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The 5th Scientific
& Annual General Meeting of the ISS took
place on 28th February 2009 at the Radisson
SAS hotel at Dublin Airport. It was an
excellent, very informative meeting and was
well attended by the various disciplines
involved in the delivery of sleep medicine
from both Northern and Southern Ireland.
There were seven oral
presentations in first session which was
co-chaired by Brenda McManus and Briege
Leddy.
The first presentation
on the
“Compliance of CPAP Therapy in Mullingar
Hospital” was given by Maria McNeill.
From Feb 04 – Dec 08 - 573 patients had
sleep studies performed of those 377
patients with positive sleep studies
commenced CPAP Therapy. They developed
their own sleep study protocol involving the
patient in educational sessions at the
beginning of their treatment and at set
times throughout the first year. This
significantly improved compliance.
The second was delivered by
Dr. Brian Kennedy from General Practice
titled “Autogenic training and sleep: Moving
beyond the anecdotes”.
Autogenic training (AT) is an established
form of behavioural or mind-body medicine.
The presenter has 25 years of experience
with teaching AT to individuals and groups.
A brief review of the evidence base
on AT revealed consistent reports of
benefits in the area of sleep, in part by
restoring the balance between sympathetic
and parasympathetic elements of the
autonomic nervous system.
Dr. John Garvey from St
Vincents hospital, Dublin then presented his
study on “Modulation of NF-κB signaling
during intermittent hypoxia by nitric
oxide”. His group found selective
activation of the NF-κB inflammatory
signaling pathway in response to
intermittent hypoxia (IH) both in vitro
and in patients with obstructive sleep apnea
syndrome (OSAS). Nitric oxide (NO), an
important physiologic regulator of cellular
metabolism was found to be increased in a
number of inflammatory conditions.
Their hypothesis was that NO modulated NF-kB
activity in response to intermittent
hypoxia, data indicated NO negatively
regulates IH-induced activation of
inflammatory pathways and may play a role in
effecting the cardioprotective response to
CPAP. The results supported a
potential role for nitrate therapy as an
additional treatment for OSAS.
The fourth
presentation by Dr. MF Haque was titled
“Monitoring of rest-activity, sleep-wake
cycle and energy expenditure in patients
with dementia and agitation using a novel
actigraphy device: a pilot study”.
The study, tested the
usefulness of an
actigraphy
device, SenseWear® armband (SWA),
to measure rest-activity, sleep-wake rhythm
disturbances and agitated behaviour in
subjects with dementia. Correlation
between actigraphic measures and validated
assessment scales of agitated behaviour in
dementia, severity and environmental
factors, in continuing care facilities was
examined.
The
conclusion
was that actigraphy is a useful tool to
examine agitated behaviour in dementia as
patients with high total
scores on behavioural scales had higher
levels of activity during day and reduced
total sleep time.
“Genioglossus fatigability in OSA patients
and Controls” was the title of Dr. David
McSharry’s study. This muscle when
contracted causes the tongue to protrude.
Studies have shown that there is increased
contraction of the muscle at the end of each
apnoeic episode which may give rise to
muscle fatigue. An increase in type II
fibres have also been found in patients with
OSA which make the muscle prone to collapse.
In this study surface EMG signals were taken
by placing the patients tongue against a
specially made sensor and asking them to
press their tongue against it for as long as
possible. It was found that endurance
time was shorter in OSA patients than
controls.
The
penultimate presentation was a further study
by Dr. J Garvey. This showed the
effectiveness of home screening for OSA
syndrome using a combined Holter- oximeter.
It was shown that there was a strong
correlation between this type of monitoring
and PSG for AHI/hr for patients with mild
OSA. However despite patients with
moderate to severe OSA showing less
correlation, it was of potential benefit as
a screening tool for OSA.
The final
talk of the morning session was on the
“Analysis of Oxygen Desaturation Index vs
Apnoea Hypopnea Index of a limited sleep
study” was presented by Emma O’Rourke from
the Midland Regional Hospital, Mullingar, Co
Westmeath. Since 2006 Pulse Oximetry
screening had been used in the sleep
department to prioritise sleep studies.
This was undertaken as a way of ensuring
that those with moderate/severe sleep apnoea
did not have to wait more than 4 months for
their sleep study to be carried out.
Fifty patients were analysed. Their
ODI from pulse oximetry was compared to
their Apnoea/Hypopnoea Index (AHI) from
subsequent overnight polysomnography to
determine if the oximetry screening had
accurately predicted the severity of OSA.
Pulse oximetry screening showed comparable
ODI recordings to the AHI recordings in
those patients who were shown to have
Moderate (AHI of 16-29) and Severe (AHI >30)
OSA. Patients with normal sleep
studies or with mild Sleep Apnoea (AHI of
5-15), pulse oximetry ODI was shown to be
less comparable, however
with prolonged waiting lists,
consideration of this method to screen all
referrals particularly those with
the
highest cardiovascular risk factors was
suggested.
Following
coffee the second session was a new feature
in our annual conference “Year in Review”
presented by Dr. Richard Costello, Dr.
Catherine Crowe and Dr. John O’Brien
reviewing aspects of Respiratory sleep
disorders, Non Respiratory sleep disorders,
and dental treatment & sleep disorders
respectively.
The last
session was hosted by our guest speaker Dr.
Renata Riha from the Edinburgh Sleep Centre
who delivered a very thorough presentation
on the “Genetic Aspects of OSA”.
All in all the 2009 meeting
was once again a great success with all
participants eagerly awaiting the next one.
All the oral presentations as
well as the Year in Review presentations and
our Guest Speaker’s talk on “Genetics
Aspects of OSA” can be accessed via the
members-only section in the website.
Paid up members for 2009 can
enter the
Members Secure Area [all
presentations for 2009 and previous years
are being presently being populated on the
secure area and will be ready for viewing
securely soon] using the relevant
password
If you are not a member but
are a health professional involved in Sleep
Medicine in Ireland and you would like to
find out more about our recent meeting
please go to our
ISS Membership
Section for further details?
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