Tuesday, June 10, 2008

Second Day of SLEEP 2008 Comes to a Close

The scientific program for the second day of SLEEP 2008 concluded with the final symposia and oral presentations of the day.

Some American Academy of Sleep Medicine
section members are finishing up their section meetings.

Day three of the scientific program will begin at 8 a.m. on Wednesday with symposia and brief oral presentations. Wednesday also is the final day for the SLEEP 2008 exhibit hall.

Neck Size a Predictor of OSA in Children

A study being presented as an oral presentation this afternoon at SLEEP 2008 describes the link between neck size and obstructive sleep apnea in children.

The study examined the records of 242 children between two and 18 years of age. The actual neck size of each patient was adjusted for age to obtain the child’s percent deviation from predicted neck size (DPN).

DPN showed a high correlation with apnea-hypopnea index (AHI), a measure of the severity of
obstructive sleep apnea (OSA). DPN showed a higher association with AHI than did body mass index (BMI) or tonsil size.

These results show that DPN may provide a more anatomically specific risk factor for OSA in children than obesity measures such as BMI.

According to the
American Academy of Sleep Medicine, OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in preschoolers. OSA often occurs between the ages of 3 and 6 years when the tonsils and adenoids are large compared to the throat.

SRS Welcomes New Leaders, Recognizes Award Recipients

Dr. Michael Vitiello, a researcher with 20 years of experience studying the neuroscience of sleep and aging, was installed as president of the Sleep Research Society during the SRS General Membership Meeting this afternoon at SLEEP 2008.

Vitiello, professor of psychiatry and behavioral sciences at the University of Washington in Seattle, was introduced by outgoing president
Dr. Eric Nofzinger after he described some of the significant achievements made by the SRS in the past year. Nofzinger then gave Vitiello a gavel to symbolize the transfer of leadership.

Vitiello elicited laughter with his characteristic sense of humor, but became serious when describing the challenges sleep scientists face in securing
funding for their research. He said that in the next year the SRS will continue to advocate for the funding of, and infrastructure development for, sleep research and training.

He added that the SRS will continue to make an impact on the professional development of its members by enhancing career entry, career development, and professional education at all levels in sleep science and sleep medicine.

Earlier in the meeting the entire SRS board of directors for 2008 – 2009 was introduced. Joining Vitiello as officers are past president Nofzinger;
Dr. Clifford Saper, who rotates from director-at-large to president-elect; and Dr. Ronald Szymusiak, a newly elected member of the board of directors who will serve as secretary-treasurer.

Dr. Mark Opp, Dr. Thomas Kilduff, Dr. Sharon Keenan and Dr. James Walsh were recognized for completing their terms on the board of directors, and
Dr. Janet Mullington, Dr. Thomas Scammell, and Dr. Terri Weaver were introduced as newly elected directors at large. Dr. Eliza Van Reen will replace Dr. Tracy Rupp as the trainee member-at-large.

The meeting also included the recognition of several SRS award recipients. Thomas Penzel, PhD, received the Bill Gruen Award for the highest-rated abstract in the instrumentation category.

Three members received the SRS Young Investigator Award: Antoine Adamantidis, PhD; Esra Tasali, MD; and Vladyslav Vyazovskiy, PhD. Honorable mention went to David M. Raizen, MD, PhD.

Benefits of Receiving Care at AASM-Accredited Sleep Centers

Two studies being presented as poster presentations today at SLEEP 2008 describe benefits of receiving medical care from American Academy of Sleep Medicine-accredited sleep centers and from board certified sleep specialists.

One ongoing study (ID# 1069) of 243 patients at four participating sleep centers found that patients cared for by AASM-accredited centers and board-certified physicians received better education than patients cared for by non-accredited centers and non-certified physicians.

One-hundred percent of study subjects at AASM-accredited centers reported receiving adequate education about
obstructive sleep apnea (OSA). At non-accredited sites, 83.5 percent of study subjects reported receiving adequate education about OSA.

Standards for Accreditation require that accredited sleep centers have on staff at least one board-certified sleep specialist. Initial results of this study were published in the Journal of Clinical Sleep Medicine in 2006.

Another study (ID# 1073) of 55 patients shows that access to specialized services with close follow up in an AASM-accredited sleep center can make a significant difference in treatment success. Each of the patients had a high risk of failure to comply with continuous positive airway pressure therapy (CPAP) for OSA. Sixty-one percent of the patients became compliant and were followed up for six months.

Is Circadian Advantage a Home Run for MLB Teams?

A study funded by Major League Baseball (ID# 0165) that is being presented as a poster presentation this morning at SLEEP 2008 examined the effect of circadian timing on the outcome of MLB games.

The analysis of 24,133 games from 1997 to 2006 found that in 79 percent of the games, both teams were “at home” in the current time zone. In the remaining 5,046 games, the team with the circadian advantage won about 52 percent of the games.

The study found that the magnitude of circadian advantage influenced success. The winning percentage for teams with a three-hour circadian advantage increased to 60.3 percent. The direction in which teams traveled did not appear to influence the outcome of games.

This study is a follow-up to a 2005 study that analyzed the results of MLB games from 2004. That study found that teams performed better traveling eastward than they did traveling westward. The initial research abstract was presented
in 2005.

According to the
American Academy of Sleep Medicine, jet lag is a circadian rhythm sleep disorder that occurs when a long trip across time zones quickly puts you in a place where you need to sleep and wake at a time that is different than what your internal body clock expects. Symptoms can include disturbed sleep, decreased alertness and impaired functioning.

