Associated Professional Sleep Societies (APSS): Sleep 2011

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.

MINNEAPOLIS – Sleep is in short supply, thanks to our "24-hour society" in which trading sleep for work or play is commonplace and sleep deprivation is worn as a badge of honor, according to Dr. Michel Cramer Bornemann, codirector of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis.

Not only have we become accustomed to trading sleep for work, Dr. Cramer Bornemann said at the annual meeting of the Associated Professional Sleep Societies, "lack of sleep is synonymous with hard work or achievement, when really it can impede both."

In fact, the effects of insufficient shut-eye extend across multiple domains, according to a collection of independent studies presented at this year’s meeting. For example, sleep loss was linked to the development or exacerbation of symptoms of ADHD in early childhood, an individual’s genetic risk of obesity, inhibitory response to images of high-calorie foods, and even marital discontent.

ADHD and Sleep Loss

In a study designed to tease out the complex relationship between sleep problems – particularly falling asleep and staying asleep – and the development or worsening of inattention and hyperactivity and impulsivity in children and adolescents diagnosed with ADHD, Erika Gaylor, Ph.D., of SRI International in Menlo Park, Calif., and her colleagues analyzed data from the preschool and kindergarten waves of the Early Childhood Longitudinal Study-Birth Cohort. The cohort comprises a representative sample of approximately 6,860 children and their families living the United States.

The investigators calculated total nighttime sleep duration based on parent-reported bedtime and wake time, and assessed children’s behavior using brief measures of attention and task persistence, Dr. Gaylor reported.

"We performed two sets of regression analyses to identify whether sleep duration in preschool-age children predicts attention and hyperactivity at kindergarten entry and [whether] attention and hyperactivity symptoms at preschool predict sleep duration at kindergarten," she explained.

Controlling for the outcome of interest at the preschool time point, sex, ethnicity, and family income, researchers found that less sleep at preschool significantly predicted worse scores on parent-reported hyperactivity and attention at kindergarten, whereas parent-reported hyperactivity and attention at preschool did not predict sleep duration at kindergarten, Dr. Gaylor stated.

"These findings suggest that some children who are not getting adequate sleep may be at risk for developing behavioral problems manifested by hyperactivity, impulsivity, and problems sitting still and paying attention," she said. The results extend those of a previous study in which she and her colleagues determined that having a consistent bedtime was the most reliable predictor of positive developmental outcomes by age 4 years, she noted.

The Link Between Sleep and Obesity

In a twin study designed to look more closely at the previously reported link between short sleep duration and elevated body mass index, Dr. Nathaniel Watson of the University of Washington in Seattle and his colleagues determined that short sleep may potentiate an underlying genetic mechanism for obesity.

The investigators examined whether sleep duration modified genetic and environmental influences on BMI in 1,811 pairs of twins drawn from the population-based University of Washington Twin Registry. The mean age of the study participants was 36.6 years. The participants provided self-reported information on height and weight, which was used to calculate BMI, as well as on habitual sleep duration, Dr. Watson said. The mean BMI of the group was 25.4 kg/m², and the mean sleep duration was 7.18 hours, he said.

©Nozomi Stall/Fotolia.com

Using behavioral genetic interaction models, the investigators found significant relationships between habitual sleep duration and genetic and shared environmental influences on BMI. Specifically, longer sleep duration was associated with decreased BMI, Dr. Watson reported.

"When sleep duration was 7 hours, the heritability of BMI was more than double [70%] that observed when sleep duration was 9 hours [33%]," he said, noting that "there appears to be something about short sleep that creates a permissive environment for expression of obesity-related genes." Similarly, he added, longer sleep duration may suppress genetic influences on body weight.

The findings are an important addition to the existing body of research on the relationship between sleep duration and BMI, Dr. Watson said. "Studies attempting to identify specific genotypes for BMI may benefit from considering the moderating role of sleep duration."

A connection between sleepiness and lack of self-control with respect to dietary choices may also contribute to the sleep loss/obesity equation, according to a study presented by William Killgore, Ph.D., of Harvard Medical School in Boston.

To test their hypothesis that greater daytime sleepiness correlates with reduced prefrontal cortex response during passive viewing of images of high-calorie foods, Dr. Killgore and his colleagues analyzed the functional magnetic resonance imaging (fMRI) scans of 12 healthy adults obtained while they were shown pictures of high-calorie foods, low-calorie foods, and control images of plants and rocks. Using a second-level regression model, the researchers correlated the fMRI findings with subjects’ self-reported daytime sleepiness, assessed via the Epworth Sleepiness Scale (ESS).

