In Kids, a Urine Test for Sleep Apnea May Be Viable Alternative to PSG

Notes from Dr. Norman Blumenstock
Early diagnosis of obstructive sleep apnea in children has benefits especially if can be done as simply as a urine test.

Published on August 4, 2014
A sleep apnea test being referred to as “less stressful” for children was presented at the 2014 American Association for Clinical Chemistry (AACC) Annual Meeting & Clinical Lab Expo. The meeting was held July 27 to 31 in Chicago.

Obstructive sleep apnea in children can lead to behavioral difficulties, learning disabilities, pulmonary/systemic hypertension, and decreased growth. However, the current gold standard for diagnosing sleep apnea—the overnight sleep study—is labor intensive, expensive, and limited by availability, in addition to being a potentially traumatic experience for children, says Trevor Pitcher, PhD. At the AACC annual meeting, Pitcher, a clinical chemistry fellow at the University of Louisville in Kentucky, reported the results of research showing that an immunoassay can effectively detect in urine the stress-coping peptide urocortin 3, which is significantly increased in children with sleep apnea. This urine test could serve as a psychologically easier alternative to a child spending a night in a strange bed in a sleep clinic, he says.

Sleep study shows dangers of driving drowsy

Notes from Dr. Norman Blumenstock

In a sleep deprivation study, a hand full of participants stayed up for 24 hours straight and was then monitored in a sleep study room. Dr Chris Hammond from the Ogden Clinic monitored their brain waves to show how sleep deprivation affects how people function.

http://www.good4utah.com/story/d/story/sleep-study-shows-dangers-of-driving-drowsy/20327/E9GIgqGZaU-4_GLJJUPhoA

OGDEN, UTAH (GOOD 4 UTAH) - The Utah Department of Transportation, the Utah Highway Patrol and the Department of Public Safety wants the public to know the dangers of driving drowsy. They say it's one of the top five behaviors killing people on Utah roads.

It’s all part of Utah's first Drowsy Driving Awareness week put together by the Utah Department of Transportation's Zero Fatalities program and participating agencies.

UDOT tells Good 4 Utah already this year there have been 636 drowsy driving related crashes in Utah and they hope by bringing light to drowsy driving it will prevent the problem from growing.

In a sleep deprivation study, a hand full of participants stayed up for 24 hours straight and was then monitored in a sleep study room. Dr Chris Hammond from the Ogden Clinic monitored their brain waves to show how sleep deprivation affects how people function.

“Not only does it affect attention, but it affects memory and executive function, which entails good judgment and good insight. Without those two we don't appreciate how sleepy we may be or how capable we are to safely driving on the road,” said Dr. Chris Hammond.

Right now Utah's has three deaths related to drowsy driving, but still UDOT says it's three too many and encourages drivers to avoid getting behind the wheel without enough sleep.

The Scientific 7-Minute Workout

Exercise science is a fine and intellectually fascinating thing. But sometimes you just want someone to lay out guidelines for how to put the newest fitness research into practice.

An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal does just that. In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.

“There’s very good evidence” that high-intensity interval training provides “many of the fitness benefits of prolonged endurance training but in much less time,” says Chris Jordan, the director of exercise physiology at the Human Performance Institute in Orlando, Fla., and co-author of the new article.

Work by scientists at McMaster University in Hamilton, Ontario, and other institutions shows, for instance, that even a few minutes of training at an intensity approaching your maximum capacity produces molecular changes within muscles comparable to those of several hours of running or bike riding.

Interval training, though, requires intervals; the extremely intense activity must be intermingled with brief periods of recovery. In the program outlined by Mr. Jordan and his colleagues, this recovery is provided in part by a 10-second rest between exercises. But even more, he says, it’s accomplished by alternating an exercise that emphasizes the large muscles in the upper body with those in the lower body. During the intermezzo, the unexercised muscles have a moment to, metaphorically, catch their breath, which makes the order of the exercises important.

The exercises should be performed in rapid succession, allowing 30 seconds for each, while, throughout, the intensity hovers at about an 8 on a discomfort scale of 1 to 10, Mr. Jordan says. Those seven minutes should be, in a word, unpleasant. The upside is, after seven minutes, you’re done.

Pledge to Stop the Snore

Notes from Dr. Norman Blumenstock
Why is it so important to stop snoring?

Published on August 14, 2014

The National Healthy Sleep Awareness Project is urging anyone with symptoms of obstructive sleep apnea to pledge to stop the snore and talk to a doctor about sleep apnea. The project is a collaboration launched by the American Academy of Sleep Medicine (AASM), Centers for Disease Control and Prevention (CDC), and the Sleep Research Society (SRS).

