The End of Sleep Medicine (Part 4)

 "You've come a long way baby" Virginia Slims cigarette tagline ~ circa 1968

Nearly five years since I have put pen to paper (so to speak) regarding the "end" or goal of sleep medicine. During that time I have, mostly quietly watched, the (r)evolution of the field.  I thought to provide some reflections on a field of medicine that was my professional life for 10 years. I would like also to thank again those who were my teachers and colleagues in the pursuit of helping those with the chronic health condition - #obstructive sleep apnea (OSA) - #sleep disordered breathing.

I recently had the occasion to visit a #CVS near me and found much to my surprise (though not really) the following displays

My earliest memories of serving as the executive director of the American Sleep Apnea Association was attending as an exhibitor at the #American Thoracic Society's 2004 International Conference in Orlando Florida. It was there I first met many of the men and women who would be my mentors. It was there I also met many of the reps of the device manufacturers #Resmed, #Respironics (now part of #Phillips Healthcare), #DeVilbiss, and #Fisher &Paykel.

While I was setting up the booth I had two encounters that have stayed with me. First was a woman working with the company setting up the exhibit hall. She saw the sign and stopped to tell me how her husband has #OSA. She lay beside him in the bed with her hand on his chest to make sure he was still breathing. This was my first encounter with sleep apnea - the first of what would be many during my tenure.

The second conversation I had was with a vice president for sales with #ResMed the number 1 or 2 in sales of #Positive Airway Pressure devices or CPAP.  I remember the conversation as if it was yesterday and these two images from CVS moved it to the front of my mind.  #Ron Richards said to me in five years you will be able to get these devices over the counter. If they work for you keep it (and use it) and if not bring it back. Like his boss, #Peter Farrell was fond of saying the only way one of these can hurt you is if it falls on your foot.

It took longer than five years and there are likely still a couple of hoops to jump through when it comes with the device, but at least when it comes to the supplies they are available when needed.

A second meaningful experience was the first time I provided testimony before a committee of  #Medicare regarding the use of #home sleeping testing (HST) for the diagnosis of #obstructive sleep apnea. This led to the publication of an open letter in the #Journal of Clinical Sleep Medicine.  It would be some years before the sleep medicine community would accept that #HST would not decrease the number of people seeking treatment for OSA and there would always be cases where the use of #HST would not be indicated. 

One of the many companies vying for a portion of the #HST market was a company using a different modality of measuring the incidence of pausing in breathing. #Itamar does not use the limitation of airflow into the lungs, something the pulmonary sleep medicine physicians were less inclined to accept as an accurate measure of disease. Without getting into the relative merits of the two modalities. #Itamar's technology  Here is an explanation of how this modality works.

Perhaps more important an alternate diagnostic modality was this technique engaged a medical community that heretofore had been reluctant to engage - cardiologists.  It is well known that untreated OSA has significant consequences on the cardiovascular system.  As far back as 2008 in the journal Circulation, there was the recognition that untreated sleep-disordered breathing is a driver of heart disease.  Perhaps the Itamar WatchPat technology spoke to cardiologists in a way ResMed Apnealink did not.   The important point here is cardiologists seem to be more engaged than previously.

Another memory - a well-respected sleep medicine physician would frequently say diagnosing sleep apnea as was so easy the janitor at the hospital where she practiced could tell just from looking a people in the waiting room whether they were positive for OSA.

The third and final meaningful experience happened at a medical conference where the ASAA was an exhibitor.  Our booth happened to catty-corner to that of the Board of Registered Polysomnographic Technologist (BRPST) and as it happened members of the American College of Chest Physicians happened to be passing by. The College had recently considered developing a certificate program for an allied health position for sleep, something akin to the Diabetes educator.  It was something subsequently they did not pursue.  But it was something I believed would be vital especially as #HST became more the norm than the exception.  I had always felt that successful treatment meaning being completely adherence to whatever therapy or treatment worked for the OSA patient was more important than how the diagnosis was arrived at. I knew both the representatives of ACCP and BRPST, and so I brought them together suggesting that BRPST take on the certificate program for what then call the sleep educator. It took some time and some hard work, but eventually, the CCSH program was born.

