At a California Hospital, Children Diagnosed via Home Sleep Tests Have Better Outcomes Than Those Who Wait for PSG Approval

UC Davis uses the Nox T3 to speed the route to sleep-disordered breathing therapy for children with complex medical issues.

When a baby came into the neonatal intensive care unit at UC Davis Medical Center with a plethora of complex medical issues, including severe snoring and trouble breathing throughout the night, the clinicians there knew they needed to conduct a sleep study.

To treat the child as fast as possible, physicians decided against prescribing a polysomnogram (PSG), often considered the gold standard in screening for sleep disorders, and opted for a home sleep study instead. By ordering the home sleep test, in this case the Nox T3 system (FDA approved for patients greater than 2-years-old), the providers were able to diagnose the baby with severe obstructive sleep apnea within 24 hours, instead of waiting potentially weeks to get the child’s health insurance company to approve a PSG.

“Sleep-disordered breathing can make underlying medical issues worse, so that explains the importance of diagnosing it early on in any children,” says Kiran Nandalike, MD, a pediatric pulmonologist at UC Davis Medical Center.

The patient was one of 51 hospitalized children, all under the age of 18, who have participated in an ongoing program in which the University of California hospital opted to use home sleep tests (HST) in pediatric patients with complex medical issues. Because the HST route facilitates patients being diagnosed and treated faster, over a few years, clinicians found that these less expensive tests contributed to faster recovery times and overall better outcomes in this patient population, says Nandalike, who spearheaded the program and trained the sleep lab technologists to work with pediatric patients.

“Now we have a system in place and after doing this for one to two years, we saw how it was making a good difference in these patients,” she says.

After seeing favorable results from their new screening protocol, one of the UC Davis medical fellows at the time, Gurinder Singh, MD, decided to take a look at the data. He and his colleagues compiled the results in a retrospective study, published in

You’re Invited! Join Me for Project Sleep’s New Year’s Celebration

Tune in this Saturday, Dec. 28th, 2019 at 12:00 noon ET for a very special  New Year’s Facebook LIVE—celebrating your amazing 2019 and looking ahead with a sneak peek of 2020! On behalf of Project Sleep’s leadership, I will broadcast live from Los Angeles to Project Sleep’s Facebook page this Saturday, Dec. 28th at 12noon ET.

You have accomplished SO much through Project Sleep’s awareness and advocacy programs this year. We can’t wait to share the story of your collective impact back to you because it’s a tremendous story of courage, hard work and making a difference!

To watch live, go to Project Sleep’s Facebook Page (https://www.facebook.com/ProjectSleepAwareness/) at 12:00 noon ET on Sat. 12/28. The live video will show up in our newsfeed shortly after 12noon ET.

Please spread the word to anyone interested. Happy Holidays, friends!

from Julie Flygare http://julieflygare.com/youre-invited-join-me-for-project-sleeps-new-years-celebration/…

Secondhand Smoke May Increase Risk for Obstructive Sleep Apnea in Children

Study results published in the International Journal of Pediatric Otorhinolaryngology show a connection between secondhand smoke and obstructive sleep apnea in children.

OSA has a relatively low prevalence in children (4%) compared with habitual snoring (10%). Few studies have assessed the role of SHS on OSA severity, and those that have demonstrate contradicting results.

The current retrospective, single-center, Institutional Review Board-approved study assessed the association between exposure to SHS and OSA severity in children between 3 and 18 years.

Data were obtained by querying Electronic Medical Records (EMR). Investigators analyzed SHS as a binary variable and OSA as a continuous variable, measured using OAHI from polysomnography (PSG) in all children.

from Sleep Review http://www.sleepreviewmag.com/2019/12/secondhand-smoke-risk-obstructive-sleep-apnea-children/…

Sleep More Than 9 Hours? Your Stroke Risk May Be Higher

People who take long naps during the day or sleep 9 or more hours at night may have an increased risk of stroke. This is according to a study published in the December 11, 2019, online issue of Neurology, the medical journal of the American Academy of Neurology.

People who took a regular midday nap lasting more than 90 minutes were 25% more likely to later have a stroke than people who took a regular nap lasting from 1 to 30 minutes. People who took no naps or took naps lasting from 31 minutes to one hour were no more likely to have a stroke than people who took naps lasting from one to 30 minutes.

