Sleep Apnea ED

Sleep 2009 (day 1) - Most important sleep apnea abstract

2009-06-09T09:28:00.003-04:00

There are is a lot of good research going on in the world sleep apnea medicine as evidenced by the "posters" or abstracts of research presented at the 2009 Associated Professional Sleep Societies meeting in Seattle Washington.

The one that really struck my eye is the following:
Sleep and Breathing: Care of CPAP Equipment a Factor of Compliance and Hygiene.

Quoting from the abstract...
This study was designed to test wheter patients have difficulty adequately cleaning CPAP interfaces and if contaminated equipment increases problems and eventual abandonment. Regular washingt of equipment should be an effectivemeans of controlling bacterial and fungal growth with older interfaces morelikely to be contaminated.

30 patients on CPAP for more than one month were studied. Baterical and fungal cultures were taken from the interfaces and humidifiers. Cultures were classified, photographed, and colonies counted. Culture growth was so significant on the first 20 patients, that a secondary trial of mask washing and repeat culture was added.

Although the cultures grew mostly normal flora, the colony counts were high: 21% of the patients had 100-500 colonies and 48% grew >2000 colonies per plate. There was no correlation of severity or cleaning frequency with colony counts. Mask age was important: with fungal growth from 100% > 1 year old, and only 25% aged 1-3 months. Gram negative bacteria increased almost linearly with mask age. In the secondary trial, interfaces were rewashed, resulting in 90% lower colony counts, unless they were > 1 year old when washing was ineffective,

Conclusion: This pilot study suggests there are high counts of bacterial and fungal flora on CPAP interfaces, despite routine washing, with the older interfaces, more contaminated and resistant to cleaning. Furhter research willbe required to determine wheter increasing frequnecy of mask replacement is effective at reducing bacterial contamination, and ultimely improve patient outcome by influencing CPAP adherence or infection risk.
****
I spoke with the presenters and they indicated that they were using warm soapy water to clean the masks once a week to remove the contamination.

The message here is to clean your mask regularly and to replace the mask at least every six months.

Is someone on The Hill listening? A House Resolution on Sleep Apnea.

2009-05-25T21:59:00.003-04:00

I got a call about month ago from the deputy chief of staff for Congressman Gus Bilirakis (R, FL -9) and he advised me that Congressman Bilirakis was introducing a resolution wanting to increase awareness about sleep apnea.
I was quite pleased to learn this and happy to have a copy to review. Here is the text of what was submitted:

111th CONGRESS
1st Session
H. RES. 384
Recognizing the importance of increased awareness of sleep apnea, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
April 30, 2009
Mr. BILIRAKIS submitted the following resolution; which was referred to the Committee on Energy and Commerce
RESOLUTION
Recognizing the importance of increased awareness of sleep apnea, and for other purposes.
Whereas sleep apnea is a common condition that affects more than 12,000,000 Americans, according to the National Heart, Lung, and Blood Institute at the National Institutes of Health;
Whereas there are several types of sleep apnea that cause people with this condition to repeatedly stop breathing throughout the night, often many times;
Whereas sleep apnea is a chronic condition that disrupts sleep three or more nights each week, leading to excessive daytime sleepiness;
Whereas sleep apnea becomes more common with age, and 1 in 10 people over the age of 65 suffers from it;
Whereas sleep apnea is more common in men than women, and more than half of the people with sleep apnea are overweight;
Whereas sleep apnea can strike anyone, at any age, at any time, including children;
Whereas untreated sleep apnea can lead to high blood pressure, heart attack, stroke, obesity, and diabetes;
Whereas untreated sleep apnea can also increase the chance of having work-related or driving accidents and adversely impact the quality of life of those suffering from this condition in other ways;
Whereas lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people; and
Whereas the lack of public awareness of this serious condition leads to many undiagnosed and untreated cases: Now, therefore, be it
Resolved, That the House of Representatives--
(1) supports raising public awareness of sleep apnea; and
(2) encourages all Americans to educate themselves and others about the consequences of sleep apnea and its potential treatments.

I would have liked to help them with the language, but no matter, the idea is there and we are hopeful that something will come of it.

If you have expressed your sentiments to your Members of Congress and the President concerning sleep apnea and healthcare reform... please do, www.sleepapnea.org/advocacy.

I am in touch with the congressman's office and have offered to be a resource to him in his efforts to raise awareness about sleep apnea on Capital Hill.

Happy Memorial Day - thank you to all the service men and women, particularly those serving while treating their sleep apnea - our hope is that we serve you as well as you served us.

