A new study from Sleep researchers at University of California campuses in Riverside and San Diego has identified the sleep mechanism that enables the brain to consolidate emotional memory, and the study results indicate a broader role for sleep in the processing of emotional stimuli with differing effects based on arousal and valence, and raises the possibility that sleep spindles causally facilitate emotional memory consolidation.

The study — “Pharmacologically Increasing Sleep Spindles Enhances Recognition for Negative and High-arousal Memories” is published in the Journal of Cognitive Neuroscience.

Read Abstract Here

In the study the researchers experimentally increase non-REM sleep features, sleep spindle density, and SWS, with pharmacological interventions using Zolpidem (ambien) and sodium oxybate (xyrem) during daytime naps. The researchers also use a full spread of emotional stimuli to test all levels of valence and arousal and found that increasing sleep spindle density increases memory discrimination (d_a) for highly arousing and negative stimuli without altering measures of bias (c_a).

Using two commonly prescribed sleep aids — zolpidem and sodium oxybate (Xyrem) the studys authors Mednick, Kaestner and Wixted were able to tease apart the effects of sleep spindles and rapid eye movement (REM) sleep on the recall of emotional memories. They determined that sleep spindles, not REM, affect emotional memory.

The researchers gave zolpidem, sodium oxybate (Xyrem) and a placebo to 28 men and women between the ages of 18 and 39 who were normal sleepers, allowing several days between doses to allow the pharmaceuticals to leave their bodies. The participants viewed standardized images known to elicit positive and negative responses for one second before and after taking supervised naps. They recalled more images that had negative or highly arousing content after taking zolpidem, a finding that also suggests that the brain may favor consolidation of negative memories.

The study may have even broader implications, the researchers said. Clinical guidelines of the U.S. Department of Veterans Affairs and Department of Defense recommend against the routine use of benzodiazepines to treat PTSD, although their use increased among men and women with PTSD between 2003 and 2010. The effects of benzodiazepines on sleep are similar to those of zolpidem. The U.S. Air Force uses zolpidem as one of the prescribed “no-go pills” to help flight crews calm down after taking stimulants to stay awake during long missions, the researchers noted in the study.

“In light of the present results, it would be worthwhile to investigate whether the administration of benzodiazepine-like drugs may be increasing the retention of highly arousing and negative memories, which would have a countertherapeutic effect,” they wrote. “Further research on the relationship between hypnotics and emotional mood disorders would seem to be in order.”

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Restless Legs Syndrome, is a neurological disorder characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso and head. Moving the affected body part modulates the sensations, providing temporary relief.

A study published in Neurology titled “Prospective Study of Restless Legs Syndrome and Mortality Among Men” looked into the possibility of increased mortality risk in men with restless legs syndrome.

Read Abstract Here

“This was a prospective cohort study of 18,425 US men free of diabetes, arthritis, and renal failure in the Health Professionals Follow-up Study (HPFS). In 2002, RLS was assessed using a set of standardized questions. Deaths were identified from state vital statistics records, the National Death Index, family reports, and the postal system.

Seven hundred subjects were diagnosed with RLS. The mortality rate in this segment was 25 percent compared to just 15 percent for those without RLS discovered after a follow-up after eight years.

The proponents led by Dr. Xiang Gao from the Brigham and Women’s Hospital located in Boston found out that men with RLS are 39 percent more likely to die earlier compared to those without RLS. The proponents noted that the statistics was still significant even after adjustments and after taking into consideration other health concerns of the subjects.

The study concluded that the higher mortality linked with RLS is independent of some known risk factors and frequently tied to immunologic disorders, metabolic disease, nutritional problems, respiratory disease, and endocrine disease.

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The threat of sleepy drivers at the helm of multi-ton commercial trucks is a problem that multiple agencies, private and public, continue to address with vigor. With the release of new clinical practice guidelines, the American Thoracic Society (ATS) is recognizing that non-commercial drivers also pose a significant risk.

The guidelines on sleep apnea, sleepiness, and driving risk for non-professional drivers are an update of a 1994 ATS statement on this topic. The full guidelines appear in the June 1, 2013 American Journal of Respiratory and Critical Care Medicine.

“Up to 20 percent of crashes that occur on monotonous roads can be attributed to sleepiness, and the most common medical cause of excessive daytime sleepiness is obstructive sleep apnea (OSA),” said Kingman P. Strohl, MD, director of the Center for Sleep Disorders Research at Case Western Reserve University and chair of the committee that drafted the guidelines. “With these new guidelines, we aimed to provide healthcare practitioners with a framework for the assessment and management of sleepy driving in the evaluation of OSA.”

