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JAMA Neurology Aug 2023Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV). (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
OBJECTIVE
To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.
DESIGN, SETTING, AND PARTICIPANTS
This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Two hundred fifty-three patients were assessed for eligibility. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. The analysis was prespecified and per-protocol.
INTERVENTIONS
After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.
MAIN OUTCOME AND MEASURES
Patients had to document whether they could provoke positional vertigo every morning. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. The secondary end point was the effect of the single maneuver performed by the physician.
RESULTS
Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 [range, 1-8] day; 95% CI, 1.64-2.28 days); in the EM group, 3.3 (3.6) days (median, 2 [range, 1-20] days; 95% CI, 2.62-4.06 days) (P = .01; α = .05, 2-tailed Mann-Whitney test). For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 [68.4%] vs 61 of 97 [62.9%]; P = .42; α = .05). No serious adverse event was detected with both maneuvers. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.
CONCLUSIONS AND RELEVANCE
The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05853328.
Topics: Humans; Female; Middle Aged; Male; Benign Paroxysmal Positional Vertigo; Prospective Studies; Physical Therapy Modalities; Treatment Outcome; Ambulatory Care
PubMed: 37358870
DOI: 10.1001/jamaneurol.2023.1408 -
Scandinavian Journal of Work,... Jul 2019Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated...
Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.
Topics: Adult; Affect; Circadian Rhythm; Diet; Energy Intake; Fatigue; Female; Humans; Male; Middle Aged; Occupational Health; Occupational Stress; Shift Work Schedule; Sleep; Socioeconomic Factors
PubMed: 30806474
DOI: 10.5271/sjweh.3803 -
American Journal of Physiology. Heart... Jan 2021Binge alcohol consumption elicits acute and robust increases of muscle sympathetic nerve activity (MSNA), yet the impact of evening binge drinking on morning-after MSNA...
Binge alcohol consumption elicits acute and robust increases of muscle sympathetic nerve activity (MSNA), yet the impact of evening binge drinking on morning-after MSNA is unknown. The present study examined the effects of evening binge alcohol consumption on polysomnographic sleep and morning-after MSNA. We hypothesized that evening binge drinking (i.e. 4-5 drink equivalent in <2 h) would reduce sleep quality and increase morning-after blood pressure (BP) and MSNA. Following a familiarization night within the sleep laboratory, 22 participants (12 men, 10 women; 25 ± 1 yr) were examined after simulated binge drinking or fluid control (randomized, crossover design). Morning MSNA was successfully recorded across both conditions in 16 participants (8 men, 8 women) during a 10-min baseline and three Valsalva's maneuvers (VM). Binge drinking reduced rapid eye movement (REM) sleep (15 ± 1 vs. 20 ± 1%, = 0.003), increased stage II sleep (54 ± 1 vs. 51 ± 1%, = 0.002), and increased total urine output (2.9 ± 0.2 vs. 2.1 ± 0.1 liters, < 0.001) but did not alter morning-after urine specific gravity. Binge drinking increased morning-after heart rate [65 (54-72) vs. 58 (51-67) beats/min, = 0.013] but not resting BP or MSNA. Binge drinking elicited greater sympathoexcitation during VM (38 ± 3 vs. 43 ± 3 bursts/min, = 0.036). Binge drinking augmented heart rate ( = 0.002), systolic BP ( = 0.022), and diastolic BP ( = 0.037) reactivity to VM phase IV and blunted cardiovagal baroreflex sensitivity during VM phases II ( = 0.028) and IV ( = 0.043). In conclusion, evening binge alcohol consumption disrupted REM sleep and morning-after autonomic function. These findings provide new mechanistic insight into the potential role of binge drinking on cardiovascular risk. Chronic binge alcohol consumption is associated with future cardiovascular disease (CVD) risk in both men and women. In addition, binge alcohol consumption is known to disrupt normal sleep quality during the early morning hours, coinciding with the morning sympathetic surge. In the present study, an evening of binge alcohol consumption increased baseline morning heart rate and cardiovascular reactivity during the Valsalva maneuver (VM) strain. Specifically, muscle sympathetic nerve activity and phase IV hemodynamic responses increased during VM the morning after binge alcohol consumption. The autonomic dysfunction and increased cardiovascular reactivity during VM suggests a contributing mechanism to CVD risk present in individuals who binge drink.
Topics: Adult; Baroreflex; Binge Drinking; Blood Pressure; Cardiovascular System; Circadian Rhythm; Cross-Over Studies; Female; Heart Rate; Humans; Male; Muscle, Skeletal; Sleep, REM; Sympathetic Nervous System; Time Factors; Urination; Young Adult
PubMed: 33185112
DOI: 10.1152/ajpheart.00743.2020 -
Metabolites Feb 2021Lipids in breastmilk play a critical role in infant growth and development. However, few studies have investigated sources of variability of both high- and low-abundant...
Lipids in breastmilk play a critical role in infant growth and development. However, few studies have investigated sources of variability of both high- and low-abundant milk lipids. The objective of our study was to investigate individual and morning-evening differences in the human milk lipidome. In this study, a modified two-phase method (MTBE: Methanol 7:2) was validated for the extraction of lipids from human breastmilk. This method was then applied to samples from a group of 20 healthy women to measure inter- and intra-individual (morning versus evening) variability of the breastmilk lipidome. We report here the levels of 237 lipid species from 13 sub-classes using reversed-phase liquid chromatography mass spectrometry (RP-LCMS) and direct-infusion mass spectrometry (DI-MS). About 85% of lipid species showed stable inter-individual differences across time points. Half of lipid species showed higher concentrations in the evening compared with the morning, with phosphatidylethanolamines (PEs) and triacylglycerols (TAGs) exhibiting the largest changes. In morning and evening samples, the biological variation was greater for diacylglycerols (DAGs) and TAGs compared with phospholipids and sphingolipids, and the variation in DAGs and TAGs was greater in evening samples compared with morning samples. These results demonstrate that variation in the milk lipidome is strongly influenced by individual differences and time of day.