The Grey Lady speaks on Sleep Apnea, again!

2009-05-14T07:21:00.005-04:00

As a native of Washington DC and a frequent reader of the The Washington Post it is easy to have an inferiority complex when I think of the residents of New York City and their local newspaper The New York Times.

Fortunately, the miracle of the Internet makes it possible for me to read the paper as often as I like and so I get the benefit of their excellent reporting.

The NYT has done an a great job reporting on sleep apnea... their overview of the condition is top notch -
Sleep Apnea - Symptoms, Diagnosis, Treatment of Sleep Apnea - NY Times Health Information

Yesterday, as a part of their series called patient voices, they published six accounts of people living with sleep apnea and the solutions they chose to deal with the condition -
Patient Voices - Sleep Apnea - Interactive Feature - NYTimes.com

Sleep apnea is a condition that affect millions of people in the United States and around the world. It is, I believe, a major contributor to the public health crisis that exists in this country. The Patient Voices piece helps to translate this disease from an incomprehensible number to six people. People like you and me... friends, neighbors and co-workers.

An important part of the work of awareness is making this condition real. I thank the Grey Lady for helping to raise awareness about sleep apnea by providing these stories in the voices of those living with it.

The sleep apnea smoking gun... so to speak.

2009-04-25T06:34:00.007-04:00

I subscribe to a wonderful web service called NAPS - New Abstracts and Papers in Sleep. It provides on a weekly basis a listing of all the recently published material on sleep apnea. I commend it all the folks out there who want to keep up with research.

I received notice of an article published recently in the journal Respirology.

The title of the study "Treatment of obstructive sleep apnea in Samoa progressively reduces daytime blood pressure." I am aware of the study because one of the authors, Dr. Colin Sullivan, alluded to it when he spoke in March at an event organized by the National Sleep Foundation.

Quoting from the objective listed in abstract: "To determine the strenght of the OSA-BP relationship, this study examined the effect of CPAP in a cohort where severe OSA and under-treated hypertension coexist."

Here is the conclusion and the cool part: "Hypertensive OSA patients can exhibit large falls in BP with CPAP at 1 month, with further significant (emphasis added) reductions at 3 and 6 months. Overall, the fall in BP was proportional to the initial elevation of BP with many patients achieving normal BP at 6 months."

During his talk in March Dr. Sullivan indicated that previous studies of hypertensives using CPAP had only shown small decreasing in blood pressure. In this study, the researchers were able to take a population (Samoans) where hypertension is particularly well-treated and manage their severe sleep apnea by eliminating it using CPAP.

All previous studies had included only people with mild hypertension so the effect size (the difference treating the OSA makes) is very small and not particularly significant.

The take-away from this study and why I refer to it as a smoking gun, is treating sleep apnea can save lives by reducing blood pressure and decreasing the risk of heart disease.

Keep using your CPAP and if you are taking anti-hypertensives, keep taking them, but talk with the doctor that prescribes them to make sure you are taking the right amount.

Sleep apnea/Snoring and your sex life... read about it here!

2009-03-26T09:43:00.003-04:00

http://www.snoringisntsexy.com/pdf/The%20Secret%20Sex%20Life%20of%20Snorers.pdf

Sleep Apnea and Healthcare reform... It is time to be heard.

2009-02-22T09:58:00.003-05:00

The American Recovery and Reinvestment Act , such as it is, has become the law of the land. The President and the Congress of the United States will now turn their attention to reforming the healthcare system of the country.

This is likely to be a long process... there are many stakeholders (read entrenched interests) whose voices will need to be heard before any proposal can be acted upon.

The American Sleep Apnea Association is asking apnea patients, their families, other affected parties, healthcare professional both in the sleep field and outside, to let our President and their Members of Congress know that untreated sleep apnea is a serious medical condition that has consequences far beyond the bedroom.

Click here to go to the ASAA advocacy page and let your voice be heard

American Sleep Apnea Association

2008-12-22T12:42:00.005-05:00

The end of the year is fast approaching and I ask readers of this blog to follow this link for an important message from the president of the ASAA.

I will be back soon with more on getting sleep apnea on the healthcare reform agenda.

In the meantime, best wishes for the holidays,

Ed

Snoring, Calories and Sleep Apnea... ripped from the headline

2008-12-16T16:02:00.005-05:00

It is interesting what sells newspapers or turns eyeballs on the Internet...