“More research is needed to understand how taking long naps and sleeping longer hours at night may be tied to an increased risk of stroke, but previous studies have shown that long nappers and sleepers have unfavorable changes in their cholesterol levels and increased waist circumferences, both of which are risk factors for stroke,” says study author Xiaomin Zhang, MD, PhD, of Huazhong University of Science and Technology in Wuhan, China, in a release. “In addition, long napping and sleeping may suggest an overall inactive lifestyle, which is also related to increased risk of stroke.”

The study involved 31,750 people in China with an average age of 62. The people did not have any history of stroke or other major health problems at the start of the study. They were followed for an average of 6 years. During that time, there were 1,557 stroke cases.

The people were asked questions about their sleep and napping habits. Midday napping is common in China, Zhang says. Eight percent of the people took naps lasting more than 90 minutes. And 24% said they slept 9 or more hours per night.

The study found that people who sleep 9 or more hours per night are 23% more likely to later have a stroke than people who sleep seven to less than 8 hours per night. People who sleep less than 7 hours per night or between 8

“I will change how I treat my patients because of your talk.”

Last month, I gave one of my favorite presentations at the 10th Biennial Pediatric Sleep Medicine Conference hosted by my alma mater, Brown University.

My “TED-style talk” had two key messages:

  1. Prescribing social support to people with narcolepsy,
  2. Partnering with patients, patient leaders and organizations to develop patient-centered research toward recognizing and addressing stigma.

I’d spent months preparing for this speech. Having only 18 minutes, every second mattered. I practiced and revised and revised more. Arriving at the conference, the room was much bigger than I’d expected, between 200-300 pediatric sleep researchers, doctors and technicians in the audience. 

Once on stage, I didn’t get through my material perfectly, but I hit the emotional arch I wanted and I articulated my first key messages in new ways that I believe resonated strongly.

The response was tremendous, people stopped me all weekend to thank me, even as I loaded my suitcases into my lyft the next day, a doctor approached me to say that she is going to change how she treats her patients because of my talk. Wow!

Also kinda funny, I overheard two doctors talking about me in the hallway (really nice things), and I had to awkwardly be like “Oh, um hi! I’m right behind you.”

To me, speaking is an art form and I’ve fallen in love with it, and I can’t wait to continue developing this talk and sharing these messages in more places.

From there, I traveled to Washington, D.C. for Project Sleep’s Congressional Briefing and Hill Day co-hosted with the Sleep Research Society (SRS). I felt ready for this advocacy day and the activities went super well.  I believe we are doing unique and important work advocating specifically for sleep health and sleep disorders research and awareness. Read the full re-cap on Project Sleep’s blog.

While in DC, I got to meet some very special people, including Project Sleep’s newest Board Member, Anne Taylor and Project Sleep’s 2017 Jack & Julie Narcolepsy Scholarship recipient, Cassandra Stewart. I also had some important meetings that will likely mean exciting things for Project Sleep in the years to come. I can’t …

26th Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring

This course has been coordinated through the University of California, San Francisco Department of Otolaryngology-Head and Neck Surgery and the Penn Center for Sleep Disorders at the University of Pennsylvania. The program is designed to provide a comprehensive review and update on recent advances in sleep apnea and snoring. New approaches and controversies in the management of patients with sleep disordered breathing will be highlighted. Leaders in the field from Pulmonary and Critical Care Medicine, Otolaryngology – Head and Neck Surgery, Dentistry, Oral and Maxillofacial Surgery, Pediatrics, Bariatric Surgery, Neurology and Obesity Research will share their medical and surgical expertise in didactic sessions, case presentations and workshops with the intent to close practice gaps in physician knowledge and competence for diagnosing and managing sleep disordered breathing and complications resulting thereof. Patients with sleep disordered breathing are highly prevalent in every physician’s practice, and complications related to the disease can manifest in a number of ways to the detriment of patient health and well-being. There will be ample opportunity for interaction with participating faculty. An electronic course syllabus, complete with program outline and up-to-date references, will be provided to each participant. Please bring your laptop or tablet if you would like to view the syllabus during the didactic sessions.

