News from Annals of Internal Medicine tip sheet Aug. 5, 2014

ACP's new evidence-based guideline recommends sleep study for individuals with unexplained daytime sleepiness

Note: Sound bites and b-roll footage available. Satellite coordinates and feed times are below.

Doctors should assess the risk factors for and the symptoms of obstructive sleep apnea (OSA) in patients with unexplained daytime sleepiness, according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) being published in Annals of Internal Medicine. Up to 18 million adults in the United States have OSA, a serious health condition that is associated with cardiovascular disease (CVD), cognitive impairment, and type 2 diabetes. OSA is caused by repetitive obstruction of the upper airway during sleep, resulting in reduced airflow (hypopnea) or complete airflow cessation (apnea). Symptoms include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring. The incidence of OSA increases with age, particularly in adults over the age of 60, and obesity is a key risk factor. To diagnose OSA in symptomatic patients, ACP recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing. When PSG is not available, ACP recommends using a home-based portable monitor. ACP's guideline, "Diagnosis of Obstructive Sleep Apnea in Adults," includes High Value Care advice to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

Note: The URL will go live at 5:00 p.m. on Monday, August 4 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks. For interviews, please contact Steve Majewski at smajewski@acponline.org or 215-351-2514.

A computer model suggests that new drug therapies and implementation of widespread screening and treatment will make chronic hepatitis C virus (HCV) infection a rare disease by 2036. The article is being published in Annals of Internal Medicine. A disease is considered rare if it affects no more than one in every 1,500 people. Currently, approximately one in 100 people is infected with HCV, causing a substantial health and economic burden in the U.S.. In recent years, strategies for screening and treating HCV have begun to evolve rapidly. In 2012, The U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention recommended one-time screening for all baby boomers, who represent more than 80 percent of those chronically infected with HCV. In 2014, new highly effective oral HCV drugs were introduced, allowing primary care physicians and infectious disease specialist to treat HCV patients. Researchers used a computer model to predict the effect of these new screening strategies and drug therapies on chronic HCV infection and associated disease outcomes. They found that implementation of birth-cohort screening and the availability of highly effective new therapies could make HCV infection a rare disease in 22 years. A more aggressive screening approach that includes one-time screening for all U.S. citizens could make HCV a rare disease a full decade earlier.

Note: The URL will go live at 5:00 p.m. on Monday, August 4 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks. To speak with an author, please contact Katrina Burton at KBurton@mdanderson.org or 713-792-8034.

Both manual physical therapy (MPT) and subacromial corticosteroid injections (CSI) provide significant improvement in pain and function for patients with unilateral shoulder impingement syndrome (SIS), according to an article being published in Annals of Internal Medicine. SIS is a generic term that refers to various conditions that cause shoulder pain, including rotator cuff syndrome, tendinosis of the rotator cuff, and bursitis. Conservative treatment includes CSI or MPT, but evidence on the long-term efficacy of those treatments is conflicting. Researchers randomly assigned 104 patients between the ages of 18 and 65 with SIS to receive either 40 mg triamcinolone acetonide subacromial CSI or six sessions of MPT. Patients in the CSI group were given up to three total triamcinolone acetonide injections during the 1-year study period. MPT was matched to individual impairments and included a combination of joint and soft-tissue mobilizations; manual stretches; contract-relax techniques; and reinforcing exercises directed to the shoulder girdle or thoracic or cervical spine. MPT patients completed six sessions over a 3-week period and home exercises were prescribed to reinforce clinical interventions. Patients reported pain and disability at 1 month, 3 months, 6 months, and a year. Patients in both groups experienced significant improvement in pain and function, but the MPT patients used less shoulder-related health care resources than the CSI group.

Note: The URL will go live at 5:00 p.m. on Monday, August 4 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks.