breathesimple’s Post

AI is finding its way into healthcare. And when it comes to sleep diagnosis, it seems that South Korea is one of the places to watch.   For example, Tae Kyoung Ha, working with colleagues at Konkuk and Soonchunhyang Universities has developed an AI-powered sleep disorder analysis algorithm called ‘Somnum’ . The software uses deep learning to analyze bio-signals in real-time for the diagnosis of sleep disorders. The application has been granted FDA 510(k) clearance to be used to improve outcome accuracy and reduce the time required by sleep physicians when analyzing polysomnography results. You can learn more at https://www.honeynaps.com/, a US company founded to commercialize the research. And just this month, Seoul-based A-Sleep corporation received approval from the Ministry of Food and Drug Safety for its digital sleep apnea diagnosis assistance app called ‘Apnotrack ’. FDA approval is planned for next year. The AI model used in Apnotrack analyzes a patient's breathing pattern using breathing sounds during sleep, thereby enabling screening for sleep apnea at home without any additional devices.  In particular, Apnotrack, in comparison tests to the 'Galaxy Watch', showed a higher confidence level. Learn more at https://www.asleep.ai/ . For full disclosure, @breathesimple is partnered with the A-Sleep team, led by CEO Lee Dong-heon, to incorporate Apnotrack into our closed-loop apnea diagnostic/treatment system. #sleep #osa #sleepdisturbedbreathing #osa #sdb

Has the brain flushing theory been flushed away? As widely reported, sleep apnea appears to be associated with a significantly increased risk of dementia, particularly for Alzheimer's and Parkinson's diseases. A recent meta-study analyzing health records of over 1.3 million patients undertaken by a team lead by Prof. Guay-Gagnon from the University of Montreal provides statistical clinical support for this statement. (See: https://lnkd.in/eXY8zti5). Neuroscientists have been seeking a theory to explain this linkage hoping to uncover potential therapies. One theory that has gained traction: slow brain waves during deep sleep help flush waste tissue away that may be early signs of plaque formation associated with dementia. Scientists at Washington University School of Medicine in St. Louis recently published research that supports this behavior (see DOI: 10.1038/s41586-024-07108-6). They suggest that individual nerve cells may coordinate to produce rhythmic waves that propel fluid through dense brain tissue, washing out the unwanted waste at night. However, new findings suggest this theory, which has become a dominant view in neuroscience, could be wrong. A new study, led by Profs. William Wisden and Nicholas Franks at the UK Dementia Research Institute, Imperial College, London published this week in Nature Neuroscience found that the clearance and movement of fluid in the brains of mice was, in fact, significantly REDUCED during sleep (see : https://lnkd.in/etCiQa2Z). The UK researchers used a fluorescent dye to study the brains of mice allowing them to see how quickly the dye moved from fluid-filled cavities to other brain regions enabling them to measure the rate of clearance of the dye from the brain directly. The study showed, contrary to expectations, that dye clearance was reduced by about 30% in sleeping mice compared with mice that were kept awake. The good news according to Prof. Wisden is that brain clearance is highly efficient during the waking state - being awake, active and exercising may be more efficient in cleaning toxins from the brain than striving for that perfect night of sleep. So back to the drawing board for the researchers. The link between poor sleep and dementia remains a mystery. We cannot yet claim to be flush with success! hashtag #dementia hashtag #alzheimers hashtag #brainflush hashtag #plaque hashtag #sleepapnea hashtag #sleepdeprivation