TARGET AUDIENCE
This continuing medical education activity is intended for the physician in Sleep Medicine, Otolaryngology-Head and Neck Surgery, Pulmonary Medicine, Oral and Maxillofacial Surgery, Family Practice, Internal Medicine, Pediatrics, Cardiology, Neurology, Psychiatry, Anesthesia, and Geriatrics. Dentists, sleep respiratory therapy technologists, nurses, and other healthcare professionals are also invited to attend this program.

from Sleep Review http://www.sleepreviewmag.com/events/26th-annual-advances-diagnosis-treatment-sleep-apnea-snoring/…

How I Transitioned My Dental Practice to a Dental Sleep Medicine Practice

Four dentists discuss their motivations, challenges, and rewards of treating patients who have obstructive sleep apnea.

Dental sleep medicine is now a viable career path for dentists looking to expand their professional horizons and help a growing number of patients who are experiencing sleep-related health problems.

But the bigger question is how? How can a dentist make the transition? What are some of the pitfalls to avoid? What are the unexpected rewards?

As the following four dental sleep medicine practitioners explain, there’s no single way to make the transition, just the one that works best for you, your practice, and your patients.

Don Johnson, DDS, Idaho

Don Johnson

Don Johnson, DDS, has been practicing dental sleep medicine for the past decade. Photo courtesy of Don Johnson, DDS

Don Johnson, DDS, has been providing dental sleep medicine services for about 10 years at his practice in Coeur d’Alene, Idaho, which includes the Northwest Snoring Center.

“The main reason I started doing sleep dentistry is because sleep apnea kills people,” Johnson says. “All you have to do is open the obituaries and you’ll see a young person who died of ‘natural causes.’ You don’t die of natural causes if you’re 39. More likely it was sleep apnea.”

And to that point, Johnson’s mission is clear: to save lives.

It’s a mission Johnson, who’s practiced general dentistry for 40 years, is quite passionate about. But his passion didn’t supersede preparation.

“You can’t do a weekend course and you’re qualified to practice sleep dentistry. It’s a huge investment in time and equipment,” says Johnson, who emphasizes that learning “everything that you can” about the temporomandibular joint (TMJ) and its disorders is essential.

Johnson not only continued his education formally, but he also found a mentor with whom he spends time with regularly to better comprehend facets such as billing and building a referrer network. “You really have to learn how to work with physicians,” he says. “And you have to get paid, including learning how to bill medically—and hire specialists to help you. If you don’t accept insurance, you’re losing a lot.”

Among

Treating Mild Sleep Apnea Results in Higher Vitality Scores

CPAP can improve energy levels and vitality in people who experience mild sleep apnea—that is, those with an apnea-hypopnea index between 5 and 15 events per hour—according to a new study.

This is the finding from a new study of over 200 patients, published in the journal The Lancet Respiratory Medicine, led by Imperial College London.

The research was conducted at 11 National Health Service (NHS) sleep centers across the United Kingdom, including the Royal Brompton & Harefield NHS Foundation Trust. Although previous trials have found a CPAP machine to improve symptoms of moderate to severe cases, the researchers say the significance of this study is it is the first large trial to find that mild cases of OSA can also be treated with this technology.

Lead author Mary Morrell, PhD, professor of Sleep and Respiratory Physiology at the National Heart and Lung Institute at Imperial, says in a release, “We are seeing increasing cases of sleep apnea, and in a wide range of patients. Although the condition was previously thought to mainly affect overweight men, we now know it also strikes post-menopausal women, the elderly, and even children.”

Morrell, who is also honorary researcher at the Royal Brompton Hospital, says, “Around 60% of all cases of sleep apnea are classed as mild, but until now we didn’t know whether a CPAP would be helpful to these patients.”

In the study, 115 patients were asked to use the CPAP for three months, while 118 received were given advice on improving sleep and avoiding anything that can exacerbate the condition, such as drinking alcohol before bed.

The research revealed those who used the CPAP machine had an improvement of 10 points on a vitality scale, compared to those who received standard care. The vitality scale assesses a range of factors such as sleep quality, energy levels, and daytime sleepiness. The researchers also saw improvements in a number of additional factors among the patients who used the CPAP, including fatigue, depression, and social and emotional functioning.

