1 00:00:05,280 --> 00:00:07,920 WELCOME TO THE NATIONAL HEART, 2 00:00:07,920 --> 00:00:09,760 LUNG AND BLOOD INSTITUTE VIRTUAL 3 00:00:09,760 --> 00:00:11,080 WORKSHOP, SLEEP HEALTH AND 4 00:00:11,080 --> 00:00:13,720 DYSFUNCTION ACROSS THE SPECTRUM 5 00:00:13,720 --> 00:00:18,520 OF PULMONARY VASCULAR DISEASE. 6 00:00:18,520 --> 00:00:20,800 I'M DR. LEI XIAO, PROGRAM 7 00:00:20,800 --> 00:00:24,880 DIRECTOR, DIVISION OF LUNG 8 00:00:24,880 --> 00:00:26,160 DISEASE, OVERSEEING THE 9 00:00:26,160 --> 00:00:28,040 PORTFOLIO, WITH THE ORGANIZING 10 00:00:28,040 --> 00:00:30,200 COMMITTEE FOR THIS WORKSHOP. 11 00:00:30,200 --> 00:00:32,520 ON BEHALF OF THE COMMITTEE AND 12 00:00:32,520 --> 00:00:35,160 NHLBI LUNG DIVISION I WOULD LIKE 13 00:00:35,160 --> 00:00:45,640 TO WELCOME EVERYONE TO THIS 14 00:00:54,720 --> 00:00:56,400 IMPORTANT NHLBI WORKSHOP. 15 00:00:56,400 --> 00:01:01,560 SORRY, CAN SOMEBODY MUTE THEIR 16 00:01:01,560 --> 00:01:02,840 MICROPHONE? 17 00:01:02,840 --> 00:01:03,840 I HEAR SOME NOISE. 18 00:01:03,840 --> 00:01:06,840 ESPECIALLY I WANT TO THANK THOSE 19 00:01:06,840 --> 00:01:08,800 SPEAKERS AND CO-CHAIRS WHO SPENT 20 00:01:08,800 --> 00:01:12,640 MANY HOURS OF PERSONAL TIME 21 00:01:12,640 --> 00:01:14,040 WORKING ON THEIR PRESENTATION. 22 00:01:14,040 --> 00:01:17,200 WE APPRECIATE YOUR EFFORTS AND 23 00:01:17,200 --> 00:01:18,080 CONTRIBUTION. 24 00:01:18,080 --> 00:01:18,640 BEFORE STARTING THE 25 00:01:18,640 --> 00:01:20,600 PRESENTATIONS I WOULD LIKE TO 26 00:01:20,600 --> 00:01:23,200 QUICKLY INTRODUCE SOME OF MY NIH 27 00:01:23,200 --> 00:01:24,400 LUNG DIVISION COLLEAGUES WHO 28 00:01:24,400 --> 00:01:25,960 HAVE BEEN WORKING ON ORGANIZING 29 00:01:25,960 --> 00:01:30,760 THIS WORKSHOP IN THE PAST YEAR. 30 00:01:30,760 --> 00:01:33,600 IF YOU COULD, PLEASE TURN ON 31 00:01:33,600 --> 00:01:34,920 YOUR CAMERA AND LET EVERYONE SEE 32 00:01:34,920 --> 00:01:36,800 YOU WHEN I CALL YOUR NAME. 33 00:01:36,800 --> 00:01:47,320 I'LL START WITH MY COLLEAGUE DR. 34 00:01:52,400 --> 00:02:00,440 ALFONSO ALFINI, AND DR. ROY 35 00:02:00,440 --> 00:02:03,920 SUTLFF AND THE BRANCH CHIEF, NOT 36 00:02:03,920 --> 00:02:05,680 SURE WHETHER HE'S HERE, HE'S 37 00:02:05,680 --> 00:02:09,960 PART OF THE COMMITTEE, ALSO DR. 38 00:02:09,960 --> 00:02:12,240 MARISHKA BROWN, SLEEP CENTER 39 00:02:12,240 --> 00:02:14,320 DIRECTOR, ALONG WITH OUR LUNG 40 00:02:14,320 --> 00:02:19,880 DIVISION DIRECTOR DR. JIM KILEY 41 00:02:19,880 --> 00:02:21,440 WHO WILL GIVE OPENING REMARKS IN 42 00:02:21,440 --> 00:02:22,200 A FEW MINUTES. 43 00:02:22,200 --> 00:02:24,480 I WOULD LIKE TO GIVE A SPECIAL 44 00:02:24,480 --> 00:02:28,800 THANKS TO THE WORKSHOP 45 00:02:28,800 --> 00:02:29,880 COORDINATOR, BRITTANY, AND HER 46 00:02:29,880 --> 00:02:32,600 SUPPORT TEAM WHO HAVE BEEN DOING 47 00:02:32,600 --> 00:02:33,800 ALL THE HEAVY LIFTING, LOGISTIC 48 00:02:33,800 --> 00:02:35,880 WORK FOR SETTING UP THIS 49 00:02:35,880 --> 00:02:36,360 WORKSHOP. 50 00:02:36,360 --> 00:02:39,040 THANK YOU, BRITTANY AND TEAM, 51 00:02:39,040 --> 00:02:44,200 FOR A WONDERFUL JOB WELL DONE. 52 00:02:44,200 --> 00:02:45,840 ANOTHER TWO WORKSHOP COMMITTEE 53 00:02:45,840 --> 00:02:47,160 MEMBERS ARE THE CO-CHAIRS, THE 54 00:02:47,160 --> 00:02:50,440 MAIN DRIVING FORCE FOR THIS 55 00:02:50,440 --> 00:02:54,320 WORKSHOP, YOU MAY KNOW THEM, DR. 56 00:02:54,320 --> 00:02:55,800 SUSAN REDLINE FROM HARVARD 57 00:02:55,800 --> 00:03:00,720 MEDICAL SCHOOL AND DR. ANNA 58 00:03:00,720 --> 00:03:01,920 HEMNES FROM VANDERBILT, WHO WILL 59 00:03:01,920 --> 00:03:03,680 YOU INTRODUCED IN A FEW MINUTES. 60 00:03:03,680 --> 00:03:05,760 NOW I'M GOING TO MOVE TO THE 61 00:03:05,760 --> 00:03:09,160 NEXT SESSION OF THIS WORKSHOP, 62 00:03:09,160 --> 00:03:11,560 FOR THE SPEAKERS 63 00:03:11,560 --> 00:03:11,960 SELF-INTRODUCTION. 64 00:03:11,960 --> 00:03:15,200 I BELIEVE BRITTANY IS GOING TO 65 00:03:15,200 --> 00:03:17,720 SHOW SOME ROSTER SLIDES WITH ALL 66 00:03:17,720 --> 00:03:20,240 THE SPEAKERS AND THE 67 00:03:20,240 --> 00:03:20,880 DISCUSSANTS' NAMES. 68 00:03:20,880 --> 00:03:23,200 WE'LL RUN DOWN THE ROSTER FOR A 69 00:03:23,200 --> 00:03:25,040 QUICK ROLL CALL SO THAT EVERYONE 70 00:03:25,040 --> 00:03:27,600 COULD HAVE A CHANCE TO BRIEFLY 71 00:03:27,600 --> 00:03:29,400 INTRODUCE YOURSELF FOR THE 72 00:03:29,400 --> 00:03:30,160 WORKSHOP AUDIENCE. 73 00:03:30,160 --> 00:03:33,240 IN ORDER TO MAKE SURE WE CAN 74 00:03:33,240 --> 00:03:37,200 STAY ON TIME, EACH PERSON 75 00:03:37,200 --> 00:03:39,080 PROBABLY WILL HAVE LESS THAN 30 76 00:03:39,080 --> 00:03:41,160 SECONDS TO INTRODUCE YOURSELF IN 77 00:03:41,160 --> 00:03:43,760 A FEW SENTENCES, INCLUDING YOUR 78 00:03:43,760 --> 00:03:45,560 NAME, TITLE, INSTITUTION, AND 79 00:03:45,560 --> 00:03:48,480 YOUR RESEARCH INTERESTS AND/OR 80 00:03:48,480 --> 00:03:50,120 CLINICAL SPECIALTY IF 81 00:03:50,120 --> 00:03:50,600 APPLICABLE. 82 00:03:50,600 --> 00:03:52,280 AGAIN, ONCE YOUR NAME IS CALLED 83 00:03:52,280 --> 00:03:56,360 PLEASE TURN DOWN YOUR CAMERA AND 84 00:03:56,360 --> 00:04:02,680 MICROPHONE AND START TO 85 00:04:02,680 --> 00:04:04,880 INTRODUCE YOURSELF. 86 00:04:04,880 --> 00:04:07,760 LET'S START WITH DR. BRYANT. 87 00:04:07,760 --> 00:04:10,400 IS HE HERE? 88 00:04:10,400 --> 00:04:10,720 OKAY. 89 00:04:10,720 --> 00:04:12,280 >>HEY GUYS. 90 00:04:12,280 --> 00:04:14,560 SORRY ABOUT THAT. 91 00:04:14,560 --> 00:04:15,640 FORGIVE THE INFORMAL NATURE. 92 00:04:15,640 --> 00:04:16,760 WE'RE IN THE MIDST OF A 93 00:04:16,760 --> 00:04:18,800 HURRICANE HERE BUT I HAVEN'T 94 00:04:18,800 --> 00:04:20,800 LOST POWER YET. 95 00:04:20,800 --> 00:04:23,200 ANDREW BRYANT, UNIVERSITY OF 96 00:04:23,200 --> 00:04:26,400 FLORIDA, AND MY CLINICAL 97 00:04:26,400 --> 00:04:29,000 EXPERTISE IS IN PULMONARY 98 00:04:29,000 --> 00:04:30,640 HYPERTENSION, AND WE HAVE 99 00:04:30,640 --> 00:04:33,720 ONGOING STUDIES LOOKING AT 100 00:04:33,720 --> 00:04:34,800 SEVERAL SLEEP MODELS. 101 00:04:34,800 --> 00:04:36,240 >>OKAY. 102 00:04:36,240 --> 00:04:39,200 THANKS, ANDREW. 103 00:04:39,200 --> 00:04:39,880 DR. MESAWRI? 104 00:04:39,880 --> 00:04:44,320 >>HI THERE. 105 00:04:44,320 --> 00:04:44,880 OMAR SEMAWRI, UNIVERSITY OF 106 00:04:44,880 --> 00:04:46,160 CALIFORNIA SAN DIEGO, NOT IN THE 107 00:04:46,160 --> 00:04:51,080 MIDST OF A HURRICANE ANY LONGER. 108 00:04:51,080 --> 00:04:52,760 MY CLINICAL EXPERTISE IS MORE 109 00:04:52,760 --> 00:04:55,920 LIKE SLEEP MEDICINE, GENERAL 110 00:04:55,920 --> 00:04:59,840 SLEEP MEDICINE, AND ICU, BUT I'M 111 00:04:59,840 --> 00:05:00,840 INTERESTED IN PULMONARY 112 00:05:00,840 --> 00:05:03,640 HYPERTENSION FROM A RESEARCH 113 00:05:03,640 --> 00:05:10,880 PERSPECTIVE AND INTERSECTION OF 114 00:05:10,880 --> 00:05:13,200 HYPOXIA AND HYPERTENSION. 115 00:05:13,200 --> 00:05:14,720 >>EVAN BRITAIN, CARDIOLOGIST, 116 00:05:14,720 --> 00:05:17,600 VANDERBILT, RESEARCH ON 117 00:05:17,600 --> 00:05:20,120 MECHANISMS OF PULMONARY VASCULAR 118 00:05:20,120 --> 00:05:20,760 DISEASE, THAT WORK GENERALLY 119 00:05:20,760 --> 00:05:31,280 INVOLVES CLINICAL TRIALS AND 120 00:05:37,800 --> 00:05:38,040 EPIDEMIOLOGY. 121 00:05:38,040 --> 00:05:39,280 >>NEXT, DR. GILELES-HILLEL. 122 00:05:39,280 --> 00:05:45,080 >>PULMONOLOGIST AND SLEEP 123 00:05:45,080 --> 00:05:49,280 PHYSICIAN FROM THE 124 00:05:49,280 --> 00:05:54,480 HADASSAH-HEBREW MEDICAL CENTER, 125 00:05:54,480 --> 00:05:55,680 PULMONOLOGY, DYSPLASIA, 126 00:05:55,680 --> 00:05:57,440 HYPERTENSION, MY LAB STUDIES 127 00:05:57,440 --> 00:06:00,720 INTERMITTENT HYPOXIA AND HOW IT 128 00:06:00,720 --> 00:06:01,360 RELATES TO CARDIOMETABOLIC 129 00:06:01,360 --> 00:06:01,600 OUTCOMES. 130 00:06:01,600 --> 00:06:05,960 >>ALL RIGHT. 131 00:06:05,960 --> 00:06:10,120 THANK YOU. 132 00:06:10,120 --> 00:06:11,480 NEXT, DR. MOKHLESI. 133 00:06:11,480 --> 00:06:14,160 >>YES, FROM CHICAGO, RUSH 134 00:06:14,160 --> 00:06:16,080 UNIVERSITY MEDICAL CENTER, AND 135 00:06:16,080 --> 00:06:24,480 I'M DIVISION CHIEF OF THE PULL 136 00:06:24,480 --> 00:06:26,680 PULMONARY CRITICAL CARE AND 137 00:06:26,680 --> 00:06:27,360 SLEEP. 138 00:06:27,360 --> 00:06:29,560 MY INTEREST IN HYPERTENSION WAS 139 00:06:29,560 --> 00:06:32,360 PERIPHERAL AS WE NOTICE MANY 140 00:06:32,360 --> 00:06:34,000 PATIENTS WITH OBESITY SYNDROME 141 00:06:34,000 --> 00:06:36,400 HAVE PULL KNOW MARRY 142 00:06:36,400 --> 00:06:39,480 HYPERTENSION, MY RESEARCH IS NOW 143 00:06:39,480 --> 00:06:43,760 FOCUSED ON ANIMAL MODELS OF 144 00:06:43,760 --> 00:06:45,840 OBESITY AND HYPOXIA AS WELL AS 145 00:06:45,840 --> 00:06:48,600 CLINICAL STUDIES LOOKING AT 146 00:06:48,600 --> 00:06:49,560 INTERSECTION OF MOUSE MODEL 147 00:06:49,560 --> 00:06:53,160 DISEASE OF OF PULMONARY DISEASE 148 00:06:53,160 --> 00:06:59,480 AND SLEEP DISORDER BREATHING. 149 00:06:59,480 --> 00:07:01,480 >>NEXT DR. PARTHASARATHY, IF I 150 00:07:01,480 --> 00:07:03,040 PRONOUNCE IT RIGHT. 151 00:07:03,040 --> 00:07:06,560 I HOPE SO. 152 00:07:06,560 --> 00:07:10,600 IS HE HERE? 153 00:07:10,600 --> 00:07:11,400 ALL RIGHT. 154 00:07:11,400 --> 00:07:14,120 MAYBE HE'S NOT HERE AT THIS 155 00:07:14,120 --> 00:07:14,720 TIME. 156 00:07:14,720 --> 00:07:22,880 LET'S MOVE TO NEXT SPEAKER, DR. 157 00:07:22,880 --> 00:07:23,080 LIAO. 158 00:07:23,080 --> 00:07:24,880 >>RHEUMATOLOGIST AT BRIGHAM AND 159 00:07:24,880 --> 00:07:25,920 WOMEN'S HOSPITAL, ALSO HARVARD 160 00:07:25,920 --> 00:07:27,040 MEDICAL SCHOOL, DEPARTMENT OF 161 00:07:27,040 --> 00:07:28,200 MEDICINE AND DEPARTMENT OF 162 00:07:28,200 --> 00:07:29,320 BIOMEDICAL INFORMATICS. 163 00:07:29,320 --> 00:07:34,560 I WILL BE TALKING MORE ABOUT THE 164 00:07:34,560 --> 00:07:36,400 APPLICATIONS OF BIOINFORMATICS 165 00:07:36,400 --> 00:07:37,640 AND MACHINE LEARNING, MY 166 00:07:37,640 --> 00:07:41,520 RESEARCH ON RUMOR OF ARTHRITIS 167 00:07:41,520 --> 00:07:42,240 AND CARDIOVASCULAR DISEASE. 168 00:07:42,240 --> 00:07:44,400 >>THANK YOU. 169 00:07:44,400 --> 00:07:45,480 NEXT DR. CADE. 170 00:07:45,480 --> 00:07:49,560 >>GOOD MORNING, BRIAN CADE, 171 00:07:49,560 --> 00:07:51,840 BRIGHAM AND WOMEN'S HOSPITAL, 172 00:07:51,840 --> 00:07:58,400 FOLLOWING DR. LIAO TALKING ABOUT 173 00:07:58,400 --> 00:08:00,760 EHRs, SLEEP DISORDER 174 00:08:00,760 --> 00:08:01,360 BREATHING, PULMONARY 175 00:08:01,360 --> 00:08:05,880 HYPERTENSION AND INTEREST IN 176 00:08:05,880 --> 00:08:06,120 GENETICS. 177 00:08:06,120 --> 00:08:08,080 >>DR. LEWIS? 178 00:08:08,080 --> 00:08:13,440 >>HI, ELDRIN LEWIS, STANFORD, 179 00:08:13,440 --> 00:08:15,840 HEART FAILURE AND TRANSPLANT, 180 00:08:15,840 --> 00:08:18,920 RESEARCH INTEREST IS IN CLINICAL 181 00:08:18,920 --> 00:08:19,920 TRIALS, LARGE CLINICAL TRIALS, 182 00:08:19,920 --> 00:08:21,680 IMPLEMENTING QUALITY OF LIFE 183 00:08:21,680 --> 00:08:24,080 INTO MEDICAL DECISION MAKING, 184 00:08:24,080 --> 00:08:25,520 BUT ALSO STUDIED INTERFACE 185 00:08:25,520 --> 00:08:28,040 BETWEEN SLEEP APNEA AND HEART 186 00:08:28,040 --> 00:08:29,600 FAILURE, LOOK FORWARD TO TALKING 187 00:08:29,600 --> 00:08:31,280 WITH YOU TOMORROW. 188 00:08:31,280 --> 00:08:33,840 >>THANK YOU. 189 00:08:33,840 --> 00:08:34,880 NEXT DR. LEOPOLD. 190 00:08:34,880 --> 00:08:37,120 >>YES, HI, JANE LEOPOLD, 191 00:08:37,120 --> 00:08:41,520 CARDIOLOGIST AT BRIG BRIGHAM 192 00:08:41,520 --> 00:08:43,760 AND WOMEN'S HOSPITAL, RESEARCH 193 00:08:43,760 --> 00:08:47,400 INTEREST IN PRECISION MEDICINE 194 00:08:47,400 --> 00:08:49,000 APPROACHES TO OMICS AND 195 00:08:49,000 --> 00:08:50,080 PULMONARY VASCULAR DISEASE. 196 00:08:50,080 --> 00:08:52,520 >>THANK YOU, JANE. 197 00:08:52,520 --> 00:08:56,280 NEXT WILL BE DR. BERTISCH. 198 00:08:56,280 --> 00:09:03,360 >>HI, SUZIE BERTISCH, 199 00:09:03,360 --> 00:09:05,240 APPLICATION OF PATIENT SCIENCE 200 00:09:05,240 --> 00:09:06,760 TO TREATING SLEEP DISORDERS 201 00:09:06,760 --> 00:09:09,520 ACROSS CLINICAL AND COMMUNITY 202 00:09:09,520 --> 00:09:11,680 SETTINGS, HOPEFULLY TO SET A 203 00:09:11,680 --> 00:09:14,160 FRAMEWORK FOR MOVING FORWARD IN 204 00:09:14,160 --> 00:09:15,960 OVERLAP BETWEEN SLEEP DISORDERS 205 00:09:15,960 --> 00:09:16,920 AND PULMONARY HYPERTENSION TO 206 00:09:16,920 --> 00:09:19,760 BROADEN REACH OF IMPACT OF THE 207 00:09:19,760 --> 00:09:22,840 RESEARCH THAT YOU ARE ALL DOING. 208 00:09:22,840 --> 00:09:23,240 THANK YOU. 209 00:09:23,240 --> 00:09:25,800 >>CAN WE MOVE TO DAY 1 210 00:09:25,800 --> 00:09:26,200 SPEAKERS? 211 00:09:26,200 --> 00:09:29,280 I THINK WE SKIPPED THE DAY 1 212 00:09:29,280 --> 00:09:29,560 SPEAKERS. 213 00:09:29,560 --> 00:09:31,600 THIS IS DAY 1 SPEAKER. 214 00:09:31,600 --> 00:09:36,200 NEXT ONE WILL BE DR. BUYSSE. 215 00:09:36,200 --> 00:09:37,600 >>UNIVERSITY OF PITTSBURGH, 216 00:09:37,600 --> 00:09:39,480 POSSIBLY THE ONLY PSYCHIATRIST 217 00:09:39,480 --> 00:09:41,480 ON THE PANEL AT THIS TIME. 218 00:09:41,480 --> 00:09:43,360 MY INTERESTS ARE IN MEASURING 219 00:09:43,360 --> 00:09:44,920 AND DEFINING SLEEP HEALTH AND 220 00:09:44,920 --> 00:09:47,480 LOOKING AT IT IN RELATION TO A 221 00:09:47,480 --> 00:09:49,360 VARIETY OF HEALTH OUTCOMES, ALSO 222 00:09:49,360 --> 00:09:53,520 VERY INTERESTED IN BEHAVIORAL 223 00:09:53,520 --> 00:09:55,040 INTERVENTIONS FOR IMPROVING 224 00:09:55,040 --> 00:09:55,240 SLEEP. 225 00:09:55,240 --> 00:09:59,840 >>THANK YOU. 226 00:09:59,840 --> 00:10:00,120 DR. SHAH? 227 00:10:00,120 --> 00:10:01,400 >>GOOD MORNING, ICAHN SCHOOL OF 228 00:10:01,400 --> 00:10:04,000 MEDICINE, VICE CHAIR OF MEDICINE 229 00:10:04,000 --> 00:10:07,200 HERE, MY RESEARCH LOOKS AT 230 00:10:07,200 --> 00:10:07,800 OBSTRUCTIVE SLEEP APNEA AND 231 00:10:07,800 --> 00:10:12,240 CARDIOVASCULAR SHE'S FOR AS -- 232 00:10:12,240 --> 00:10:13,720 DISEASE, FOCUSED ON 233 00:10:13,720 --> 00:10:20,680 HETEROGENEITY OF TREATMENT 234 00:10:20,680 --> 00:10:21,280 EFFECTS WITH CPAP. 235 00:10:21,280 --> 00:10:23,480 >>THANK YOU. 236 00:10:23,480 --> 00:10:24,240 NEXT ONE, DR. CHAN. 237 00:10:24,240 --> 00:10:27,760 >>GOOD TO BE WITH YOU ALL, 238 00:10:27,760 --> 00:10:31,600 STEVE CHAN, DIRECTOR OF VASCULAR 239 00:10:31,600 --> 00:10:32,160 RESEARCH MEDICINE INSTITUTE, 240 00:10:32,160 --> 00:10:34,640 PITTSBURGH SCHOOL OF MEDICINE, 241 00:10:34,640 --> 00:10:37,240 MOLECULAR MECHANISMS, SYSTEMS 242 00:10:37,240 --> 00:10:39,240 BIOLOGY OF PULMONARY VASCULAR 243 00:10:39,240 --> 00:10:39,440 DISEASE. 244 00:10:39,440 --> 00:10:42,840 >>THANK YOU. 245 00:10:42,840 --> 00:10:46,920 NEXT DR. DEJESUS PEREZ. 246 00:10:46,920 --> 00:10:48,880 >>GOOD MORNING, ASSOCIATE 247 00:10:48,880 --> 00:10:50,840 PROFESSOR OF PULMONARY CRITICAL 248 00:10:50,840 --> 00:10:53,040 CARE MEDICINE AT STANFORD. 249 00:10:53,040 --> 00:10:54,360 RESEARCH INTEREST IS PULMONARY 250 00:10:54,360 --> 00:10:57,280 VASCULAR DISEASE WITH FOCUS ON 251 00:10:57,280 --> 00:10:58,240 GENETIC AND MOLECULAR MECHANISMS 252 00:10:58,240 --> 00:11:01,760 AND TODAY I WILL BE TALKING TO 253 00:11:01,760 --> 00:11:05,720 YOU ABOUT THE GENERAL PURVIEW OF 254 00:11:05,720 --> 00:11:07,240 PULMONARY HYPERTENSION, 255 00:11:07,240 --> 00:11:08,640 RELEVANCE TO SLEEP HEALTH. 256 00:11:08,640 --> 00:11:12,320 >>THANK YOU. 257 00:11:12,320 --> 00:11:14,840 DR. HILL. 258 00:11:14,840 --> 00:11:20,400 NICK, ARE YOU THERE? 259 00:11:20,400 --> 00:11:23,480 >>I AM THERE, EXCEPT I FORGOT 260 00:11:23,480 --> 00:11:24,520 TO PRESS MY BUTTONS. 261 00:11:24,520 --> 00:11:29,040 >>THAT'S WHAT I FIGURED. 262 00:11:29,040 --> 00:11:31,480 >>BUT NICK HILL, PULMONARY 263 00:11:31,480 --> 00:11:32,760 CRITICAL CARE, TUFTS MEDICAL 264 00:11:32,760 --> 00:11:35,400 CENTER IN BOSTON, I'VE HAD 265 00:11:35,400 --> 00:11:38,200 LONGSTANDING RESEARCH AND 266 00:11:38,200 --> 00:11:40,280 CLINICAL INTERESTS IN PULMONARY 267 00:11:40,280 --> 00:11:41,720 HYPERTENSION AND NON-INVASIVE 268 00:11:41,720 --> 00:11:43,880 RESPIRATORY SUPPORT, ALSO CHAIR 269 00:11:43,880 --> 00:11:47,880 OF THE STEERING COMMITTEE OF THE 270 00:11:47,880 --> 00:11:48,400 OMICS NETWORK. 271 00:11:48,400 --> 00:11:52,480 >>NEXT ONE DR. MEHRA. 272 00:11:52,480 --> 00:11:54,640 >>HI, GOOD MORNING. 273 00:11:54,640 --> 00:11:56,080 LOOKS LIKE I'M WEARING THE SAME 274 00:11:56,080 --> 00:11:57,320 JACKET AS IN MY PICTURE. 275 00:11:57,320 --> 00:11:59,760 I DO HAVE MORE THAN ONE. 276 00:11:59,760 --> 00:12:02,320 SO, GREAT TO BE WITH YOU HERE 277 00:12:02,320 --> 00:12:03,760 THIS MORNING. 278 00:12:03,760 --> 00:12:06,920 I'M DIRECTOR OF SLEEP DISORDERS 279 00:12:06,920 --> 00:12:09,000 RESEARCH, CLEVELAND CLINIC, 280 00:12:09,000 --> 00:12:12,160 PROFESSOR OF MEDICINE, AND HAVE 281 00:12:12,160 --> 00:12:12,960 APPOINTMENTS ALIGNED WITH 282 00:12:12,960 --> 00:12:16,800 INTERESTS IN HEART AND VASCULAR 283 00:12:16,800 --> 00:12:17,960 INSTITUTE LERNER RESEARCH 284 00:12:17,960 --> 00:12:20,280 INSTITUTE, AND TRAINED PULMONARY 285 00:12:20,280 --> 00:12:22,040 AND CRITICAL CARE PHYSICIAN, MY 286 00:12:22,040 --> 00:12:23,560 RESEARCH HAS BEEN FOCUSED OVER 287 00:12:23,560 --> 00:12:25,960 THE LAST SEVERAL DECADES ON THE 288 00:12:25,960 --> 00:12:28,720 INTERSECTION OF SLEEP DISRUPTION 289 00:12:28,720 --> 00:12:31,000 AND SLEEP DISORDERS ON 290 00:12:31,000 --> 00:12:32,440 CARDIOPULMONARY DISEASE VIA 291 00:12:32,440 --> 00:12:33,520 CLINICAL RESEARCH, ALSO 292 00:12:33,520 --> 00:12:35,280 TRANSLATIONAL SCIENCE. 293 00:12:35,280 --> 00:12:39,000 I'M LEAD FOR THE PVD OMICS SLEEP 294 00:12:39,000 --> 00:12:42,040 CORE, SO WILL BE SHARING SOME OF 295 00:12:42,040 --> 00:12:45,800 OUR FINDINGS IN OUR TALK TODAY 296 00:12:45,800 --> 00:12:47,320 DISCUSSING GROUPS 1 AND 2 WITH 297 00:12:47,320 --> 00:12:48,480 PULMONARY HYPERTENSION WITH 298 00:12:48,480 --> 00:12:49,960 SLEEP DISORDERS. 299 00:12:49,960 --> 00:12:50,360 THANK YOU. 300 00:12:50,360 --> 00:12:53,520 >>THANK YOU. 301 00:12:53,520 --> 00:12:54,480 NEXT, DR. PUNJABI. 302 00:12:54,480 --> 00:12:57,840 >>GOOD MORNING, MY CAMERA IS 303 00:12:57,840 --> 00:12:59,880 NOT WORKING, CHIEF OF PULMONARY 304 00:12:59,880 --> 00:13:01,640 CRITICAL CARE AND SLEEP 305 00:13:01,640 --> 00:13:03,080 MEDICINE, UNIVERSITY OF MIAMI, 306 00:13:03,080 --> 00:13:07,000 INTERESTED IN SLEEP APNEA 307 00:13:07,000 --> 00:13:08,880 EFFECTS, EPIDEMIOLOGICALLY, ALSO 308 00:13:08,880 --> 00:13:12,440 IN THE CONTEXT OF CLINICAL 309 00:13:12,440 --> 00:13:12,680 TRIALS. 310 00:13:12,680 --> 00:13:14,000 >>DR. GOSS? 311 00:13:14,000 --> 00:13:23,640 >>GOOD MORNING, U.T. 312 00:13:23,640 --> 00:13:24,240 SOUTHWESTERN, TREATING HEART 313 00:13:24,240 --> 00:13:26,400 FAILURE IN CLINIC BUT HAVE A 314 00:13:26,400 --> 00:13:28,040 RESEARCH FOCUS ON LONG-TERM 315 00:13:28,040 --> 00:13:31,240 OUTCOMES AFTER PRE-TERM BIRTH OR 316 00:13:31,240 --> 00:13:36,040 EXTREME PRE-TERM BIRTH AROUND 317 00:13:36,040 --> 00:13:37,760 RVPV ACCESS AND CARDIOPULMONARY 318 00:13:37,760 --> 00:13:41,480 OUTCOMES, EXCITED TO LEARN MORE 319 00:13:41,480 --> 00:13:41,680 TODAY. 320 00:13:41,680 --> 00:13:45,640 >>NEXT, DR. KATZ. 321 00:13:45,640 --> 00:13:47,520 >>DAN KATZ, CARDIOLOGIST, 322 00:13:47,520 --> 00:13:49,600 STANFORD UNIVERSITY, AND 323 00:13:49,600 --> 00:13:50,600 ADVANCED HEART FAILURE AND 324 00:13:50,600 --> 00:13:51,440 CARDIOLOGY GROUP. 325 00:13:51,440 --> 00:13:53,400 MY RESEARCH IS FOCUSED ON 326 00:13:53,400 --> 00:13:55,280 LEVERAGING MULTIOMIC DATA TO 327 00:13:55,280 --> 00:13:57,280 BETTER UNDERSTAND HEART FAILURE, 328 00:13:57,280 --> 00:13:57,880 HETEROGENEITY AND MECHANISMS, 329 00:13:57,880 --> 00:14:02,080 AND MY TALK TODAY WILL FOCUS ON 330 00:14:02,080 --> 00:14:03,120 GIVING OVERVIEW OF MULTIOMICS 331 00:14:03,120 --> 00:14:03,440 STRATEGIES. 332 00:14:03,440 --> 00:14:07,320 >>THANK YOU. 333 00:14:07,320 --> 00:14:12,840 NEXT SPEAKER, DR. SOFER. 334 00:14:12,840 --> 00:14:15,800 >>HI, ASSISTANT PROFESSOR AT 335 00:14:15,800 --> 00:14:18,560 BETH ISRAEL DEAN ONES, WORKING 336 00:14:18,560 --> 00:14:22,920 ON SLEEP FOR SIX YEARS, MOSTLY 337 00:14:22,920 --> 00:14:24,440 TRYING TO DO OMICS, UNDERSTAND 338 00:14:24,440 --> 00:14:29,920 SLEEP, HOW IT RELATES TO OTHER 339 00:14:29,920 --> 00:14:30,320 HEALTH OUTCOMES. 340 00:14:30,320 --> 00:14:31,560 >>ALL RIGHT. 341 00:14:31,560 --> 00:14:33,520 BRITTANY, CAN WE MOVE TO THE 342 00:14:33,520 --> 00:14:36,280 NEXT SLIDE FOR THE DISCUSSANTS. 343 00:14:36,280 --> 00:14:36,880 GOOD. 344 00:14:36,880 --> 00:14:41,320 SO THE NEXT ONE WILL BE DR. 345 00:14:41,320 --> 00:14:41,520 ABMAN. 346 00:14:41,520 --> 00:14:42,640 >>GOOD MORNING, EVERYBODY. 347 00:14:42,640 --> 00:14:45,720 PLEASURE TO BE HERE, PROFESSOR 348 00:14:45,720 --> 00:14:48,000 OF PEDIATRICS IN COLORADO, AND 349 00:14:48,000 --> 00:14:50,080 MY BACKGROUND IS IN PULMONARY 350 00:14:50,080 --> 00:14:51,640 AND CRITICAL CARE MEDICINE, 351 00:14:51,640 --> 00:14:53,680 LONGSTANDING INTEREST IN TERMS 352 00:14:53,680 --> 00:14:55,480 OF CLINICAL RESEARCH AND 353 00:14:55,480 --> 00:14:57,960 LABORATORY SCIENCE IN THE 354 00:14:57,960 --> 00:14:59,720 DEVELOPING LUNG AND PULMONARY 355 00:14:59,720 --> 00:15:00,840 MORE BROADLY IN CHILDREN, 356 00:15:00,840 --> 00:15:02,320 ESPECIALLY INTERESTED IN THE 357 00:15:02,320 --> 00:15:04,720 ROLE OF SLEEP DISORDERED 358 00:15:04,720 --> 00:15:06,040 BREATHING AND INTERMITTENT 359 00:15:06,040 --> 00:15:08,560 HYPOXIA AND DISEASE PROGRESSION, 360 00:15:08,560 --> 00:15:09,880 ALSO PREMATURE INFANT, 361 00:15:09,880 --> 00:15:14,160 PATHOGENESIS OF DISEASE WITH 362 00:15:14,160 --> 00:15:15,320 INTERMITTENT HYPOXIA AND FEEL 363 00:15:15,320 --> 00:15:17,000 GRATEFUL TO JOIN YOU TODAY, 364 00:15:17,000 --> 00:15:19,520 LOOKING FORWARD TO THE 365 00:15:19,520 --> 00:15:20,080 PRESENTATIONS. 366 00:15:20,080 --> 00:15:21,240 THANK YOU. 367 00:15:21,240 --> 00:15:23,560 >>THANK YOU. 368 00:15:23,560 --> 00:15:23,920 DR. HASSAN? 369 00:15:23,920 --> 00:15:26,720 >>GOOD MORNING, A PLEASURE TO 370 00:15:26,720 --> 00:15:27,480 BE HERE. 371 00:15:27,480 --> 00:15:30,680 I JUST JOINED BRIGHAM AND 372 00:15:30,680 --> 00:15:34,240 WOMEN'S HOSPITAL AFTER FINISHING 373 00:15:34,240 --> 00:15:35,720 PRIMARY CRITICAL CARE, 374 00:15:35,720 --> 00:15:39,200 INTERESTED IN PHENOTYPING SLEEP 375 00:15:39,200 --> 00:15:41,720 APNEA IN PRIMARY HYPERTENSION 376 00:15:41,720 --> 00:15:47,440 PATIENTS USING OTHER MARKERS IN 377 00:15:47,440 --> 00:15:49,200 ADDITION LIKE HYPOXIA BURDEN IN 378 00:15:49,200 --> 00:15:50,000 THESE PATIENTS. 379 00:15:50,000 --> 00:15:55,120 >>THANK YOU. 380 00:15:55,120 --> 00:16:02,240 DR. MATHAI? 381 00:16:02,240 --> 00:16:06,480 >>>PULMONOLOGIST AT JOHNS 382 00:16:06,480 --> 00:16:08,880 HOPKINS, PATIENTS WITH 383 00:16:08,880 --> 00:16:09,600 CONNECTIVE TISSUE DISEASES AND 384 00:16:09,600 --> 00:16:12,400 EXCITED TO BE HERE TODAY AND 385 00:16:12,400 --> 00:16:12,640 TOMORROW. 