By TIMOTHY W. MARTIN Wall Street Journal 09/27/2011

More than two-thirds of U.S. high school students don’t get enough sleep on school nights, and they’re more likely than their well-rested peers to drink, smoke, and seriously consider suicide, according to a federal study released Monday.

Sleep researchers have long known teens don’t get enough sleep, advocating that school districts start classes later. But this study is the first to assess on a national scale whether sleep deprivation is associated with risky health behaviors, according to the Centers for Disease Control and Prevention, which did the study.

The study didn’t assess whether lack of sleep causes teens to engage in risky behavior, however. Many overachieving high-school students lack sleep because they’re busy, experts note.

The study analyzed 11 health-risk behaviors between those who sleep at least eight hours a night—the CDC-recommended amount—versus those who slept less. About 69% of more than 12,100 teens in a 2007 survey said they got eight hours or less of nightly rest on school nights.

More than half of weary-eyed teens reported alcohol use, compared to 37% of more well-rested adolescents. Nearly a quarter of sleep-deprived teens smoked, compared to 15% of those who got a good night’s rest. Sleep deprivation also increased the likelihood a high-school student had seriously contemplated suicide, to 17% compared with 9.8%.

Tired teens were also more likely to be less physically active, use marijuana, be sexually active and feel sad or hopeless, among other behaviors. There was no link between television watching and a lack of sleep.

A chronic lack of sleep impairs the ability to comprehend consequences and increases the likelihood a teen gives in to peer pressure, the study said. More than half of those surveyed got six or seven hours of sleep on school nights. Some 10% reported five hours, and 5.9% said they got four hours or fewer.

The report doesn’t suggest that lack of sleep prompts teens to engage in unhealthy behaviors.

“An incorrect interpretation of this research would be that only sleepy kids have sex,” said Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy. “The CDC is only making associations, not suggesting a causal link.”

One problem is that the biological clock changes in adolescence, making many teens want to go to bed and get up roughly two hours later than they did before reaching puberty—often meaning later than the 8 a.m. hour that many schools start, said Lela McKnight-Eily, a researcher for the CDC’s Division of Adult and Community Health and the study’s lead author.

“During adolescence, there is a shift in certain hormones that occur with puberty that cause the circadian rhythm to change,” Dr. McKnight-Eily said.

The report used data from the national Youth Risk Behavior Survey and an unedited version was published online last week by Preventive Medicine.

Signals are being given that the National Transportation Safety Board (NTSB) and Federal Motor Carrier Safety Administration (FMCSA) are nearing sleep apnea testing regulations for truckers.  Everyone is concerned about safety, but none of the interested parties wants another regulation that is just going to be a nuisance costing more money and posing greater risk liability.  Many legitimate objections have been raised:

• What is the scientific basis for diagnosis of sleep apnea that mandates treatment?
• What is the scientific basis for standards of successful treatment?
• What is a reasonable time period to allow from diagnosis to successful treatment?
• Being diagnosed with sleep apnea is a “scarlet letter” decreasing employment opportunities and health insurability should a trucker terminate employment.
• “The National Sleep Foundation appears to be a lobby for sleep companies trying to fleece truckers.”
• There is little or no data showing that truckers are tired or that drivers with sleep apnea are causing large numbers of wrecks
• Federal regulations already require a physician to examine for sleep apnea
• Truckers who would normally bring up the subject of daytime sleepiness with their physicians won’t do so if the threat of a $2,000 to $5,000 laboratory sleep study hangs over them
• Most truckers’ benefits will not cover costs in that price range
• CPAP and pharmaceutical manufacturers pay millions of dollars in perks and unreported cash to physicians for listening to their pitch.  Medical consumers cannot make independent and informed purchasing decisions listening to advice from physicians getting such “Sunshine Payments”.

According to the white paper by ACS (Affiliated Computer Services, Inc.), a Xerox Company in business process and information technology services, “The real problem the trucking industry is currently facing is sleep apnea.”  They suggest in this paper that the following steps would be an adequate solution:

1. Truck drivers will get screened for sleep apnea by their employers at a credible sleep lab.

2. Drivers found to have sleep apnea will be required to receive medical treatment.

3. Carriers will have to ensure their drivers with sleep apnea are taking their treatments.

4. Drivers receiving treatments will be required to remove data from their CPAP and upload the data on a device which would transfer the results to a sleep lab.

