The sleep field is intertwined with technological advances. Innovative devices are being developed every day, some of which are crossing over into the clinical realm. In this episode of Talking Sleep, Dr. Scott Ryals and Dr. Steven Holfinger describe how some novel home sleep apnea test devices work and explain how clinicians should approach them.
Scott Ryals, MD, is a sleep physician at Atrium Health in Charlotte, North Carolina. He is a fellow of the American Academy of Sleep Medicine, a current member of the AASM Scoring Manual Committee, and a former member of the AASM Emerging Technology Committee.
Steven Holfinger, MD, is an assistant professor practicing sleep medicine at The Ohio State University in the Department of Pulmonary, critical care, and sleep medicine. He is also the associate program director of OSU’s sleep medicine fellowship and a member of the AASM Emerging Technology Committee.
DARIEN, IL – The Count on Sleep partnership, a collaboration between several professional and patient-focused organizations, has released a national indicator report for obstructive sleep apnea through a grant awarded to the American Academy of Sleep Medicine by the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. The report provides an in-depth analysis of the symptoms, risk factors, prevalence, and burden of obstructive sleep apnea and serves as a resource for both the public and the healthcare communities on the importance of diagnosis and long-term treatment.
“Through this report, we can increase awareness of obstructive sleep apnea with patients, health workers, public health officials, regulators, and others to spur prompt diagnosis and management, allowing patients to reap the many benefits of treatment,” said Dr. Indira Gurubhagavatula, chair of the project’s Tool Development and Surveillance Workgroup. “Benefits of treatment include improved daytime alertness, cardiovascular health, performance at home and at work, and quality of life.”
Obstructive sleep apnea affects nearly 30 million Americans, and an estimated 80% of cases remain undiagnosed. Untreated sleep apnea can lead to serious health consequences including cardiovascular disease, stroke, diabetes, and depression. It also can lead to substantial costs; approximately 23.5 million cases of undiagnosed OSA in the U.S. incur $149.6 billion annually due to greater healthcare utilization, increased motor vehicle, and workplace accidents, and reduced productivity.
There are many barriers to sleep apnea diagnosis and treatment including insufficient awareness among the public and health care professionals. This initiative aims to drive more conversations between healthcare workers and patients about sleep health. Healthcare professionals should recognize and address the signs of sleep apnea, and people who think they may have undiagnosed sleep apnea should talk to their doctor about their sleep.
The collaborative Count on Sleep partnership is led by the American Academy of Sleep Medicine and the Sleep Research Society. Other partnering organizations are the Alliance of Sleep Apnea Partners, American Academy of Dental Sleep Medicine, American Academy of Otolaryngology–Head and Neck Surgery, American College of Chest Physicians, American Society for Metabolic and Bariatric Surgery, American Thoracic Society, and National Sleep Foundation. These organizations are committed to raising awareness of obstructive sleep apnea and providing expertise to educate the public and healthcare professionals.
Resources to assist the public and healthcare professionals in recognizing sleep apnea are available on the Count on Sleep website at countonsleep.org.
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This campaign is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $704,163 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, or the U.S. government.
For more information about the campaign, or to schedule an interview with an AASM spokesperson, please contact [email protected].
About the American Academy of Sleep Medicine
Established in 1975, the AASM advances sleep care and enhances sleep health to improve lives. The AASM has a combined membership of 12,000 accredited sleep centers and individuals, including physicians, scientists, and other healthcare professionals who care for patients with sleep disorders. As the leader in the sleep field, the AASM sets standards and promotes excellence in sleep medicine health care, education, and research.
DARIEN, IL – To help educators communicate the principles of good sleep habits to their students, the American Academy of Sleep Medicine, in partnership with Young Minds Inspired, has developed free standards-based lesson plans and engaging activities that will teach students in grades three to five, six to eight, and nine to 12 about the physical and mental benefits of healthy sleep.
“Healthy sleep is critical to children’s health, and so many — a third of children and a majority of teenagers — don’t get the sleep they need,” said Jennifer L. Martin, a licensed clinical psychologist and president of the AASM. “These resources will empower children to learn more about the importance of sleep in their lives and help them to develop healthy habits that will improve their health, emotional well-being, and school performance.”
Lesson plans are available in a downloadable, printer-friendly format and are categorized by grade level. The lesson plans are cross-curricular, allowing educators the flexibility to adapt and use the content in subject areas including arts, math, health, and social studies. In addition, there are guides to assist educators as they engage with their students.
For example, “Sleep Smart,” the program for grades three to five, offers three reproducible student activities, each of which involves active engagement, quizzes, and discussions. Students are also encouraged to take home and share the quiz with their families to test their knowledge and have a conversation about healthy sleep habits. The new “Sleep Well” program for grades nine to 12 focuses on the science behind the importance of a good night’s sleep, sleep tips to ensure healthy sleep habits and a sleep tracking chart.