Perhaps it is fitting this blog post, the last in a series is published today on the 40th anniversary of the publication in the journal  The Lancet of Colin Sullivan's seminal research study 

Thank you to all my teachers, colleagues, and most importantly the patients who made this experience one I will always cherish.

When was the last time someone described what you had done as brilliant.

I have just returned from a brief trip to London where I participated in the Sleep Apnoea Trust Association's annual meeting, held John Radcliffe Hospital in Oxford (pictured here on the left).

I managed an invitation to speak at their annual meeting after a long correspondence with one of their trustees (Rob Holt) and their Chairman (Frank Govan). The ASAA has been on the mailing list of their newsletter for many years and I saw this visit an opportunity establish a personal connection with their leadership.

I had a wonderful time. Frank and his wife Wilma hosted me on the day I arrived. We had a number of long talks about operating a non-profit (read getting money) and about areas where we have mutual interests. Another guest at their home was Jean Gall who is the Chair of the Sleep Apnoea Scottish Association.

The next day was onto Oxford and SATAday (I love the name). The meeting drew about 300 people from all over England. It is similar to an A.W.A.K.E. meeting... with medical speakers (in this case Prof. John Stradling) and others from the hospital. There was an equipment fair and since there is no DME/HME arrangement in England - the manufacturers can sell direct to the patient (with proper documentation, ie prescription). Lunch was also served and there were "chatshops" or break-out sessions in the afternoon on specific topics.

I spoke in the morning session, following a presentation by Professor Stradling. My topic was OSA in the USA.

My title slide had two pictures of Jimmy Stewart. One from the Alfred Hitchcock film "Rear Window" and the second from the Frank Capra film "It's A Wonderful Life." I told the audience that many times in my capacity as executive director of the ASAA that I felt alternately like the Jimmy Stewart character in "Rear Window"; he was stuck watching a murder being committed and was somewhat powerless to do anything, I am stuck watching apnea patients not get the care they need at the hands of unethical sleep testing facilities or uncaring homecare companies (though unlike him, I don't have Grace Kelly to keep me company). On the other hand, sometimes I feel like Jimmy's character George Bailey in "It's a Wonderful Life" because despite all the bad stuff and my despair, the association has a positive influence and the apnea patient would be worse off if we weren't there.
My presentation had two objectives: providing some insight into healthcare in the United States in general and to provide some specific insights about the treatment of OSA for the American patient.

My brief discussion of the healthcare reform debate began by saying there are a number of challenges to reforming the system. The first is captured by a quote attributed to Princeton economist Uwe Reinhardt, Ph.D: Americans are the only people who think death is a failure of the healthcare system. The second has to do with the attitude towards the problem of obesity. Here I trotted out a slide that has become iconic on obesity. The audience had a good laugh on both comments.

The second part of my talk compared the way sleep apnea diagnosis and treatment are provided in the United States versus England. And while there maybe some shortcomings with the National Health Service, though less now that the National Institute for Health and Clinical Excellence has weighed in on the subject of treating sleep apnea; at least there is less chance of a patient falling through the cracks because in the U.S. in some cases the diagnosis is delivered by one medical professional and treatment is delivered/"monitored" by another possibly leading to what I called a bad Alfonse and Gaston routine.

The second point I made was concerning the technology to treat sleep apnea. The audience might feel a bit jealous that the devices available to treat sleep apnea in the United States is latest and greatest available compared to what is provided to them. But in actuality, the technology is like the bullet train passing Mt Fuji in Japan and getting ahead of the physician who prescribe them. The patients who consult the Internet learn about these devices and demand prescriptions specifying these machines, without the physician fully understanding if this is the

appropriate therapy for the patient.

My final point in this part of the talk was on adherence or compliance to therapy. For a number of different reasons adherence to therapy particularly with CPAP is not great averaging around 50%. Though this rate of adherence is comparable to adherence to therapy of other chronic diseases. That said, people are always looking for additional reason to use the CPAP... beyond that fact that it improves the quality and quantity of your life. I pointed out to the

audience the result of a recent study conducted in the U.S. showing that using the CPAP takes a stroke off your golf score and that an improved golf score was motivation enough to improve compliance with therapy... everyone wants to be Tiger Woods.

