Getting enough undisturbed sleep is essential to good health. The good news is that disturbed sleep does not have to be permanent for either adult or pediatric patients. A number of sessions will bring the practicing clinician up to speed on sleep disorders and breathing during the last three days of the ATS 2011 International Conference.
Richard Schwab, MD
Breathing’s Link
Monday’s “Treatment of Sleep Disordered Breathing” is a primer on the latest research examining novel treatments for sleep apnea, said co-chair Richard Schwab, MD, associate professor of medicine and co-director at the Penn Sleep Center at the University of Pennsylvania Medical Center in Philadelphia.
The B29 session will take place from 8:15 to 10:45 a.m. in rooms 403-404 on the street level of the Colorado Convention Center. The session includes 22 poster presentations.
“The overriding theme of this session is new treatment options for sleep disordered breathing, including obstructive and central sleep apnea, Cheyne-Stokes respiration, breathing at altitude and obesity hypoventilation syndrome,” said Dr. Schwab. “In this session, unique treatments for sleep apnea will be discussed. Many of these new treatment options for sleep disordered breathing are safe, simple and effective.”
Atul Malhotra, MD
Chronic Lung Disease
On Tuesday, two other sleep sessions from 2 to 4:30 p.m. C86 “Sleep in Chronic Lung Disease: Challenges of Sleep and Breathing” will offer eight different perspectives, said co-chair Atul Malhotra, MD, associate professor of medicine at Harvard Medical School and medical director of Brigham and Women’s Hospital Sleep Disorders Program in Boston.
The program will be in rooms 301-302-303 on the street level of the Colorado Convention Center.
“Sleep has profound effects on most respiratory diseases,” Dr. Malhotra said. “In some cases, the disease is affecting sleep. In other cases, sleep is affecting the disease. Either way, many of us may be ignoring the interaction. Those of us who take care of patients with asthma don’t tend to think of how asthma may be affecting sleep and how sleep may be affecting asthma. The same is true of chronic obstructive pulmonary disease and a variety of other conditions.”
Simply raising clinician awareness of potential sleep-disease interactions will make this course a success, he said. Once physicians and patients see the link between disease and sleep, they can make better informed therapeutic decisions. A number of COPD patients, for example, could benefit from non-invasive ventilation, but only a minority of patients are being treated, he noted.
Pediatric Sleep
Ann Halbower, MD, associate professor of pediatrics and director of the pediatric sleep research program at the University of Colorado Anschutz Medical Campus, Denver, will moderate a poster session, C96 “What’s New in Pediatric Sleep?” during the same 2 to 4:30 p.m. time period, but in rooms 505-506-507 on street level of the Colorado Convention Center.
Because children are in a state of development, clinicians can pick up early symptoms of sleep disorders before the symptoms become permanent. The presentation of sleep disorders in children can be very different from what is seen in adults.
Ann Halbower, MD
“Several posters show that children with sleep-disordered breathing have increased ventilation during sleep compared to adults, for example,” Dr. Halbower said. “Children have a response that depends on a neuromuscular tone that is different than in adults.”
“Other posters show that pediatric sleep apnea is strongly associated with inflammation, inflammation that is associated with increased cardiovascular risk,” she continued. “That inflammation in children may be a place that we can target therapy.”
An accumulating body of evidence has revealed that treatment of sleep-disordered breathing in children can lead to improved outcomes, including improved neuropsychological performance and daytime behavior.
“All of these posters beg the question of whether we may need to consider early diagnosis and early treatment to allow children a more normal development and a more normal potential,” said Dr. Halbower, who is chair of the ATS Health Policy Committee. “If we are going to consider medical treatment, anti-inflammatories might bring improvement without surgery.”
Diagnosis & Management
Charles Atwood, MD, FCCP, FAASM, associate professor of medicine at the University of Pittsburgh Medical Center, will co-chair a sleep session from 2 to 4:30 p.m. on Wednesday, D108 “Diagnosis and Management of Sleep Disorders.” The session, which offers 19 posters focusing on different aspects of sleep apnea, will be in rooms 401-402 on the street level of the Colorado Convention Center.
“A body of evidence shows that sleep apnea can be a risk factor for respiratory complications following surgery,” Dr. Atwood said. “On any given day in the United States, about 60,000 people undergo surgery. Some percentage of them will have respiratory complications. We would like to find these people prior to surgery, so we can give them special attention to prevent any kind of respiratory complications.”
Other posters will look at the underuse of CPAP in the elderly, risk stratification for sleep apnea, novel treatments and home testing.
“They key point is that sleep apnea remains largely unrecognized in different settings,” he said. “One setting is the pre- and peri-operative period. Another is the elderly. The field is still looking for better ways to diagnose sleep apnea more simply and more reliably, ways that don’t rely on patients having to come to a sleep laboratory.”