WCSA2012 - #6 – Faces of sleep apnea

The last full day of the World Congress on Sleep Apnea began with a presentation by Dr. Josep Maria Montserrat of Barcelona with another vexing issue in sleep medicine – auto-titrating positive airway pressure devices. His presentation outlined the work he has done to understand the technology and how it can benefit the patient, particularly as a means of titrating the proper pressure to use with a PAP device.

One telling comment he made after mentioning that the algorithms for the different APAPs differ from one another and that they change from one generation of the device to the next without the manufacturer’s announcing the change. The technology has gotten ahead of the science, he said. I had heard this comment at another conference a number of years ago – it was troubling then and it remains  troubling now.

The second talk of the day, perhaps my favorite of the congress, was delivered by Dr. Meir Kryger of Yale. His talk was titled “Faces of Sleep Apnea.” Kryger has, by his count, treated 12,000 patients since 1972 when he started in the field of sleep medicine. His presentation consisted of pictures of sleep apnea patients he has treated over the years. Some of the faces were familiar typology for the OSA patients and some were not. Each image had a story and it was clear that he cared about each one. His talk reminded those present that the physical examination and the patient history are critical to getting to a diagnosis.

The congress ended without a clear statement on where the event would next be held. Pressure from the sponsors of these events to consolidate the number of sleep medicine conferences leaves the date of the next World Congress on Sleep Apnea open. Perhaps it is fitting that the last scheduled congress was held in the Eternal City, the place I call my spiritual home.

Arrivederci!

WCSA2012 - #5 - New under the sun

In an earlier post I mentioned that conferences like the World Congress on Sleep Apnea provide an opportunity to present information on work in progress. Today I add that they also serve to bring people up to date on later stages of development.

On Thursday Dr. Alan R. Schwartz, a pulmonologist from Johns Hopkins School of Medicine, provided a review of the current literature on neuromodulation of the upper airway in OSA. Currently there are three companies in various phases of clinical trials using neurostimulation of the tongue to prevent sleep apnea from occurring. The results so far are mixed, with each company reporting different levels of success.  The use of a “pacemaker” to treat sleep apnea likely will be a component of future OSA treatment. How many companies will be engaged remains to be seen.

Pediatric OSA was a significant topic area during the conference. One of most promising treatments for OSA in children is rapid maxillary expansion.  Dr. Paola Pirelli, an orthodontist who pioneered the use of RME, reported on the use of this technique.

The most interesting poster of the day, for me, added to the debate on calculating severity of sleep apnea. Prof. Andreo Larsen from Finland presented “Apnoea Load – A new supplementary index for assessing sleep.” He argued that the current measure of severity, the apnea-hypopnea index or AHI, does not take into consideration time or duration. He believes that a patient with longer apnea events (spending more time in a hypoxic state) has more severe disease than someone with the same number but of shorter duration.  He calculates the apnoea load or AL by taking the average number of apneas per hour times the average duration of apneas in minutes. The AL would be a useful supplement to the AHI to identify borderline cases.

I am confident that the field of sleep apnea research is good hands. My only worry, and it is not small, is who is dictating the direction of the work.