What matters is not the idea a man holds, but the depth at which he holds it. 

                                                                            Ezra Pound

WEDNESDAY, Dec. 14 (HealthDay News) -- Along with helping people with obstructive sleep apnea get a better night's sleep, machines that help keep the airways open during sleep can also help improve the symptoms of metabolic syndrome, according to new research.

Metabolic syndrome is a group of symptoms that indicate a higher risk of heart disease. These symptoms include excess weight, especially in the abdomen, high blood pressure, abnormal cholesterol levels, higher blood sugar levels and insulin resistance. Many people with obstructive sleep apnea also have metabolic syndrome, according to the study.

After three months of continuous positive airway pressure (CPAP) treatment, study participants with obstructive sleep apnea and metabolic syndrome had improvements in their blood pressure, cholesterol, and blood sugar levels. Thirteen percent of those who received the breathing treatment had such significant reductions in their symptoms that they no longer qualified as having metabolic syndrome after three months of therapy.

"Patients with obstructive sleep apnea should be actively screened for metabolic syndrome or constituents of metabolic syndrome, and, in addition to lifestyle modification, weight reduction and dietary modification, [should be given] proper counseling for CPAP use, and a CPAP machine should be used regularly," said the study's lead author, Dr. Surendra Sharma, a professor and head of the department of internal medicine at the All India Institute of Medical Sciences in New Delhi, India.

Results of the study are published in the Dec. 15 issue of the New England Journal of Medicine. Funding for the study was provided by a grant from Pfizer. Sharma said that Pfizer does not produce CPAP machines, and they were not involved in the study's design, implementation or interpretation.

Obstructive sleep apnea occurs when the airways close during sleep, causing a lack of oxygen that startles the person awake momentarily, though they may not be aware of awakening. This can happen several times to 100 times an hour, according to the U.S. National Heart, Lung, and Blood Institute.

The current study included 86 adults between the ages of 30 and 65. All had obstructive sleep apnea, but none was being treated with CPAP. Eighty-seven percent also had metabolic syndrome.

The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn't tell who was receiving standard CPAP and who received the sham treatment.

After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.

Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.

Blood sugar levels went down slightly, as did waist circumference, according to the study.

Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.

Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.

"This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences," said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.

Rapoport said it wasn't clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.

"This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we'd want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful," said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.

More information

To learn more about CPAP, go to the U.S. National Heart, Lung, and Blood Institute.

THURSDAY, Dec. 15 (HealthDay News) -- Snow shoveling does increase the risk of heart attack, a new study confirms.

While many people believe this, there has been little actual evidence, according to researchers at Queen's University in Kingston, Canada. So they decided to look for proof.

They reviewed the records of 500 patients who went to Kingston General Hospital with heart problems over two winter seasons. Of those patients, 35 (7 percent) started experiencing heart symptoms while shoveling snow.

"That is a huge number," Dr. Adrian Baranchuk, a professor in Queen's School of Medicine and a cardiologist at Kingston General Hospital, said in a university news release.

"Seven percent of anything in medicine is a significant proportion. Also, if we take into account that we may have missed some patients who did not mention that they were shoveling snow around the time that the episode occurred, that number could easily double," he explained.

The researchers also identified three main factors that put people at high risk for heart problems while shoveling snow: being male (31 patients); having a family history of premature coronary artery disease (20 patients); and smoking (16 patients).

They also found that regularly taking four or more cardiac medications could lower the risk.

The study was recently published online in the journal Clinical Research in Cardiology.

More information

Toronto Emergency Medical Services offers snow shoveling safety tips  .

THURSDAY, Dec. 15 (HealthDay News) -- Using a robotic assist system along with conventional rehabilitation therapy boosts the walking ability of people who've suffered a severe stroke, Italian researchers say.

They tracked 48 stroke survivors who were unable to walk at the start of the study. Half of the patients underwent conventional gait rehabilitation and half had conventional rehab plus robotic-assisted gait training for several months.

The robotic devices are therapist-controlled electromechanical platforms attached to the patient's feet. The therapist assesses the patient's status and then progressively sets the walking pace and bearing weight.

