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ATS 2007 wraps up / APSS 2007 soon begins

Posted Sep 12 2008 11:49am
The ATS meeting did not disappoint again this year... it never does!

Here are a couple of the interesting presentations I was able to attend...

Are patients with sleep apnea at risk for cardiovascular morbidity and mortality? This talk was presented by J.R. Stradling, MD from Oxford England. Professor Stradling is associated with one of our sister organizations The Sleep Apnea Trust.
Professor Stradling's presentation brought a hush to the room, which I found surprising until I listen to what he had to say and spoke with others who are familiar with his talks. He is well known for taking a critical look at current research and suggesting that it is not as solid as the authors would have you believe.

Heavy snoring as a cause of carotid artery atherslerosis. I was very interested in this presentation because it highlighted something I had discussed with Colin Sullivan last year concerning the potentially harmful effects of snoring.
Quoting from the conclusion of the study "In addition to known risk factors (age, gender, smoking hypertension), snoring (independent of nocturnal hypoxia and apnea hypopnea index) is a specific risk factor for carotid atheroscleotic plaque only. Snoring exerts a local pathogenic influence on arterial plaque formation, possibly via chronic carotid artery wall vibration."

One is left wondering if there is such a thing a benign snoring. Hopefully there will be follow-up on this study.

While this series of presentations was taking place, Dr. Alan Pack from the University of Pennsylvania Division of Sleep Medicine was presenting the Clinical Year in Review for Sleep Medicine. He highlighted four studies that he thought were particularly noteworthy.

1. Chronic intermittent hypoxia induces athersclerosis (Am J Resp Crit Care Med - in press) Important study since it is first study to directly demonstrate that chronic intermittent hypoxia (IH) plays an atherogenic role. But, the study infers that IH alone is not sufficient since in this case it also required a high cholesterol diet. The frequency and magnitude of IH in this study is fairly large. Future studies will need to establish dose response relationship to see the what frequency and magnitude of desaturations will produce atherosclerosis.

2. Diagnosis and initial management of obstructive sleep apnea without polymongraphy. A randomized validation study. (Ann Intern Med 2007; 146:157-66) The study demonstrated that similiar improvement in reduction of Apnea-Hypopnea Index (AHI) and sleepiness (using the Epworth Sleepiness Scale) between patients using the traditional in-lab polysomnography and a group using an auto-titrating CPAP to determine the required pressure to treat their apnea. Noteworthy was that patients in the auto-titrating arm has greater compliance than those in the traditional arm.

3. Impaired performance in commercial drivers. Role of sleep apnea and short sleep duration. (Am J Respir. Crit Care Med 2006;174:446-54) This was the largest, most in-depth study of performance and its determinants in commercial drivers. The study showed that a substantial percentage of drivers in the the sample had performance impairments. The major determinants of performance impairment and excessive sleepiness were severe sleep apnea (AHI > 30) and short sleep duration ( < 5 hours). 4,500 people are killed each year in crashes involving commercial drivers. Treating the sleep apnea could reduce that number.

4. Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial. (BMJ 2006;332:266-70) Dr. Pack noted that this was a provocative study, but that due to the small sample size(n=25)it could be a false positive result. And while it is very unlikely to be used clinically, the study does raise an interesting new concept for treatment od mild disease. Finally, he said that it is of interest that both CPAP and the didgeridoo are Australian inventions.

I am usually fortunate to have help in the booth in the exhibit hall. The day can get awfully long standing there by yourself. Earlier this year I made a point of announcing the conferences where we would be exhibiting in the ASAA newsletter and asking for volunteers. Several people stepped forward and offered to help.

Thanks Dean Dizikes and Rob Flandermayer for their help at the booth and offering the patient's perspective to those with questions about sleep apnea.

For the third year in a row the ASAA has provided patient speakers to during one of the symposia on sleep disorders. This year Ruth Kwitko Lym provided her insights into sleep apnea to an assembly of physicians.

Working in the exhibit hall is always interesting, particularly at the ATS show. Physicians and researchers from around the world stopping by to see what we are doing to help doctors help their patients. There is much interest in helping to establish branches of the ASAA in other parts of the world.

I will close out my fourth ATS conference with a note thanks to the members of the Respiratory Neurobiology and Sleep Assembly of the ATS for letting me join them for their Assembly dinner and to ask them not to lose heart, that we at the ASAA are working diligently to raise the money necessary to participate in the matching grant program.

On to the Twin Cities and the Associated Professional Sleep Societies (SLEEP 2007) meeting... stay tuned for news from there.
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