The results of a recent study published in the professional journal of the American Academy of Otolaryngology (Archives of Otolaryngology Head and Neck Surgery. 2008;134(12):1270-1275) presents information that people who snore burn more calories than people who don't.

Burning calories is good... if you can do it in your sleep, even better. But, if you look a little deeper you see why burning calories this way is not so good. The reason why overweight people are burning calories is that they trying to survive the equivalent of someone pushing a pillow over their face every couple of minutes while they sleep.

This would cause an increase in metabolic rate (in the form of an adrenaline rush) even in people of normal weight.

Bottom line... Read past the headline, snoring is not a new weight loss strategy.

What the news hounds missed was the announcement of a study, published in the Journal of Clinical Sleep Medicine (2008;4(6):543-550). The study involved data mining (not very sexy, but then neither is snoring) records from 278 public and 180 private hospitals in Australia.

The dataset comprised more than one and half million hospital records. Four percent - 60,197 patients had sleep apnea with the male to female ratio of 2.6:1 (holding pretty true to the numbers published by Dr. Terry Young, et. al in 1993).

The analysis of the hospital admissions (over the period 1999 to 2004) indicate that OSA patients are frequent users of health-care services with most involving cardiovascular disease, endocrine/metabolic diseases (diabetes) and other respiratory diseases.

The researchers were able plot data showing that the onset and peak occurrences of sleep apnea and obesity are the same. Two other interesting findings: that from the onset of obesity there is a latent period of five years for the development of hypertension and type 2 diabetes and 15 years for chronic ischemic heart conditions and that there is a distinct occurence peak between the ages of 55 and 59.

They say "that any press is good press" and I would tend to agree because it helps to raise awareness about a serious medical condition that affects a significant percentage of the population. But given the choice of what should get the attention of the popular media I would have to say the results of the latter study are more important than the former... with all due respect to Dr. Kezirian and colleagues.

Back soon with an Open letter to Secretary-designate Tom Daschle

What does the Obama presidency mean to the sleep apnea patient?

2008-11-16T15:57:00.014-05:00

I am not aware that President-elect Obama spoke directly to the question of sleep apnea during the campaign, but it is possible to infer from his major speech on the subject of health care and from his plan on health care reform some areas where the sleep apnea patient could benefit from the reforms he is planning.

Early in the plan he discusses the need to support disease management programs. He states "Over seventy-five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood pressure."

These are all co-morbid conditions with untreated sleep apnea. One wonders if early intervention on sleep apnea would not decrease the economic burden with these life-threatening conditions.

He goes on to say "[M]any patients with chronic diseases benefit greatly from disease management programs, which help patients manage their condition and get the care they need."

Obstructive Sleep Apnea (OSA) is certainly a chronic disease. For many it starts at a young age and stays with them their entire life. A life shortened needlessly because of cardiovascular disease.

OSA is a condition that would benefit from being treated according a disease management model. A model where there is a continuum of care from awareness through diagnosis/treatment and long-term follow-up. I offered an "ideal" treatment pathway in an 2007 article I wrote for Sleep Review.

Further in the same section of the plan Obama states that he "... will support providers to put in place care management programs and encourage team care through implementation of medical home type models that will improve coordination and integration of care of those with chronic conditions."

The challenge here is to get sleep apnea recognized as a chronic condition in which disease management strategy would be appropriate.

Elsewhere in the plan, Obama discusses moving away from paying physicians based on the volume of services provided and towards payment based on the quality or effectiveness of care.

For the OSA patient could mean something beyond just a reduction of the number of apneas and hypopneas. Effectiveness of care may be measured in improvement in resting blood pressure and elimination of daytime sleepiness.

He also discusses the use of comparative effectiveness reviews and research as keys to eliminating waste and missed opportunities for improved treatment.

As new technologies are developed for the treatment of OSA, comparative effectiveness research will help physicians and patients better understand which treatment will provide greater efficacy.

OSA is a chronic condition that affects all segments of our society, but it disproportionately affect the minority populations in the United States. Another element of the Obama plan is to tackle disparities in health care. If sleep apnea can be effectively diagnosed and treated, it will certainly accrew additional benefits, such as reduced health care utilization and improved quality of life. Finally, the health care reform proposed by the Obama campaign includes coverage for pre-existing conditions. This is an important benefit for the treated apnea patient who no longer need worry about continuing their treatment should they need to change insurance carriers.

Health care reform is on the agenda for the upcoming Congress, so change is coming. There is an opportunity for the reform to include sleep apnea. Seize the moment to let President-elect Obama know that recognizing sleep apnea is a serious condition and needs to be included in reform considerations.