5. A receipt will be printed from the printer located next to the computer, giving the driver proof of their upload.

6. The data will then be centralized to distribute data to the driver, carrier, and physician. This data must be transparent so all parties can manage and document the findings.

7. The data will have the ability to be shared and documented through a web-portal.  The web-portal will provide substantiated analytical proof of compliance that the driver is receiving proper medical attention for their sleep apnea.

Does this sound like they want to impose a police state, “big brother is watching you” dictum or what?  It could reasonably be construed as an attempt by a big CPAP/sleep lab consortium to fleece the trucking industry with increased liability and risk, and truckers with bearing exorbitant regulatory costs.  This white paper does not give any alternative solutions to CPAP and overnight sleep lab testing.  ACS found this very serious problem and they can provide all the answers.  But do they really?

For driver safety regulations to be effective, they must be based on a win-win situation.  Let’s impose common sense to the problem.  There are certain points that seem obvious, undeniable and logical.

• Studies of all human drivers have shown a link between sleepiness, untreated apnea and motor vehicle accidents.
• Drivers with sleep apnea do not sleep as well as drivers who do not have sleep apnea.
• Tired, sleepy drivers are more likely to crash than drivers who are alert and well-rested.
• Obesity, diabetes, smoking, high blood pressure, cardiovascular disease, male gender and large neck size have all been linked to sleep apnea.
• People having these characteristics should be referred to their physicians for sleep testing and proper treatment if indicated.

These points are the basis for the recommendations of the National Review Board to the Federal Motor Safety Administration.  All references specific to truckers were removed.  It is easy to see in this context that good principles of road safety apply to all motorists – not just truckers.  This is not arguable.  The unhappiness is over implementation of these guidelines relative to truckers.  There appear to be commercial interests that want to make these into rules specific to truckers.  We like to think of the United States of America as a free country.  Events comparable to September 11, 2001 however have required some compromises of freedom for security and safety.

In July 1997 a college student, Maggie McDonnell was struck and killed in a head-on motor vehicle accident by a driver who fell asleep at the wheel.  The driver at fault had not slept in over 30 hours.  Because there were no drowsy driving laws the offender received a $200 fine and a suspended sentence.  Maggie’s mother campaigned successfully and in 2003 New Jersey passed a vehicular homicide law.  It made vehicular accidents caused by someone driving without sleep during the preceding 24 hours a felony offense carrying a $100,000 fine and up to 10 years in jail.  To date no other state has passed a vehicular homicide law for driving while drowsy.  Certainly what is fair for the general population is fair for truckers.  An accident where a drowsy auto driver runs into a truck has the same damage and injury potential as one where the trucker hits the auto.  If sleepy driver regulation is not wanted by the general population for themselves, it certainly seems unfair to impose it just on truckers.

Good sleep is extremely important to good health.  Acute lack of sleep causes alterations in physical well being, irritability, mood and overall cognitive functioning, including reduced acuity in controlling a motor vehicle.  Chronic lack of sleep can cause depression, lethargy, fatigue and contribute to numerous morbid medical conditions.  Scientific research has strongly associated sleep apnea with high blood pressure, severely increased risk of heart attack, stroke, diabetes, weight gain, immune system disorders, and reduced sexual libido.  Epidemiologic research has demonstrated that motor vehicle accidents caused by falling asleep at the wheel are more prevalent than those caused by excessive alcohol use.

Unpopular but necessary to address, sleep apnea has more acceptable alternatives than uncomfortable and expensive CPAP machines and uncomfortable, expensive and threatening overnight studies in a sleep lab.  Inexpensive and reliable home sleep studies are available.  Recent guidelines published by the American Academy of Sleep Medicine (Collop et al., 2007) recommend that the same technology used in sleep laboratories be used for unattended portable monitoring in the home.  Such technology includes the use of a thermal oronasal airflow sensor to detect apnea, a nasal airflow cannula to determine hypopnea, respiratory effort belts using respiratory inductive plethysmography technology, pulse oximetry, and body position.  This technology is available today and has been found to be easy to use with high specificity and sensitivity.

