Lung Function and Bronchial Hyperresponsiveness in Adults Born Prematurely. A Cohort Study.

RATIONALE: Bronchopulmonary dysplasia and the long-term consequences of prematurity are underrecognized entities, unfamiliar to adult clinicians. Well described by the pediatric community, these young adults are joining the ranks of a growing population of adults with chronic lung disease. OBJECTIVES: To describe the quality of life, pulmonary lung function, bronchial hyperresponsiveness, body composition, and trends in physical activity of adults born prematurely, with or without respiratory complications. METHODS: Four groups of young adults born in Canada between 1987 and 1993 were enrolled in a cohort study: (1) preterm subjects with no neonatal respiratory complications, (2) preterm subjects with neonatal respiratory distress syndrome, (3) preterm subjects with bronchopulmonary dysplasia, and (4) subjects born at term. The following measurements were compared across the four groups: health-related quality of life, respiratory health, pulmonary function, methacholine challenge test results, and sedentary behavior and physical activity level. MEASUREMENTS AND MAIN RESULTS: Adult subjects who had bronchopulmonary dysplasia in infancy had mild airflow obstruction (FEV1, 80% predicted; FEV1/FCV ratio, 70) and gas trapping compared with others. They also had less total active energy expenditure and more time spent in sedentary behavior compared with subjects born at term. All preterm groups had a high prevalence of bronchial hyperresponsiveness compared with term subjects. CONCLUSIONS: In a population-derived, cross-sectional study, we confirmed previous reports that adults 21 or 22 years of age who were born prematurely with neonatal bronchopulmonary dysplasia are more likely to have airflow obstruction, bronchial hyperresponsiveness, and pulmonary gas trapping than subjects born prematurely without bronchopulmonary dysplasia or at term. Clinicians who care for adults need to be better informed of the long-term respiratory consequences of premature birth to assist young patients in maintaining lung function and health.

Healthcare utilization and health-related quality of life of adult survivors of preterm birth complicated by bronchopulmonary dysplasia.

AIM: This study aims to characterize the impact of preterm birth, respiratory distress syndrome and bronchopulmonary dysplasia on quality of life and healthcare utilization in adulthood. METHODS: A mail survey on quality of life and respiratory health was sent to a list of potential subjects identified using the databases of the Régie de l'asssurance maladie du Québec. Four groups of adults born between 1987 and 1993 were compared: (i) preterm with bronchopulmonary dysplasia, (ii) preterm with respiratory distress syndrome, (iii) preterm without respiratory complications and (iv) term controls. As a complement, data from the governmental healthcare administrative databases were extracted for responders. RESULTS: Although the groups differed in their use of healthcare services and prescription drugs, no clinically significant difference was observed for Saint George's Respiratory Questionnaire (SGRQ), SF-36v2 and Medical Research Council (MRC) Dyspnea Scale scores. However, compared to term subjects, bronchopulmonary dysplasia subjects were less likely to access higher education and more likely to be either invalid or unemployed. CONCLUSION: Compared to term subjects, subjects with a history of prematurity and respiratory distress syndrome or bronchopulmonary dysplasia had similar health-related quality of life and respiratory symptoms despite greater use of healthcare services and prescription drugs.

Bronchopulmonary dysplasia - trends over three decades.

OBJECTIVES: To describe the characteristics of bronchopulmonary dysplasia (BPD) and respiratory distress syndrome subjects, along with the trends in severity and mortality associated with BPD over the past three decades. METHODS: Retrospective study of BPD and respiratory distress syndrome subjects born between 1980 and 2008, and admitted to Montreal Children's Hospital (Montreal, Quebec). Data were abstracted from hospital records. RESULTS: Gestational age and birth weight were correlated with the occurrence of BPD with each additional week of gestation and 100 g in birth weight being associated with an OR of developing BPD of 0.77 and 0.89, respectively. BPD severity was associated with male sex, Apgar score and the occurrence of neonatal pneumonia. Significant trends were observed for lower mortality despite lower gestational age and birth weight, greater maternal age and multiple gestations. CONCLUSION: Mortality from BPD has improved over the past three decades despite significant trends toward more pronounced prematurity and lower birth weights.

