With much of the sleep world convening in Minnesota for the past few days, and into next week, many sleep specialists are likely reading the latest news on a laptop or smart phone.

website for the AADSM show http://www.aadsm.org/annualmeeting.aspx

website for the AASM show http://www.sleepmeeting.org

The American Academy of Dental Sleep Medicine will finish its 23rd Annual Meeting in just two days, and by most accounts, organizers succeeded in helping attendees gain clinical insight about the latest developments in oral appliance therapy.

The 2014 meeting included educational courses for all experience levels for both clinicians and staff. The meeting also had an exhibit hall for dentists to gather information about the latest products and services and opportunities for networking.

Of course, SLEEP 2014, the 28th Annual Meeting of the Associated Professional Sleep Societies LLC (APSS) continues today in Minneapolis, running through to Wednesday, June 4, 2014, at the Minneapolis Convention Center. Attendees at the meeting will be able to choose from more than 90 clinical and scientific sessions, plus dozens of ticketed courses and events.

Sleep Diagnosis and Therapy editors Alan Hickey and Maura Konwar will be attending SLEEP, and can be reached at alan@sleepdt.com and maura@apolismedical.com

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The hormone melatonin is well known for its role in regulating circadian rhythms, but a new study suggests it may also lead to greater bone density. So far, the bone building effects have only been demonstrated in elderly rats, but researchers are already looking to a possible osteoporosis prevention role in humans.

According to a study “Melatonin dietary supplement as an anti-aging therapy for age-related bone loss” led by Faleh Tamimi, a professor at McGill’s School of Dentistry in Montreal, found that supplemental doses of the naturally occurring hormone increased bone strength in elderly rats. “As we age, we sleep less well, which means that the osteoclasts are more active,” says Tamimi. “This tends to speed up the process of bone breakdown.”

In the study, twenty 22-month-old male rats were reportedly accommodated at the University of Madrid and given melatonin supplements diluted in their drinking water. After 10 weeks, or approximately six human years, bone density and bone strength tests revealed increased volume and density in the test group and little difference in the control group.

Despite positive results, Tamimi says more testing is necessary to determine whether supplemental doses of the sleep hormone are preventing bone breakdown or reversing it. “Until there is more research as well as clinical trials to determine how exactly the melatonin is working, we can’t recommend that people with osteoporosis go ahead and simply take melatonin supplements,” says Tamimi.

Click Here for Abstract

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Sleep news continues to pour forth from this week’s American Thoracic Society International Conference, with the latest research declaring that home testing of sleep apnea followed by initiation of home treatment with an auto-titrating CPAP device reduced costs compared with in-laboratory testing and titration. Furthermore, home testing did not negatively impact clinical outcomes.

“While the use of home testing and initiation of CPAP therapy is increasingly common, studies of its cost-effectiveness are scarce,” said lead author Charles W. Atwood, Jr., MD, associate professor of medicine at the University of Pittsburgh School of Medicine and director of the Sleep Disorders Program of the VA Pittsburgh Healthcare System in a NewsWise summary. “In our randomized study, sleep-related costs were substantially lower for patients who underwent home testing and treatment initiation than for those who underwent laboratory testing, and this cost saving was accomplished without sacrificing clinical quality.”

According to a news report, the study enrolled 296 subjects, 113 of whom began CPAP at home and 110 of whom began in a laboratory. Assessment with the Functional Outcomes of Sleep Questionnaire, a disease-specific quality of life questionnaire designed to assess the impact of sleep disorders on activities of everyday living and the extent to which these abilities are improved by treatment, showed no significant difference in outcomes between groups.

Publication summary:

Cost-Effectiveness Of Home Management Of Obstructive Sleep Apnea: The Veterans Sleep Apnea Treatment Trial, [Publication Page: A3672]C.W. Atwood, MD¹, S.T. Kuna, MD², K.C. Little, MS¹, S. Hin, MS², R. Gupta, MS², I. Gurubhagavatula, MD, MPH², H. Glick, PhD^2
1Pittsburgh, PA/US, ²Philadelphia, PA/US

Click Here to access ATS abstracts and presentations

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Umbian Inc, a ResMed company and provider of cloud-based healthcare compliance solutions, released study results this week that show measurable efficiency gains when using the automated messaging capabilities of its U-Sleep compliance management solution.

The study, funded by ResMed, revealed a 59% reduction in labor associated with intervening with and coaching patients on CPAP therapy when using U-Sleep. The study was presented this week at the American Thoracic Society (ATS) 2014 International Conference in San Diego by lead investigator Dominic Munafo, MD, DABSM, medical director, Sleep Data Inc, and was supported by Umbian and ResMed.

“This is an opportunity for home medical equipment (HME) providers to redesign the way they interact with patients to improve efficiency, and therefore their bottom line,” said Raj Sodhi, president of Umbian. “Every HME is under pressure to minimize the costs associated with gaining compliance, and these findings show that U-Sleep’s automated messaging can help significantly.”

The goal of the study was to compare the effectiveness and coaching labor requirements of a web-based, automated messaging (via U-Sleep) with standard-of-care CPAP adherence coaching, and measure the coaching labor necessary to achieve Medicare-defined adherence. A secure and flexible compliance solution, U-Sleep monitors CPAP device usage and helps HMEs coach and manage their patients during therapy.