Recommendations include:

• All patients undergoing initial evaluation for suspected or confirmed OSA should be asked about daytime sleepiness and recent unintended motor vehicle crashes or near misses attributable to sleepiness, fatigue, or inattention. Patients with these characteristics are considered high-risk drivers, and should be warned about the potential risk of driving until effective therapy is initiated.

• Additional information that should be elicited during initial evaluation for suspected or confirmed OSA includes the clinical severity of the OSA and treatment that the patient has received, including behavioral interventions. Adherence and response to therapy should be assessed at subsequent visits. Drowsy driving risk should be reassessed at subsequent visits if it was initially increased.

The post Beyond Trucking: ATS Addresses Sleepy Driving in the Non Commercial World appeared first on Sleep Diagnosis and Therapy.

Short sleep duration is common in adolescents and young adults, and is a risk factor for motor vehicle crash.

In the new study “Sleep-Deprived Young Drivers and the Risk for Crash –  The Drive Prospective Cohort Study” published in JAMA Pediatrics, this first of its kind study found sleeping less on weekends puts young drivers at greater risk of having a car crash at night.

To read abstract click here

The authors of the study analyzed the association between sleep and motor vehicle crashes in newly licensed people aged between 17 and 24. Measuring a sample size of 20,000, the participants were followed up on average two years after being enrolled in the study.

Beginning in 2003, the researchers analyzed police-reported crash data and driver sub-groups to determine who had an increased crash risk. The study found that less sleep per night significantly increased young drivers’ crash risk and that less sleep on weekends increases run-off road and late night crash risks.

Other Studies
Leon Lack, Professor of Psychology at Flinders University and a sleep expert, said that other studies have shown that younger people tend to be higher risk takers in general.

“Even though, intellectually, they may appreciate they will be sleepy and should not be driving, in reality they may do so anyway,” said Professor Lack.

“We have recently done a nationwide study on sleepiness. As a group, people of this age tend to report more sleepiness. Sleepiness continues to be reported up to about the age of 50 and then tends to decline with older age groups,” he said.

“Sleep need of that younger age group is still quite high, an average of about eight hours a night with individual variations. Younger people are perhaps pushing the boundaries a little more than older people.”

Professor Lack said young people may feel they don’t have enough time for sleep.

“They may have a second job, they may be studying full time, they may be married and if they have young kids, they have a lot of commitments,” he said.

“That, in conjunction with potentially a bit of alcohol and the effect of circadian rhythms on late night driving, can have a very strong effect to produce extreme sleepiness.”

Source: ScienceAlert.com.au

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Sleep labs can now rely on revenue from scoring and interpretation.

Sleep laboratories and sleep physicians have long complained that it’s difficult to make money with home sleep testing (HST). The key to making it work could well be to expand revenue-producing services associated with HST.

Hani Kayyali, president of Cleveland Medical Devices (CleveMed), believes the idea can work if sleep specialists can successfully reach out and offer interpreting and/or scoring services to ordering clinicians. Those healthcare providers could be primary care physicians (PCPs), nurse practitioners (NP), dentists, cardiologists, and many more providers who typically care for those patients all the time, are interested in adding sleep evaluation to their practice but desperately need sleep specialist’s oversight and disease management expertise.

“Some sleep labs are facing considerable challenges due to losing their referrals to mail-order Home Sleep Testing, worsening no-show rates, or high cost structure and PSG-based workflow that cannot be re-factored easily to handle the lower reimbursement HST,” explains Kayyali from his Ohio-based office, “but our web portal technology allows those local sleep labs and / or sleep physicians to expand the reach of their sleep services and to make up for some of the lost revenues by scoring and interpreting sleep studies — even though patient screening and home sleep testing are initiated from a different site.”

“Once screened for OSA by the healthcare provider, patients go home with the SleepView monitor and self-administer it that same night”, says Kayyali, “next day, practice staff can upload the data to our web portal, which is then forwarded to RPSGT and sleep physician for scoring and interpretation.  Guided by the sleep doctor’s diagnostic report, which includes therapy recommendations, the ordering provider would then initiate treatment or send the patient to the sleep lab for more extensive workup if needed.  The whole point is that sleep labs now have a tool that can easily deliver their professional services to other practitioners.  In addition to study reads, sleep specialists can offer other valuable clinical expertise such as training providers on screening, care pathways, and others”.

While CleveMed has its own network of sleep physicians licensed in all 50 states, Kayyali maintains that the recently-added web portal flexibility allows any practice to seamlessly assign sleep studies to qualified sleep scorers or physicians of their choosing, which can strengthen local relationships and enhance the continuity of patient care. “Our overall web portal adoption is seeing double digit growth every month” adds Sarah Weimer, director of Sleep Products at CleveMed. “Many healthcare providers want to adopt HST. They see sleep apnea patients all the time and hear of their symptoms before anyone else. These providers frequently request local sleep specialists to provide oversight, which can be easily done with our newest web portal release.”

