ATS 2007 wraps up / APSS 2007 soon begins

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.

On the road again - ATS in SFO

This my fourth international conference of the American Thoracic Society (ATS). The ATS meeting was the first medical conference I attended as executive director of the ASAA back in 2004.


The ASAA participates as an exhibitor at medical conferences like the ATS meeting as one of the ways we stay in touch with medical professional - in this case those involved in research on sleep disorders like sleep apnea. It is important that physicians, especially research doctors don't lose touch with the patients they are treating.


We are fortunate to patient volunteers interested in helping staff the booth and to speak with the doctors.


This meeting in particular provides an excellent opportunity to learn what is on the cutting edge of sleep apnea research. I will be pouring over the book of research abstracts for interesting posters to review.


Check back for updates over the next couple of days.

Ut Prosim - That I may serve - 3 years at the helm

May 4th marked the beginning of the fourth year that I serve as the executive director of the American Sleep Apnea Association.

Perhaps it is fitting that I note the day while on the campus of Plymouth State University where my son is a second semester freshman. The motto of the school is the Latin in the title.

The work I am doing feels so right. My diligent efforts to expand and enhance the resources the association makes available to those seeking information and support, are making a difference. It would be too much to say I am saving lives, but fair to say that I am improving the quality of lives for some who need help and seek it out.

There is more to do... so much more to do, that sometimes I am overwhelmed. The challenges of leading a small organization with a large mission are many, but I endure; helped by the members of our Board of Directors and through the financial support of many (large and small).

My proudest accomplishments came late in my third year... the 3rd Sleep Apnea Awareness Day lecture, was probably the best one to date. In addition to Terri Weaver speaking on the efforts of snoring and sleep apnea on the family, Ashley Keenan spoke on her experience as a young woman living with the condition and ASAA Board member Nancy Rothstein provided compelling reasons for the need to do more. It is available on the Internet and as a DVD as a permanent record of the event.

The Apnea Advocacy Action Program... our entrance into grassroots advocacy. Apnea patients have an easier way to speak up and speak out on issues of importance to them and their families. Our first "call to action" is in collaboration with the National Sleep Awareness Roundtable and involves asking Congress to provide additional funds to the CDC for data collection activities on sleep and sleep-disorders. I am pleased with the response and look forward to further developing this resource.

Finally, this accomplishment is still in process Assistance Program (CAP). In partnership with , but is likely to be among the most beneficial... the CPAPResMed the ASAA will make available a limited number of Positive Airway Pressure devices through the A.W.A.K.E. Network of support groups to those who have no insurance and cannot afford to purchase a device. This is a pilot program and one I hope we can expand. I highlight still in process, because the details of the program are being finalized now. Stay tuned for developments!

I'll close this first post in a long time with a necrology. Two people, on nearly opposite coasts, from two very different stations in life passed away over the weekend... former football player Kevin Mitchell (age 36!) and a young man just shy of his 20th birthday, Nate Williams... both died in their sleep. The disclosed culprit in one case was sleep apnea. In the other, it can be safely assumed that OSA played a part.

There much too much still to do... watch this space for updates from the medical conferences starting later this month... please continue to support the important work of the ASAA with a financial contribution.

All the best,

ED