To evaluate the effect of automated messaging on coaching labor and patient adherence, researchers conducted a multi-center, prospective trial of patients newly diagnosed with obstructive sleep apnea. A total of 122 patients completed the three-month study follow-up, with 58 in the U-Sleep arm and 64 in the standard-of-care arm. All patients were set up on a CPAP device with heated humidification and a ResMed wireless modem, and both groups received identical CPAP education and orientation.

The U-Sleep arm received an automated series of text messages and/or emails triggered by one of five situations that indicated non-compliance, such as No CPAP data for two consecutive days or CPAP usage of less than four hours for three consecutive nights. In contrast, the standard-of-care arm received scheduled telephone calls on days one, seven, 14, and 30.

Reducing Labor while Increasing Compliance

The results of the study reveal a significant reduction in the mean number of minutes of adherence coaching required per patient for the U-Sleep arm, equating to a 59 percent reduction in labor. In addition, there was an observed difference of +10 percent in Medicare-defined adherence for the U-Sleep group (83 vs. 73 percent). Medicare-defined adherence is the documented use of CPAP therapy for at least four hours per night for 70 percent or more nights during a consecutive 30-day period within the first 90 days of therapy.

As the number of people using CPAP therapy to treat sleep apnea increases, the ability to efficiently and effectively monitor and manage CPAP therapy becomes a critical aspect of healthcare.

“Scaling to meet the growing sleep apnea patient base requires new ways of thinking for HMEs,” said Sodhi. “Using automated messaging technology to keep patients on track with therapy has the potential to increase an HME’s patient base capacity, and improve a growing number of lives.”

Source: ResMed

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New research reveals that activity among neurons that keeps heart rate low is reduced among the people with sleep apnea.

The study titled “Chronic intermittent hypoxia‐hypercapnia blunts heart rate responses and alters neurotransmission to cardiac vagal neurons” was published in the Journal of Physiology

A summary reported that researchers at the George Washington University state that in sleep apnea, neurons in the brainstem that controls heart rate experience a reduced activity. This diminished neuronal activity then activates increased heart rate, blood pressure and also the risk of adverse cardiovascular events in OSA patients.

Lack of oxygen during these incidents puts the sufferers in lighter state of sleep or brief wakefulness for restoration of normal breathing. Cycles of interrupted breathing and arousal from sleep can occur as frequently as once per minute.

“Lack of sleep leaves the mind and body tired, leading to poor mental and physical performance, and if untreated OSA increases a person’s risk of developing hypertension and irregular heartbeats,” said lead study author Dr David Mendelowitz. “Therefore it is very important that we have discovered some of the underlying mechanisms that could injure the heart and other cardiovascular tissues.”

The team explored these mechanisms in rats, by mimicking OSA for four weeks and studying the changes in blood pressure, heart rate, and synaptic activity in parasympathetic neurons that control heart rate.

Future work will need to build from this foundation and focus on finding targets to restore the usual cardio-protective function of these neurons to help reduce the risk of arrhythmias, elevated heart rate, and blood pressure that occur with this disease.

Click here to Read Abstract

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A nationwide “Sleep Well, Be Well” campaign is being launched this week as part of the National Healthy Sleep Awareness Project, a collaboration between the American Academy of Sleep Medicine (AASM), Centers for Disease Control and Prevention (CDC) and the Sleep Research Society (SRS).

The campaign will promote widespread awareness of the dangers of chronic sleep loss and untreated sleep illness, encouraging Americans to achieve healthy sleep for improved overall health.

“The urgency of our message cannot be overstated: Sleep is a necessity, not a luxury, and the pursuit of healthy sleep should be one of our top priorities,” said Dr. Safwan Badr, president of the AASM and a national spokesperson for the Healthy Sleep project. “Sufficient sleep is one of the three pillars of a healthy lifestyle – as important as good nutrition and regular exercise. There’s no avoiding it or catching up: You must sleep well to be well.”

CDC data indicate that 28 percent of U.S. adults report sleeping six hours or less in a 24-hour period. Poor sleep health increases the risk of physical and mental health problems, mortality, accidents, injuries and disability.

“Poor sleep has a cumulative impact on nearly every key indicator of public health, including obesity, hypertension and diabetes,” said Janet B. Croft, PhD, senior chronic disease epidemiologist, in CDC’s Division of Population Health. “Healthy sleep is a vital sign of good health.”

The National Healthy Sleep Awareness Project was initiated in 2013 through a cooperative agreement between the Centers for Disease Control and Prevention and the American Academy of Sleep Medicine. The ongoing project involves a partnership between the AASM, CDC, Sleep Research Society and other collaborators to promote the importance of healthy sleep.

Source: American Academy of Sleep Medicine

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In the United States and around the world, CPAP compliance is an ongoing problem. Researchers at the Faculty of Medicine, University of Barcelona (Unit of Biophysics and Bioengineering), Spain, wanted to know if a telemedicine approach could work as well, or even better, than a face-to-face approach.

“We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management,” wrote researchers in the new study “Telemedicine-based approach for obstructive sleep apnea management: building evidence”. “The objective of our study was to evaluate the application of a telemedicine-based approach in CPAP therapy management, focusing on patients’ CPAP follow-up and training.”

Ultimately, more than 95% (49/50) of the interviewed patients were satisfied with teleconsultation, and 66% (33/50) answered that teleconsultation could replace 50% to 100% of their CPAP follow-up visits.

“OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training,” concluded researchers. “These results support the use of this telemedicine-based approach as a valuable strategy for patients’ CPAP training and clinical follow-up.”

Click Here to Read Full Study

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