PubMed: 33670205
DOI: 10.3390/metabo11020104 -
The American Journal of Clinical... Nov 2020Poor dietary choices may underlie known associations between having an evening diurnal preference and cardiometabolic diseases. Assessing causal links between diurnal...
BACKGROUND
Poor dietary choices may underlie known associations between having an evening diurnal preference and cardiometabolic diseases. Assessing causal links between diurnal preference and food intake is now possible in Mendelian randomization (MR) analyses.
OBJECTIVES
We aimed to use a 2-sample MR to determine potential causal effects of genetic liability to a morning preference on food intake. We also examined potential causal effects of a morning preference on objectively captured response performances to email-administered 24-h diet recalls.
METHODS
We used genetic variants associated with a morning preference from a published genome-wide association meta-analysis. Our outcomes included 61 food items with estimates from a food-frequency questionnaire in the UK Biobank (n = 361,194). For significant findings, we repeated the analysis using intake estimates from modified 24-h diet recalls in a subset of overlapping participants (n = 146,086). In addition, we examined 7 response performance outcomes, including the time and duration of responses to 24-h diet recalls (n = 123,035). MR effects were estimated using an inverse-variance weighted analysis.
RESULTS
Genetic liability to a morning preference was associated with increased intake of 6 food items (fresh fruit, alcohol with meals, bran cereal, cereals, dried fruit, and water), decreased intake of 4 food items (beer plus cider, processed meat, other cereals [e.g., corn or frosted flakes], and full cream milk), increased temperature of hot drinks, and decreased variation in diet (PFalse Discovery Rate < 0.05). There was no evidence for an effect on coffee or tea intake. Findings for fresh fruit, beer plus cider, bran cereal, and cereal were consistent when intakes were estimated by 24-h diet recalls (P < 0.05). We also identified potential causal links between a morning preference with earlier timing and a shorter duration for completing email-administered 24-h diet recalls.
CONCLUSIONS
Our findings provide evidence for a potentially causal effect of a morning preference with the increased intake of foods known to constitute a healthy diet, suggesting possible health benefits of adopting a more morning diurnal preference.
Topics: Adult; Circadian Rhythm; Diet; Diet Records; Eating; Feeding Behavior; Female; Genome-Wide Association Study; Humans; Male; Mendelian Randomization Analysis
PubMed: 32860398
DOI: 10.1093/ajcn/nqaa219 -
Cardiology in Review Mar 2024The aim of the present paper is to explore the option of chronotherapy of hypertension and its effectiveness in blood pressure (BP) lowering compared with its standard...
The aim of the present paper is to explore the option of chronotherapy of hypertension and its effectiveness in blood pressure (BP) lowering compared with its standard daily treatment. The treatment of BP has gone through many different schemes over the years. From no treatment in the early 1930s, to step care, to multiple drug combinations, or to single daily drug combinations with 2-3 drugs, still BP is not well controlled in a significant number of patients. Recently, the role of the circadian rhythm in the treatment of hypertension has been tested by several studies comparing the evening versus the morning drug administration with no clear evidence of superiority of either mode of drug administration. However, in cases of morning surge of BP, nocturnal hypertension, and renal disease, the evening drug administration has been more effective than the morning drug administration, and thus, more preferable. In order to get a better perspective on this approach of hypertension treatment, a Medline search of the English literature was contacted between 2010 and 2023 using the terms BP control, circadian rhythm, morning drug administration, evening drug administration, and 38 pertinent papers were selected for analysis. Careful review of the selected papers showed that chronotherapy of hypertension is effective. However, the overall effectiveness of evening drug administration compared with the morning administration is not significantly more effective compared to the morning administration and more work is needed in this field.
PubMed: 38506526
DOI: 10.1097/CRD.0000000000000644 -
The American Journal of Medicine Jul 2023A comprehensive approach to hypertension requires out-of-office determinations by home or ambulatory monitoring. The 4 phenotypes comparing office and out-of-office... (Review)
Review
A comprehensive approach to hypertension requires out-of-office determinations by home or ambulatory monitoring. The 4 phenotypes comparing office and out-of-office pressures in treated and untreated patients include normotension, hypertension, white-coat phenomena, and masked phenomena. Components of out-of-office pressure may be equally as important as mean values. Nighttime pressures are normally 10%-20% lower than daytime (normal "dipping") pressures. Abnormalities include dipping more than 20% (extreme dippers), less than 10 % (nondippers), or rising above daytime (risers) and have been associated with elevated cardiovascular risk. Nighttime pressure may be elevated (nocturnal hypertension) in isolation or together with daytime hypertension. Isolated nocturnal hypertension theoretically changes white-coat hypertension to true hypertension and normotension to masked hypertension. Pressure normally peaks in the morning hours ("morning surge") when cardiovascular events are most common. Morning hypertension may result from residual nocturnal hypertension or an exaggerated surge and has been associated with enhanced cardiovascular risk, especially in Asian populations. Randomized trials are needed to determine whether altering therapy based solely on either abnormal dipping, isolated nocturnal hypertension, or an abnormal surge is justified.
Topics: Humans; Blood Pressure Monitoring, Ambulatory; Circadian Rhythm; Hypertension; Blood Pressure; Phenotype
PubMed: 36893831
DOI: 10.1016/j.amjmed.2023.02.018