Getting enough sleep is critical to a child’s physical, intellectual, and emotional development, affecting everything from weight to mood and attentiveness. Conversely, insufficient sleep — or being unable to sleep well — can cause a variety of health and behavioral problems in children. Students and educators can learn more about the importance of sleep using these free resources, available at https://ymiclassroom.com/lesson-plans/sleep/.
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For more information about the lesson plans, or to schedule an interview with an AASM spokesperson, please contact [email protected].
About the American Academy of Sleep Medicine
Established in 1975, the AASM advances sleep care and enhances sleep health to improve lives. The AASM has a combined membership of 12,000 accredited sleep centers and individuals, including physicians, scientists, and other healthcare professionals who care for patients with sleep disorders. As the leader in the sleep field, the AASM sets standards and promotes excellence in sleep medicine health care, education, and research.
According to a March 2023 survey commissioned by the American Academy of Sleep Medicine, one-third of adults (32%) “always or often” lose sleep at night due to worries about environmental issues. The survey found that younger generations are more likely to experience this problem, with 41% of Generation Z and 37% of millennials reporting they “always or often” lose sleep due to environmental worries. In contrast, only 11% of baby boomers and 6% of the Silent Generation reported the same sleep concern.
“Global warming, pollution, and weather events are an ongoing concern and worries about these environmental issues are affecting how people sleep,” said Jennifer Martin, a licensed clinical psychologist and president of AASM. “As Earth Day approaches, it’s important to manage stress over climate change and other environmental issues and to make healthy sleep a priority.”
Below are some tips from the AASM to help manage worries and improve sleep health:
Disconnect from Technology: Avoid checking social media, news updates, or any other technology that may trigger environmental worries before bedtime.
Create a Soothing Sleep Environment: Keep your bedroom lights dim; keep the room at a comfortable, cool temperature; and use a comfortable pillow, mattress, and bedding that promote restful sleep.
Establish a Relaxing Bedtime Routine: Try reading, taking a relaxing bath, or meditating to unwind before going to bed.
Keep these tips in mind or connect with a specialist at an AASM-accredited sleep center near you to discuss any serious sleep concerns. To learn more about the importance of healthy sleep and to find more sleep tips, visit SleepEducation.org.
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About the Survey
The American Academy of Sleep Medicine commissioned an online survey of 2,005 adults in the U.S. The overall margin of error fell within +/- 2 percentage points with a confidence interval of 95 percent. Fieldwork took place between March 24-29, 2023. Atomik Research is an independent market research agency.
About the American Academy of Sleep Medicine
Established in 1975, the AASM advances sleep care and enhances sleep health to improve lives. The AASM has a combined membership of 12,000 accredited sleep centers and individuals, including physicians, scientists, and other healthcare professionals who care for patients with sleep disorders. As the leader in the sleep field, the AASM sets standards and promotes excellence in sleep medicine health care, education, and research.
Recent evidence and data have highlighted important associations between obstructive sleep apnea and the microbiome. Here to help us learn more about how sleep and the gut microbiome impact our health is Dr. Andrew Goldberg.
Dr. Goldberg is a Professor, Vice Chair, Medical Director, and Director of the Division of Rhinology and Sinus Surgery in the Department of Otolaryngology–Head and Neck Surgery (OHNS) at the University of California, San Francisco. Dr. Goldberg is a member of the UCSF Haile T. Debas Academy of Medical Educators and an awardee for both Excellence in Teaching and Clinical Excellence. He is a member of over 10 medical societies and academies and has published over 130 peer-reviewed articles and book chapters.
Obstructive sleep apnea is regularly linked to the posterior oropharynx and the tongue, but its relationship with the nose is often overlooked. Recent research suggests that the assessment of the nose plays an important role in the physiology of sleep. Nasal obstruction is common in sleep apnea and contributes greatly to the development of OSA. Here to talk to us about the role of the nose in OSA is Dr. Jolie Chang.
Jolie L. Chang, MD, is an Associate Professor of Otolaryngology, Head and Neck Surgery, and Chief of the Division of Sleep Surgery and General Otolaryngology at the University of California, San Francisco. She specializes in sleep apnea surgery and minimally invasive approaches for salivary gland surgery including sialendoscopy. She also provides comprehensive and individualized evaluations for patients considering surgery for sleep apnea and specializes in drug-induced sleep endoscopy, soft palate surgery, tongue base surgery, snoring surgery, and hypoglossal nerve stimulation implant surgery.
Like you, our goal at the Penn CPAP Alternatives Clinic is to have excellent patient outcomes. This question, “what is causing my sleep apnea” is a very common and important one. After all, if we can accurately identify the cause for the blockage(s) in your throat, we can tailor treatments to address them. While the answer is often not straightforward, we use several tests to best address the question.
It is important to understand that obstructive sleep apnea is generally caused by two problems working together: anatomy and physiology.
Anatomy refers to the development of the bones and soft tissues of the face and throat. Patients with sleep apnea often have bones that are too small (“small room size”) or too much soft tissue (“large pieces of furniture”) that result in airway restriction.