Contact your Member of Congress and let them know that sleep apnea is a serious condition and needs to be included in health care reform considerations.

Contact your Senators and them know that sleep apnea is a serious condition and needs to be included in health care reform considerations.

The ASAA published a position paper on sleep apnea as a public health concern, click here.

All the best,

Ed

ASAA to award 2008 Sleep Apnea Awareness Award

2008-10-18T09:49:00.003-04:00

In recognition of their efforts to raise awareness about and the treatment of sleep apnea, the American Sleep Apnea Association (ASAA) will present Jonathan Benumof, M.D., and American Society of Anesthesiologists (ASA) with its 2008 Sleep Apnea Awareness Award on Tuesday, October 21 at the their annual meeting in Orlando, Florida.

"The concept behind this award is to honor individuals and organizations outside of the sleep community who promote awareness about sleep apnea," said Mr. Grandi. "It’s through such efforts that sleep apnea patients ultimately benefit."

Dr. Benumof was instrumental in developing the ASA’s 2006 Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea, which Mr. Grandi credits with serving as a crucial reference point for hospitals and surgical centers as they work to implement their own sleep apnea protocols.

In the early 1990s, Dr. Benumof became intensely interested in obstructive sleep apnea when he began to receive requests from lawyers to review cases that had perioperative catastrophic outcomes in obese patients who snored and were tired during the day. "As the number of inquiries increased, I became greatly impressed by the breadth and depth of the perioperative sleep apnea problem, and I concluded that it needed national attention and a guideline," said Dr. Benumof.

"We also want to recognize all the members of ASA for what they do," said Mr. Grandi. "We want to encourage them to be strong and empowered, to go out and tell the surgeons about sleep apnea and to work with hospitals on advocating for apnea patients and their families."

Founded in 1990, ASAA is the only non-profit organization dedicated to educating the public about sleep apnea and to serving people with this common disorder.

This is the second time the award has been given, said Mr. Grandi, and is presented only when accomplishments of exceptional merit have been recognized.

Celebrating the Father of Sleep Medicine

2008-07-26T20:20:00.004-04:00

I traveled to Palo Alto this weekend to join with a very large group of people to celebrate the 80th birthday of William C. Dement, a long-time professor of medicine at Stanford University and the recognized father of sleep medicine.

I can think of no person, physician or layman, who has done more to put the subject of sleep on the public agenda. His efforts have been tireless educating the policy makers that "Drowsiness is Red Alert".

In additional to all of his scientific research (the discovery of REM - Rapid Eye Movement - Sleep),establishing the first sleep disorder clinic in United States (on the campus of Stanford), his establishment of the American Sleep Disorders Association (which went on to become the American Academy of Sleep Medicine)...perhaps the most important contribution is his mentorship of so many people who have gone on to do significant work in the field of sleep medicine.

I was pleased to be a part of the celebration and experience the great outpouring of love for a man who has done so much to bring into focus a segment of everyone's life (fully 1/3) that is so little understood - sleep.

http://www.youtube.com/v/Y1yCDVJzYKc&hl=en&fs=1

Happy Birthday Bill!

FYI

2008-07-04T09:42:00.014-04:00

After 10 years in the same location, downtown Washington, DC the American Sleep Apnea Association is heading uptown... Takoma to be exact.

The ASAA takes up residence at the Takoma Metro Centre,

6856 Eastern Avenue, NW

Suite 203,

Washington, DC 20012

effective August 1st.

The telephone and fax numbers will remain the same.

Exciting times at the ASAA... stay tuned!

Catching my breath...

2008-06-29T07:59:00.015-04:00

It may be a cliche... but there just aren't hours in the day to get done everything that needs to be done and not the least of which is posting content in this space.

May 1st marks the beginning of year 5 as the executive director of the ASAA and I get the distinct sense that the great wave of awareness about sleep apnea is nearing the crest. All the work done by us and others is about to reap the award of national/international attention being focused on this life- threatening condition. One hint that "we" have arrived... Phillips, and a second... Medtronic and one more just for good measure J&J .

So I will pause to look back over the past year and couple months, but not for long. There is no resting on your laurels here... it is a lot more of "what are you doing for me NOW".

Two significant happenings, one internal and one external in the past year are likely to shape the future of the association's work and the focus of my activities:

The completion of the video - What Is Sleep Apnea?

