ATS 2012: The severity of sleep disordered breathing and nocturnal hypoxemia independently predict both glycosylated hemoglobin (HbA1c) levels and type 2 diabetes mellitus(T2DM), according to a new study.

“Because people with obstructive sleep apnea syndrome (OSAS) are often overweight or obese it has been difficult to interpret earlier studies of the relationship between sleep disordered breathing and metabolic disorders,” said Brian Kent, MBBCh, research fellow at St. Vincent’s University Hospital in Dublin. “We found that obstructive sleep apnea syndrome (OSAS) severity and low nocturnal oxygen levels were significant independent predictors of prevalent T2DM and HbA1c levels, even after adjustment for a number of confounding variables, including obesity.”

The research will be presented at the ATS 2012 International Conference in San Francisco.

The study involved 7,886 prospectively assessed subjects from 22 sleep laboratories in 16 European countries. All subjects completed overnight sleep studies.

After adjustment for comorbidities and demographic and anthropometric variables, moderate and severe OSAS were each significant (P=.003) predictors of having a diagnosis of T2DM. Apnea/hypopnea index, oxyhemoglobin desaturation index, and mean oxygen saturation (SpO2) were significant (P<.0001) predictors of HbA1c levels.

“A diagnosis of T2DM is associated with a significantly increased risk of cardiovascular morbidity and death, and elevated HbA1c levels predict cardiovascular mortality in non-diabetic subjects,” said Dr. Kent. “OSAS has also been shown to be associated with adverse cardio-metabolic outcomes, although whether OSAS independently predicts these outcomes is not clear.”

“Our study shows that OSAS is independently associated with metabolic disturbances,” said Dr. Kent. “This is important because individuals with T2DM or elevated HbA1c levels are more likely to die of cardiovascular disease.”

“Further detailed studies are needed to understand the mechanism underlying this relationship in people with OSAS.”

Source: American Thoracic Society Conference San Francisco 2012

Madison, Wisconsin, and ATS 2012 – Sleep-disordered breathing (SDB), commonly known as sleep apnea, is associated with an increased risk of cancer mortality, according to a new study.

While previous studies have associated SDB with increased risks of hypertension, cardiovascular disease, depression, and early death, this is the first human study to link apnea with higher rate of cancer mortality.

Lead author Dr. F. Javier Nieto, chair of the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health, says the study showed a nearly five times higher incidence of cancer deaths in patients with severe SDB compared to those without the disorder, a result that echoes previous findings in animal studies.

“Clearly, there is a correlation, and we are a long way from proving that sleep apnea causes cancer or contributes to its growth,” says Nieto, an expert in sleep epidemiology. “But animal studies have shown that the intermittent hypoxia (an inadequate supply of oxygen) that characterizes sleep apnea promotes angiogenesis-increased vascular growth – and tumor growth. Our results suggest that SDB is also associated with an increased risk of cancer mortality in humans.”

Dr. Nieto presented his study May 20 at the American Thoracic Society 2012 International Conference in San Francisco. The study was supported, in part, by the National Institutes of Health’s the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Aging, and the former National Center for Research Resources.

“These findings provide clues to help further our understanding of the relationship between sleep and health,” said Dr. Susan B. Shurin, acting director of the National Heart, Lung, and Blood Institute. “It will be important to understand the relationship and mechanisms, if the association is confirmed.”

The team of University of Wisconsin-Madison investigators led by Nieto conducted this research in collaboration with Dr. Ramon Farré, professor of physiology at University of Barcelona, Spain. In a separate study also presented at the ATS conference, Dr. Farré’s group showed that the effect of intermittent hypoxia on cancer growth is considerably stronger in lean mice than in obese mice.

The Wisconsin researchers examined 22-year mortality data on 1,522 subjects from the Wisconsin Sleep Cohort. This cohort is a longitudinal, community-based epidemiology study of sleep apnea and other sleep problems that begun in 1989 under the leadership of Dr. Terry Young, also a member of the UW population health sciences faculty. The cohort began was a random sample of Wisconsin state employees.

The participants undergo overnight sleep studies that include polysomnography – an all-night recording of sleep and breathing – and many other tests at four-year intervals. The studies are conducted in a specially designed unit at the federally funded UW Institute for Clinical and Translational Research Center (ICTR).

After adjustment for age, sex, body mass index and smoking, Nieto’s study found that both all-cause and cancer mortality were associated with the presence and severity of SDB in a dose-response fashion. People with severe sleep-disordered breathing  died of cancer at a rate 4.8 times higher than people with no sleep breathing problems.

These associations were similar after excluding the 126 subjects who had used continuous positive airway pressure and were stronger among non-obese subjects than obese subjects.