386 00:16:12,640 --> 00:16:16,280 >>THANK YOU. 387 00:16:16,280 --> 00:16:17,480 DR. MINHAS? 388 00:16:17,480 --> 00:16:19,240 >>PART OF THE PULMONARY AND 389 00:16:19,240 --> 00:16:20,280 CRITICAL CARE DIVISION 390 00:16:20,280 --> 00:16:22,240 UNIVERSITY OF PENNSYLVANIA, 391 00:16:22,240 --> 00:16:25,000 RESEARCH FOCUSED ON PULMONARY 392 00:16:25,000 --> 00:16:26,680 HYPERTENSION PRIMARILY REMOTE 393 00:16:26,680 --> 00:16:31,480 MONITORING OF PATIENTS WITH 394 00:16:31,480 --> 00:16:33,240 PULMONARY HYPERTENSION USING 395 00:16:33,240 --> 00:16:33,880 ACCELEROMETRY TO IDENTIFY 396 00:16:33,880 --> 00:16:36,520 BIOMARKERS THAT CAN BE 397 00:16:36,520 --> 00:16:38,400 INTERVENED ON. 398 00:16:38,400 --> 00:16:40,120 >>THANK YOU. 399 00:16:40,120 --> 00:16:40,400 DR. PAREKH? 400 00:16:40,400 --> 00:16:43,400 >>THANK YOU FOR THE INVITE. 401 00:16:43,400 --> 00:16:47,880 ASSISTANT PROFESSOR OF SLEEP 402 00:16:47,880 --> 00:16:50,280 MEDICINE, MOUNT SINAI SCHOOL OF 403 00:16:50,280 --> 00:16:51,680 MEDICINE, APPLIED MATHEMATICIAN 404 00:16:51,680 --> 00:16:53,480 TRAINED IN SLEEP PHYSIOLOGY, 405 00:16:53,480 --> 00:16:54,760 RESEARCH INTERESTS MAINLY 406 00:16:54,760 --> 00:16:56,400 LOOKING AT CRITICAL MARKERS OF 407 00:16:56,400 --> 00:16:59,120 IMMEDIATE AND LONG-TERM 408 00:16:59,120 --> 00:17:00,120 CONSEQUENCES OF SLEEP APNEA. 409 00:17:00,120 --> 00:17:04,720 >>THANK YOU. 410 00:17:04,720 --> 00:17:05,120 DR. RISCHARD? 411 00:17:05,120 --> 00:17:08,400 >>HI, THANKS FOR HAVING ME. 412 00:17:08,400 --> 00:17:11,280 PULMONARY CRITICAL CARE, 413 00:17:11,280 --> 00:17:14,360 UNIVERSITY OF ARIZONA. 414 00:17:14,360 --> 00:17:16,080 AND MY RESEARCH IS IN -- 415 00:17:16,080 --> 00:17:21,360 INTERESTS IN RV FUNCTION AND RV 416 00:17:21,360 --> 00:17:24,320 ADAPTATION TO STRESS, EXERCISE 417 00:17:24,320 --> 00:17:26,280 PHYSIOLOGY, AND AN INTEREST IN 418 00:17:26,280 --> 00:17:27,720 TODAY'S TOPIC PARTICULARLY AS 419 00:17:27,720 --> 00:17:29,920 RELATES TO THAT. 420 00:17:29,920 --> 00:17:30,360 THANKS AGAIN. 421 00:17:30,360 --> 00:17:31,440 >>ALL RIGHT. 422 00:17:31,440 --> 00:17:37,120 THANK YOU. 423 00:17:37,120 --> 00:17:37,920 DR. SCHMICKL? 424 00:17:37,920 --> 00:17:39,920 >>HI, ASSISTANT PROFESSOR AT 425 00:17:39,920 --> 00:17:41,520 UCSD, I HAVE A FEW CAREER 426 00:17:41,520 --> 00:17:43,440 DEVELOPMENT AWARDS INCLUDING ONE 427 00:17:43,440 --> 00:17:46,200 FROM THE NIH, FOCUS ON USING 428 00:17:46,200 --> 00:17:47,040 BETTER UNDERSTANDING OF 429 00:17:47,040 --> 00:17:49,240 PHYSIOLOGY TO TRANSLATE THAT 430 00:17:49,240 --> 00:17:52,760 INTO NEW TREATMENT OPTIONS FOR 431 00:17:52,760 --> 00:17:55,600 PATIENTS WITH OBSTRUCTIVE SLEEP 432 00:17:55,600 --> 00:17:59,760 APNEA, I'M EXCITED TO BE HERE 433 00:17:59,760 --> 00:18:00,960 TODAY. 434 00:18:00,960 --> 00:18:02,240 THANK YOU. 435 00:18:02,240 --> 00:18:03,520 >>DR. SWEATT? 436 00:18:03,520 --> 00:18:06,120 >>HI, EVERYBODY, I'M A 437 00:18:06,120 --> 00:18:06,720 PHYSICIAN-SCIENTIST AT STANFORD 438 00:18:06,720 --> 00:18:07,760 UNIVERSITY, DIVISION OF 439 00:18:07,760 --> 00:18:10,160 PULMONARY AND CRITICAL CARE 440 00:18:10,160 --> 00:18:12,880 MEDICINE, RESEARCH FOCUSES ON 441 00:18:12,880 --> 00:18:15,520 USE OF MACHINE LEARNING TO 442 00:18:15,520 --> 00:18:20,320 IDENTIFY NOVEL BIOMARKERS AND 443 00:18:20,320 --> 00:18:21,440 SUBPHENOTYPES OF PULMONARY 444 00:18:21,440 --> 00:18:21,800 HYPERTENSION. 445 00:18:21,800 --> 00:18:32,320 >>I WANT TO DOUBLECHECK THAT IF 446 00:18:32,800 --> 00:18:34,040 DOCTOR (INDISCERNIBLE) IS HERE. 447 00:18:34,040 --> 00:18:35,800 IF YOU'RE HERE, TURN ON YOUR 448 00:18:35,800 --> 00:18:37,120 CAMERA AND INTRODUCE YOURSELF. 449 00:18:37,120 --> 00:18:38,640 PROBABLY HE'S NOT HERE AT THIS 450 00:18:38,640 --> 00:18:39,600 TIME. 451 00:18:39,600 --> 00:18:39,800 OKAY. 452 00:18:39,800 --> 00:18:41,280 THANK YOU, EVERYONE, FOR STAYING 453 00:18:41,280 --> 00:18:42,360 ON TIME. 454 00:18:42,360 --> 00:18:47,720 NOW I WOULD LIKE TO WELCOME OUR 455 00:18:47,720 --> 00:18:51,840 LUNG DIVISIONAL DIRECTOR TO GIVE 456 00:18:51,840 --> 00:18:54,400 OPENING REMARKS FROM THE NHLBI 457 00:18:54,400 --> 00:18:55,160 LEADERSHIP PERSPECTIVE. 458 00:18:55,160 --> 00:19:02,120 JIM, ARE YOU HERE? 459 00:19:02,120 --> 00:19:12,520 >>YEAH, GOOD MORNING. 460 00:19:14,400 --> 00:19:18,360 >>A WARM WELCOME, AND WE'RE 461 00:19:18,360 --> 00:19:22,600 GRATEFUL TO ALL OF YOU GIVING UP 462 00:19:22,600 --> 00:19:24,480 SOME PRECIOUS TIME TO HELP WITH 463 00:19:24,480 --> 00:19:29,000 CRITICALLY IMPORTANT TOPIC WE'RE 464 00:19:29,000 --> 00:19:30,360 ALL QUITE EXCITED ABOUT IN THE 465 00:19:30,360 --> 00:19:34,480 LUNG DIVISION AND ACROSS THE 466 00:19:34,480 --> 00:19:37,960 INSTITUTE. 467 00:19:37,960 --> 00:19:44,440 I DO WANT TO EXPRESS THANKS TO 468 00:19:44,440 --> 00:19:46,080 LEI AND ALFONSO WHO DROVE THIS 469 00:19:46,080 --> 00:19:56,600 FORWARD FROM THE NHLBI SIDE AND 470 00:19:58,520 --> 00:19:59,200 SUSAN REDLINE. 471 00:19:59,200 --> 00:20:01,200 IT IMPRESSES ME WHAT A SUPER 472 00:20:01,200 --> 00:20:02,640 GROUP WE HAVE, NOT ONLY DO WE 473 00:20:02,640 --> 00:20:05,320 HAVE A MIX OF BASIC AND CLINICAL 474 00:20:05,320 --> 00:20:07,960 BUT WE ALSO CAN REALLY CROSS 475 00:20:07,960 --> 00:20:11,560 BRIDGE VARIOUS DISCIPLINES THAT 476 00:20:11,560 --> 00:20:13,200 MIGHT NOT NECESSARILY TALK TEACH 477 00:20:13,200 --> 00:20:14,320 OTHER ON A REGULAR BASIS. 478 00:20:14,320 --> 00:20:17,360 IF THERE'S A MESSAGE TO LEAVE 479 00:20:17,360 --> 00:20:19,760 WITH YOU TODAY, THAT IS THE 480 00:20:19,760 --> 00:20:20,960 GOAL, TO BRING COMMUNITIES 481 00:20:20,960 --> 00:20:23,360 TOGETHER THAT DON'T SPEAK TO 482 00:20:23,360 --> 00:20:27,240 EACH OTHER OR HAVE INTERACTIONS 483 00:20:27,240 --> 00:20:28,280 TO SEE WHERE OPPORTUNITIES ARE 484 00:20:28,280 --> 00:20:30,600 TO MAKE PROGRESS IN THE RESEARCH 485 00:20:30,600 --> 00:20:31,080 DOMAIN. 486 00:20:31,080 --> 00:20:38,720 I THINK THE TOPIC WE'RE GOING TO 487 00:20:38,720 --> 00:20:42,120 ADDRESS IS JUST A SUPER EXAMPLE 488 00:20:42,120 --> 00:20:46,840 OF WHERE WE HAVE DIVERSE 489 00:20:46,840 --> 00:20:49,520 COMMUNITIES, WHEN YOU PUT THAT 490 00:20:49,520 --> 00:20:51,880 COLLECTIVE BRAINPOWER TOGETHER 491 00:20:51,880 --> 00:20:53,280 YOU GET REMARKABLE RESULTS. 492 00:20:53,280 --> 00:20:54,680 SO, I DON'T HAVE TO TELL ALL OF 493 00:20:54,680 --> 00:20:56,560 YOU OVER THE NEXT COUPLE DAYS 494 00:20:56,560 --> 00:21:03,200 THIS WORKSHOP IS GOING TO ASK 495 00:21:03,200 --> 00:21:05,520 THE BIDIRECTIONAL RELATIONSHIP 496 00:21:05,520 --> 00:21:07,720 WITH SLEEP DISORDER BREATHING 497 00:21:07,720 --> 00:21:10,880 AND CIRCADIAN DISORDERS WITH 498 00:21:10,880 --> 00:21:12,080 PULMONARY VASCULAR DISEASES, NOT 499 00:21:12,080 --> 00:21:13,760 JUST PULMONARY HYPERTENSION BUT 500 00:21:13,760 --> 00:21:17,240 TO LEANING SOME OF THE 501 00:21:17,240 --> 00:21:17,840 PATHOBIOLOGICAL UNDERSTANDING 502 00:21:17,840 --> 00:21:19,560 AND UNDERPINNINGS TO THE 503 00:21:19,560 --> 00:21:22,040 RELEVANCE TO CARDIOVASCULAR 504 00:21:22,040 --> 00:21:22,400 HEALTH. 505 00:21:22,400 --> 00:21:24,720 AND I THINK THERE'S THE SECOND 506 00:21:24,720 --> 00:21:27,400 MESSAGE FOR YOU TO HEAR, THIS IS 507 00:21:27,400 --> 00:21:29,160 CONSISTENT WITH OUR GOAL IN THE 508 00:21:29,160 --> 00:21:31,160 INSTITUTE, TO TAKE THAT BASIC 509 00:21:31,160 --> 00:21:32,960 SCIENCE AND TRY TO TRANSLATE 510 00:21:32,960 --> 00:21:36,200 THAT TO BETTER UNDERSTANDING OF 511 00:21:36,200 --> 00:21:37,800 HOW WE CAN HELP PATIENTS WITH 512 00:21:37,800 --> 00:21:39,360 DISEASES THAT WE ARE MOST 513 00:21:39,360 --> 00:21:40,000 CONCERNED ABOUT. 514 00:21:40,000 --> 00:21:43,920 AND I THINK THIS IS, AGAIN, A 515 00:21:43,920 --> 00:21:45,360 WONDERFUL OPPORTUNITY TO BRING 516 00:21:45,360 --> 00:21:47,800 TOGETHER PATIENT COMMUNITIES AS 517 00:21:47,800 --> 00:21:50,280 WELL AS CLINICIANS AND 518 00:21:50,280 --> 00:21:51,160 INVESTIGATORS AND SCIENTISTS WHO 519 00:21:51,160 --> 00:21:53,360 ARE NOT ONLY TAKING CARE OF 520 00:21:53,360 --> 00:21:55,880 PATIENTS BUT TRYING TO 521 00:21:55,880 --> 00:21:56,960 UNDERSTAND THEIR BASIC 522 00:21:56,960 --> 00:22:00,120 PATHOBIOLOGY TO FIND BETTER WAYS 523 00:22:00,120 --> 00:22:01,800 TO INTERVENE. 524 00:22:01,800 --> 00:22:02,760 IT'S INTERESTING BECAUSE MANY, 525 00:22:02,760 --> 00:22:07,600 MANY YEARS AGO, IN FACT, WE 526 00:22:07,600 --> 00:22:09,440 RECOGNIZED THAT THE RELATIONSHIP 527 00:22:09,440 --> 00:22:11,760 BETWEEN PULMONARY HYPERTENSION, 528 00:22:11,760 --> 00:22:14,400 THE INVOLVEMENT OF HYPOXIA, AND 529 00:22:14,400 --> 00:22:15,680 THEN WHERE THAT MAY INTERFACE 530 00:22:15,680 --> 00:22:20,520 WITH THINGS THAT ARE GOING ON AT 531 00:22:20,520 --> 00:22:21,400 NIGHT WITH SLEEP DISORDERED 532 00:22:21,400 --> 00:22:22,160 BREATHING. 533 00:22:22,160 --> 00:22:24,680 ONE OF THE THINGS I THINK THAT 534 00:22:24,680 --> 00:22:26,280 IS EXCITING ABOUT THIS WORKSHOP 535 00:22:26,280 --> 00:22:28,840 TO GET AN UPDATE ON WHERE WE ARE 536 00:22:28,840 --> 00:22:30,520 WITH THE DATA THAT REALLY TELLS 537 00:22:30,520 --> 00:22:33,240 US SOMETHING ABOUT NOT ONLY THE 538 00:22:33,240 --> 00:22:34,560 MEDIATORS OF PULMONARY 539 00:22:34,560 --> 00:22:38,720 HYPERTENSION BUT ALSO HOW SLEEP 540 00:22:38,720 --> 00:22:39,920 DISORDERED BREATHING IMPACTS 541 00:22:39,920 --> 00:22:40,560 PULMONARY HYPERTENSION 542 00:22:40,560 --> 00:22:41,880 DEVELOPMENT, PROGRESSES IS, AND 543 00:22:41,880 --> 00:22:43,560 WHAT CAN BE DONE TO HELP TREAT 544 00:22:43,560 --> 00:22:45,040 SOME OF THOSE CONDITIONS. 545 00:22:45,040 --> 00:22:49,360 SO THE ROLE OF SLEEP AND 546 00:22:49,360 --> 00:22:51,240 CIRCADIAN HEALTH MORE GENERALLY, 547 00:22:51,240 --> 00:22:54,360 THAT EXTENDS TO MORE THAN JUST 548 00:22:54,360 --> 00:22:56,040 HYPOXIA, IT'S INSOMNIA, 549 00:22:56,040 --> 00:22:57,720 INSUFFICIENT SLEEP DURATION, 550 00:22:57,720 --> 00:22:58,760 MISALIGNMENT OF SLEEP, A LOT OF 551 00:22:58,760 --> 00:22:59,960 THINGS GOING ON THAT WE'VE 552 00:22:59,960 --> 00:23:03,720 LEARNED ABOUT IN TERMS OF THE 553 00:23:03,720 --> 00:23:06,880 SLEEP PHYSIOLOGY PATHOBIOLOGY 554 00:23:06,880 --> 00:23:08,760 AND MECHANISMS WITH WHAT WE'VE 555 00:23:08,760 --> 00:23:10,360 LEARNED ABOUT PULMONARY 556 00:23:10,360 --> 00:23:11,600 HYPERTENSION AND NEW ADVANCES 557 00:23:11,600 --> 00:23:13,000 THERE WITH RESPECT TO 558 00:23:13,000 --> 00:23:14,360 INTERVENTIONS, IT'S GOING TO 559 00:23:14,360 --> 00:23:23,320 BRING US TO A BETTER 560 00:23:23,320 --> 00:23:25,640 UNDERSTANDING OF LANDSCAPE, AND 561 00:23:25,640 --> 00:23:27,400 WHAT IS MISSING, WHAT WE NEED TO 562 00:23:27,400 --> 00:23:28,600 DO TO ADDRESS OVERLAPPING 563 00:23:28,600 --> 00:23:29,000 CONDITIONS. 564 00:23:29,000 --> 00:23:29,640 UNDERSTANDING THAT RELATIONSHIP 565 00:23:29,640 --> 00:23:33,880 IS GOING TO BE IMPORTANT, NOT 566 00:23:33,880 --> 00:23:35,320 ONLY TO REFINE THERAPEUTIC 567 00:23:35,320 --> 00:23:36,080 APPROACHES, AND MANY THINGS 568 00:23:36,080 --> 00:23:39,000 YOU'RE GOING TO ADDRESS WHETHER 569 00:23:39,000 --> 00:23:41,000 IT'S OXYGEN, CPAP, BEHAVIOR, 570 00:23:41,000 --> 00:23:43,000 OTHER THINGS THAT WILL HOPEFULLY 571 00:23:43,000 --> 00:23:43,960 INFORM BOTH CONDITIONS. 572 00:23:43,960 --> 00:23:45,800 THE OTHER PART OF THIS THAT I 573 00:23:45,800 --> 00:23:48,880 THINK IS ALSO EXCITING IS THE 574 00:23:48,880 --> 00:23:51,120 ABILITY TO NOW INTEGRATE 575 00:23:51,120 --> 00:23:52,240 MULTIOMICS DATA, AND I THINK 576 00:23:52,240 --> 00:23:54,560 THAT IS A GOAL THAT I KNOW THAT 577 00:23:54,560 --> 00:23:57,520 THE AGENDA IS GOING TO ADDRESS 578 00:23:57,520 --> 00:23:58,840 BECAUSE IT'S QUITE A NICE 579 00:23:58,840 --> 00:23:59,920 PROGRAM, AND I THINK YOU'RE 580 00:23:59,920 --> 00:24:02,240 GOING TO LOOK AT IT FROM NOT 581 00:24:02,240 --> 00:24:04,640 JUST THE BASIC SCIENCE BUT ALSO 582 00:24:04,640 --> 00:24:07,360 THE IMPLEMENTATION, HOW DO WE 583 00:24:07,360 --> 00:24:11,400 THEN TAKE WHAT WE KNOW ABOUT 584 00:24:11,400 --> 00:24:12,520 VARIOUS TECHNOLOGIES, MOBILE 585 00:24:12,520 --> 00:24:15,160 HEALTH, YOU KNOW, HOW DO WE USE 586 00:24:15,160 --> 00:24:18,520 ELECTRONIC HEALTH RECORDS AND 587 00:24:18,520 --> 00:24:19,200 TAKE THAT INFORMATION INTEGRATE 588 00:24:19,200 --> 00:24:22,160 IT AND USE IT IN A WAY THAT 589 00:24:22,160 --> 00:24:24,600 MIGHT BE IMPACTFUL TO THE 590 00:24:24,600 --> 00:24:26,000 PATIENTS THAT YOU'RE ALL SEEING 591 00:24:26,000 --> 00:24:28,240 ON A REGULAR BASIS. 592 00:24:28,240 --> 00:24:30,600 SO, THE OVERARCHING GOAL IS TO 593 00:24:30,600 --> 00:24:32,120 DISCUSS THE STATE OF KNOWLEDGE 594 00:24:32,120 --> 00:24:35,960 OF SLEEP HEALTH AND DYSFUNCTION 595 00:24:35,960 --> 00:24:37,320 AND ITS IMPACT ON PULMONARY 596 00:24:37,320 --> 00:24:38,360 VASCULAR DISEASE AND IDENTIFY 597 00:24:38,360 --> 00:24:43,000 AREAS WHERE FUTURE RESEARCH IS 598 00:24:43,000 --> 00:24:44,840 NEEDED AND EXPLORE WHERE 599 00:24:44,840 --> 00:24:46,560 THOSE -- WHERE THE MOST PRESSING 600 00:24:46,560 --> 00:24:49,200 NEEDS ARE THAT WILL HELP MOVE 601 00:24:49,200 --> 00:24:50,760 THE FIELD FORWARD. 602 00:24:50,760 --> 00:24:52,920 SO, ALL OF THIS ALIGNS VERY 603 00:24:52,920 --> 00:24:55,160 NICELY, I DON'T HAVE TO SAY THIS 604 00:24:55,160 --> 00:24:58,080 TO THIS GROUP, WITH THE SLEEP 605 00:24:58,080 --> 00:24:59,400 RESEARCH PLAN, NIH SLEEP 606 00:24:59,400 --> 00:25:01,400 RESEARCH PLAN, ALSO WITH THE 607 00:25:01,400 --> 00:25:06,640 STRATEGIC VISION OF THE NHLBI, 608 00:25:06,640 --> 00:25:07,720 VERY DEDICATED CRITICAL 609 00:25:07,720 --> 00:25:10,120 QUESTIONS AND SUCH THAT ALIGN 610 00:25:10,120 --> 00:25:12,520 WITH THE GOALS OF THIS WORKSHOP. 611 00:25:12,520 --> 00:25:14,920 WE'RE REALLY EXCITED ABOUT NOT 612 00:25:14,920 --> 00:25:17,560 ONLY FITTING NICELY WITH WHAT 613 00:25:17,560 --> 00:25:19,000 THE INSTITUTE SAYS ARE 614 00:25:19,000 --> 00:25:20,720 PRIORITIES BUT ALSO TO BRIDGE 615 00:25:20,720 --> 00:25:22,080 THESE TWO DISCIPLINES AND REALLY 616 00:25:22,080 --> 00:25:23,720 SEE WHERE WE CAN GO. 617 00:25:23,720 --> 00:25:27,120 I'LL LEAVE YOU WITH ONE FINAL 618 00:25:27,120 --> 00:25:29,800 THOUGHT, AND THIS IS FOR -- 619 00:25:29,800 --> 00:25:31,800 MOSTLY I THINK TO OUR CHAIRS TO 620 00:25:31,800 --> 00:25:34,400 PAY ATTENTION TO, BUT IT'S VERY 621 00:25:34,400 --> 00:25:37,160 TEMPTING FOR ALL OF YOU TO 622 00:25:37,160 --> 00:25:38,680 REALLY PRODUCE A LAUNDRY LIST, A 623 00:25:38,680 --> 00:25:40,640 VERY LONG LIST OF NEEDS AND 624 00:25:40,640 --> 00:25:41,000 OPPORTUNITIES. 625 00:25:41,000 --> 00:25:41,680 AND THAT'S WONDERFUL. 626 00:25:41,680 --> 00:25:43,080 YOU CAN DO THAT. 627 00:25:43,080 --> 00:25:46,360 IT'S ALSO VERY TEMPTING TO START 628 00:25:46,360 --> 00:25:49,320 TO TELL US WE NEED A MECHANISM 629 00:25:49,320 --> 00:25:51,080 AND FUNDING AND, YES, THAT'S 630 00:25:51,080 --> 00:25:53,120 ALSO IN BOUND, YOU CAN DO THOSE 631 00:25:53,120 --> 00:25:53,480 THINGS. 632 00:25:53,480 --> 00:25:54,760 BUT REALLY WHAT WE WANT TO HEAR 633 00:25:54,760 --> 00:25:57,640 AT THE END IS WHAT ARE THE BIG 634 00:25:57,640 --> 00:25:59,480 ISSUES, IF YOU WERE ONLY ABLE TO 635 00:25:59,480 --> 00:26:01,960 DO ONE THING, WHAT WOULD IT BE 636 00:26:01,960 --> 00:26:04,280 THAT WOULD BE MORE THAN AN 637 00:26:04,280 --> 00:26:05,920 INCREMENTAL ADVANCE BUT BOLD 638 00:26:05,920 --> 00:26:08,040 MOVE FORWARD THAT WOULD HELP 639 00:26:08,040 --> 00:26:09,880 CHANGE THE LANDSCAPE AND REALLY 640 00:26:09,880 --> 00:26:11,520 IMPACT ON PATIENT OUTCOMES. 641 00:26:11,520 --> 00:26:13,880 I THINK THE IMPORTANT POINT HERE 642 00:26:13,880 --> 00:26:16,200 IS NOT TO BE ALL THINGS TO ALL 643 00:26:16,200 --> 00:26:20,280 PEOPLE, TRY TO REALLY PUT YOUR 644 00:26:20,280 --> 00:26:22,520 FOCUS ON WHAT ARE THE MAIN 645 00:26:22,520 --> 00:26:26,280 THINGS AND IF NIH WERE TO HELP 646 00:26:26,280 --> 00:26:27,160 PUSH THAT FORWARD, FACILITATE 647 00:26:27,160 --> 00:26:29,680 THAT, WHAT WOULD IT BE? 648 00:26:29,680 --> 00:26:31,640 BECAUSE OBVIOUSLY WE'RE IN A 649 00:26:31,640 --> 00:26:32,840 CLIMATE OF DIFFICULT COMPETITIVE 650 00:26:32,840 --> 00:26:34,800 RESOURCES AND SO FORTH, SO WE 651 00:26:34,800 --> 00:26:36,120 REALLY WANT TO KNOW WHAT IS 652 00:26:36,120 --> 00:26:39,080 GOING TO HAVE THE BIGGEST 653 00:26:39,080 --> 00:26:39,320 IMPACT. 654 00:26:39,320 --> 00:26:41,920 WE HOPE THERE WILL BE A 655 00:26:41,920 --> 00:26:43,320 PUBLICATION OF THIS MEETING 656 00:26:43,320 --> 00:26:44,840 BECAUSE NOT EVERYBODY CAN ATTEND 657 00:26:44,840 --> 00:26:45,320 IT. 658 00:26:45,320 --> 00:26:48,360 IF WE WERE IN BETHESDA HOLDING 659 00:26:48,360 --> 00:26:50,680 THIS IN THE OLD DAYS, PRE-COVID, 660 00:26:50,680 --> 00:26:52,080 IT WOULD BE ABOUT HALF THIS 661 00:26:52,080 --> 00:26:54,160 GROUP IN THE ROOM, MAYBE LESS, 662 00:26:54,160 --> 00:26:55,920 AND THE BENEFIT OF DOING THIS 663 00:26:55,920 --> 00:26:57,800 VIRTUALLY IS THAT I THINK THE 664 00:26:57,800 --> 00:27:00,840 LAST LOOK THERE WAS ALMOST 70 665 00:27:00,840 --> 00:27:02,200 PEOPLE ONLINE, IT WILL PROBABLY 666 00:27:02,200 --> 00:27:04,760 GROW OVER THE NEXT COUPLE DAYS 667 00:27:04,760 --> 00:27:05,920 BECAUSE THE AGENDA AND FULL AND 668 00:27:05,920 --> 00:27:08,840 RICH. 669 00:27:08,840 --> 00:27:10,360 I HOPE ALL OF YOU ARE ABLE TO 670 00:27:10,360 --> 00:27:14,840 SHARE THE WEALTH OF KNOWLEDGE 671 00:27:14,840 --> 00:27:16,720 YOU BRING TO THIS WORKSHOP, 672 00:27:16,720 --> 00:27:17,840 SHARE THOUGHTS WHERE WE NEED TO 673 00:27:17,840 --> 00:27:25,800 GO AS A COMMUNITY AND GIVE GOOD 674 00:27:25,800 --> 00:27:27,000 RECOMMENDATIONS AND 675 00:27:27,000 --> 00:27:29,400 OPPORTUNITIES TO PUSH THE 676 00:27:29,400 --> 00:27:29,680 ENVELOPE. 677 00:27:29,680 --> 00:27:31,040 I LOOK FORWARD TO THE MEETING. 678 00:27:31,040 --> 00:27:33,000 YOU'RE IN WONDERFUL HANDS WITH 679 00:27:33,000 --> 00:27:34,320 OUR STAFF AND FACILITATORS AND 680 00:27:34,320 --> 00:27:38,920 CONTRACTORS WHO HELPED US PUT 681 00:27:38,920 --> 00:27:39,560 THIS TOGETHER. 682 00:27:39,560 --> 00:27:40,920 MANY THANKS FROM US AT THE 683 00:27:40,920 --> 00:27:48,600 INSTITUTE AND WE WISH YOU A VERY 684 00:27:48,600 --> 00:27:50,320 PRODUCTIVE MEETING, AND I HOPE I 685 00:27:50,320 --> 00:27:54,320 GET TO MEET YOU OVER THE NEXT 686 00:27:54,320 --> 00:27:55,040 PERIOD OF TIME. 687 00:27:55,040 --> 00:27:57,400 THANK YOU FOR THE INTRO AND 688 00:27:57,400 --> 00:27:58,520 OPPORTUNITY TO INTRODUCE THE 689 00:27:58,520 --> 00:27:59,720 WORKSHOP AND WELCOME YOU AND 690 00:27:59,720 --> 00:28:02,640 LOOK FORWARD TO THE MEETING 691 00:28:02,640 --> 00:28:03,480 TODAY AND TOMORROW. 692 00:28:03,480 --> 00:28:06,960 I'LL TURN IT BACK OVER TO YOU, 693 00:28:06,960 --> 00:28:10,480 LEI, OR ALFONSO, CAN'T REMEMBER 694 00:28:10,480 --> 00:28:11,760 WHO IS NEXT. 695 00:28:11,760 --> 00:28:12,520 >>ALFONSO, ALL YOURS. 696 00:28:12,520 --> 00:28:15,840 >>THANK YOU, DR. KYLIE. 697 00:28:15,840 --> 00:28:16,800 >>GOOD MORNING. 698 00:28:16,800 --> 00:28:18,240 I'M A PROGRAM DIRECTOR IN THE 699 00:28:18,240 --> 00:28:19,640 NATIONAL CENTER ON SLEEP 700 00:28:19,640 --> 00:28:22,160 DISORDERS RESEARCH WHERE I 701 00:28:22,160 --> 00:28:23,680 OVERSEE PORTFOLIO ON SLEEP 702 00:28:23,680 --> 00:28:24,120 DISORDERS MEDICINE. 703 00:28:24,120 --> 00:28:27,000 I'M A PART OF THE ORGANIZING 704 00:28:27,000 --> 00:28:28,080 COMMITTEE, IT'S WITH GREAT 705 00:28:28,080 --> 00:28:31,480 PLEASURE I INTRODUCE YOU TO OUR 706 00:28:31,480 --> 00:28:32,560 TWO OUTSTANDING CO-CHAIRS, BOTH 707 00:28:32,560 --> 00:28:34,440 PLAY CRITICAL ROLES IN PLANNING, 708 00:28:34,440 --> 00:28:36,840 DEVELOPMENT, ORGANIZATION OF 709 00:28:36,840 --> 00:28:40,240 THIS WORKSHOP. 710 00:28:40,240 --> 00:28:41,320 FIRST DR. SUSAN REDLINE, 711 00:28:41,320 --> 00:28:43,160 PROFESSOR OF SLEEP MEDICINE AT 712 00:28:43,160 --> 00:28:44,920 HARVARD MEDICAL SCHOOL, 713 00:28:44,920 --> 00:28:46,280 PROFESSOR OF EPIDEMIOLOGY AT 714 00:28:46,280 --> 00:28:48,200 HARVARD pH CHAN SCHOOL OF 715 00:28:48,200 --> 00:28:50,000 PUBLIC HEALTH, DIRECTOR OF 716 00:28:50,000 --> 00:28:51,720 PROGRAMS IN SLEEP AND 717 00:28:51,720 --> 00:28:54,320 CARDIOVASCULAR MEDICINE AND 718 00:28:54,320 --> 00:29:01,040 SLEEP MEDICINE EPIDEMIOLOGY AT 719 00:29:01,040 --> 00:29:03,160 BRIGHAM AND WOMEN'S HOSPITAL, 720 00:29:03,160 --> 00:29:04,920 HAS LED TRIALS INCLUDING ROLE OF 721 00:29:04,920 --> 00:29:06,480 GENETIC AND EARLY LIFE 722 00:29:06,480 --> 00:29:08,120 DEVELOPMENTAL FACTORS, AND 723 00:29:08,120 --> 00:29:08,920 SECOND TO UNDERSTAND 724 00:29:08,920 --> 00:29:10,440 CARDIOVASCULAR AND OTHER HEALTH 725 00:29:10,440 --> 00:29:11,920 OUTCOMES OF SLEEP DISORDERS AND 726 00:29:11,920 --> 00:29:14,120 ROLE OF SLEEP INTERVENTIONS IN 727 00:29:14,120 --> 00:29:15,360 IMPROVING HEALTH AND WELL-BEING. 728 00:29:15,360 --> 00:29:16,560 SHE LEADS THE SLEEP READING 729 00:29:16,560 --> 00:29:19,520 CENTER FOR A NUMBER OF MAJOR 730 00:29:19,520 --> 00:29:21,160 MULTI-CENTER STUDIES, AND 731 00:29:21,160 --> 00:29:23,680 FOUNDED AND CO-DIRECTS NATIONAL 732 00:29:23,680 --> 00:29:25,000 SLEEP RESEARCH RESOURCE, AN 733 00:29:25,000 --> 00:29:26,840 INTERNATIONAL SLEEP DATA SHARING 734 00:29:26,840 --> 00:29:28,920 REPOSITORY THAT HAS MADE SLEEP 735 00:29:28,920 --> 00:29:30,360 DATA SEARCHABLE AND ACCESSIBLE 736 00:29:30,360 --> 00:29:31,240 SUPPORTING COMMUNITY ACCESS TO 737 00:29:31,240 --> 00:29:33,960 DATA AND A SUITE OF OPEN SOURCE 738 00:29:33,960 --> 00:29:34,480 TOOLS. 739 00:29:34,480 --> 00:29:37,800 SHE SUPPORTS A SLEEP APNEA 740 00:29:37,800 --> 00:29:40,200 PATIENT-FOCUSED VIRTUAL 741 00:29:40,200 --> 00:29:40,480 COMMUNITY. 742 00:29:40,480 --> 00:29:45,240 AND NEXT DR. ANNA HEMNES, 743 00:29:45,240 --> 00:29:47,720 ENDOWED CHAIR IN PULMONARY 744 00:29:47,720 --> 00:29:50,720 MEDICINE VANDERBILT UNIVERSITY 745 00:29:50,720 --> 00:29:52,040 MEDICAL CENTER, TRANSLATIONAL 746 00:29:52,040 --> 00:29:52,800 PHYSICIAN-SCIENTIST WITH 747 00:29:52,800 --> 00:29:57,200 RESEARCH FOCUS ON ROLE OF 748 00:29:57,200 --> 00:30:02,320 ALTERED METABOLISM, RESEARCH IS 749 00:30:02,320 --> 00:30:08,560 ON EFFECT OF MUTATION ON 750 00:30:08,560 --> 00:30:10,640 SIGNALING, INCLUDING ROLE OF 751 00:30:10,640 --> 00:30:15,040 INSULIN RESISTANCE AND METABOLIC 752 00:30:15,040 --> 00:30:21,120 SYNDROME IN HUMAN PVD, GENETIC 753 00:30:21,120 --> 00:30:21,600 SUSCEPTIBLABILITY AND 754 00:30:21,600 --> 00:30:23,960 PHENOTYPING, LEADING TO WORK IN 755 00:30:23,960 --> 00:30:34,520 OMICS SIGNATURE OF VASODILATORY 756 00:30:34,880 --> 00:30:35,600 HYPERTENSION. 