“Research shows that the number of sleep apnea sufferers continues to increase–the disease afflicts at least 25 million American adults, and most of them remain untreated, increasing their risk of cardiac disease, hypertension, Type 2 diabetes and obesity,” says Dr Timothy Morgenthaler, AASM president and a national spokesperson for the Healthy Sleep Project, in a release. “Fortunately, many of the damaging effects of sleep apnea can be stopped, and even reversed, through diagnosis and treatment by a board-certified sleep specialist.”

The Healthy Sleep Project provided these 5 warning signs for sleep apnea via a press release:

Snoring. Besides being a nuisance to your bed partner or roommate, loud and frequent snoring is a common symptom of sleep apnea. While not everyone who snores has this sleep illness, snoring is a warning sign that should be taken seriously.

Choking or gasping during sleep. When snoring is paired with choking, gasping or silent breathing pauses during sleep, it’s a strong indicator of sleep apnea.

Fatigue or daytime sleepiness. “Sleep apnea can leave you waking in the morning feeling tired, even after a full night’s sleep,” says Morgenthaler. “Excessive daytime sleepiness often occurs because sleep apnea causes numerous arousals throughout the night, and your body isn’t getting the quality sleep it needs.”

Obesity. An adult with a body mass index (BMI) of 30 or higher is considered to be obese, and the risk of sleep apnea increases with the amount of excess body weight.

High blood pressure. A staggering 67 million Americans have high blood pressure, which is about one in every three adults. Between 30% and 40% of adults with high blood pressure also have sleep apnea, and getting treatment for sleep apnea is a proven means of decreasing blood pressure.

“A common misconception is that sleep apnea only affects older, overweight men,” says Morgenthaler. “This widely-held assumption is wrong: anyone can have sleep apnea, regardless of gender, age, or body type–even if you’re not overweight.”

“Obstructive sleep apnea is a chronic disease that has a negative impact on the health and well-being of millions of people in the US,” says Janet B. Croft, PhD, senior chronic disease epidemiologist in CDC’s Division of Population Health. “It is important to discuss the warning signs for sleep apnea with your doctor to determine if you are at risk.”

How do I know if my partner has sleep apnea?

Notes from Dr. Norman Blumenstock
A sleep test can determine for sure if one has obstructive sleep apnea.

By Courtney Humphries   

| GLOBE STAFF   AUGUST 04, 2014

Q. How do I know if my partner has sleep apnea?

A. Sleep apnea is a common condition in which breathing pauses temporarily during sleep. As you sleep, the muscles that keep your airway open relax, which can narrow the airway. “There’s a spectrum from snoring to shallow breathing to sleep apnea,” says James Mojica, a pulmonologist and sleep specialist at Massachusetts General Hospital. When people develop apnea, Mojica says, they pause at least 10 seconds without breathing, followed by a start that wakens them and restores the muscle tone of the airway. Pauses may happen about five times per hour in mild cases, or more than 30 times per hour in severe cases.

Surprisingly, says Mojica, “even in severe cases, many times patients are completely unaware.” They only discover the problem when their partner brings it to their attention.

Not all snorers have apnea, but all people with apnea snore, says Mojica. Other signs include gasping or choking-like sounds, and irregular breathing. People with apnea may feel excessively sleepy during the day due to lost sleep, and sometimes wake up with a headache in the morning. Obesity is a risk factor for developing apnea, and drinking alcohol can worsen it. It’s more common in men, but women increasingly develop sleep apnea after menopause.

Mojica says that the only way to know for sure if you have sleep apnea is to get a sleep study. It also allows doctors to determine the severity of the problem, which guides the choice of treatment.

Are You at Risk for Heart Failure?

Notes from Dr. Norman Blumenstock
U.S. News & World Report discusses the relationship between sleep apnea and heart failure.

Sleep apnea, pauses in breathing during sleep, doesn’t just leave you tired – it can lead to heart failure if untreated, Curry says. At St. John’s Prairie Heart Institute, “even though patients say they don’t snore or have problems [where] they’re not sleeping at night, we’ll do a sleep study to confirm that,” she says. Patients found to have apnea are put on a CPAP device to make sure they get enough oxygen during sleep.

Why it’s better to protect your pump while it’s healthy.

Heart failure is most prevalent in older adults and affects nearly 5 million Americans.

Heart failure – a weakened heart muscle that can’t pump properly – is every bit as serious as it sounds. You’d expect heart disease and damaging heart attacks to put you at higher risk, and they do. High blood pressure and diabetes are also major contributors. But more surprisingly, sleep apnea has a role in heart failure risk, as do drugs such as amphetamines and cocaine. Here’s what it’s like to live with heart failure and what you can do to prevent it.

Heart Failure: Stage D

Lawrence Lamotte, 70, a Southern California retiree, has advanced heart failure. In 2006, soon after experiencing pressure in his chest “like an accordion squeezing,” he underwent triple bypass surgery, which likely saved his life. But with a heart that was no longer strong enough to sustain circulation on its own, his quality of life plummeted.