“In our large population-based sample, SDB was associated with an elevated risk of cancer mortality,” concluded Dr. Nieto. “Additional studies are needed to replicate these results. If the relationship between SDB and cancer mortality is validated in further studies, the diagnosis and treatment of SDB in patients with cancer might be indicated to prolong survival.”

Source: University of Wisconsin Madison

The Board of Registered Polysomnographic Technologists (BRPT) is now accepting applications for the third annual Andrea Patterson Memorial Scholarship Program. The Scholarship Program, named in honor of an early and highly regarded leader in the field of sleep technology, awards a $2,500 tuition grant each year to a promising student of polysomnography.

Said BRPT President Cindy Altman, RPSGT R. EEG/EP T., “Now in its third year, the Scholarship program has gained momentum and draws a pool of very strong applicants. I’m proud to honor Andrea’s legacy while rewarding a stellar student each year.”

Andrea Patterson, RPSGT, R. EEG T., managed the Hennepin County Sleep Program in Minneapolis, Minnesota for almost 30 years and was a leader in early efforts to develop a standardized competency-based test for sleep technologists. Those efforts were instrumental in the development of the RPSGT credentialing program. She published extensively in scientific journals and served on the BRPT Exam Development Committee for over 20 years, until her death in 2007.

Scholarship applicants must be enrolled in or accepted by a CAAHEP-accredited program in PSG, a CoARC-accredited program with a PSG add-on or an accredited END program with a PSG add-on. The scholarship application, a full description of eligibility requirements and other program details are available at www.brpt.org. Applications must be completed and returned to the BRPT no later than close of business November 1. The Andrea Patterson Memorial Scholarship Committee is chaired by BRPT Board member, Theresa Krupski, RPSGT, RRT. The Committee will select the scholarship recipient and the winner will be announced in January 2013.

BRPT is an independent, non-profit certification board that cultivates the highest professional and ethical standards for polysomnographic technologists.

Source: www.brpt.org

Fort Collins, Colorado – Disabled residents who use electrical power for life support equipment have long had access to financial help for utilities, but those breaks have extended to CPAP users in one Colorado community. Sixty miles north of Denver, the Fort Collins City Council passed the measure to ease costs for those who don’t have the option to conserve energy.

Fort Collins residents who rely on electric-powered medical equipment can apply for the discount, which city officials say would give qualified customers discounts up to $11.71 per month during nonsummer months, depending on their electrical use. During June, July, and August, if customers use air conditioning to relieve or treat a medical condition, the discount could be up to $41.66 per month.

“A program like this is not that common,” says Lance Smith, strategic financial planning manager, Fort Collins Utilities. “In California, they have legislated that municipal utilities should have a program like this. The nearby city of Longmont, Colo, has a program, but it is geared more toward life support items, rather than the quality of life equipment that we are trying to deal with here in Fort Collins.”

Additional $1m contract in China underpins key growth focus on emerging markets for Compumedics

* Compumedics’ Germany-based business, DWL, continues to expand its Chinese market presence booking another $1m  (EUR750k) order

* Compumedics Group sales to China increases momentum with FY2012 sales growth expected to be at least 40% over FY2011, an increase over the 38% growth in sales to China achieved in FY2011

* Compumedics has over a 20-year period become the premier supplier of China sleep, neurology and ultrasonic Doppler  blood-flow monitoring systems, with an unsurpassed array of key-opinion-leader Compumedics’ reference-centers now  established across China and Hong Kong

Compumedics Limited (ASX: CMP) is pleased to announce the Company’s Germany-based brain blood-flow ultrasonography division, Compumedics Germany GmbH (DWL), has secured new orders of approximately €0.75 million (≈AUD1.0 million) from Beijing Beike Digital Medical Technology (Beike) for the purchase of DWL® products.

This adds to the €0.6 million (≈AUD0.9 million) order received in early FY2012, bringing total business, for DWL, for the financial year-to-date to $1.7m (€1.3m) or a 37% increase, compared to the entire prior financial year.   This milestone for Compumedics Germany continues to underpin the Compumedics Group’s growing presence in China and is further evidence the Company’s growth strategy of focusing on this growing market is well on track.
As a result of the Group’s successful and highly developed partnerships in China, Compumedics has achieved the following outcomes over the past 5 years, with significant momentum building over the last two years:

•     Since FY2007 Group sales to China have almost tripled from USD1.8m to USD4.4m in FY2011
•     Sales growth into China has gained momentum in the last two years with DWL sales growing 10% in FY2010 and a further  37% in Y2011 with FY2012 growth likely to be in excess of 37%, at this point in time
•     Since FY2007 sales of Compumedics® sleep diagnostic systems have grown 400% from USD0.25m to USD1.0m in FY2011, providing an enormous opportunity for future growth given China’s potential market size and its early phase of  development
•     Across the Asia region, including India, Compumedics has grown its sales from the region by about 11% per annum from  USD4.5m in FY2007 to USD7.6m in FY2011
•     Compumedics new neuro-diagnostic range of products, including the Neuvo® long-term EEG monitoring (LTEM) system,  remains an untapped commercial opportunity in the region with initial sales forecast for FY2012.