The patients' mobility was evaluated while in hospital, at discharge and then again two years later.

Among the patients in the robotic device-assisted group, only those with the greatest degree of disability showed improvement, according to the study published in the Dec. 15 issue of the journal Stroke.

"After two years, five times more patients who underwent robotic assistance training were able to walk without assistance, but only the most severely impaired," lead researcher Dr. Giovanni Morone, a physiatrist specialist and temporary assistant professor at the Santa Lucia Foundation, Institute for Research Hospitalization and Health Care in Rome, said in a journal news release.

"In others it seemed to make little difference, so the patient selection for this type of treatment is most important," he noted.

Some studies have found that robotic assistance can help improve stroke patients' mobility for six months, while others have found that it's equal to or less effective than having patients walk outside, the researchers pointed out in the news release.

"It could be time to change the research question from whether or not robotic-assisted walking training is effective, to who will benefit the most," Morone said. "Doctors need to select the right patients and remember that this is an adjunct [added] to traditional gait training."

One U.S. expert agreed that the role of robotics in stroke recovery remains unclear.

"While exciting, there is still much work to be done in establishing the effectiveness of robotics," said Dr. Craig Rosenberg, chairman of the department of rehabilitation medicine, at North Shore-LIJ Southside Hospital in Bay Shore, NY. "The cost of robotics remains high and there is limited availability to the stroke- and brain-injured population," he added.

Rosenberg also noted that "robotic technology is typically available only through research studies at this time."

More information

The National Stroke Association has more about stroke recovery and rehabilitation.

THURSDAY, Dec. 15 (HealthDay News) -- Americans' heart health is in a woeful state, says this year's report card from the American Heart Association.

And it's largely because people just aren't taking care of themselves.

In the past three or so decades, women have upped their calorie consumption by 22 percent and men by 10 percent, with carbohydrates and sugar-sweetened beverages both major sources of unneeded calories.

The inevitable result is that more than two-thirds of U.S. adults and about one-third of children are over the ideal body weight, the extra layers of fat putting a major strain on Americans' hearts.

The trend is particularly concerning in children. Today, about 20 percent of U.S. kids are obese, compared with just 4 percent 30 years ago.

Neither adults nor children are exercising enough and about 21 percent of men and 18 percent of women still smoke. About one-fifth of high school students also have taken up the smoking habit.

"This is very disturbing but not at all surprising," said Dr. Robert Michler, co-director of the Montefiore Einstein Center for Heart and Vascular Care in New York City. "Heart disease is this nation's number-one killer and the continued growth of our nation's waistline will deliver serious consequences."

The authors of the report, which appears online Dec. 15 in the journal Circulation, looked at seven markers of cardiovascular health: smoking, weight, exercise, diet, cholesterol, blood pressure and fasting blood sugar levels, as well as whether or not a person had a diagnosis of heart disease.

Using those criteria, 94 percent of U.S. adults -- that's almost everyone -- have at least one risk factor for heart disease. For example, one-third of U.S. adults have high blood pressure while 15 percent have high cholesterol.

And children aren't far behind.

The only good news?

The death rate from cardiovascular disease fell almost 31 percent in the last decade, although it still accounts for one in three deaths each year.

Stroke rates also dropped nearly 35 percent, making it now the fourth leading cause of death rather than the third.

But gains are largely due to better treatments rather than lifestyle improvements.

"The population overall is not taking care of themselves. When you leave it to the individual, the individual doesn't behave well," said Dr. Jacob Shani, chair of the Maimonides Cardiac Institute in New York City.

"But when the individual actually comes to the cardiologist or to the doctor, the news is very good," Shani added. "We decrease the mortality; people live longer after a heart attack. We do a lot of things now we couldn't do in the past."

Advances include better surgical techniques as well as cholesterol-lowering statins, sometimes referred to as the "wonder drug."

Such advances will continue to happen but "we need to get our arms around this," Michler said. "Lifestyle changes will have a major impact on this problem if we take it seriously. . . People need to become more active and they need to be very concerned about everything they put in their mouth."

More information

Visit the U.S. National Heart, Lung, and Blood Institute to learn about heart disease.