Physiology refers to the muscle tone of your throat during sleep. Patients with sleep apnea often have reductions in muscle tone that cause the throat to collapse in sleep.
In order to determine the best surgical plan, we often require 3 tests to be performed.
Sleep Study (physiology) – this overnight study would likely have been performed before your consultation visit. However, the study may need to be updated in preparation for a procedure. This study captures airflow and oxygen changes throughout the night, providing an understanding of the severity of your sleep apnea and other details (e.g., sleep apnea is worse on your back than side)
CT Scan (anatomy) – this 3-dimensional x-ray will provide high-resolution images of your jaws, throat tissues and airway from top to bottom. Several measurements will be made which have been shown to help determine which sleep apnea procedure(s) is right for you.
Drug Induced Sleep Endoscopy or DISE (anatomy & physiology) – this sedation procedure uses IV medicine to reproduce Stage 2 sleep. Once you are in this sleep state, a thin scope is passed through your nasal passages to examine your throat. The Penn team has developed state-of-the-art diagnostics to determine both the site and severity of collapse. With these tests, Dr. Dedhia and team will be able to determine where your throat collapses during sleep and develop a treatment plan to address these blockages.
Darien, IL – In the first official joint guideline from the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM), oral appliance therapy is recommended for the treatment of adult patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure (CPAP) therapy or prefer alternate therapy. The new guideline supports increased teamwork between physicians and dentists to achieve optimal treatment of patients with OSA.
Published online in the July 15 issue of the Journal of Clinical Sleep Medicine, the clinical practice guideline updates the practice parameters that were published by the AASM in 2006. The updated recommendations are based on a systematic review of the relevant scientific literature, which has grown considerably in the past decade. A total of 51 articles met inclusion criteria and were used for data extraction, meta-analysis, and grading.
“This evidence-based guideline reinforces the fact that effective treatment options are available for obstructive sleep apnea, a chronic disease that afflicts at least 25 million adults in the U.S.,” said AASM President Dr. Nathaniel Watson. “Although CPAP therapy is still the first-line option for treating OSA, oral appliance therapy is an effective alternative that is preferred by some patients. Sleep medicine physicians and dentists can promote high quality, patient-centered care by working together to identify the optimal treatment for each patient who has sleep apnea.”
According to the clinical practice guideline, data show that oral appliance therapy can significantly reduce sleep-disordered breathing, and patient adherence to the treatment may be higher than for CPAP therapy. However, meta-analyses show that CPAP therapy is superior to oral appliance therapy in reducing sleep-disordered breathing, eliminating arousals from sleep, and improving oxygen saturation.
The guideline notes that the treating board-certified sleep medicine physician should take the patient’s preference into consideration when prescribing treatment for sleep apnea. After a sleep physician prescribes oral appliance therapy, treatment should be provided by a qualified dentist using a custom, titratable device. An oral appliance helps maintain an open and unobstructed airway during sleep by protruding and stabilizing the mandible.
“Communication and teamwork between sleep physicians and dentists are imperative to providing exceptional patient care,” said AADSM President Kathleen Bennett, DDS. “The new guideline supports this collaborative relationship and highlights the important role that dentists can play in the treatment of obstructive sleep apnea.”
The guideline also recommends oral appliance therapy as an effective treatment for primary snoring in adults. However, because snoring is a cardinal symptom of OSA, a diagnosis of primary snoring should be rendered by a sleep physician prior to treatment initiation.
To develop the guideline, the AASM and AADSM commissioned a task force that included three sleep physicians and two dentists with expertise in oral appliance therapy. The task force members performed an extensive review of the scientific literature to draft recommendations and supporting text. A draft of the guideline was made available for a public comment period, and the revised guideline was approved by the board of directors of the AASM and AADSM.
The clinical practice guideline comprises the following recommendations:
1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment for primary snoring (without obstructive sleep apnea). (STANDARD)
2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE)
3. We recommend that sleep physicians consider the prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD)
4. We suggest that qualified dentists provide oversight – rather than no follow-up – of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE)
5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE)
6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits – as opposed to no follow-up – with a qualified dentist and a sleep physician. (GUIDELINE)
About American Academy of Sleep Medicine Established in 1975, the American Academy of Sleep Medicine (AASM) improves sleep health and promotes high-quality patient-centered care through advocacy, education, strategic research, and practice standards. With nearly 10,000 members, the AASM is the largest professional membership society for physicians, scientists and other health care providers dedicated to sleep medicine.
About American Academy of Dental Sleep Medicine The American Academy of Dental Sleep Medicine (AADSM) is the only non-profit national professional society dedicated exclusively to the practice of dental sleep medicine. The AADSM provides educational resources for dentists and promotes the use of oral appliance therapy for the treatment of obstructive sleep apnea and sleep-disordered breathing. Established in 1991, the AADSM has nearly 3,000 member dentists worldwide. For more information, visit www.aadsm.org.