757 00:30:35,600 --> 00:30:38,080 HER LAB IS INVESTIGATING NOVEL 758 00:30:38,080 --> 00:30:39,640 BLOOD-BASED OMIC PREDICTIVE 759 00:30:39,640 --> 00:30:50,120 STRATEGIES FOR FDA APPROVED 760 00:30:54,120 --> 00:30:56,040 THERAPIES FOR PULMONARY 761 00:30:56,040 --> 00:30:56,560 HYPERTENSION. 762 00:30:56,560 --> 00:30:59,640 HER LAB HAS UNIQUE AND POWERFUL 763 00:30:59,640 --> 00:31:04,120 CAPACITY TO STUDY MOLECULAR 764 00:31:04,120 --> 00:31:07,600 MECHANISMS OF PVD AND RIGHT 765 00:31:07,600 --> 00:31:09,160 HEART DYSFUNCTION THROUGH 766 00:31:09,160 --> 00:31:09,840 CLINICAL TRIALS. 767 00:31:09,840 --> 00:31:11,680 WITH THAT I'M GOING TO TURN 768 00:31:11,680 --> 00:31:15,760 THINGS OVER TO OUR CHAIRS, 769 00:31:15,760 --> 00:31:16,520 STARTING WITH DR. REDLINE. 770 00:31:16,520 --> 00:31:18,600 >>THANK YOU VERY MUCH. 771 00:31:18,600 --> 00:31:25,520 I'M GOING TO SHARE MY SLIDES 772 00:31:25,520 --> 00:31:35,680 RIGHT NOW. 773 00:31:36,040 --> 00:31:37,600 OKAY. 774 00:31:37,600 --> 00:31:39,800 CAN YOU SEE THIS? 775 00:31:39,800 --> 00:31:41,120 OKAY, GREAT. 776 00:31:41,120 --> 00:31:43,240 FIRST OF ALL, THANK YOU VERY 777 00:31:43,240 --> 00:31:43,640 MUCH. 778 00:31:43,640 --> 00:31:45,960 I FIRST WANT TO EXPRESS REALLY 779 00:31:45,960 --> 00:31:50,520 MY DEEP GRATITUDE TO NHLBI FOR 780 00:31:50,520 --> 00:31:52,280 REALLY IDENTIFYING AND REALLY 781 00:31:52,280 --> 00:31:55,720 ADVANCING THIS VERY, VERY UNIQUE 782 00:31:55,720 --> 00:31:57,200 WORKSHOP THAT BRINGS TOGETHER 783 00:31:57,200 --> 00:31:59,720 TWO COMMUNITIES, THE SLEEP 784 00:31:59,720 --> 00:32:00,840 COMMUNITY AND PULMONARY 785 00:32:00,840 --> 00:32:02,480 HYPERTENSION COMMUNITY, IN A WAY 786 00:32:02,480 --> 00:32:07,280 THAT I THINK IS GOING TO TRULY 787 00:32:07,280 --> 00:32:08,160 BRING TOGETHER OVER THE COURSE 788 00:32:08,160 --> 00:32:12,000 OF THE NEXT TWO DAYS A VERY 789 00:32:12,000 --> 00:32:12,480 VIBRANT DISCUSSION, AND 790 00:32:12,480 --> 00:32:17,800 HOPEFULLY ADDRESS MANY OF THE 791 00:32:17,800 --> 00:32:20,720 GAPS THAT DR. KILEY SUMMARIZED. 792 00:32:20,720 --> 00:32:22,280 I WANT TO EMPHASIZE THE INTEREST 793 00:32:22,280 --> 00:32:24,680 IN NOT ONLY THE NEXT TWO DAYS OF 794 00:32:24,680 --> 00:32:27,120 WORK BUT REALLY THE WEEKS, 795 00:32:27,120 --> 00:32:30,160 MONTHS, AND YEARS AHEAD OF 796 00:32:30,160 --> 00:32:32,760 WORKING ALTOGETHER TO TRY TO 797 00:32:32,760 --> 00:32:33,880 BETTER UNDERSTAND THIS 798 00:32:33,880 --> 00:32:36,640 INTERSECTION OF SLEEP AND 799 00:32:36,640 --> 00:32:37,560 PULMONARY VASCULAR DISEASE. 800 00:32:37,560 --> 00:32:40,360 TO BEGIN WITH, I WANTED TO 801 00:32:40,360 --> 00:32:43,200 MENTION A FEW MAYBE HIGH LEVEL 802 00:32:43,200 --> 00:32:45,040 THOUGHTS THAT UNDERSCORE THE 803 00:32:45,040 --> 00:32:46,480 MOTIVATIONS FOR THE WORKSHOP, 804 00:32:46,480 --> 00:32:49,320 SEVERAL OF THOSE THAT DR. KILEY 805 00:32:49,320 --> 00:32:49,600 MENTIONED. 806 00:32:49,600 --> 00:32:52,800 I WANTED TO FIRST GIVE A SHOUT 807 00:32:52,800 --> 00:32:54,200 OUT TO THE AMERICAN HEART 808 00:32:54,200 --> 00:32:58,080 ASSOCIATION, WHICH JUST IN THIS 809 00:32:58,080 --> 00:33:01,280 YEAR WENT BEYOND THE HEALTHY 810 00:33:01,280 --> 00:33:03,480 SEVEN TO UNDERSTAND THE 811 00:33:03,480 --> 00:33:06,960 IMPORTANCE OF SLEEP NOW 812 00:33:06,960 --> 00:33:09,960 EMBRACING THE TERM "LIFE'S 813 00:33:09,960 --> 00:33:11,560 ESSENTIAL 8" AS A COMPONENT TO 814 00:33:11,560 --> 00:33:14,040 HEART DISEASE AND GENERAL 815 00:33:14,040 --> 00:33:14,360 WELL-BEING. 816 00:33:14,360 --> 00:33:18,360 AS A MEMBER OF THE SLEEP 817 00:33:18,360 --> 00:33:22,440 COMMUNITY, YOU KNOW, MYSELF AND 818 00:33:22,440 --> 00:33:24,160 MY PEERS RECOGNIZE THAT 40 TO 60 819 00:33:24,160 --> 00:33:28,320 MILLION PEOPLE IN THE U.S. ALONE 820 00:33:28,320 --> 00:33:30,720 SUFFER FROM SLEEP DISORDER. 821 00:33:30,720 --> 00:33:33,120 AND FURTHERMORE, WE UNDERSTAND 822 00:33:33,120 --> 00:33:34,880 THAT SLEEP DISORDERS INCLUDE 823 00:33:34,880 --> 00:33:39,560 SLEEP APNEA WITH ALL ITS MYRIAD 824 00:33:39,560 --> 00:33:48,800 CO-MORBIDITIES BUT ALSO INCLUDE 825 00:33:48,800 --> 00:33:49,560 OBESITY HYPOVENTILATION 826 00:33:49,560 --> 00:33:51,720 SYNDROME, BEHAVIORS THAT IMPACT 827 00:33:51,720 --> 00:33:53,240 SHORT SLEEP DURATION. 828 00:33:53,240 --> 00:33:55,640 AND WHAT'S UNIQUE TODAY IS THIS 829 00:33:55,640 --> 00:34:00,040 COMMUNITY OF SOME OF THE I THINK 830 00:34:00,040 --> 00:34:00,600 LEADING EXPERTS IN SLEEP 831 00:34:00,600 --> 00:34:02,680 MEDICINE ARE GOING TO BE 832 00:34:02,680 --> 00:34:06,920 SPEAKING WITH LEADING EXPERTS IN 833 00:34:06,920 --> 00:34:08,120 PULMONARY HYPERTENSION AWARE OF 834 00:34:08,120 --> 00:34:09,920 THE MANY NUANCES AND SUBGROUPS 835 00:34:09,920 --> 00:34:13,920 OF PULMONARY HYPERTENSION AND 836 00:34:13,920 --> 00:34:14,520 THEIR MOLECULAR CLINICAL 837 00:34:14,520 --> 00:34:17,000 BEHAVIORS, AND ONE OF THE GOALS 838 00:34:17,000 --> 00:34:19,160 IS TO IN FACT UNDERSTAND THESE 839 00:34:19,160 --> 00:34:21,920 LINKAGES, AND MANY OF THE 840 00:34:21,920 --> 00:34:29,440 LINKAGES MAY IN FACT BE FROM 841 00:34:29,440 --> 00:34:39,560 MECHANISMS FROM SLEEP DISORDERS, 842 00:34:39,560 --> 00:34:41,560 INCLUDING INTERMITTENT 843 00:34:41,560 --> 00:34:44,280 HYPOXEMIA, CIRCADIAN DISRUPTION 844 00:34:44,280 --> 00:34:45,920 AND BIDIRECTIONAL ASSOCIATION OF 845 00:34:45,920 --> 00:34:48,960 DIFFERENCE IN LUNG STRUCTURE MAY 846 00:34:48,960 --> 00:34:51,520 PREDISPOSE AND EXACERBATE SLEEP 847 00:34:51,520 --> 00:34:51,960 DISORDERS. 848 00:34:51,960 --> 00:34:54,360 AND FINALLY, WE WILL BE 849 00:34:54,360 --> 00:34:56,640 ADDRESSING SORT OF THE 850 00:34:56,640 --> 00:35:00,680 UNDERLYING SORT OF SOIL OR 851 00:35:00,680 --> 00:35:03,320 COMMON MECHANISMS OR PLEIOTROPY 852 00:35:03,320 --> 00:35:05,080 THAT UNDERLIE DISORDERS 853 00:35:05,080 --> 00:35:06,720 INCLUDING GENETIC AND 854 00:35:06,720 --> 00:35:08,880 ENVIRONMENTAL EXPOSURES BUT ALSO 855 00:35:08,880 --> 00:35:11,200 MAY INVOLVE CENTRAL DISRUPTION 856 00:35:11,200 --> 00:35:16,200 OF REGULATORY NETWORKS AND 857 00:35:16,200 --> 00:35:16,800 CIRCADIAN DYSFUNCTION. 858 00:35:16,800 --> 00:35:18,520 WE'RE NOT ONLY GOING TO ADDRESS 859 00:35:18,520 --> 00:35:19,840 THESE RELATIONSHIPS BUT WE'RE 860 00:35:19,840 --> 00:35:23,440 GOING TO PUT OUR LENS IN FOR 861 00:35:23,440 --> 00:35:26,400 LONG-TERM NEEDS IN TERMS OF THE 862 00:35:26,400 --> 00:35:28,280 IMPLICATIONS OF THE EMERGING 863 00:35:28,280 --> 00:35:29,800 SCIENCE ON PATIENT CARE. 864 00:35:29,800 --> 00:35:32,400 WE'RE GOING TO BE BEGINNING TO 865 00:35:32,400 --> 00:35:35,600 THINK OF WHICH PATIENTS, WHICH 866 00:35:35,600 --> 00:35:37,320 DISORDERS, WHICH SUBDISORDERS OF 867 00:35:37,320 --> 00:35:41,400 THESE DISORDERS MAY BEST BENEFIT 868 00:35:41,400 --> 00:35:44,040 FROM IMPROVING THE TREATMENT OF 869 00:35:44,040 --> 00:35:45,760 THEIR SLEEP OR PULMONARY 870 00:35:45,760 --> 00:35:46,080 HYPERTENSION. 871 00:35:46,080 --> 00:35:47,640 AND WHICH ARE THE TREATMENTS, 872 00:35:47,640 --> 00:35:49,600 THERE ARE MANY TREATMENTS THAT 873 00:35:49,600 --> 00:35:52,000 WE COULD THINK ABOUT, JUST FROM 874 00:35:52,000 --> 00:35:54,520 A SLEEP PERSPECTIVE IT COULD 875 00:35:54,520 --> 00:35:56,800 INCLUDE POSITIVE AIRWAY 876 00:35:56,800 --> 00:35:59,640 PRESSURE, OXYGEN, BEHAVIORAL 877 00:35:59,640 --> 00:36:01,080 INTERVENTIONS, AND MEDICATIONS. 878 00:36:01,080 --> 00:36:03,280 AND, AGAIN, THE GOAL WILL BE 879 00:36:03,280 --> 00:36:05,800 THAT EVENTUALLY WE'LL BE ABLE TO 880 00:36:05,800 --> 00:36:07,640 CONNECT HEALTHY SLEEP WITH 881 00:36:07,640 --> 00:36:09,400 HEALTHY HEARTS BY REALLY 882 00:36:09,400 --> 00:36:12,880 IMPACTING SOME OF THESE 883 00:36:12,880 --> 00:36:14,960 MECHANISTIC PATHWAYS THAT CAUSE 884 00:36:14,960 --> 00:36:16,600 EXACERBATIONS AND EVEN 885 00:36:16,600 --> 00:36:17,680 POTENTIALLY AMPLIFYING EFFECTS 886 00:36:17,680 --> 00:36:20,560 OF DYSFUNCTION OF EITHER SLEEP 887 00:36:20,560 --> 00:36:21,960 OR HEART FUNCTION. 888 00:36:21,960 --> 00:36:24,160 AND I WANT TO CONCLUDE BEFORE 889 00:36:24,160 --> 00:36:26,800 PASSING THIS OVER TO MY CO-CHAIR 890 00:36:26,800 --> 00:36:28,000 THAT WHAT IS REALLY SPECIAL 891 00:36:28,000 --> 00:36:30,080 AGAIN IS THAT WE'RE BRINGING 892 00:36:30,080 --> 00:36:32,160 TOGETHER TWO GROUPS OF 893 00:36:32,160 --> 00:36:34,360 INVESTIGATORS THAT BY AND LARGE 894 00:36:34,360 --> 00:36:37,000 HAVE BEEN WORKING IN SILOS TO BE 895 00:36:37,000 --> 00:36:41,480 IN THE VIRTUAL WORKSHOP, AND AS 896 00:36:41,480 --> 00:36:43,880 DR. KILEY STATED, IT'S MORE -- 897 00:36:43,880 --> 00:36:45,520 ONE OF THE THINGS PARTICULARLY 898 00:36:45,520 --> 00:36:48,800 EXCITING IS THAT WHAT WE HAVE AS 899 00:36:48,800 --> 00:36:52,280 PARTICIPANTS IN THIS WORKSHOP 900 00:36:52,280 --> 00:36:53,520 ARE ALSO REPRESENTATIVES FOR 901 00:36:53,520 --> 00:36:56,360 MULTIPLE DISCIPLINES FROM BASIC 902 00:36:56,360 --> 00:37:05,000 SCIENCE AND VASCULAR BIOLOGY, 903 00:37:05,000 --> 00:37:06,000 GENETICS, EPIDEMIOLOGY, 904 00:37:06,000 --> 00:37:06,840 TRANSLATIONAL RESEARCH, AND 905 00:37:06,840 --> 00:37:09,040 CLINICAL TRIALS, AND AS I 906 00:37:09,040 --> 00:37:12,640 MENTIONED MY REAL HOPE IS THAT 907 00:37:12,640 --> 00:37:15,640 THIS WORKSHOP IN ADDITION TO 908 00:37:15,640 --> 00:37:19,640 IDENTIFYING THOSE BOLD NEW IDEAS 909 00:37:19,640 --> 00:37:23,400 DR. KILEY SPOKE ABOUT REALLY 910 00:37:23,400 --> 00:37:24,520 HELPS COALESCE OUR TWO 911 00:37:24,520 --> 00:37:25,880 COMMUNITIES TO CONTINUE TO WORK 912 00:37:25,880 --> 00:37:28,400 TOGETHER AND ADVANCE THE FIELD. 913 00:37:28,400 --> 00:37:32,560 SO I'M GOING TO -- I WANT TO 914 00:37:32,560 --> 00:37:35,880 ALSO EMPHASIZE MY DEEP GRATITUDE 915 00:37:35,880 --> 00:37:38,360 FOR EVERY PARTICIPANTS AND 916 00:37:38,360 --> 00:37:39,600 DISCUSSANT ON THIS WORKSHOP, 917 00:37:39,600 --> 00:37:41,000 EVERYONE'S GOING TO BRING 918 00:37:41,000 --> 00:37:42,360 TOGETHER SOMETHING VERY SPECIAL 919 00:37:42,360 --> 00:37:43,760 AND, AGAIN, I RECOGNIZE HOW 920 00:37:43,760 --> 00:37:45,720 PRECIOUS YOUR TIME IS SO THANK 921 00:37:45,720 --> 00:37:45,880 YOU. 922 00:37:45,880 --> 00:37:53,160 NOW I'D LIKE TO TURN THIS OVER 923 00:37:53,160 --> 00:37:56,320 TO OUR CO-CHAIR, ANNA HEMNES, 924 00:37:56,320 --> 00:37:59,160 WHO I FEEL PRIVILEGED TO WORK 925 00:37:59,160 --> 00:37:59,360 WITH. 926 00:37:59,360 --> 00:37:59,560 ANNA? 927 00:37:59,560 --> 00:38:01,560 >>THANK YOU SO MUCH, SUSAN. 928 00:38:01,560 --> 00:38:03,320 I FEEL THE SAME WAY ABOUT YOU. 929 00:38:03,320 --> 00:38:07,560 IT'S REALLY AN HONOR TO CO-CHAIR 930 00:38:07,560 --> 00:38:09,240 THIS WORKSHOP. 931 00:38:09,240 --> 00:38:13,320 I THINK FOR ME I WANTED TO START 932 00:38:13,320 --> 00:38:17,600 WITH A PERSONAL STORY, AND SAY 933 00:38:17,600 --> 00:38:18,840 WHY ARE WE HERE NOW. 934 00:38:18,840 --> 00:38:22,640 THERE'S A LOT OF DATA THAT HAS 935 00:38:22,640 --> 00:38:25,520 TALKED ABOUT SLEEP AND PULMONARY 936 00:38:25,520 --> 00:38:28,680 HYPERTENSION FOR YEARS, BUT I 937 00:38:28,680 --> 00:38:33,040 PERSONALLY HAD AN AHA MOMENT 938 00:38:33,040 --> 00:38:35,320 WORKING WITH PVD-OMICS AND OUR 939 00:38:35,320 --> 00:38:35,640 DATA. 940 00:38:35,640 --> 00:38:40,040 IT IS WITH A MULTI-CENTER U.S. 941 00:38:40,040 --> 00:38:42,000 COHORT STUDY THAT ENROLLED 942 00:38:42,000 --> 00:38:44,440 PATIENTS ACROSS THE SPECTRUM OF 943 00:38:44,440 --> 00:38:46,200 PULMONARY VASCULAR DISEASE 944 00:38:46,200 --> 00:38:46,960 INCLUDING DISEASE COMPARATORS, I 945 00:38:46,960 --> 00:38:49,360 THINK YOU'LL HEAR MORE ABOUT IT 946 00:38:49,360 --> 00:38:53,280 IN THE TALKS LATER ON TODAY AND 947 00:38:53,280 --> 00:38:54,160 TOMORROW. 948 00:38:54,160 --> 00:38:55,880 BUT IT HAD PATIENTS WITH ALL 949 00:38:55,880 --> 00:38:57,760 KINDS OF PULMONARY HYPERTENSION 950 00:38:57,760 --> 00:38:58,840 AND DISEASE COMPARATORS AND 951 00:38:58,840 --> 00:39:04,080 HEALTHY CONTROLS AND HAD 952 00:39:04,080 --> 00:39:05,480 COMPREHENSIVE PHENOTYPING THAT 953 00:39:05,480 --> 00:39:06,560 INCLUDED STUDIES LOOKING FOR 954 00:39:06,560 --> 00:39:09,400 POSSIBLE SLEEP DISORDERS IN 955 00:39:09,400 --> 00:39:11,120 PATIENTS WHO HAD PULMONARY 956 00:39:11,120 --> 00:39:11,480 HYPERTENSION. 957 00:39:11,480 --> 00:39:16,160 AND WHEN WE GOT THE DATA BACK, 958 00:39:16,160 --> 00:39:17,720 WE CREATED THIS FIGURE THAT YOU 959 00:39:17,720 --> 00:39:19,880 SEE THAT WAS ONE OF THE ONLY FEW 960 00:39:19,880 --> 00:39:22,640 FIGURES THAT WE PUT IN OUR 961 00:39:22,640 --> 00:39:23,720 MANUSCRIPT OF CLINICAL DATA 962 00:39:23,720 --> 00:39:28,320 BECAUSE IT WAS SO IMPRESSIVE. 963 00:39:28,320 --> 00:39:31,080 AND IF YOU LOOK AT PATIENTS, 964 00:39:31,080 --> 00:39:39,400 THIS IS A SPIDER PLOT OF 965 00:39:39,400 --> 00:39:41,600 NOCTURNAL RECORDING TIME, A HOME 966 00:39:41,600 --> 00:39:42,360 SLEEP STUDY. 967 00:39:42,360 --> 00:39:46,640 FOR PATIENTS WHO HAD GROUP 1 968 00:39:46,640 --> 00:39:47,720 PULMONARY HYPERTENSION WE FOUND 969 00:39:47,720 --> 00:39:50,680 THAT THE FOLKS THAT HAD 970 00:39:50,680 --> 00:39:51,760 PULMONARY HYPERTENSION ABOUT 40% 971 00:39:51,760 --> 00:39:56,400 OF THEIR NIGHT WAS SPENT WITH 972 00:39:56,400 --> 00:39:58,560 OXYGEN SATURATION LESS THAN 90%. 973 00:39:58,560 --> 00:40:02,240 I'M SORRY, 40% OF PATIENTS HAD 974 00:40:02,240 --> 00:40:05,440 SOME TIMELESS THAN 90%, AND THEN 975 00:40:05,440 --> 00:40:06,840 THAT WAS STRONGLY SIGNIFICANT 976 00:40:06,840 --> 00:40:10,280 COMPARED TO DISEASE COMPARATORS, 977 00:40:10,280 --> 00:40:12,120 ALSO PRESENT IN OTHER FORMS OF 978 00:40:12,120 --> 00:40:13,640 HOW MANY HYPERTENSION GROUP 3 979 00:40:13,640 --> 00:40:16,320 AND GROUP 4, AND GROUP 2 HAD 980 00:40:16,320 --> 00:40:18,040 MORE TREATED SLEEP APNEA, SO I 981 00:40:18,040 --> 00:40:19,680 THINK THAT IS WHY THAT 982 00:40:19,680 --> 00:40:22,120 PERCENTAGE IS LOWER IN THERE. 983 00:40:22,120 --> 00:40:24,040 BUT I REALIZED I'VE NOT BEEN 984 00:40:24,040 --> 00:40:25,640 LOOKING FOR DEEP SLEEP DISORDERS 985 00:40:25,640 --> 00:40:27,760 IN MY PATIENTS, AND I NEEDED TO 986 00:40:27,760 --> 00:40:29,840 DO A BETTER JOB BASED ON THESE 987 00:40:29,840 --> 00:40:31,240 DATA. 988 00:40:31,240 --> 00:40:34,360 IT WAS REALLY EYE OPENING TO 989 00:40:34,360 --> 00:40:35,640 PREVALENCE OF SLEEP DISTURBANCES 990 00:40:35,640 --> 00:40:38,040 IN THE PATIENTS WHO HAVE 991 00:40:38,040 --> 00:40:39,160 PULMONARY HYPERTENSION, AND IT'S 992 00:40:39,160 --> 00:40:43,960 HARD TO IGNORE THIS AND SAY THIS 993 00:40:43,960 --> 00:40:47,320 IS JUST UNRELATED, THERE ANYWAY 994 00:40:47,320 --> 00:40:48,920 BE INTERPLAY BETWEEN THE TWO 995 00:40:48,920 --> 00:40:49,640 THINGS IMPACTING BOTH DISEASES. 996 00:40:49,640 --> 00:40:51,440 FOR ME THAT WAS A TIME WHERE WE 997 00:40:51,440 --> 00:41:01,920 THOUGHT WE NEED TO LOOK INTO 998 00:41:02,400 --> 00:41:02,560 THIS. 999 00:41:02,560 --> 00:41:05,400 OBJECTIVES TO DISCUSS CURRENT 1000 00:41:05,400 --> 00:41:06,720 UNDERSTANDINGP SLEEVE HEALTH AND 1001 00:41:06,720 --> 00:41:08,240 DYSFUNCTION IN FIVE ESTABLISHED 1002 00:41:08,240 --> 00:41:09,640 GROUPS, TO IDENTIFY GAPS IN 1003 00:41:09,640 --> 00:41:12,040 KNOWLEDGE AND CRITICAL NEEDS 1004 00:41:12,040 --> 00:41:14,240 REGARDING IMPACT OF SLEEP 1005 00:41:14,240 --> 00:41:17,320 DISORDER BREATHING, AND OTHER 1006 00:41:17,320 --> 00:41:19,280 DISTURBANCES ON PULMONARY 1007 00:41:19,280 --> 00:41:21,840 VASCULAR DISEASE INCLUDING MILD 1008 00:41:21,840 --> 00:41:23,480 PULMONARY HYPERTENSION, EXPLORE 1009 00:41:23,480 --> 00:41:26,840 INTERVENTIONS, TRIALS DESIGNS TO 1010 00:41:26,840 --> 00:41:28,360 EVALUATE EFFECTIVENESS IN 1011 00:41:28,360 --> 00:41:31,000 TREATING PULMONARY VASCULAR 1012 00:41:31,000 --> 00:41:32,000 DISEASE, AND ADDRESS 1013 00:41:32,000 --> 00:41:32,320 DISPARITIES. 1014 00:41:32,320 --> 00:41:35,600 AND YOU CAN SEE THAT IN THE 1015 00:41:35,600 --> 00:41:38,880 AGENDA WE ALIGNED OUR TALKS AND 1016 00:41:38,880 --> 00:41:41,400 SESSIONS TO ADDRESS THESE 1017 00:41:41,400 --> 00:41:45,880 SOMETIMES THROUGHOUT AN ENTIRE 1018 00:41:45,880 --> 00:41:47,480 SMALL SESSION OR SOMETIMES 1019 00:41:47,480 --> 00:41:48,960 PROGRAMMATICALLY THROUGHOUT THE 1020 00:41:48,960 --> 00:41:52,560 TWO DAYS OF DISCUSSING. 1021 00:41:52,560 --> 00:42:00,760 SO OUR HOPES AND EXPECTATIONS WE 1022 00:42:00,760 --> 00:42:02,560 HOPE YOU DISCUSS AND CLARIFY KEY 1023 00:42:02,560 --> 00:42:03,960 UNANSWERED QUESTIONS OR UNMET 1024 00:42:03,960 --> 00:42:05,360 NEEDS, TO THINK AS A COMMUNITY 1025 00:42:05,360 --> 00:42:09,320 WHERE ARE THE MOST IMPORTANT AND 1026 00:42:09,320 --> 00:42:13,800 IMPACTFUL WAYS WE WOULD ANSWER 1027 00:42:13,800 --> 00:42:17,080 QUESTIONS THAT HAVE ARISEN FROM 1028 00:42:17,080 --> 00:42:17,280 THIS. 1029 00:42:17,280 --> 00:42:19,360 HOPE TO HAVE ACTIVE DISCUSSION 1030 00:42:19,360 --> 00:42:20,400 FROM PARTICIPANTS. 1031 00:42:20,400 --> 00:42:24,440 THIS IS A TIME TO RAISE YOUR 1032 00:42:24,440 --> 00:42:25,880 HAND AND PARTICIPATE ACTIVELY. 1033 00:42:25,880 --> 00:42:29,160 WE WANT TO HEAR FROM EACH OF YOU 1034 00:42:29,160 --> 00:42:30,680 WHO HAS COME HERE. 1035 00:42:30,680 --> 00:42:33,400 EACH OF YOU IS HIGHLY VALUED 1036 00:42:33,400 --> 00:42:35,040 ACCOMPLISHED PERSON IN THESE 1037 00:42:35,040 --> 00:42:36,480 FIELDS AND YOUR INPUT IS 1038 00:42:36,480 --> 00:42:39,760 CRITICAL TO MAKING THIS A 1039 00:42:39,760 --> 00:42:40,840 PRODUCTIVE WORKSHOP. 1040 00:42:40,840 --> 00:42:42,920 WE HOPE TO IDENTIFY FUTURE 1041 00:42:42,920 --> 00:42:46,760 DIRECTIONS FOR NHLBI AND 1042 00:42:46,760 --> 00:42:48,240 SCIENTIFIC COMMUNITY. 1043 00:42:48,240 --> 00:42:50,480 SO DELIVERABLES, AT THE END OF 1044 00:42:50,480 --> 00:42:53,000 THE WORKSHOP WE'RE GOING TO 1045 00:42:53,000 --> 00:42:55,440 IDENTIFY KEY FUTURE DIRECTIONS 1046 00:42:55,440 --> 00:42:56,880 FOR SCIENTIFIC COMMUNITY AND 1047 00:42:56,880 --> 00:42:58,560 NHLBI INCLUDING AREAS OF 1048 00:42:58,560 --> 00:42:59,840 MULTI-DISCIPLINARY SYNERGY WHICH 1049 00:42:59,840 --> 00:43:01,880 I THINK IS A TREMENDOUS STRENGTH 1050 00:43:01,880 --> 00:43:03,200 OF THE WORKSHOP. 1051 00:43:03,200 --> 00:43:05,880 WE WILL MAKE AN EXECUTIVE 1052 00:43:05,880 --> 00:43:07,040 SUMMARY, THE GOAL IN THE BALL 1053 00:43:07,040 --> 00:43:08,760 PARK OF FOUR TO SIX WEEKS FROM 1054 00:43:08,760 --> 00:43:11,840 THE WORKSHOP, AND IN SIX MONTHS 1055 00:43:11,840 --> 00:43:14,920 WE WILL WRITE A MANUSCRIPT AND 1056 00:43:14,920 --> 00:43:17,120 SUBMIT IT TO A JOURNAL THAT IS 1057 00:43:17,120 --> 00:43:21,920 TO BE DETERMINED FROM THIS 1058 00:43:21,920 --> 00:43:22,200 WORKSHOP. 1059 00:43:22,200 --> 00:43:25,080 I'D LIKE TO SAY THANK YOU, 1060 00:43:25,080 --> 00:43:27,840 ECHOING WHAT OTHERS HAVE SAID. 1061 00:43:27,840 --> 00:43:29,680 EVERYBODY HERE, YOUR TIME IS 1062 00:43:29,680 --> 00:43:31,960 PRECIOUS AND WE'RE THANKFUL 1063 00:43:31,960 --> 00:43:36,280 YOU'RE TAKING THE TIME TO 1064 00:43:36,280 --> 00:43:38,000 DISCUSS, LEARN, PRESENT AND 1065 00:43:38,000 --> 00:43:39,440 PARTICIPATE IN THE AUDIENCE AND 1066 00:43:39,440 --> 00:43:40,960 THESE ACTIVITIES OVER THE NEXT 1067 00:43:40,960 --> 00:43:42,160 TWO DAYS. 1068 00:43:42,160 --> 00:43:44,560 I'M THANKFUL FOR THE NIH 1069 00:43:44,560 --> 00:43:46,120 LEADERSHIP INCLUDING DR. KILEY 1070 00:43:46,120 --> 00:43:52,920 FOR SUPPORTING THIS WORKSHOP. 1071 00:43:52,920 --> 00:43:55,080 ALSO THE HELP IN PUTTING 1072 00:43:55,080 --> 00:43:56,960 TOGETHER THIS SESSION AND FOR 1073 00:43:56,960 --> 00:44:00,840 SUPPORT OF THIS REALLY EXCITING 1074 00:44:00,840 --> 00:44:01,240 WORKSHOP. 1075 00:44:01,240 --> 00:44:06,960 WE HAVE WRITING SUPPORT FROM DR. 1076 00:44:06,960 --> 00:44:08,280 TARABOLETTI, I'M THANKFUL FOR 1077 00:44:08,280 --> 00:44:09,360 THE WORK SHE'S GOING TO DO IN 1078 00:44:09,360 --> 00:44:10,880 THE FUTURE, THAT WILL HELP TO 1079 00:44:10,880 --> 00:44:17,000 KEEP US ON TRACK AND GET OUR 1080 00:44:17,000 --> 00:44:17,920 DELIVERABLES ACCOMPLISHED. 1081 00:44:17,920 --> 00:44:21,160 AND A SPECIAL THANK YOU TO THE 1082 00:44:21,160 --> 00:44:25,560 SUPPORT FROM NIH AND NHLBI, 1083 00:44:25,560 --> 00:44:27,200 ESPECIALLY BRITTANY VILLAFANA 1084 00:44:27,200 --> 00:44:28,240 WHO RECEIVED COUNTLESS E-MAILS 1085 00:44:28,240 --> 00:44:32,640 AND WORKED HARD TO MAKE SURE WE 1086 00:44:32,640 --> 00:44:33,680 DELIVER A TECHNICALLY GREAT 1087 00:44:33,680 --> 00:44:37,920 WORKSHOP OVER THE NEXT TWO DAYS. 1088 00:44:37,920 --> 00:44:42,200 ALSO THANKS TO SUSAN WHO HAS 1089 00:44:42,200 --> 00:44:45,480 TAUGHT ME ABOUT THE BREADTH AND 1090 00:44:45,480 --> 00:44:51,520 VARIOUS KINDS OF SLEEP 1091 00:44:51,520 --> 00:44:52,280 DISORDERED BREATHING AND EXCITED 1092 00:44:52,280 --> 00:44:54,920 TO LEARN FROM EVERYBODY HERE 1093 00:44:54,920 --> 00:44:55,160 TODAY. 1094 00:44:55,160 --> 00:44:58,280 WITH THAT WE'LL GO INTO OUR 1095 00:44:58,280 --> 00:45:00,040 FIRST SESSION I THINK. 1096 00:45:00,040 --> 00:45:00,680 >>OKAY, GREAT. 1097 00:45:00,680 --> 00:45:02,880 THANK YOU SO MUCH, ANNA. 1098 00:45:02,880 --> 00:45:04,440 THAT WAS SUCH A NICE OVERVIEW OF 1099 00:45:04,440 --> 00:45:07,360 WHAT WE'RE GOING TO BE STEPPING 1100 00:45:07,360 --> 00:45:07,600 INTO. 1101 00:45:07,600 --> 00:45:11,960 JUST TO MAYBE REMIND YOU, WE'RE 1102 00:45:11,960 --> 00:45:15,560 GOING TO BE ORGANIZING, WE'LL 1103 00:45:15,560 --> 00:45:17,720 HAVE SESSIONS BY TEAM TOPICS, 1104 00:45:17,720 --> 00:45:19,640 AFTER EACH SPEAKER FIVE MINUTES 1105 00:45:19,640 --> 00:45:21,280 FOR SOME QUESTIONS AND 1106 00:45:21,280 --> 00:45:23,240 CLARIFICATIONS, AND AT THE END 1107 00:45:23,240 --> 00:45:26,960 OF EACH SESSION THERE WILL BE A 1108 00:45:26,960 --> 00:45:28,160 WRAP-UP OPPORTUNITY, 1109 00:45:28,160 --> 00:45:29,600 PARTICULARLY FOR DISCUSSANTS AND 1110 00:45:29,600 --> 00:45:32,000 PARTICIPANTS TO REALLY SHARE 1111 00:45:32,000 --> 00:45:36,280 THEIR THOUGHTS AND ENGAGE IN 1112 00:45:36,280 --> 00:45:38,160 SOME DISCUSSION. 1113 00:45:38,160 --> 00:45:41,520 SO, FIRST SESSION WILL SET THE 1114 00:45:41,520 --> 00:45:45,760 STAGE FOR EMPHASIZING THE 1115 00:45:45,760 --> 00:45:48,640 SPECTRUM OF SLEEP HEALTH, SLEEP 1116 00:45:48,640 --> 00:45:50,160 DISORDERS, APPROACHES TO 1117 00:45:50,160 --> 00:45:51,920 ASSESSMENT AND OVERALL 1118 00:45:51,920 --> 00:45:53,240 APPROACHES TO CARDIOVASCULAR 1119 00:45:53,240 --> 00:45:53,680 DISEASE. 