Increasing severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, according to preliminary results of a new study.

Results show that each standard deviation increase in the apnea-hypopnea index, a measure of sleep-disordered breathing severity, was associated with the equivalent of 215 days of biological age acceleration. Similarly, each standard deviation increase in the arousal index, a measure of sleep disruption, was associated with the equivalent of 321 days of age acceleration.

“People’s biological age might not be the same as their chronological age,” said lead author Xiaoyu Li, ScD, a postdoctoral research fellow in the Division of Sleep and Circadian Disorders in the Department of Medicine at Brigham and Women’s Hospital and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. “Individuals whose biological age is higher than their chronological age exhibit age acceleration or fast aging. In our study, we found that more severe sleep-disordered breathing is associated with epigenetic age acceleration. Our data provide biological evidence supporting adverse physiological and health effects of untreated sleep-disordered breathing.”

Sleep-disordered breathing, such as obstructive sleep apnea, is characterized by abnormalities of respiration during sleep. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Nearly 30 million adults in the U.S. have obstructive sleep apnea. Common warning signs include snoring and excessive daytime sleepiness.

According to the authors, epigenetic age acceleration is a DNA methylation-based marker of fast biological aging, and it is associated with modifiable lifestyle factors. Although sleep-disordered breathing is associated with multiple age-related health disorders, its relationship with epigenetic aging has not been well studied.

The study involved 622 adults with a mean age of 69 years; 53.2% were women. Participants were measured for blood DNA methylation, and their sleep was evaluated at home by polysomnography. Age acceleration measures were calculated as residuals from the regression of each epigenetic age on chronological age. The association of each sleep-disordered breathing trait with age acceleration was estimated using linear regression, controlling for socio-demographics, health behaviors, body

In an interview with MD Magazine, Andrew Varga, MD,  explains the most cognitively-affected OSA patient population, and expanded on the association between sleep apnea and psychiatric conditions.

Varga: This was a group of older people, average age was around 68 years old. One of the really interesting things is that these were people that were recruited from the community and didn’t intrinsically have any sleep complaints. So they were not necessarily complaining that they had  snoring or any other breathing issues with sleep apnea. They were not complaining of any cognitive complaints, were not complaining of any sleepiness.

Get the full story at www.mdmag.com

What makes a clinician-friendly medical referral form? An engineer publishes tested recommendations to close the communication loop.

By Sree Roy

You’ve likely heard the advice before: Provide user-friendly consultation order forms to your referring providers. Be sure the referral forms promote the transmittal of clear, complete, and correct data to your sleep or dental sleep practice.

But what exactly makes for a clinician-friendly referral template? Recommendations have been published before, but recently a human factors engineer went a step further. April Savoy, PhD, a research scientist with the VA Center for Health Information and Communication at the Richard L. Roudebush Veterans Affairs Medical Center, and colleagues implemented several recommendations into a scenario-based simulation experiment. They tested a control electronic referral form and their recommendation-incorporating prototyped form with primary care clinicians who were referring patients to a variety of specialists.

Some of the communication problems that Savoy’s team hoped to resolve included unclear goals in referral, specialists rejecting a consultation pending more information, missing details that needed to be provided by the patient, and phone tag between busy professionals. The researchers found that implementing a few recommendations from the referral communication literature significantly improved clinicians’ satisfaction, workload, and efficiency. You could implement several of the successful features immediately into your own referral templates.

Include a checklist of “urgency” options. The prototype form allowed for “routine (30 days),” “stat,” or “specific time,” as well as a free-text field for comments. “Referrers, who are most familiar with their patients’ typical health, are best equipped to gauge urgency, not consultants or schedulers,” the authors note.

Remind referring providers of your expectations at a glance. Include an “About Us” section with a few bullet points, such as “Individuals with sleep irregularities manifested by daytime sleepiness, snoring, witnessed apneas, morning headaches, insomnia, or abnormal nocturnal movements or behaviors would benefit from a sleep evaluation.” Bulleted information on how to avoid cancelled consults is also appreciated. For example, a dental sleep medicine practice may want to include verbiage such as, “Interpreted sleep study results, from a home or in-lab study done in the past 12 months, must

Inspire Medical, Respicardia, LivaNova, and Nyxoah share the latest data on their devices.

By Sree Roy

FDA APPROVED

Inspire Medical Systems Inc Inspire Upper Airway Stimulation

Information source: Howard Green, vice president of marketing

FDA status: FDA approved in April 2014.

Size: 15 cc

Implant location: Inserted just under the skin of the neck and chest through 3 incisions.

Lead location: The sensing lead is placed in the intercostal muscle area; the stimulation lead is wrapped around the hypoglossal nerve (which controls the muscles and movements of the tongue).

How it works: As a patient sleeps, Inspire senses when they breathe in and delivers mild stimulation nudging the tongue forward, opening the airway. The patient uses a sleep remote to turn Inspire on when they go to sleep and off when they wake up.

Treats: Moderate-to-severe obstructive sleep apnea. AHI between 15 and 65.

Titration: Inspire is turned on about a month after it’s implanted. The patient is given a sleep remote and initial settings are established. The patient uses Inspire at home for 2-3 months and adjusts the amplitude using the remote to find a level that gives them comfortable, restful sleep. After this, the patient has an overnight sleep study where stimulation levels can be adjusted to optimize patient outcomes.

Future titrations: The vast majority of patients find stable settings after one lab titration. Inspire is customizable so any adjustments can be made simply in the physician’s office.

Overall efficacy: A recent peer-reviewed publication on the ADHERE Registry concluded that: median patient AHI was reduced from 34.0 to 7.0 events/hour; quality of life: ESS was reduced from 12 to 7; after 12 months, patients used Inspire 5.7 hours per night; 94% of physicians rated improvement in patients after Inspire implant. Patient-reported response to therapy experience: 94% stating they would undergo Inspire implant again; 96% of patients reported they would recommend Inspire to family and friends; 94% of patients reported they were overall satisfied with Inspire therapy.

Efficacy by demographic: Men and women within the FDA-approved AHI range (15-65) benefit equally from Inspire therapy. The ADHERE registry concluded: