September 02, 2012

WCSA2012 - #4 - Sleep Apnea and Nothing but Sleep Apnea

The World Congress on Sleep Apnea provides a unique opportunity among the medical/sleep meetings I attend. This gathering exclusively addresses the condition that is my work—sleep apnea. It can be exhausting to spend so much time listening and learning on one subject, but heck . . . in this case, it is Rome.

Several of Wednesday’s presentations were particular provocative.

The first session of the day focused the thorny issue of scoring. At present there are several criteria for evaluating or scoring a sleep study.  How the study is scored can change the key measure of disease, the apnea-hypopnea Index or AHI. The presenter reviewed how two different scoring techniques, “Chicago” and American Academy of Sleep Medicine 7, could affect the estimate of prevalence of sleep-disordered breathing in the general population. Without getting into a lot of detail, suffice it to say that addressing this issue is critical to having consistency in our research.

This type of conference is also a venue for researchers to present preliminary data from their work. These “poster sessions” are occasions for researchers to get feedback positive and negative. Sometimes the work continues after this check-in. Sometimes it ends right there.

Two of these check-ins caught my attention this day – “Time- but not dose-dependent amelioration of obstructive sleep apnea by dronabinol” and “Predictive utility of a risk assessment for nonadherence to CPAP: nap index.”

The first is looking at using dronabinol, a cannabinoid medication (yup, you guessed it), to reduce OSA. Interestingly this component of marijuana affects the vagal nerve, which among things works on the muscles involved in the control of breathing. This research still in its early phases is exploring the possibility of a drug that could help treat sleep apnea, either alone or in conjunction with other treatments.

The second involves the use of a risk assessment tool that helps predict whether a patient prescribed PAP therapy will have difficulty adjusting to the treatment. The value of this tool will be better  identification of people who may need special attention early in treatment.

Another feature of these meetings is “industry-sponsored” presentations. Companies often present data about their products as well as details on what they produce. I was particularly interested in the Philips/Respironics offering titled “CPAP Compliance.” The first talk by Dr. Luigi Ferini Strambi of Milan – “What is the rationale for using CPAP and how much use is enough?”— was certainly a provocative title. Ferini provided a comprehensive review of the current medical literature on the benefits of using PAP therapy on cardiovascular, metabolic, and mental health issues.  As to the question of how much use is enough – the more the better.

This is an exciting time to be involved in the field of sleep medicine, and I am pleased to serve as a conduit conveying information to patients.

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