CPAP Therapy Eases Acid Reflux Symptoms in Patients With Sleep Apnea, Indian Study Reports

India: A new prospective cohort study from India has revealed that consistent use of continuous positive airway pressure (CPAP) therapy not only alleviates obstructive sleep apnea (OSA) but also improves gastroesophageal reflux disease (GERD) symptoms. The research, led by Dr. Sohini Saha and Dr. Meghanad Meher from the Department of General Medicine, Institute of Medical Sciences and Siksha ‘O’ Anusandhan Medical Hospital, Bhubaneswar, has been published in Cureus.

The study included 89 adults aged 18 to 75 years diagnosed with both moderate-to-severe OSA and GERD. Patients were prescribed auto-titrating CPAP therapy, and adherence was defined as using the device for more than four hours per night on at least 70% of nights over one month. Clinical assessments, including GERD symptom scores, daytime sleepiness scales, and polysomnographic measures, were conducted at baseline and repeated after one month of therapy.
Based on the study, the researchers reported the following findings:
  • 72 patients (80.9%) demonstrated adequate CPAP adherence.
  • Significant reductions in GERD symptoms were observed, as measured by the GERD-Q questionnaire.
  • Improvements were noted in apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and daytime sleepiness scores.
  • No adverse effects from CPAP use were reported during the study period.
  • CPAP improved GERD outcomes independent of changes in sleep apnea severity or oxygen levels, suggesting a possible direct therapeutic effect on reflux mechanisms.
The researchers further observed that smoking and adopting right-sided or supine sleep positions reduced the extent of GERD relief, whereas patients who showed greater improvement in daytime sleepiness were more likely to experience stronger benefits. Based on these observations, the authors emphasized the importance of patient education and telemedicine-based support during the first month of CPAP use, which they described as a critical period for habit formation and long-term adherence. They also highlighted the need to address modifiable risk factors such as smoking and sleep positioning to maximize therapy outcomes.
“The findings highlight the potential of CPAP as a frontline treatment option for patients with both OSA and GERD, even in cases where reflux symptoms may not directly correlate with apnea severity. The use of validated assessment tools like the GERD-Q and Epworth Sleepiness Scale (ESS) was recommended to help clinicians monitor treatment response and personalize therapy more effectively,” the authors wrote.
At the same time, the authors acknowledged limitations, including the non-randomized single-center design, relatively small sample size, and short one-month follow-up, which may limit generalizability and long-term applicability. The exclusion of patients on proton pump inhibitors (PPIs) was also noted as a factor that could reduce the relevance of the findings to typical GERD populations.
“Overall, the study provides valuable evidence that consistent CPAP use can deliver dual benefits by improving both sleep-related outcomes and reflux symptoms in patients living with OSA and GERD. Strengthening early adherence support, integrating lifestyle modifications, and tailoring patient counseling could further enhance the effectiveness of this therapy in routine clinical practice,” they concluded.
Reference:
Saha S, Meher M (August 25, 2025) Impact of Continuous Positive Airway Pressure Therapy on Gastroesophageal Reflux Disease in Patients With Obstructive Sleep Apnea: A Prospective Cohort Study. Cureus 17(8): e90927. doi:10.7759/cureus.90927

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Navigating Endoscopic Sedation: Study Compares Safety Profiles of Propofol, Remimazolam, and Ciprofol

As endoscopic procedures become increasingly common, the choice of sedative agent used during these delicate procedures is of paramount importance. While propofol remains a widely utilized option, its limitations related to cardiovascular depression and injection pain have prompted the exploration of novel sedatives like remimazolam and ciprofol. A recent systematic review and network meta-analysis set out to provide a comprehensive comparison of these three anesthetic agents in the context of endoscopic sedation. The study examined a range of primary and secondary outcomes, including respiratory adverse events, cardiac adverse events, induction time, sedation recovery time, injection pain, gastrointestinal adverse events, and patient satisfaction. The findings paint a nuanced picture of the strengths and weaknesses of each medication. Respiratory Safety: Remimazolam and Ciprofol Shine One of the key findings was the significantly lower risk of respiratory adverse events with remimazolam and ciprofol compared to propofol. The analysis showed that the risk ratios for respiratory adverse events were 0.36 for remimazolam and 0.48 for ciprofol, relative to propofol. This suggests that remimazolam and ciprofol may be safer options for patients with compromised respiratory function, such as those with COPD or sleep apnea. Cardiovascular Considerations: Remimazolam Emerges as the Frontrunner The study also evaluated the impact of these sedatives on the cardiovascular system. Remimazolam demonstrated a 56% reduction in the risk of adverse cardiac events, such as hypotension and bradycardia, compared to propofol. Ciprofol also fared better than propofol in this regard, with a 24% lower risk of cardiac complications. These findings suggest that remimazolam may be the preferred choice for patients with pre-existing cardiovascular conditions. Injection Pain and Patient Satisfaction: Remimazolam and Ciprofol Shine One of the notable advantages of remimazolam and ciprofol was their ability to significantly reduce the incidence of injection pain compared to propofol. Both agents demonstrated an over 90% reduction in the risk of injection pain, which can greatly enhance the patient experience during the induction of anesthesia. Additionally, patient satisfaction scores tended to be higher with remimazolam and ciprofol, although the differences did not reach statistical significance. Navigating the Tradeoffs: Tailoring Sedation to Patient Needs The study highlights the importance of considering individual patient characteristics and procedural requirements when selecting the optimal sedative agent. For patients with respiratory or cardiovascular comorbidities, remimazolam emerges as the safer choice, while ciprofol may be preferred for gastrointestinal endoscopic procedures due to its favorable gastrointestinal tolerance profile. In settings where rapid turnover is crucial, propofol’s shorter induction and recovery times may be advantageous, but the trade-off is the higher risk of adverse effects. In conclusion, this comprehensive analysis provides valuable insights for clinicians navigating the complex landscape of endoscopic sedation. By understanding the unique strengths and limitations of propofol, remimazolam, and ciprofol, healthcare providers can make informed decisions that prioritize patient safety and optimize the procedural experience. As the field of endoscopic sedation continues to evolve, further research exploring combination strategies and long-term cognitive impacts will be crucial to refine these evidence-based guidelines.

