Innovations in Sleep Medicine (SF Meetup) 4/26/18
Dr. Robson Capasso is the Chief of Sleep Surgery, Associate Professor of Otolaryngology and Head and Neck Surgery at Stanford University School of Medicine and Global Advisor to Stanford Byers Center for Biodesign.
Dr. Capasso opened the talk with sleep medicine stats:
- 30% of patients have sleep complaints
- 80% of Sleep apnea patients go undiagnosed
The real challenge is to build a solution that works 90% of the time with low risk and low costs. He introduced a very important concept of “Cycle of Care – Wealth of unmet needs” and how a patient Joe (with sleep apnea and snoring) goes through this complex and time-consuming flow to resolve his issue.
Dr. Capasso explains that it typically takes 6 doctors, 5 – 6 tests, and 7+ therapists to treat the condition. The risk of CPAP is minimal but the cycle of care takes the patient to a cost of $15,000 to recommend a CPAP machine($700) for a low-risk treatment.
Healthcare is changing to being value-based, personalized and data-driven. But the problem is implementation. Healthcare expenditure is complex and 20% of GDP so the industry is looking at how to close this gap and cost using digital Health.
Wearing his Bio-design hat Dr. Capasso recommended the audience to look at the Cycle of Care for low hanging fruits to improve access and provided an example of a company that monitors sleep by embedding a sensor in the mattress. He also gave an example of the now defunct Jawbone device that monitors sleep patterns of 10,000’s of people gathering large sleep pattern evidence for researchers to work on.
How do you quantify Sleep? This is a very important question that sleep researchers are trying to explore. Dr. Capasso ’s team screened multiple digital apps focused on sleep in the market and zeroed in on clinically relevant apps. He introduced the audience to two apps: CBT-I Coach and Sleep IO and advised the audience to not “TRY to SLEEP” to avoid Insomnia. Dr. Capasso’s team also researched multiple wearables and non-wearable sensors for sleep in the market and narrowed down three categories:
- Contact Sensors
- Under the sheet/under the mattress sensors
- Doppler/ Sound Sensors
It was hard to determine which type was best for tracking sleep as each sensor touched different thresholds and through research on Sample cohorts it was determined that mattress-based sensors have higher sensitivity and may be used to guide patients to CPAP treatment or Surgery or post-surgery monitoring, cutting down multiple levels of expensive steps in the current cycle of care of an “Obstructive Sleep Apnea” patient.
Dr. Capasso concluded that current model will change as it is limited and expensive and Sleep Medicine is a fertile field with clinical validation and implementation of mobile health.
Greg Tranah from Sutter Health
Dr. Tranah is a Professor at the California Pacific Medical Center Research Institute and an Adjunct Professor in the Department of Epidemiology and Biostatistics at the University of California, San Francisco.
Greg started his talk by providing two real-life examples of aging vs health and how Healthy Aging researchers are focused on Health Span rather than Lifespan. Devices today are good at answering “How much?” Sleep, activity, steps did one get but the challenge to the researchers is identifying “who and when” and how things change as humans age.
Greg studies Circadian Rhythms and introduced the concept to the audience and its importance in Health Aging and Sleep medicine. Biological Rhythms or Circadian Rhythms is something we experience in a 24-hour day and most devices today only measure activity as day or night and not as an entire 24-hour window.
Circadian rhythms degrade with age and Greg’s research is focused on the “who”, “when” and “why”. The rhythms themselves are influenced by internal and external pressures that interact with each other over a 24-hour window. Greg explained the concept of how Growth hormone, leptin /ghrelin and glucose/ insulin Vs Time (24-hour window) and how it impacts health and unfortunately the existing apps don’t measure that.
The world is a diverse place both genetically and culturally. “How can we as researchers utilize technology to help an individual?” The real challenge is to move intervention from a “marketplace solution” to” Groups in need” to technology that can solve “Individual needs “, Greg considers this transition from the marketplace to individual-focused solution a tougher challenge.
Greg further introduced the various stages of sleep and how a correlation between “Deep sleep” and “Dementia” patients can be misread by a wearable as healthy. Slow wave sleep is not a binary concept and cannot always be good or bad and should involve the understanding of who and the risk of disease of the person this is being measured on.
The Latter half of the talk involved research around the change in Circadian Rhythm pattern overage and their impact on disease risk and mortality.
Rhythm and the peak activity times have a correlation to mortality rates specifically stroke and cancer for a cohort of 80 or 90-year old’s where circadian rhythms are shifting. Temperature rhythms are also co-related to mortality outcomes and are another marker to consider.
Greg and his co-researchers are now using a “functional principal component analysis” to understand patterns as is and not as normal up-down patterns. We all don’t fit the same pattern and it is important to know who and when the timing of activity to make a conclusion.
He also introduced Phasor magnitude study to the audience that explains the impact of “24hr light/dark vs activity patterns” on mortality or specifically risk of contracting a certain disease
Greg concluded the talk stating that there is enough research out there and there is a real need to spend more time on interventions that regulate circadian activity rhythms and sleep and hence improve health outcomes. Prescribing physical activity or light exposure at the right time can improve outcomes or CBT online or in person may vastly improve sleep-related issues and healthspan.