CMS Advisory Panel Cool to Home Testing for Obstructive Sleep Apnea

On September 28, a Medicare Coverage Advisory Committee organized by the U.S. Center for Medicare and Medicaid Services (CMS) conducted an all-day meeting to review the accuracy and effectiveness of portable devices used at home to diagnose obstructive sleep apnea (OSA). Research evidence on the portable devices was compared to the current "gold standard" diagnostic technology for OSA, an overnight, technician-attended, polysomnogram conducted in a sleep laboratory, and evaluated in terms of the ability of portable devices to accurately diagnose OSA. The Advisory Committee expressed limited confidence in the quality of the data comparing portable devices to PSG, but expressed greater confidence in the portable devices for measures limited to cardio-respiratory parameters often used as the sole basis for OSA diagnosis. The Advisory Panel supported the potential for home testing, but called for improved research data. A spokesperson for CMS expected that the agency would be soliciting additional information and that a final coverage (insurability) decision will be published in January 2005 followed by a 60 day comment period. For more information and to track the issue, visit CMS' web site at http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=110

Once upon a Time….

Once upon a time tonsillectomies were performed on most children who had swollen tonsils or adenoids. The swollen tonsils and/or adenoids aided in many infections that are now treated with antibiotics. Most parents today are not even aware that this procedure is still preformed, but, in 1996, 400,000 were preformed (1996 was the last year that the Federal government counted all inpatient and outpatient procedures). (Usatoday.com.com, 4/14/2004,Kim Painter) Why are tonsillectomies still performed if antibiotics help with the infections? It is because by removing swollen tonsils and/or adenoids a different, under-diagnosed disorder can be cured: obstructive sleep disordered breathing (OSA). Anna Messner, an otolaryngologist at Lucile Packard states that 90% of the tonsillectomies performed are to cure this disorder. (Usatoday.com, 4/14/2004) The way that swollen tonsils create sleep-breathing disorder is that the sheer size of swollen tonsils blocks an already narrow airway: add obesity to the mix and the problem gets worse. The true tragedy of this is that children who are suffering from OSA due to enlarged tonsils may be and often are diagnosed as having ADHD. Dr. David Gozol, a pediatric sleep specialist at Kosair Children’s Hospital says that these children “often fight drowsiness with over-activity and can become the kind of cranky, aggressive kids that are as likely to end up in the principal’s office as the doctor’s office”. (Usatoday.com, 4/14/2004) Some even feel that the breathing pauses can promote brain damage by cutting off the oxygen to the brain. If you suspect your child of having ADHD, the important thing is to watch and listen to your child sleep. If they snore or gasp for breath; if they sleep in unusual positions; if they thrash around in their sleep or sleep in odd positions, then your child may have obstructive sleep apnea. It is recommended that a child suspected of ADHD, who also has some of these symptoms, have a sleep study performed to find the exact cause of the problem. “We think there is a group of kids out there being treated for ADHD…who don’t have ADHD”- Dr. David Gozol (Usatoday.com, 4/14/2004)

NATIONAL SLEEP FOUNDATION LAUNCHES DROWSY DRIVING WEBSITE (NSF Press Release)

