A late-breaking abstract (LBA 8) that will be presented at noon Pacific Time as an oral presentation demonstrates that people with mild to moderate obstructive sleep apnea may experience a clinically relevant and statistically significant improvement in functional status at eight weeks on active continuous positive airway pressure (CPAP) therapy.
The study analyses involved 113 people who were randomized to an active CPAP therapy treatment group, and 110 people who were randomized to a sham treatment group. The adjusted group difference in mean changes from baseline to week eight of treatment was 0.95 points on the Functional Outcomes of Sleep Questionnaire total score.
You can read the abstract in the final program.
Showing posts with label OSA. Show all posts
Showing posts with label OSA. Show all posts
Thursday, June 11, 2009
Sleep & Hypertension
A symposium taking place until 10 a.m. and being led by chair Dr. Antonio Culebras is focusing on “Sleep and Hypertension.” Topics being discussed include the relationship between sleep, sleep disorders and high blood pressure, as well as how to manage patients with high blood pressure through the identification of these sleep disorders.
Sleep disorders that will be prominent in this discussion include obstructive sleep apnea, periodic limb movements and insomnia. A study in the April 1 issue of the journal SLEEP reported that the risk of hypertension associated with insomnia and a short sleep duration is comparable to the risk associated with obstructive sleep apnea.
Culebras was one co-author of a scientific statement published last summer that focused on the growing evidence linking sleep apnea to cardiovascular disease. The statement reported that about 50 percent of OSA patients are hypertensive, and an estimated 30 percent of hypertensive patients also have OSA, often undiagnosed.
Sleep disorders that will be prominent in this discussion include obstructive sleep apnea, periodic limb movements and insomnia. A study in the April 1 issue of the journal SLEEP reported that the risk of hypertension associated with insomnia and a short sleep duration is comparable to the risk associated with obstructive sleep apnea.
Culebras was one co-author of a scientific statement published last summer that focused on the growing evidence linking sleep apnea to cardiovascular disease. The statement reported that about 50 percent of OSA patients are hypertensive, and an estimated 30 percent of hypertensive patients also have OSA, often undiagnosed.
Sleep & Weight Gain
Two studies that will be presented later this morning as oral presentations shed light on the associations between sleep and weight gain.
One study (#0981) used data from 1,797 twins with an average age of 37 years to show that body mass index (BMI) varied as a function of habitual sleep duration. Results show that twins who slept between 7 and 8.9 hours each night had a lower mean BMI (25.0 kg/m2) compared with those who regularly slept either more (25.2 kg/m2) or less (26.4 kg/m2) per night. The findings remained significant even after careful adjustment for genetics and shared environment.
Analyzing data from the Sleep Heart Health Study, another study (#0515) suggests that there is a positive association between the severity of obstructive sleep apnea and subsequent change in BMI over approximately five years. The study involved 3,001 people with an average age of 62 years. Compared with participants who did not have sleep apnea, individuals with baseline moderate to severe sleep apnea had a mean change in BMI of 0.52 kg/m2; those with mild sleep apnea had a BMI change of 0.22 kg/m2. The association was significant despite adjustments for age, gender and race.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
One study (#0981) used data from 1,797 twins with an average age of 37 years to show that body mass index (BMI) varied as a function of habitual sleep duration. Results show that twins who slept between 7 and 8.9 hours each night had a lower mean BMI (25.0 kg/m2) compared with those who regularly slept either more (25.2 kg/m2) or less (26.4 kg/m2) per night. The findings remained significant even after careful adjustment for genetics and shared environment.
Analyzing data from the Sleep Heart Health Study, another study (#0515) suggests that there is a positive association between the severity of obstructive sleep apnea and subsequent change in BMI over approximately five years. The study involved 3,001 people with an average age of 62 years. Compared with participants who did not have sleep apnea, individuals with baseline moderate to severe sleep apnea had a mean change in BMI of 0.52 kg/m2; those with mild sleep apnea had a BMI change of 0.22 kg/m2. The association was significant despite adjustments for age, gender and race.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Tuesday, June 9, 2009
Nightmares & Other Parasomnias
Two studies being presented later this morning as posters focus on parasomnias – undesirable physical events or experiences that occur during entry into sleep, within sleep or during arousals from sleep.
One study (#0600) reports that the prevalence of parasomnia symptoms in patients with obstructive sleep apnea is higher than the prevalence rates of individual parasomnias in the general population. Of 537 adult participants with OSA, 51 (9.5 percent) had at least one type of parasomnia complaint; in the general population, the reported prevalence of common parasomnias is 2 percent to 5 percent. The most commonly reported complaints were sleep paralysis, sleep-related hallucinations and symptoms suggestive of REM sleep behavior disorder.