Key Points

Here are the 6 key points from the research paper:

1. Remimazolam had the lowest risk of respiratory adverse events compared to propofol (RR = 0.36) and ciprofol (RR = 0.48).

2. Remimazolam had the lowest risk of cardiovascular adverse events compared to propofol (RR = 0.44) and ciprofol (RR = 0.76).

3. Remimazolam and ciprofol had significantly lower incidence of injection pain compared to propofol.

4. Ciprofol had the lowest incidence of gastrointestinal adverse events, followed by remimazolam and propofol.

5. Remimazolam had the highest probability of ranking first in terms of patient satisfaction, exceeding both ciprofol and propofol. 6. Propofol had the shortest induction and awakening times, but was associated with higher rates of cardiovascular/respiratory events and injection pain.

Reference –

Siqi Zhou et al. (2025). The Safety And Efficacy Of Remimazolam, Ciprofol, And Propofol Anesthesia In Endoscopy: A Systematic Review And Network Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03108-9.

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Breastfeeding After Breast Cancer Found Safe in POSITIVE Trial

A new study published in the Journal of Clinical Oncology found women who breastfed after breast cancer did not face an increased risk of recurrence or contralateral disease. Many women were also able to breastfeed successfully after breast-conserving surgery, including from the affected breast. 

The POSITIVE trial evaluated the safety of temporarily interrupting endocrine therapy (ET) in young women with early HR+ breast cancer who desire pregnancy. Previous findings confirmed that pausing treatment did not elevate short-term recurrence risk. The latest report delves deeper into what happens after live births, specifically exploring breastfeeding frequency, duration, and whether outcomes differ between those who breastfed and those who did not.

Among 317 women in the trial who had at least one live birth, 313 were eligible for the breastfeeding analysis. Of these, 196 (62.6%) breastfed their infants. Notably, women who had breast-conserving surgery were most likely to breastfeed, with 77.8% doing so. However, most of these women (about 69%) breastfed only from the unaffected breast. In contrast, only 45.2% of women who had undergone unilateral mastectomy reported breastfeeding.

Age and prior parenthood also influenced breastfeeding patterns. Women over 35 years of age were more likely to breastfeed when compared with younger counterparts (67.6% vs. 55.7%). Likewise, first-time mothers showed higher breastfeeding rates than women who already had children (66.4% vs. 48.5%).

Duration of breastfeeding was also substantial. More than half of breastfeeding women (52.6%) continued for over 4 months. The median duration was 4.4 months, with confidence intervals suggesting consistency around this timeframe.

A key focus of the study was whether breastfeeding might influence breast cancer outcomes. At a median follow-up of 41 months, the cumulative incidence of breast cancer events within 24 months of the first on-study live birth was nearly identical between groups. Specifically, rates were 3.6% among women who breastfed and 3.1% among those who did not. The 0.5% difference fell well within statistical margins of uncertainty, indicating no meaningful risk increase.

Overall, the findings provide important reassurance for young survivors weighing the decision to pursue both pregnancy and breastfeeding. With two-thirds of participants successfully breastfeeding after treatment, the results challenge longstanding concerns about safety and feasibility.

Source:

Peccatori, F. A., Niman, S. M., Partridge, A. H., Ruggeri, M., Colleoni, M., Saura, C., Shimizu, C., Satersdal, A. B., Kroep, J. R., Gelmon, K., Amant, F., Mailliez, A., Moore, H. C. F., Ruiz-Borrego, M., Walshe, J. M., Borges, V. F., Gombos, A., Kataoka, A., Rousset-Jablonski, C., … International Breast Cancer Study Group and the POSITIVE Trial Collaborators. (2025). Breastfeeding after hormone receptor-positive breast cancer: Results from the POSITIVE trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 43(24), 2712–2719. https://doi.org/10.1200/JCO-24-02697

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Antidepressant Use Linked to Lower Risk of Age-Related Macular Degeneration: Study Shows

USA: Use of common antidepressants may lower the risk of developing age-related macular degeneration (AMD) and slow its progression, according to a large U.S. database analysis.