"Greater ESS scores correlated with reduced activation in the dorsolateral prefrontal cortex when high-calorie vs. low-calorie food images were perceived," Dr. Killgore reported, noting that this region is typically implicated in attention and inhibitory processing. Similarly, greater daytime sleepiness was also associated with increased activation in the right parietal and inferior temporal cortex, he said.

The findings suggest the possibility that sleepiness may affect an individual’s inhibitory control when he or she is exposed to highly appetizing, high-calorie foods, according to Dr. Killgore, although it’s uncertain as of yet whether the observed patterns relate to actual food consumption, he said.

Marital Discord

Although most sleep research focuses on the individual, the fact that sleep problems and relationship trouble often co-occur led Wendy M. Troxel, Ph.D., of the University of Pittsburgh, and her colleagues to consider the dyadic nature of sleep in a recent study. The investigators examined the bidirectional links between nightly sleep and daily marital interactions among 35 healthy married couples (mean age, 32 years) by correlating the actigraph results for sleep latency, wakefulness after sleep onset, and total sleep time of each partner over 10 nights, with daily self-reported positive and negative marital interactions assessed via electronic diaries during the same period.

"We found stronger evidence linking sleep to the next day’s marital interactions, rather than the reverse direction," Dr. Troxel reported.

Specifically, wives’ prolonged sleep latency significantly predicted their own and their husbands’ reports of more negative and less positive interactions the next day, even after adjustment for depressive symptoms, whereas the quality of marital interactions did not appear to predict sleep measures in women, she said. The sleep quality of husbands did not appear to affect their own or their wives’ reports of next-day marital interactions; however, for men, a higher level of positive marital interactions predicted shorter total sleep duration the next night.

The findings suggest, perhaps, that "men are more likely to repress their feelings or not be as aware" of mood changes, whereas women are more likely to express their emotional concerns and to "drive the emotional climate of the relationship," Dr. Troxel said. The results highlight the potential interpersonal consequences of sleep disorders, and as such may have important clinical implications, she said.

In March of this year, the Centers for Disease Control and Prevention reported that nearly a third of the country’s adults get fewer than the minimum recommended 7 hours of sleep per night, and it’s not because they’re not tired: Nearly 40% of the survey population reported unintentionally falling asleep during the day, and nearly 5% reported nodding off while driving in the preceding 30 days (MMWR 2011;60:233-8).

In addition to the negative consequences of sleep deprivation noted above, previous studies have linked sleep insufficiency to a range of adverse health outcomes, including cardiovascular disease, asthma, diabetes, and stroke, according to the report.

The presenters reported no financial conflicts of interest relevant to their respective presentations.

MINNEAPOLIS – Sleep is in short supply, thanks to our "24-hour society" in which trading sleep for work or play is commonplace and sleep deprivation is worn as a badge of honor, according to Dr. Michel Cramer Bornemann, codirector of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis.

Not only have we become accustomed to trading sleep for work, Dr. Cramer Bornemann said at the annual meeting of the Associated Professional Sleep Societies, "lack of sleep is synonymous with hard work or achievement, when really it can impede both."

In fact, the effects of insufficient shut-eye extend across multiple domains, according to a collection of independent studies presented at this year’s meeting. For example, sleep loss was linked to the development or exacerbation of symptoms of ADHD in early childhood, an individual’s genetic risk of obesity, inhibitory response to images of high-calorie foods, and even marital discontent.

ADHD and Sleep Loss

In a study designed to tease out the complex relationship between sleep problems – particularly falling asleep and staying asleep – and the development or worsening of inattention and hyperactivity and impulsivity in children and adolescents diagnosed with ADHD, Erika Gaylor, Ph.D., of SRI International in Menlo Park, Calif., and her colleagues analyzed data from the preschool and kindergarten waves of the Early Childhood Longitudinal Study-Birth Cohort. The cohort comprises a representative sample of approximately 6,860 children and their families living the United States.

The investigators calculated total nighttime sleep duration based on parent-reported bedtime and wake time, and assessed children’s behavior using brief measures of attention and task persistence, Dr. Gaylor reported.

"We performed two sets of regression analyses to identify whether sleep duration in preschool-age children predicts attention and hyperactivity at kindergarten entry and [whether] attention and hyperactivity symptoms at preschool predict sleep duration at kindergarten," she explained.

