Adaptive servo ventilation (ASV) is an effective treatment option for patients with complex sleep apnea, according to a Philips-sponsored study published in the American Journal of Respiratory and Critical Care Medicine. The study, Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea, compared the performance of 4 different ASV devices with different algorithms, including Philips DreamStation BiPAP autoSV (pictured), and the ASV device that was originally associated with greater mortality during a prior SERVE-HF trial published in 2015. The recent study revealed that certain physiological performances were quite different across the devices.

In the prior SERVE-HF trial, it was suggested that ASV therapy was harmful to central sleep apnea patients with heart failure, with limited information suggesting that some of the patients in the trial may have received excessive minute ventilation that may have increased patient mortality. This new Philips-funded randomized controlled study suggests the mechanisms underlying the adverse effects of ASV may be secondary to excessive ventilation due to device-based effect rather than a class-effect.

“The pursuit for scientific understanding of various disease and treatment processes is an iterative process where we revisit successes and failures to deepen our understanding of disease processes,” says Sairam Parthasarathy, MD, a lead investigator on the study, professor of medicine and interim chief of Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at University of Arizona College of Medicine, in a release.

Adaptive servo ventilation (ASV) is an effective treatment option for patients with complex sleep apnea, according to a Philips-sponsored study published in the American Journal of Respiratory and Critical Care Medicine. The study, Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea, compared the performance of 4 different ASV devices with different algorithms, including Philips DreamStation BiPAP autoSV (pictured), and the ASV device that was originally associated with greater mortality during a prior SERVE-HF trial published in 2015. The recent study revealed that certain physiological performances were quite different across the devices.

In the prior SERVE-HF trial, it was suggested that ASV therapy was harmful to central sleep apnea patients with heart failure, with limited information suggesting that some of the patients in the trial may have received excessive minute ventilation that may have increased patient mortality. This new Philips-funded randomized controlled study suggests the mechanisms underlying the adverse effects of ASV may be secondary to excessive ventilation due to device-based effect rather than a class-effect.

“The pursuit for scientific understanding of various disease and treatment processes is an iterative process where we revisit successes and failures to deepen our understanding of disease processes,” says Sairam Parthasarathy, MD, a lead investigator on the study, professor of medicine and interim chief of Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at University of Arizona College of Medicine, in a release.

A new study of the challenges and burdens faced by CPAP users reports that successful patient adherence to CPAP therapy requires new, personalized patterns of behavior incorporating physical, psychological, and cognitive adaptations. The study was conducted by research scientists from the Regenstrief Institute, Richard M. Roudebush Veterans Affairs Medical Center, and Indiana University – Purdue University Indianapolis (IUPUI).

“Telling patients they should exercise more or go on a diet is not a prescription for success, and neither is just handing them a CPAP machine with basic use instructions,” says Regenstrief Institute research scientist Edward Miech, EdD, who led the new study, in a release. “Simple actions, such as discussing the patient’s specific concerns during the crucial initial period, can successfully introduce CPAP treatment and could increase the likelihood of successful adherence.

“Unlike taking a pill, personal context—especially in the home situation—can make an enormous difference in terms of how well individual patients adapt to CPAP after receiving a diagnosis of obstructive sleep apnea. Given the irritating, ongoing challenges associated with CPAP adherence, helping patients adapt the treatment to the specifics of where and how they live represents a major opportunity to improve CPAP adherence and improve obstructive sleep apnea outcomes.” Miech is a health services researcher, and an implementation scientist who assesses how interventions, implementation strategies and contexts work together to influence implementation success and sustainability.

The objective of the new study was to understand the processes that help explain

With the new format over 20% of the store is dedicated to health services, including new durable medical equipment (DME) and supplies and new product and service combinations for sleep apnea and diabetes care.

CVS Health is encouraged by its early results and customer response to HealthHUB^®. The company says it will continue to pilot the Houston-based locations, with the goal of continuing to innovate and test to determine the right mix of products and services that can impact patient health while being scalable.

“We have a sense of urgency about the need to bring real change to health care,” said Kevin Hourican, EVP, CVS Health and president of CVS Pharmacy. “What’s clear to us is that it will take more than incremental steps to fix what is broken in the health care system. That’s why we’re excited about how the combination of CVS and Aetna can begin to establish an innovative health care model that will create an entirely new consumer experience and help people on their path to better health.”

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Withings has added new capabilities to its sleep sensor mat, the Withings Sleep, that it says will track and provide detailed information about breathing disturbances experienced during the night. Available to all current Sleep owners after performing an app update, the new feature charts their breathing disturbances over time and provides educational content to help users recognize the signs of sleep apnea.