1120 00:45:53,680 --> 00:45:58,040 I KNOW NO BETTER SPEAKER TO KICK 1121 00:45:58,040 --> 00:46:01,960 OFF THIS SESSION THAN DAN 1122 00:46:01,960 --> 00:46:04,400 BUYSSE, OUR TOKEN PSYCHIATRIST 1123 00:46:04,400 --> 00:46:07,120 BUT THE MOST AMAZING SLEEP 1124 00:46:07,120 --> 00:46:09,520 RESEARCHER AND I WOULD SAY ONE 1125 00:46:09,520 --> 00:46:10,640 OF THE BEST METHODOLOGISTS I'M 1126 00:46:10,640 --> 00:46:13,600 AWARE OF WHO IS GOING TO BE 1127 00:46:13,600 --> 00:46:16,880 TALKING ABOUT SLEEP HEALTH, A 1128 00:46:16,880 --> 00:46:19,080 CONCEPT HE HAS REALLY HELPED 1129 00:46:19,080 --> 00:46:21,240 GALVANIZE ATTENTION TO IN TERMS 1130 00:46:21,240 --> 00:46:23,520 OF ITS MULTI-DIMENSIONALITY AND 1131 00:46:23,520 --> 00:46:26,040 HE WILL BE DISCUSSING 1132 00:46:26,040 --> 00:46:26,920 DEFINITIONS, MEASUREMENTS, AND 1133 00:46:26,920 --> 00:46:30,400 RELEVANCE TO DISEASE. 1134 00:46:30,400 --> 00:46:31,280 SO THANK YOU, DAN. 1135 00:46:31,280 --> 00:46:32,960 >>ALL RIGHT. 1136 00:46:32,960 --> 00:46:33,720 THANK YOU, SUSAN. 1137 00:46:33,720 --> 00:46:35,920 CAN YOU SEE MY SLIDES? 1138 00:46:35,920 --> 00:46:36,560 >>YES. 1139 00:46:36,560 --> 00:46:37,400 >>OKAY. 1140 00:46:37,400 --> 00:46:37,800 EXCELLENT. 1141 00:46:37,800 --> 00:46:41,800 LET ME DO ONE MORE THING HERE. 1142 00:46:41,800 --> 00:46:42,800 ALL RIGHT. 1143 00:46:42,800 --> 00:46:44,440 SO I APPRECIATE THE INVITATION 1144 00:46:44,440 --> 00:46:47,560 TO SPEAK WITH EVERYONE TODAY. 1145 00:46:47,560 --> 00:46:51,720 AS SUSAN SAID MY JOB IS TO 1146 00:46:51,720 --> 00:46:55,760 PRESENT A WIDE ANGLE OVERVIEW OF 1147 00:46:55,760 --> 00:46:57,720 SLEEP IN RELATION TO PULMONARY 1148 00:46:57,720 --> 00:46:59,360 VASCULAR DISEASE. 1149 00:46:59,360 --> 00:47:01,000 I DO NOT REALLY KNOW ANYTHING 1150 00:47:01,000 --> 00:47:01,960 ABOUT PULMONARY VASCULAR DISEASE 1151 00:47:01,960 --> 00:47:04,520 BUT I HOPE THAT IN THIS 1152 00:47:04,520 --> 00:47:06,040 DISCUSSION OF SLEEP AND 1153 00:47:06,040 --> 00:47:07,800 CIRCADIAN RHYTHM WE MAY GENERATE 1154 00:47:07,800 --> 00:47:11,400 NEW IDEAS ON HOW TO INCORPORATE 1155 00:47:11,400 --> 00:47:14,400 SLEEP INTO INTERROGATION OF THIS 1156 00:47:14,400 --> 00:47:16,680 IMPORTANT CONDITION. 1157 00:47:16,680 --> 00:47:18,640 SO, FOR STARTERS, WE KNOW SLEEP 1158 00:47:18,640 --> 00:47:20,520 IS RELATED TO HEALTH IN MANY 1159 00:47:20,520 --> 00:47:21,040 WAYS. 1160 00:47:21,040 --> 00:47:24,680 SLEEP IS RELATED TO OBESITY, 1161 00:47:24,680 --> 00:47:27,320 DIABETES, CANCER, HEART DISEASE, 1162 00:47:27,320 --> 00:47:29,320 DEPRESSION, SUBSTANCE USE, AND 1163 00:47:29,320 --> 00:47:30,320 EVEN MORTALITY. 1164 00:47:30,320 --> 00:47:33,520 AND THIS RECOGNITION THAT SLEEP 1165 00:47:33,520 --> 00:47:36,520 IS CRITICAL TO HEALTH HAS REALLY 1166 00:47:36,520 --> 00:47:38,880 BEEN TAKEN UP AS SUSAN MENTIONED 1167 00:47:38,880 --> 00:47:41,640 BY THE AHA THAT HAS NOW 1168 00:47:41,640 --> 00:47:43,800 INDICATED THAT SLEEP IS ONE OF 1169 00:47:43,800 --> 00:47:45,000 THE ESSENTIAL BEHAVIORAL FACTORS 1170 00:47:45,000 --> 00:47:48,200 THAT WE NEED TO CONSIDER IN 1171 00:47:48,200 --> 00:47:50,400 EVALUATING PERSONS' HEALTH AND 1172 00:47:50,400 --> 00:47:51,280 MORTALITY. 1173 00:47:51,280 --> 00:47:53,240 SO, THE QUESTION IS WHY IS THAT 1174 00:47:53,240 --> 00:47:56,200 SLEEP SHOULD BE RELATED TO ALL 1175 00:47:56,200 --> 00:47:58,120 OF THESE IMPORTANT OUTCOMES? 1176 00:47:58,120 --> 00:48:00,880 TO INVESTIGATE THAT QUESTION, WE 1177 00:48:00,880 --> 00:48:04,000 NEED TO GO BACK QUITE A WAYS AND 1178 00:48:04,000 --> 00:48:06,040 REMIND OURSELVES THAT WE LIVE ON 1179 00:48:06,040 --> 00:48:08,520 A PLANET THAT ROTATES ON ITS 1180 00:48:08,520 --> 00:48:11,600 AXIS EVERY 24 HOURS, EXPOSING TO 1181 00:48:11,600 --> 00:48:14,160 US REGULAR ENVIRONMENTAL SIGNALS 1182 00:48:14,160 --> 00:48:15,520 OF LIGHT AND DARKNESS. 1183 00:48:15,520 --> 00:48:18,760 WHAT THAT MEANS IS DURING THE 1184 00:48:18,760 --> 00:48:20,400 COURSE OF EVOLUTION VARIOUS 1185 00:48:20,400 --> 00:48:23,240 RESOURCES AVAILABLE TO ANY 1186 00:48:23,240 --> 00:48:25,520 ANIMAL AND SPECIES WILL VARY 1187 00:48:25,520 --> 00:48:26,400 ACCORDING TO THIS TEMPORAL 1188 00:48:26,400 --> 00:48:28,680 ENVIRONMENT JUST AS THEY VARY 1189 00:48:28,680 --> 00:48:30,760 WITH PHYSICAL ENVIRONMENT. 1190 00:48:30,760 --> 00:48:32,640 SO, EVOLUTION HAS ENDOWED US 1191 00:48:32,640 --> 00:48:35,080 WITH A MECHANISM TO MATCH OUR 1192 00:48:35,080 --> 00:48:37,760 BIOLOGY TO THIS GEO PHYSICAL 1193 00:48:37,760 --> 00:48:38,880 REALITY, AND THE MECHANISM BY 1194 00:48:38,880 --> 00:48:44,160 WHICH IT DOES THAT IS WITH A SET 1195 00:48:44,160 --> 00:48:46,960 OF CANONICAL CLOCK GENES THAT 1196 00:48:46,960 --> 00:48:48,600 REGULATE THEIR OWN TRANSCRIPTION 1197 00:48:48,600 --> 00:48:52,800 AND TRANSLATION ON A 24-HOUR 1198 00:48:52,800 --> 00:48:53,200 BASIS. 1199 00:48:53,200 --> 00:48:54,960 NOW, BECAUSE THE CIRCADIAN 1200 00:48:54,960 --> 00:48:56,480 24-HOUR MECHANISM IS EMBEDDED IN 1201 00:48:56,480 --> 00:48:58,360 OUR GENES, THAT MEANS THAT IT'S 1202 00:48:58,360 --> 00:49:00,760 PRESENT IN EVERY CELL AND TISSUE 1203 00:49:00,760 --> 00:49:03,920 IN OUR BODY, INDEED IF YOU TAKE 1204 00:49:03,920 --> 00:49:06,320 LUNG CELL CULTURES AND PLACE 1205 00:49:06,320 --> 00:49:09,320 THEM OUT, YOU CAN DETERMINE THAT 1206 00:49:09,320 --> 00:49:11,920 THEY CYCLE ON A 24-HOUR BASIS 1207 00:49:11,920 --> 00:49:14,560 JUST AS THE PRODUCTS OF OTHER 1208 00:49:14,560 --> 00:49:15,880 TISSUES THROUGHOUT THE BODY 1209 00:49:15,880 --> 00:49:18,280 CYCLE ON A 24-HOUR BASIS. 1210 00:49:18,280 --> 00:49:20,920 WE HAVE CLOCKS EVERYWHERE IN OUR 1211 00:49:20,920 --> 00:49:23,000 BODY, AND THOSE CLOCKS ARE 1212 00:49:23,000 --> 00:49:26,720 REGULATED BY A MASTER CLOCK IN 1213 00:49:26,720 --> 00:49:30,440 THE SUPER CHIASMATIC NUCLEI OF 1214 00:49:30,440 --> 00:49:33,760 THE HYPOTHALAMUS WHICH THROUGH 1215 00:49:33,760 --> 00:49:34,520 ENDOCRINE OUTPUTS SYNCHRONIZES 1216 00:49:34,520 --> 00:49:37,240 RHYTHMS OF OUR BODY CLOCKS. 1217 00:49:37,240 --> 00:49:38,800 BECAUSE WE HAVE CLOCKS 1218 00:49:38,800 --> 00:49:40,960 EVERYWHERE, IT STANDS TO REASON 1219 00:49:40,960 --> 00:49:42,600 THAT OUR PHYSIOLOGY THEN VARIES 1220 00:49:42,600 --> 00:49:45,320 AS A FUNCTION OF THE TIME OF DAY 1221 00:49:45,320 --> 00:49:46,240 AS WELL. 1222 00:49:46,240 --> 00:49:49,560 TO TAKE ONE OBVIOUS EXAMPLE, 1223 00:49:49,560 --> 00:49:51,360 BLOOD PRESSURE, OUR BLOOD 1224 00:49:51,360 --> 00:49:52,440 PRESSURE VARIES ROUTINELY WITH 1225 00:49:52,440 --> 00:49:55,760 TIME OF DAY SO THAT IT'S LOWEST 1226 00:49:55,760 --> 00:49:59,800 AT NIGHT, AND HIGHEST IN THE 1227 00:49:59,800 --> 00:50:01,360 EARLY EVENING HOURS. 1228 00:50:01,360 --> 00:50:03,440 AS YOU'RE AWARE THE DEGREE OF 1229 00:50:03,440 --> 00:50:05,440 NIGHTTIME DIPPING AND BLOOD 1230 00:50:05,440 --> 00:50:08,840 PRESSURE ASSOCIATED WITH 1231 00:50:08,840 --> 00:50:09,960 CARDIOVASCULAR OUTCOMES, THAT 1232 00:50:09,960 --> 00:50:13,800 24-HOUR CYCLING IS SEEN IN 1233 00:50:13,800 --> 00:50:17,400 PEOPLE WHO ARE NORMO TENSIVE AND 1234 00:50:17,400 --> 00:50:18,920 HYPERTENSION, IN THIS CASE 1235 00:50:18,920 --> 00:50:21,000 DURING PREGNANCY, AND IF YOU 1236 00:50:21,000 --> 00:50:22,320 THINK THAT MAYBE OUR BLOOD 1237 00:50:22,320 --> 00:50:25,600 PRESSURE DIPS ONLY BECAUSE WE'RE 1238 00:50:25,600 --> 00:50:27,160 ASLEEP, THERE ARE EXPERIMENTAL 1239 00:50:27,160 --> 00:50:30,320 PARADIGMS THAT CAN SEPARATE THE 1240 00:50:30,320 --> 00:50:38,560 EFFECTS OF SLEEP FROM CIRCADIAN 1241 00:50:38,560 --> 00:50:39,320 RHYTHM, DEMONSTRATING RHYTHM OF 1242 00:50:39,320 --> 00:50:40,320 BLOOD PRESSURE VARIES 1243 00:50:40,320 --> 00:50:43,480 INDEPENDENT OF OUR SLEEP. 1244 00:50:43,480 --> 00:50:44,760 CLOCK TIME, EVERYTHING IN 1245 00:50:44,760 --> 00:50:47,080 PHYSIOLOGY INCLUDING KEY ASPECTS 1246 00:50:47,080 --> 00:50:48,240 OF CARDIOVASCULAR FUNCTION. 1247 00:50:48,240 --> 00:50:53,960 IN SOME CASE THE MOST OBVIOUS 1248 00:50:53,960 --> 00:50:54,840 MANIFESTATION OF THE CIRCADIAN 1249 00:50:54,840 --> 00:50:58,040 CLOCK IS SLEEP AND WAKE RHYTHM 1250 00:50:58,040 --> 00:51:00,760 WHICH VARIES WITH TIME OF DAY. 1251 00:51:00,760 --> 00:51:04,800 WE ALL KNOW WHAT SLEEP IS, BUT 1252 00:51:04,800 --> 00:51:07,640 WHAT IS SLEEP GOOD FOR? 1253 00:51:07,640 --> 00:51:10,200 WE KNOW SLEEP MUST BE PRETTY 1254 00:51:10,200 --> 00:51:16,880 IMPORTANT BECAUSE IT'S PRESENT 1255 00:51:16,880 --> 00:51:18,600 THROUGHOUT THE PHYLOGENETIC 1256 00:51:18,600 --> 00:51:20,040 SPECTRUM FROM JELLYFISH WITHOUT 1257 00:51:20,040 --> 00:51:22,680 A PROPER BRAIN TO C. ELEGANS TO 1258 00:51:22,680 --> 00:51:25,760 DROSOPHILA, ALL SERVED AS 1259 00:51:25,760 --> 00:51:28,840 EXCELLENT MODELS FOR SLEEP/WAKE 1260 00:51:28,840 --> 00:51:30,440 FUNCTION IN SPECIES. 1261 00:51:30,440 --> 00:51:34,080 AND WHILE WE COULD HAVE A LONG 1262 00:51:34,080 --> 00:51:36,280 ARGUMENT ABOUT WHAT SLEEP IS FOR 1263 00:51:36,280 --> 00:51:38,920 I THINK THAT IT PRETTY MUCH GOES 1264 00:51:38,920 --> 00:51:40,560 WITHOUT SAYING THERE'S NO 1265 00:51:40,560 --> 00:51:43,400 FUNCTION AT ANY LEVEL OF 1266 00:51:43,400 --> 00:51:44,640 BIOLOGICAL ORGANIZATION, NO 1267 00:51:44,640 --> 00:51:45,920 FUNCTION THAT DOESN'T WORK 1268 00:51:45,920 --> 00:51:48,440 BETTER IN THE PRESENCE OF SLEEP 1269 00:51:48,440 --> 00:51:51,160 AND REGULAR REST ACTIVITY 1270 00:51:51,160 --> 00:51:51,520 RHYTHMS. 1271 00:51:51,520 --> 00:51:55,080 INDEED, WE KNOW THAT SLEEP IS 1272 00:51:55,080 --> 00:52:00,240 RELATED TO A NUMBER OF KEY 1273 00:52:00,240 --> 00:52:01,000 SYSTEMIC PHYSIOLOGICAL 1274 00:52:01,000 --> 00:52:01,920 MECHANISMS RELEVANT TO PULMONARY 1275 00:52:01,920 --> 00:52:03,560 VASCULAR DISEASE AS WELL AS 1276 00:52:03,560 --> 00:52:04,960 CARDIOVASCULAR DISEASE, A HOST 1277 00:52:04,960 --> 00:52:07,800 OF OTHER AILMENTS AS WELL. 1278 00:52:07,800 --> 00:52:09,560 NOW, WHEN IT COMES TO MEASURING 1279 00:52:09,560 --> 00:52:11,840 SLEEP IN HUMANS WE HAVE SEVERAL 1280 00:52:11,840 --> 00:52:13,920 OPTIONS AVAILABLE TO US. 1281 00:52:13,920 --> 00:52:16,000 SIMPLEST WAY IS TO USE 1282 00:52:16,000 --> 00:52:17,560 SELF-REPORTS OF SLEEP THAT STILL 1283 00:52:17,560 --> 00:52:20,840 CONTINUE TO BE A USEFUL 1284 00:52:20,840 --> 00:52:21,120 METHODOLOGY. 1285 00:52:21,120 --> 00:52:23,120 WE CAN MEASURE SLEEP 1286 00:52:23,120 --> 00:52:24,760 BEHAVIORALLY, WE CAN MEASURE 1287 00:52:24,760 --> 00:52:28,480 REST ACTIVITY RHYTHMS WITH 1288 00:52:28,480 --> 00:52:35,120 SOMETHING LIKE RISK ACTIGRAPHY, 1289 00:52:35,120 --> 00:52:36,360 MOVEMENT IS CORRELATED WITH 1290 00:52:36,360 --> 00:52:38,680 SLEEP BUT KNOWS A PHYSIOLOGIC OR 1291 00:52:38,680 --> 00:52:39,760 ELECTROPHYSIOLOGIC MEASURE OF 1292 00:52:39,760 --> 00:52:39,960 SLEEP. 1293 00:52:39,960 --> 00:52:50,520 THAT'S FROM POLYS OMNOGRAHPY AND 1294 00:52:54,040 --> 00:52:55,480 BREATHING AND RESPIRATORY 1295 00:52:55,480 --> 00:52:56,640 FUNCTION AND OXYGEN SATURATION 1296 00:52:56,640 --> 00:53:02,880 DURING SLEEP THAT YOU'LL BE 1297 00:53:02,880 --> 00:53:04,400 HEARING MORE ABOUT. 1298 00:53:04,400 --> 00:53:06,080 WE CAN MEASURE FUNCTIONAL NEURAL 1299 00:53:06,080 --> 00:53:10,360 IMAGING THAT WE AND OTHERS HAVE 1300 00:53:10,360 --> 00:53:10,560 DONE. 1301 00:53:10,560 --> 00:53:12,080 I WANT TO PROVIDE THAT BROAD 1302 00:53:12,080 --> 00:53:14,840 OVERVIEW TO GET US ALL THINKING 1303 00:53:14,840 --> 00:53:17,560 AND KIND OF LEVEL SETTING WITH 1304 00:53:17,560 --> 00:53:19,640 REGARD TO WHAT SLEEP IS, HOW WE 1305 00:53:19,640 --> 00:53:21,280 MIGHT MEASURE IT AND WHY, 1306 00:53:21,280 --> 00:53:22,720 BROADLY SPEAKING, IT'S IMPORTANT 1307 00:53:22,720 --> 00:53:23,920 TO OUR HEALTH. 1308 00:53:23,920 --> 00:53:27,320 NEXT I'D LIKE TO TALK ABOUT THIS 1309 00:53:27,320 --> 00:53:28,640 CONCEPT OF MULTI-DIMENSIONAL 1310 00:53:28,640 --> 00:53:30,280 SLEEP HEALTH. 1311 00:53:30,280 --> 00:53:31,360 AGAIN, WE'VE ALREADY ESTABLISHED 1312 00:53:31,360 --> 00:53:33,920 THAT SLEEP IS RELATED TO HEALTH 1313 00:53:33,920 --> 00:53:34,880 IN SEVERAL WAYS. 1314 00:53:34,880 --> 00:53:37,600 AND IF WE TRY TO INVESTIGATE 1315 00:53:37,600 --> 00:53:39,360 THOSE RELATIONSHIPS, THERE ARE 1316 00:53:39,360 --> 00:53:41,840 SEVERAL -- THERE ARE BROAD WAYS 1317 00:53:41,840 --> 00:53:44,160 WE MIGHT TRY TO LOOK FOR MORE 1318 00:53:44,160 --> 00:53:46,800 INFORMATION ON HOW AND WHY THIS 1319 00:53:46,800 --> 00:53:47,040 HAPPENS. 1320 00:53:47,040 --> 00:53:49,440 SO, THE FIRST WAY THAT WE CAN DO 1321 00:53:49,440 --> 00:53:52,520 THAT IS BY CONSIDERING SLEEP 1322 00:53:52,520 --> 00:53:53,200 DISORDERS. 1323 00:53:53,200 --> 00:53:55,120 THERE ARE SIX MAJOR CATEGORIES 1324 00:53:55,120 --> 00:53:57,440 OF SLEEP DISORDERS, AS DEFINED 1325 00:53:57,440 --> 00:53:59,400 BY THE SLEEP COMMUNITY, AND YOU 1326 00:53:59,400 --> 00:54:00,600 SEE THEM HERE. 1327 00:54:00,600 --> 00:54:03,120 WE'LL BE TALKING MAINLY ABOUT 1328 00:54:03,120 --> 00:54:03,800 SLEEP-RELATED BREATHING 1329 00:54:03,800 --> 00:54:04,480 DISORDERS DURING THIS CONFERENCE 1330 00:54:04,480 --> 00:54:09,800 BUT THIS IS JUST A REMINDER THAT 1331 00:54:09,800 --> 00:54:12,440 SLEEP DISORDERED BREATHING IS 1332 00:54:12,440 --> 00:54:16,800 NOT THE ONLY DISORDER. 1333 00:54:16,800 --> 00:54:18,760 THEY CAN BE COMORBID AND THERE'S 1334 00:54:18,760 --> 00:54:20,400 EVIDENCE EACH TYPE OF DISORDER 1335 00:54:20,400 --> 00:54:23,240 IS ASSOCIATED WITH POOR HEALTH 1336 00:54:23,240 --> 00:54:23,520 OUTCOMES. 1337 00:54:23,520 --> 00:54:26,000 NOT TO BELABOR THE POINT, OTHERS 1338 00:54:26,000 --> 00:54:27,520 WILL BE PRESENTING MUCH MORE 1339 00:54:27,520 --> 00:54:29,480 DETAIL ON THIS, WE KNOW FOR 1340 00:54:29,480 --> 00:54:33,480 INSTANCE THAT OBSTRUCTIVE SLEEP 1341 00:54:33,480 --> 00:54:35,040 APNEA SYNDROME AS A PARTICULAR 1342 00:54:35,040 --> 00:54:38,480 SLEEP DISORDER IS RELATED TO ALL 1343 00:54:38,480 --> 00:54:40,200 SORTS OF HEALTH OUTCOMES, 1344 00:54:40,200 --> 00:54:41,840 INCLUDING RISK OF FATAL 1345 00:54:41,840 --> 00:54:44,120 CARDIOVASCULAR EVENTS FROM THIS 1346 00:54:44,120 --> 00:54:47,960 CLASSIC STUDY FROM SPAIN THAT 1347 00:54:47,960 --> 00:54:49,760 EXAMINED PEOPLE WITH AND WITHOUT 1348 00:54:49,760 --> 00:54:52,000 OBSTRUCTIVE SLEEP APNEA AND WITH 1349 00:54:52,000 --> 00:54:54,760 AND WITHOUT TREATMENT SHOWING 1350 00:54:54,760 --> 00:54:56,400 SEVERE OBSTRUCTIVE SLEEP APNEA 1351 00:54:56,400 --> 00:54:58,720 SYNDROME IS ASSOCIATED WITH AN 1352 00:54:58,720 --> 00:55:00,600 INCREASE IN FATAL CARDIOVASCULAR 1353 00:55:00,600 --> 00:55:02,880 EVENTS, AND SUGGESTING IF NOT 1354 00:55:02,880 --> 00:55:05,960 DEMONSTRATING THAT TREATED SLEEP 1355 00:55:05,960 --> 00:55:07,680 APNEA REDUCES ONE'S RISK. 1356 00:55:07,680 --> 00:55:09,680 BUT CARDIOVASCULAR AND HEALTH 1357 00:55:09,680 --> 00:55:11,880 OUTCOMES ARE NOT THE EXCLUSIVE 1358 00:55:11,880 --> 00:55:16,880 DOMAIN OF OBSTRUCTIVE SLEEP 1359 00:55:16,880 --> 00:55:19,840 APNEA SYNDROME. 1360 00:55:19,840 --> 00:55:23,120 INSOMNIA IS ALSO ASSOCIATED AND 1361 00:55:23,120 --> 00:55:25,520 DOSE-RESPONSE WAY WITH ADVERSE 1362 00:55:25,520 --> 00:55:26,080 HEALTH OUTCOMES INCLUDING 1363 00:55:26,080 --> 00:55:26,720 ALL-CAUSE MORTALITY. 1364 00:55:26,720 --> 00:55:29,000 THESE ARE DATA FROM THE HEALTH 1365 00:55:29,000 --> 00:55:30,360 AND RETIREMENT STUDY SHOWING 1366 00:55:30,360 --> 00:55:34,480 THAT AS THE NUMBER OF INSOMNIA 1367 00:55:34,480 --> 00:55:36,680 SYMPTOMS INCREASE, ADJUSTED 1368 00:55:36,680 --> 00:55:38,360 HAZARD FOR MORTALITY ON 14-YEAR 1369 00:55:38,360 --> 00:55:43,680 FOLLOW-UP GOES UP IN MORE OR 1370 00:55:43,680 --> 00:55:45,440 LESS LINEAR FASHION. 1371 00:55:45,440 --> 00:55:47,280 HOWEVER, SLEEP DISORDERS ARE 1372 00:55:47,280 --> 00:55:49,800 CLEARLY IMPORTANT IN OUR 1373 00:55:49,800 --> 00:55:50,760 CONSIDERATION OF HEALTH 1374 00:55:50,760 --> 00:55:52,520 OUTCOMES, BUT NOT EVERYBODY HAS 1375 00:55:52,520 --> 00:55:54,320 A SLEEP DISORDER. 1376 00:55:54,320 --> 00:55:55,800 THIS RAISES THE QUESTION OF ARE 1377 00:55:55,800 --> 00:55:57,560 THERE OTHER ASPECTS OF SLEEP 1378 00:55:57,560 --> 00:55:59,160 THAT MIGHT BE RELATED TO HEALTH 1379 00:55:59,160 --> 00:56:01,760 WHICH HINGES ON THE QUESTION OF 1380 00:56:01,760 --> 00:56:05,160 WHAT IS GOOD SLEEP. 1381 00:56:05,160 --> 00:56:07,640 AGAIN, A SIMPLE QUESTION, 1382 00:56:07,640 --> 00:56:08,120 DECEPTIVELY. 1383 00:56:08,120 --> 00:56:10,760 IN A 24-HOUR DAY, GOOD SLEEP 1384 00:56:10,760 --> 00:56:11,720 TYPICALLY OCCUPIES ABOUT A THIRD 1385 00:56:11,720 --> 00:56:12,600 OF THAT. 1386 00:56:12,600 --> 00:56:15,800 SLEEP HERE IS INDICATED IN BLUE. 1387 00:56:15,800 --> 00:56:17,280 WAKEFULNESS IN YELLOW. 1388 00:56:17,280 --> 00:56:19,600 BUT NOT EVERYBODY HAS GOOD 1389 00:56:19,600 --> 00:56:19,840 SLEEP. 1390 00:56:19,840 --> 00:56:22,560 AND SLEEP CAN BE POOR IN MANY 1391 00:56:22,560 --> 00:56:24,080 WAYS. 1392 00:56:24,080 --> 00:56:25,200 FOR INSTANCE, ONE MIGHT HAVE 1393 00:56:25,200 --> 00:56:26,840 SATISFACTION WITH THEIR SLEEP OR 1394 00:56:26,840 --> 00:56:28,560 GOOD QUALITY OF SLEEP, OR POOR 1395 00:56:28,560 --> 00:56:30,320 QUALITY SLEEP. 1396 00:56:30,320 --> 00:56:33,520 YOU MIGHT HAVE SLEEP THAT 1397 00:56:33,520 --> 00:56:35,040 RELATES -- RESULTS IN GOOD DAY 1398 00:56:35,040 --> 00:56:39,000 TIME ALERTNESS OR POOR DAYTIME 1399 00:56:39,000 --> 00:56:39,320 ALERTNESS. 1400 00:56:39,320 --> 00:56:41,040 SLEEP TIMING THAT'S NORMAL, 1401 00:56:41,040 --> 00:56:43,360 EXPECTED CIRCADIAN TIME OR TOO 1402 00:56:43,360 --> 00:56:45,120 LATE OR TOO EARLY RELATIVE TO 1403 00:56:45,120 --> 00:56:46,080 EXPECTED TIMING. 1404 00:56:46,080 --> 00:56:47,760 YOU MIGHT HAVE HIGHLY EFFICIENT 1405 00:56:47,760 --> 00:56:49,280 SLEEP WITH LITTLE WAKEFULNESS OR 1406 00:56:49,280 --> 00:56:51,040 POORLY EFFICIENT SLEEP WITH LOTS 1407 00:56:51,040 --> 00:56:52,120 OF AWAKENINGS. 1408 00:56:52,120 --> 00:56:54,080 YOU MIGHT HAVE SLEEP DURATION 1409 00:56:54,080 --> 00:56:56,040 THAT IS NORMAL, SHORT, OR LONG. 1410 00:56:56,040 --> 00:56:59,240 AND YOU MAY HAVE SLEEP THAT 1411 00:56:59,240 --> 00:57:00,520 OCCURS AT REGULAR TIMES IN 1412 00:57:00,520 --> 00:57:02,200 AMOUNTS THROUGHOUT THE WEEK OR 1413 00:57:02,200 --> 00:57:05,040 IRREGULAR IN ANY OF THESE WAYS. 1414 00:57:05,040 --> 00:57:07,560 NOW, IT MAY SEEM THAT, AGAIN, 1415 00:57:07,560 --> 00:57:08,440 CHARACTERIZING THESE BASIC 1416 00:57:08,440 --> 00:57:11,400 FEATURES OF SLEEP IS UNLIKELY TO 1417 00:57:11,400 --> 00:57:12,800 BE RELATED TO HEALTH OUTCOMES 1418 00:57:12,800 --> 00:57:14,360 BUT THAT'S NOT THE CASE. 1419 00:57:14,360 --> 00:57:17,440 IN FACT, EACH OF THESE DIFFERENT 1420 00:57:17,440 --> 00:57:18,960 DIMENSIONS HAS INDIVIDUALLY BEEN 1421 00:57:18,960 --> 00:57:22,240 ASSOCIATED WITH A RANGE OF 1422 00:57:22,240 --> 00:57:24,440 ADVERSE HEALTH OUTCOMES, 1423 00:57:24,440 --> 00:57:26,360 INCLUDING ASPECTS OF 1424 00:57:26,360 --> 00:57:27,000 CARDIOVASCULAR DISEASE. 1425 00:57:27,000 --> 00:57:28,880 AND OF COURSE WHEN WE THINK 1426 00:57:28,880 --> 00:57:30,640 ABOUT THESE DIFFERENT DIMENSIONS 1427 00:57:30,640 --> 00:57:34,720 OF SLEEP, THEY DON'T EXIST IN 1428 00:57:34,720 --> 00:57:35,200 ISOLATION. 1429 00:57:35,200 --> 00:57:37,200 AN INDIVIDUAL CAN HAVE MULTIPLE 1430 00:57:37,200 --> 00:57:38,960 WAYS IN WHICH SLEEP IS DISTURBED 1431 00:57:38,960 --> 00:57:39,560 AT ONCE. 1432 00:57:39,560 --> 00:57:43,160 YOU MIGHT HAVE LATE SLEEP 1433 00:57:43,160 --> 00:57:44,360 TIMING, POOR SLEEP EFFICIENCY, 1434 00:57:44,360 --> 00:57:45,800 SHORT SLEEP DURATION, POOR 1435 00:57:45,800 --> 00:57:47,840 SATISFACTION WITH SLEEP. 1436 00:57:47,840 --> 00:57:50,480 THE QUESTION IS WHETHER THAT 1437 00:57:50,480 --> 00:57:52,680 NUMBER OF ABNORMAL SLEEP 1438 00:57:52,680 --> 00:57:54,520 CHARACTERISTICS HAS A CUMULATIVE 1439 00:57:54,520 --> 00:57:55,520 EFFECT ON HEALTH. 1440 00:57:55,520 --> 00:57:58,920 IN ORDER TO INVESTIGATE THAT WE 1441 00:57:58,920 --> 00:58:00,040 DEVELOPED THIS DEFINITION 1442 00:58:00,040 --> 00:58:02,000 PROPOSAL FOR SLEEP HEALTH AS A 1443 00:58:02,000 --> 00:58:03,320 MULTI-DIMENSIONAL PATTERN OF 1444 00:58:03,320 --> 00:58:04,400 SLEEP AND WAKEFULNESS. 1445 00:58:04,400 --> 00:58:07,920 AND WHAT IT REALLY SAYS IS THAT 1446 00:58:07,920 --> 00:58:09,640 AN INDIVIDUAL, EVERY INDIVIDUAL, 1447 00:58:09,640 --> 00:58:10,960 CAN BE CHARACTERIZED AT SOME 1448 00:58:10,960 --> 00:58:14,560 POINT ON THESE DIFFERENT 1449 00:58:14,560 --> 00:58:17,960 DIMENSIONS AT ALL TIMES, IN 1450 00:58:17,960 --> 00:58:18,920 AGGREGATE OUR MULTI-DIMENSIONAL 1451 00:58:18,920 --> 00:58:20,800 SLEEP HEALTH RELATES TO OTHER 1452 00:58:20,800 --> 00:58:22,880 IMPORTANT HEALTH OUTCOMES. 1453 00:58:22,880 --> 00:58:25,840 THESE DIFFERENT DIMENSIONS, YOU 1454 00:58:25,840 --> 00:58:30,440 CAN REMEMBER BY THE ACRONYM 1455 00:58:30,440 --> 00:58:31,960 RU-SATED FOR THE SIX DIMENSIONS 1456 00:58:31,960 --> 00:58:32,160 HERE. 1457 00:58:32,160 --> 00:58:33,680 AS AN ILLUSTRATION OF WHY IT'S 1458 00:58:33,680 --> 00:58:34,880 IMPORTANT TO THINK ABOUT 1459 00:58:34,880 --> 00:58:36,320 MULTIPLE SLEEP DURATIONS LET'S 1460 00:58:36,320 --> 00:58:37,880 CONSIDER THREE INDIVIDUALS. 1461 00:58:37,880 --> 00:58:40,080 EACH OF WHOM HAS A SLEEP 1462 00:58:40,080 --> 00:58:41,720 DURATION OF FIVE HOURS. 1463 00:58:41,720 --> 00:58:44,880 BUT THE FIRST PERSON IS A NIGHT 1464 00:58:44,880 --> 00:58:46,080 SHIFT WORKER WHO HAS MODERATE 1465 00:58:46,080 --> 00:58:47,960 QUALITY AND EFFICIENCY OF SLEEP 1466 00:58:47,960 --> 00:58:49,760 BUT SLEEPING AT THE WRONG TIME 1467 00:58:49,760 --> 00:58:50,360 OF DAY. 1468 00:58:50,360 --> 00:58:52,440 THAT'S ONE WAY THAT A PERSON 1469 00:58:52,440 --> 00:58:54,080 MIGHT SLEEP FIVE HOURS. 1470 00:58:54,080 --> 00:58:57,120 ANOTHER WAY IS A PERSON MAY HAVE 1471 00:58:57,120 --> 00:58:59,440 ADEQUATE OPPORTUNITY FOR SLEEP 1472 00:58:59,440 --> 00:59:02,480 BUT SLEEP WITH LOW QUALITY, LOW 1473 00:59:02,480 --> 00:59:04,120 SATISFACTION, HAVE POOR SLEEP 1474 00:59:04,120 --> 00:59:06,240 EFFICIENCY, THAT INDIVIDUAL 1475 00:59:06,240 --> 00:59:07,080 MIGHT HAVE INSOMNIA. 1476 00:59:07,080 --> 00:59:09,280 YET ANOTHER WAY A PERSON MIGHT 1477 00:59:09,280 --> 00:59:11,920 GET TO FIVE HOURS IS BY JUST NOT 1478 00:59:11,920 --> 00:59:12,880 HAVING ENOUGH TIME. 1479 00:59:12,880 --> 00:59:14,720 SOMEONE WHO IS WORKING MULTIPLE 1480 00:59:14,720 --> 00:59:16,520 JOBS, RAISING A FAMILY, AND WHEN 1481 00:59:16,520 --> 00:59:17,960 THEY SLEEP THEY MAY ACTUALLY 1482 00:59:17,960 --> 00:59:20,000 HAVE GOOD SLEEP QUALITY AND 1483 00:59:20,000 --> 00:59:21,880 EFFICIENCY BUT THEY JUST HAVE 1484 00:59:21,880 --> 00:59:22,840 LIMITED TIME TO SLEEP. 1485 00:59:22,840 --> 00:59:25,440 SO IF WE WERE ONLY CONSIDERING 1486 00:59:25,440 --> 00:59:27,000 SLEEP DURATION, WE WOULD NOT BE 1487 00:59:27,000 --> 00:59:29,000 ABLE TO DISTINGUISH BETWEEN 1488 00:59:29,000 --> 00:59:31,320 THESE THREE CONDITIONS AND YET 1489 00:59:31,320 --> 00:59:33,040 THE CONSEQUENCES FOR HEALTH AND 1490 00:59:33,040 --> 00:59:37,440 FUNCTION MAY BE VERY DIFFERENT. 