Controlling for the outcome of interest at the preschool time point, sex, ethnicity, and family income, researchers found that less sleep at preschool significantly predicted worse scores on parent-reported hyperactivity and attention at kindergarten, whereas parent-reported hyperactivity and attention at preschool did not predict sleep duration at kindergarten, Dr. Gaylor stated.

"These findings suggest that some children who are not getting adequate sleep may be at risk for developing behavioral problems manifested by hyperactivity, impulsivity, and problems sitting still and paying attention," she said. The results extend those of a previous study in which she and her colleagues determined that having a consistent bedtime was the most reliable predictor of positive developmental outcomes by age 4 years, she noted.

The Link Between Sleep and Obesity

In a twin study designed to look more closely at the previously reported link between short sleep duration and elevated body mass index, Dr. Nathaniel Watson of the University of Washington in Seattle and his colleagues determined that short sleep may potentiate an underlying genetic mechanism for obesity.

The investigators examined whether sleep duration modified genetic and environmental influences on BMI in 1,811 pairs of twins drawn from the population-based University of Washington Twin Registry. The mean age of the study participants was 36.6 years. The participants provided self-reported information on height and weight, which was used to calculate BMI, as well as on habitual sleep duration, Dr. Watson said. The mean BMI of the group was 25.4 kg/m², and the mean sleep duration was 7.18 hours, he said.

©Nozomi Stall/Fotolia.com

Using behavioral genetic interaction models, the investigators found significant relationships between habitual sleep duration and genetic and shared environmental influences on BMI. Specifically, longer sleep duration was associated with decreased BMI, Dr. Watson reported.

"When sleep duration was 7 hours, the heritability of BMI was more than double [70%] that observed when sleep duration was 9 hours [33%]," he said, noting that "there appears to be something about short sleep that creates a permissive environment for expression of obesity-related genes." Similarly, he added, longer sleep duration may suppress genetic influences on body weight.

The findings are an important addition to the existing body of research on the relationship between sleep duration and BMI, Dr. Watson said. "Studies attempting to identify specific genotypes for BMI may benefit from considering the moderating role of sleep duration."

A connection between sleepiness and lack of self-control with respect to dietary choices may also contribute to the sleep loss/obesity equation, according to a study presented by William Killgore, Ph.D., of Harvard Medical School in Boston.

To test their hypothesis that greater daytime sleepiness correlates with reduced prefrontal cortex response during passive viewing of images of high-calorie foods, Dr. Killgore and his colleagues analyzed the functional magnetic resonance imaging (fMRI) scans of 12 healthy adults obtained while they were shown pictures of high-calorie foods, low-calorie foods, and control images of plants and rocks. Using a second-level regression model, the researchers correlated the fMRI findings with subjects’ self-reported daytime sleepiness, assessed via the Epworth Sleepiness Scale (ESS).

"Greater ESS scores correlated with reduced activation in the dorsolateral prefrontal cortex when high-calorie vs. low-calorie food images were perceived," Dr. Killgore reported, noting that this region is typically implicated in attention and inhibitory processing. Similarly, greater daytime sleepiness was also associated with increased activation in the right parietal and inferior temporal cortex, he said.

The findings suggest the possibility that sleepiness may affect an individual’s inhibitory control when he or she is exposed to highly appetizing, high-calorie foods, according to Dr. Killgore, although it’s uncertain as of yet whether the observed patterns relate to actual food consumption, he said.

Marital Discord

Although most sleep research focuses on the individual, the fact that sleep problems and relationship trouble often co-occur led Wendy M. Troxel, Ph.D., of the University of Pittsburgh, and her colleagues to consider the dyadic nature of sleep in a recent study. The investigators examined the bidirectional links between nightly sleep and daily marital interactions among 35 healthy married couples (mean age, 32 years) by correlating the actigraph results for sleep latency, wakefulness after sleep onset, and total sleep time of each partner over 10 nights, with daily self-reported positive and negative marital interactions assessed via electronic diaries during the same period.

"We found stronger evidence linking sleep to the next day’s marital interactions, rather than the reverse direction," Dr. Troxel reported.

Specifically, wives’ prolonged sleep latency significantly predicted their own and their husbands’ reports of more negative and less positive interactions the next day, even after adjustment for depressive symptoms, whereas the quality of marital interactions did not appear to predict sleep measures in women, she said. The sleep quality of husbands did not appear to affect their own or their wives’ reports of next-day marital interactions; however, for men, a higher level of positive marital interactions predicted shorter total sleep duration the next night.