"I had special medication with an IV and a computer, and I had to carry it around with me at all times," he recalls. He felt lightheaded and dizzy and kept having falls. He was still very sick and getting progressively worse.

In a healthy heart, the right and left ventricles – the two lower chambers – work together to circulate oxygen-rich blood throughout the body. With heart failure, one or both ventricles can't do their job. It's called "congestive" heart failure as fluid builds up in the lungs, causing a frightening sense of suffocation, or leaks into other parts of the body.

[See: The Facts on Heart Disease.]

Hallmarks of Heart Failure

Rather than coming on all at once, heart failure tends to develop slowly and insidiously. Fatigue is one of the first warning signs.

A drastic change in exercise tolerance is another, says David Friedman, a cardiologist with the North Shore Long Island Jewish Health System. Patients describe "more shortness of breath with the same number of city blocks, or now they’re short of breath after walking just a half block."

Swelling, especially in the legs and feet, is a key complaint, with people sometimes putting on 2 or 3 pounds of fluid weight in a day, or 5 or more pounds in a week. "Their shoes don't fit. Their ankles are swollen," says Sharon Curry, facilitator for heart failure patient care at St. John's Hospital in Springfield, Illinois. "Sometimes they have abdominal swelling."

And then there's the pillow sign. “I ask patients, ‘How many pillows do you need to sleep on to breathe?” Friedman says. If they can’t lie down comfortably without piling on pillows, or they resort to sleeping in a reclining chair instead of bed, it could be due to fluid collecting in their lungs.

[See: U.S. News Best Heart-Healthy Diets.]

Cardiac Causes

Major heart conditions put people at higher risk for heart failure: heart attack, coronary artery disease, cardiomyopathy (heart muscle disease), cardiomegaly (enlarged heart) and inflammatory heart disease, along with heart valve abnormalities and murmurs that can worsen over the years. Some 20 to 30 percent of people with heart murmurs don’t even realize it, Friedman says.

Family history is another risk factor for heart failure, which affects nearly 5 million Americans, according to the Heart Failure Society of America. The prognosis is often grim, with the five-year survival rate after diagnosis less than 50 percent. "Heart failure is the dark side of living longer [with] heart disease," Friedman says. "Now a person's first heart attack isn't their last one."

While age in itself is not necessarily a risk factor, heart failure is more prevalent in older adults. However, people can be diagnosed in their 30s and 40s.

Sleep and Drug Connection

Sleep apnea, pauses in breathing during sleep, doesn't just leave you tired – it can lead to heart failure if untreated, Curry says. At St. John’s Prairie Heart Institute, "even though patients say they don't snore or have problems [where] ​they're not sleeping at night, we'll do a sleep study to confirm that," she says. Patients found to have apnea are put on a CPAP device to make sure they get enough oxygen during sleep.

Even among perfectly healthy people, “anyone who ingests or imbibes cardiac toxins – cocaine, methamphetamines – is at risk for heart failure," says Teresa De Marco, ​director of the Advanced Heart Failure Evaluation and Therapies Program at UCSF Medical Center. And "alcohol is a toxin to the heart."

Certain classes of cancer drugs can also contribute, she says, so oncologists evaluate a patient's heart failure risk before using those treatments.

[Read: Why a Sleep Apnea Diagnosis May Save Your Life.]

Stages of Sickness

Heart failure is classified into four stages. Patient in stage D, like Lamotte, require intensive treatments such as mechanical pumps, continuous IV infusions of cardiac drugs and eventually, heart transplant or hospice care.

Patients in stage B or stage C heart failure have structural heart disease, with or without symptoms. “Some people live long and very well with heart failure,” Curry says, “and other people’s symptoms are so severe that it greatly limits their daily lives."

During hospital readmissions, Curry says, patients often require IV and oral diuretics “to pull all the extra fluid out of their lungs and tissues. We give them medications to help their heart muscle pump and squeeze to the best of its ability. They might need blood pressure support. Some people are so critically ill they have to be admitted into the intensive care unit.”

With some conditions, De Marco says, such as inflammatory or alcohol-induced heart disease, heart function can sometimes be normalized and heart failure reversed, but it’s not usually about a cure. In systolic-type heart failure, she says, “some of the best medicines for disease progression can slow disease progression, reverse some abnormalities, can improve quality of life” and improve life expectancy and side effects.

De Marco, who is also medical director of heart transplantation at UCSF, says it’s at stage A, when patients are only at risk of developing heart failure, where health care providers "can really make a major impact" by closely following and "aggressively attacking" risk factors such as diabetes and high blood pressure.

Protect Your Pump

Anything you do that’s good for your heart will help protect you from heart failure, Curry says. And clearly, making lifestyle changes beats waiting for heart failure to change your whole life.

