven years, but the downward trend has slowed since 2020, a new study shows.

Overall, the rate of surgery-related opioid prescriptions dropped by 36% from 2016 to the end of 2022, and the average amount of opioids in those prescriptions dropped by 46%, the study of pharmacy data finds.

That combination of declines means that the total amount of opioids dispensed to surgical patients in late 2022 was 66% lower compared with early 2016, according to the findings published in JAMA Network Open by a team from the University of Michigan.

But the rate of decline was much faster before the pandemic, the researchers report after comparing surgical opioid patterns before and after 2020. That’s even after they took into account the unusual circumstances of spring 2020, when most elective surgery temporarily stopped to free up hospital capacity for COVID-19 patients and reduce unnecessary exposure to the SARS-CoV-2 virus.

Even with the overall declines, American surgery patients in late 2022 still received the equivalent of 44 5-milligram pills of hydrocodone from pharmacies after their operations on average. That’s far higher than what patients need for most procedures.

“These data suggest surgical teams have substantially reduced opioid prescribing, but also suggest that efforts to right-size opioid prescriptions after surgery must continue,” said Kao-Ping Chua, M.D., Ph.D., the senior author of the new study and an assistant professor of pediatrics at U-M. He worked with first author and former U-M research assistant Jason Zhang, who is now in medical school at Northwestern University.

The researchers also find that some types of surgeons have reduced the amount of opioids dispensed to patients more than others. For instance, reductions were particularly large in cardiothoracic surgery and ophthalmology.

Orthopedic surgeons still account for more than half of all surgical opioids dispensed to American patients, even as the rate and size of prescriptions filled by their patients dropped.

Right-sizing prescribing

The authors note that surgeons should not strive to eliminate opioid prescribing altogether.

“The goal should be to ensure that opioids are only prescribed when necessary, and that the amount of opioids prescribed matches the amount that patients need,” said Zhang. “Achieving these goals could help reduce the risk of opioid misuse, persistent opioid use, and diversion of pills to other people besides the patient.”

The potential for accidental exposure to opioids by others in the household, and interactions between opioids and other substances including alcohol and prescription drugs, are other reasons to focus on non-opioid surgical pain care.

Chua and colleagues have studied procedure-related opioid prescribing multiple times, including a recent study showing that the reduction in the rate of dental opioid prescribing has similarly slowed in recent years.

They have worked with the Michigan Opioid Prescribing Engagement Network (OPEN) to develop prescribing guidelines for adult and pediatric surgical care available at https://michigan-open.org/prescribing-recommendations

Surgical organizations and the Centers for Disease Control and Prevention have advised surgeons to rely less on opioid-based acute pain relief for their patients since the mid-2010s. But no studies have examined surgical opioid prescribing trends using pandemic-era data.

The new study is based on data from a company called IQVIA that tracks prescriptions dispensed at 92% of U.S. pharmacies.

Reference:

Zhang J, Waljee JF, Nguyen TD, et al. Opioid Prescribing by US Surgeons, 2016-2022. JAMA Netw Open. 2023;6(12):e2346426. doi:10.1001/jamanetworkopen.2023.46426.