Compumedics remains focused on growing the Group through:

• Expansion of the Company’s existing products into emerging markets particularly China; and
• Continuing the initial penetration of the neuro-diagnostic market, particularly the US, with Compumedics new range of  neuro-diagnostic products, including the Neuvo® LTEM system

In commenting on the further boost to Compumedics’ China business, Dr. David Burton, Chairman and CEO, said:

“These significant sales orders achieved through the course of the financial year further validate Compumedics’ superior product offering, highlighting another important milestone for our Company. They reinforce our commitment to developing Compumedics’ potential for exponential growth in the Asian markets, particularly in China.”

“A recent study by the Shanghai Institution of Traditional Chinese Medicine for Sleep Disorders, published in the China Daily, estimates that up to 38% of the population of Shanghai suffers from some form of sleep disorder.  In a city of 19 million people, this represents approximately 7 million potential sleep disorder patients who would greatly benefit from Compumedics’ products.”

“Market research (Global Data 2010) confirms that Sleep Apnea Diagnostic Systems have been reported as the fastest growing category within the Chinese anaesthesia and respiratory devices market, with growth rates of 15.7 % between 2002 and 2009 and a forecast of 14.1% between 2009 and 2016.  Importantly, in partnership with an extraordinary long-term network of existing distributors, Compumedics has established itself over the past 2 decades as the leading supplier of premier sleep and also neurology systems amongst the finest Chinese hospitals, universities and clinics, alike.  Coupled with Compumedics’ Australian headquarters ideal geographical positioning and global brand recognition built up over 25 years, we believe it is imperative that we investigate the potential to further strengthen our Chinese investment and trade prospects.  The prospect of Compumedics further combining Chinese investment, manufacturing and engineering resources with Compumedics global market sleep and neurology technological and innovative leadership can provide a formidable expanded business opportunity and will be vigorously pursued.” Dr. Burton added.

Source: Compumedics

FRISCO, Texas, SomnoMed  (SOM.AX) – expects shipment of its 100,000th SomnoDent® apnea appliance case since the inception of the company in June 2012. This important company milestone is anticipated to occur whilst SomnoMed attends the annual Associated Professional Sleep Societies (APSS) conference in Boston.

“This is a significant milestone for us as it demonstrates continued strong demand for SomnoDent® sleep apnea treatment,” said Ralf Barschow, President & CEO of SomnoMed. “With more than 100,000 patients and counting we are continuing to grow and expand the products and services associated with SomnoDent sleep apnea treatment.”

We look forward to announcing further details associated with this 100,000 treatment in June.

About SomnoMed

SomnoMed is a public company (SOM.AX) providing diagnostic and treatment solutions for Sleep Breathing Disorders such as Obstructive Sleep Apnea. SomnoMed was commercialized on the basis of extensive clinical research. Supporting independent clinical research, continuous innovation and instituting medical manufacturing standards has resulted in SomnoDent® becoming the state-of-the-art and clinically proven medical oral appliance therapy for obstructive sleep apnea. For additional information, visit SomnoMed at www.somnomed.com

SOURCE SomnoMed

Could REM sleep be a biological biomarker for anxiety disorders

Although interest in finding biological biomarkers for psychiatric illnesses has been longstanding, efforts to find biological biomarkers have not been very successful. It has been known for quite some time that most antidepressants suppress REM (rapid eye movement) sleep in depressed patients, normal controls and laboratory animals 1. Thus it is postulated that increased REM density could be a possible biological biomarker for depression 2. Several anti-depressant medications are FDA approved for anxiety disorders as well, such as Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Panic Disorder, implying there may some commonality in the pathophysiology of depressive and anxiety disorders.

There is a relative paucity of articles looking at electroencephalographic sleep patterns in anxiety disorders. This review is an effort to summarize the REM sleep abnormalities in Generalized Anxiety Disorder, Obsessive compulsive disorder and panic disorder. Further research is needed to clarify the relationship of REM sleep in anxiety disorders. Reference: 1. Steiger A, Kimura M: Wake and sleep EEG provide biomarkers in depression : J Psychiatr Res. 2010 Mar;44(4):242-52. 2. Pillai V, Kalmbach DA, Ciesla JA: A meta-analysis of electroencephalographic sleep in depression: evidence for genetic biomarkers. : Biol Psychiatry. 2011 Nov 15; 70(10):912-9.

Source: American Psychiatric Association 2012 Annual Meeting