Because salt causes people to retain fluid, cutting dietary salt is a standard instruction for heart failure patients. In his case, Lamotte says, sodium is even more restricted: "None. Salt-free diet. It was hard in the beginning; I’m used to it now.” That doesn't only apply to people with heart failure – because of its strong link to high blood pressure, healthy adults are strongly encouraged to watch their salt intake.

Smoking is also a thing of the past for Lamotte, who hasn’t had a cigarette since 2006. “You’d be crazy to go back to smoking once they’ve got you together,” he says.

Everyone "should keep their blood pressure under control,” Curry says. “They should maintain a healthy weight. They should follow a 1,500 milligram-per-day sodium diet. They should be screened for possible sleep apnea. That's what you can do to avoid heart failure if you're a young, healthy 40-year-old."

Pump Replacement

In 2012, Lamotte underwent another surgery, this time to implant a left ventricular assist device – a mechanical heart pump. That's helped, but it means going about his day "wearing" the external controller, monitor and battery pack. His outlook remains positive and matter of fact. "I do my church duties," he says, like serving communion to the sick and shut-in. But he had to stop singing in the choir: "You've got to carry those long, long notes sometimes. But I keep cheering them on."

In his case, the LVAD is considered a temporary measure, a bridge, Lamotte says: "I'm on the list – I'm just waiting for a heart transplant."

As De Marco says, “There are an awful lot of people out there with heart failure – and once they have heart failure, they’re on a path which may not be good going forward. So it’s really important to prevent heart failure. It’s important to treat it, but let’s try to prevent it first.”

[Read: Life on an Organ Transplant Waiting List.]

Sleep Deprivation May Increase Susceptibility to False Memories

Notes from Dr. Norman Blumenstock
Researchers at the University of California and Michigan State University found that sleep deprivation may actually create false memories. Physical disorders have long been linked to poor sleep, and the study titled “Sleep Deprivation and False Memories” published in Psychological Science builds on previous work that found a poor/false memory connection to sleep.

Not getting enough sleep may increase the likelihood of forming false memories, according to research published in Psychological Science, a journal of the Association for Psychological Science.

In a study conducted by psychological scientist Steven J. Frenda of the University of California, Irvine and colleagues, sleep-deprived people who viewed photographs of a crime being committed and then read false information about the photos were more likely to report remembering the false details in the photos than were those who got a full night’s sleep.

Research has demonstrated that failing to get your full eight hours interferes with cognitive functioning, but Frenda noticed a gap in the literature when it came to sleep and memory.

“Over the years I noticed that whenever I had a bad night’s sleep, my perception and memory seemed to get fuzzy until I had a good recovery sleep,” explains Frenda. “I was surprised to find that there were so few empirical studies connecting sleep deprivation with memory distortion in an eyewitness context. The studies that do exist look mostly at sleep deprived people’s ability to accurately remember lists of words—not real people, places and events.”

A preliminary study conducted by Frenda and colleagues suggested that getting 5 hours of sleep or less was associated with the formation of false memories. The researchers then designed an experiment to investigate whether pulling an all-nighter would increase the likelihood of forming false memories.

Upon arriving to the lab in the late evening, the 104 college-age participants were assigned to one of four groups. Two groups were presented with a series of photos depicting a crime being committed as soon as they arrived to the lab — one group was then allowed to go to sleep, while the other group had to stay awake all night in the lab. The remaining two groups did things in the reverse order — they either slept or stayed awake all night and then viewed the crime photos in the morning.

In the second part of the experiment, the participants read narratives containing statements that contradicted what the photographs actually showed.  For instance, a text description might say that the thief put a stolen wallet in his pants pocket, whereas the photo shows him putting it in his jacket.

The researchers found that only those students who had been sleep deprived for all parts of the experiment — that is, they viewed the photos, read the narratives, and took the memory test after having stayed up all night — were more likely to report the false details from the text narrative as having been  present in the crime photos.

The students who viewed the photos before staying up all night, however, were no more susceptible to false memories than the students who’d been allowed to sleep.

The researchers believe these findings have important legal applications:

“Recent studies are suggesting that people are getting fewer hours of sleep on average, and chronic sleep deprivation is on the rise,” says Frenda. “Our findings have implications for the reliability of eyewitnesses who may have experienced long periods of restricted or deprived sleep.”

Frenda concludes that more research is necessary before scientists can provide law enforcement with evidence-based guidelines on how to best ensure that eyewitnesses’ memories are accurate:

“We are running new experiments now, in order to better understand the influence of sleep deprivation on processes related to false memory.”

In addition to Frenda, co-authors on the study include Lawrence Patihis and Elizabeth Loftus of the University of California, Irvine, and Holly Lewis and Kimberly Fenn of Michigan State University.