Another study (#1120) found that self-reported nightmares by adult patients seeking emergency psychiatric evaluation uniquely predicted elevated suicidal symptoms. Results indicate that after controlling for depression, the severity of self-reported disturbing dreams and nightmares independently predicted higher scores for suicide ideation as a non-significant trend; insomnia severity scores were no longer associated with suicide ideation after controlling for depression. The results suggest that nightmares may be an acute warning sign and risk factor for suicide.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
One study (#0600) reports that the prevalence of parasomnia symptoms in patients with obstructive sleep apnea is higher than the prevalence rates of individual parasomnias in the general population. Of 537 adult participants with OSA, 51 (9.5 percent) had at least one type of parasomnia complaint; in the general population, the reported prevalence of common parasomnias is 2 percent to 5 percent. The most commonly reported complaints were sleep paralysis, sleep-related hallucinations and symptoms suggestive of REM sleep behavior disorder.
Another study (#1120) found that self-reported nightmares by adult patients seeking emergency psychiatric evaluation uniquely predicted elevated suicidal symptoms. Results indicate that after controlling for depression, the severity of self-reported disturbing dreams and nightmares independently predicted higher scores for suicide ideation as a non-significant trend; insomnia severity scores were no longer associated with suicide ideation after controlling for depression. The results suggest that nightmares may be an acute warning sign and risk factor for suicide.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Musicians & the Risk for Obstructive Sleep Apnea
A study (#0715) being presented later this morning as a poster examines the risk of obstructive sleep apnea in 847 professional musicians.
Results show that musicians who played a high-resistance wind instrument had a significantly lower risk for OSA, while playing a high-resistance brass instrument such as the trumpet or horn produced no difference in OSA risk. Specifically, musicians who played double-reed woodwind instruments such as the oboe or the bassoon had the lowest risk for OSA, suggesting that these instruments promote “naturalistic” respiratory muscle training. Overall, 29.2 percent of musicians had a high risk for OSA. Risk also was related to the number of hours spent practicing per week.
In January the Sleep Education Blog reported on the theory that playing a wind instrument makes the muscles in the upper airway stronger, thus preventing soft tissue in the throat from collapsing and blocking the airway during sleep. The theory gained support from a small study in 2006 in the British Medical Journal. Results show that daytime sleepiness and sleep apnea severity improved in participants who played the didgeridoo.
Another study in the June issue of Sleep Medicine, however, found that wind players were more likely (odds ratio 1.47) than non-wind players to be at high risk for OSA; but this association was no longer statistically significant (adjusted odds ratio 1.12) after adjusting for age, body mass index, and gender. The researchers surveyed 1,111 orchestra members, including 369 wind instrument players.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Results show that musicians who played a high-resistance wind instrument had a significantly lower risk for OSA, while playing a high-resistance brass instrument such as the trumpet or horn produced no difference in OSA risk. Specifically, musicians who played double-reed woodwind instruments such as the oboe or the bassoon had the lowest risk for OSA, suggesting that these instruments promote “naturalistic” respiratory muscle training. Overall, 29.2 percent of musicians had a high risk for OSA. Risk also was related to the number of hours spent practicing per week.
In January the Sleep Education Blog reported on the theory that playing a wind instrument makes the muscles in the upper airway stronger, thus preventing soft tissue in the throat from collapsing and blocking the airway during sleep. The theory gained support from a small study in 2006 in the British Medical Journal. Results show that daytime sleepiness and sleep apnea severity improved in participants who played the didgeridoo.
Another study in the June issue of Sleep Medicine, however, found that wind players were more likely (odds ratio 1.47) than non-wind players to be at high risk for OSA; but this association was no longer statistically significant (adjusted odds ratio 1.12) after adjusting for age, body mass index, and gender. The researchers surveyed 1,111 orchestra members, including 369 wind instrument players.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Obstructive Sleep Apnea in Non-Obese Patients
The major predisposing factor for obstructive sleep apnea is excess body weight. But a study (#0565) being presented as a poster later this morning confirms a high prevalence of OSA in non-obese, adult patients who were referred to a sleep center for overnight polysomnography; the primary cause for referral was a complaint of excessive daytime sleepiness.
Each patient was 18 years of age or older; 57 percent were men. Patients were considered non-obese if they had a body mass index (BMI) of 18.5 to 27. Results show that OSA was diagnosed in 2,906 of the 5,426 non-obese patients (54 percent) who were evaluated by polysomnography at one of 18 sleep centers.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Each patient was 18 years of age or older; 57 percent were men. Patients were considered non-obese if they had a body mass index (BMI) of 18.5 to 27. Results show that OSA was diagnosed in 2,906 of the 5,426 non-obese patients (54 percent) who were evaluated by polysomnography at one of 18 sleep centers.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Monday, June 8, 2009
Improving CPAP Compliance for Sleep Apnea
Two studies being presented as posters later this morning address issues related to patient compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea.
One study (#0582) shows that some problem-solving and coping styles contribute to successful CPAP use. These include seeking advice and information from other people, and creating goal-oriented schedules.