The audience was very appreciative and many made a point of coming up to me afterwords to express thanks for coming all that way to speak. They said the talk was "brilliant" and they usually had a story to share about a relative in the States.

I was happy to receive the invitation and would be happy to return at some point in the future to talk about sleep apnea diagnosis and treatment when healthcare reform is done.

International Symposium - Day Two

The second day of presentations was more along the lines I am familiar with... human beings.

The talks ranged from sleep disordered breathing and fragmentation in people with COPD to standard anthropometric measurements predicting SDB in active NFL players.

The most interesting talk of the many interesting talks came later in the day and was delivered by Dr. Andrew Wellman of Brigham and Women's Hospital in Boston. The title was "A technique for measuring ventilatory control stability (loop gain).

Loop gain is one of those concepts that comes up often in discussions about making CPAP therapy more comfortable for those with sleep apnea - Andrew explained this way - "Loop gain was calcualted by dividing the ventilatory response (the amount by wihich ventilation increased above eupnea when CPAP was turned back to the optimum pressure) by the ventiliatory disturbance (the amount by which ventilation was reduced below eupnea during the dial-down).

I am not doing his presentation justice, but Andrew Wellman is one to watch.

The second day concluded with a festive buffet dinner on the grounds of the Frick Mansion. The highlight of the dinner was the awarding of three young investigator awards in memory of Anne Elizabeth Suratt, the daughter of Paul Suratt one of the founders of the symposium.

The awards went to:

Kevin Grace from the University of Toronto his talk - "On the role of pedunculopontine tegmental neurons in the modulation of the REM sleep state and its respiratory phenotype"

Gaspard Montadon also from the Toronto - "State-dendent modulation of respiratory activity by perfusion of neuropeptides into the pre-Botzinger Complex of the adult rat in-vivo"

Josiane Broussard from the University of Chicago - "Experimental reducation of sleep duration or quality is associated with impaired insulin signaling in the adipocyte"

The symposium concludes today and I will be back with info and final thoughts. Let me say this, I am impressed with the enthusiasm of the young investigators - the field of sleep medicine is in good hands.

11th Symposium on Sleep and Breathing - Day One

I was never one that was particularly good at science. I think most of the instructors took pity on me and gave me a passing grade because my heart was in the right place (so to speak).

My work as the executive director of the American Sleep Apnea Association has so much more to do with the effects on humans of untreated sleep apnea and the challenges of adherence to treatment than with the mechanics of the breathing during sleep and the architecture of the upper airway. Though having something beyond a passing understanding of these topics is important, especially when thinking about the future of treatment for this condition.

So here I am, lovely Pittsburgh, home of the Steelers, Pirates and Penguins and the site of the 11th Symposium on Sleep and Breathing - a meeting held every two years or so that brings together the leading researchers in the field of sleep and breathing from all around the world.

Yesterday was the first full day, with 12 presentations and a featured talk from the Mark T. Gladwin, MD from the University of Pittsburgh it was quite a day.

Dr. Gladwin's speech on nitrite and the biology of hypoxic NO signaling was fascinating and one of the take aways is that cured meats may be helpful.

All of the other presentations were excellent - the format of this year's meeting was different from past years. In lieu of the senior researcher presenting, it is one of the junior researchers presenting work in progress.

All of the presentations provided insights to me and so were educational... the one that struck me the most was from a researcher associated with Dr. Montserrat of Barcelona Spain - Isaac Alemendros. The title of his talk was "Dyanamic changes in brain oxygen partial pressure during obstructive apneas."

The aim of his work was to carry-out a real-time measurment of tissue oxygen partial pressure (PtO2) in the cerebral cortex of rats during recurrent obstructive apneas mimicking those experienced by humans with OSA.

Conclusion - "These data suggest that the cerebral cortex tissue is partially protected from the intermittent hypoxia/reoxygenation stimulus induced by recurrent obstructive apneas."

