Strategic Goal: Goal 2: Reduce Human Disease

Sleep Apnea - Trial of Treatment vs No Treatment of Snoring

Randomized trial of the treatment of snoring vs. no treatment.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Snoring is increasingly implicated as potential disruptor of carotid artery intima and function. Repetitive vibratory trauma has been hypothesized as cause of this. Intermediate markers of cardiovascular risk such as intimal thickening have been linked to snoring as independent from sleep apnea. This field is ready for a larger scale trial in which snoring is intervened upon and IMT is measured as one of several endpoints. Other endpoints could be QOL measures, sleepiness, etc. Another reason this field is ready to be addressed is we now have inexpensive nasal resistors, which treat snoring without the need for surgery, oral appliances, or CPAP. These would allow the sleep medicine field to do a trial of such therapy vs. a sham therapy.

Name of idea submitter and other team members who worked on this idea : ATS Member

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Strategic Goal: Goal 2: Reduce Human Disease

What causes the structural abnormalities that cause sleep apnea, and how can they be prevented?

It is estimated that up to 28% of the population suffer from sleep apnea, which impairs functioning and reduces quality of life, while increasing risk of accidents and a variety of cardiovascular, metabolic, and neuropsychiatric diseases. A large portion of sleep apnea cases are caused by abnormal oro-nasal-maxillo-mandibular features that result in crowding of the upper airway, making it vulnerable to collapsing or ...more »

Submitted by (@bmdixon)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Obstructive sleep apnea (OSA) is a common condition, which causes chronic fatigue and daytime sleepiness, as well as cognitive impairments affecting learning, concentration, and memory. Over the long term, it increases many health risks, including accidents, cardiovascular disease, and depression. OSA is characterized by partial, or complete, blockage of the airway during sleep, so that breathing repeatedly pauses or airflow is limited, causing repeated arousals from sleep. It is usually secondary to a narrow, or collapsible, airway due to either 1) obesity or overweight, or 2) abnormal morphology of the mandible or maxilla bones, which crowds facial structures, such as the tongue and nose, narrowing the pharynx. The causes of obesity are already being well studied, but there is relatively little research on the etiology of the structural abnormalities involved in OSA. Abnormalities of facial structure are widespread in the population causing, not only OSA, but also orthodontic problems that require many to get braces or have wisdom teeth extracted, and widespread temporomandibular joint (TMJ) problems. However, multiple studies have documented that these abnormalities are almost completely absent from populations living a preindustrial, agrarian or forager, lifestyle, making them a “disease of civilization”. In particular, the abnormalities are associated with consumption of a modern diet of processed foods during prenatal, infant, and early childhood development.

Feasibility and challenges of addressing this CQ or CC :

Current evidence implicates three factors in the development of these structural abnormalities: prenatal maternal nutrition (especially vitamin K2 status), breastfeeding vs. bottle-feeding, and frequency of consumption of tough foods after weaning (which provides exercise to the jaw). We need to form a large cohort and study orthodontic development prospectively from fetal development through mid-childhood, with data on diet, feeding practices, and physiological measures of nutrient status. Measurement methods are available using existing technologies to collect the necessary data on each of these measures. Determining the causes responsible for these structural abnormalities will enable further research to demonstrate effective methods of preventing them. Given that many patients with OSA are rendered so miserable by it that they undergo maxillomandibular advancement surgery to correct it, an expensive procedure with a lengthy recovery period, prevention would be a far better solution. This research will move us a big step closer to a future without sleep apnea and its formidable collection of negative effects on health and functioning.

Name of idea submitter and other team members who worked on this idea : Bonnie Dixon

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Strategic Goal: Goal 2: Reduce Human Disease

What are the biological consequences of sleep loss or disruption and how can they best be avoided?

