A Test for Sleep Apnea From Your Own Bedroom
By LAURA JOHANNES
The Ache: At least 2% of women and 4% of men have sleep apnea—and most don't know it, according to scientific literature.
The Claim: You can get tested conveniently at home rather than during a night at a sleep laboratory.
NovaSom Inc.
NovaSom home sleep-apnea test.
The Verdict: Home testing is fairly accurate for people with moderate-to-severe apnea, but it may miss mild cases, doctors say.
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In obstructive sleep apnea, the airway repeatedly collapses during sleep causing sufferers to stop breathing briefly. It can cause daytime sleepiness and long-term health problems such as increased high blood pressure and stroke, says Sam Fleishman, president of the American Academy of Sleep Medicine, a Darien, Ill.-based professional society. Sleep apnea is commonly treated with a "continuous positive airway pressure," or CPAP, machine worn at night to keep the airway open.
Apnea testing measures how many times per hour you stop breathing while sleeping. More than five times indicates sleep apnea. Until recently, to get tested you'd spend the night in a lab hooked up to some 20 sensors.
Home testing, which has gained popularity recently, is "less obtrusive" as it is done in the patient's own bed, says Christine Won, director of the sleep program at the Veterans Affairs Connecticut Healthcare System in West Haven, Conn., which offers a home test.
Home testing uses fewer sensors—typically a nose or mouth sensor to detect breathing, a finger clip to measure blood oxygen levels and a chest band to see if your body is trying to breathe. It is done over one to three nights, depending on the device and the doctor's instructions, and costs $200 to $600, compared with about $800 to $3,000 for an overnight visit in a sleep lab, physicians say. Insurers increasingly are requiring home tests as a first step before paying for an in-lab test.
The home test, unlike the lab, lacks brain-wave monitoring. As a result, it may overestimate the time spent sleeping and underestimate the number of hourly apnea events. "If you have very severe sleep apnea, it's unlikely to miss it, but if you have mild apnea, it might," says Douglas Kirsch, an instructor at Harvard Medical School.
NovaSom Inc.
A home sleep-apnea test like this one from NovaSom, has fewer sensors than a lab test. Sometimes a further test in a sleep lab may be necessary.
For this reason, the AASM recommends the home test only for people considered at high risk for moderate-to-severe apnea based on a pretest exam. The devices, made by a number of manufacturers, catch on average about 80% to 90% of sleep apnea cases in those patients, says Nancy A. Collop, director of the Emory Sleep Center at Emory University in Atlanta and author of a 2011 study on the tests' accuracy.
If the home test is negative, the academy recommends in-lab testing, which rarely misses a case. If the home test is positive, a lab test still may be needed to determine the proper CPAP machine settings. "Why not just do the lab test in everyone so you don't need to do it twice?" argues Sairam Parthasarathy, associate professor of medicine at the University of Arizona in Tucson.
I tested a home device from NovaSom Inc., Glen Burnie, Md., for two nights. After it arrived, a NovaSom respiratory therapist called me, just as she would a patient, to go over how to use it. I needed to place a breath sensor on my upper lip, an oximeter on my finger and a band around my chest. All were attached by wires to a box strapped to my upper arm.
The apparatus was reasonably comfortable, but the first night, I was repeatedly awakened by a nagging voice from the machine prompting me to "check chest sensor." The next morning, the respiratory therapist suggested I move the band higher on my body, which solved the problem.
Write to Laura Johannes at laura.johannes@wsj.com
A version of this article appeared May 14, 2013, on page D2 in the U.S. edition of The Wall Street Journal, with the headline: A Test for Sleep Apnea From Your Own Bedroom.
Skin Cancer Strikes Men Differently
Malignant skin cancers develop in different areas of the head and neck in men and women. The reason may simply be because men are often the drivers of a car.
Malignant skin cancers develop in different areas of the head and neck in men and women. The reason may simply be because men are often the drivers of a car, while women are more often the passengers, according to a study in the Journal of Investigative Dermatology.