Translation - It appears that that brain (in rats anyway) protects itself from damage from lack of oxygen during the on again/off again/on again that occurs during apneic events.

Great stuff!

Catching my breath...

It may be a cliche... but there just aren't hours in the day to get done everything that needs to be done and not the least of which is posting content in this space.

May 1st marks the beginning of year 5 as the executive director of the ASAA and I get the distinct sense that the great wave of awareness about sleep apnea is nearing the crest. All the work done by us and others is about to reap the award of national/international attention being focused on this life- threatening condition. One hint that "we" have arrived... Phillips, and a second... Medtronic and one more just for good measure J&J .

So I will pause to look back over the past year and couple months, but not for long. There is no resting on your laurels here... it is a lot more of "what are you doing for me NOW".

Two significant happenings, one internal and one external in the past year are likely to shape the future of the association's work and the focus of my activities:

• The completion of the video - What Is Sleep Apnea?

The video was unveiled to the medical community at the American Thoracic Society meeting in Toronto. There is was great interest among the physicians attending from outside North America. In fact, the video is now playing in Poland, Qatar, Venezuela and the Czech Republic. In addition to the English language version there is a version in Spanish as well. There were a number of inquiries about creating a version in Arabic, Portuguese and Chinese... (these are items for the ever lengthening to do list).

The video proved to be very popular at the Associated Professional Sleep Societies (aka Sleep) meeting as well. Sleep Technologists passing by the booth stopped to watch and took advantage of the discounted price to pick up a copy or two for the office. Watch it here.

The timing of creating this video could not be more on target and this is due to the second happening - the external one that will most definitely shape the future work of the association:

• Revisions to the Centers for Medicare and Medicaid Services - National Coverage Determination 240.4 .

This decision, which modifies the basis of how Medicare will provide reimbursement for the prescription of CPAP therapy for the treatment of OSA, is a watershed event. Once fully implemented, and the non-government insurance companies adopt (which they usually do to keep life simple) the practice of allowing the use of home sleep studies for the diagnosis of sleep apnea... there is likely to be many, many more people getting diagnosed and hopefully treated. There is likely to be many with questions and concerns. Who will they turn to when they can't reach their primary care physician, sleep specialist or the respiratory therapist associated with the home care company? Three guesses... Google - more on this next time.

I had the good fortune to have a friend recommend a book to me that significantly influenced the way I think about moving the ASAA forward... Good to Great, by Jim Collins and in particular the monograph he wrote for the benefit of non-profit organizations.

The beauty of this book and I highly recommend it to all people in either the for-profit or non-profit sector is the simplicity of the main idea for moving an organization from good to great... the Hedgehog Concept:
I am pretty clear on the two of the three circles...Our challenge in the coming months will be to answer the question - What drives your economic engine. It is vital that the leadership of the ASAA do so, because our long-term success depends on us clearly identifying what it is and using it to measure our success to those who will support our operations in the future.

Thanks for checking in and I will be back with future directions soon.

Notes from the ACCP meeting 10/2007

I did not attend the ACCP meeting in 2006, so this was my first time since their meeting in Montreal in 2005. One thing I noticed immediately was the number of physicians from overseas. I had not thought of this professional society as garnering that much interest from outside the country, but it did. I relish the opportunity to share our educational materials with physicians from outside the US and to help them help their patients be more adherent to therapy.

A first for the ASAA in a long time was sharing a booth with our colleagues at the National Sleep Foundation. Unlike NBC4 at the DC Convention Center some years ago, they joined us and I feel it worked out well. We will share a booth at the American Public Health Association meeting in early November.

I was able to attend a few of the educational sessions. One presentation was an update of the consensus conference hosted by the ACCP Sleep Institute last year. The presenters described the process used to formulate the consensus and the initial results. Their hope is to publish the results in the Spring of 2008 and to hope a follow-up conference on implementing a continuity of care strategy for OSA patient next year as well.

