Sleep Dynamic Therapy

Archive for the ‘SDB’ Category

My research team will be in Baltimore for the annual APSS, presenting 5 works from the past year, including:

1. Oral presentation by me on the topic of “Sleep Disordered Breathing in Patients Dependent on Prescription Sleep Medications.”
2. Oral presentation by Eddie Romero on the topic of “Nocturia as a Screening Tool for Sleep-Disordered Breathing.”
3. Poster by Linda Trujillo on the topic of “Self-Guided Imagery for Insomnia Patients undergoing Polysomnography Testing.”
4. Poster by Natalia McIver on the topic of “Self-Guided Imagery for SDB Patients undergoing a Polysomnography Titration.”
5. Poster by Eddie Romero on the topic of “Nocturia as a Screening Tool in Insomnia Patients with Potential Risk for Sleep-Disordered Breathing.”

This media piece on recent research about UPPP fails to make note of the frequent side-effects induced by this procedure. The technique sometimes worsens sleep breathing problems in patients, but more importantly, UPPP sometimes makes it more diifficult to use CPAP in the future. A simple Google search provides many links discussing these problems and more.

Today, at my talk at Sandia National Laboratories, the audience was interested in my opinion on the recent article on sleep duration in relationship to premature death from heart disease. As I’ve pointed out previously, these studies are incomplete works because they are looking at a sleep quantity model. Yet, the real insight is mostly likely explained by underlying physiological sleep disorders that causes one group to sleep too long (for example, classic sleep apnea patients with hypersomnia) and one group to sleep too short (for example, sleep breathing patients with a co-occurring problem of insomnia). Both types of patients have an underlying physical sleep disorder, but they look very different due to their pronounced differences in sleep duration. So, is sleep duration the important risk, or is it really the underlying physical sleep disorder? Parsimony suggests that sleep breathing problems provide the best reason to explain premature death rates.

This report from the European Respiratory Society highlights two important problems in the way the media and bariatric researchers are framing the discussion about post-operative sleep breathing changes following significant weight loss. First and foremost, they only report the AHI, the apnea-hypopnea index, and not the RDI, the Respiratory Disturbance Index. Thus, it is safe to assume that the researchers did not use advanced respiratory technology to measure UARS events (a.k.a. flow limitation events), the subtle breathing patterns that also provoke sleep fragmentation and subsequent daytime impairment in ways quite similar to classic sleep apnea. The second issue is the comment that the surgical intervention reduced or eliminated snoring in some patients, as if to suggest that snoring is a reliable marker of sleep breathing problems.

In sum, we are faced with the dilemma that both the media and the bariatric researchers are accepting outdated metrics for assessing sleep-disordered breathing (SDB). In the first instance, the assumption is that the AHI tells the whole story. It’s wonderful news to hear that AHI drops post-weight loss, but by not defining and measuring the RDI, it is safe to assume that many of these patients still suffer from SDB that likely needs treatment. The commentary on snoring represents another outdated metric in that we know many patients don’t snore and have SDB, and there are some who do snore and don’t have SDB. Bottom line is that snoring doesn’t tell us a lot about someone’s SDB condition. Again, it’s wonderful news that snoring decreases or disappears with post-op weight loss, and it likely signals that SDB severity has decreased, but it doesn’t tell us whether or not the patient still suffers from SDB, and that is the most important issue in question about the patient’s sleep health.

Imagine if the heart surgeon told a patient, “Looks like we’ve cut down your coronary blockages by 50%.” No intelligent heart patient would be satisfied with such a claim. “Okay, but how much coronary blockage do I still have left?” Same goes for SDB, “how much SDB do these patients still suffer from?” is the question at hand.

Again, another high profile commentary on obesity and no mention of sleep. No discussion on how obesity worsens sleep breathing problems, which in turn may adversely influence eating behaviors, and no mention of how underlying poor sleep quality may influence eating behaviors and lead to obesity.