According to Kayyali, making it convenient for healthcare providers to initiate care for sleep disordered breathing will not only generate revenue for both the ordering physicians and sleep specialists, but more importantly has immediate patient care benefits as it can speed diagnosis and treatment.  For example, research done by CleveMed showed that the entire process from the time the patient first discusses symptoms with their primary care provider to diagnosis was 3.1 days.

Within the Realm of Primary Care Settings?

The healthcare system has always recognized the need to improve delivery of care of chronic diseases like hypertension, diabetes, and asthma, and many believe that the recent focus on care coordination between primary care and specialists will help achieve that goal.  “Sleep apnea is now being bundled with those high cost chronic diseases and I believe that the various healthcare stakeholders can peacefully coexist with the CleveMed model”, Kayyali says.  “As long as sleep physicians maintain oversight on scoring, interpretation and follow-up, sleep labs could accept a Provider Practice-based HST Model.”, he says.

Kayyali says clinical guidelines for portable monitoring do not preclude non-sleep specialists from screening and initiating the sleep test.  “Practice staff like nurse practitioners and physician assistants has been trusted for decades to care for complex diseases like asthma and diabetes.  So, there is no reason to doubt their ability to handle OSA including administering sleepiness questionnaires, training on monitor sensor hookup, and others as evidenced by research findings,” says Kayyali.  “Furthermore, due to the strong on-going patient-doctor relationship and the face-to-face training in the office, it is expected that compliance with HST and eventually treatment will likely be higher than any other HST model.  However, as said before, identifying at-risk patients and dispensing monitors is only one piece of the puzzle and must always be complemented with sleep specialty oversight whether it is for baseline diagnosis or follow-up management to ensure proper continuity of care.  That is why the clinical guidelines correctly require that studies be scored by registered sleep technologists and read by board certified sleep physicians “, he says.

While not all insurance carriers reimburse for Provider Practice-based HST, healthcare in general and third party payers in specific are demanding improved delivery of care while avoiding traditional in-lab costs, “Our technologies allow various stakeholders to be engaged, who together offer a more efficient solution to the patient without compromising care or burdening any one entity with all the work”, says Kayyali.

Ultimately, Kayyali says, “Our long-term success in controlling the spiraling human and financial costs of chronic diseases, including sleep apnea, must incorporate a pivotal role for primary care practitioners including the new and emerging workforce; nurse practitioners and physician assistants.  The sooner we incorporate their skills in sleep apnea care pathways the better off we will all be”.

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Is it beneficial for children to undergo an adenotonsillectomy, or is watching and waiting the better option? As it turns out, a few extra benefits put surgery in the win column.

As detailed in the New England Journal of Medicine, the study, “A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea“, concludes that:

As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy.

Several news outlets, seized on the new study, essentially saying that the widely-performed surgical procedure “can reduce sleepiness and improve the quality of life, but putting off the surgery might not hurt either.”

In an article by Reuters reporter Gene Emery, Dr. Susan Redline of Boston-based Brigham and Women’s Hospital conceded that “Where you objectively measure these cognitive tasks, children can do fairly well in that motivated and structured environment” whether or not they have surgery.

Children with the surgery showed a large improvement on ratings of things such as impulsiveness, emotional control, and quality of sleep that were assessed by parents and teachers. “It really was across-the-board improvement in everyday life for surgery patients,” Redline said in the Reuters article. On the other hand, Redline added that “almost half the children improved spontaneously over the 7-month period without surgery.”

The post Early Adenotonsillectomy Wins By a Nose appeared first on Sleep Diagnosis and Therapy.

Evidence for the obesity/sleep apnea connection is mounting, but asthma is back on the radar thanks to researchers at the University of Wisconsin (UW).

In a new study “Asthma Predicts 8 Year Incidence Of Obstructive Sleep Apnea In The Wisconsin Sleep Cohort“ presented at the recent American Thoracic Society meeting in Philadelphia, PA, researchers used data from a National Institutes of Health (Heart, Lung, and Blood Institute) and Wisconsin Sleep Cohort Study, which followed approximately 1,500 people since 1988. Patients who had asthma were 1.70 times (95% CI=1.15-2.51) more likely to develop sleep apnea after eight years.

To read abstract Click Here

“This is the first longitudinal study to suggest a causal relationship between asthma and sleep apnea diagnosed in laboratory-based sleep studies,” said Mihaela Teodorescu, MD, MS, assistant professor of medicine at UW, who will present the research at ATS 2013. “Cross-sectional studies have shown that OSA is more common among those with asthma, but those studies weren’t designed to address the direction of the relationship.”