The researchers have not yet conducted an economic analysis of the cost to the NHS

How Does Sleep Deprivation Affect The Body?

Is something, or are some things keeping you up? Maybe you’ve had a lot of coffee than you normally do, or maybe you are having insomnia for some reason. If you are not getting the recommended hours of sleep a day, you won’t just feel tired, cranky, and moody the next day. Sleep deprivation has other effects too.

 

Sleep is an important part of everyday life. It is just as important as eating. The body won’t last for too long if left without sleep. In other words, it is crucial. But it isn’t just the hours of sleep that you get that should be paid attention to. It’s also the quality of it. Other than making the brain hazy, sleep deprivation can adversely affect other parts of the body as well.

 

The brain is a part of a bigger system called the Central Nervous System. Brain cells travel and function within it. A deprivation in sleep can cause fatigue in the brain.

During sleep, pathways form between nerve cells (neurons) in your brain that help you remember new information you’ve learned. Sleep deprivation leaves your brain exhausted, so it can’t perform its duties as well.

You may also find it more difficult to concentrate or learn new things. The signals your body send may also be delayed, decreasing your coordination and increasing your risk for accidents.

Sleep deprivation also negatively affects your mental abilities and emotional state. You may feel more impatient or prone to mood swings. It can also compromise decision-making processes and creativity.

(Via:https://www.healthline.com/health/sleep-deprivation/effects-on-body#4)

 

Your immune system functions to protect the body from foreign invaders, especially pathogenic ones. It also works to fight such intruders.

While you sleep, your immune system produces protective, infection-fighting substances like cytokines. It uses these substances to combat foreign invaders such as bacteria and viruses.

Cytokines also help you sleep, giving your immune system more energy to defend your body against illness.

Sleep deprivation prevents your immune system from building up its forces. If you don’t get enough sleep, your body may not be able to fend off

How Important Is Sleep To Children?

Kids do get sleep. In fact, babies sleep almost all the time. While adults need the recommended 7-9 hours of sleep a day, babies need 2/3 of the day sleeping.

As children grow older, the amount of sleep they need varies:

  • toddlers: 11 to 14 hours
  • preschoolers: 10 to 13 hours
  • school-aged children: 9 to 12 hours
  • teens: 8 to 10 hours

(Via:https://www.healthline.com/health/how-much-deep-sleep-do-you-need#deep-sleep)

Children need to have good quality and quantity of sleep simply because they are growing. And sleep helps support their growth stage. A lot of things can happen during the growth stage. They will need all the help they can get for optimum growth. And sleep is one of them.

 

Deep sleep stimulates growth, especially in babies.

“Growth hormone is primarily secreted during deep sleep,” says Judith Owens, M.D., director of sleep medicine at Children’s National Medical Center, in Washington, D.C., and a Parents advisor. Mother Nature seems to have protected babies by making sure they spend about 50 percent of their time in this deep sleep, considered to be essential for adequate growth. Italian researchers, studying children with deficient levels of growth hormone, have found that they sleep less deeply than average children do.

(Via:https://www.parents.com/health/healthy-happy-kids/the-7-reasons-your-kid-needs-sleep/)

 

Even at a young stage, sleep protects children from cardiovascular harm due to cholesterol and stress hormones.

“Children with sleep disorders have excessive brain arousal during sleep, which can trigger the fight-or-flight response hundreds of times each night,” says Jeffrey Durmer, M.D., Ph.D., a sleep specialist and researcher in Atlanta. “Their blood glucose and cortisol remain elevated at night. Both are linked to higher levels of diabetes, obesity, and even heart disease.”

(Via:https://www.parents.com/health/healthy-happy-kids/the-7-reasons-your-kid-needs-sleep/)

 

Children, including babies, can actually go overboard with food as well, especially if parents mistook their babies’ cry as hunger. But getting enough sleep can counter this.

That’s key, because the sleep-weight connection seems to snowball. When we’ve eaten enough to be satisfied, our fat cells create the hormone leptin, which signals us to stop eating. Sleep deprivation may impact this hormone, so kids keep right on eating. “Over