The relationship between sleep and physical function in community-dwelling adults: a pilot study.

More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.

Effect of bronchodilator treatment on the incidence of postoperative atrial fibrillation after cardiac surgery.

OBJECTIVE: We sought to examine the effects of bronchodilator treatment on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery. METHODS: A cross-sectional design using a retrospective chart review was performed in patients who underwent cardiac surgery. Those who had previous atrial fibrillation or preoperative bronchodilator treatment were excluded from the final sample (n = 506). The Statistical Package for the Social Sciences (SPSS, Inc., Chicago, IL) was used for statistical analyses. RESULTS: The incidence of POAF in this study was 27.9%, and was associated with age (P < .01) and type of cardiac surgery (P < .05), indicating that increasing age, and combined cardiac surgery were more likely to precipitate POAF. Bronchodilator treatment did not increase POAF. However, combined therapy significantly (P < .01) precipitated more POAF (48.7%) than did albuterol (21.4%) or levalbuterol (18.5%). CONCLUSIONS: Postoperative atrial fibrillation continues to be a common complication after cardiac surgery. Bronchodilator treatment with either albuterol or levalbuterol did not precipitate POAF, unless both agents were given to the same patients postoperatively.

Uridine supplementation in the treatment of HIV lipoatrophy: results of ACTG 5229.

BACKGROUND: Lipoatrophy is prevalent on thymidine nucleoside reverse transcriptase inhibitors (tNRTIs). A pilot trial showed that uridine (NucleomaxX) increased limb fat. METHODS: A5229 was a multicenter trial in which HIV-infected individuals with lipoatrophy on tNRTI regimens were randomized to NucleomaxX or placebo. Primary endpoint was change in limb fat from baseline to week 48. The study was powered to detect 400-g difference between arms at week 48. A stratified Wilcoxon rank-sum test was used to assess between-arm differences. RESULTS: The 165 participants were 91% men, 62% white; median age 49 years, CD4 cell count 506 cells/µl, and limb fat 3037 g; 81% had HIV-1 RNA 50 copies/ml or less; 76% were on zidovudine (ZDV). Baseline characteristics were similar between groups. Only 59% completed 48 weeks of treatment; however, only three participants (one on uridine) discontinued due to toxicity (diarrhea). In intent to treat, there was no difference for changes in limb fat between treatments at week 24 or week 48. On as-treated analysis, uridine resulted in an increase in %limb fat vs. placebo (3.4 vs. -0.8%, P = 0.01) at week 24 but not at week 48 (1.8 vs. 3.8%, P = 0.93). Similar results were seen when limiting the analysis to patients with at least 80% adherence. The results were not related to severity of lipoatrophy or type of tNRTI. No changes were found in facial anthropometrics, fasting lipids, trunk fat, CD4 cell count, or HIV RNA. CONCLUSIONS: We found a modest transient improvement in limb fat after 24 weeks of uridine. The lack of sustained efficacy at week 48 was not due to changes in adherence or reduction in sample size. Uridine was well tolerated and did not impair virologic control.