In a recent study involving 73 patients comparing the attended sleep laboratory data collection method against the MediByte^® unattended portable home monitoring method, Driver et al. (in press) found that the association for the detection of sleep apnea between the two methods were very high: a Pearson correlation of 0.92, accounting for 85% of the variance in the data.  When apnea was moderate to severe, the sensitivity and specificity of the unattended home method was 80% and 97%, respectively.  When the apnea+hypopnea index was greather than 30 times per hour (i.e., severe) the positive predictive value of the MediByte unattended home recorder was 100%, while the negative predictive value was 88%.  The authors concluded that the home recorder accurately identified patients without sleep apnea and had a high sensitivity for moderate to severe apnea patients.

With the aging baby boomer demographics, unattended home sleep apnea testing presents an inexpensive opportunity to increase sleep apnea screening in the USA.  It is also an efficient and convenient technique to evaluate the efficacy of oral appliance therapy.  In most of Europe unattended home sleep testing has been used for many years to economically and reliably diagnose and monitor sleep apnea.  Recent improvements in technology coupled with approval of home sleep testing by the Center for MediCare / MediCaid in 2008 reinforce the view that home sleep testing is a valid and widely accepted option for both diagnosis and monitoring of snoring and sleep apnea.  Now is the time to take advantage of this modern technique to properly address the important issue of sleep apnea diagnosis and management of sleepy drivers.

The diagnosis and treatment of sleep apnea is rapidly approaching critical mass in terms of recent new technological innovations and gaining public awareness.  Numerous intraoral appliances that are FDA approved, and AASM approved for mild to moderate sleep apnea are already being prescribed and fitted by dentists qualified to practice sleep dentistry.  They are comfortable and have a very high compliance rate according to patient testimonials.  Other intraoral sleep apnea devices are in late stage development as comfortable alternatives to CPAP that are both inexpensive and highly effective.    Compliance chips to monitor usage of oral appliances are also in late stage development.  Both technologies, inexpensive intraoral appliances and compliance chips are expected to be available for market by the end of the year.   Collaboration between the trucking industry, the insurance industry, the medical and dental community of interest and the regulatory agencies offer far more affirmative possibilities to make safer roadways than a biased white paper and behind the scenes lobbying efforts by those standing to reap huge financial gain from poorly conceived regulatory mandates.

Allen J. Moses, DDS, Chicago, IL, USA

Richard A. Bonato, PhD, Ottawa, Canada

Natus Medical Incorporated (Nasdaq:BABY) today 9/16/2011 announced that it has acquired Embla Systems LLC, a leader in the development, manufacturing, and sales of devices used in the diagnosis of sleep apnea. Embla is the largest company in the world focused solely on sleep diagnostics (Polysomnography or PSG and Home Sleep Testing). The company offers a wide spectrum of innovative sleep diagnostic solutions including Embletta home sleep testing devices and three leading PSG platforms: Sandman, REMbrandt, and RemLogic, and Enterprise Sleep Business Management Systems. This breadth of product offerings provides a unique set of tools to help optimize the efficiency of sleep labs.

Natus acquired all outstanding shares of Embla capital stock for $16.1 million in cash, exclusive of direct costs of the acquisition. Embla reported revenue of approximately $30 million for its fiscal year ended December 31, 2010.

Natus expects the acquisition will be accretive to earnings in 2012, adding $0.08 to non-GAAP earnings per share for the year. The non-GAAP results will exclude amortization of acquired intangible assets and potential restructuring and other one-time charges related to the acquisition.

“The Embla acquisition affirms our leadership position in diagnostic neurology products,” said Jim Hawkins, Chief Executive Officer of Natus. “With this acquisition, Natus will now hold the number one position in the worldwide sleep diagnostic market with annual revenue approaching $35 million.”

“Additionally, with approximately 40% of Embla’s revenue coming from international markets, this acquisition positions Natus as the leader in sleep diagnostics outside the United States,” added Hawkins. “More than 100 million people worldwide are suspected to have obstructive sleep apnea. Because of lack of awareness among both patients and physicians more than 80% of those affected remain undiagnosed.”