Up to 20% of aggressive skin cancers called melanomas occur on the head and neck, which are exposed to greater amounts of ultraviolet radiation than other parts of the body. But few studies have compared gender differences in the distribution of these cancers, the researchers said.
The study analyzed 279 head-and-neck melanomas diagnosed in 121 men and 158 women in their early 70s from the Champagne-Ardenne region of France, between 2004 and 2009. About half of the cancers were invasive, or had spread beyond the initial site.
The data revealed two distinct patterns. In men, 57% of melanomas were located in the peripheral area of the head and neck, which included the scalp, forehead, temple, ears and neck, while 43% developed on the eyelids, nose, cheeks, chin and mouth, or the central area. In women, 79% of melanomas developed in the central area and 21% in the peripheral area. Peripheral cancers were more common on the left side in men and on the right side in women, and tended to be invasive, researchers said.
Men spend more time driving than women and are often the principal driver, researchers said, which may explain the asymmetrical distribution of melanomas. The peripheral area is particularly exposed to UV radiation while traveling in a car, although longer hair on women appears to provide some protection, they said.
Caveat: Effects of hairstyle on head-and-neck cancers weren't assessed. Exposure to UV radiation in cars varies with glass type.
Title:
uArterial pressure: Preeclampsia is a potentially dangerous condition in pregnant women that involves a rapid rise in blood pressure, often without warning symptoms. A study in Anesthesia & Analgesia suggests that measuring the elasticity of a pregnant woman's arteries may help identify those at risk of preeclampsia and prevent major complications.
The cause of preeclampsia, which affects 8% of pregnancies in the U.S., isn't known, but studies have suggested that abnormalities in the placenta and cardiovascular system may both play a role.
Researchers analyzed clinical data for 43 hypertensive pregnant women in their early 30s who were assessed for preeclampsia at Massachusetts General Hospital. None of the women took blood-pressure medications or had symptoms of preeclampsia. A noninvasive technology that analyzes arterial pressure, was used to measure the elastic properties of large and small arteries in each subject.
Eighteen, or 42%, of the women had preeclampsia, including seven with severe preeclampsia, results showed. Small-artery elasticity was significantly lower in these women and in six others who developed preeclampsia later in pregnancy, compared with 19 who had the more benign gestational hypertension.
Arterial elasticity in the hypertensive women was about 35% lower than levels in healthy nonpregnant women and similar to those found in postmenopausal women with heart disease, researchers said. Large-artery elasticity didn't differ among subjects.
Caveat: The study didn't include a control group of healthy pregnant women.
Title:
u Inflammation: People with rheumatoid arthritis, or RA, may benefit from frequent dental-hygiene treatments. Periodontal treatment may reduce the severity of RA by decreasing the exposure of joints to harmful bacteria and their toxins, according to a study in Oral Diseases. RA affects an estimated 1.3 million Americans, mainly women.
The study involved 60 normal-weight Turkish subjects in their early 40s with chronic periodontitis and RA. Half of the subjects had mild RA and half had moderate to severe RA. Once a week for four weeks, subjects received periodontal treatments that included oral-hygiene instructions and standard plaque-removal procedures such as tooth scaling. Blood tests compared levels of three inflammatory biomarkers—C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-a), and erythrocyte sedimentation rate (ESR)—at the start of the study and three months after the treatments.
All three biomarkers decreased significantly in both groups, results showed. CRP decreased by 9.3% in subjects with mild RA and 49.5% in those with more severe or active disease. TNF-a decreased by 20.5% and 21% in the mild and severe RA groups respectively, while ESR decreased by 7% and 46%. Periodontal improvements were similar in both groups.
Caveat: The study lacked a control group. The follow-up period was short.
Title:
u Living alone: A study in the American Journal of Cardiology found that heart patients who live alone were 24.4% less active a month after discharge from hospital than patients with spouses or live-in partners. Living alone is associated with several adverse health conditions and may play a role in determining activity levels and health outcomes in heart patients, researchers said.