Yet another reason to discard the use of AHI (Apnea-Hypoxia Index) for sleep disorders. One reason why - we recently reported a new study led by Dr. Christopher M Carosella at Johns Hopkins University linking late epilepsy (LOE) onset with poor sleep. ( https://lnkd.in/dPUQuwTm). Patients whose oxygen saturation level (SpO2) fell below 80% during sleep were three times more likely to develop LOE compared to those who did not show such low levels. However,  there was NO correlation between LOE and AHI, further evidence of the inability of AHI to predict health dangers. The AHI metric was introduced over fifty years ago and remains a standard index in sleep diagnosis despite major shortcomings. Quoting a review paper in Sleep Review by a team led by Prof. Dirk Pevernagie, Campus Rumbeke in Belgium (doi: 10.1111/jsr.13066. Epub 2020),  “the application of AHI as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if AHI is above an diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of AHI as the prime diagnostic metric of clinically relevant obstructive sleep apnea.’ AHI does not take into account the total integration of hypoxic events, including both time intervals and desaturation depth; it is now recognized that total ‘hypoxic stress’ (HS) is far more important in predicting long term chronic health issues than just the number of SpO2 drops per hour. Fortunately there are better diagnostic options. A recent paper from the Dept. of Pulmonary Medicine, Brugmann University Hospital, (DOI:10.2147/NSS.S374572) describes two new indices. Obstructive and Desaturation Severity (OS and DS) that, by more accurately quantifying the full impact of HS, are better able to predict the likelihood of hypertension. Wearables can play an important role in moving on from AHI. For example, the chart shows data collected over 3 weeks by the development team @breathesimple using the FDA approved Circul+ ring wearable. Hypoxic stress is only a moderate correlate with AHI and can therefore offer a better determination of possible sleep issues. Surely it is time for sleep physicians and device manufacturers to move on from the inadequacies of AHI to more accurate diagnostic and tracking metrics. The technology is here, patients deserve it. #ahi #cpap #odi #hypoxicstress #epilepsy #hypertension

We have learned from many studies how sleep apnea can have severe impact on long-term health. Dangers include diabetes, cardio-vascular illnesses, dementia, and reduced longevity. Now a new study led by Dr. Christopher M Carosella at Johns Hopkins University adds yet another threat, late onset epilepsy (LOE). LOE refers to seizures that develop after 60. Seizures are a result of uncontrolled cell firings arising from damaged neurons which makes them more likely to 'kindle' endogenously. The research team identified 1,300 cases using Medicare claims with associated sleep data. Patients whose oxygen saturation level (SpO2) fell below 80% during sleep were three times more likely to develop LOE compared to those who did not show such low levels. Adding to this evidence, subjects with self-reported sleep apnea were twice as likely to develop LOE as those without the sleep disorder. Linking LOE to nocturnal hypoxia suggests that repeated chronic exposure to low oxygen levels overnight might lead to changes in brain morphology that ultimately lead to risk of epilepsy. Although not mentioned in the research report (see https://lnkd.in/d8JX43AY) possible neurological mechanisms are discussed in depth in a fascinating paper published by Drs. Xu Y and Fan Q at Qinghai University Graduate School, Xining China in CNS Neurosci Ther. (see doi: 10.1111/cns.13942). Their paper reports on heightened occurrence of epilepsy found in populations living at high altitudes where chronic hypobaric hypoxia occurs. The paper reviews the data and proposes a number of possible neurological causes. As one example, the chart illustrates how abnormal activation of astrocytes resulting from oxygen deficiency may set up conditions for epileptic episodes. These studies strongly suggests that further research on how brain morphology changes under hypoxic conditions is likely to yield valuable insights in how sleep apnea links to a number of chronic long-term health issues. The data already shows clearly why AHI, the Apnea Hypoxic Index, commonly used to categorize OSA, is unsuitable as a predictor of long-term dangers. More about this in a post to occur shortly. Stay tuned. #osa #lateonsetepilepsy #seizures #epilepsy #hypoxia #AHI #sleepapnea

As we have reported earlier, wearable technology continues to advance from purely consumer applications into the medical arena. As an illustration of this trend, a team specializing in biomedical engineering at the University of Palermo just reported on a novel wearable device format that takes the technology another step forward. Their device synchronously acquires electrocardiographic (ECG), photoplethysmographic (PPG), galvanic skin response (GSR) and motion signals. The team chose a ring format, which increasingly seems to be the preferred configuration due to comfort, ease of use and accuracy. In fact, two rings are deployed, one on each hand. This enables continuous monitoring of blood pressure by detecting the pulse arrival time (PAT) between two different locations on the body. PAT is defined as the time delay from the R-peak of the electrocardiogram (ECG) to a peak of the finger PPG. This method is also used by the CIrcul+ ring, which, however, requires placing a ‘non-ring’ finger on an external electrode on the ring and therefore not really suitable for continuous BP tracking. The simultaneous acquisition of different biosignals allows the extraction of important physiological indices, such as heart rate (HR) and its variability (HRV), pulse arrival time (PAT), GSR level, blood oxygenation level (SpO2), and respiratory rate, as well as motion detection, enabling the assessment of physiological states, together with the detection of potential physical and mental stress conditions. The team’s report, found at https://lnkd.in/ekhfUQmR, provides both engineering details and early test data using the device. For full disclosure, @breathesimple uses the Circul+ ring in its closed loop solution for the detection and alleviation of sleep disturbed breathing. hashtag #wearables hashtag #bloodpressuredetection hashtag #ringwearables hashtag #sleepdisturbedbreathing hashtag #sdb hashtag #sleepapnea hashtag #osa hashtag #pat

