Add neurodegenerative conditions to the long list of problems associated with poor sleep. Researchers at Washington University School of Medicine in St. Louis and the University of Pennsylvania published their latest findings in the Journal of Clinical Investigation. These researchers found that sleep loss increases the risk of Alzheimer’s disease, and disrupted sleeping patterns are among the first signs of the devastating disorder.

Researchers specifically found that brain cell damage, similar to that seen in Alzheimer’s disease and other disorders, results when a gene that controls the sleep-wake cycle and other bodily rhythms is disabled. Researchers found evidence that disabling a circadian clock gene that controls the daily rhythms of many bodily processes blocks a part of the brain’s housekeeping cycle that neutralizes dangerous chemicals known as free radicals.

“Normally in the hours leading up to midday, the brain increases its production of certain antioxidant enzymes, which help clean up free radicals,” said first author Erik Musiek, MD, PhD, an assistant professor of neurology. “When clock genes are disabled, though, this surge no longer occurs, and the free radicals may linger in the brain and cause more damage.”

Musiek conducted the research in the labs of Garret FitzGerald, MD, chairman of pharmacology at the University of Pennsylvania, and of David Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of the Department of Neurology at Washington University School of Medicine, who are co-senior authors.

According to the Medical News outlet, Musiek studied mice lacking a master clock gene called Bmal1. Without this gene, activities that normally occur at particular times of day are disrupted. “For example, mice normally are active at night and asleep during the day, but when Bmal1 is missing, they sleep equally in the day and in the night, with no circadian rhythm,” Musiek said. “They get the same amount of sleep, but it’s spread over the whole day. Rhythms in the way genes are expressed are lost.”

Source: Medical news

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Sleep professionals have heard about the trucking industry ad nauseum. Meanwhile, members of the general public also care about truckers because they justifiably fear sleepy drivers guiding multi-ton vehicles on the nation’s highways.

There is undeniable opportunity in the trucking industry, but a once promising landscape has been muddied a bit by the powerful trucking lobby that will make official rulemaking about sleep apnea increasingly difficult. Beyond the realm of trucking, boating, flying, and various transportation industry jobs, is a largely uncharted territory of corporate America.

No one will die in mangled wreckage if an accountant does his job poorly, but the consequences of an error-riddled audit could add up to dollars lost on the bottom line. Poor sleep affects every job, and every job adds up to a massive pool of opportunity.

How best to tap into that opportunity is the question on the minds of sleep lab directors and sleep physicians throughout the country. The consequences of poor performance for employees in the nation’s corporations is not insignificant, and the right marketing pitch could add up to lucrative referral streams flowing from the cubicles of America.

Research companies call them “health and productivity strategies” or “outcome-based incentive and engagement programs.” In the wake of the Affordable Care Act, the shape of such programs is still in doubt, but possible models could include on-site/near-site primary care delivery—perhaps even sleep tests administered right there at the office work site.

If such programs are covered as a benefit and/or perk, employee response could well be positive. After all, employees are used to cost-cutting measures that inevitably reduce benefits. Adding a “better sleep program,” to existing employee wellness packages could reverse the trend—leading to increased loyalty or even helping to attract better talent.

Industry innovators believe the key to convincing managers to make such an investment is to convince them that better sleep equals increased productivity. With new studies coming out virtually every week linking sleep to countless comorbidities, such an equation is entirely accurate.

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Cardiology Consultants of Philadelphia (CCP), the largest independent Cardiology group in the United States, and CleveMed, a leading manufacturer of Home Sleep Testing (HST) equipment and web-based solutions, announce the launch of a new sleep disorders program at CCP to reduce cost and improve access to sleep apnea diagnosis and treatment. A significant percentage of the patients seen at cardiology practices have sleep apnea due to the strong link between sleep disorders and many cardiac conditions. However, the majority of the patients remain undiagnosed and untreated due to the cost and inconvenience of in-laboratory based testing. Physicians at CCP will now be able to identify patients suspected of Obstructive Sleep Apnea (OSA) and initiate a sleep study in the comfort of their own home using CleveMed’s SleepView® Monitor and Web Portal technologies. Diagnostic reports generated by local sleep specialists allow CCP physicians to start treatment or coordinate follow-up care quickly. In addition to convenience and cost savings of diagnosis, which is expected to be more than 75%, sleep apnea treatment has been shown to improve cardiac disease, further emphasizing the need to identify and treat OSA patients seen in cardiology practices.