The subjects were 107 men and women ages 55 to 71 who were hospitalized for acute coronary syndromes, an umbrella term for heart attacks, angina and other conditions, at New York's Columbia University Medical Center from 2009 to 2010. Most subjects were overweight and 65% were men. More than half, 58%, lived alone, while only 11% reported on questionnaires that they had low social support. Subjects wore a wristwatchlike accelerometer continuously for a month following discharge. Data for the most active 10 hours of the day were analyzed.
Most subjects wore the accelerometers for 23 of the 30 days, results showed. Patients with significant posttreatment fatigue, termed anergia, were 20% less active than those without anergia, but those who received angioplasty treatment to open blocked arteries—77% of all subjects—had 26% higher activity levels than patients who didn't.
Decreased physical activity was associated with older age and longer hospitalization, but not with perceived support from family and friends, suggesting that partner status and social support don't completely overlap, researchers said.
Caveat: Information about other patient illnesses or physical therapy during hospitalization wasn't collected.
A Better Night's Sleep for All
New Thinking on Swaddling Infants; Sleeping Sacks Arrive at the Maternity Ward
Sleeping sacks arrive at the maternity ward and give a better night's sleep to all.
Check out almost any newborn baby picture, and if it was taken in a U.S. hospital, chances are the infant will be wrapped up in a familiar white flannel blanket with a blue-and-pink stripe.
That could be about to change as a blanket alternative—known as a wearable blanket or a sleep sack—makes inroads in hospital maternity wards as part of a campaign to promote safer sleep for babies.
More than 4,500 infant deaths each year occur suddenly due to factors including accidental suffocation and heart malfunctions and are broadly categorized as Sudden Unexpected Infant Deaths, or SUIDS. Roughly half can't be explained after investigation and are classified as Sudden Infant Death Syndrome, or SIDS. SIDS rates have declined more than 50% since 1999, as research has shown putting babies on their backs to sleep decreases the risk and a national education campaign has emphasized the importance of consistently doing so.
At the same time, rates of deaths classified as accidental suffocation have risen, and many SUIDS cases are linked to unsafe sleep environments, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics' 2011 guidelines warning against loose crib blankets are part of an expanded "Safe to Sleep" program sponsored in part by the National Institute of Child Health and Human Development.
Swaddling infants in a blanket is an age-old practice that can help comfort a fussy baby. But incorrect swaddling can be a health threat: Too loose, and a blanket can unwind and hinder breathing; too tight, and it can cause serious hip problems. The International Hip Dysplasia Institute recommends that infants' legs should be able to bend up and out at the hips, not tightly wrapped straight down and pressed together.
Infant sleep sacks, with fabric flaps that swaddle the baby's arms to the body and close securely, are meant to make swaddling safer and easier by giving babies a secure feeling and freedom of leg movement without danger of loose fabric around the head. As part of safe-sleep education programs, 1,000 hospitals are receiving free annual allotments of SleepSack-branded wearable blankets based on birth rates from Halo Innovations Inc., of Minnetonka, Minn. Company founder, Bill Schmid, lost a daughter to SIDS in 1991.
At Abbott Northwestern Hospital in Minneapolis, baby blankets now are used only to dry off and present newborns to parents. After that, the newborns go into sleep sacks. Sarah Scherbring, a first-time mother who delivered her son, Owen, at the hospital in January, calls the safe-sleep information from prenatal classes "very eye-opening." As a result, she avoided overstuffed bedding she had been thinking about buying in favor of an undecorated crib with a firm mattress and a tight flat sheet.
Babies can't wriggle out, but sleep sacks need to be used properly. The night Owen was born, Ms. Scherbring and her husband, AJ, swaddled the baby in his sack and placed him in the bassinet in her hospital room. Exhausted, they fell asleep—only to be startled awake by his crying when a nurse came in and unwrapped him. She told the groggy parents that they had secured the sack a little too close to the baby's nose and mouth. Ms. Scherbring says they were grateful to learn the proper technique "to keep our baby safe."