A new Web site dedicated exclusively to preventing the nationwide problem of drowsy driving is being launched by the National Sleep Foundation (NSF) Monday, November 24, as millions of Americans prepare to take to the roads for the Thanksgiving holiday weekend. This comprehensive NSF site, www.drowsydriving.org, is the first of its kind, providing a collection of the latest information and resources to help raise awareness about a common, though often ignored problem that injures and kills thousands of people every year. “Sleepiness has no place on the road. Yet crashes caused by a driver who was drowsy or actually fell asleep behind the wheel occur almost daily in this country and in countries around the world,” notes Richard L. Gelula, NSF’s executive director. “This new Web site is the first of many new NSF initiatives dedicated to preventing drowsy driving and the needless deaths and injuries that often result.” According to NSF’s annual Sleep in America polls, about one-half of adult drivers – some 100 million people – say they have driven feeling drowsy, while 17 percent, about 32 million people, say they have actually fallen asleep at the wheel. The National Highway Traffic Safety Administration (NHTSA) conservatively estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year, resulting in an estimated 1,550 deaths, 71,000 injuries and $12.5 billion in monetary losses including diminished productivity and property loss. Visitors to www.drowsydriving.org can get tips that describe warning signs and symptoms of the onset of sleepiness and actions to follow if one becomes sleepy behind the wheel. Tools for better sleep, including sleep tips selected from NSF materials, will also be provided along with information targeted specifically to at-risk groups such as teens, shift workers and commercial drivers. Those seeking information about new detection devices will find them listed along with criteria the devices must meet to be considered effective and valid. Additional tools and resources are available for drivers of all ages, employers and teachers. There are also special features for researchers, academics, policymakers and advocates working to prevent the injuries and deaths that result each year because of drowsy drivers. These include research studies and surveys on drowsy driving, and links to other research and related documents listed by subject category for easy reference. “Sleep-Wake joins the National Sleep Foundation in urging all drivers in our community to pay attention to the way they feel before getting behind the wheel,” says Dr. Robert Schader. “If you’re tired or sleepy, don’t drive.” Sleep-Wake is a NSF member, working with the Foundation as a Community Sleep Awareness Partner. NSF and Sleep-Wake encourage companies, schools, institutions, unions, organizations and government agencies to link to www.drowsydriving.org. A special “Link To This Site” feature is provided to facilitate greater awareness and use of the prevention information. NSF will also use the new site to try to get more people involved as advocates on the issue at the state and local levels and within institutions. www.drowsydriving.org visitors can join the call to action by urging their elected officials to address sleep-related issues. The new Web site will also feature updates on reported drowsy driving crashes, press articles, and legislative actions as well as a special “memorial page” designated for stories about people whose lives have ended because of drowsy driving. www.drowsydriving.org is the first of many new phases of NSF’s “Drive Alert…Arrive Alive” campaign to raise awareness about the dangers of driving while feeling drowsy. It will be followed by a major report from NSF early next year on recommended preventive actions that can be taken in the public and private sectors at the national, state and local levels. The National Sleep Foundation is an independent nonprofit organization dedicated to improving public health and safety by achieving public understanding of sleep and sleep disorders, and by supporting public education, sleep-related research, and advocacy. NSF is based in Washington, DC.

Menopause and Sleep in Women

A woman's body goes through many changes as they age. Around age 50, they enter a stage known as menopause. This is when, usually over years; a woman's ovaries decrease production of estrogen and progesterone. This decrease causes a myriad of symptoms which disrupt their sleep. A 1998 poll conducted by the National Sleep Foundation (NSF) found that 40% of women in menopause suffer from disruptions in their sleep. The most common factor that interferes with a woman's sleep during this phase is from hot flashes. This is caused by changes to the estrogen levels in their bodies. The average woman going through menopause suffers from hot flashes three days per week. The NSF states that, on average, sleep is interfered with five nights per month for approximately five years. While the hot flashes do not fully arouse most women, it does interfere with the quality of their sleep and many women wake up feeling un-refreshed the following day. While the problem is common, there is no simple solution. What makes it so hard for these women to find help is that the most effective treatment for menopause, Hormone Replacement Therapy (HRT), has certain health risks associated with it. Some studies have found an increased risk of developing breast cancer or heart disease in women receiving HRT. On the other side, without some form of HRT, the symptoms of menopause may actually increase over time. A woman may suffer from increased hot flashes, insomnia, or even develop sleep apnea. There are other treatments available for these women. These include vitamin supplements, creams, and even sleep inducing pills. The NSF states that any form of estrogen in the blood will reduce hot flashes. Recent studies have found that soy products such as tofu or soymilk can reduce some menopausal symptoms. Also, phytoestrogen (plant estrogen) can relieve symptoms. Before a treatment is either begun or ended, a physician should be consulted. In the meantime, doing minor things such as limiting one's caffeine during the day, exercising no less than three hours before bed, or even changing the temperature of one's room can make the quality of one's sleep improve.

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