A second presentation and where I stood up to comment, was on the screening of hospital in-patients for OSA - pro and con. The pro side was offered by Dr. Anne O'Donnell of Georgetown University and Dr. Barbara Phillips of University of Kentucky (and incoming chair of the Sleep Institute) argued the con side. Having just been to the Anesthesiologist meeting in San Francisco I did have a couple things to say... including how I was feeling the "love" from the anesthesiologists, more so than from the sleep doctors - it got a chuckle.

The third presentation offered an interesting insight. Dr. Peter Gay from the Mayo Clinic provided an excellent overview of the technological advances in continuous positive airway pressure therapy from when it was first created by Dr. Colin Sullivan in 1981. The title of his talk was "Industry and Sleep Physician: Rowing in the Same Direction?" His thesis is that the advances in PAP therapy have gotten ahead of the sleep physician/researchers. Changes in PAP sleep apnea treatment are being dictated by forces other than changes in physician's understanding of how to treat the condition. Interesting food for thought.

ACCP is in Philadelphia next year.

Can you spell... an·es·the·si·ol·o·gist

I am among the fortunate to have required general anesthesia only a couple time in my life and the second was after I had become the E.D. of American Sleep Apnea Association. The anesthesiologist, learning of my relationship to the association, came in before the procedure and talked my ear off (in a nice way) about the problem of undiagnosed OSA patients coming in to the ambulatory surgery center and she having to deal with them... meaning not be a party to their sudden or not so sudden demise after administering anesthetics.

It makes complete sense that an anesthesiologist would be concerned about an undiagnosed OSA patient. According to Dr. Johnathan Benumof, whose presentation I attended on Saturday, there are three points at which the anesthesiologist should be concerned about an OSA patient, treated or untreated... intubation - administering the anesthetic too soon may cause the airway to close thereby making it very difficult to put the breathing tube in the throat. Extubation - for the same reason, but in reverse and pain management, post operative... many of the opiod-type pain medicines can suppress breathing and with the OSA patient the problem is compounded.

Dr. Benumof's presentation to a nearly standing room only hall provided an excellent overview to OSA and explained, briefly the guidelines adopted two years ago by the American Society of Anesthesiology on management of the OSA patient.

I was able to attend a clinic forum where the case study was a man who is suspected of having sleep apnea come in to an ambulatory surgical center for repair to his rotator cuff. It was interesting to listen to their discussion, many of whom believed that the surgery, for a number of reasons should be done in a hospital setting where it would be possible to monitor the patient after the surgery... since the surgery itself is not the problem, but the pain management afterwards is.

Dr. Benumof admonished those assembled during his talk that they were likely the last physicians to see the patient and it was their responsibility to make sure they received the proper care. It is very true... on more than one occasion, the surgery has been a success, but the patient dies in the recovery room or "out on the ward" because they were not properly monitored or given the correct analgesia given their diagnosed and not announced or their undiagnosed obstructive sleep apnea.

For those with sleep apnea reading this... please say something before going in for surgery or a procedure requiring anesthetic (think colonoscopy)... click on the links below for more information. If you have not been diagnosed and it is clear from looking at you and asking a couple of telling questions that you are at risk of OSA... you may find yourself diagnosed before you leave the hospital after having surgery. Assuming you leave under your own steam and not feet first.

The conversations in the exhibit hall have centered on our most recent Patient Education Bulletins on CPAP in Hospital and the checklist. Our web site has more information for the anesthesiologist, but looking at it, it needs some work.

There is potential for great synergy with this group of doctors who are very interested in this subject. I will move it high on my list of relationships to explore.

Next week Chicago and the American College of Chest Physicians

PS... found in my fortune cookie after dinner last night... You could make a name for yourself in the field of medicine... nice thought!

APSS 2007 ... the sleep meeting

The annual Sleep meeting is the most important medical conference the ASAA attends each year. It is so for a number of reasons... not the least of which is to see who is there and to be seen by the other organizations that attend. Not to be at the APSS meeting, especially if you represent a sleep-related disorder, leads one to wonder if there is a problem. Happily, the ASAA was present in full force... including some volunteer patient members of the association. Thanks to Robert and Jean, Lionel, Bob and Jim for helping at the booth during the three days of the meeting.

