What is new in sleep medicine?
An integral part of the practice of medicine is lifelong learning, defined as all learning activity undertaken throughout life with the aim of improving knowledge, skills and competencies. The concept of lifelong learning has become even more important with the emergence of new technologies that change how we receive and gather information, collaborate and communicate with others.
How is this relevant to Southern Sleep Services?
After many years of active NHS and academic work, Dr Venn and Professor Williams now practice sleep medicine in an independent setting. How then do we continue this lifelong learning, making it a priority and not ‘an extra’ ?
Here are 4 of our chosen methods:
· Using digital tools such as feeds from leading medical journals
· Learning through writing; to explain a topic simply in words, which requires a deeper knowledge of the subject. In this way writing is like teaching.
· Lifelong learning strategies such as attending our specialist society meetings such as SLEEP2022, the first face to face meeting for 3 years, highlighting the latest advances in clinical sleep medicine and sleep research, an evidence-based education experience to advance clinical precision.
I am fortunate to have just returned from SLEEP2022 in Charlotte, USA.
The sessions included discussion groups, symposia, lunchtime debates, prestigious clinical presentations, clinical workshops and technologies, a large trade exhibition and, of course, networking.
AJW [2nd from left] with a group developing home polysomnography using just a headband rather than multiple electodes
Meir Kryger, a close friend, editor of one of the leading textbooks in Sleep Medicine and recipient of an award at the meeting
So – what did I learn?
Ahh, there’s the rub: so much and too much to write about in one blog but here are 3 tasters.
Dr Susan Redline, a leading Harvard professor, lectured on sleep disordered breathing (snoring and sleep apnoea) that is associated with a real increase in cardiovascular risk. This is especially poignant for me having, in 1984, been the first person to link high blood pressure to sleep apnoea. The number of people suffering from some sleep apnoea (characterized by repeated interruptions of breathing during sleep) is staggering, with a global prevalence of 12%. It’s a condition that impairs the restorative function of sleep and is a risk factor for cardiovascular disease. At a practical level the old standard metric for measuring the severity is a number called the Apnoea Hypopnoea Index (AHI) which has traditionally been measured through a laboratory night-study. Now, however, technology has moved to Home Sleep Apnoea Testing (HSAT) using wearable devices, providing a level of unobtrusiveness that cannot be achieved in the laboratory, hence our current practice of using HSAT knowing the scientific basis is secure.
Another fascinating development is the recent discovery that the brain has a waste management systemrelated to disposing of toxic substances that accumulate in wakefulness. The discovery in 2012 of the system that allows this to happen is seminal, a lymphatic system that is a series of tubes that dilate mainly during sleep bringing in fresh fluid mixing with the waste-filled fluid then flushing into the blood. Does an under-functioning of this system play any role in declining cognitive abilities including possibly Alzheimer’s? And here the crux – does reduced sleep or interrupted sleep play any part in reducing the waste management ability? Many think so!
And insomnia, that most prevalent condition, indeed the commonest sleep disorder with up to 33% of the population at some point in any year being troubled, and 10% of the population being more continuously affected. For the past 15 years it has been thought that this section of the population is susceptible through genetic predisposition, having a degree of hyperarousal. This is becoming more clear with recent studies showing that the vulnerability to arousal is indeed genetic in these individuals, having a more sensitive part of the brainstem called the Locus Coeruleus, sort of sleeping with one eye open. Apart from the poor sleep resulting, there may be clear mental health risks, all this making the treatment of insomnia important medically, and not just an irritation.
Fascinating stuff and more soon!
Adrian Williams
Professor of Sleep Medicine & Consultant
Sussex Sleep Services