1491 00:59:37,440 --> 00:59:39,840 IT'S ALSO IMPORTANT TO MENTION 1492 00:59:39,840 --> 00:59:41,120 THAT THESE DIFFERENT ASPECTS OF 1493 00:59:41,120 --> 00:59:46,160 SLEEP HEALTH HAVE BEEN SHOWN TO 1494 00:59:46,160 --> 00:59:48,560 VARY WITH RACE AND SOCIOECONOMIC 1495 00:59:48,560 --> 00:59:49,560 STATUS AND REALLY ULTIMATELY IF 1496 00:59:49,560 --> 00:59:52,520 YOU DIG BENEATH THAT WHAT WE'RE 1497 00:59:52,520 --> 00:59:53,040 TALKING ABOUT ARE SOCIAL 1498 00:59:53,040 --> 00:59:54,720 DETERMINANTS OF HEALTH. 1499 00:59:54,720 --> 00:59:58,840 SO, IT'S BEEN SHOWN THAT THINGS 1500 00:59:58,840 --> 01:00:02,680 LIKE NEIGHBORHOOD SOCIAL 1501 01:00:02,680 --> 01:00:05,320 COHESION, NAKED AND HOUSEHOLD 1502 01:00:05,320 --> 01:00:14,640 CHARACTERISTICS, SOCIOECONOMIC 1503 01:00:14,640 --> 01:00:15,720 SOCIAL DETERMINANTS OF HEALTH 1504 01:00:15,720 --> 01:00:16,480 RELATE. 1505 01:00:16,480 --> 01:00:18,920 AS WE THINK ABOUT ANY SLEEP 1506 01:00:18,920 --> 01:00:21,120 DISORDER, ANY OTHER HEALTH 1507 01:00:21,120 --> 01:00:22,840 OUTCOMES RELATED TO SLEEP, WE 1508 01:00:22,840 --> 01:00:24,600 SHOULD KEEP IN MIND AS WELL THAT 1509 01:00:24,600 --> 01:00:27,680 ALL OF THESE THINGS ARE GOING TO 1510 01:00:27,680 --> 01:00:32,600 BE AFFECTED BY THESE IMPORTANT 1511 01:00:32,600 --> 01:00:34,800 SOCIAL DETERMINANTS OF HEALTH. 1512 01:00:34,800 --> 01:00:37,280 I'D LIKE TO TALK ABOUT IDEAS HOW 1513 01:00:37,280 --> 01:00:39,480 WE MEASURE AND ANALYZE 1514 01:00:39,480 --> 01:00:40,680 MULTI-DIMENSIONAL SLEEP HEALTH. 1515 01:00:40,680 --> 01:00:42,560 I'M NOT GOING TO BELABOR THIS 1516 01:00:42,560 --> 01:00:45,160 BUT WHEN YOU'RE TRYING TO 1517 01:00:45,160 --> 01:00:46,960 MEASURE SIX OR MORE THINGS 1518 01:00:46,960 --> 01:00:49,320 SIMULTANEOUSLY AND MAKE SENSE OF 1519 01:00:49,320 --> 01:00:50,880 THEM AS A COMPOSITE THERE ARE 1520 01:00:50,880 --> 01:00:52,280 DIFFERENT WAYS YOU CAN DO THAT. 1521 01:00:52,280 --> 01:00:54,800 ONE WAY IS THAT YOU CAN 1522 01:00:54,800 --> 01:00:56,560 CHARACTERIZE THE DIFFERENT 1523 01:00:56,560 --> 01:00:58,320 DIMENSIONS OF SLEEP AND SIMPLY 1524 01:00:58,320 --> 01:00:59,520 ADD THEM UP. 1525 01:00:59,520 --> 01:01:01,160 COME UP WITH A COMPOSITE SCORE. 1526 01:01:01,160 --> 01:01:04,000 ANOTHER WAY THAT YOU CAN ANALYZE 1527 01:01:04,000 --> 01:01:06,840 THIS IS TO SEE AND ENSURE THAT 1528 01:01:06,840 --> 01:01:11,320 YOU HAVE CORRECT DIMENSIONS BY 1529 01:01:11,320 --> 01:01:17,560 DOING FACTOR ANALYSIS, PRINCIPAL 1530 01:01:17,560 --> 01:01:20,000 COMPONENT ANALYSIS. 1531 01:01:20,000 --> 01:01:21,280 CLUSTER ANALYSIS TO IDENTIFY 1532 01:01:21,280 --> 01:01:22,080 WERE CHARACTERISTICS HANG 1533 01:01:22,080 --> 01:01:23,920 TOGETHER IN SPECIFIC GROUPS OF 1534 01:01:23,920 --> 01:01:25,480 PEOPLE WHO HAVE DIFFERENT 1535 01:01:25,480 --> 01:01:27,520 PHENOTYPES OR PROFILES OF SLEEP 1536 01:01:27,520 --> 01:01:27,960 HEALTH. 1537 01:01:27,960 --> 01:01:29,920 AND FINALLY YOU CAN USE VARIETY 1538 01:01:29,920 --> 01:01:31,640 OF MACHINE LEARNING APPROACHES 1539 01:01:31,640 --> 01:01:32,880 TO IDENTIFY PATTERNS IN THE 1540 01:01:32,880 --> 01:01:34,840 SLEEP DATA AND HEALTH OUTCOMES 1541 01:01:34,840 --> 01:01:36,960 THAT MAY NOT BE IMMEDIATELY 1542 01:01:36,960 --> 01:01:37,440 APPARENT. 1543 01:01:37,440 --> 01:01:39,120 I'M NOT GOING TO GO THROUGH 1544 01:01:39,120 --> 01:01:39,600 THESE IN DETAIL. 1545 01:01:39,600 --> 01:01:42,320 I'D LIKE TO GIVE YOU A COUPLE 1546 01:01:42,320 --> 01:01:44,480 EXAMPLES OF HOW PEOPLE HAVE 1547 01:01:44,480 --> 01:01:46,160 CONSIDERED MULTI-DIMENSIONAL 1548 01:01:46,160 --> 01:01:48,680 SLEEP HEALTH IN RELATION TO 1549 01:01:48,680 --> 01:01:51,040 IMPORTANT HEALTH OUTCOMES. 1550 01:01:51,040 --> 01:01:53,280 SO, FIRST IF WE LOOK AT A 1551 01:01:53,280 --> 01:01:54,360 COMPOSITE MEASURE OF SLEEP 1552 01:01:54,360 --> 01:01:59,400 HEALTH, THESE ARE DATA FROM THE 1553 01:01:59,400 --> 01:02:01,280 MIDUS STUDY, SELF-REPORT AND 1554 01:02:01,280 --> 01:02:04,320 ACTIGRAPHY MEASURES, I WON'T GO 1555 01:02:04,320 --> 01:02:11,000 INTO DETAILS BUT IF WE LOOK AT 1556 01:02:11,000 --> 01:02:15,600 HEART DISEASE RISK, AND THIS WAS 1557 01:02:15,600 --> 01:02:16,480 CROSS-SECTIONAL, NONETHELESS THE 1558 01:02:16,480 --> 01:02:21,720 SLEEP HEALTH COMPOSITE SCORE WAS 1559 01:02:21,720 --> 01:02:24,360 SIGNIFICANTLY RELATED TO 1560 01:02:24,360 --> 01:02:25,360 CARDIOVASCULAR -- TO HEART 1561 01:02:25,360 --> 01:02:27,960 DISEASE RISK WHETHER USING 1562 01:02:27,960 --> 01:02:29,520 SELF-REPORT COMPOSITES OR 1563 01:02:29,520 --> 01:02:31,520 COMBINATION OF ACTIGRAPHY AND 1564 01:02:31,520 --> 01:02:32,720 SELF-REPORT SLEEP HEALTH 1565 01:02:32,720 --> 01:02:33,160 MEASURES. 1566 01:02:33,160 --> 01:02:36,320 NOW, CONSIDER AS WELL THAT THE 1567 01:02:36,320 --> 01:02:38,360 RISK ASSOCIATED WITH THE SLEEP 1568 01:02:38,360 --> 01:02:40,440 HEALTH MEASURES IS ON PAR WITH 1569 01:02:40,440 --> 01:02:43,160 OR EXCEEDS THAT OF MANY COMMON 1570 01:02:43,160 --> 01:02:46,160 RISK FACTORS FOR HEART DISEASE, 1571 01:02:46,160 --> 01:02:47,360 SUGGESTING, AGAIN, THAT THIS 1572 01:02:47,360 --> 01:02:48,560 COMPOSITE MEASURE OF SLEEP 1573 01:02:48,560 --> 01:02:49,760 HEALTH IS SOMETHING THAT WE 1574 01:02:49,760 --> 01:02:52,160 SHOULD REALLY BE CONSIDERING AS 1575 01:02:52,160 --> 01:02:54,040 WE INVESTIGATE ALL SORTS OF 1576 01:02:54,040 --> 01:02:56,760 HEART DISEASE AND CARDIOVASCULAR 1577 01:02:56,760 --> 01:02:57,120 OUTCOMES. 1578 01:02:57,120 --> 01:02:59,480 ONE OTHER EXAMPLE OF HOW WE CAN 1579 01:02:59,480 --> 01:03:00,600 MEASURE SLEEP HEALTH AND HOW 1580 01:03:00,600 --> 01:03:04,640 THAT MIGHT BE IMPORTANT IS TO 1581 01:03:04,640 --> 01:03:05,840 CONSIDER LATENT CLASS ANALYSES, 1582 01:03:05,840 --> 01:03:08,560 THESE ARE DATA FROM MY COLLEAGUE 1583 01:03:08,560 --> 01:03:12,360 MEREDITH WALLACE, WHO DID LATENT 1584 01:03:12,360 --> 01:03:14,840 CLASS ANALYSES IN THE MROS AND 1585 01:03:14,840 --> 01:03:18,360 SOF STUDIES, IN EACH GROUP 1586 01:03:18,360 --> 01:03:21,200 IDENTIFIED THREE LATENT CLASSES, 1587 01:03:21,200 --> 01:03:22,160 THREE PROFILES OF 1588 01:03:22,160 --> 01:03:24,040 MULTI-DIMENSIONAL SLEEP HEALTH. 1589 01:03:24,040 --> 01:03:28,760 THOSE PROFILES WERE A HIGH SLEEP 1590 01:03:28,760 --> 01:03:31,720 PROPENSITY GROUP, AVERAGE GROUP, 1591 01:03:31,720 --> 01:03:34,800 INSOMNIA WITH SHORT SLEEP GROUP. 1592 01:03:34,800 --> 01:03:36,280 NOT ONLY CAN YOU MEASURE 1593 01:03:36,280 --> 01:03:38,080 DIMENSIONS BUT THEY CLUSTER IN 1594 01:03:38,080 --> 01:03:40,560 INDIVIDUALS IN DIFFERENT WAYS 1595 01:03:40,560 --> 01:03:43,880 AND INDEED THIS PHENOTYPES WERE 1596 01:03:43,880 --> 01:03:45,160 ASSOCIATED WITH MORTALITY 1597 01:03:45,160 --> 01:03:47,040 OUTCOMES IN EACH OF THESE 1598 01:03:47,040 --> 01:03:49,120 COHORTS AND IN THE AGGREGATE 1599 01:03:49,120 --> 01:03:49,360 COHORT. 1600 01:03:49,360 --> 01:03:52,600 IN THIS CASE TURNED OUT THE HIGH 1601 01:03:52,600 --> 01:03:54,160 SLEEP PROPENSITY GROUP IN 1602 01:03:54,160 --> 01:03:58,440 PARTICULAR WAS THE ONE THAT 1603 01:03:58,440 --> 01:04:00,160 CARRIED INCREASED RISK. 1604 01:04:00,160 --> 01:04:01,880 WE'VE BEEN PROPONENTS OF THIS 1605 01:04:01,880 --> 01:04:03,560 MODEL BUT THERE ARE OTHER WAYS 1606 01:04:03,560 --> 01:04:05,720 OF MEASURING SLEEP HEALTH AS 1607 01:04:05,720 --> 01:04:06,080 WELL. 1608 01:04:06,080 --> 01:04:07,800 NATIONAL SLEEP FOUNDATION HAS A 1609 01:04:07,800 --> 01:04:09,480 SLEEP HEALTH INDEX WITH THREE 1610 01:04:09,480 --> 01:04:11,680 SUBSCALES YOU SEE HERE. 1611 01:04:11,680 --> 01:04:13,280 AND OTHER INVESTIGATORS USING 1612 01:04:13,280 --> 01:04:17,760 DATA FROM THE U.K. BIOBANK 1613 01:04:17,760 --> 01:04:19,080 INCLUDED A MULTI-DIMENSIONAL 1614 01:04:19,080 --> 01:04:22,360 SLEEP HEALTH MEASURE THAT 1615 01:04:22,360 --> 01:04:23,600 INCLUDED TIMING, DURATION, 1616 01:04:23,600 --> 01:04:25,760 INSOMNIA, WHICH IS ESSENTIALLY 1617 01:04:25,760 --> 01:04:28,040 LIKE EFFICIENCY, BUT ALSO 1618 01:04:28,040 --> 01:04:31,240 INCLUDED SNORING, SO A SLEEP 1619 01:04:31,240 --> 01:04:33,520 DISORDER SYMPTOM WITHIN THEIR 1620 01:04:33,520 --> 01:04:35,400 CLASSIFICATION OF 1621 01:04:35,400 --> 01:04:36,440 MULTI-DIMENSIONAL SLEEP HEALTH. 1622 01:04:36,440 --> 01:04:40,200 WHEN PEOPLE HAVE USED VARIOUS 1623 01:04:40,200 --> 01:04:42,480 DEFINITIONS OF SLEEP HEALTH, 1624 01:04:42,480 --> 01:04:43,280 WE'VE BEEN FINDING INCREASINGLY 1625 01:04:43,280 --> 01:04:45,120 THAT THERE ARE A NUMBER OF 1626 01:04:45,120 --> 01:04:46,880 HEALTH OUTCOMES THAT ARE 1627 01:04:46,880 --> 01:04:52,040 ASSOCIATED WITH THESE SLEEP 1628 01:04:52,040 --> 01:04:52,880 HEALTH PROFILES, BOTH 1629 01:04:52,880 --> 01:04:54,000 CROSS-SECTIONALLY AND 1630 01:04:54,000 --> 01:04:54,680 LONGITUDINALLY. 1631 01:04:54,680 --> 01:04:57,600 A COUPLE OTHER EXAMPLES RELATING 1632 01:04:57,600 --> 01:05:01,440 TO CARDIOVASCULAR AND PULMONARY 1633 01:05:01,440 --> 01:05:04,040 DISEASES, ONE IS LOOKING AT 1634 01:05:04,040 --> 01:05:05,520 MULTI-DIMENSIONAL SLEEP HEALTH 1635 01:05:05,520 --> 01:05:08,360 IN CARDIOVASCULAR DISEASE AND 1636 01:05:08,360 --> 01:05:10,680 CARDIOMETABOLIC HEALTH OUTCOMES. 1637 01:05:10,680 --> 01:05:14,680 THIS IS FROM THE NHANES STUDY. 1638 01:05:14,680 --> 01:05:16,120 HERE WE HAD CROSS-SECTIONAL DATA 1639 01:05:16,120 --> 01:05:18,200 AGAIN, BUT SHOWING THAT 1640 01:05:18,200 --> 01:05:19,320 MULTI-DIMENSIONAL SLEEP HEALTH 1641 01:05:19,320 --> 01:05:24,680 IS RELATED TO A NUMBER OF 1642 01:05:24,680 --> 01:05:28,360 CARDIOMETABOLIC OUTCOMES AND 1643 01:05:28,360 --> 01:05:30,000 SIGNIFICANTLY SO. 1644 01:05:30,000 --> 01:05:32,200 A LONGITUDINAL STUDY LOOKING AT 1645 01:05:32,200 --> 01:05:36,600 DIFFERENT OUTCOMES HERE LOOKING 1646 01:05:36,600 --> 01:05:39,560 ACTUALLY AT RISK OF DEVELOPING A 1647 01:05:39,560 --> 01:05:42,520 POST COVID-19 19, A PROSPECTIVE 1648 01:05:42,520 --> 01:05:45,240 STUDY FROM THE NURSES HEALTH 1649 01:05:45,240 --> 01:05:46,080 STUDY, LOOKING AT BASELINE SLEEP 1650 01:05:46,080 --> 01:05:48,640 HEALTH AND HOW IT WAS RELATED TO 1651 01:05:48,640 --> 01:05:50,840 THE RISK OF DEVELOPING A 1652 01:05:50,840 --> 01:05:52,160 POST-COVID CONDITION A NUMBER OF 1653 01:05:52,160 --> 01:05:52,840 YEARS LATER. 1654 01:05:52,840 --> 01:05:56,120 AND AS YOU CAN SEE, A 1655 01:05:56,120 --> 01:05:57,760 MULTI-DIMENSIONAL SLEEP HEALTH 1656 01:05:57,760 --> 01:05:59,760 SCORE IN THE BETTER RANGE WAS 1657 01:05:59,760 --> 01:06:03,800 ASSOCIATED WITH LOWER RISK OF 1658 01:06:03,800 --> 01:06:05,800 DEVELOPING THIS IMPORTANT 1659 01:06:05,800 --> 01:06:06,320 OUTCOME. 1660 01:06:06,320 --> 01:06:10,000 FINAL EXAMPLE THEORETICAL BASIS, 1661 01:06:10,000 --> 01:06:13,640 IF WE LOOK AT PULMONARY ARTERIAL 1662 01:06:13,640 --> 01:06:15,200 PRESSURE RELATED TO OBSTRUCTIVE 1663 01:06:15,200 --> 01:06:17,680 SLEEP APNEA, IT MAY BE THAT 1664 01:06:17,680 --> 01:06:19,680 SLEEP HEALTH IS RELATED TO SOME 1665 01:06:19,680 --> 01:06:22,080 OF THE KEY MECHANISMS BECAUSE 1666 01:06:22,080 --> 01:06:23,280 INDEED WE KNOW INDIVIDUAL 1667 01:06:23,280 --> 01:06:28,200 DIMENSIONS ARE RELATED TO THESE 1668 01:06:28,200 --> 01:06:30,960 DIFFERENT ASPECTS OF THE 1669 01:06:30,960 --> 01:06:33,960 PATHOPHYSIOLOGY OF PULMONARY 1670 01:06:33,960 --> 01:06:35,400 ARTERIAL HYPERTENSION. 1671 01:06:35,400 --> 01:06:37,720 VERY LAST FEW SLIDES, I WANT TO 1672 01:06:37,720 --> 01:06:43,040 POINT OUT THAT WE CAN USE THIS 1673 01:06:43,040 --> 01:06:44,240 CONCEPTUALIZATION TO DEVELOP 1674 01:06:44,240 --> 01:06:45,480 BEHAVIORAL INTERVENTIONS THAT 1675 01:06:45,480 --> 01:06:49,760 CAN IMPROVE HEALTH, ONE EXAMPLE 1676 01:06:49,760 --> 01:06:51,160 IS SOMETHING CALLED 1677 01:06:51,160 --> 01:06:52,080 TRANSDIAGNOSTIC INTERVENTION 1678 01:06:52,080 --> 01:06:54,040 THAT ALLISON AND I DEVELOPED, 1679 01:06:54,040 --> 01:06:56,080 AND BASICALLY THIS IS A 1680 01:06:56,080 --> 01:06:58,600 BEHAVIORAL INTERVENTION THAT CAN 1681 01:06:58,600 --> 01:07:01,760 TARGET NUMEROUS ASPECTS OF SLEEP 1682 01:07:01,760 --> 01:07:02,040 HEALTH. 1683 01:07:02,040 --> 01:07:05,640 THIS HASN'T BEEN USED WIDELY TO 1684 01:07:05,640 --> 01:07:08,360 LOOK AT CARDIOVASCULAR HEALTH 1685 01:07:08,360 --> 01:07:09,760 OUTCOMES, THERE'S A TANTALIZING 1686 01:07:09,760 --> 01:07:11,520 CLUE FROM A SMALL PILOT STUDY 1687 01:07:11,520 --> 01:07:13,040 THAT LOOKED AT JUST ONE 1688 01:07:13,040 --> 01:07:15,800 DIMENSION OF SLEEP, THAT IS 1689 01:07:15,800 --> 01:07:19,000 SLEEP DURATION, AND LOOKED AT 1690 01:07:19,000 --> 01:07:19,640 WHETHER INCREASING SOMEONE'S 1691 01:07:19,640 --> 01:07:21,440 SLEEP DURATION MIGHT HAVE AN 1692 01:07:21,440 --> 01:07:23,120 EFFECT ON 24-HOUR BLOOD 1693 01:07:23,120 --> 01:07:26,280 PRESSURE, THESE ARE DATA FROM 1694 01:07:26,280 --> 01:07:29,920 MONICA HAAK AND JANET 1695 01:07:29,920 --> 01:07:32,760 MULLINGTON. 1696 01:07:32,760 --> 01:07:34,160 BASELINE, GROUPS DIDN'T DIFFER 1697 01:07:34,160 --> 01:07:36,560 IN TERMS OF 24-HOUR BLOOD 1698 01:07:36,560 --> 01:07:40,960 PRESSURE BUT AFTER TWO WEEKS OF 1699 01:07:40,960 --> 01:07:43,040 SLEEP EXTENSION THE GROUP THAT 1700 01:07:43,040 --> 01:07:46,880 HAD SLEEP EXTENSION SHOWED LOWER 1701 01:07:46,880 --> 01:07:48,520 24-HOUR BLOOD PRESSURE COMPARED 1702 01:07:48,520 --> 01:07:49,400 TO SLEEP MAINTENANCE GROUP, THAT 1703 01:07:49,400 --> 01:07:53,560 IS THE ONE THAT DID NOT CHANGE 1704 01:07:53,560 --> 01:07:54,880 THEIR SLEEP DURATION. 1705 01:07:54,880 --> 01:07:56,040 AND FINAL CONSIDERATION I WANT 1706 01:07:56,040 --> 01:07:59,920 TO GO BACK TO THE FACT THAT WE 1707 01:07:59,920 --> 01:08:00,880 DO HAVE CIRCADIAN RHYTHMS 1708 01:08:00,880 --> 01:08:03,640 EXISTING IN MORE THAN JUST 1709 01:08:03,640 --> 01:08:04,720 SLEEP. 1710 01:08:04,720 --> 01:08:06,520 AND THOSE RHYTHMS RESULT FROM 1711 01:08:06,520 --> 01:08:09,000 CLOCKS EVERYWHERE IN OUR BODY 1712 01:08:09,000 --> 01:08:11,880 THAT DETERMINE VARIOUS BRAIN AND 1713 01:08:11,880 --> 01:08:14,480 BODY FUNCTIONS, TRANSLATING TO 1714 01:08:14,480 --> 01:08:14,960 PHYSIOLOGY, BEHAVIOR, 1715 01:08:14,960 --> 01:08:17,360 PERFORMANCE, INCLUDING ALL OF 1716 01:08:17,360 --> 01:08:18,640 THESE KEY HEALTH BEHAVIORS, ALL 1717 01:08:18,640 --> 01:08:21,480 OF WHICH IN TURN FEED BACK TO 1718 01:08:21,480 --> 01:08:22,680 THE CIRCADIAN CLOCK. 1719 01:08:22,680 --> 01:08:25,120 SO, IT MAY BE THAT WHEN WE TAKE 1720 01:08:25,120 --> 01:08:28,280 INTO ACCOUNT THE FACT THAT 1721 01:08:28,280 --> 01:08:29,280 EVERYTHING IN OUR PHYSIOLOGY 1722 01:08:29,280 --> 01:08:32,120 VARIES AS A FUNCTION OF TIME OF 1723 01:08:32,120 --> 01:08:35,600 DAY, THAT WE CAN USE SOME 1724 01:08:35,600 --> 01:08:37,360 PRINCIPAL CIRCADIAN PRINCIPLES 1725 01:08:37,360 --> 01:08:40,680 TO ADDRESS A NUMBER OF KEY 1726 01:08:40,680 --> 01:08:42,080 HEALTH BEHAVIORS, USING 1727 01:08:42,080 --> 01:08:42,920 CIRCADIAN PRINCIPLES, AGAIN, 1728 01:08:42,920 --> 01:08:46,200 PAYING ATTENTION TO THE AMOUNT 1729 01:08:46,200 --> 01:08:48,760 OF EACH BEHAVIOR, REGULARITY AND 1730 01:08:48,760 --> 01:08:50,600 TIMING BOTH OF WHICH REALLY TEND 1731 01:08:50,600 --> 01:08:55,880 TO LOCK IN OUR CIRCADIAN 1732 01:08:55,880 --> 01:08:56,560 RHYTHMS. 1733 01:08:56,560 --> 01:08:58,040 I HOPE I'VE GIVEN AN OVERVIEW 1734 01:08:58,040 --> 01:09:00,040 THAT SUPPORTS THE NOTION THAT 1735 01:09:00,040 --> 01:09:00,800 SLEEP AND CIRCADIAN RHYTHMS 1736 01:09:00,800 --> 01:09:03,440 AFFECT A WIDE RANGE OF HEALTH 1737 01:09:03,440 --> 01:09:04,880 OUTCOMES, SLEEP DISORDERS IN 1738 01:09:04,880 --> 01:09:06,600 PARTICULAR RELATED TO 1739 01:09:06,600 --> 01:09:08,240 CARDIOVASCULAR OUTCOMES, WE CAN 1740 01:09:08,240 --> 01:09:10,560 DEFINE MULTI-DIMENSIONAL SLEEP 1741 01:09:10,560 --> 01:09:12,840 HEALTH AND ITS RELATED TO 1742 01:09:12,840 --> 01:09:13,840 CARDIOVASCULAR AND MORTALITY 1743 01:09:13,840 --> 01:09:17,000 HEALTH OUTCOMES AND HAVE INKLING 1744 01:09:17,000 --> 01:09:17,840 THAT INTERVENTIONS TARGETING 1745 01:09:17,840 --> 01:09:20,160 MULTI-DIMENSIONAL SLEEP HEALTH 1746 01:09:20,160 --> 01:09:21,760 MAY PLAUSIBLY IMPROVE 1747 01:09:21,760 --> 01:09:23,040 CARDIOVASCULAR OUTCOMES. 1748 01:09:23,040 --> 01:09:25,880 THESE ARE THE THREE KNOWLEDGE 1749 01:09:25,880 --> 01:09:28,400 GAPS THAT I'VE IDENTIFIED FOR 1750 01:09:28,400 --> 01:09:29,040 FURTHER CONSIDERATION, FOCUSING 1751 01:09:29,040 --> 01:09:32,640 ON MEASURES OF SLEEP HEALTH, 1752 01:09:32,640 --> 01:09:33,240 MECHANISMS, INTERVENTIONS, AND 1753 01:09:33,240 --> 01:09:36,280 THANK ALL SORTS OF COLLEAGUES, 1754 01:09:36,280 --> 01:09:38,360 ESPECIALLY MEREDITH WALLACE WHO 1755 01:09:38,360 --> 01:09:40,320 HAS BEEN PUSHING FORWARD THIS 1756 01:09:40,320 --> 01:09:41,920 NOTION OF MULTI-DIMENSIONAL 1757 01:09:41,920 --> 01:09:43,480 SLEEP HEALTH MEASUREMENT AND 1758 01:09:43,480 --> 01:09:44,320 RELATION TO CONSEQUENCES. 1759 01:09:44,320 --> 01:09:51,600 THANK YOU. 1760 01:09:51,600 --> 01:09:54,760 >>THANK YOU FOR AN OUTSTANDING 1761 01:09:54,760 --> 01:09:56,760 PRESENTATION AND I THINK 1762 01:09:56,760 --> 01:09:58,960 CHALLENGING ALL OF US AS WE 1763 01:09:58,960 --> 01:10:00,000 THINK ABOUT PULMONARY 1764 01:10:00,000 --> 01:10:01,640 HYPERTENSION TO BROADEN OUR 1765 01:10:01,640 --> 01:10:03,000 LENS, WHICH IS ABSOLUTELY 1766 01:10:03,000 --> 01:10:05,840 PERFECT FOR THE THEME OF THE 1767 01:10:05,840 --> 01:10:08,120 WORKSHOP AND NOT ONLY TO THINK 1768 01:10:08,120 --> 01:10:10,880 ABOUT SLEEP APNEA, OTHER DEEP 1769 01:10:10,880 --> 01:10:11,880 SLEEP DISORDERS, EVEN AGGREGATE 1770 01:10:11,880 --> 01:10:14,360 OR WAYS TO THINK ABOUT THE 1771 01:10:14,360 --> 01:10:15,280 COMBINATION. 1772 01:10:15,280 --> 01:10:16,760 THANK YOU FOR THAT. 1773 01:10:16,760 --> 01:10:19,040 WE HAVE TIME FOR ONE QUESTION, 1774 01:10:19,040 --> 01:10:20,160 IF ANYONE HAS IT. 1775 01:10:20,160 --> 01:10:22,240 IF NOT MAYBE WE COULD PICK UP 1776 01:10:22,240 --> 01:10:24,440 ANY STRANDS IN THE WRAP-UP 1777 01:10:24,440 --> 01:10:24,760 DISCUSSION. 1778 01:10:24,760 --> 01:10:26,760 IS THERE ANY BURNING QUESTIONS 1779 01:10:26,760 --> 01:10:30,800 FROM ANYONE? 1780 01:10:30,800 --> 01:10:31,000 OKAY. 1781 01:10:31,000 --> 01:10:33,920 WE'LL TAKE THIS UP AGAIN. 1782 01:10:33,920 --> 01:10:35,200 THANKS, DAN. 1783 01:10:35,200 --> 01:10:38,440 WE'RE GOING TO THE NEXT SPEAKER, 1784 01:10:38,440 --> 01:10:42,080 NOW WE'RE GOING TO TAKE A LITTLE 1785 01:10:42,080 --> 01:10:44,080 DIFFERENT APPROACH AND DIVE INTO 1786 01:10:44,080 --> 01:10:47,240 SLEEP APNEA AND ITS COMPLEXITY 1787 01:10:47,240 --> 01:10:48,880 AND HETEROGENEITY AND GIVING 1788 01:10:48,880 --> 01:10:54,560 THIS TALK IS DR. NEOMI SHAH, 1789 01:10:54,560 --> 01:10:55,720 DOING INNOVATIVE WORK IN THIS 1790 01:10:55,720 --> 01:10:58,080 SPATES, SHE'S GOING TO BE 1791 01:10:58,080 --> 01:10:59,360 SPEAKING ON UNRAVELING THE 1792 01:10:59,360 --> 01:11:04,000 HETEROGENEITY OF SLEEP APNEA AND 1793 01:11:04,000 --> 01:11:07,040 ITS RELEVANCE TO PULMONARY 1794 01:11:07,040 --> 01:11:07,600 HYPERTENSION. 1795 01:11:07,600 --> 01:11:07,920 THANK YOU. 1796 01:11:07,920 --> 01:11:11,320 >>YOU CAN SEE MY SLIDES AND THE 1797 01:11:11,320 --> 01:11:11,440 -- 1798 01:11:11,440 --> 01:11:11,960 >>YES. 1799 01:11:11,960 --> 01:11:13,840 >>OKAY, GREAT. 1800 01:11:13,840 --> 01:11:14,240 THE RIGHT SCREEN? 1801 01:11:14,240 --> 01:11:14,440 >>YEAH. 1802 01:11:14,440 --> 01:11:15,800 >>OKAY. 1803 01:11:15,800 --> 01:11:16,040 WONDERFUL. 1804 01:11:16,040 --> 01:11:16,800 THANK YOU. 1805 01:11:16,800 --> 01:11:18,640 THANK YOU FOR THE INVITATION TO 1806 01:11:18,640 --> 01:11:19,960 SPEAK HERE TODAY. 1807 01:11:19,960 --> 01:11:23,920 IT'S AN HONOR AND I'M LOOKING 1808 01:11:23,920 --> 01:11:25,440 FORWARD TO THE TALKS. 1809 01:11:25,440 --> 01:11:26,880 DAN'S TALK WAS INFORMATIVE SO I 1810 01:11:26,880 --> 01:11:27,760 CAN ONLY IMAGINE HOW MUCH I'M 1811 01:11:27,760 --> 01:11:32,880 GOING TO LEARN IN THE NEXT TWO 1812 01:11:32,880 --> 01:11:33,080 DAYS. 1813 01:11:33,080 --> 01:11:34,520 TODAY DISCUSSING HETEROGENEITY 1814 01:11:34,520 --> 01:11:36,480 OF SLEEP APNEA, WHAT I TRIED TO 1815 01:11:36,480 --> 01:11:40,560 DO IS TIE THAT AS BEST I CAN TO 1816 01:11:40,560 --> 01:11:41,360 PULMONARY HYPERTENSION EVEN 1817 01:11:41,360 --> 01:11:46,680 THOUGH MOST OF THE WORK IS ON 1818 01:11:46,680 --> 01:11:48,040 CARDIOVASCULAR DISEASE END 1819 01:11:48,040 --> 01:11:52,760 POINTS LIKE STROKE AND 1820 01:11:52,760 --> 01:11:57,120 CARDIOVASCULAR DISEASE-RELATED 1821 01:11:57,120 --> 01:11:59,160 DEATH, TO HELP ADDRESS WHAT DR. 1822 01:11:59,160 --> 01:12:01,720 KILEY SAID, TO THINK BROADLY AND 1823 01:12:01,720 --> 01:12:06,360 MAYBE COME UP WITH SOME SPECIFIC 1824 01:12:06,360 --> 01:12:06,840 DIRECTIONS. 1825 01:12:06,840 --> 01:12:12,600 SO WITH THAT I'LL GET STARTED. 1826 01:12:12,600 --> 01:12:15,160 SO, THERE'S A LOT OF EMERGING 1827 01:12:15,160 --> 01:12:19,240 EVIDENCE SUGGESTING A NEED FOR 1828 01:12:19,240 --> 01:12:19,840 DEFINING SPECIFIC SUBGROUPS, 1829 01:12:19,840 --> 01:12:22,400 WE'VE SEEN THIS WORK IN THE LAST 1830 01:12:22,400 --> 01:12:24,240 FIVE YEARS FOR SURE, MAYBE MORE. 1831 01:12:24,240 --> 01:12:27,720 AND WHAT IT'S DOING IS REALLY 1832 01:12:27,720 --> 01:12:32,240 PUSHING US TOWARDS PRECISION AND 1833 01:12:32,240 --> 01:12:33,440 PERSONALIZED MEDICINE 1834 01:12:33,440 --> 01:12:35,520 PARTICULARLY FOR OSA. 1835 01:12:35,520 --> 01:12:36,320 SUBGROUPS REPRESENT A 1836 01:12:36,320 --> 01:12:38,160 SIGNIFICANT STEP TO MORE 1837 01:12:38,160 --> 01:12:40,000 TAILORED EFFECTIVE TREATMENTS 1838 01:12:40,000 --> 01:12:41,200 FOR OSA PATIENTS. 1839 01:12:41,200 --> 01:12:42,760 I KNOW AT THE LAST SLEEP MEETING 1840 01:12:42,760 --> 01:12:44,720 WHERE I SPOKE ABOUT THIS TOPIC, 1841 01:12:44,720 --> 01:12:46,880 THERE WAS A LITTLE BIT OF 1842 01:12:46,880 --> 01:12:51,520 CONCERN ABOUT WHERE WE ARE IN 1843 01:12:51,520 --> 01:12:54,240 THE FIELD IN TERMS OF NOT HAVING 1844 01:12:54,240 --> 01:12:55,560 THE OSA FOR ALL AND WE SHOULD 1845 01:12:55,560 --> 01:12:56,200 TREAT ALL. 1846 01:12:56,200 --> 01:13:01,440 THIS IS A REALLY GOOD TIME FOR 1847 01:13:01,440 --> 01:13:07,480 THE FIELD, AND WE SHOULD BE 1848 01:13:07,480 --> 01:13:09,200 CAUTIOUSLY OPTIMISTIC. 