June 26, 2006

Sleep 2006 part one

Unlike the other conferences I attend on behalf of the ASAA, the Sleep meeting has the most content on sleep apnea. I am likely to be overwhelmed by trying to recount every detail of the meeting affecting my topic of interest... witness my earlier post.

The science is important, very important, but for me so are the people. The sleep field is filled with charactors, some of whom I have mentioned in this journal.

I have had the wonderful opportunity to become friends withDr. William C. Dement. He is considered by some to be the father of sleep medicine. I am not certain about that claim, but what I do know for certain is that he has for many years been the most vocal person around about the importance of sleep and sleep research. If he is speaking and there is a way for me to get there I go to listen to him. This time he was providing the keynote address to Sleep Research Society trainee day. Bill was relating experiences from the early days of his sleep research. In his powerpoint presentation he included pictures of himself with a narcoleptic dog (included here). The photographer doing a story about the research Dr. Dement was doing with these special dogs, wanted Bill to hold the dog until it had a bout of cataplesy and went limp. Bill related that holding the dog in sun made it a whole lot longer to happen. Everyone got a good laugh.

The Sleep meeting also afford me the chance to with a group, last year only two, physicians, surgeons actually who also attend the meeting. Dr. Edward Weaver and Dr. Tucker Woodson are Ear, Nose and Throat Surgeons who are very interested in sleep medicine. They offer a very different perspective from what hears the pulmonologists - who make up a large portion of the sleep physician community.

Ed, Tucker and I had pizza and beer on Sunday with a couple of other ENTs and Dave Hargett (the ASAA board chair). To hear them tell it... they have a strong commitment to PAP therapy in OSA patients. If one accepts Dr. Guilleminault's assumption that sleep apnea starts at the tip of the nose, the ENT very definitely has a role to play in the treatment of sleep apnea.

Next the exhibit hall...

June 18, 2006

Learning what I know... Dental Sleep (Part II)

The beauty of not being an exhibitor is that you can spend all your time at the educational sessions. This year as in past years, courtesy of the management of the ADSM I have attended the meeting at no charge - thank you management of ADSM!

There was an excellent review of sleep disorders and how oral applicances are a treatment option for some sleep apnea suffers. What followed the overview were three presentations - one on sleep apnea and metabolic syndrome, sleep apnea and cardiovascular disease and sleep apnea and oxidative stress and inflammation.

The case for a relation between sleep apnea and metabolic syndrome has always been clear un my mind. But in the first presentation, Naresh Punjabi, M.D., Ph.D. from Johns Hopkins established rather persuasively that OSA and metabolic syndrome are linked through a condition that develops in people with both conditions - obesity.

The second presentation was offered by Dr. John W. Shepard, Jr. of the Mayo Clinic. He began talking about breathing and the problems caused to the heart by the cessations in breathing that occur during apneas. He presented through numerous diagrams and charts that described the acute cardiovascular responses to asphyxia (which is what happens, for some, countless times during the night. He closed his presentation with the Ode to the Pickwickian (an allusion to the Dicken's novel the Pickwick Papers where a character with a form of sleep apnea was first described).

The third presentation in this series was from Virend Somers... who I had met while in Detroit earlier in the year. His presentation took the discussion to a whole different level... the molecular level. There are three actors in his drama - Adioponectin, C-reactive_protein (CRP)and Leptin. The stage where this drama is played out is in the Endothelium. Without going into a lot of detail... which is more than I can do. CRP had been shown to be a mediator of heart disease and sleep deprivation increases the amount of CRP in the blood stream. More CRP... more heart disease.

The keynote address was delivered by Dr. Remmers and his presentation was an exhordation the sleep dentists assembled to do more to recognize and treat sleep apnea. He used the series of slides showing the increase in obesity in the United States from 1990... it is frightening! As he was speaking I thought to myself... I should comment on the Institute of Medicine (IOM) report about the need changes in diagnostic technology. And as if he was reading my mind he mentioned the IOM report. Nothing like having your sentences finished by someone you admire.