Pharmaceutical giant Eli Lilly just announced results from two year-long clinical trials indicating that injections of its obesity drug tirzepatide aka Zepbound can provide up to a 63% reduction in AHI, a standard measure of sleep apnea severity. On average, subjects lost about 20% of their weight during the trials. Obesity is a known cause of obstructive sleep apnea (OSA), contributing to collapse of the upper airways during sleep so it is not surprising that the weight loss resulting from the drug helped. The findings could indicate a potential treatment for the more than 20 million individuals living with moderate to severe OSA. This poses a direct challenge to the suppliers of CPAP masks, which, although effective, have a poor compliance record. The threat will become more prevalent if, and when, an oral version of the drug becomes available. Costs will inevitably decline as existing competitors, already providing GLP-1 compounds for the treatment of diabetes, follow Eli Lilly into the sleep market. It is worth pointing out that losing weight only helps with sleep apnea symptoms related to upper airway flabbiness and does not impact the 30% of patients that have neurophysiological breathing control issues that can also trigger sleep apnea. This is our focus @breathesimple. The GLP-1 class of agents work on receptors in the pancreas to modify insulin release. Originally developed to manage type-II diabetes, they have made major inroads into the treatment of obesity which is a major factor in other chronic diseases such as heart attacks and strokes. Expect these drugs to seek approval for the prevention of cardio-vascular diseases in the near future. According to the Harvard School of Public Health, 69% of U.S. adults are overweight or obese and 36% are obese. If U.S. trends continue unabated, by 2030, estimates predict that roughly half of all men and women will be obese. A large and growing market for these drugs. For a population that seems bent on reducing their lifespan by eating poorly and avoiding exercise, this new class of drugs might just provide them with a few more years to enjoy their comforts. Read more about how tirzepatide improves sleep here: https://bit.ly/49JdaIF #sleepapnea #tirzepatide #osa #glp-1 #sdb #obesity #neuroplaticity 

For the first time in Gallup polling since 2001, a majority of U.S. adults, 57%, say they would feel better if they got more sleep, while only 42% say they get as much sleep as they need. This is a clear reversal of the figures last measured in 2013, when the numbers were 56% to 43%. Over the same period, those respondents reporting that stress was affecting their life has grown steadily to nearly 50%. We are a society suffering from growing stress, and insufficient sleep. It is estimated that over the last decade or so, since the launch of a number of sleep tracking wearables as shown on the chart, 30% of Americans have used a consumer sleep-tracking device. Over the same period downloads of meditation apps such as Calm (7.7 million globally, around 4mm in the US ) and second-placed Headspace (5 million globally and about 1.6 million in the US) have promised to reduce stress in our lives. Of course, the data may show some high level correlation but does not indicate any causal relationship. Would the situation be worse without sleep trackers or meditation apps? Or are they contributors to these problems? One sign of disappointment: the shine has gone from mindfulness apps with subscriber numbers declining significantly from quarter to quarter. Will there be a similar decline in the use of sleep tracking wearables as the promises of restful sleep are not fulfilled? What do you think? You can read the full Gallup report here: https://bit.ly/3vTQOWZ  where the data is further segmented by gender and age. #sleepdeprivation #sleeptrackers #mindfulness #meditationapps #breathesimple