Pediatric asthma patients had an even stronger likelihood to develop sleep apnea later in life. Specifically, childhood-onset asthma was associated with 2.34 times (95% CI=1.25-4.37) the likelihood of developing sleep apnea.

Researchers also found that the duration of asthma affected the chances of developing sleep apnea. For every five-year increase in asthma duration, the chances of developing OSA after eight years increased by 10 percent.

The post Asthma Patients 1.7 Times More Likely to Have Sleep Apnea appeared first on Sleep Diagnosis and Therapy.

It’s not difficult for sleep physicians to predict which patients are most likely to have sleep apnea. The latest study from researchers at the University of Wisconsin-Madison (UWM) confirms the patient profile, adding more evidence to the widely held belief that obesity is, at least in part, fueling a rise in sleep apnea.

Originally published in the American Journal of Epidemiology “Increased Prevalence of Sleep-Disordered Breathing in Adults”.

“There are probably 4 million to 5 million people who are more likely to have sleep apnea due to the obesity epidemic,” says Paul Peppard, PhD, assistant professor of population health sciences at UWM in an article by Traci Pedersen. “It’s certainly an uncalculated cost of the obesity epidemic, an epidemic of its own.”

Specific findings show a sizable spike in sleep apnea cases over the past two decades—as much as 55%. The study involved more than 600 adults, ages 30 to 70, who underwent sleep tests between 1988 and 1994—with some continuing to take part along with hundreds of new participants from 2007 to 2010.

Pedersen summarizes that among all groups, heavier people were much more likely than thinner people to suffer from sleep apnea. Peppard estimates that 80% to 90% of the increase in symptoms is due to the growth in obesity.

Click here for the study abstract.

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Sleep physicians who recommend the pharmaceutical route to better slumber must always take side effects into account. The tradeoffs are usually worth it, but what if the tell-tale fogginess could be eliminated?

A Los Angeles Times article by Melissa Healy reports that an investigational drug that works on certain receptors in the brain, particularly the lateral hypothalamus where molecules called orexins are released, could help. The medication, dubbed DORA-22, is unlike existing hypnotic sedatives that “work on so-called GABA receptors, which are found throughout the brain. That makes them a relative blunderbuss in inducing sleep and often results in residual effects.”

Those residual effects prompted the FDA recently to order changes to the recommended dosing of Ambien, particularly for women and the elderly, among whom lingering cognitive effects have proved to be common.

The study (Read Abstract Here) “Orexin Receptor Antagonists Differ from Standard Sleep Drugs by Promoting Sleep at Doses that do not Disrupt Cognition” released this week in the journal Science Translational Medicine, demonstrated effectiveness in inducing sleep in rats and rhesus monkeys. “The researchers showed that the minimum effective dose of DORA-22 to induce sleep had no effect on the animals’ [lab animals]attention and memory performance after it was administered,” writes Healy. “In the case of the widely marketed hypnotics, the minimal dose to induce sleep also resulted in cognitive deficits.”

The drug’s originator, Merck, is asking the Food and Drug Administration to consider approval of a proposed sleep medication, called suvorexant, with a similar mechanism of action to that of the DORA-22 medication.

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How important is sleep? The evidence piles up every week, with UC Davis Sleep Laboratory researchers adding their wisdom in the February issue of American Journal of Physiology: Regulatory, Integrative and Comparative Physiology.

The new study “Longitudinal Sleep EEG trajectories indicate complex patterns of adolescent brain maturation” monitored brain waves of sleeping adolescents, documenting major changes in the brain as it “prunes away neuronal connections” and transitions from childhood to adulthood.

Read Abstract

“We’ve provided the first long-term, longitudinal description of developmental changes that take place in the brains of youngsters as they sleep,” said Irwin Feinberg, professor emeritus of psychiatry and behavioral sciences and director of the UC Davis Sleep Laboratory. “Our outcome confirms that the brain goes through a remarkable amount of reorganization during puberty that is necessary for complex thinking.”

The research also confirms that electroencephalogram, or EEG, is a powerful tool for tracking brain changes during different phases of life, and that it could potentially be used to help diagnose age-related mental illnesses. According to Science Daily, the research is the final component in a three-part series of studies carried out over 10 years and involving more than 3,500 all-night EEG recordings.

The new findings show that synaptic density in the cerebral cortex reaches its peak at age 8 and then begins a slow decline. The recent findings also confirm that the period of greatest and most accelerated decline occurs between the ages of 12 and 16-1/2 years, at which point the drop markedly slows.

“Discovering that such extensive neuronal remodeling occurs within this 4-1/2 year timeframe during late adolescence and the early teen years confirms our view that the sleep EEG indexes a crucial aspect of the timing of brain development,” said Feinberg.

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