1849 01:13:09,200 --> 01:13:11,400 THIS SLIDE SHOWS YOU THAT 1850 01:13:11,400 --> 01:13:14,360 PULMONARY HYPERTENSION IS COMMON 1851 01:13:14,360 --> 01:13:17,640 IN OBSTRUCTIVE SLEEP APNEA, A 1852 01:13:17,640 --> 01:13:24,440 SLIDE FROM MY MENTEE WHO IS 1853 01:13:24,440 --> 01:13:27,040 WORKING IN THIS, BOTTOM LINE 1854 01:13:27,040 --> 01:13:31,680 THAT DEPENDING ON HOW YOU 1855 01:13:31,680 --> 01:13:37,440 DIAGNOSE OBSTRUCTIVE SLEEP APNEA 1856 01:13:37,440 --> 01:13:40,640 AND DIAGNOSIS OF PULMONARY 1857 01:13:40,640 --> 01:13:42,800 HYPERTENSION, PREVALENCE OF 70%, 1858 01:13:42,800 --> 01:13:44,000 AN IMPORTANT ASSOCIATION, 1859 01:13:44,000 --> 01:13:48,520 HOPEFULLY WE'LL BE ABLE TO 1860 01:13:48,520 --> 01:13:53,120 IDENTIFY HOW HETEROGENEITY OF 1861 01:13:53,120 --> 01:13:54,200 OBSTRUCTIVE SLEEP APNEA AND 1862 01:13:54,200 --> 01:13:59,640 FINDINGS MAY HELP US WITH THIS 1863 01:13:59,640 --> 01:14:00,000 ASSOCIATION. 1864 01:14:00,000 --> 01:14:07,960 SO IN STANDARD MEDICINE WE HAVE 1865 01:14:07,960 --> 01:14:08,960 CLINICAL PRESENTATION, 1866 01:14:08,960 --> 01:14:10,840 ENDOTYPING, RANDOMIZED CLINICAL 1867 01:14:10,840 --> 01:14:11,920 TRIALS, NON-OSA ACROSS THE BOARD 1868 01:14:11,920 --> 01:14:17,280 FOR ALL DISEASES WE SEE, 1869 01:14:17,280 --> 01:14:19,560 PHYSICIAN EXPERIENCE PLAYS IN, 1870 01:14:19,560 --> 01:14:20,880 BUT THERE'S STANDARDIZED 1871 01:14:20,880 --> 01:14:21,640 TREATMENT EVENTUALLY. 1872 01:14:21,640 --> 01:14:22,960 EFFECTIVE INSIDE VARIES. 1873 01:14:22,960 --> 01:14:25,680 SOME PATIENTS HAVE 100% 1874 01:14:25,680 --> 01:14:27,920 EFFECTIVENESS, SOME GROUPS OR 1875 01:14:27,920 --> 01:14:29,560 SUBGROUPS HAVE PARTIAL RESPONSE, 1876 01:14:29,560 --> 01:14:30,200 SOME NO RESPONSE. 1877 01:14:30,200 --> 01:14:36,080 I THINK IF YOU APPLY THIS TO 1878 01:14:36,080 --> 01:14:38,960 OPA, THERE ARE ENDOTYPES AND 1879 01:14:38,960 --> 01:14:40,880 CLINICAL MANIFESTATION OR 1880 01:14:40,880 --> 01:14:43,080 PHENOTYPES BECOMING INCREASINGLY 1881 01:14:43,080 --> 01:14:44,960 IMPORTANT TO BETTER PREDICT 1882 01:14:44,960 --> 01:14:46,520 RESPONSE TO TREATMENT BECAUSE WE 1883 01:14:46,520 --> 01:14:54,520 ARE SORT OF IN THIS NEUTRAL OR 1884 01:14:54,520 --> 01:14:55,560 NULL FINDING TERRITORY 1885 01:14:55,560 --> 01:14:56,680 ESPECIALLY FOR CARDIOVASCULAR 1886 01:14:56,680 --> 01:15:00,800 DISEASE OUTCOMES. 1887 01:15:00,800 --> 01:15:01,600 HETEROGENEITY RESEMBLES MANY 1888 01:15:01,600 --> 01:15:05,000 CONDITIONS, FAR AHEAD IN TERMS 1889 01:15:05,000 --> 01:15:06,160 OF THIS PERSONALIZED APPROACH, 1890 01:15:06,160 --> 01:15:07,480 HOPEFULLY SLEEP MEDICINE WILL BE 1891 01:15:07,480 --> 01:15:09,480 THERE SOON ENOUGH. 1892 01:15:09,480 --> 01:15:10,600 AGAIN, PRECISION MEDICINE 1893 01:15:10,600 --> 01:15:12,560 APPROACH DRIVEN THROUGH THESE 1894 01:15:12,560 --> 01:15:14,400 ENDOTYPING AND PHENOTYPING AND 1895 01:15:14,400 --> 01:15:16,840 SUBGROUP ANALYSIS WILL ALLOW US 1896 01:15:16,840 --> 01:15:21,000 TO GET TO MORE OF THE PRECISION 1897 01:15:21,000 --> 01:15:21,800 AND PERSONALIZED TREATMENT 1898 01:15:21,800 --> 01:15:22,080 APPROACH. 1899 01:15:22,080 --> 01:15:25,560 A LOT IS GOING TO BE DEPENDENT 1900 01:15:25,560 --> 01:15:28,200 ON INDIVIDUAL PATIENT 1901 01:15:28,200 --> 01:15:29,400 CHARACTERISTICS, INCLUDING 1902 01:15:29,400 --> 01:15:30,600 PHYSIOLOGIC CHARACTERISTICS THAT 1903 01:15:30,600 --> 01:15:33,000 ARE DEPENDENT ON DATA THAT WE 1904 01:15:33,000 --> 01:15:43,480 WOULD SEE FROM SONNOGRAMS, AND 1905 01:15:45,720 --> 01:15:48,560 THE FOCUS IN THE FIELD TO 1906 01:15:48,560 --> 01:15:50,960 IMPROVE OUR ABILITY TO PREDICT 1907 01:15:50,960 --> 01:15:51,960 TREATMENT RESPONSE TO 1908 01:15:51,960 --> 01:15:55,240 CARDIOVASCULAR DISEASE OUTCOMES 1909 01:15:55,240 --> 01:15:57,880 BUT EVEN THINGS LIKE NEURO 1910 01:15:57,880 --> 01:15:58,960 COGNITIVE DYSFUNCTION, 1911 01:15:58,960 --> 01:16:03,040 ALZHEIMER'S DISEASE, SLEEPINESS, 1912 01:16:03,040 --> 01:16:06,640 AND THE LIKE. 1913 01:16:06,640 --> 01:16:08,720 OSA DIAGNOSIS COMPRISES OF 1914 01:16:08,720 --> 01:16:11,680 MECHANISTIC AND CLINICAL 1915 01:16:11,680 --> 01:16:17,960 PHENOTYPES AND ENDOTYPES 1916 01:16:17,960 --> 01:16:21,440 PRIMARILY THROUGH 1917 01:16:21,440 --> 01:16:23,400 POLYSOMNOGRAPHIC FEATURES. 1918 01:16:23,400 --> 01:16:25,280 AND OVERLOOKING HETEROGENEITY 1919 01:16:25,280 --> 01:16:26,480 THAT OSA PRESENTS. 1920 01:16:26,480 --> 01:16:28,520 WE'RE TRYING, THE FIELD IS 1921 01:16:28,520 --> 01:16:35,120 PERHAPS MOVING AWAY FROM USING 1922 01:16:35,120 --> 01:16:40,240 THE SOLE PREDICTOR AND THAT'S A 1923 01:16:40,240 --> 01:16:41,640 REALLY IMPORTANT TIME TO FURTHER 1924 01:16:41,640 --> 01:16:43,560 AGAIN GET TO THE PERSONALIZED 1925 01:16:43,560 --> 01:16:47,040 TREATMENT AND PRECISION MEDICINE 1926 01:16:47,040 --> 01:16:47,640 APPROACHES. 1927 01:16:47,640 --> 01:16:51,760 SO IN TERMS OF ENDOTYPING, AS A 1928 01:16:51,760 --> 01:16:59,080 REVIEW FOR THOSE NOT IN THE 1929 01:16:59,080 --> 01:17:00,120 FIELD RESPIRATORY ENDOTYPING 1930 01:17:00,120 --> 01:17:01,360 IDENTIFIES PATHOPHYSIOLOGIC 1931 01:17:01,360 --> 01:17:03,920 TRAITS, AND THESE CORRELATE 1932 01:17:03,920 --> 01:17:05,760 DIRECTLY WITH PATHOPHYSIOLOGIC 1933 01:17:05,760 --> 01:17:06,640 MECHANISMS WHICH IS HOPEFULLY 1934 01:17:06,640 --> 01:17:08,840 PAVING THE WAY FOR PERSONALIZED 1935 01:17:08,840 --> 01:17:11,120 TREATMENT STRATEGIES. 1936 01:17:11,120 --> 01:17:13,600 SO HERE ARE THE FOUR COMMONLY 1937 01:17:13,600 --> 01:17:14,640 KNOWN ENDOTYPES WE'RE TALKING 1938 01:17:14,640 --> 01:17:15,800 ABOUT IN THE FIELD. 1939 01:17:15,800 --> 01:17:23,480 THERE WOULD BE ANATOMICAL COME 1940 01:17:23,480 --> 01:17:26,120 COMPROMISE, ON THE LEFT LOWER 1941 01:17:26,120 --> 01:17:27,880 THRESHOLD PREDISPOSED TO WAKING 1942 01:17:27,880 --> 01:17:29,720 UP WITH DISTURBANCE MORE OFTEN 1943 01:17:29,720 --> 01:17:31,840 THAN OTHERS. 1944 01:17:31,840 --> 01:17:38,080 THERE'S THE IMPAIRED PHARYNGEAL 1945 01:17:38,080 --> 01:17:41,720 DILATOR MUSCLE AND UNSTABLE 1946 01:17:41,720 --> 01:17:44,360 VENTILATORY CONTROL. 1947 01:17:44,360 --> 01:17:49,040 THE ALOWER AROUSAL THRESHOLD 1948 01:17:49,040 --> 01:17:52,000 PREVENTS AROUSALS, POTENTIALLY 1949 01:17:52,000 --> 01:18:01,880 SYMPATHETIC ACTIVATION, 1950 01:18:01,880 --> 01:18:07,320 SIMILARLY RESPONDING TO DRUGS, 1951 01:18:07,320 --> 01:18:09,200 AS OPPOSED TO CPAP. 1952 01:18:09,200 --> 01:18:12,040 THIS HAS HELPED US BRING THIS TO 1953 01:18:12,040 --> 01:18:13,480 THE CLINICAL PRACTICE BY 1954 01:18:13,480 --> 01:18:23,920 PROVIDING US A TOOL CALLED 1955 01:18:25,680 --> 01:18:29,880 PHENOTYPING USING 1956 01:18:29,880 --> 01:18:33,160 POLYSOMNOGRAPHY, TO INCORPORATE 1957 01:18:33,160 --> 01:18:35,000 THESE ENDOTYPES INTO DISCUSSIONS 1958 01:18:35,000 --> 01:18:40,520 ABOUT PULMONARY VASCULAR 1959 01:18:40,520 --> 01:18:42,600 DISEASE, AND SO ON, THIS IS 1960 01:18:42,600 --> 01:18:48,280 ANOTHER SLIDE THAT I LIKE FROM A 1961 01:18:48,280 --> 01:18:50,760 PAPER THAT DEMONSTRATES HOW THE 1962 01:18:50,760 --> 01:18:52,880 POSSIBLE ENDOTYPE AND POSSIBLE 1963 01:18:52,880 --> 01:18:55,600 PHENOTYPE MAY THEN INFORM 1964 01:18:55,600 --> 01:18:58,560 THERAPEUTIC OPTIONS IN DIFFERENT 1965 01:18:58,560 --> 01:19:00,440 PATIENT SCENARIOS. 1966 01:19:00,440 --> 01:19:02,920 SO THE OSA PHENOTYPES ARE BASED 1967 01:19:02,920 --> 01:19:04,160 ON RISK FACTORS, THERE'S OBESITY 1968 01:19:04,160 --> 01:19:08,080 WHICH IS A MAJOR RISK FACTOR, 1969 01:19:08,080 --> 01:19:09,160 THERE'S CRANIOFACIAL 1970 01:19:09,160 --> 01:19:11,040 RESTRICTION, AS WE SAW NEURAL 1971 01:19:11,040 --> 01:19:12,760 AND VENTILATORY CONTROL. 1972 01:19:12,760 --> 01:19:16,520 THERE ARE ALSO CLINICAL 1973 01:19:16,520 --> 01:19:20,320 PHENOTYPES, SPECIFICALLY GAINING 1974 01:19:20,320 --> 01:19:22,840 MOMENTUM AS SLEEPINESS AND 1975 01:19:22,840 --> 01:19:23,840 INSOMNIA PHENOTYPE IS WELCOMING 1976 01:19:23,840 --> 01:19:26,000 INCREASINGLY IMPORTANT IN TERMS 1977 01:19:26,000 --> 01:19:30,280 OF RISK FACTOR AND PHENOTYPE FOR 1978 01:19:30,280 --> 01:19:31,600 OUTCOMES PERTAINING TO 1979 01:19:31,600 --> 01:19:34,880 CARDIOVASCULAR DISEASE. 1980 01:19:34,880 --> 01:19:38,840 PHYSIOLOGIC FEATURES ARE ALSO 1981 01:19:38,840 --> 01:19:45,080 HYPOXIC HEART, SLEEP STAGE 1982 01:19:45,080 --> 01:19:48,240 DEPENDENCY, AND OF COURSE 1983 01:19:48,240 --> 01:19:50,120 COMORBIDITY, MEDICATIONS FOR 1984 01:19:50,120 --> 01:19:51,320 HYPERTENSION, FOR DIABETES, FOR 1985 01:19:51,320 --> 01:19:54,480 CARDIOVASCULAR HEALTH, HOW ARE 1986 01:19:54,480 --> 01:19:55,240 THEY POTENTIALLY IMPACTING 1987 01:19:55,240 --> 01:19:56,880 PHENOTYPES WE SEE BUT MORE 1988 01:19:56,880 --> 01:19:58,320 IMPORTANTLY SOME WORK WE'RE 1989 01:19:58,320 --> 01:20:00,400 DOING HOW DO THEY IMPACT 1990 01:20:00,400 --> 01:20:02,680 TREATMENT RESPONSE. 1991 01:20:02,680 --> 01:20:04,680 FOR EXAMPLE IN INDIVIDUALS ON 1992 01:20:04,680 --> 01:20:09,600 STATINS DO THEY BENEFIT FROM 1993 01:20:09,600 --> 01:20:12,680 CPAP THERAPY AS MUCH AS OTHERS, 1994 01:20:12,680 --> 01:20:14,080 AND THERE ARE COMBINATION DRUGS. 1995 01:20:14,080 --> 01:20:23,040 I'M GOING TO LOOK AT SLEEPINESS, 1996 01:20:23,040 --> 01:20:26,560 HEART RATE RESPONSE AS 1997 01:20:26,560 --> 01:20:27,640 PHENOTYPES, AND I CAN'T COVER 1998 01:20:27,640 --> 01:20:30,360 ALL OF IT BUT WE'LL JUST 1999 01:20:30,360 --> 01:20:33,320 HOPEFULLY TRY TO DEMONSTRATE BY 2000 01:20:33,320 --> 01:20:39,600 EXAMPLES WITH THESE THREE 2001 01:20:39,600 --> 01:20:40,600 ENDOPHENOTYPES. 2002 01:20:40,600 --> 01:20:46,680 SO THIS IS WORK BY MAZZOTTI IN 2003 01:20:46,680 --> 01:20:49,360 2019, FOCUSING ON CHARACTERIZING 2004 01:20:49,360 --> 01:20:51,280 OSA SYMPTOM SUBTYPES AND IMPACT 2005 01:20:51,280 --> 01:20:53,920 ON CARDIOVASCULAR HEALTH. 2006 01:20:53,920 --> 01:20:58,840 THEY USED DATA FROM HEART STUDY 2007 01:20:58,840 --> 01:21:00,720 IDENTIFYING FOUR SYMPTOM 2008 01:21:00,720 --> 01:21:03,000 SUBTYPES. 2009 01:21:03,000 --> 01:21:05,120 AND THEN THE SUBTYPE THAT WAS 2010 01:21:05,120 --> 01:21:07,840 PRIMARILY THE ONE THAT HAS LED 2011 01:21:07,840 --> 01:21:11,680 TO A LOT OF ATTENTION IS THE 2012 01:21:11,680 --> 01:21:13,440 SLEEPY SUBTYPE, WHICH WAS LINKED 2013 01:21:13,440 --> 01:21:19,240 TO A THREE-FOLD RISK OF HEART 2014 01:21:19,240 --> 01:21:20,880 FAILURE AND EVENTS ON THE RIGHT 2015 01:21:20,880 --> 01:21:24,560 AND PRIMARY TAKEAWAY IS THAT OSA 2016 01:21:24,560 --> 01:21:27,120 SYMPTOM SUBTYPES DO INDEED HOLD 2017 01:21:27,120 --> 01:21:29,720 UNIQUE ASSOCIATIONS OF 2018 01:21:29,720 --> 01:21:31,360 CARDIOVASCULAR OUTCOMES WITH 2019 01:21:31,360 --> 01:21:32,360 SUBTYPE SHOWING SIGNIFICANT 2020 01:21:32,360 --> 01:21:32,680 RISK. 2021 01:21:32,680 --> 01:21:34,440 THIS IS ANOTHER AREA THAT 2022 01:21:34,440 --> 01:21:38,040 POTENTIALLY WE COULD FOCUS ON AS 2023 01:21:38,040 --> 01:21:40,160 WE TALK ABOUT PULMONARY VASCULAR 2024 01:21:40,160 --> 01:21:41,800 DISEASE HOW DOES SLEEPINESS AS A 2025 01:21:41,800 --> 01:21:44,760 PHENOTYPE GET INTO NOT JUST THE 2026 01:21:44,760 --> 01:21:47,240 EVALUATION AND TREATMENT BUT 2027 01:21:47,240 --> 01:21:48,440 ALSO RESPONSIVENESS TO TREATMENT 2028 01:21:48,440 --> 01:21:50,240 FOR SPECIFIC PATIENTS AND WHAT 2029 01:21:50,240 --> 01:21:52,640 ARE THE UNDERLYING MECHANISMS 2030 01:21:52,640 --> 01:21:56,760 LINKING SLEEPINESS TO 2031 01:21:56,760 --> 01:21:59,960 CARDIOVASCULAR OUTCOMES AND 2032 01:21:59,960 --> 01:22:00,440 POTENTIALLY PULMONARY 2033 01:22:00,440 --> 01:22:01,600 HYPERTENSION-RELATED OUTCOMES. 2034 01:22:01,600 --> 01:22:05,880 THIS WORK DEMONSTRATES SYMPTOM 2035 01:22:05,880 --> 01:22:10,920 BASED SUBTYPES SUCH AS DISTURBED 2036 01:22:10,920 --> 01:22:21,440 SLEEP FROM DIFFERING IMPACT ON 2037 01:22:26,160 --> 01:22:26,640 CPAP. 2038 01:22:26,640 --> 01:22:30,080 ALL OF THESE MAY VARY IN RISK 2039 01:22:30,080 --> 01:22:34,960 AND RESPONSE TO THERAPY. 2040 01:22:34,960 --> 01:22:45,440 AND THIS IS AGAIN WORK FROM 2041 01:22:47,080 --> 01:22:48,800 YALE, LIMB MOVEMENTS, RISK FOR 2042 01:22:48,800 --> 01:22:51,400 CARDIOVASCULAR DISEASE EVENTS IN 2043 01:22:51,400 --> 01:22:53,800 THE CLUSTER WITH PERIODIC LIMB 2044 01:22:53,800 --> 01:22:55,760 MOVEMENTS, IN HOME SLEEP TESTING 2045 01:22:55,760 --> 01:22:59,320 WE'RE NOT GETTING THIS DATA, NOT 2046 01:22:59,320 --> 01:23:02,880 SEEING LIMB MOVEMENTS, A LOT OF 2047 01:23:02,880 --> 01:23:05,160 CLINICAL DIAGNOSTICS HAVE MOVED 2048 01:23:05,160 --> 01:23:07,320 TO HOME SLEEP TESTING, 2049 01:23:07,320 --> 01:23:10,720 EXCLUSIVELY IN SOME PLACES, AND 2050 01:23:10,720 --> 01:23:13,040 AS WE KNOW CONVENTIONALLY ARE 2051 01:23:13,040 --> 01:23:15,200 REALLY NOT TURNING OUT TO BE 2052 01:23:15,200 --> 01:23:16,560 PRIMARILY ASSOCIATED WITH 2053 01:23:16,560 --> 01:23:18,000 CARDIOVASCULAR DISEASE ENDPOINTS 2054 01:23:18,000 --> 01:23:20,800 SO THESE PHENOTYPES THAT MAY BE 2055 01:23:20,800 --> 01:23:24,600 HIDDEN IN Ph.D. DATA WE'RE 2056 01:23:24,600 --> 01:23:32,720 MISSING SO, AGAIN, IMPORTANT TO 2057 01:23:32,720 --> 01:23:37,000 HAVE COMPREHENSIVE INFORMATION 2058 01:23:37,000 --> 01:23:39,840 INCLUDING MOVEMENTS. 2059 01:23:39,840 --> 01:23:43,040 HYPOXIC BURDEN IS GAINING 2060 01:23:43,040 --> 01:23:44,240 INTEREST, WORK HAS HIGHLIGHTED 2061 01:23:44,240 --> 01:23:46,880 AS SHOWN HERE REALLY DOES 2062 01:23:46,880 --> 01:23:47,760 PREDICT CARDIOVASCULAR DISEASE 2063 01:23:47,760 --> 01:23:49,720 MORTALITY. 2064 01:23:49,720 --> 01:23:51,480 AND THIS IS PRIMARILY BASED ON 2065 01:23:51,480 --> 01:23:52,680 DURATION OF SLEEP RELATED 2066 01:23:52,680 --> 01:23:54,400 OBSTRUCTION. 2067 01:23:54,400 --> 01:23:58,040 THIS IS DATA FROM THE HEART 2068 01:23:58,040 --> 01:24:01,440 HEALTH STUDY, AGAIN POINTING 2069 01:24:01,440 --> 01:24:03,600 HYPOXIC BURDEN OUTPERFORMS 2070 01:24:03,600 --> 01:24:07,280 TRADITIONAL METRIC FOR 2071 01:24:07,280 --> 01:24:10,080 DIAGNOSING SLEEP APNEA, IN BOTH 2072 01:24:10,080 --> 01:24:10,760 COHORTS. 2073 01:24:10,760 --> 01:24:13,600 INDIVIDUALS WITH HIGHEST HYPOXIC 2074 01:24:13,600 --> 01:24:15,320 BURDEN HAD HIGHEST CVD MORTALITY 2075 01:24:15,320 --> 01:24:24,880 RISK SO THIS IS IMPORTANT IN 2076 01:24:24,880 --> 01:24:33,240 UNDERSTANDING OUR NEED AND 2077 01:24:33,240 --> 01:24:34,840 BRIDGE THE POLYSOMNOGRAPHIC 2078 01:24:34,840 --> 01:24:35,640 DATA. 2079 01:24:35,640 --> 01:24:37,880 THEY LOOKED AT AUTONOMIC 2080 01:24:37,880 --> 01:24:39,680 RESPONSE, ELEVATED DELTA HEART 2081 01:24:39,680 --> 01:24:41,160 RATE, ASSOCIATED WITH INCREASED 2082 01:24:41,160 --> 01:24:46,320 RISK FOR CARDIOVASCULAR 2083 01:24:46,320 --> 01:24:48,520 MORBIDITY AND MORTALITY, 2084 01:24:48,520 --> 01:24:50,520 DEMONSTRATING HOW THE PULSE RATE 2085 01:24:50,520 --> 01:24:52,800 RESPONSE POST EVENT, SO HAVING 2086 01:24:52,800 --> 01:24:55,120 TOO HIGH DELTA HEART RATE OR TOO 2087 01:24:55,120 --> 01:24:56,160 LOW WAS ASSOCIATED WITH 2088 01:24:56,160 --> 01:24:59,600 INCREASED RISK FOR 2089 01:24:59,600 --> 01:25:01,120 CARDIOVASCULAR DISEASE EVENTS. 2090 01:25:01,120 --> 01:25:04,000 WHAT WAS MOST INTRIGUING TO ME 2091 01:25:04,000 --> 01:25:05,840 IN THEIR SUBSEQUENT WORK WHERE 2092 01:25:05,840 --> 01:25:08,560 THEY LOOKED AT HOW THESE 2093 01:25:08,560 --> 01:25:10,760 SUBGROUPS OF HEART RATE RESPONSE 2094 01:25:10,760 --> 01:25:12,920 RESPOND TO CPAP THERAPY, WHAT 2095 01:25:12,920 --> 01:25:14,600 THEY FOUND IS THAT, YOU KNOW, 2096 01:25:14,600 --> 01:25:16,200 THERE WAS A PREFERENTIAL BENEFIT 2097 01:25:16,200 --> 01:25:18,400 OF CPAP IN HIGH PULSE RATE 2098 01:25:18,400 --> 01:25:19,920 RESPONSE BUT REALLY THERE WAS 2099 01:25:19,920 --> 01:25:21,920 SUGGESTION OF POTENTIAL HARM 2100 01:25:21,920 --> 01:25:24,120 FROM CPAP IN THOSE WITH LOW 2101 01:25:24,120 --> 01:25:24,960 DELTA HEART RATE. 2102 01:25:24,960 --> 01:25:27,520 THIS IS, AGAIN, IMPORTANT FOR US 2103 01:25:27,520 --> 01:25:30,680 TO NOT ONLY SUBGROUP AND 2104 01:25:30,680 --> 01:25:33,120 PHENOTYPE AND ENDOTYPE 2105 01:25:33,120 --> 01:25:34,320 INDIVIDUALS FOR PROGNOSTICATION 2106 01:25:34,320 --> 01:25:39,120 FOR CARDIOVASCULAR DISEASE 2107 01:25:39,120 --> 01:25:40,120 ENDPOINTS AND SIMILARLY 2108 01:25:40,120 --> 01:25:41,760 HYPERTENSION BUT CAN'T ASSUME 2109 01:25:41,760 --> 01:25:43,280 RESPONSE TO CPAP IN HIGH RISK 2110 01:25:43,280 --> 01:25:45,160 SUBGROUPS IS GOING TO BE THE 2111 01:25:45,160 --> 01:25:46,920 SAME, THAT WE CAN PREDICT IT'S 2112 01:25:46,920 --> 01:25:49,080 GOING TO BE BENEFICIAL. 2113 01:25:49,080 --> 01:25:50,880 THIS IS WHERE HETEROGENEITY OF 2114 01:25:50,880 --> 01:25:53,320 TREATMENT RESPONSE FOR CPAP OR 2115 01:25:53,320 --> 01:25:55,720 OTHER THERAPIES AND ITS 2116 01:25:55,720 --> 01:25:58,560 RELEVANCE TO PULMONARY 2117 01:25:58,560 --> 01:25:59,880 HYPERTENSION IS IMPORTANT. 2118 01:25:59,880 --> 01:26:03,040 SO WE TALKED ABOUT THE ENDOTYPES 2119 01:26:03,040 --> 01:26:05,240 AND PHENOTYPES, OF COURSE THE 2120 01:26:05,240 --> 01:26:06,320 GENOTYPE IS IMPORTANT AND 2121 01:26:06,320 --> 01:26:07,960 THERE'S WORK THAT'S BEEN DONE. 2122 01:26:07,960 --> 01:26:09,720 HOWEVER I THINK THERE'S MORE 2123 01:26:09,720 --> 01:26:12,880 THAT NEEDS TO BE DONE TO BETTER 2124 01:26:12,880 --> 01:26:14,520 UNDERSTAND THE GENETIC 2125 01:26:14,520 --> 01:26:17,160 ASSOCIATIONS BUT HOW -- AND HOW 2126 01:26:17,160 --> 01:26:18,800 THEY SORT OF INFORM RATES FOR 2127 01:26:18,800 --> 01:26:21,200 CARDIOVASCULAR DISEASE AND MAYBE 2128 01:26:21,200 --> 01:26:22,080 SIMILARLY PULMONARY HYPERTENSION 2129 01:26:22,080 --> 01:26:24,680 RISK AND SO OVERALL A DEEPER 2130 01:26:24,680 --> 01:26:27,200 UNDERSTANDING OF HOW OSA 2131 01:26:27,200 --> 01:26:29,320 ENDOTYPES DRIVE CLINICAL 2132 01:26:29,320 --> 01:26:32,040 PHENOTYPE OF OSA TO BETTER 2133 01:26:32,040 --> 01:26:34,000 DECIDE INTERPRETATION AND USE 2134 01:26:34,000 --> 01:26:34,760 DIAGNOSTIC AND PROGNOSTIC 2135 01:26:34,760 --> 01:26:38,520 MARKERS, AND THIS IS REALLY JUST 2136 01:26:38,520 --> 01:26:42,560 A BEAUTIFUL PICTURE FROM BRAD 2137 01:26:42,560 --> 01:26:43,640 EDWARDS' PAPER. 2138 01:26:43,640 --> 01:26:48,120 SO IN THE LAST FEW MINUTES I 2139 01:26:48,120 --> 01:26:51,760 BELIEVE I GO TILL 11:35, RIGHT? 2140 01:26:51,760 --> 01:26:52,080 YES. 2141 01:26:52,080 --> 01:26:56,240 JUST CHECKING ON TIME. 2142 01:26:56,240 --> 01:26:58,640 PROPOSED MECHANISMS ARE SHOWN IN 2143 01:26:58,640 --> 01:27:04,680 THIS FIGURE HERE. 2144 01:27:04,680 --> 01:27:05,200 PRIMARILY THERE'S HYPOXIC 2145 01:27:05,200 --> 01:27:05,800 VASOCONSTRUCTION, NEGATIVE 2146 01:27:05,800 --> 01:27:10,440 PRESSURE IS LINKED TO THE 2147 01:27:10,440 --> 01:27:16,360 INCREASED LOAD AND CAPILLARY 2148 01:27:16,360 --> 01:27:17,000 DECREASED VENTRICULAR 2149 01:27:17,000 --> 01:27:21,720 COMPONENTS, AND THEN ENDOTHELIAL 2150 01:27:21,720 --> 01:27:29,160 DYSFUNCTION, HEIGHTENED 2151 01:27:29,160 --> 01:27:30,680 INFLAMMATORY STATE, SYMPATHETIC, 2152 01:27:30,680 --> 01:27:31,400 IMPLICATED AS PROPOSED 2153 01:27:31,400 --> 01:27:33,560 MECHANISMS AND AS DAN POINTED 2154 01:27:33,560 --> 01:27:36,320 OUT OBSTRUCTIVE SLEEP APNEA IS 2155 01:27:36,320 --> 01:27:40,120 IMPORTANT BUT OF COURSE OTHER 2156 01:27:40,120 --> 01:27:42,160 SLEEP DIMENSIONS INCLUDING 2157 01:27:42,160 --> 01:27:43,600 INSOMNIA PHENOTYPE, FREQUENT 2158 01:27:43,600 --> 01:27:46,880 AROUSAL, MAY DRIVE THE 2159 01:27:46,880 --> 01:27:49,520 SYMPATHETIC ACTIVATION, SYSTEMIC 2160 01:27:49,520 --> 01:27:50,880 HYPERTENSION AND PULMONARY 2161 01:27:50,880 --> 01:27:54,240 OUTCOME WE'RE ALL HERE TO 2162 01:27:54,240 --> 01:27:55,640 DISCUSS. 2163 01:27:55,640 --> 01:27:56,640 HYPOXIC BURDEN AND PULMONARY 2164 01:27:56,640 --> 01:27:58,040 HYPERTENSION, MOST OF THE DATA 2165 01:27:58,040 --> 01:28:00,040 IS LOOKING AT CARDIOVASCULAR 2166 01:28:00,040 --> 01:28:02,960 DISEASE ENDPOINTS LIKE 2167 01:28:02,960 --> 01:28:03,960 MYOCARDIAL INFUNCTION, STROKE, 2168 01:28:03,960 --> 01:28:07,120 HOWEVER WHAT DO WE KNOW ABOUT 2169 01:28:07,120 --> 01:28:09,320 THIS, AND THERE ARE STUDIES THAT 2170 01:28:09,320 --> 01:28:12,960 LOOKED AT THIS, THIS IS ONE THAT 2171 01:28:12,960 --> 01:28:14,440 IS MOST RECENT WORK PUBLISHED IN 2172 01:28:14,440 --> 01:28:16,640 THE JOURNAL OF CLINICAL SLEEP 2173 01:28:16,640 --> 01:28:20,920 MEDICINE WHERE WE LOOK AT 2174 01:28:20,920 --> 01:28:21,920 CORRELATION BETWEEN PULMONARY 2175 01:28:21,920 --> 01:28:23,120 HEMODYNAMICS AND PARAMETERS. 2176 01:28:23,120 --> 01:28:27,480 WHAT WAS INTERESTING HERE IS 2177 01:28:27,480 --> 01:28:31,000 THAT T90 WAS THE FACTOR 2178 01:28:31,000 --> 01:28:33,920 ASSOCIATED WITH MEAN ARTERIAL 2179 01:28:33,920 --> 01:28:36,360 PRESSURE AND EVERY FIVE UNIT 2180 01:28:36,360 --> 01:28:41,520 INCREASE 36% GREATER RISK OF 2181 01:28:41,520 --> 01:28:44,680 MEAN ARTERIAL PRESSURE GREATER 2182 01:28:44,680 --> 01:28:46,960 THAN 25 MILLIMETERS OF MERCURY, 2183 01:28:46,960 --> 01:28:50,480 NOT AN INDEPENDENT RISK FACTOR, 2184 01:28:50,480 --> 01:28:53,520 CONFIRMED IN OTHER STUDIES AT 2185 01:28:53,520 --> 01:28:55,720 THE BOTTOM WHERE WHEN USED ALONE 2186 01:28:55,720 --> 01:29:00,520 IT WAS NOT STRONGLY LINKED WITH 2187 01:29:00,520 --> 01:29:03,240 PULMONARY HYPERTENSION, AND THAT 2188 01:29:03,240 --> 01:29:10,040 T90 IN ANOTHER STUDY WAS A 2189 01:29:10,040 --> 01:29:12,440 BETTER -- STRONGLY CORRELATED 2190 01:29:12,440 --> 01:29:13,480 WITH PULMONARY HEMODYNAMICS, H I 2191 01:29:13,480 --> 01:29:14,960 WAS NOT. 2192 01:29:14,960 --> 01:29:16,840 THERE IS INTEREST HERE, 2193 01:29:16,840 --> 01:29:19,240 INTERESTING DATA HERE, 2194 01:29:19,240 --> 01:29:21,640 SUGGESTING THAT THE HYPOXIC 2195 01:29:21,640 --> 01:29:24,560 BURDEN MAY HELP US IDENTIFY HIGH 2196 01:29:24,560 --> 01:29:26,120 RISK PHENOTYPES. 2197 01:29:26,120 --> 01:29:30,280 T 90 ONLY MEASURES DESATURATION 2198 01:29:30,280 --> 01:29:32,360 BELOW 90%, IN SOME INDIVIDUALS 2199 01:29:32,360 --> 01:29:37,400 IF YOU ARE STARTING AT 96% T90 2200 01:29:37,400 --> 01:29:39,000 WILL MISS ALL OF THESE 2201 01:29:39,000 --> 01:29:39,280 INDIVIDUALS. 2202 01:29:39,280 --> 01:29:41,480 ON THE OTHER HAND IF YOUR 2203 01:29:41,480 --> 01:29:44,080 BASELINE OXYGEN IS SLIGHTLY 2204 01:29:44,080 --> 01:29:46,440 BELOW T90 THE WHOLE TIME, IT 2205 01:29:46,440 --> 01:29:50,960 WILL BE 100%. 2206 01:29:50,960 --> 01:29:54,720 IT IS NOT HIGHLY CORRELATED WITH 2207 01:29:54,720 --> 01:29:56,880 HYPOXIC BURDEN BUT JUST, AGAIN, 2208 01:29:56,880 --> 01:29:58,600 FOOD FOR THOUGHT, DIRECTIONS WE 2209 01:29:58,600 --> 01:30:01,360 MAY WANT TO MOVE TOWARDS. 2210 01:30:01,360 --> 01:30:04,000 PULSE RATE RESPONSE AND 2211 01:30:04,000 --> 01:30:04,840 PULMONARY HYPERTENSION, WHAT 2212 01:30:04,840 --> 01:30:15,240 EVIDENCE DO WE HAVE ON 2213 01:30:16,280 --> 01:30:17,600 DYSREGULATION, AND THE CHANGE 2214 01:30:17,600 --> 01:30:19,680 FROM MINIMUM HEART RATE TO 2215 01:30:19,680 --> 01:30:21,840 MAXIMUM HEART RATE, DELTA HEART 2216 01:30:21,840 --> 01:30:23,160 RATE, AFTER A RESPIRATORY EVENT 2217 01:30:23,160 --> 01:30:28,960 MAY REFLECT THE FACT THAT BOTH 2218 01:30:28,960 --> 01:30:37,920 PARASYMPATHETIC AND SYMPATHETIC 2219 01:30:37,920 --> 01:30:41,320 SYSTEM AND MORE PRONOUNCED 2220 01:30:41,320 --> 01:30:43,280 SYMPATHETIC RESPONSE, A LARGER 2221 01:30:43,280 --> 01:30:47,120 INCREASE IN HEART RATE, MAY BE 2222 01:30:47,120 --> 01:30:48,120 SYMPATHETIC RESPONSE, OR 2223 01:30:48,120 --> 01:30:48,440 COMBINATION. 