The video was unveiled to the medical community at the American Thoracic Society meeting in Toronto. There is was great interest among the physicians attending from outside North America. In fact, the video is now playing in Poland, Qatar, Venezuela and the Czech Republic. In addition to the English language version there is a version in Spanish as well. There were a number of inquiries about creating a version in Arabic, Portuguese and Chinese... (these are items for the ever lengthening to do list).

The video proved to be very popular at the Associated Professional Sleep Societies (aka Sleep) meeting as well. Sleep Technologists passing by the booth stopped to watch and took advantage of the discounted price to pick up a copy or two for the office. Watch it here.

The timing of creating this video could not be more on target and this is due to the second happening - the external one that will most definitely shape the future work of the association:

Revisions to the Centers for Medicare and Medicaid Services - National Coverage Determination 240.4 .

This decision, which modifies the basis of how Medicare will provide reimbursement for the prescription of CPAP therapy for the treatment of OSA, is a watershed event. Once fully implemented, and the non-government insurance companies adopt (which they usually do to keep life simple) the practice of allowing the use of home sleep studies for the diagnosis of sleep apnea... there is likely to be many, many more people getting diagnosed and hopefully treated. There is likely to be many with questions and concerns. Who will they turn to when they can't reach their primary care physician, sleep specialist or the respiratory therapist associated with the home care company? Three guesses... Google - more on this next time.

I had the good fortune to have a friend recommend a book to me that significantly influenced the way I think about moving the ASAA forward... Good to Great, by Jim Collins and in particular the monograph he wrote for the benefit of non-profit organizations.

The beauty of this book and I highly recommend it to all people in either the for-profit or non-profit sector is the simplicity of the main idea for moving an organization from good to great... the Hedgehog Concept:
I am pretty clear on the two of the three circles...Our challenge in the coming months will be to answer the question - What drives your economic engine. It is vital that the leadership of the ASAA do so, because our long-term success depends on us clearly identifying what it is and using it to measure our success to those who will support our operations in the future.

Thanks for checking in and I will be back with future directions soon.

The ASAA educational video - on Youtube

2008-04-15T14:23:00.003-04:00

Visit the ASAA web site for information on how to obtain a DVD copy for yourself.

The video is also available in Spanish.

Sleep Apnea Video premiere

2008-03-04T14:42:00.003-05:00

As a part of National Sleep Awareness Week and in advance of Thursday - March 6 - Sleep Apnea Awareness Day, the American Sleep Apnea Association will have a premiere of it educational video - What Is Sleep Apnea? This video, available on DVD, is the remake of our first educational video of the same title, produced in 1994.

Of the many things I have wanted to accomplish in my capacity as executive director of the association, recreating this video was high on the list.

We were fortunate to find unrestricted educational funding from Cephalon to make this a reality. I personally was fortunate to have a collaborator who was extremely interested in the project, so I did not have to give up running the ASAA during the four months it took to produce the finally product.

Tonight is a celebration of that effort and a chance to say thank you to the many people who were involved in making the film possible.

Two segments from the video are on Youtube as PSA - just search sleep apnea psa.

You can order the DVD from our web site and later this month a Spanish language verison will be available as well.

All the best and sleep well.
ED

A new metaphor for untreated sleep apnea

2008-02-24T09:59:00.001-05:00

Imagine a pebble dropped into a pond...what happens is an expanding concentric circle from where the pebble touched the water.

I am beginning to understand untreated sleep apnea in this way: an expanding circle of misery.

It begins with the individual, the lack of restorative sleep from the frequent arousals caused by the apneic events results in excessive daytime sleepiness. The frequent arousals can result in a spikes in blood pressure resulting in hypertension. The apneic events can cause oxygen destaturation which can result in cognitive deficits.

The circle expands to affecting the bedpartner and the family. The bedpartner experiences lack of restorative sleep due to concern over the pauses in breathing or the sound of loud snoring. Increased irritability from lack of sleep can result in conflict in the family. In extreme cases, this can tear the family apart.

The circle expands further affecting the workplace. A sleep deprived employee is less productive due to lack of focus, more prone to accidents and injuries. People with untreated sleep apnea have higher utilization of the healthcare system and increase healthcare.

The circle of misery at its largest point affects the larger community and society as a whole. Sleepy drivers are more likely to have automobile accidents. A number of major industrial accidents, whose impact extended far beyond the confines of the plant were attributed to excessive daytime sleepiness.

March 6th is Sleep Apnea Awareness Day... check your snore score and if necessary talk to your doctor.

