Blood Test for Narcolepsy on the Horizon?

A new Stanford study could pave the way for a diagnostic blood test for narcolepsy. As reported in several other media outlets, Alberto De la Herrán-Arita and colleagues have “closed the loop” on the autoimmune basis of narcolepsy, showing that “in patients with cataplexy reactive CD4+ T cells are present in most patients but not in controls.”

A recent article by Dr. Emmanuel Mignot in the Huffington Post declares that the discovery has two consequences. “First, narcolepsy joins the club of diseases with an undisputable autoimmune basis,” writes Mignot. “Because of the relative simplicity of the HLA association, the small number of epitopes presented, and the relationship with a specific triggering antigen in the 2009 H1N1 flu, it is likely to be a major model to understand autoimmunity in the future.”

The study titled “CD4+ T Cell Autoimmunity to Hypocretin/Orexin and Cross-Reactivity to a 2009 H1N1 Influenza A Epitope in Narcolepsy“ from the Stanford Center for Sleep Sciences and Medicine has prompted researchers predict that narcolepsy will become the prototype of several other diseases that affect neurons. “We believe these have been difficult to detect, as they likely primarily involve T cell rather than B cell immunity, a speculation we hope to discuss further in a future blog,” writes Mignot. “Second is the possibility of diagnosing narcolepsy with a blood test, a development that is rapidly implementable, and the object of this discussion.”

Click here to access study PDF

Researchers say the next step is to test patients and a population sample with unexplained sleepiness: narcolepsy without cataplexy, idiopathic hypersomnia, or sleep apnea patients who remain sleepy. It is suspected that some cases without cataplexy will have reactivity, the question is, how many?

Source: Stanford School of Medicine Center for Narcolepsy

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Politicians Adding Weight to Sleep Apnea Awareness

Governors nationwide have begun issuing proclamations to bring awareness to sleep apnea. In just the last several months, twelve United States Governors have issued Sleep Apnea Awareness Proclamations following the passing of Helen Marie Bousquet in a Methuen, Massachusetts hospital. Her website is The loss has caused an outpouring of support from politicians nationwide.

All fifty governors have been approached to issue Sleep Apnea Proclamations, and proclamations have been issued by:

• Governor Dr. John Kitzhaber of Oregon;

• Govenor Maggie Hassan of New Hampshire;

• Governor Pat Quinn of Illinois;

• Governor Bill Haslam of Tennessee;

• Governor Neil Abercrombie of Hawaii;

• Governor Paul LePage of Maine;

• Governor Pat McCrory of North Carolina;

• Governor Brian Sandoval of Nevada;

• Governor John Hickenlooper of Colorado;

• Governor Jay Nixon of Missouri; Governor Susana Martinez of New Mexico; and

• Governor Dave Heineman of Nebraska.

Only three Governors have flat out refused to issue proclamations, or any other kind of public support for the campaign to bring attention to the condition. They are: Governor Steve Bullock of Montana; Governor Deval Patrick of Massachusetts; and Governor Gary Herbert of the state of Utah.

Thirty five requests from the remaining states are awaiting responses, though the Governor of Florida, Rick Scott, has indicated that he intended to become the next state to issue the awareness of the condition

Source: Sacramento Bee

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Pneumonia Risk Goes Up for Sleep Apnea Sufferers

New research from Taiwanese researchers suggests that sleep apnea sufferers “appear to have” a higher risk of pneumonia. The study, published in the Canadian Medical Association Journal, titled “Sleep apnea and risk of pneumonia: a nationwide population-based study“, is reportedly the largest study to examine the pneumonia/apnea link.

According to the an MNT report by Catharine Paddock, PhD, Dr. Vincent Yi-Fong Su, of Taipei Veterans General Hospital in Taiwan, and colleagues, selected over 34,000 patients from Taiwan’s National Health Insurance Research Database (nearly 7,000 patients with sleep apnea matched to over 27,000 people without sleep apnea) for the study. They followed the participants for 11 years, from the beginning of 2000 to the end of 2010, and compared occurrence of pneumonia in the two groups.

“They found the group with sleep apnea had a 1.20-fold increase in incident pneumonia, compared with the group without sleep apnea (9.36% developed it in the apnea group versus 7.77% in the controls),” writes Paddock. “They also noticed that the people who developed pneumonia tended to be older and had more illnesses, such as diabetes, heart disease and dementia.”

While they did not explore the mechanisms linking sleep apnea with pneumonia, the researchers suggest it could be that people with sleep apnea are more likely to aspirate liquid from the throat into the lungs.

“Another reason could be a weaker immune system, which can result from frequently disturbed sleep,” reports Paddock.

Click here to access CMAJ abstract

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OSA Predictions from a Poke?

Researchers at the University of Saskatchewan took on a folksy question when they attempted to determine the “utility of the elbow” as an OSA predictor.

Mark E. Fenton, MD, along with six other researchers, sifted through multiple questionnaires, zeroing in on two questions: 1) Does your bed partner ever poke or elbow you because you are snoring?; and 2) Does your bed partner ever poke or elbow you because you have stopped breathing?

Researchers specifically sought to determine whether a simple two-part questionnaire has predictive value in the pretest clinical evaluation for OSA. The two questionnaires were prospectively administered to patients evaluated in a sleep disorders clinic prior to undergoing polysomnography. Age, sex, BMI, and Epworth Sleepiness Scale data were collected.

The study titled “The Utility of the Elbow Sign in the Diagnosis of OSA” is published in the recent edition of CHEST from the American College of Chest Physicians. According to the abstract, among the 128 patients who had a polysomnogram, answering “yes” to being awakened for snoring increased the OR of an apnea-hypopnea index ≥ 5/h 3.9 times compared with “no.” Answering “yes” to being awakened for apneic spells was associated with an OR of 5.8 for an apnea-hypopnea index ≥ 5/h compared with “no.”

“These associations did not differ by sex, BMI, Epworth Sleepiness Scale or answering ‘yes’ to the other question,” write researchers in the abstract. “Subjects > 50 years old with OSA were less likely to report a positive elbow sign and had a significantly lower OR for being awakened for apneic spells than those < 50 years old…Among patients referred to a sleep disorders clinic, a positive response to being elbowed/poked for apneic spells significantly improves the pretest prediction of OSA.”

Click here to read the Abstract

Source: ACCP

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