The AAP also recommends avoiding loose bedding, bumper pads and soft toys in cribs, which are linked to SUIDS, and it warns parents not to share a bed with their infant, especially at ages younger than three months. Also not recommended are "co-sleeping" cribs, which have one open side pushed against the parent's bed and are promoted as safe within the "attachment parenting" movement. The AAP says some studies show sharing a bed with an infant increases the risk of SIDS or suffocation, so instead parents should share a room—a practice that has been shown to reduce the risk of SIDS by as much as 50%.
"These infant deaths are preventable accidents that remain a silent epidemic in our country," says Michael Goodstein, a member of the AAP's task force on SIDS and a neonatologist at York Hospital in York, Pa. "Wearable blankets are completely appropriate in place of a blanket," he says, as long as the size is appropriate and it doesn't result in overbundling, which overheats infants and increases the SIDS risk. In Pennsylvania, a 2010 law requires hospitals to provide information on SUIDS and SIDS risks and to ask parents to sign a voluntary acknowledgment form.
Amanda Albright, who gave birth to triplets in January at York, says nurses and doctors "were very hands on" about instructing her and her husband how to use sleep sacks and avoid putting other items in the crib. They have lined up two cribs with no extra bedding along their bedroom wall for daughter Macy and son Reid, and have a third ready for Lena, who is still in the neonatal intensive care unit. They won't be sleeping with the babies, Ms. Albright says. "It is very intimidating at first to learn about the risks, and there are some that you can't control," she says. "But we have to practice the prevention steps that we do know about."
Halo and others sell wearable blankets at retail as infant sleepwear priced from $25 to $30. In 2006, Mr. Schmid began offering newborn-size sacks at no charge to hospitals that pay shipping costs. Hospitals can buy replacements at just over cost and at a discount to give or sell to new parents. Halo gives some proceeds to SIDS research and prevention groups such as First Candle, of Bel Air, Md., and it provides hospitals educational materials from First Candle promoting sacks over blankets. Halo says the groups use its funding at their own discretion and it isn't aware of specific studies linking wearable blankets to a lower risk of SIDS.
Medline Industries, of Mundelein, Ill., supplies about 40% of hospital baby blankets and says sales of its 60-year-old Kuddle-Up line of familiar striped blankets, caps and other pediatric apparel are up about 5% this year. Medline sells the blankets to hospitals for $1.50 to $2.50 each and recently began offering a sack-type garment for $7.50 to $8.50.
Jennifer Walrich, Medline senior product manager, says while the company isn't seeing an "overwhelming trend" in hospital requests for sleep sacks, there is definite interest. "If the blankets were to go away in five years, we will always have another product that fits their needs," she says. Safe-sleep guidelines don't specifically recommend eliminating swaddling in blankets, she notes, but rather warn that blankets shouldn't be allowed to come loose in a crib.
Still, nurses who have long prided themselves on their blanket-swaddling technique—sometimes called "baby origami"—now are delivering stern warnings about how easily blankets can get loose. Karen Shirley, director of maternal-newborn services at HCA Inc.'s Chippenham Hospital in Richmond, Va., says some babies "are like little Houdinis. One minute you think you've swaddled them tightly, and the next minute they don't have one part of the blanket left on them."
With their Velcro closures and zippers, the Halo sleep sacks can't be sent through hospitals' industrial laundries, the way blankets are, and instead must be sent out for special washing, adding to costs. But given the risks of loose blankets, "it's the only way to go," says Marilyn Maggioncalda, clinical nurse specialist in the neonatal intensive care unit at Hurley Medical Center in Flint, Mich. Her unit puts new babies into sleep sacks while they're in the hospital and sends each one of them home with a free sack of their own.
Write to Laura Landro at laura.landro@wsj.com
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