Preparing for Sleep Apnea Awareness Day 2008

2008-02-02T21:15:00.000-05:00

I started working for the ASAA in May of 2004. I realized soon after I got there that what needed to addressed sooner than later was updating the educational video the association had released in 1994!

It took some time and some doing, but it is almost finished. The completed video, which will be available on DVD will run 10 minutes and is shot in high definition. The video will have a prologue and an epilogue that can be used as PSA for television.

Currently the prologue is available on Youtube.

Our plan is to hold an event in Washington, DC during National Sleep Awareness Week, to premiere the video and then to take it to Minneapolis to where the largest A.W.A.K.E. group will be holding an all day event on March 6 - Sleep Apnea Awareness Day.

The video will feature prominently in the RSVP campaign which will be unveiled in the spring.

2008 is already shaping up to be a big year for the ASAA. Check back for more news on SAAD 2008!

ED

A new year and new challenges - testing for sleep apnea

2008-01-13T09:10:00.000-05:00

Be careful what you wish for... that was a comment I heard while attending the hearing on using Home Sleep Testing (HST) for the diagnosis of Obstructive Sleep Apnea (OSA). Be careful indeed.

The Centers for Medicare and Medicaid Services has proposed a revision to their National Coverage Determination concerning the prescription of CPAP for the treatment of OSA.

Currently, the prescription for CPAP would only be reimbursed if the diagnosis was made on the basis of a sleep study done in a sleep lab or sleep center.

The proposed decision could significantly change the landscape for the diagnosis and treatment of OSA. It would allow for the prescription to be reimbursed on the basis of an HST.

HST will be a good thing for the thousands/millions of people who have sleep apnea and are prevented getting treatment due to cost of testing or ability to access an existing sleep testing facility. But, the decision removes necessary participation of the sleep specialist from the treatment pathway and places great reliance on the primary care physician, who may or may not be able properly care the patient with a sleep disorder.

A dear colleague and friend says that the custodian in the office of her sleep lab is capable of diagnosing cases of sleep apnea. But what about the cases that generate a false positive or worse a false negative. What happens with those cases?

CMS will need the wisdom of Solomon to work this out. Whatever their decision, the ASAA will continue to be the comprehensive resource for those seek information about diagnosis and treatment and the home of A.W.A.K.E. and the Apnea Support Forum

2008 promises to be an interesting year... check back often for new entries.

Help the American Sleep Apnea Association

2008-01-05T09:03:00.000-05:00

The ASAA is participating in America's Giving Challenge sponsored by Parade and the Case Foundation. Please help us meet the challenge!

http://www.networkforgood.org/pca/Badge.aspx?BadgeId=109008

Back in a few days with exciting news and updates.

ED

Thanksgiving 2007

2007-11-22T12:49:00.000-05:00

The office is closed today and tomorrow. This gives me a couple of moments to reflect on my activities since the last post....

The American Public Health Association meeting was incredible. I believe this was the first time the association had exhibited or at least since I came on-board with the ASAA. We came prepared for the show. Annelise Thornton, MHS of Sleepwell Solutions, prepared an excellent document outlining the need for the public health community to focus its attention on sleep apnea as a public health crisis. Attending the meeting provided a number of excellent networking opportunities, particularly with people who help connect with minority communities. Work is underway to do more with the APHA.

The ASAA held its annual Board meeting in early November . While the formalities of elections is not quite completed we are welcoming three new Board members... M. Elizabeth Johns, Burton Abrams and Eric Rude. Each one of these new Board members brings a special set of talents to the association and I am pleased to have them working with us.

The meeting itself was giving over to discussing some of the ideas put forward in Jim Collin's monograph Good to Great and the Social Sectors. It was a lively discussion and from that several working groups were created to develop sets of objectives and actions items. I am thankful for the work of the Board and look forward to the results of the group's efforts.

On top of all this activity, work on the remake of our 1994 educational video - What is Sleep Apnea? began in earnest. This is a project I have wanted to undertake since I started at the association. I am pleased to be working Henninger Productions. We have completed two days of filming... including one at the Sleep Lab at Georgetown University Hospital. The video should be available near the end of the year. Plans are to have video available in Spanish.

It is a busy time at the ASAA. I glad to have a moment to catch my breath and to give thanks to all the generous people who have helped to advance the cause of the association. Thereby making it the leading organization that it is today.