2224 01:30:48,440 --> 01:30:50,000 BOTTOM LINE IN THE FIGURE ON THE 2225 01:30:50,000 --> 01:30:54,040 LEFT HERE, YOU CAN SEE THERE'S A 2226 01:30:54,040 --> 01:30:55,800 VERY HEAVY AUTONOMIC NERVOUS 2227 01:30:55,800 --> 01:30:58,080 SYSTEM INVOLVEMENT IN THE 2228 01:30:58,080 --> 01:31:00,360 TRACHEOBRONCHIAL TREE IN THE 2229 01:31:00,360 --> 01:31:07,040 LUNG, IN THE HEART, AND THE BLUE 2230 01:31:07,040 --> 01:31:09,240 FIBERS ARE THE PARASYMPATHETIC 2231 01:31:09,240 --> 01:31:12,840 NERVOUS SYSTEM, I THINK THIS MAY 2232 01:31:12,840 --> 01:31:15,600 POTENTIALLY HELP US FURTHER 2233 01:31:15,600 --> 01:31:17,680 PHENOTYPE PATIENTS WITH 2234 01:31:17,680 --> 01:31:19,480 PULMONARY HYPERTENSION IF WE 2235 01:31:19,480 --> 01:31:23,040 FURTHER UNDERSTAND RULES OF THE 2236 01:31:23,040 --> 01:31:28,520 SYMPATHETIC AND PARASYMPATHETIC 2237 01:31:28,520 --> 01:31:31,760 IN PATIENTS BASED ON WORK IN THE 2238 01:31:31,760 --> 01:31:33,880 NON-PULMONARY HYPERTENSION 2239 01:31:33,880 --> 01:31:34,200 SETTING. 2240 01:31:34,200 --> 01:31:36,160 AND THIS SLIDE SHOWS SAME THING, 2241 01:31:36,160 --> 01:31:36,640 MAGNIFIED. 2242 01:31:36,640 --> 01:31:40,320 WHAT I WANT TO POINT OUT THERE 2243 01:31:40,320 --> 01:31:42,520 IS WORK, I'M MORE FAMILIAR IN 2244 01:31:42,520 --> 01:31:44,040 THE LAST FEW MONTHS, PREPARING 2245 01:31:44,040 --> 01:31:45,680 FOR THIS TALK. 2246 01:31:45,680 --> 01:31:47,440 BETA BLOCKERS REALLY APPARENTLY 2247 01:31:47,440 --> 01:31:51,040 DID NOT PAN OUT AS A MAJOR 2248 01:31:51,040 --> 01:31:52,600 TARGET AND EXPERTS ON THIS PANEL 2249 01:31:52,600 --> 01:31:55,880 CAN SPEAK TO THAT MORE BUT MAYBE 2250 01:31:55,880 --> 01:31:57,880 PULMONARY ARTERY INNERVATION MAY 2251 01:31:57,880 --> 01:32:00,480 BE AN OPTION, HAS SHOWN PROMISE 2252 01:32:00,480 --> 01:32:02,080 IN EARLY CLINICAL TRIALS, BUT 2253 01:32:02,080 --> 01:32:04,320 HOW DOES THIS FIT INTO 2254 01:32:04,320 --> 01:32:06,240 OBSTRUCTIVE SLEEP APNEA, WHAT 2255 01:32:06,240 --> 01:32:08,760 DOES CPAP DO TO THE RESPONSE, 2256 01:32:08,760 --> 01:32:12,800 POST EVENTS IN INDIVIDUALS WITH 2257 01:32:12,800 --> 01:32:13,920 SLEEP APNEA AND PULMONARY 2258 01:32:13,920 --> 01:32:14,520 HYPERTENSION ARE THE QUESTIONS 2259 01:32:14,520 --> 01:32:16,560 TO HELP US UNDERSTAND THE ROLE 2260 01:32:16,560 --> 01:32:18,400 OF THE AUTONOMIC NERVOUS SYSTEM 2261 01:32:18,400 --> 01:32:26,680 BECAUSE THERE'S INCREASED 2262 01:32:26,680 --> 01:32:28,280 SYMPATHETIC ACTIVITY. 2263 01:32:28,280 --> 01:32:29,680 LET'S TALK ABOUT THE EFFECTS 2264 01:32:29,680 --> 01:32:31,000 CPAP THERAPY. 2265 01:32:31,000 --> 01:32:32,320 THERE'S A TALK SPECIFICALLY 2266 01:32:32,320 --> 01:32:33,600 DEDICATED TO THIS. 2267 01:32:33,600 --> 01:32:38,120 I WANT TO SHOW A RANGE OF DELTA 2268 01:32:38,120 --> 01:32:40,080 IMPROVEMENT IN THE PRESSURE WITH 2269 01:32:40,080 --> 01:32:40,400 CPAP. 2270 01:32:40,400 --> 01:32:46,240 SO THERE MAY BE A POTENTIAL, YOU 2271 01:32:46,240 --> 01:32:47,680 KNOW, HETEROGENEITY OF TREATMENT 2272 01:32:47,680 --> 01:32:50,960 RESPONSE SIGNAL THAT WE MAY BE 2273 01:32:50,960 --> 01:32:52,920 SEEING IN PULMONARY HYPERTENSION 2274 01:32:52,920 --> 01:32:53,640 PATIENTS. 2275 01:32:53,640 --> 01:32:55,120 AND WE'RE SORT OF GETTING CLOSER 2276 01:32:55,120 --> 01:32:58,400 TO THE END OF MY TALK BUT I WANT 2277 01:32:58,400 --> 01:33:02,240 TO DEMONSTRATE THAT BY SHOWING 2278 01:33:02,240 --> 01:33:04,320 THAT THE AVERAGE TREATMENT 2279 01:33:04,320 --> 01:33:05,440 RESPONSE, AND WE'VE SEEN 2280 01:33:05,440 --> 01:33:06,720 CARDIOVASCULAR DISEASE TRIALS 2281 01:33:06,720 --> 01:33:09,240 THAT HAVE NOT SHOWN IMPACT OF 2282 01:33:09,240 --> 01:33:12,480 CPAP THERAPY BUT MAYBE BY 2283 01:33:12,480 --> 01:33:13,120 SEGREGATING PATIENT POPULATION 2284 01:33:13,120 --> 01:33:14,160 BASED ON TREATMENT RESPONSE WE 2285 01:33:14,160 --> 01:33:15,480 CAN GO AFTER THE INDIVIDUALS 2286 01:33:15,480 --> 01:33:19,080 THAT WE SEE A GREATER SIGNAL FOR 2287 01:33:19,080 --> 01:33:22,040 BENEFIT, FOR CPAP OR ANY OTHER 2288 01:33:22,040 --> 01:33:24,800 TREATMENT RESPONSE, SIMILAR 2289 01:33:24,800 --> 01:33:26,120 APPROACH CAN HELP WITH PULMONARY 2290 01:33:26,120 --> 01:33:26,440 HYPERTENSION. 2291 01:33:26,440 --> 01:33:31,600 WE'VE DONE THIS WORK IN OUR 2292 01:33:31,600 --> 01:33:32,800 COLLABORATION WITH A STUDY THAT 2293 01:33:32,800 --> 01:33:35,640 LOOKED AT IMPACT OF CPAP ON 2294 01:33:35,640 --> 01:33:37,440 CARDIOVASCULAR DISEASE EVENTS IN 2295 01:33:37,440 --> 01:33:40,040 INDIVIDUALS WITH ACUTE CORONARY 2296 01:33:40,040 --> 01:33:40,320 SYNDROME. 2297 01:33:40,320 --> 01:33:43,440 WE APPLIED MACHINE LEARNING AND 2298 01:33:43,440 --> 01:33:46,480 WHAT WE FOUND IS THAT BASICALLY 2299 01:33:46,480 --> 01:33:48,360 THERE'S THIS SORT OF -- THERE 2300 01:33:48,360 --> 01:33:50,680 ARE SUBGROUPS WITH DIFFERENTIAL 2301 01:33:50,680 --> 01:33:51,760 TREATMENT RESPONSE, THERE ARE 2302 01:33:51,760 --> 01:33:53,720 TREATMENTS THAT THERE ARE 2303 01:33:53,720 --> 01:33:54,720 SUBGROUPS THAT MAY EXPERIENCE 2304 01:33:54,720 --> 01:33:56,440 HARM, THIS WORK IS CURRENTLY 2305 01:33:56,440 --> 01:33:58,840 UNDER REVIEW AND WE PRESENTED 2306 01:33:58,840 --> 01:34:03,360 THIS AT THE ATF, AND THERE ARE 2307 01:34:03,360 --> 01:34:05,880 SPECIFIC VARIABLES IN OUR MODEL 2308 01:34:05,880 --> 01:34:08,840 THAT SEEM TO RISE TO THE TOP AS 2309 01:34:08,840 --> 01:34:11,000 A DECISION POINT FOR TREATMENT 2310 01:34:11,000 --> 01:34:12,760 RESPONSE IN INDIVIDUALS WITH 2311 01:34:12,760 --> 01:34:14,600 SHORTER EVENT DURATION SEEMED TO 2312 01:34:14,600 --> 01:34:16,040 BENEFIT MORE FROM CPAP THERAPY. 2313 01:34:16,040 --> 01:34:20,960 AND THIS HAS BEEN SHOWN BY WORK 2314 01:34:20,960 --> 01:34:23,280 FROM BUTLER AND REDLINE WHERE 2315 01:34:23,280 --> 01:34:25,360 EVENT DURATION DID PREDICT 2316 01:34:25,360 --> 01:34:27,480 MORTALITY IN A THREE-PART 2317 01:34:27,480 --> 01:34:31,800 HEALTHY STUDY. 2318 01:34:31,800 --> 01:34:34,320 THERE ARE MORE TO SLEEP DATA AND 2319 01:34:34,320 --> 01:34:36,520 HI THAT WE'RE MISSING AND 2320 01:34:36,520 --> 01:34:38,680 HOPEFULLY SOME OF THESE 2321 01:34:38,680 --> 01:34:40,360 PHYSIOLOGIC ENDOTYPES AND 2322 01:34:40,360 --> 01:34:42,360 PHENOTYPES WE TALKED ABOUT WILL 2323 01:34:42,360 --> 01:34:44,640 HELP INFORM THE RELATIONSHIP 2324 01:34:44,640 --> 01:34:45,520 BETWEEN OBSTRUCTIVE SLEEP APNEA 2325 01:34:45,520 --> 01:34:47,280 AND PULMONARY HYPERTENSION AND 2326 01:34:47,280 --> 01:34:49,320 MORE IMPORTANTLY HOW CPAP OR 2327 01:34:49,320 --> 01:34:51,680 OTHER TREATMENT OPTIONS MAY 2328 01:34:51,680 --> 01:34:52,040 INFLUENCE THAT. 2329 01:34:52,040 --> 01:34:54,040 FINALLY WE HAVEN'T TALKED ABOUT 2330 01:34:54,040 --> 01:34:55,560 OMICS OR BIOMARKERS AND I THINK 2331 01:34:55,560 --> 01:34:57,680 THAT'S ANOTHER AREA THAT REALLY 2332 01:34:57,680 --> 01:35:00,280 NEEDS TO BE EXAMINED BECAUSE OUR 2333 01:35:00,280 --> 01:35:04,760 WORK WHERE WE'VE USED 2334 01:35:04,760 --> 01:35:05,880 INFLAMMATION IN BASELINE 2335 01:35:05,880 --> 01:35:08,480 BIOMARKERS TO THEN DETERMINE HOW 2336 01:35:08,480 --> 01:35:09,520 THESE INDIVIDUAL SUBGROUPS 2337 01:35:09,520 --> 01:35:11,360 RESPOND TO CPAP THERAPY WE DO 2338 01:35:11,360 --> 01:35:13,880 SEE THAT CPAP THERAPY HAS 2339 01:35:13,880 --> 01:35:15,080 DIFFERENTIAL TREATMENT RESPONSE 2340 01:35:15,080 --> 01:35:16,120 IN INDIVIDUALS WITH HIGH 2341 01:35:16,120 --> 01:35:26,680 INFLAMMATION AT BASELINE VERSES 2342 01:35:28,560 --> 01:35:28,840 LOW. 2343 01:35:28,840 --> 01:35:30,560 I WON'T GO INTO THIS BUT JUST 2344 01:35:30,560 --> 01:35:32,440 AGAIN TO PROVIDE A LITTLE BIT OF 2345 01:35:32,440 --> 01:35:35,640 FLAVOR AND YOU CAN LOOK AT THE 2346 01:35:35,640 --> 01:35:37,920 MANUSCRIPT IF YOU'RE INTERESTED. 2347 01:35:37,920 --> 01:35:39,840 AGAIN, TO DRAW ATTENTION TO THIS 2348 01:35:39,840 --> 01:35:42,000 FIGURE ON THE LEFT, 3A, 2349 01:35:42,000 --> 01:35:46,680 INDIVIDUALS IN THE HIGH 2350 01:35:46,680 --> 01:35:50,920 INFLAMMATORY SUBGROUP USING 2351 01:35:50,920 --> 01:35:52,360 BASELINE BIOMARKERS BENEFITED 2352 01:35:52,360 --> 01:35:54,240 FROM CPAP, SCORE FOR 2353 01:35:54,240 --> 01:35:55,640 INFLAMMATION REDUCED. 2354 01:35:55,640 --> 01:35:58,160 HOWEVER INDIVIDUALS WHO HAD LOW 2355 01:35:58,160 --> 01:35:59,480 INFLAMMATION AT BASELINE, THEIR 2356 01:35:59,480 --> 01:36:01,440 INFLAMMATION APPEARED TO WORSE 2357 01:36:01,440 --> 01:36:02,680 WITHIN CPAP. 2358 01:36:02,680 --> 01:36:06,280 AGAIN, JUST USING THIS APPROACH 2359 01:36:06,280 --> 01:36:07,400 IN PULMONARY HYPERTENSION I 2360 01:36:07,400 --> 01:36:10,640 THINK WILL MOVE THE NEEDLE. 2361 01:36:10,640 --> 01:36:12,080 SPECIFICALLY ON INFLAMMATION, I 2362 01:36:12,080 --> 01:36:19,640 WANT TO SHARE MY COLLEAGUE 2363 01:36:19,640 --> 01:36:21,480 DEMONSTRATE BY PET MRI 2364 01:36:21,480 --> 01:36:24,800 ASSOCIATED WITH PULMONARY 2365 01:36:24,800 --> 01:36:27,520 HYPERTENSION AND THAT INTENSITY 2366 01:36:27,520 --> 01:36:30,040 CORRELATED WITH PULMONARY ARTERY 2367 01:36:30,040 --> 01:36:32,120 PRESSURE, WORK IN SARCOIDOSIS. 2368 01:36:32,120 --> 01:36:33,600 WHAT WE'RE DOING AT THE MOMENT, 2369 01:36:33,600 --> 01:36:38,200 A FELLOW HERE AT SINAI IS 2370 01:36:38,200 --> 01:36:39,200 MEASURING UPTAKE IN ABOUT 200 2371 01:36:39,200 --> 01:36:41,520 PATIENTS BEFORE AND AFTER CPAP 2372 01:36:41,520 --> 01:36:42,800 THERAPY, SHE'S PRETTY MUCH DONE 2373 01:36:42,800 --> 01:36:45,440 SO WE'RE HOPING TO SUBMIT THE 2374 01:36:45,440 --> 01:36:47,520 WORK TO OF SO PLEASE KEEP AN EYE 2375 01:36:47,520 --> 01:36:48,400 OUT. 2376 01:36:48,400 --> 01:36:49,880 WE'RE TRYING TO AGAIN UNDERSTAND 2377 01:36:49,880 --> 01:36:57,040 HOW OBSTRUCT IVE SLEEP APNEA MAY 2378 01:36:57,040 --> 01:36:59,680 BE POTENTIALLY, YOU KNOW, I USE 2379 01:36:59,680 --> 01:37:03,720 THE WORD CAUSING IN QUOTATIONS, 2380 01:37:03,720 --> 01:37:05,240 PULMONARY HYPERTENSION OR HOW 2381 01:37:05,240 --> 01:37:06,360 TREATMENT RESPONSE MAY VARY 2382 01:37:06,360 --> 01:37:10,960 BASED ON PULMONARY ARTERY 2383 01:37:10,960 --> 01:37:12,240 INFLAMMATION FOR EXAMPLE. 2384 01:37:12,240 --> 01:37:19,880 I HOPE I'VE SHED SOME LIGHT ON 2385 01:37:19,880 --> 01:37:20,800 PHENOTYPES, SPECIFICALLY 2386 01:37:20,800 --> 01:37:21,440 POLYSOMNOGRAPHIC DATA. 2387 01:37:21,440 --> 01:37:25,720 I DIDN'T HAVE TIME TO GO INTO 2388 01:37:25,720 --> 01:37:29,000 EFFECT DIFFERENCES BUT THAT'S AN 2389 01:37:29,000 --> 01:37:31,520 IMPORTANT AREA, PERTAINING TO 2390 01:37:31,520 --> 01:37:33,920 SLEEP APNEA, ANOTHER PHENOTYPE, 2391 01:37:33,920 --> 01:37:35,480 OBESITY, VISCERAL FAT IS ANOTHER 2392 01:37:35,480 --> 01:37:38,120 AREA OF INTEREST FOR OUR GROUP. 2393 01:37:38,120 --> 01:37:40,400 WHAT IS THE IMPACT OF PULMONARY 2394 01:37:40,400 --> 01:37:41,520 HYPERTENSION OF THESE 2395 01:37:41,520 --> 01:37:43,360 SUBPHENOTYPES, WHAT IS RESPONSE 2396 01:37:43,360 --> 01:37:45,880 TO CPAP IN TERMS OF VARIABLE 2397 01:37:45,880 --> 01:37:48,280 RESPONSE TO CPAP AND 2398 01:37:48,280 --> 01:37:50,920 HETEROGENEITY OF CPAP RESPONSE, 2399 01:37:50,920 --> 01:37:53,200 UNEXPLORED GENETIC INFLUENCES 2400 01:37:53,200 --> 01:37:54,720 AND OTHER OMICS LEVERAGING 2401 01:37:54,720 --> 01:37:56,240 ADVANCED TECHNIQUES LIKE WE HAVE 2402 01:37:56,240 --> 01:37:57,880 TO APPLY MACHINE LEARNING TO 2403 01:37:57,880 --> 01:38:01,840 EXISTING DATASETS TO THEN GET A 2404 01:38:01,840 --> 01:38:11,040 BETTER SORT OF MORE HYPOTHESIS 2405 01:38:11,040 --> 01:38:12,560 GENERATING AND REALLY USE 2406 01:38:12,560 --> 01:38:17,960 DATASETS AND CLINICAL TRIALS AND 2407 01:38:17,960 --> 01:38:19,600 EPIDEMIOLOGICAL COHORTS TO 2408 01:38:19,600 --> 01:38:23,600 ENRICH THE FUTURE OF RANDOMIZED 2409 01:38:23,600 --> 01:38:26,040 CONTROLLED TRIALS TO IDENTIFY 2410 01:38:26,040 --> 01:38:27,600 THROUGH ADVANCED ANALYSES, WE 2411 01:38:27,600 --> 01:38:29,040 CAN APPLY TO PULMONARY 2412 01:38:29,040 --> 01:38:29,440 HYPERTENSION. 2413 01:38:29,440 --> 01:38:33,920 I WANT TO END WITH THIS 2414 01:38:33,920 --> 01:38:34,760 ESSENTIALLY IMPORTANT REMINDER 2415 01:38:34,760 --> 01:38:37,320 AS A PHYSICIAN AND AS OUR 2416 01:38:37,320 --> 01:38:38,200 CO-CHAIR POINTS OUT, IN OUR 2417 01:38:38,200 --> 01:38:39,840 HASTE TO DEVELOP NEW TREATMENTS 2418 01:38:39,840 --> 01:38:41,600 FOR THIS DEADLY SYNDROME WE NEED 2419 01:38:41,600 --> 01:38:43,680 TO REMEMBER OUR PLEDGE AS 2420 01:38:43,680 --> 01:38:47,280 PHYSICIANS, FIRST DO NO HARM. 2421 01:38:47,280 --> 01:38:49,360 AND GIVEN THE SIGNALS WE'RE 2422 01:38:49,360 --> 01:38:51,240 SEEING OUR WORK AGAIN IT'S NOT 2423 01:38:51,240 --> 01:38:52,560 ENOUGH JUST TO SUBPHENOTYPE. 2424 01:38:52,560 --> 01:38:55,160 IT'S REALLY IMPORTANT TO FURTHER 2425 01:38:55,160 --> 01:38:56,680 UNDERSTAND THE RESPONSE TO CPAP 2426 01:38:56,680 --> 01:38:58,880 THERAPY IN ALL OF THESE 2427 01:38:58,880 --> 01:38:59,320 INDIVIDUALS. 2428 01:38:59,320 --> 01:39:01,720 SO I'LL STOP SHARING AND I THANK 2429 01:39:01,720 --> 01:39:08,160 YOU FOR YOUR ATTENTION AND TIME. 2430 01:39:08,160 --> 01:39:08,960 >>FANTASTIC. 2431 01:39:08,960 --> 01:39:11,880 AGAIN, SO EXPANSIVE AND DEEP AND 2432 01:39:11,880 --> 01:39:13,680 STIMULATING, AND PERFECT FOR 2433 01:39:13,680 --> 01:39:14,120 THIS SESSION. 2434 01:39:14,120 --> 01:39:17,920 AGAIN, I THINK YOU'VE HEARD A 2435 01:39:17,920 --> 01:39:20,880 LOT ABOUT THE INTRODUCTION ABOUT 2436 01:39:20,880 --> 01:39:23,080 HYPOXIA AND I THINK YOU'RE NOW 2437 01:39:23,080 --> 01:39:24,800 CHALLENGING US TO EVEN RECOGNIZE 2438 01:39:24,800 --> 01:39:26,920 THAT SLEEP APNEA, WHETHER 2439 01:39:26,920 --> 01:39:31,400 MEASURED BY SIMPLE HYPOXIC 2440 01:39:31,400 --> 01:39:32,920 MEASURE OR AHI MAY BE 2441 01:39:32,920 --> 01:39:34,880 INSUFFICIENT AS WE THINK ABOUT 2442 01:39:34,880 --> 01:39:37,720 THE SUBGROUPS AND THE TARGETS OF 2443 01:39:37,720 --> 01:39:38,960 INTERVENTION, I'M SURE WE'LL 2444 01:39:38,960 --> 01:39:41,680 PICK MORE UP LATER. 2445 01:39:41,680 --> 01:39:43,960 AGAIN, IS THERE ANYONE WITH ONE 2446 01:39:43,960 --> 01:39:50,440 OR TWO QUESTIONS BEFORE WE END 2447 01:39:50,440 --> 01:39:53,560 THIS PARTICULAR TALK? 2448 01:39:53,560 --> 01:39:54,600 >>GO AHEAD. 2449 01:39:54,600 --> 01:39:56,560 >>GO AHEAD. 2450 01:39:56,560 --> 01:39:59,280 >>THANK YOU. 2451 01:39:59,280 --> 01:40:01,360 I HAVE A QUESTION ABOUT THE 2452 01:40:01,360 --> 01:40:04,640 DIRECTION WE'RE GOING WITH SLEEP 2453 01:40:04,640 --> 01:40:05,960 STUDIES, EMPHASIS ON DOING A LOT 2454 01:40:05,960 --> 01:40:11,320 OF HOME SLEEP STUDIES USING 2455 01:40:11,320 --> 01:40:13,640 SIMPLE DEVICES, HOW WILL THAT 2456 01:40:13,640 --> 01:40:16,360 AFFECT YOUR PLEA FOR MORE 2457 01:40:16,360 --> 01:40:18,880 PRECISION MEDICINE AND DOING 2458 01:40:18,880 --> 01:40:20,400 THESE FAIRLY SOPHISTICATED 2459 01:40:20,400 --> 01:40:24,000 TECHNIQUES TO BETTER PHENOTYPE 2460 01:40:24,000 --> 01:40:24,280 PATIENTS? 2461 01:40:24,280 --> 01:40:30,480 >>YEAH, A GREAT QUESTION. 2462 01:40:30,480 --> 01:40:32,800 MY COLLEAGUE ON THIS CALL, WE'RE 2463 01:40:32,800 --> 01:40:34,120 WORKING TO HELP ANSWER THAT IS 2464 01:40:34,120 --> 01:40:35,840 WHAT I WILL SAY. 2465 01:40:35,840 --> 01:40:38,920 WE'RE PUTTING TOGETHER GRANT 2466 01:40:38,920 --> 01:40:41,320 PROPOSAL TO ADDRESS THAT. 2467 01:40:41,320 --> 01:40:43,080 WITHOUT REALLY GOING INTO THE 2468 01:40:43,080 --> 01:40:44,840 DETAILS I HAVE SORT OF 2469 01:40:44,840 --> 01:40:46,160 POTENTIALLY THOUGHT ABOUT MAYBE 2470 01:40:46,160 --> 01:40:49,680 WHETHER IT'S TIME TO BRING BACK 2471 01:40:49,680 --> 01:40:50,240 FULL (INDISCERNIBLE) BECAUSE 2472 01:40:50,240 --> 01:40:52,160 THERE'S ALL OF THIS INFORMATION 2473 01:40:52,160 --> 01:40:59,400 THAT'S LEFT ON THE TABLE IN OUR, 2474 01:40:59,400 --> 01:41:00,720 YOU KNOW, SEARCH FOR EASY 2475 01:41:00,720 --> 01:41:04,000 DIAGNOSTIC TOOL. 2476 01:41:04,000 --> 01:41:06,200 YOU COULD DO THIS FULL AT HOME, 2477 01:41:06,200 --> 01:41:08,960 SUSAN CAN SPEAK TO THAT, BUT I 2478 01:41:08,960 --> 01:41:11,120 AGREE, I THINK THERE'S -- WE'RE 2479 01:41:11,120 --> 01:41:13,640 GOING TO HAVE TO TAKE A PAUSE TO 2480 01:41:13,640 --> 01:41:14,960 FIGURE OUT HOW WE APPLY WHAT 2481 01:41:14,960 --> 01:41:18,240 WE'RE DOING IN THE RESEARCH 2482 01:41:18,240 --> 01:41:18,800 SETTING, CLINICAL SETTING, 2483 01:41:18,800 --> 01:41:21,520 BECAUSE IT IS MOVING TOWARDS A 2484 01:41:21,520 --> 01:41:24,520 VERY NARROW FEW CHANNELS OF 2485 01:41:24,520 --> 01:41:26,320 QUICK H I AND AS I SHARED NONE 2486 01:41:26,320 --> 01:41:27,920 OF THE STUFF I PROVIDED TODAY 2487 01:41:27,920 --> 01:41:34,160 REALLY TALKED ABOUT THE H I 2488 01:41:34,160 --> 01:41:34,960 EXCLUSIVELY. 2489 01:41:34,960 --> 01:41:37,840 WE MAY BRING THG BACK OR HAVE A 2490 01:41:37,840 --> 01:41:39,200 TOTALLY NEW DIAGNOSTIC DEVICE 2491 01:41:39,200 --> 01:41:41,880 THAT WILL BE, YOU KNOW, DRIVEN 2492 01:41:41,880 --> 01:41:43,760 BY SOME FINDINGS AND WILL 2493 01:41:43,760 --> 01:41:47,080 BASICALLY HAVE A NEW CATEGORY OF 2494 01:41:47,080 --> 01:41:49,000 HOME SLEEP TEST. 2495 01:41:49,000 --> 01:41:50,800 >>THANK YOU. 2496 01:41:50,800 --> 01:41:52,240 THAT'S A GREAT QUESTION. 2497 01:41:52,240 --> 01:41:53,720 I SUGGEST THAT THAT MAY BE ONE 2498 01:41:53,720 --> 01:41:57,320 OF THE ITEMS WE PICK UP IN THE 2499 01:41:57,320 --> 01:41:58,240 WRAP-UP DISCUSSION AREA. 2500 01:41:58,240 --> 01:42:02,480 JUST FOR THE PURPOSES OF TIME, I 2501 01:42:02,480 --> 01:42:03,720 APOLOGIZE TO DR. CHAN BUT IF YOU 2502 01:42:03,720 --> 01:42:05,520 COULD KEEP YOUR QUESTIONS FOR 2503 01:42:05,520 --> 01:42:06,640 THE WRAP-UP, I WILL MAKE SURE 2504 01:42:06,640 --> 01:42:13,560 THAT YOU ARE THE TWO THAT ARE 2505 01:42:13,560 --> 01:42:14,840 FIRST CALLED ON. 2506 01:42:14,840 --> 01:42:17,240 I'LL GIVE DR. CHAN OPPORTUNITY 2507 01:42:17,240 --> 01:42:19,120 TO NOW REALLY WRAP UP THIS 2508 01:42:19,120 --> 01:42:21,840 SESSION AND I THINK MOST PEOPLE 2509 01:42:21,840 --> 01:42:24,240 REALIZE HE'S A KEY LEADER IN 2510 01:42:24,240 --> 01:42:27,240 REALLY THE FIELD IN TERMS OF 2511 01:42:27,240 --> 01:42:28,600 UNDERSTANDING MECHANISMS FOR 2512 01:42:28,600 --> 01:42:31,240 PULMONARY HYPERTENSION SO OUR 2513 01:42:31,240 --> 01:42:34,960 FIRST CARDIOLOGIST JOINING US 2514 01:42:34,960 --> 01:42:37,520 TODAY, DR. CHAN WILL CONTINUE 2515 01:42:37,520 --> 01:42:40,680 THE THEME OF PRECISION MEDICINE 2516 01:42:40,680 --> 01:42:42,000 BUT NOW FOCUSING SPECIFICALLY ON 2517 01:42:42,000 --> 01:42:43,320 THE LINK BETWEEN VASCULAR 2518 01:42:43,320 --> 01:42:46,720 DISEASE AND SLEEP APNEA. 2519 01:42:46,720 --> 01:42:47,680 THANK YOU, DR. CHAN. 2520 01:42:47,680 --> 01:42:49,200 >>WELL, THANK YOU FOR THE 2521 01:42:49,200 --> 01:42:50,560 INVITATION, HAPPY TO BE HERE. 2522 01:42:50,560 --> 01:42:54,600 I'M GOING TO TRY TO SHARE MY 2523 01:42:54,600 --> 01:42:55,040 SLIDES. 2524 01:42:55,040 --> 01:42:58,640 DO YOU SEE PRESENTATION MODE? 2525 01:42:58,640 --> 01:43:00,680 HOPEFULLY THAT'S A YES. 2526 01:43:00,680 --> 01:43:00,920 >>YES. 2527 01:43:00,920 --> 01:43:02,480 >>SO AS SUSAN MENTIONED I'M 2528 01:43:02,480 --> 01:43:05,080 GOING TO TRY TO ADDRESS AND GIVE 2529 01:43:05,080 --> 01:43:07,160 OVERVIEW FROM A MOLECULAR 2530 01:43:07,160 --> 01:43:10,120 BIOLOGIST PERSPECTIVE, AS A 2531 01:43:10,120 --> 01:43:11,000 CARDIOLOGIST, VASCULAR 2532 01:43:11,000 --> 01:43:11,640 BIOLOGIST, THE LINK BETWEEN 2533 01:43:11,640 --> 01:43:14,960 VASCULAR DISEASE IN GENERAL AND 2534 01:43:14,960 --> 01:43:16,360 SLEEP APNEA, SPINNING WITH A 2535 01:43:16,360 --> 01:43:17,680 PRECISION MEDICINE LENS, THAT'S 2536 01:43:17,680 --> 01:43:20,200 A LOT OF WHERE THE THEMES ARE 2537 01:43:20,200 --> 01:43:21,960 GOING WITH THIS WORKSHOP. 2538 01:43:21,960 --> 01:43:25,320 THESE ARE MY DISCLOSURES. 2539 01:43:25,320 --> 01:43:28,600 TO START, WE HAVE HEARD THE 2540 01:43:28,600 --> 01:43:30,800 CONNECTION HAS BEEN KNOWN FOR 2541 01:43:30,800 --> 01:43:32,600 TWO DECADES, AN EXCERPT FROM A 2542 01:43:32,600 --> 01:43:33,680 SEMINAL NEW ENGLAND JOURNAL 2543 01:43:33,680 --> 01:43:35,280 PAPER FROM 2000 WHERE THEY 2544 01:43:35,280 --> 01:43:36,680 REPORTED ON SLEEP DISORDERED 2545 01:43:36,680 --> 01:43:37,880 BREATHING AND HYPERTENSION AND 2546 01:43:37,880 --> 01:43:40,560 IT WAS REPORTED THAT THERE WAS 2547 01:43:40,560 --> 01:43:42,240 PERSONS WITH INCREASING SEVERITY 2548 01:43:42,240 --> 01:43:43,440 OF SLEEP DISORDERED BREATHING 2549 01:43:43,440 --> 01:43:45,080 MEASURED BY AHI AND I KNOW THERE 2550 01:43:45,080 --> 01:43:46,800 ARE A LOT OF QUESTIONS ABOUT 2551 01:43:46,800 --> 01:43:48,920 THAT GOING FORWARD IN TERMS OF 2552 01:43:48,920 --> 01:43:50,440 ENDOTYPING BUT IN THIS CASE IT 2553 01:43:50,440 --> 01:43:52,400 WAS SEEN ACROSS THE BOARD IN 2554 01:43:52,400 --> 01:43:54,040 TERMS OF ASSOCIATION WITH 2555 01:43:54,040 --> 01:43:55,000 ADJUSTMENTS OF NON-MODIFIABLE 2556 01:43:55,000 --> 01:43:56,600 RISK FACTORS SUCH AS AGE AND SEX 2557 01:43:56,600 --> 01:44:03,120 AS WELL AS MODIFIABLE SUCH AS 2558 01:44:03,120 --> 01:44:06,080 HABITS, ALCOHOL AND SMOKING, THE 2559 01:44:06,080 --> 01:44:06,640 CONNECTION IS COMPELLING. 2560 01:44:06,640 --> 01:44:10,240 OVER THE PAST TWO DECADES DATA 2561 01:44:10,240 --> 01:44:12,760 HAVE BEEN GENERATED FOR MORE 2562 01:44:12,760 --> 01:44:14,600 ACUTE VASCULAR DISEASE LIKE 2563 01:44:14,600 --> 01:44:16,560 ACUTE CORONARY SYNDROME SHOWN 2564 01:44:16,560 --> 01:44:19,640 FROM A PUBLICATION IN 2015 WHERE 2565 01:44:19,640 --> 01:44:21,080 DISEASE SEVERITY OF ACS AS 2566 01:44:21,080 --> 01:44:25,760 REFLECTED BY NUMBER OF DISEASE 2567 01:44:25,760 --> 01:44:29,600 VESSELS, CARDIAC EJECTION 2568 01:44:29,600 --> 01:44:31,560 FRACTION AND TROPONIN ASSOCIATED 2569 01:44:31,560 --> 01:44:32,120 WITH SLEEP APNEA. 2570 01:44:32,120 --> 01:44:35,280 THIS WAS TAKEN FROM A WHITE 2571 01:44:35,280 --> 01:44:37,920 PAPER FROM 2017, BEYOND 2572 01:44:37,920 --> 01:44:40,120 HYPERTENSION AND ACS RISK AND 2573 01:44:40,120 --> 01:44:41,520 SEVERITY OF OTHER VASCULAR 2574 01:44:41,520 --> 01:44:43,520 DISEASES HAVE SHOWN ASSOCIATIONS 2575 01:44:43,520 --> 01:44:46,360 WITH SLEEP APNEA INCLUDING 2576 01:44:46,360 --> 01:44:47,240 STROKE, PULMONARY HYPERTENSION, 2577 01:44:47,240 --> 01:44:53,360 THE FOCUS OF THIS WORK SHOPPE 2578 01:44:53,360 --> 01:44:56,000 AND DIABETES AND DYSLIPIDEMIA. 