I try to start my blogs in a lighthearted way, but there is nothing lighthearted about amyotrophic lateral sclerosis, more commonly known as ALS. ALS is a group of progressive diseases of upper and lower motor neurons, resulting in weakness of muscles. The course is often rapid, with most people dying from respiratory failure within three to five years from the onset of symptoms. Patients have difficulty breathing due to weakness of respiratory muscles. As the disease progresses, patients may require tracheostomy and ventilation. There is no known treatment.
Key opinion leaders who worked with me to develop the Predictions for Sleep Technology Profession in 2018 e-book emphasized the role that wearable monitors might play in the future of sleep medicine. In addition, I recently wrote a blog on a preliminary study using wrist monitors to diagnose OSA. This got me thinking about the potential value of the information collected by these devices beyond sleep disorders. A pair of articles in the most recent Journal of Clinical Sleep Medicine is the focus of the January Journal Club. Surprisingly, neither of these articles focused on sleep disorders – instead, the focus was on sleep health.
For the past five years I have been teaching in the Psychology Department at California State University, Long Beach (Go Beach! Of course, when you think about it, the beach can’t really go anywhere. And what school has a beach as a mascot? But I digress.). My students are very diverse and many are the first in their families to attend college. Communication skills and scientific knowledge are often lacking. But when I speak to my students during office hours I find that they are intelligent, enthusiastic and motivated to learn. They make me want to learn how to be a better teacher.
Don’t let the fancy name of the medication fool you. The cannabimimetic is dronabinol, a synthetic non-selective CB1 and CB2 receptor agonist. But really, it’s marijuana. As medical and recreational use of marijuana becomes legal state by state, research that has been impossible has now become available. And the therapeutic effects of marijuana are extending beyond the well-known positive effects for chemotherapy patients. High on that list of benefits is, believe it or not, obstructive sleep apnea.
So, after much deliberation, I ordered an Apple Watch. I ordered it because I can never hear the phone ring when it is in my pocket. The advertisements tell me that the watch will blink and vibrate and yell at me when the phone rings, and hopefully that will be enough to get my attention.
Lately, the news has not been great for CPAP users and the sleep centers that care for them. The USPSTF recommended against screening of asymptomatic patients and, in doing so, threw some major shade on the use of CPAP.
The AASM released a “Clinical Practice Guideline” for diagnostic testing for OSA.1 Not surprisingly, the guideline is heavy on home sleep apnea testing (HSAT). This replaces a practice parameter and a clinical guideline from a decade ago.
Not a big fan of Arizona. Went to APSS when it was in Phoenix years ago and the soles of my shoes melted because the sidewalk was so hot. I kinda like the grumpy old “mavericky” senator sometimes. And maybe the airplane graveyard outside of Tucson. And the food. And the cacti are cool. OK, maybe I like it more than I thought. The best reason for liking Arizona may be that they do not go along with this Daylight Savings Time (DST) business. Good for them.
This morning I sat down at my computer and searched for “sleep apnea screening.” The first headline was “MTA to Expand Sleep Apnea Screening to Include LIRR and NYCT.”1 I took a sip of my medium roast Sumatra Mandheling and, nodding my head, said to myself, “yes, yes, screening is good.” The next headline was “USPSTF Fails to Endorse Routine Sleep Apnea Screening.”2 Out came the coffee in a fine spray on my iMac Retina 5K display.
Creating the Journal Club modules is one of the best parts of my job as educational consultant for the AAST. I read the literature on a regular basis just for fun, which shows you what kind of person I am. When I sit down to construct a Journal Club I get to trace back the influences on a paper or series of papers, and from time to time I get to talk with the authors.