Arousals in obstructive sleep apena (OSA) are life saving, but the associated disruption of sleep is now thought to cause cognitive impairment, increased risk of high blood pressure and atherosclerosis, as well as glucose intolerance and metabolic syndrome. The mechanisms for these downstream effects, however, are not well understood. Can these specific pathophysiological mechanisms be identified, and can ways for mitigating ...more »

Submitted by (@csaper)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

By identifying the mechanisms by which sleep loss or disruption affects cognitive, cardiovascular, and metabolic function, we hope to find key regulatory points for which interventions may be developed. For example, if we can allow respiratory reflex responses to reopen the airway without EEG activation during OSA, we may be able to forestall some of the cognitive consequences of inadequate sleep. If we can prevent the autonomic responses associated with the EEG arousals and increases in respiratory drive, we may be able to block the repetiive elevations of blood pressure that lead to long term hypertension and accelerated atherosclerosis. If we can identify the reason for metabolic derangement associated with OSA, we may find, for example, that it is due to circadian misalignment and find ways to realign the sequence of metabolic events with the actual wake-sleep patterns of the patients. Finally, if we can potentiate the respiratory reflexes that re-establish the airway in OSA, without triggering the other components of arousals, we may be able to minimize or prevent the apneas. While current methods for treating OSA (e.g., CPAP and dental appliances) help many people, many others cannot tolerate these devices, and we require additional modes of therapy to mitigate the consequences of OSA.

Feasibility and challenges of addressing this CQ or CC :

The methods are currently available to address the questions that are raised above. The revolution in methods for evaluating the functions of neural circuits, using optogenetics and chemogenetics, for example, should allow us to identify brain circuits that are involved in the various components of the reflex responses to apnea. We can examine their neurotransmitters and receptors, and design new therapies based on manipulating CNS circuitry. Methods for assessing ongoing autonomic, respiratory, and metabolic responses in genetically mutated mouse modesl may require further miniaturization of various physiological methods, but this field is also rapidly advancing. Finally, methods for examining ongoing changes in neuronal activity in the living brain of awake mice are rapidly advancing.

Name of idea submitter and other team members who worked on this idea : Clifford B Saper, MD, PhD

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Strategic Goal: Goal 3: Advance Translational Research

treating sleep apnea without a nose or facial mask

I am lucky to still be alive. I developed heart failure at 41. I turn 60 this month. For the last five years, doctors have tried to get me on a CPAP. I have told them that I'd rather die. I have absolutely no interest in sleeping with a darth vader mask or some strange thing strapped to my nose. Furthermore I had sinus surgery 30 years ago that only partiallly cleared my sinus passage. So forcing air up my nose is very ...more »

Submitted by (@chriscage)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

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If my doctors are correct, patients like myself are at high-risk. Before we die, we will need expensive hospital or nursing home based care. If some one can develop a mask or device that will work, he or she will literally save lives and reduce the financial burden on families, communities and hospitals.

Feasibility and challenges of addressing this CQ or CC :

This shouldn't be difficult research. We're talking about an air delivery system, not a cure for cancer or AIDS. The challenge is that this is not a prestige issue. There won't be a lot of research centers spending on on this.

 

Yet it could save lives and reduce healthcare costs. Maybe this research could be conducted as a joint project of associations for ENT doctors, cardiologists and dentists.

Name of idea submitter and other team members who worked on this idea : Mary Crystal Cage

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Strategic Goal: Goal 2: Reduce Human Disease

Sleep Apnea and Metabolic Complications

Does treating sleep apnea benefit metabolic complications including non-alcoholic fatty liver disease?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : ATS Member

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Strategic Goal: Goal 2: Reduce Human Disease

Sleep apnea treatment and comorbidities

Does screening for and treating sleep apnea improve outcomes in HLB diseases, such as heart failure?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Strategic Goal: Goal 2: Reduce Human Disease

Developing approaches to the dissemination of behavioral weight loss programs

The Challenge is to make behavioral weight loss programs readily available to he many overweight and obese patients who need them. Behaivoral weight loss programs are effective in producing weight losses of 7-10% of initial body weight, which has been shown to have major beneficial effects on a number of diseases relevant to NHLBI--including hypertension and sleep apnea. However, at present, these programs are not widely ...more »

Submitted by (@rwing0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

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Strategic Goal: Goal 1: Promote Human Health

Missing upper teeth & sleep apnea treatment: Problems?