“CCP has defined itself over the years as being a leader in providing our patients with state-of –the-art technology in an outpatient setting,” says Mark Victor, MD, CCP CEO. “We offer the entire spectrum of outpatient services, from basic preventative care to on-site noninvasive diagnostic imaging. Top quality care is consistent across all of our 27 locations. Our decision to partner with CleveMed, a recognized leader in Home Sleep Testing, meets CCP’s goal of providing our patients with efficient, cost-effective, high quality care in a convenient location. We specialize in patient focused care to optimize each patient’s needs.”

“We are happy to be the diagnostic partner for CCP’s Home Sleep Testing Program,” said Kirk Scovill, CleveMed National Sales Director. “The flexibility of our web-portal will allow for all of CCP’s offices to connect with local sleep specialists and treatment providers in order to provide an effective continuum of care to their patients.”

“CleveMed’s HST web-based platform is growing rapidly nationwide. Our partnership with CCP is particularly exciting because it aims to lead the nation in incorporating sleep apnea services within cardiac care. This program promises to help thousands of patients because it is convenient, inexpensive, and can improve outcome”, said Hani Kayyali, CleveMed President.

The SleepView® Monitor is the market’s smallest and lightest type three portable home sleep monitor. It allows patients to be tested for OSA in the comfort, convenience and privacy of their own home. The SleepView Web Portal provides prescribing physicians with secure, HIPAA compliant online access to sleep study reports generated by board certified sleep physicians, and a pathway to initiate various treatments. Sleep Apnea is the repeated stoppage of breathing during the night, which can severely disrupt patient’s sleep. Sleep Apnea affects more than 40 million patients and the vast majority of sufferers remain undiagnosed and untreated.

Source: CleveMed

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San Diego based ResMed Corp said the Munich District Court entered preliminary injunctions against Apex Medical Corp and BMC Medical “against several patent infringing activities.”

The initial orders, entered by the Munich District Court, prohibit APEX and BMC from selling or marketing certain products in Germany without a further court order. Those products effected by the rulings are:

• The APEX WiZARD 210 and WiZARD 220 mask headgear
• BMC’s  RESmart CPAP devices
• BMC’s Willow/FeaLite nasal pillows patient interface

ResMed has also filed patent infringement lawsuits in Munich, Germany, seeking damages and permanent injunctions to stop infringement of ResMed patents by the products listed above, as well as the additional products below:

• The APEX iCH and XT Fit CPAP devices
• The APEX WiZARD 210 and WiZARD 220 masks

“ResMed has a global business built on its investment in research and development, resulting in products that excel in performance, quality and comfort,” general counsel David Pendarvis said in prepared remarks. “We will continue to defend our investment in intellectual property and pursue all legal remedies to prevent infringement in any country where that infringement exists.”

Source: ResMed

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Anatomy, weight, and age may not be the only OSA culprits, according to Australian scientist Danny Eckert and his team. New research in the American Journal of Respiratory and Critical Care Medicine (click here for abstract) uncovers what Eckert calls “brand new problem areas.”

As summarized by several media outlets, additional causes of OSA include muscle responsiveness in sleep, waking too easily, and a response to carbon dioxide that builds up while asleep. Eckert, a former Harvard researcher now at Neuroscience Research Australia, believes the discovery could lead to new treatments for people who suffer from OSA.

“We might be able to treat these rather than focus solely on the problem of a collapsing airway, as we have until now,” Eckert said to reporters. “That’s a pretty exciting development that takes treatment in a totally new direction.”

The study suggests that in future more than half of sleep apnea patients could be treated with medication. The Conclusions section in the abstract state: “This study confirms that OSA is a heterogeneous disorder. Although Pcrit-anatomy is an important determinant, abnormalities in nonanatomic traits are also present in most patients with OSA.”

Australasian Sleep Association president Nick Antic told Australian media that the finding proves the disease is far more complex than thought. Antic also said that potential new treatments could take years to reach patients.

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Relinquishing control of crucial diagnostics has never been a favored practice of clinicians. Instead, dedicated sleep technologists prefer to monitor physiological variables while administering a gold standard polysomnography.

But many veterans in the sleep world know that labs are not right for everyone. Demand is increasing, and some patients simply have no interest in spending the night in a laboratory—whether it’s comfortable or not. The Sleep Center is an environment where little is left to chance. There is no doubt that some people do better with the additional care they get in the lab. In the lab, patients get the one-on-one attention that ensures everything is being properly recorded. Physicians know what their patients need and want, and being in a lab patients get that additional education.