The SLEEP 2008 abstract book is available online at http://www.journalsleep.org/PDF/AbstractBook2008.pdf.

Do You Sleep Like You Eat?

Two studies from Brazil that are being presented as poster presentation this morning at SLEEP 2008 address the relationship between your sleep and the food you eat. Both studies involved 52 healthy subjects between the ages of 20 and 45 years.

One study (ID# 0084) found that both total energy intake and late-night snack energy intake are significantly correlated with awakenings during sleep. Both measures of energy intake also were correlated with apnea-hypopnea index, a measurement of the severity of obstructive sleep apnea.

Another study (ID# 0085) found that total fat intake is related to a number of sleep measures, including percentage of REM sleep, arousal index and apnea-hypopnea index. The study also found that fat intake at dinner is associated with sleep measures such as sleep efficiency and REM percentage. The results show that total fat intake and dinner fat intake seem to have a negative influence on the sleep pattern of healthy adults.

The SLEEP 2008 abstract book is available online at http://www.journalsleep.org/PDF/AbstractBook2008.pdf.

Experts Take a Look at Home Sleep Testing

In a clinical workshop taking place this morning at SLEEP 2008, leaders of the American Academy of Sleep Medicine are providing a detailed analysis of home sleep testing for the detection of obstructive sleep apnea.

The workshop will compare
AASM guidelines with a recent decision from the Centers for Medicare & Medicaid Services and will discuss the impact that the CMS decision will have on sleep-medicine providers. There also will be a discussion of current local coverage determination (LCD) policies.

In the December 15, 2007, issue of the
Journal of Clinical Sleep Medicine, the AASM published “Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients.”

The guidelines recommend unattended portable monitoring (PM) as a valid option for detecting OSA in adults who have a high pretest probability of moderate to severe OSA, and who have no comorbid medical conditions or
sleep disorders that may degrade the accuracy of PM.

The guidelines also recommend that PM testing be administered by
AASM-accredited sleep centers and labs and reviewed by a board-certified sleep specialist.

In March 2008 CMS released its “Decision Memo for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (CAG-00093R2).” The decision allows coverage of home sleep testing for the detection of OSA in Medicare beneficiaries.

Sleep Loss, Alzheimer’s and Sleep Apnea

A study (ID# 0291) being presented as an oral presentation this morning at SLEEP 2008 evaluated 52 older adults who have both Alzheimer’s disease (AD) and obstructive sleep apnea (OSA).

When the study subjects were treated with continuous positive airway pressure (
CPAP) therapy, the resulting increase in total sleep time was significantly associated with improvements in neurocognitive testing.

No other variables, including changes in oxygenation, were significant. This implies that the cognitive impairment associated with OSA in AD patients may result from short sleep time.

American Academy of Sleep Medicine reports that the steepest prevalence increase for OSA is in the transition from middle-aged to older-aged adults. According to the National Institute on Aging, up to 4.5 million Americans suffer from AD, which usually begins after the age of 60.

The SLEEP 2008 abstract book is available online at

U.S. Veterans Battle Insomnia after Returning from Iraq

A study (ID# 0697) being presented as an oral presentation this morning at SLEEP 2008 shows that insomnia is a significant problem for combat-exposed U.S. soldiers returning from Iraq.

The study examined the sleep of 14
Operation Iraqi Freedom veterans who have post-deployment adjustment disorders. They were compared with 14 people who have primary insomnia and 14 good sleepers.

The veterans reported much worse sleep quality and sleep efficiency, increased time to fall asleep and wake time after falling asleep, and more nocturnal awakenings than good sleepers. Sleep measures of the veterans were similar to those of the people with primary insomnia.

The veterans also had more severe disruptive nocturnal behaviors than both good sleepers and people with primary insomnia.

A study (ID# 0736) that was presented yesterday as a poster presentation shows that U.S. veterans of the war in Iraq who struggle with insomnia may prefer treatment that combines medications with non-pharmacological approaches such as relaxation therapy. Veterans also preferred receiving therapy through MP3 files and the Internet.

Another study (ID# 0556) presented yesterday as a poster presentation reports that black veterans are significantly less likely than white or Asian veterans to adhere to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea.

The SLEEP 2008 abstract book is available online at http://www.journalsleep.org/PDF/AbstractBook2008.pdf.

Day Two of SLEEP 2008 Begins with a Focus on Heart Health

The second day of SLEEP 2008 begins with three symposia, one of which focuses on the impact that sleep-disordered breathing has on heart health. The symposium is entitled, “Sleep Disordered Breathing as a Cardiovascular Risk Factor: An Epidemiological Perspective from the Sleep Heart Health Study.”

The ongoing
Sleep Heart Health Study, which is sponsored by the National Heart, Lung, and Blood Institute, has contributed significantly to the scientific data showing that sleep-disordered breathing may increase the risk for high blood pressure and cardiovascular diseases such as coronary artery disease and stroke.

According to the NHBI,
the study has been renewed several times since it began in 1994, allowing for the collection of more data and follow up. The estimated study completion date is August 2008.

The chair of the symposium is
Dr. Stuart Quan of the University of Arizona, one of the principal investigators working on the multi-site study. Dr. Quan is a past president of the American Academy of Sleep Medicine and the editor of the Journal of Clinical Sleep Medicine.

He will be joined by four other experts who will make presentations about the relationship between sleep-disordered breathing and cardiovascular disease, stroke, cardiac arrhythmia and mortality.