OBJECTIF: Décrire les caractéristiques des sujets atteints de la dysplasie bronchopulmonaire (DBP) et du syndrome de détresse respiratoire, de même que les tendances quant à la gravité de la DBP et à la mortalité s'y rapportant depuis 30 ans. MÉTHODOLOGIE: Les chercheurs ont mené une étude rétrospective des sujets atteints de la DBP et du syndrome de détresse respiratoire nés entre 1980 et 2008 et hospitalisés à L'Hôpital de Montréal pour enfants, au Québec. Ils ont tiré les données des dossiers hospitaliers. RÉSULTATS: Les chercheurs ont corrélé l'âge gestationnel et le poids de naissance avec l'occurrence de DBP, chaque nouvelle semaine de grossesse et nouvelle tranche de 100 g de poids de naissance s'associant à un RRR de DBP de 0,77 et de 0,89, respectivement. La gravité de la DBP s'associait au sexe masculin, à l'indice d'Apgar et à l'occurrence d'une pneumonie néonatale. Les chercheurs ont observé des tendances importantes de diminution de la mortalité malgré un âge gestationnel et un poids de naissance moins élevés, l'âge plus avancé des mères et des gestations multiples. CONCLUSION: La mortalité liée à la DBP a diminué depuis 30 ans, malgré des tendances importantes vers une prématurité plus prononcée et un plus petit poids à la naissance.

Phototherapy and orange-tinted goggles for night-shift adaptation of police officers on patrol.

The aim of the present combined field and laboratory study was to assess circadian entrainment in two groups of police officers working seven consecutive 8/8.5-h night shifts as part of a rotating schedule. Eight full-time police officers on patrol (mean age ± SD: 29.8 ± 6.5 yrs) were provided an intervention consisting of intermittent exposure to wide-spectrum bright light at night, orange-tinted goggles at sunrise, and maintenance of a regular sleep/darkness episode in the day. Orange-tinted goggles have been shown to block the melatonin-suppressing effect of light significantly more than neutral gray density goggles. Nine control group police officers (mean age ± SD: 30.3 ± 4.1 yrs) working the same schedule were enrolled. Police officers were studied before, after (in the laboratory), and during (ambulatory) a series of seven consecutive nights. Urine samples were collected at wake time and bedtime throughout the week of night work and during laboratory visits (1 × /3 h) preceding and following the work week to measure urinary 6-sulfatoxymelatonin (UaMT6s) excretion rate. Subjective alertness was assessed at the start, middle, and end of night shifts. A 10-min psychomotor vigilance task was performed at the start and end of each shift. Both laboratory visits consisted of two 8-h sleep episodes based on the prior schedule. Saliva samples were collected 2 × /h during waking episodes to assay their melatonin content. Subjective alertness (3 × /h) and performance (1 × /2 h) were assessed during wake periods in the laboratory. A mixed linear model was used to analyze the progression of UaMt6s excreted during daytime sleep episodes at home, as well as psychomotor performance and subjective alertness during night shifts. Two-way analysis of variance (ANOVA) (factors: laboratory visit and group) were used to compare peak salivary melatonin and UaMT6s excretion rate in the laboratory. In both groups of police officers, the excretion rate of UaMT6s at home was higher during daytime sleep episodes at the end compared to the start of the work week (p < .001). This rate increased significantly more in the intervention than control group (p = .032). A significant phase delay of salivary melatonin was observed in both groups at the end of study (p = .009), although no significant between-group difference was reached. Reaction speed dropped, and subjective alertness decreased throughout the night shift in both groups (p < .001). Reaction speed decreased throughout the work week in the control group (p ≤ .021), whereas no difference was observed in the intervention group. Median reaction time was increased as of the 5th and 6th nights compared to the 2nd night in controls (p ≤ .003), whereas it remained stable in the intervention group. These observations indicate better physiological adaptation in the intervention group compared to the controls.

Working on atypical schedules.

Shift work has been associated with a number of health problems including cardiovascular disease, impaired glucose and lipid metabolism, gastrointestinal discomfort, reproductive difficulties, and breast cancer. The specific contributions of disturbed physiological rhythms, circadian misalignment, and sleep debt to the various medical problems encountered by shift workers remain to be clarified. Fatigue can be caused by extended on-duty and/or waking periods, inadequate sleep quantity, sleep disturbances, disruption of circadian rhythms, and difficult work and familial conditions. Fatigue-related accidents raise a safety concern for shift workers, especially at the end of the night when the circadian nadir of alertness interacts with increased time awake. Individuals vary greatly in their capacity to adjust to atypical work schedules and their tolerance to circadian misalignment. Predisposing individual and domestic factors have been identified, such as increasing age, being a single woman in charge of children, and split sleep patterns, all of which can affect the ability to adjust to atypical schedules. However, prior studies indicate that predisposing individual and social determinants are generally poor predictors of shift work tolerance in a given individual. In this manuscript, we review several countermeasures to improve adaptation to shift work.