The findings suggest, perhaps, that "men are more likely to repress their feelings or not be as aware" of mood changes, whereas women are more likely to express their emotional concerns and to "drive the emotional climate of the relationship," Dr. Troxel said. The results highlight the potential interpersonal consequences of sleep disorders, and as such may have important clinical implications, she said.

In March of this year, the Centers for Disease Control and Prevention reported that nearly a third of the country’s adults get fewer than the minimum recommended 7 hours of sleep per night, and it’s not because they’re not tired: Nearly 40% of the survey population reported unintentionally falling asleep during the day, and nearly 5% reported nodding off while driving in the preceding 30 days (MMWR 2011;60:233-8).

In addition to the negative consequences of sleep deprivation noted above, previous studies have linked sleep insufficiency to a range of adverse health outcomes, including cardiovascular disease, asthma, diabetes, and stroke, according to the report.

The presenters reported no financial conflicts of interest relevant to their respective presentations.

MINNEAPOLIS – Sleep is in short supply, thanks to our "24-hour society" in which trading sleep for work or play is commonplace and sleep deprivation is worn as a badge of honor, according to Dr. Michel Cramer Bornemann, codirector of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis.

Not only have we become accustomed to trading sleep for work, Dr. Cramer Bornemann said at the annual meeting of the Associated Professional Sleep Societies, "lack of sleep is synonymous with hard work or achievement, when really it can impede both."

In fact, the effects of insufficient shut-eye extend across multiple domains, according to a collection of independent studies presented at this year’s meeting. For example, sleep loss was linked to the development or exacerbation of symptoms of ADHD in early childhood, an individual’s genetic risk of obesity, inhibitory response to images of high-calorie foods, and even marital discontent.

ADHD and Sleep Loss

In a study designed to tease out the complex relationship between sleep problems – particularly falling asleep and staying asleep – and the development or worsening of inattention and hyperactivity and impulsivity in children and adolescents diagnosed with ADHD, Erika Gaylor, Ph.D., of SRI International in Menlo Park, Calif., and her colleagues analyzed data from the preschool and kindergarten waves of the Early Childhood Longitudinal Study-Birth Cohort. The cohort comprises a representative sample of approximately 6,860 children and their families living the United States.

The investigators calculated total nighttime sleep duration based on parent-reported bedtime and wake time, and assessed children’s behavior using brief measures of attention and task persistence, Dr. Gaylor reported.

"We performed two sets of regression analyses to identify whether sleep duration in preschool-age children predicts attention and hyperactivity at kindergarten entry and [whether] attention and hyperactivity symptoms at preschool predict sleep duration at kindergarten," she explained.

Controlling for the outcome of interest at the preschool time point, sex, ethnicity, and family income, researchers found that less sleep at preschool significantly predicted worse scores on parent-reported hyperactivity and attention at kindergarten, whereas parent-reported hyperactivity and attention at preschool did not predict sleep duration at kindergarten, Dr. Gaylor stated.

"These findings suggest that some children who are not getting adequate sleep may be at risk for developing behavioral problems manifested by hyperactivity, impulsivity, and problems sitting still and paying attention," she said. The results extend those of a previous study in which she and her colleagues determined that having a consistent bedtime was the most reliable predictor of positive developmental outcomes by age 4 years, she noted.

The Link Between Sleep and Obesity

In a twin study designed to look more closely at the previously reported link between short sleep duration and elevated body mass index, Dr. Nathaniel Watson of the University of Washington in Seattle and his colleagues determined that short sleep may potentiate an underlying genetic mechanism for obesity.

The investigators examined whether sleep duration modified genetic and environmental influences on BMI in 1,811 pairs of twins drawn from the population-based University of Washington Twin Registry. The mean age of the study participants was 36.6 years. The participants provided self-reported information on height and weight, which was used to calculate BMI, as well as on habitual sleep duration, Dr. Watson said. The mean BMI of the group was 25.4 kg/m², and the mean sleep duration was 7.18 hours, he said.

©Nozomi Stall/Fotolia.com

Using behavioral genetic interaction models, the investigators found significant relationships between habitual sleep duration and genetic and shared environmental influences on BMI. Specifically, longer sleep duration was associated with decreased BMI, Dr. Watson reported.