I am a 73 year old female with Hypersensitivity Pneumonitis, Complex Sleep Neap, using oxygen @ 4-5 L/min 24/7 who just had my upper teeth extracted. I notice this has a negative effect, or appears to, on the effectiveness of apnea treatment. I wake several times during the night with lips flapping! This did not happen before the extraction. Because there are still some lower teeth, I am unable to close my mouth tightly ...more »

Submitted by (@lesliesmyth)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

If this question has an answer, it would help an unknown number of persons by once again providing effective treatment for sleep apnea. I find fatigue is building again, as it did before I was diagnosed and treated.

 

It may be simply a matter of a different style of mask, but it appears ideas on what kind are a bit sparse on the ground.

Feasibility and challenges of addressing this CQ or CC :

One would need a sampling of persons with lower teeth (some, or all) who also have sleep apnea. One would have to determine whether indeed, there is a deterioration in quality of treatment, and if the number of lower teeth are a factor. Does the form of apnea make a difference? Does age or body weight play a part?

 

This is not exactly couched in academic, medical terms, but it is still a valid question. Its solution, or if a solution already exists, it's distribution among sleep physicians, would help those who experience this combination of circumstances.

Name of idea submitter and other team members who worked on this idea : Leslie H. Smyth

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Strategic Goal: Goal 2: Reduce Human Disease

Do patients with cardiovascular disease benefit from sleep apnea therapy?

Do patients with cardiovascular disease benefit from sleep apnea therapy?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : ATS Member

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Strategic Goal: Goal 3: Advance Translational Research

The effectiveness of a protocol-based screening in treating common COPD comorbidities

Does a protocol-based screening for commonly occurring comorbid conditions in patients with COPD (eg. CAD, CHF, depression, sleep apnea) improve management and outcomes for patients with COPD?

Submitted by (@dmcgowan)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

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Many times co- morbidities are not address appropriately in patients with COPD- a protocol- based screening would support better identification and adherence to guidelines and would improve management and outcomes of individuals with COPD>

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Strategic Goal: Goal 2: Reduce Human Disease

Clinical Trials in Pediatric Sleep Disorders - Effect of adenotonsillectomy

Effect of adenotonsillectomy on neurocognitive and behavioral outcomes in infants and and toddlers with obstructive sleep apnea syndrome.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

The CHAT study showed few significant changes in cognitive outcomes in school-aged children with OSAS. However, these children (aged 5-9 years) may have suffered from OSAS too long to allow for reversibility of central nervous system damage. The peak prevalence of OSAS occurs in much younger children. Theoretically, these children are much more likely to show cognitive improvement after treatment, due to a shorter duration of OSAS (with its resultant hypoxemic damage) and increased plasticity of their nervous system. These young children are often not treated, due to either underdiagnosis or concern about the increased risks of adenotonsillectomy in very young children. Thus, if it is found that early treatment reverses cognitive damage, the clinical management of these children would be profoundly affected.

Name of idea submitter and other team members who worked on this idea : ATS Member

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Strategic Goal: Goal 2: Reduce Human Disease

Can At-home sleep studies change the rural area diagnosis of obstructive sleep apnea

At home sleep tests or personal monitors (PM) have been shown to effectively provide an adequate diagnosis of OSA with the proper pre-screening tests and evaluation. These methods can be adopted by hospitals and if used effectively can save money to the patients and healthcare facility. With the Affordable Healthcare Act the focus is on providing quality care for less money, but many hospitals are slow to adapt. Sleep ...more »

Submitted by (@jeremyplambeck)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Setting up a protocol for rural hospitals, or all healthcare facilities in developing and taking care of patients with sleep disorder breathing.

Name of idea submitter and other team members who worked on this idea : Jeremy Plambeck

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