The findings suggest that selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) could play a protective role against both non-exudative and exudative AMD, though more research is needed to confirm the link. The study has been published in the American Journal of Ophthalmology.

The investigation was led by Raziyeh Mahmoudzadeh from the Department of Ophthalmology, Virginia Commonwealth University, Richmond, Virginia, along with colleagues. Using real-world evidence, the team explored whether patients on antidepressants had a different risk profile for AMD compared with those not taking these medications.

For their analysis, the researchers used the TriNetX database, covering patients aged 40 years and older between October 2004 and October 2023. Individuals were categorized into three groups—those exclusively using SSRIs, SNRIs, or TCAs—and were compared with matched controls without antidepressant exposure. To minimize confounding, the authors applied propensity score matching that accounted for 17 variables, including age, sex, smoking status, hypertension, and cardiovascular disease. The main outcomes included the incidence of non-exudative AMD, exudative AMD, and progression from non-exudative to exudative AMD.

The key findings of the study were as follows:

  • The study included over 633,000 SSRI users, 826,000 SNRI users, and about 502,000 TCA users after matching.
  • SSRI use was associated with a 39% lower risk of non-exudative AMD (RR 0.606) and a 27% lower risk of exudative AMD (RR 0.733).
  • SNRI use showed an 86% reduced risk of non-exudative AMD (RR 0.141) and an 84% lower risk of exudative AMD (RR 0.161).
  • TCA use was linked to a 77% reduced risk of non-exudative AMD (RR 0.234) and a 73% reduced risk of exudative AMD (RR 0.267).
  • Antidepressant use also reduced the risk of progression from non-exudative to exudative AMD: 30% reduction with SSRIs (RR 0.701), 34% with SNRIs (RR 0.665), and 32% with TCAs (RR 0.676).

The authors highlighted that the potential mechanisms may involve reduced systemic inflammation, decreased oxidative stress, and neuroprotective effects mediated by brain-derived neurotrophic factors, and suppression of pro-inflammatory cytokines. Since both depression and AMD share pathways of inflammation and neurodegeneration, antidepressants may inadvertently influence eye health.

However, they cautioned that these results are exploratory and hypothesis-generating. As the study was retrospective and based on observational data, causality cannot be confirmed. Prospective clinical trials and mechanistic studies will be essential to determine whether antidepressants can be recommended as part of AMD prevention strategies.

“The analysis suggests that antidepressant use is associated with a lower risk of developing and progressing AMD, offering new insights into the potential dual benefits of these medications. If confirmed in future research, antidepressants could emerge as an unexpected ally in the fight against one of the leading causes of vision loss among older adults,” the authors concluded.

Reference:

Mahmoudzadeh R, et al “Antidepressant use and incidence and progression of age-related macular degeneration in a national United States database.” Am J Ophthalmol 2025; DOI: 10.1016/j.ajo.2025.08.052.

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Can Florida really end vaccine mandates? What would this mean for the US and countries like Australia?

When it comes to the future of childhood immunizations, all eyes are on Robert F. Kennedy Jr, US Secretary of Health and Human Services, and his audacious attempt to discredit vaccinations with misinformation and dodgy “science.”

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Can Florida really end vaccine mandates? What would this mean for the US and countries like Australia?

When it comes to the future of childhood immunizations, all eyes are on Robert F. Kennedy Jr, US Secretary of Health and Human Services, and his audacious attempt to discredit vaccinations with misinformation and dodgy “science.”

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Jamie Oliver is right—this is how much fruit and veg we really should be eating every day

Celebrity chef Jamie Oliver has stirred debate by calling the familiar five-a-day message “a lie”. Speaking to the Times, he argued that the real health benefits of fruit and vegetables only start to add up at seven, eight or even 11 portions a day.

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No, organ transplants won’t make you live forever, whatever Putin says

What do world leaders talk about when they think we’re not listening? This week it was the idea of living forever.

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AI lung cancer risk model validated in predominantly Black population at hospital

A new study presented at the International Association for the Study of Lung Cancer 2025 World Conference on Lung Cancer (WCLC) validates the use of Sybil, a deep learning artificial intelligence model, for predicting future lung cancer risk in a predominantly Black population.

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New antibody-drug conjugate shows promising efficacy in EGFR-mutated NSCLC patients

A novel antibody-drug conjugate (ADC), iza-bren (BL-B01D1), demonstrates encouraging safety and efficacy results in previously treated patients with EGFR-mutated non-small cell lung cancer (NSCLC), according to findings presented at the International Association for the Study of Lung Cancer (IASLC) 2025 World Conference on Lung Cancer (WCLC).

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