Natus funded the acquisition through available cash. The purchase price is subject to adjustment based on net working capital as of the purchase date.

Sleep Apnea

Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing during sleep. There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e., a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively. Studies have shown that as many as one in every 15 Americans is affected by at least moderate sleep apnea. One study showed that in middle-age as many as 9% of women and 24% of men were affected, undiagnosed, and untreated. Conditions linked to obstructive sleep apnea include coronary artery disease, congestive heart failure, hypertension, pulmonary hypertension, stroke, and clinical depression, as well as other illnesses including asthma, chronic obstructive pulmonary disease, and diabetes mellitus.

About Embla

Embla Systems began development of medical devices for the detection of sleep apnea beginning in the mid 1990′s. The company has consistently developed innovative products to assist sleep labs in the diagnosis of the condition. In international markets the company is a leader in devices used for sleep studies performed in the patient’s home. With headquarters in Denver, Colorado, the company also has facilities near Buffalo, New York; Ottawa, Ontario, Canada; the Netherlands; and Germany.

Additional information about Embla can be found at http://www.embla.com.

Additional information about Natus Medical can be found at www.natus.com.

By Stephanie Pappas | LiveScience.com – Mon, Aug 29, 2011

American pediatricians want to help their patients with sleep problems, but a new study finds that few have the proper knowledge and training to do so.

According to a national random survey of primary care pediatricians, only about 18 percent had ever received any formal training on sleep disorders and less than 20 percent answered more than half of eight basic questions about sleep issues correctly.

“Knowledge is lacking,” said study researcher Ramalinga Reddy, a doctor at the Children’s Pulmonary/Sleep Center at the Mercy Children’s Hospital in Toledo, Ohio. Few medical schools and residency programs provide training in pediatric sleep problems, Reddy told LiveScience, despite the fact that 96 percent of pediatricians surveyed said they thought it was their duty to advise patients and families on sleep issues. [Read: Top 10 Spooky Sleep Disorders]

Sleep studies

Although adult sleep disorders are more well known, children experience sleep problems, too. Studies estimate that between 10 percent and 33 percent of children and 40 percent of adolescents experience sleep problems including trouble sleeping, snoring and sleep apnea, a condition that causes people to stop breathing briefly while asleep. About 1 percent to 3 percent of youth have sleep apnea, while as many as 27 percent of children and teens snore.

Reddy and his colleagues conducted the survey by mailing questionnaires to 700 general pediatricians who were members of the American Academy of Pediatrics. About half, or 349, responded, enabling the researchers to make inferences about the total population of American pediatricians with 95 percent confidence and a sampling error of plus or minus 5 percent.

The respondents answered questions about how much formal sleep disorder training they’d had and whether they screened their patients for sleep disorders. The responses showed that doctors often do reach out to their patients about sleep: Almost three-quarters regularly asked kids and their parents about sleep problems, and more than half also asked about bedtimes, bedwetting and snoring or sleep apnea.

But the pediatricians’ knowledge of sleep problems was less robust. When asked eight basic true/false sleep questions, such as “school-age children who are sleepy should be encouraged to take at least one nap per day,” only 19.1 percent scored five out of eight or above. The median, or middle score in the range, was around three correct answers. (By the way, the correct answer to the nap question above is “false.”)

Why sleep matters

Those low scores and the lack of formal training is a problem, Reddy said, pointing out that sleep problems in children are linked to obesity, asthma and even greater risk-taking in teens. Many people believe that “sleep debts” during the week can be made up on the weekends, but research suggests that once sleep is lost, it’s lost forever.

Pediatricians should have more formal training opportunities in sleep issues, starting in medical school and continuing throughout their careers, Reddy said. His institution has started holding regular half-hour lectures on sleep for pediatric residents.

But part of the problem is that talking sleep doesn’t pay for doctors, Reddy said. One respondent reported lacking the time and resources to counsel parents on sleep routines for their children, as insurance companies reimburse for procedures, not doctor-patient conversations.

“Politicians and the health care industry need to look into this and provide the proper attention to sleep in children,” Reddy said.

The researchers reported their results online today (Aug. 29) in the journal Pediatrics.