The new feature acts as a first step towards Withings’ strategy to introduce even more advanced sleep diagnostics including sleep apnea detection. Withings aims to add these capabilities by the end of 2019, subject to FDA and CE clearances.

According to the company, the new Withings Sleep breathing feature provides users with an early warning system to allow them to identify hard to diagnose potential issues and where appropriate, seek medical advice.

Breathing disturbances is a free upgrade for Withings Sleep and was developed and extensively tested by sleep physician Dr Pierre Escourrou within the Paris-Béclère hospital sleep lab using polysomnography (PSG) analysis.

Withings Sleep is a mat that fits under the mattress and after a onetime setup automatically provides a look at users’ nights by monitoring sleep cycles, tracking heart rate, and detecting snoring. The new feature monitors vital signs such as respiration and heart rate, as well as motion and snoring to track and chart the intensity of breathing disturbances throughout the night. The Health Mate App rates the intensity of those disturbances from low to

Sleep apnea can cause a range of health risks and problems, from heart disease and type 2 diabetes to drowsy driving and metabolic disruptions affecting performance. Even children between 2 and 8 can develop sleep apnea, which can affect normal development, learning and behavior.

“Treatments often fail because there is a knowledge gap of the fundamental science behind the reasons for this health issue,” says Haibo Dong, PhD, a University of Virginia associate professor of mechanical and aerospace engineering who specializes in fluid dynamics research, in a release.

Dong and PhD students Junshi Wang and Pan Han are gaining new understanding of the fundamental science behind sleep apnea by using CT scans and MRIs to image the mouth and nose and the full airway during snoring and apnea, and then computer-modeling the actions that cause vibrations of the uvula and obstructions. They are looking for the changes in the shape of the airway during sleep that cause perturbations in airflow. Those perturbations are the vibrations of snoring and the often-resulting breathing difficulties.

The three images here represent vortices, streamlines, and velocity contours of snoring flows in the human pharyngeal airway.

If Dong’s team and his research colleagues, including James Daniero, MD, a head and neck surgeon in UVA’s Department of Otolaryngology, can understand the basic mechanics of sound produced during normal breathing, then perhaps better treatments and longer-term solutions for abnormalities may be possible.

“This work is highly interdisciplinary and

The NCSDR has helped to answer the question: How does sleep impact health?

By Lisa Spear

Over the last few decades, we’ve seen a tremendous uptick in sleep research. Many of the clinical investigations that have advanced the medical world’s understanding of sleep have been supported by the National Center on Sleep Disorders Research (NCSDR), established to foster sleep and circadian research within the National Institutes of Health (NIH).

A part of the National Heart, Lung, and Blood Institute (NHLBI), the center is just now celebrating its 25^th anniversary, but its accomplishments are wide reaching for such a young government agency. Since the center’s inception in 1993, the number of sleep and circadian grants funded across the NIH has nearly tripled, says Michael Twery, PhD, the NCSDR’s director.

“The progress has been nothing short of remarkable,” says Patrick M. Fuller, PhD, associate professor of neurology at Harvard Medical School.

To honor the 25^th anniversary of the NCSDR, Fuller will take part in a discussion group during SLEEP 2019, an annual conference hosted in partnership with the Sleep Research Society and the American Academy of Sleep Medicine that brings together clinical investigators from across the country. This year the meeting will take place in San Antonio. Several leaders in the field, including the current director of the National Heart, Lung, and Blood Institute, Gary H. Gibbons, will discuss the accomplishments of the NCSDR and the future of research

Neurobiological processes that occur during sleep have a profound impact on brain health, especially as we get older, writes neuropsychologist Margaret O’Connor, PhD, ABPP.

Numerous studies have shown that structural and physiological changes that occur in the brain during sleep affect capacity for new learning, as well as the strength of memories formed during the day. Sleep promotes the consolidation of experiences and ideas; it plays a pivotal role in memory, and has been shown to enhance attention, problem solving, and creativity.

When we get older, we tend to feel sleepy earlier in the evening. This may result in waking up early in the morning as our sleeping hours shift. Older people have less REM and less slow wave sleep. Less slow wave sleep may impede memory consolidation in older adults.In addition to changes in sleep cycles, older people are increasingly vulnerable to sleep disturbances that cause poor sleep and low brain oxygen such as sleep apnea, a medical condition characterized by loud snoring, breathing pauses during sleep, and daytime fatigue.

Get the full story at www.health.harvard.edu