I can see why the sleep dentists made Dr. Remmers and honorary member of the Academy.

Next... onto the main event... Sleep 2006

June 17, 2006

Dental Sleep Meeting Part I

The Academy of Dental Sleep Medicine (ADSM) meeting is much smaller than the American Academy of Sleep Medicine (AASM) meeting. It has a much different feel. Dentists who decide to pursue dental sleep medicine are a dedicated lot and very interested in learning about sleep apnea... the condition that they treat through the use of oral applicances.

Recently a number of changes... updates have occurred that has made the practice of dental sleep medicine much more interesting. Late last year the AASM released a revised set of practice parameters for the use of oral appliances in the treatment of certain forms of sleep apnea... mild to moderate (AHI = 5 to 30). So the field got the formal blessing from the sleep doctors. Second and perhaps just as important happened at the beginning of the year without a lot of fanfare. The Centers for Medicare and Medicaid Services approved two reimbursement codes for the use of an oral appliance for the treatment of OSA.

These codes will make it possible, at some point in time in the future (perhaps a year from now), for people getting a device to be reimbursed by their insurer. Up to now, there hasn't been insurance coverage, so other payment arrangements were necessary.

So these are exciting times for the sleep dentists. There are still some impediments to their being able to diagnose *and* treat the patient, but let's let them savory the advance in peace... for now.

If it is a medical meeting, there has to be an exhibit hall. This is not one where the ASAA exhibits, though in the future we will need to strongly consider doing so. It is a small meeting ( a couple of hundred attendees) and so a small exhibit hall. The majority of exhibitors are manufacturers of the applicances themselves. A recent entry to the field is Respironics. They will begin marketing, in July, a "boil and bit" type applicance that comes in three settings: 00 (no adjustment forward) 2.5 (the lower insert is advanced 2.5 mm forward) and .5 (the lower is advanced 5 mm forward). This device is intended as a spare appliance or perhaps something for a CPAP user to use when they are away from the power grid to use their machine.

This could be a signal they are serious about oral applicances as an additional arrow in their quiver in the battle with OSA... very interesting. Another item they had was a single channel apnea screening device similiar to what ResMed has and has had on the market for a year or so.

One more item on the exhibit hall... in addition to the appliances there are sleep apnea screening devices. This is the equipment the dentist use to determine if their patients may sleep apnea before sending them for an overnight sleep study (a polysomnographic examination or PSG for short).

Among those marketing this type of machine was Dr. John Remmers of Calgary in the province of Alberta Canada... who is also an emeritus member of our board of directors. Dr. Remmer's has developed a very sophisticated unattended sleep apnea monitoring device. I had occasion to listen in while he reviewed a couple of test studies with attendees who stopped by. Certainly the technology is currently available to provide the precision needed to diagnose 99% of the sleep apnea cases out there without needing to have a PSG... now if only the "powers that be" could come to some agreement.

Next up... the educational sessions and the return of Dr. Virend Somers.

June 16, 2006

Sleep 2006 (the medical conference formerly known as APSS)

I am in Salt Lake City (SLC) for the medical conference , that for 20 years now, brings together all, or at least, most of the medical researcher and clinicians in the field of sleep medicine. APSS stands for Associatied Professional Sleep Societies. It is the umbrella organization for the American Academy of Sleep Medicine (primarily clinical) and the Sleep Research Society (primarily research). And like most medical conferences there are educational sessions and posters (my favorite), but it is also the occasion for other sleep related organizations to get together as well. While they do not meet at the same time, another group, the Academy of Dental Sleep Medicine has its annual meeting a couple days before Sleep.

I am in SLC two days early to attend the educational sessions for the dental group. Starting Sunday I will be reporting on the Sleep meeting and related activities.

June 02, 2006

On a personal note

I traveled to New York City yesterday to see my eldest child grduate from college. It was the first time in a number of years when we were all together. There are always complications when five people are all in the same place, but it was worth it.

In four years time, we will gather again to see my son finish and my youngest child start.

Time passes quickly.

Next time... notes from the Sleep meeting (formerly APSS)