A good night sleep makes you feel like winning a lottery worth $ 250000.

Getting the right amount and good quality  sleep is as beneficial to health and happiness as winning the lottery, according to research by the University of Warwick. The paper was published in March issue of Sleep Journal to mark  World Sleep Day on March 17, 2017. [1]

Lack of enough sleep has already been recognized as a major public health problem and has been linked to many chronic health diseases like hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.

CDC recommends that adults between the age of 18-60 years need a minimum of 7 or more hours of good quality sleep. [2]

Dr. Nicole Tang in the Department of Psychology at the University of Warwick in England, analyzed sleep patterns of more than 30,594 people in the United Kingdom for a period of 4 years.

The study assessed three key patterns of interests, sleep quantity, sleep quality, use of sleep medication. The outcome of interests were general health and well-being which were measured by General Health Questionnaire (GHQ-12; Likert scoring)  and the 12-item Short-Form Health Survey (SF-12).

About 77% participants reported an average sleep duration of 6–8 hours per night, nearly 80% reported good sleep quality while 16% took sleep medication at-least 3 times a week.

After adjusting for baseline variations and known confounders it was seen that good night sleep is associated with benefits in health and well-being, with quality of sleep is more important than quantity of sleep. Physical benefits of sleep take longer time to occur than mental well-being. Sleep is a multi-dimensional experience where the quality also matters along with the quantity.

“The current findings suggest that a positive change in sleep is linked to better physical and mental well-being further down the line,” said Dr Tang.

“It is refreshing to see the healing potential of sleep outside of clinical trial settings, as this goes to show that the benefits of better sleep are accessible to everyone and not reserved for those with extremely bad sleep requiring intensive treatments.

Association between sleep deprivation and medical errors like clinical performance deficit, and daytime fatigue are well established by earlier studies. It has also been linked to many vehicular accidents, industrial disasters and other work related errors.

Taking sleep medication is worse for health and these group of patients performed worse over course of years than those not requiring sleeping aides.  

An estimated 50-70 million US adults have sleep or wakefulness disorder and Questions about sleep are seldom asked by physicians.

Sleep has recently emerged as a feasible target for applying preventive measure to improve health of public. 

The full text of article  can be accessed here.

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[1] https://worldsleepday.org/

[2] https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

Anencephalic Newborn as an organ donor! An Ethical and Medical Dilemma.

Keri Young and her husband Royce

There has been lot of headlines recently about a young mom from Oklahoma, carrying her congenitally malformed baby till term so that her organs can be used for donation to other children and research purpose too!

Keri Young and her husband, Royce, made the difficult decision of not to abort the baby when they received diagnosis that Keri is carrying an anencephalic baby during a routine prenatal scan at 20 weeks.

Courtesy: CDC

According to CDC statistics, three in every 10,000 pregnancies in the U.S. result in anencephaly, his means about 1,206 pregnancies are affected by these conditions each year in the United States.[1]

Organ procurement from anencephalic babies has been a subject of debate since early 1980s due to difficulty in establishing brain death in these patients.  In 2005, the Canadian Pediatric Society published a position paper recommending against organ donation from anencephalic neonates due to the difficulty in establishing brain death in this condition.[2] Reports of donations from anencephalic babies are fewer since then. Wijetunga et al. reported the organ recovery of an anencephalic infant in 2015.[3]

Donation possibilities for babies, specifically babies with anencephaly, have expanded in USA since 2012. Each case is unique in itself and requires certain criteria’s that must be fulfilled, donation is a very viable option for a baby with anencephaly if families wish to pursue this option. 

Donations can be for transplant or for research purposes.

A baby with anencephaly may be able to donate heart valves, corneas (both tissue donation), and sometimes kidneys and liver cells (both organ donations) for transplant, if the requirements are fulfilled after the birth of the baby.

Currently, if there is a current research need and specific criteria are met, a baby with anencephaly may be capable of donating liver, lung, heart, kidney, pancreas, thymus (organ donations), skin samples, corneas, retinas, and some musculoskeletal tissue (tissue donation).

Keri Young and her husband took this brave decision so that organs from their daughter can help some kids, who are on the long list of organ transplant with gift of life. “We know she will not live. But someone else is desperately hoping for a miracle. Their kidneys are failing them. Their liver has betrayed them. They deserve life, and they’re probably praying for it. Eva can be their answer to it.” said Keri.

Many pro-life advocates in USA are concerned about getting organs from the anencephalic baby, because they want the hospital to ensure that her parents will not take any action to hasten her natural death.

Looking at the whole decision from a doctor or ob/gyn perspective is very complicated. Most anencephalic infants die within days or weeks without life-supporting interventions. If the parents are planning to donate the organs after birth, then the baby needs to be shifted to NICU for hooking the baby to an incubator. This is done so that the organs are well oxygenated before they are harvested.

Once the baby is put on the machine then it’s a painful process of waiting her to pass off so that the organs can be donated. This does not allow the family to begin the natural grieving process because the baby is still alive. It is also hard for NICU staff who is caring for the baby, despite knowing the full prognosis.  What happens if the baby is alive for months and consumes lot of healthcare resources?

All the hospital staff, doctors and parents are waiting for the baby to die so that the organs can be recovered. If it was not for the machines the baby would have passed away long back. We do not know?

These are some very tough questions that need to be answered before a decision of organ donation is taken. Even if all the legal dilemmas are met with, uniform criteria for death are observed and ethical considerations are acknowledged, the emotional aspects are very tough to address. 

Keri is due on 7 May 2017. 

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[1] https://www.cdc.gov/ncbddd/birthdefects/anencephaly.html

[2] Canadian Paediatric Society. Use of anencephalic newborns as organ donors. Paediatr Child Health (2005) 10:335–7

[3] Wijetunga I, Ecuyer C, Martinez-Lopez S, Benetatos N, Griffiths A, Adappa R, et al. Neonatal organ donation for transplantation in the UK. Arch Dis Child Fetal Neonatal Ed (2015).10.1136/archdischild-2015-308575

North American Menopause Society (NAMS) video series about important midlife health topics: March 2017.

The North American Menopause Society (NAMS) has started comprehensive video series for clinicians about important midlife health topics. All the interviews in the series are hosted by NAMS Board of Trustees Member and President Dr. Marla Shapiro, a Canadian physician, who led this exciting initiative.

In this monthly series, the latest video is “A Clinician's Guide to Bone Drug Holidays”, Dr. Shapiro interviews Dr. Michael McClung, NAMS Board Member and Founding Director of the Oregon Osteoporosis Center in Portland, Oregon. Dr. McClung discusses the right timing for drug holidays from bisphosphonates for women at low risk and as well as follow-up procedures. He discusses those who should not consider a drug holiday.

                     Dr Michael McClung discusses a clinician's approach to bone drug holidays