However, with the number of patients out there, a new study from researchers with the Health Technology and Policy Unit at the University of Alberta, which conducts health technology assessments for Alberta Health believe that home sleep testing could be a valuable screening modality.

This study has data to back it up. Researchers followed up in-laboratory validation studies of level III portable monitoring. The study “Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis” published in the Canadian Medical Association Journal compared findings from home study with in-laboratory polysomnography for screening of obstructive sleep apnea. Portable devices used at home offer similar levels of diagnostic accuracy to sleep laboratory testing for diagnosing obstructive sleep apnea. This finding is based on a systematic review of 59 studies involving 5026 patients. Portable devices are safe and convenient to confirm obstructive sleep apnea in patients with a high likelihood of the condition.

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Acknowledging “a growing body of research” linking sleep apnea and Type 2 diabetes, a story by author Valerie Lauer reports that primary care physicians are increasingly identifying and treating OSA as an insulin-impacting comorbidity.

Though the connection between Type 2 diabetes and OSA is not fully understood, some small-scale studies, such as one published last year by University of Chicago researchers, suggest restricted or frequently interrupted sleep can cause lipocytes and fat cells to become more insulin resistant, a precursor of Type 2 diabetes.

“The main thing with treatment of diabetes is to minimize the effects of comorbid conditions,” says Alvah R. Cass, MD, SM, Professor of Family Medicine with The University of Texas Medical Branch. “OSA appears to be emerging as one of those modifiable conditions, and if we were to pay attention to it, recognize it and treat it, we might have better outcomes associated with diabetes, as well as OSA.”

Lauer reports that Cass is the main author of a study initiated by W. Jerome Alonso, MD, that appeared earlier in 2013 in the Family Medicine Journal – The Society of Teachers of Family Medicine “Risk of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus“. The study used several low-cost methods, most notably the Berlin Questionnaire, to assess the OSA risk of 297 patients with Type 2 diabetes from three broad ethnic groups.

Despite the prevalence of OSA — an estimated 12 million adults in the United States have the condition — and its shared risk factors with Type 2 diabetes, only 37 participants had been diagnosed with OSA prior to joining the study. After answering the Berlin Questionnaire, almost half of the remaining participants were found to be at high risk for OSA.

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The American Academy of Sleep Medicine (AASM) is partnering with the Centers for Disease Control and Prevention (CDC) on a new project to increase awareness of sleep illness and the importance of sufficient sleep. The long-term goal of the National Healthy Sleep Awareness Project is to promote widespread and measurable public behavior changes leading to improved sleep health.

The AASM and CDC both recognize that untreated sleep illness and chronic sleep loss have a cumulative impact on nearly every key public health indicator, increasing the risk of physical and mental health problems, mortality, accidents, injuries and disability.

“Sleep and sleep disorders, such as obstructive sleep apnea and insomnia, are increasingly recognized as vital to a wide variety of public health and chronic disease concerns, including obesity, hypertension and cancer,” said Janet B. Croft, PhD, CDC senior chronic disease epidemiologist in the Division of Population Health. “The CDC is collaborating with the AASM to improve the health of people through diagnosis and treatment of sleep illness.”

The project addresses the “Healthy People 2020″ focus area of sleep health, which includes objectives related to increasing the medical evaluation of people with symptoms of obstructive sleep apnea, reducing vehicular crashes due to drowsy driving and ensuring more Americans get sufficient sleep.

The cooperative agreement calls for the project to last five years with an approximate total funding from the CDC of $1 million, which will be used to launch a public awareness campaign and promote health care provider education to improve knowledge of sleep and sleep illness. The project also will generate recommendations to improve current models for nationwide sleep health data collection.

According to AASM President Dr. M. Safwan Badr, public health policies and wellness programs frequently fail to recognize the substantial body of evidence illustrating that sleep duration and sleep quality are as important to health as good nutrition and adequate exercise.

“Diagnosis and treatment of sleep illnesses can bring relief to the millions of Americans suffering from poor sleep,” said Badr. “However, fundamental to the success of these efforts is the recognition and awareness that healthy sleep is not a luxury; it is a necessity and should be thought of as a vital sign of good health.”

SOURCE American Academy of Sleep Medicine

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