Another study (#0576) shows that a spouse or cohabiting partner’s involvement can help improve CPAP compliance. The most effective methods of helping were “bilateral tactics,” which involve a collaborative effort to work together.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
One study (#0582) shows that some problem-solving and coping styles contribute to successful CPAP use. These include seeking advice and information from other people, and creating goal-oriented schedules.
Another study (#0576) shows that a spouse or cohabiting partner’s involvement can help improve CPAP compliance. The most effective methods of helping were “bilateral tactics,” which involve a collaborative effort to work together.
You can download the SLEEP 2009 abstract supplement as an 11 MB file in PDF format.
Wednesday, June 11, 2008
Symposium Examines Causes of Drowsy Driving
A symposium taking place this afternoon at SLEEP 2008 is examining the contributing factors related to drowsy driving. Co-chairs Dr. Naomi Rodgers and Dr. Kenneth Wright Jr., along with a faculty of experts, are presenting the latest information.
According to the U. S. National Highway Traffic Safety Administration, drowsy driving is a cause of at least 100,000 auto crashes each year. These crashes injure an average of 40,000 people and result in more than 1,550 deaths; the NHTSA suggests that the actual numbers are much higher.
Drowsy-driving crashes tend to occur late at night, are likely to be serious, often involve a single vehicle leaving the roadway, and tend to involve a driver who is alone in the vehicle. In addition to veering off the road, drowsy drivers are likely to wander into another lane or steer into oncoming traffic.
Sleep loss is an obvious factor in drowsy driving. Studies show that sleep deprivation impairs drivers in a manner that is comparable to alcohol, causing lapses in attention and slowing critical reaction times.
Other factors such as late or irregular work shifts, poor sleep habits and untreated sleep disorders such as obstructive sleep apnea and narcolepsy can combine to make anyone vulnerable to drowsy driving. Young men in their teens and 20s are more likely to be involved in a drowsy-driving crash.
According to the American Academy of Sleep Medicine, tips to avoid drowsy driving include getting a full night of sleep before a long drive and pulling off the road to take a nap if you begin to feel sleepy.
According to the U. S. National Highway Traffic Safety Administration, drowsy driving is a cause of at least 100,000 auto crashes each year. These crashes injure an average of 40,000 people and result in more than 1,550 deaths; the NHTSA suggests that the actual numbers are much higher.
Drowsy-driving crashes tend to occur late at night, are likely to be serious, often involve a single vehicle leaving the roadway, and tend to involve a driver who is alone in the vehicle. In addition to veering off the road, drowsy drivers are likely to wander into another lane or steer into oncoming traffic.
Sleep loss is an obvious factor in drowsy driving. Studies show that sleep deprivation impairs drivers in a manner that is comparable to alcohol, causing lapses in attention and slowing critical reaction times.
Other factors such as late or irregular work shifts, poor sleep habits and untreated sleep disorders such as obstructive sleep apnea and narcolepsy can combine to make anyone vulnerable to drowsy driving. Young men in their teens and 20s are more likely to be involved in a drowsy-driving crash.
According to the American Academy of Sleep Medicine, tips to avoid drowsy driving include getting a full night of sleep before a long drive and pulling off the road to take a nap if you begin to feel sleepy.
Children Who Snore Have Higher Heart Rates
A study (ID# 0253) being presented as a poster presentation this morning at SLEEP 2008 shows that snoring has a significant impact on the cardiovascular functioning of children during sleep.
The study involved 40 children with an average age of 8 years. Children with severe obstructive sleep apnea (OSA) had the highest average heart rate of 92 beats per minute (bpm). Children with primary snoring had an average heart rate of 82 bpm, which was higher than children with moderate OSA (76 bpm) and children with mild OSA (74 bpm). The heart rate of matched controls was 71 bpm.
The abstract authors conclude that these results challenge the notion that snoring is harmless.
According to the American Academy of Sleep Medicine, the incidence of snoring in children is reported to be 10 percent to 12 percent.
The SLEEP 2008 abstract book is available online at http://www.journalsleep.org/PDF/AbstractBook2008.pdf.
The study involved 40 children with an average age of 8 years. Children with severe obstructive sleep apnea (OSA) had the highest average heart rate of 92 beats per minute (bpm). Children with primary snoring had an average heart rate of 82 bpm, which was higher than children with moderate OSA (76 bpm) and children with mild OSA (74 bpm). The heart rate of matched controls was 71 bpm.
The abstract authors conclude that these results challenge the notion that snoring is harmless.
According to the American Academy of Sleep Medicine, the incidence of snoring in children is reported to be 10 percent to 12 percent.
The SLEEP 2008 abstract book is available online at http://www.journalsleep.org/PDF/AbstractBook2008.pdf.
Tuesday, June 10, 2008
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.
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.
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.
AASM 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.
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.
AASM 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.
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.
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.
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.
The 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 http://www.journalsleep.org/PDF/AbstractBook2008.pdf.
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.
The 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 http://www.journalsleep.org/PDF/AbstractBook2008.pdf.
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