Happy Thanksgiving (and remember to PAP while you NAP ;) )

Notes from the ACCP meeting 10/2007

2007-10-29T04:58:00.000-04:00

I did not attend the ACCP meeting in 2006, so this was my first time since their meeting in Montreal in 2005. One thing I noticed immediately was the number of physicians from overseas. I had not thought of this professional society as garnering that much interest from outside the country, but it did. I relish the opportunity to share our educational materials with physicians from outside the US and to help them help their patients be more adherent to therapy.

A first for the ASAA in a long time was sharing a booth with our colleagues at the National Sleep Foundation. Unlike NBC4 at the DC Convention Center some years ago, they joined us and I feel it worked out well. We will share a booth at the American Public Health Association meeting in early November.

I was able to attend a few of the educational sessions. One presentation was an update of the consensus conference hosted by the ACCP Sleep Institute last year. The presenters described the process used to formulate the consensus and the initial results. Their hope is to publish the results in the Spring of 2008 and to hope a follow-up conference on implementing a continuity of care strategy for OSA patient next year as well.

A second presentation and where I stood up to comment, was on the screening of hospital in-patients for OSA - pro and con. The pro side was offered by Dr. Anne O'Donnell of Georgetown University and Dr. Barbara Phillips of University of Kentucky (and incoming chair of the Sleep Institute) argued the con side. Having just been to the Anesthesiologist meeting in San Francisco I did have a couple things to say... including how I was feeling the "love" from the anesthesiologists, more so than from the sleep doctors - it got a chuckle.

The third presentation offered an interesting insight. Dr. Peter Gay from the Mayo Clinic provided an excellent overview of the technological advances in continuous positive airway pressure therapy from when it was first created by Dr. Colin Sullivan in 1981. The title of his talk was "Industry and Sleep Physician: Rowing in the Same Direction?" His thesis is that the advances in PAP therapy have gotten ahead of the sleep physician/researchers. Changes in PAP sleep apnea treatment are being dictated by forces other than changes in physician's understanding of how to treat the condition. Interesting food for thought.

ACCP is in Philadelphia next year.

Email to a young OSA patient

2007-10-22T07:42:00.000-04:00

I got the following email today...

I am 31 years old and I have been told that I have sleep apnea, I currently have begun using a CPAP machine and just wanted to know will I have to use that device for the rest of my life and how do I become a memeber of the ASAA.

My thoughtful response at 7 in the morning...

Thank you for writing... the answer to your first question is hard. It depends a lot on why you developed sleep apnea... genetics (runs in the family), excess weight, naturally occurring narrow upper airway. I have heard of people losing a significant weight through improved diet, increased exercise and consistent use of CPAP being able to leave the machine behind... there are others who just feel so much better from getting a good night's sleep that it does not matter to them that CPAP has become a part of their nightly routine.

At this point... I would worry less about that and more about making sure you have the right equipment and are getting the most effective treatment possible. Hopefully it won't make a difference.

***********
News from the ACCP conference later... stay tuned.

Can you spell... an·es·the·si·ol·o·gist

2007-10-15T09:29:00.000-04:00

I am among the fortunate to have required general anesthesia only a couple time in my life and the second was after I had become the E.D. of American Sleep Apnea Association. The anesthesiologist, learning of my relationship to the association, came in before the procedure and talked my ear off (in a nice way) about the problem of undiagnosed OSA patients coming in to the ambulatory surgery center and she having to deal with them... meaning not be a party to their sudden or not so sudden demise after administering anesthetics.

It makes complete sense that an anesthesiologist would be concerned about an undiagnosed OSA patient. According to Dr. Johnathan Benumof, whose presentation I attended on Saturday, there are three points at which the anesthesiologist should be concerned about an OSA patient, treated or untreated... intubation - administering the anesthetic too soon may cause the airway to close thereby making it very difficult to put the breathing tube in the throat. Extubation - for the same reason, but in reverse and pain management, post operative... many of the opiod-type pain medicines can suppress breathing and with the OSA patient the problem is compounded.

Dr. Benumof's presentation to a nearly standing room only hall provided an excellent overview to OSA and explained, briefly the guidelines adopted two years ago by the American Society of Anesthesiology on management of the OSA patient.

I was able to attend a clinic forum where the case study was a man who is suspected of having sleep apnea come in to an ambulatory surgical center for repair to his rotator cuff. It was interesting to listen to their discussion, many of whom believed that the surgery, for a number of reasons should be done in a hospital setting where it would be possible to monitor the patient after the surgery... since the surgery itself is not the problem, but the pain management afterwards is.