The annual meeting is also an opportunity to bring together representatives of the Industry Roundtable, the corporate supporters of the ASAA. It is our practice to have a speaker on a topic of interest to the members. Our hope is to expose them to something they might not otherwise hear about in the sleep apnea field (without a lot of looking). I was fortunate to have Dr. Susheel Patil from Johns Hopkins Hospital on hand to speak on a subject he has done extensive work on and had published a study in the Journal of Applied Physiology. He gave an excellent overview of the subject.

There are many treats to attending the Sleep meeting. Among them this time was visiting with Colin Sullivan and meeting his wife Janette. I thoroughly enjoy talking with him and wish him only great success.

I was not able to attend as many of the educational sessions as I had hoped. But an important one was on portable monitoring of suspected sleep apnea. A majority of the presenters were associated with Veteran's Administration hospitals and they had, due to the sheer number of patients needing to be seen, developed a protocol incorporating at-home studies for diagnosing sleep apnea. Dr. Nancy Collop chaired the session and she is also the chair of a task force organized by the Academy of Sleep Medicine on this subject. The task force is to due report thei findings later this year. A highlight of the meeting was when William Dement introduced Colin Sullivan as the one person who made it possible for everyone in the room to do what they do... there was a standing ovation for him... way cool.

Something new this year was leading a discussion group with Dave Hargett, ASAA Board Chair, on improving patient adherence to therapy using the support group model. I enjoyed the opportunity to present information to interested sleep techs.

A number of good conversations with a number of people and so, a productive meeting for me. The next Sleep meeting is closer to home in Baltimore next year.

I get a bit of a respite for the summer before we conclude the season with three meetings... Anesthesiologists, Chest Physicians and for the first time under my watch... the American Public Health Association.

I'll be back.

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.

National Patient Sleep Conference

What I report on here are generally the medical conferences I attend, but the last weekend in October I had the pleasure of participating in something entirely different... the first ever conference on sleep disorders oriented to patients.

The event was organized by Talk About Sleep, an online distributor of CPAP equipment and longtime sponsor of message board support group of the same name.

Our part in the conference was to secure some of speakers for the sleep apnea break out session and to publicize the event broadly. I was fortunate to get David Rapoport to speak. He gave his talk to the apnea patients as well as the sleep techs who there for a continuing medical education program. Also participating was Colleen Bazzani, who is the director of patient education for a large hospital in Minneapolis.

In addition to David and Colleen presenting in the OSA breakout sessions was Sleep Dentist Gail Demko, who provided an excellent overview of oral applicances for the treatment of sleep apnea. Thinking about it now... I realize that what was missing was a presentation on the role of surgery in the treatment of OSA (something to keep in mind for a future conference).

The attendance at the conference was less than what the organizers had hoped for, but those who were there were very interested in learning more about their condition. At the dinner presentation hosted by ResMed, David Rapoport and shared a table with an apnea patient from New England. He was frustrated by the care he was receiving at home and came searching for more information. Knowing more, he could be proactive in his care instead of reactive. Empowerment... that is what it about.

An important example of empowerment was Dr. Matthew Abraham's presentation on understanding your sleep study. Certainly, a presentation like this is a must for any future conference.

The general session on Sunday morning led off with Dr. Dement ( Click here for Dement post from Sleep meeting ). Bill provided an overview of his work in the field of sleep research. It was clear the audience thoroughly enjoyed his talk and there were many lined up for to autograph is his book The Promise of Sleep.

Life is all about serendipity. As I was getting on the elevator at the hotel I met Mark Bronstein, an attorney who would be speaking about sleep disorders and disability on Sunday. Turns out that he answered questions in the Ask the Lawyer column that ran in the earlier incarnation of the ASAA newsletter. I was happy to meet him and we agreed to working together in the future.

It is not for me to judge the first National Patient Sleep Conference... but this I can say - the conference provided an excellent opportunity for motivated patients to learn more about their condition and to share experiences that might not otherwise be able to do on a local level.

I look forward to a future patient conference.