Wearable sleep trackers may have created a new disease category - orthosomnia - the fixation on data from trackers to the point that it causes anxiety and disrupted sleep that can interfere with daily life. Rather than improving sleep, trackers may have the opposite effect at least on some individuals. Some evidence of this danger has been reported by a number of research teams including from the University of Paris, https://bit.ly/3U86QWr , University of Turku, https://lnkd.in/dNgjXpfp , Rush Medical Center https://lnkd.in/eBe-vWMN and others. The jury is still out whether the benefits outweigh the downsides. One of the issues associated with consumer sleep trackers is a lack of standards. As we have reported elsewhere, it is impossible to accurately compare data between different devices. Manufacturers compete partly by claiming the superior accuracy of their secret algorithms. Independent testing, however, shows large discrepancies in sleep data between devices all claiming to be the most accurate. Research indicates that concern about lack of accuracy is one trigger for anxiety. As a start to address this problem, the Consumer Technology Associate has just published a first attempt to create some standards. (See: CTA-NSF-2052.2-A Methodology of Measurements for Features in Sleep Tracking Consumer Technology Devices and Applications). The report is a good start. However, as consumer devices add more parameters such as AHI, ODI, OS and DS, and interest in sleep phenotyping expands, the initial definition categories will need to be expanded. And it remains to be seen whether device providers will support such standards or continue to hide behind their algorithms. It is important that your tracker knows how old you are. As the chart shows, there are already excellent sleep stage data standards across age groups. Users can benefit from comparing their sleep stage measurements against their age norms. This might avoid a 70 year-old aunt becoming anxious when comparing her data with a niece half her age! #wearables #sleeptrackers #sleepstages #orthosomnia #remsleep #deepsleep

Thanks to a great partner! Futurice! Finding and working effectively with the best talent worldwide is vital for a company exploiting today’s virtual network structures. breathesimple™ is one such company. We engage with expert teams based in Australia, China, Europe, Korea, UK and across the US to transform the way sleep problems are diagnosed and treated. In order to implement its latest product which uses an advanced wearable to monitor and improve certain sleep issues, the company partnered with the London office of Futurice. Here we found the perfect match of deep technical skills and collaborative corporate culture that met our demanding requirements quickly and efficiently. The London team is one of an international family of several hundred experts working collaboratively within a group autonomous companies co-founded and majority owned by Futurice. They all work to support clients with highly specialized services and expertise, enabling businesses to harness the benefits of digital transformation. Here is a deeper dive into how the collaboration is working: https://lnkd.in/dtdhng4C hashtag #sleepdeprivation hashtag #apnea hashtag #wearables hashtag #circul+ hashtag #OSA hashtag #Loopgain hashtag #arousalindex hashtag #cpap hashtag #neuroplasticity hashtag #digital transformation

Humans are rather poor at recognizing when their mental state may not be too good at making key decisions. Now research by a team led by Prof. Daniel Forger at the University of Michigan underpins the development of a new wearable-based app called ‘Social Ribbons’. It will warn when it may be inopportune to be undertaking key tasks while at work. We already know that lack of sleep can lead to poor decision-making (see https://lnkd.in/g6_P5XY). However the researchers added another variable, the phasing of individual body clocks. 2,500 first-year resident physicians were tracked over 2 years using Fitbit wearables that recorded when they were awake and, using some unique algorithms, derived their Circadian rhythm patterns. Each subject noted their mood daily. The cohort was an ideal population - first year residency is known for its long and irregular hours on duty and the stressful and unexpected situations that are confronted. As the charts indicate, both the number of wake hours AND Circadian phases influence mood. As found in earlier research, the longer awake, the greater the impact on mood and concomitant ability to make rational decisions. But, additionally, mood swings become greater the longer the awake period. In such cases, knowing where you are in the Circadian rhythm becomes a key factor in the ability to perform at work. Quoting Dr. Forger, "People are not very good at assessing what the state of their biological clock is, and they're actually not so good at assessing how well they've slept, and that's why all these wearables are providing a lot more information to people." The research is reported in the January 2024 volume of Digital Health https://bit.ly/3J3XapI . And for more about how body clocks work and why they affect moods see https://lnkd.in/e6unhnzU . #digitalhealth #bodyclock #sleepdeprivation #depression #circadian #wearables #mentalhealth