Dr. Benumof admonished those assembled during his talk that they were likely the last physicians to see the patient and it was their responsibility to make sure they received the proper care. It is very true... on more than one occasion, the surgery has been a success, but the patient dies in the recovery room or "out on the ward" because they were not properly monitored or given the correct analgesia given their diagnosed and not announced or their undiagnosed obstructive sleep apnea.

For those with sleep apnea reading this... please say something before going in for surgery or a procedure requiring anesthetic (think colonoscopy)... click on the links below for more information. If you have not been diagnosed and it is clear from looking at you and asking a couple of telling questions that you are at risk of OSA... you may find yourself diagnosed before you leave the hospital after having surgery. Assuming you leave under your own steam and not feet first.

The conversations in the exhibit hall have centered on our most recent Patient Education Bulletins on CPAP in Hospital and the checklist. Our web site has more information for the anesthesiologist, but looking at it, it needs some work.

There is potential for great synergy with this group of doctors who are very interested in this subject. I will move it high on my list of relationships to explore.

Next week Chicago and the American College of Chest Physicians

PS... found in my fortune cookie after dinner last night... You could make a name for yourself in the field of medicine... nice thought!

Traveling to Mecca

2007-10-13T13:17:00.000-04:00

I am in San Francisco for the annual meeting of American Society of Anesthesiologists... our association has exhibited at their meetings for a number of years. They have always had an interest in managing the sleep apnea patient before, during and after surgery. In the past couple of years they have introduced a set of guidelines for managing the patients... so our presence here helps to reinforce the importance of identifying and managing apnea patients. This is the first one of these I attend, so it will be interesting. I will report on details in another entry.

On Friday, I went to what I call Mecca for the sleep field - the campus of Stanford University. I say Mecca, because it is the home of the Stanford University Center of Excellence for the Diagnosis and Treatment of Sleep Disorders. Housed here is the Sleep Disorder Clinic founded in 1970 by Drs. William Dement and Christian Guilleminault (both whom I have mentioned in this blog before). In addition to Dement and Guilleminault are world-renowned sleep surgeons Nelson Powell, Robert Riley and Kasey Li. Dr. Emmanuel Mignot, and the Stanford Center for Narcolepsy was the first to that narcolepsy-cataplexy is caused by hypocretin (orexin) abnormalities in both animal models and humans. With the School for Sleep Medicine, it is the center of the sleep universe.

While I was there I spent time with Bill Dement and together we attended the weekly Grand Rounds presentation. The subject of the talk by Craig Harris on hibernation and its relate to sleep.

Bill and I spent a long time talking about the course he has presented at Stanford to undergraduates on Sleep and Dreams. It is the most popular course with undergrads at the University. Bill would like to see the course taught at all 4,000 colleges and universities around the country – a tall order indeed. He has put together the course slides and the course textbook – The Stanford Sleep Book. My hope is to work with him to get the course offered at one university in the Washington area.

The treat of the day, was to attend Bill’s talk… Sleepless at Stanford, which he did for the alumni who had returned for Homecoming weekend. I heard this talk before, and I always marvel at the energy and enthusiasm of this nearly 80-year-old man. I can only hope to have this much verve when and if I get to 80.

On MySpace - social networking

2007-09-16T05:53:00.000-04:00

I am not certain people still believe that the Internet is leading all of us into greater and greater isolation. I would argue just the opposite. As the Internet evolves it is promoting a new connected-ness through social networking channels like MySpace and Facebook.

I created a MySpace page for the ASAA in 2005 with the thought using it as way to get more people to visit our various web sites. Looking at the stats as far back as they go that site has generated only a couple hundred referrals.

I have spent time, as many people do, pursuing friends and the list has grown to over 400. Of course, this pales in comparison with the number of friends popular actors and musical groups have for their pages.

I can usual count on a new friend request every couple of days and I enjoy "commenting" on their page with one of my two standard comments... sometimes there is more behind the snore or happy PSGing. The list of my friends includes many apneics and family members of those with apnea, but included are also many RPGSTs and sleep techs (hence the reference to PSG).

From time to time I answer questions and provide in some small way encouragement for those with OSA. Mostly, MySpace is a perch for me to observe a small portion of humanity... a portion that I have something in common with.

Am I "connected" with these people? The cynic would argue it is, in a false sense. Anyone can write anything they want about themselves or others and there is no easy way to confirm what they written. While that may be the case for some, that is not what I see when I read the entries.

While it is not likely that I will meet more than just a few of my friends from MySpace and most will remain just words and pictures on a computer screen. I feel I am part of a community, perhaps more as an observer and as such not entirely alone.

Busy week ahead... I'll be back.