"When sleep duration was 7 hours, the heritability of BMI was more than double [70%] that observed when sleep duration was 9 hours [33%]," he said, noting that "there appears to be something about short sleep that creates a permissive environment for expression of obesity-related genes." Similarly, he added, longer sleep duration may suppress genetic influences on body weight.

The findings are an important addition to the existing body of research on the relationship between sleep duration and BMI, Dr. Watson said. "Studies attempting to identify specific genotypes for BMI may benefit from considering the moderating role of sleep duration."

A connection between sleepiness and lack of self-control with respect to dietary choices may also contribute to the sleep loss/obesity equation, according to a study presented by William Killgore, Ph.D., of Harvard Medical School in Boston.

To test their hypothesis that greater daytime sleepiness correlates with reduced prefrontal cortex response during passive viewing of images of high-calorie foods, Dr. Killgore and his colleagues analyzed the functional magnetic resonance imaging (fMRI) scans of 12 healthy adults obtained while they were shown pictures of high-calorie foods, low-calorie foods, and control images of plants and rocks. Using a second-level regression model, the researchers correlated the fMRI findings with subjects’ self-reported daytime sleepiness, assessed via the Epworth Sleepiness Scale (ESS).

"Greater ESS scores correlated with reduced activation in the dorsolateral prefrontal cortex when high-calorie vs. low-calorie food images were perceived," Dr. Killgore reported, noting that this region is typically implicated in attention and inhibitory processing. Similarly, greater daytime sleepiness was also associated with increased activation in the right parietal and inferior temporal cortex, he said.

The findings suggest the possibility that sleepiness may affect an individual’s inhibitory control when he or she is exposed to highly appetizing, high-calorie foods, according to Dr. Killgore, although it’s uncertain as of yet whether the observed patterns relate to actual food consumption, he said.

Marital Discord

Although most sleep research focuses on the individual, the fact that sleep problems and relationship trouble often co-occur led Wendy M. Troxel, Ph.D., of the University of Pittsburgh, and her colleagues to consider the dyadic nature of sleep in a recent study. The investigators examined the bidirectional links between nightly sleep and daily marital interactions among 35 healthy married couples (mean age, 32 years) by correlating the actigraph results for sleep latency, wakefulness after sleep onset, and total sleep time of each partner over 10 nights, with daily self-reported positive and negative marital interactions assessed via electronic diaries during the same period.

"We found stronger evidence linking sleep to the next day’s marital interactions, rather than the reverse direction," Dr. Troxel reported.

Specifically, wives’ prolonged sleep latency significantly predicted their own and their husbands’ reports of more negative and less positive interactions the next day, even after adjustment for depressive symptoms, whereas the quality of marital interactions did not appear to predict sleep measures in women, she said. The sleep quality of husbands did not appear to affect their own or their wives’ reports of next-day marital interactions; however, for men, a higher level of positive marital interactions predicted shorter total sleep duration the next night.

The findings suggest, perhaps, that "men are more likely to repress their feelings or not be as aware" of mood changes, whereas women are more likely to express their emotional concerns and to "drive the emotional climate of the relationship," Dr. Troxel said. The results highlight the potential interpersonal consequences of sleep disorders, and as such may have important clinical implications, she said.

In March of this year, the Centers for Disease Control and Prevention reported that nearly a third of the country’s adults get fewer than the minimum recommended 7 hours of sleep per night, and it’s not because they’re not tired: Nearly 40% of the survey population reported unintentionally falling asleep during the day, and nearly 5% reported nodding off while driving in the preceding 30 days (MMWR 2011;60:233-8).

In addition to the negative consequences of sleep deprivation noted above, previous studies have linked sleep insufficiency to a range of adverse health outcomes, including cardiovascular disease, asthma, diabetes, and stroke, according to the report.

The presenters reported no financial conflicts of interest relevant to their respective presentations.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – Maxillomandibular advancement may be a reasonable option for patients who have severe sleep apnea and are unable to tolerate continuous positive airway pressure therapy, according to a study by the Department of Veterans Affairs.

In maxillomandibular advancement (MMA), the upper and lower jaws are moved forward to optimize the airway and minimize soft-tissue blockages. Dr. Vincent Mysliwiec and his colleagues in the Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord in Tacoma, Wash., evaluated the outcomes of the surgery in an active-duty population.

"Obstructive sleep apnea is an increasingly common diagnosis in soldiers, and those soldiers with more severe cases are not deployable without going through an extensive waiver process," Dr. Mysliwiec said at the annual meeting of the Associated Professional Sleep Societies. "We wanted to assess whether [MMA] represents a surgical cure that can potentially remove the requirement for CPAP in these individuals and, in so doing, increase the number of soldiers who are fully deployable."

The researchers reviewed all of the MMA procedures performed for obstructive sleep apnea at their institution in 2006-2009 and identified 37 soldiers who had severe disease – defined as an apnea-hypopnea index (AHI) of more than 30 events/hr – and underwent the surgery as well as pre- and postoperative polysomnography. The primary study outcomes were comparisons of the pre- and postoperative AHI and minimum nocturnal oxyhemoglobin saturation. Surgical cure was defined as an AHI reduction of at least 50%, compared with preoperative AHI, and a postoperative AHI of less than 15.

The mean body mass index of the study cohort was 29 kg/m², and the mean preoperative AHI was 50.5, Dr. Mysliwiec reported. Following the procedure, "the mean postoperative [AHI] dropped significantly to 13.8," he said. "Twenty-two of the soldiers – nearly 60% of the group – reduced their [AHI] by at least half, which met the criteria for surgical cure." Further, he said, 16 of the soldiers had a postoperative AHI of less than 5, "meaning they had no residual disease at all following the procedure." One study patient did not experience a clinically significant reduction in AHI following the surgery. The mean minimum nocturnal oxyhemoglobin saturation increased postoperatively from 85% to 86%, a nonsignificant change (P = .21; standard deviation for both measures, 7%).

"Maxillomandibular advancement significantly reduced the severity of sleep apnea for our patients and improved the quality of their sleep," Dr. Mysliwiec said. "These findings could improve the standard of care for civilians and active-duty service members with severe obstructive sleep apnea who can’t tolerate CPAP or have failed other soft-tissue procedures."

Dr. Mysliwiec reported having no financial conflicts of interest.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.

MINNEAPOLIS – An automated analysis of tracheal breath sounds while awake was predictive of obstructive sleep apnea in a small study.

If validated in larger studies, the findings may streamline the obstructive sleep apnea (OSA) screening process, resulting in earlier diagnosis and treatment of severe cases, Zahra Moussavi, Ph.D., said at the annual meeting of the Associated Professional Sleep Societies. "The ability to predict the likelihood and severity of obstructive sleep apnea without performing overnight polysomnography is very appealing and would lead to significant reductions in health care costs, compared with full-night sleep assessments."

Obstructive sleep apnea (OSA) is highly prevalent in the general population, but only 30% of patients referred to a sleep lab for evaluation have severe OSA requiring treatment, said Dr. Moussavi, a professor in the department of electrical and computer engineering at the University of Manitoba, Winnipeg. With no fast, accurate, clinical or laboratory tools for predicting the severity of suspected OSA, full-night polysomnography is required to confirm the diagnosis and determine its severity. "Unfortunately, the demand [for full-night sleep studies] outweighs the available resources, resulting in appointment backlogs and long wait times, which can delay the initiation of potentially lifesaving care," she said.

Acoustic analysis has been used during sleep to evaluate the breathing and snoring patterns of suspected apnea patients. To examine wakeful breathing patterns associated with OSA, Dr. Moussavi and colleagues, recorded the tracheal breath sounds of 35 patients with varying severity of OSA and 17 age-matched controls.

"We recorded the tracheal breath sound in supine and upright positions during nose and mouth breathing," said Dr. Moussavi.

Spectral analysis of the respiratory signals indicated that variation in the average power of the tracheal breath sounds at different positions was a characteristic feature that discriminated the OSA and control groups.

Using the maximum relevancy/minimum redundancy method, the investigators reduced the number of sound features that were significantly different between the groups to two, "and unsupervised clustering of these showed an overall accuracy of 84%, with a sensitivity of 88% and a specificity of 80%," Dr. Moussavi reported.

"It is known that [OSA] patients have a smaller and more collapsible pharynx, which is compensated by increased dilator muscle activity during wakefulness. They tend to have more negative pharyngeal pressure, which can be detected via breathing sounds through the nose because of higher resistance," she said. Because breath sounds are directly related to pharyngeal pressure, "this method is sensitive to the severity of [OSA] even during wakefulness."

The study was supported by the National Sciences and Engineering Research Council of Canada and TRI Labs Winnipeg where Dr. Moussavi is an adjunct scientist.