2579 01:44:56,000 --> 01:45:00,520 PEOPLE ARE AT RISK FOR 2580 01:45:00,520 --> 01:45:02,440 CARDIOMYOPATHY, HEART FAILURE, 2581 01:45:02,440 --> 01:45:03,680 AND PORTENDS HIGHER 2582 01:45:03,680 --> 01:45:06,440 CARDIOVASCULAR MORTALITY RATE IN 2583 01:45:06,440 --> 01:45:08,480 GENERAL AS DR. BUYSSE SHOWED. 2584 01:45:08,480 --> 01:45:10,200 THERE'S ALSO AN INCREASING 2585 01:45:10,200 --> 01:45:12,040 APPRECIATION THAT THESE 2586 01:45:12,040 --> 01:45:12,800 CARDIOVASCULAR AND METABOLIC 2587 01:45:12,800 --> 01:45:17,880 CONSEQUENCES MAY IN TURN WORSEN 2588 01:45:17,880 --> 01:45:19,680 PATHOGENIC CAUSES TURNING THIS 2589 01:45:19,680 --> 01:45:21,200 INTO A BIDIRECTIONAL AND VICIOUS 2590 01:45:21,200 --> 01:45:22,320 DISEASE CYCLE. 2591 01:45:22,320 --> 01:45:23,920 THERE ARE A NUMBER OF KEY 2592 01:45:23,920 --> 01:45:25,040 KNOWLEDGE GAP QUESTIONS THAT WE 2593 01:45:25,040 --> 01:45:29,400 CAN GO INTO THIS TALK. 2594 01:45:29,400 --> 01:45:31,040 THE FIRST QUESTION IS THE ONE 2595 01:45:31,040 --> 01:45:34,120 WE'RE GOING TO SPEND THE MOST 2596 01:45:34,120 --> 01:45:35,080 TIME ON. 2597 01:45:35,080 --> 01:45:36,200 ESSENTIALLY EMPHASIZING WHAT IS 2598 01:45:36,200 --> 01:45:38,600 KNOWN IN THE FIELD AT THIS POINT 2599 01:45:38,600 --> 01:45:41,120 AND EMPHASIZING WHAT THE FUTURE 2600 01:45:41,120 --> 01:45:42,640 DIRECTIONS COULD BE PARTICULARLY 2601 01:45:42,640 --> 01:45:43,600 IF PRECISION MEDICINE MAY BE 2602 01:45:43,600 --> 01:45:47,640 ABLE TO FILL IN THE GAPS OF 2603 01:45:47,640 --> 01:45:49,120 KNOWLEDGE AND TRANSLATIONAL 2604 01:45:49,120 --> 01:45:49,480 IMPLEMENTATION. 2605 01:45:49,480 --> 01:45:51,520 THE FIRST QUESTION IS WHAT ARE 2606 01:45:51,520 --> 01:45:52,840 THE MOLECULAR MECHANISMS THAT WE 2607 01:45:52,840 --> 01:45:56,000 KNOW ABOUT THAT CONTROL THE 2608 01:45:56,000 --> 01:45:57,120 BIDIRECTIONAL RELATIONSHIP 2609 01:45:57,120 --> 01:45:59,640 BETWEEN SLEEP APNEA AND MULTIPLE 2610 01:45:59,640 --> 01:46:00,880 VASCULAR DISEASES? 2611 01:46:00,880 --> 01:46:01,720 CERTAINLY PULMONARY VASCULAR 2612 01:46:01,720 --> 01:46:02,720 DISEASE IS ONE OF THOSE BUT 2613 01:46:02,720 --> 01:46:05,760 THERE'S A LOT OF OVERLAP IN 2614 01:46:05,760 --> 01:46:07,040 TERMS OF VASCULAR PATHOBIOLOGY 2615 01:46:07,040 --> 01:46:08,600 IN GENERAL. 2616 01:46:08,600 --> 01:46:09,680 THINKING FIRST AT THE MOLECULAR 2617 01:46:09,680 --> 01:46:12,640 LEVEL WE KNOW SLEEP APNEA HAS 2618 01:46:12,640 --> 01:46:14,840 BEEN LINKED TO INTERMITTENT 2619 01:46:14,840 --> 01:46:17,240 HYPOXIA AND HYPOXEMIA, WE HAVE 2620 01:46:17,240 --> 01:46:20,200 EXPERTS WORKING ON THAT IN THIS 2621 01:46:20,200 --> 01:46:20,880 WORKSHOP. 2622 01:46:20,880 --> 01:46:26,320 THIS IS THE BASIS OF MOLECULAR 2623 01:46:26,320 --> 01:46:28,320 AND CELLULAR STUDIES RELATING TO 2624 01:46:28,320 --> 01:46:32,480 CONTROL OF BREATHING AND CONTROL 2625 01:46:32,480 --> 01:46:33,760 OF SEQUENCES ON PULMONARY 2626 01:46:33,760 --> 01:46:34,560 VASCULATURE. 2627 01:46:34,560 --> 01:46:35,840 CENTRAL IS THE MAJOR 2628 01:46:35,840 --> 01:46:39,600 TRANSCRIPTION FACTOR OR FACTORS 2629 01:46:39,600 --> 01:46:42,600 OF HYPOXIA, INDUCIBLE FACTORS, 2630 01:46:42,600 --> 01:46:43,440 HIF. 2631 01:46:43,440 --> 01:46:44,400 HIF ABILITIES TO REPROGRAM 2632 01:46:44,400 --> 01:46:50,840 RESPONSE IN TERMS OF OXYGEN 2633 01:46:50,840 --> 01:46:53,560 UTILIZATION, METABOLISM, ROS 2634 01:46:53,560 --> 01:46:59,560 FORMATION AND ANGIOGENESIS, IN 2635 01:46:59,560 --> 01:47:06,160 ADDITION TO HYPOXIA, THIS CAN 2636 01:47:06,160 --> 01:47:07,600 DRIVE INFLAMMATORY PROGRAMMING, 2637 01:47:07,600 --> 01:47:09,760 PRIMARILY THROUGH A NUMBER OF 2638 01:47:09,760 --> 01:47:11,320 CENTRAL TRANSCRIPTION FACTORS 2639 01:47:11,320 --> 01:47:12,160 SHOWN HERE, NF-kappaB, THERE 2640 01:47:12,160 --> 01:47:15,400 BE A NUMBER OF OTHERS KNOWN AT 2641 01:47:15,400 --> 01:47:16,680 THE LEVEL OF TRANSCRIPTOMICS 2642 01:47:16,680 --> 01:47:18,120 THAT ARE IN PLAY HERE. 2643 01:47:18,120 --> 01:47:27,440 NOTABLY IN CASES OF SLEEP APNEA, 2644 01:47:27,440 --> 01:47:29,160 FRAGMENTATION CAN DRIVE. 2645 01:47:29,160 --> 01:47:31,800 TOGETHER, THEY CAN DRIVE 2646 01:47:31,800 --> 01:47:32,920 DYSFUNCTION OF ENDOTHELIAL 2647 01:47:32,920 --> 01:47:36,400 BARRIER, IMMUNE RECRUITMENT OF 2648 01:47:36,400 --> 01:47:40,160 LEUKOCYTES AND MACROPHAGES, 2649 01:47:40,160 --> 01:47:41,200 INCREASED COLLAGENATION BY FOAM 2650 01:47:41,200 --> 01:47:43,400 CELLS AS WELL AS VASCULAR AND 2651 01:47:43,400 --> 01:47:45,720 SMOOTH MUSCLE REMODELING IN 2652 01:47:45,720 --> 01:47:48,920 GENERAL. 2653 01:47:48,920 --> 01:47:50,800 NOW, ALL OF THESE POINTS CAN 2654 01:47:50,800 --> 01:47:52,600 HAVE EVEN GREATER EFFECTS ON 2655 01:47:52,600 --> 01:47:53,720 MOLECULAR PROGRAMS IN THE 2656 01:47:53,720 --> 01:47:54,400 VASCULATURE. 2657 01:47:54,400 --> 01:47:57,640 THIS IS A CARTOON OF ENDOTHELIUM 2658 01:47:57,640 --> 01:47:59,640 WHERE THOSE PATHWAYS WHEN 2659 01:47:59,640 --> 01:48:01,160 INITIATED CAN FURTHER CONTROL 2660 01:48:01,160 --> 01:48:09,480 VASOMOTOR TONE, PLATELET 2661 01:48:09,480 --> 01:48:12,520 AGGREGATION, INCREASE APOPTOSIS 2662 01:48:12,520 --> 01:48:14,280 AND AFFECT SURVIVAL, AGAIN REDOX 2663 01:48:14,280 --> 01:48:16,280 STATE IS IMPORTANT IN THIS 2664 01:48:16,280 --> 01:48:17,560 REGARD AND DOWNSTREAM SMOOTH 2665 01:48:17,560 --> 01:48:18,880 MUSCLE REMODELING IN GENERAL. 2666 01:48:18,880 --> 01:48:21,000 IN RECENT YEARS NEW LANDSCAPES 2667 01:48:21,000 --> 01:48:27,640 OF REGULATORY MOLECULES 2668 01:48:27,640 --> 01:48:28,400 EMERGED. 2669 01:48:28,400 --> 01:48:31,840 IN THIS EXAMPLE FROM A BLUE 2670 01:48:31,840 --> 01:48:35,440 JOURNAL ARTICLE IN 2023 HYPOXIA 2671 01:48:35,440 --> 01:48:36,480 DEPENDENT microRNA 210 FOUND 2672 01:48:36,480 --> 01:48:41,640 TO BE CIRCULATING IN PLASMA, 2673 01:48:41,640 --> 01:48:44,600 IDENTIFIED AS A BIOMARKER AND A 2674 01:48:44,600 --> 01:48:47,200 MAJOR REGULATOR OF INFLAMMATION, 2675 01:48:47,200 --> 01:48:49,640 METABOLIC SYNDROME AND 2676 01:48:49,640 --> 01:48:51,040 METABOLISM AND PULMONARY 2677 01:48:51,040 --> 01:48:52,160 VASCULAR FUNCTION IN SLEEP 2678 01:48:52,160 --> 01:48:53,640 RELATED DISORDERS. 2679 01:48:53,640 --> 01:48:58,040 THESE FINDINGS OFFER US A WINDOW 2680 01:48:58,040 --> 01:49:01,240 AND IMPETUS TO LOOK PRECISELY AT 2681 01:49:01,240 --> 01:49:04,160 THESE NEW PERHAPS EMERGING 2682 01:49:04,160 --> 01:49:05,960 SYSTEMS OR MULTIOMICS LEVEL OF 2683 01:49:05,960 --> 01:49:09,320 DATA TO DEFINE FULL MOLECULAR 2684 01:49:09,320 --> 01:49:12,200 PROFILE THAT'S ALTERED IN SLEEP 2685 01:49:12,200 --> 01:49:16,120 APNEA AND VASCULAR DISEASE. 2686 01:49:16,120 --> 01:49:17,760 BEYOND MOLECULES, IN ADDITION 2687 01:49:17,760 --> 01:49:19,600 AND BEYOND THAT, SLEEP APNEA 2688 01:49:19,600 --> 01:49:23,000 ALSO IS KNOWN TO HAVE MANY 2689 01:49:23,000 --> 01:49:25,400 EFFECTS ON COMPLEX 2690 01:49:25,400 --> 01:49:26,640 INTERRELATIONSHIPS BETWEEN THE 2691 01:49:26,640 --> 01:49:27,520 SYMPATHETIC NERVOUS SYSTEM AND 2692 01:49:27,520 --> 01:49:29,320 CARDIOVASCULAR TISSUE. 2693 01:49:29,320 --> 01:49:30,440 DR. SHAH'S TALK ALSO TOUCHED 2694 01:49:30,440 --> 01:49:35,920 UPON THIS AS WELL. 2695 01:49:35,920 --> 01:49:37,440 THIS CARTOON FROM 2014 DESCRIBED 2696 01:49:37,440 --> 01:49:38,960 THIS, UNDER BASELINE CONDITIONS 2697 01:49:38,960 --> 01:49:42,920 AND PANEL A ON THE LEFT NORMAL 2698 01:49:42,920 --> 01:49:45,000 VENTILATION AND NORMOXIA CAN 2699 01:49:45,000 --> 01:49:46,280 REGULATE INHIBITOR AND 2700 01:49:46,280 --> 01:49:49,040 EXCITATORY NEURAL INPUT TO THE 2701 01:49:49,040 --> 01:49:50,360 BRAINSTEM, AND WITH MODULATORS 2702 01:49:50,360 --> 01:49:54,040 CAN LEAD TO A BASELINE 2703 01:49:54,040 --> 01:49:54,600 HOMEOSTASIS OF SYMPATHETIC 2704 01:49:54,600 --> 01:49:56,040 NEURAL ACTIVITY THAT LEADS TO 2705 01:49:56,040 --> 01:49:58,160 REGULATION OF BLOOD PRESSURE AND 2706 01:49:58,160 --> 01:49:59,000 CARDIAC FUNCTION. 2707 01:49:59,000 --> 01:50:00,800 HOWEVER, UNDER CONDITIONS OF 2708 01:50:00,800 --> 01:50:04,160 APNEA WHICH INHIBIT THIS 2709 01:50:04,160 --> 01:50:06,680 INHIBITORY INPUT, HYPOXIA WHICH 2710 01:50:06,680 --> 01:50:08,000 EXCITES NEURAL ACTIVITY ACROSS 2711 01:50:08,000 --> 01:50:11,480 THE BRAINSTEM CAN LEAD TO 2712 01:50:11,480 --> 01:50:19,920 EXCESSIVE SUSTAINED SYMPATHETIC 2713 01:50:19,920 --> 01:50:21,760 ACTIVITY, ULTIMATELY END ORGAN 2714 01:50:21,760 --> 01:50:22,200 DAMAGE. 2715 01:50:22,200 --> 01:50:25,800 INTERESTINGLY THERE IS EMERGING 2716 01:50:25,800 --> 01:50:28,120 WORK NOW SUGGESTING THAT THESE 2717 01:50:28,120 --> 01:50:29,200 CARDIOVASCULAR DISEASE STATES 2718 01:50:29,200 --> 01:50:32,920 CAN FEED BACK AND REINFORCE SUCH 2719 01:50:32,920 --> 01:50:37,680 DYSFUNCTION ACROSS SPINAL CORD 2720 01:50:37,680 --> 01:50:39,840 GANGLIA AND COGNITIVE FUNCTION 2721 01:50:39,840 --> 01:50:42,280 DRIVING THE CYCLE OF DISEASE. 2722 01:50:42,280 --> 01:50:46,760 THIS IS COMING FROM A RECENT 2723 01:50:46,760 --> 01:50:57,280 REVIEW, KNOWS SAME PRINCIPLES 2724 01:50:57,640 --> 01:51:00,320 CAN PROMOTE PATHOGENIC VASCULAR 2725 01:51:00,320 --> 01:51:02,160 AND THROMBOTIC COMPLICATIONS. 2726 01:51:02,160 --> 01:51:03,280 THIS FOCUSES ON VASCULAR 2727 01:51:03,280 --> 01:51:05,600 COMPLICATIONS, IT IS IMPORTANT 2728 01:51:05,600 --> 01:51:08,840 TO NOTE THAT THERE ARE KNOWN 2729 01:51:08,840 --> 01:51:10,800 THORACIC AND CARDIAC HEMODYNAMIC 2730 01:51:10,800 --> 01:51:15,280 COUPLING AVENUES THAT LEAD TO AN 2731 01:51:15,280 --> 01:51:18,920 INCREASE THE REALM OF 2732 01:51:18,920 --> 01:51:21,320 INTRATHORACIC PRESSURE SWINGS IN 2733 01:51:21,320 --> 01:51:23,720 SLEEP APNEA, THAT COUPLING 2734 01:51:23,720 --> 01:51:25,480 ALTERS PRE-LOAD AND AFTER-LOAD 2735 01:51:25,480 --> 01:51:31,400 SPECIFICALLY SEEN BY THE LEFT 2736 01:51:31,400 --> 01:51:32,600 VENTRICLE, LEADING TO FIBROSIS 2737 01:51:32,600 --> 01:51:35,760 AND REMODELING OF CARDIAC 2738 01:51:35,760 --> 01:51:41,720 TISSUE, LEADING TO HEART 2739 01:51:41,720 --> 01:51:42,160 FAILURE. 2740 01:51:42,160 --> 01:51:45,320 I WANT TO NOTE THERE ARE MORE 2741 01:51:45,320 --> 01:51:46,440 ADVANCES EMERGING IN 2742 01:51:46,440 --> 01:51:48,840 UNDERSTANDING HOW OTHER ORGAN 2743 01:51:48,840 --> 01:51:50,680 SYSTEMS RELATE TO BOTH SLEEP 2744 01:51:50,680 --> 01:51:51,880 APNEA AND VASCULAR DISEASE. 2745 01:51:51,880 --> 01:51:54,720 THIS IS AN EXAMPLE OF THE GUT 2746 01:51:54,720 --> 01:51:56,920 MICROBIOME, HOW THOSE CHANGES IN 2747 01:51:56,920 --> 01:51:59,440 THE GUT MICROBIOME MAY ACTUALLY 2748 01:51:59,440 --> 01:52:03,200 BE ALTERED WITH SLEEP APNEA AND 2749 01:52:03,200 --> 01:52:03,800 CARDIOVASCULAR DYSFUNCTION AND 2750 01:52:03,800 --> 01:52:06,440 WHETHER OR NOT IT REMAINS TO BE 2751 01:52:06,440 --> 01:52:09,840 SEEN IF SELECTIVE OR PRECISE 2752 01:52:09,840 --> 01:52:14,000 PROBIOTIC MODULATION OF THE GUT 2753 01:52:14,000 --> 01:52:15,840 MICROBIOME CAN BE USED AS A 2754 01:52:15,840 --> 01:52:21,560 NOVEL THEY HAVE -- THERAPEUTIC. 2755 01:52:21,560 --> 01:52:24,160 IN ADDITION, WHAT IS THE 2756 01:52:24,160 --> 01:52:25,600 RELATIONSHIP BETWEEN THOSE AND 2757 01:52:25,600 --> 01:52:28,080 SPECIFIC VASCULAR DISEASES THAT 2758 01:52:28,080 --> 01:52:29,880 WE'RE SEEING, PULMONARY AND 2759 01:52:29,880 --> 01:52:30,440 PERIPHERAL. 2760 01:52:30,440 --> 01:52:32,480 SO IN THAT CONTEXT, I FOUND AT 2761 01:52:32,480 --> 01:52:34,800 LEAST IN TERMS OF A LOT OF 2762 01:52:34,800 --> 01:52:35,880 REVIEWS OUT THERE THAT THERE'S 2763 01:52:35,880 --> 01:52:39,600 QUITE A BIT OF OVERLAP BETWEEN 2764 01:52:39,600 --> 01:52:41,040 THOSE PATHOGENIC PROGRAMS ACROSS 2765 01:52:41,040 --> 01:52:44,560 THESE VASCULAR STATES. 2766 01:52:44,560 --> 01:52:48,720 EXAMPLE HERE IS ATHEROSCLEROSIS, 2767 01:52:48,720 --> 01:52:49,880 OBVIOUSLY CORONARY ARTERY 2768 01:52:49,880 --> 01:52:52,880 DISEASE, ACUTE CORONARY SYNDROME 2769 01:52:52,880 --> 01:52:54,960 AND STROKE ASSOCIATED WITH 2770 01:52:54,960 --> 01:52:57,240 OBSTRUCTIVE SLEEP APNEA THOUGHT 2771 01:52:57,240 --> 01:53:02,920 TO BE REGULATED BY SAME 2772 01:53:02,920 --> 01:53:03,920 PATHOGENIC PATHWAYS REPRESENTED 2773 01:53:03,920 --> 01:53:05,800 WITHIN THESE GIVEN STATES. 2774 01:53:05,800 --> 01:53:07,640 I WANT TO EMPHASIZE THAT IN 2775 01:53:07,640 --> 01:53:10,800 ADDITION TO THE DIRECT HYPOXIC 2776 01:53:10,800 --> 01:53:14,440 AND INFLAMMATORY MECHANISMS THAT 2777 01:53:14,440 --> 01:53:16,520 AFFECT CARDIAC AND VASCULAR 2778 01:53:16,520 --> 01:53:19,000 TISSUE SHOULD NOT FORGET 2779 01:53:19,000 --> 01:53:21,200 CONVERGES OF PATHOGENIC EFFECTS 2780 01:53:21,200 --> 01:53:23,600 THAT'S APPRECIATED THROUGH SLEEP 2781 01:53:23,600 --> 01:53:29,080 APNEA ALTERATIONS OF INSULIN 2782 01:53:29,080 --> 01:53:31,720 RESISTANCE AND DIABETES, 2783 01:53:31,720 --> 01:53:32,920 PANCREATIC AND ADIPOCYTE 2784 01:53:32,920 --> 01:53:34,680 FUNCTION BY SLEEP DISORDERED 2785 01:53:34,680 --> 01:53:35,120 BREATHING. 2786 01:53:35,120 --> 01:53:37,640 I WON'T GO INTO DETAIL HOW THEY 2787 01:53:37,640 --> 01:53:38,480 DRIVE PULMONARY HYPERTENSION, 2788 01:53:38,480 --> 01:53:40,800 WE'RE GOING TO SEE MULTIPLE 2789 01:53:40,800 --> 01:53:42,520 DETAILED TALKS, AND DR. SHAH 2790 01:53:42,520 --> 01:53:44,200 ALREADY MENTIONED THIS, I THINK 2791 01:53:44,200 --> 01:53:46,400 I WOULD EMPHASIZE THAT WE KNOW 2792 01:53:46,400 --> 01:53:48,160 THERE ARE MECHANISMS THAT ARE 2793 01:53:48,160 --> 01:53:49,760 SURROUNDING THE DEVELOPMENT OF 2794 01:53:49,760 --> 01:53:55,600 BOTH PRE-CAPILLARY AS WELL AS 2795 01:53:55,600 --> 01:53:56,080 POST-CAPILLARY PULMONARY 2796 01:53:56,080 --> 01:53:58,000 HYPERTENSION CENTRALIZED IN 2797 01:53:58,000 --> 01:54:01,840 TERMS OF APNEIC EVENTS AS WELL 2798 01:54:01,840 --> 01:54:03,360 AS NEGATIVE INTERTHORACIC 2799 01:54:03,360 --> 01:54:05,320 PRESSURE LEADING TO RV 2800 01:54:05,320 --> 01:54:06,200 DYSFUNCTION, FROM THE 2801 01:54:06,200 --> 01:54:07,640 POST-CAPILLARY STANDPOINT AGAIN 2802 01:54:07,640 --> 01:54:11,240 THE IDEA OF RV STRAIN DUE TO 2803 01:54:11,240 --> 01:54:12,680 INCREASED VENOUS RETURN FROM THE 2804 01:54:12,680 --> 01:54:16,160 NEGATIVE PRESSURE CAN LEAD TO A 2805 01:54:16,160 --> 01:54:18,920 CASCADING EFFECT ULTIMATELY 2806 01:54:18,920 --> 01:54:22,160 REDUCING LV FILLING, INCREASING 2807 01:54:22,160 --> 01:54:23,160 SYMPATHETIC TONE, COMPROMISING 2808 01:54:23,160 --> 01:54:25,920 LV FUNCTION IN THE 2809 01:54:25,920 --> 01:54:27,200 POST-CAPILLARY STATE, SOMETHING 2810 01:54:27,200 --> 01:54:29,520 STILL ONGOING IN TERMS OF 2811 01:54:29,520 --> 01:54:30,840 INVESTIGATION, WE STILL DON'T 2812 01:54:30,840 --> 01:54:33,000 UNDERSTAND PRECISELY WHAT THE 2813 01:54:33,000 --> 01:54:34,760 MOLECULAR MECHANISMS ARE THAT 2814 01:54:34,760 --> 01:54:36,520 DIFFERENTIATE THOSE TWO. 2815 01:54:36,520 --> 01:54:39,680 AS MENTIONED PREVIOUSLY THERE IS 2816 01:54:39,680 --> 01:54:42,080 ADVANCING APPRECIATION OF 2817 01:54:42,080 --> 01:54:43,000 BIDIRECTIONAL RELATIONSHIPS 2818 01:54:43,000 --> 01:54:44,920 COLLECTING SLEEP APNEA AND 2819 01:54:44,920 --> 01:54:45,520 CARDIOVASCULAR DISEASE, NAMELY 2820 01:54:45,520 --> 01:54:51,080 THROUGH THE SAME THORACIC 2821 01:54:51,080 --> 01:54:51,960 CARDIOVASCULAR COUPLING THAT 2822 01:54:51,960 --> 01:54:53,800 WORSENS CARDIAC FUNCTION AND 2823 01:54:53,800 --> 01:55:00,600 THAT CAN FEED BACK AND AUGMENT 2824 01:55:00,600 --> 01:55:04,520 INTERTHORACIC SWINGS, CHRONIC 2825 01:55:04,520 --> 01:55:05,840 INFLAMMATION IS PATHOGENIC FOR 2826 01:55:05,840 --> 01:55:11,080 VASCULAR DISEASE AND SLEEP 2827 01:55:11,080 --> 01:55:13,880 REDUCTION AND NEURAL ACTIVITY 2828 01:55:13,880 --> 01:55:17,320 WORSENS SLEEP EFFICIENCY, AT THE 2829 01:55:17,320 --> 01:55:20,400 MOLECULAR AND PATHWAY LEVEL 2830 01:55:20,400 --> 01:55:22,360 INFLAMMATION, HYPOXIA AND HEART 2831 01:55:22,360 --> 01:55:25,520 FAILURE ARE DRIVEN AND DRIVE 2832 01:55:25,520 --> 01:55:26,320 SYMPATHETIC ACTIVATION. 2833 01:55:26,320 --> 01:55:28,520 SO, FINAL WORD ABOUT SOME 2834 01:55:28,520 --> 01:55:29,080 MOLECULAR MECHANISMS, WE'RE 2835 01:55:29,080 --> 01:55:32,320 STILL IN THE MIDST OF TRYING TO 2836 01:55:32,320 --> 01:55:33,520 UNDERSTAND MORE PRECISELY THE 2837 01:55:33,520 --> 01:55:35,240 LANDSCAPE OF MOLECULES AND 2838 01:55:35,240 --> 01:55:36,480 PATHWAYS THAT ARE IMPORTANT, 2839 01:55:36,480 --> 01:55:40,000 THERE ARE SOME UNMET NEEDS TO DO 2840 01:55:40,000 --> 01:55:40,440 THAT. 2841 01:55:40,440 --> 01:55:41,320 FUTURE DIRECTIONS FOR 2842 01:55:41,320 --> 01:55:43,400 FUNDAMENTAL INSIGHT IN THIS 2843 01:55:43,400 --> 01:55:47,000 REGARD SHOULD INCLUDE NEED FOR 2844 01:55:47,000 --> 01:55:48,640 MORE SPECIFIC SLEEP RELEVANT 2845 01:55:48,640 --> 01:55:51,160 ANIMAL MODELS THAT GO BEYOND 2846 01:55:51,160 --> 01:55:51,880 INTERMITTENT HYPOXIA. 2847 01:55:51,880 --> 01:55:54,800 I BELIEVE THAT WE'RE NOW IN AN 2848 01:55:54,800 --> 01:55:57,040 AGE WHERE EX VIVO SYNTHETIC 2849 01:55:57,040 --> 01:55:59,600 BIOLOGY MODELS, SO FOR INSTANCE 2850 01:55:59,600 --> 01:56:00,480 ENGINEERED 3D BIOPRINTED 2851 01:56:00,480 --> 01:56:02,760 TISSUES, EXAMPLE HERE IS 2852 01:56:02,760 --> 01:56:04,840 BIOPRINTED HEART FROM OUR 2853 01:56:04,840 --> 01:56:07,480 INSTITUTE, MAY BE VERY USEFUL IN 2854 01:56:07,480 --> 01:56:10,320 TERMS OF IDENTIFYING MECHANISMS 2855 01:56:10,320 --> 01:56:12,280 AND SCREENING FOR THERAPEUTIC 2856 01:56:12,280 --> 01:56:12,600 APPLICATIONS. 2857 01:56:12,600 --> 01:56:16,240 OF COURSE, THE NEED FOR 2858 01:56:16,240 --> 01:56:20,080 A.I.-DRIVEN MACHINE LEARNING AND 2859 01:56:20,080 --> 01:56:21,360 MULTIOMIC PROFILING OF 2860 01:56:21,360 --> 01:56:23,000 OBSTRUCTIVE SLEEP APNEA AND 2861 01:56:23,000 --> 01:56:24,440 LINKED CARDIOVASCULAR DISEASE 2862 01:56:24,440 --> 01:56:25,880 ARE ONGOING, WE'LL HEAR MORE BUT 2863 01:56:25,880 --> 01:56:30,680 THE NEED IS PROMINENT IN THAT 2864 01:56:30,680 --> 01:56:31,960 REGARD TO MAKE PROGRESS. 2865 01:56:31,960 --> 01:56:34,480 IN TERMS OF SECOND QUESTION, 2866 01:56:34,480 --> 01:56:36,560 WHAT ROLE DOES GENETICS PLAY IN 2867 01:56:36,560 --> 01:56:38,880 CONTROLLING LINK BETWEEN SLEEP 2868 01:56:38,880 --> 01:56:40,720 APNEA AND VASCULAR DISEASE, 2869 01:56:40,720 --> 01:56:44,200 TOUCHED UPON IN PRIOR TALKS BUT 2870 01:56:44,200 --> 01:56:48,640 A NUMBER OF GENOME I'D 2871 01:56:48,640 --> 01:56:50,120 ASSOCIATION STUDIES IDENTIFIED 2872 01:56:50,120 --> 01:56:50,440 POLYMORPHISMS. 2873 01:56:50,440 --> 01:56:52,520 HOWEVER, THERE'S SPARSE DATA 2874 01:56:52,520 --> 01:56:53,960 LINKING THESE PARTICULAR SNPs 2875 01:56:53,960 --> 01:56:57,480 TO A DYNAMIC RISK OF VASCULAR 2876 01:56:57,480 --> 01:56:58,880 DISEASE AND FURTHERMORE THE 2877 01:56:58,880 --> 01:57:04,360 GENOMIC OR GENE REGULATORY 2878 01:57:04,360 --> 01:57:06,680 MECHANISMS HAVE NOT BEEN 2879 01:57:06,680 --> 01:57:07,000 EXPLORED. 2880 01:57:07,000 --> 01:57:09,000 IF SLEEP ENDOTYPES AS DISCUSSED 2881 01:57:09,000 --> 01:57:12,000 ELEGANTLY BY DR. SHAH COULD BE 2882 01:57:12,000 --> 01:57:13,360 ADJUDICATED PRECISELY WE AS A 2883 01:57:13,360 --> 01:57:16,440 COMMUNITY ARE IN A POSITION TO 2884 01:57:16,440 --> 01:57:20,800 LEVERAGE SOME EXISTING AT LARGE 2885 01:57:20,800 --> 01:57:23,080 POPULATION COHORTS, EXAMPLES 2886 01:57:23,080 --> 01:57:25,600 INCLUDING U.K. BIOBANK, I WAS 2887 01:57:25,600 --> 01:57:28,520 INTRIGUED BY A RECENT 2888 01:57:28,520 --> 01:57:30,840 PRESENTATION AT THE AAJ SESSION 2889 01:57:30,840 --> 01:57:36,200 WHERE IS MGH GROUP UTILIZED THE 2890 01:57:36,200 --> 01:57:45,760 U.K. BIOBANK MRI DATA, THOSE 2891 01:57:45,760 --> 01:57:48,600 HITS COULD BE ANALYZED THROUGH 2892 01:57:48,600 --> 01:57:50,000 SLEEP DISORDERED BREATHING TO 2893 01:57:50,000 --> 01:57:52,080 GAIN INSIGHTS OF GENETIC FACTORS 2894 01:57:52,080 --> 01:57:54,240 DRIVING AGAIN THOSE CONNECTIONS 2895 01:57:54,240 --> 01:57:56,440 OF SLEEP APNEA AND PULMONARY 2896 01:57:56,440 --> 01:57:59,520 VASCULAR AND EVEN PERIPHERAL 2897 01:57:59,520 --> 01:58:01,920 VASCULAR DISEASE. 2898 01:58:01,920 --> 01:58:04,320 FINALLY, CAN MULTI-MODALITY 2899 01:58:04,320 --> 01:58:05,800 THERAPIES REDUCE CARDIOVASCULAR 2900 01:58:05,800 --> 01:58:07,080 DISEASE OR SEVERITY? 2901 01:58:07,080 --> 01:58:08,480 THIS IS A BURNING QUESTION. 2902 01:58:08,480 --> 01:58:11,200 THERE'S A LONG HISTORY OF DATA 2903 01:58:11,200 --> 01:58:12,760 SHOWING CPAP OR CONTINUOUS 2904 01:58:12,760 --> 01:58:15,320 POSITIVE AIR WAY PRESSURE IS 2905 01:58:15,320 --> 01:58:18,360 IMPROVE MULTIPLE MOLECULAR 2906 01:58:18,360 --> 01:58:20,320 INDICES OF HYPOXIA, 2907 01:58:20,320 --> 01:58:20,800 INFLAMMATION, VASCULAR 2908 01:58:20,800 --> 01:58:22,280 DYSFUNCTION, SHOWN HERE, AND IN 2909 01:58:22,280 --> 01:58:23,400 THIS SUMMARY TABLE THERE HAVE 2910 01:58:23,400 --> 01:58:25,680 BEEN A NUMBER OF CLINICAL 2911 01:58:25,680 --> 01:58:27,560 STUDIES DEMONSTRATING BENEFIT OF 2912 01:58:27,560 --> 01:58:29,520 CPAP, PARTICULARLY IN PRIMARY 2913 01:58:29,520 --> 01:58:30,920 PREVENTION OF HYPERTENSION AND 2914 01:58:30,920 --> 01:58:32,440 OTHER CARDIOVASCULAR EVENTS, 2915 01:58:32,440 --> 01:58:38,040 THERE'S DATA ALSO REGARDING 2916 01:58:38,040 --> 01:58:41,440 BENEFIT OF USING CPAP BUT NOT 2917 01:58:41,440 --> 01:58:44,320 ALL DATA ARE CLEAN AND POSITIVE. 2918 01:58:44,320 --> 01:58:46,920 EXAMPLE IS THIS ISAAC STUDY, 2919 01:58:46,920 --> 01:58:48,560 MANY INVESTIGATORS ARE VERY 2920 01:58:48,560 --> 01:58:51,400 FAMILIAR WITH THIS, WERE PART OF 2921 01:58:51,400 --> 01:58:52,960 THAT TRIAL, SHOWING NO 2922 01:58:52,960 --> 01:58:54,800 SIGNIFICANT BENEFIT IN REDUCING 2923 01:58:54,800 --> 01:58:56,080 PREVALENCE OF ACUTE CORONARY 2924 01:58:56,080 --> 01:58:58,280 SYNDROME WHEN NOT FULLY 2925 01:58:58,280 --> 01:59:00,160 ENDOTYPING THAT POPULATION. 2926 01:59:00,160 --> 01:59:00,920 SO THE QUESTION REMAINS WHETHER 2927 01:59:00,920 --> 01:59:04,440 OR NOT THERE ARE ENDOTYPES WHERE 2928 01:59:04,440 --> 01:59:06,440 CPAP COULD BE HELPFUL OR PERHAPS 2929 01:59:06,440 --> 01:59:07,920 WE SHOULD BE THINKING MORE AT 2930 01:59:07,920 --> 01:59:08,800 THE PRECISION LEVEL. 2931 01:59:08,800 --> 01:59:10,800 THAT'S TO SAY THE SIMPLE 2932 01:59:10,800 --> 01:59:12,760 MODULATION OF CPAP FOR AIRWAY 2933 01:59:12,760 --> 01:59:14,840 ANATOMY MAY BE THE TIP OF THE 2934 01:59:14,840 --> 01:59:17,200 ICEBERG IN ORDER TO INTERVENE 2935 01:59:17,200 --> 01:59:18,680 ACROSS ASSOCIATED DETERMINANTS 2936 01:59:18,680 --> 01:59:20,560 AS WELL AS MOLECULAR 2937 01:59:20,560 --> 01:59:23,120 DETERMINANTS IN THIS REGARD 2938 01:59:23,120 --> 01:59:24,400 GENETICALLY AND OTHERWISE. 2939 01:59:24,400 --> 01:59:26,680 I'D LIKE TO END, I SHOULD BE 2940 01:59:26,680 --> 01:59:28,440 RIGHT ON TIME, CONCLUDE WE 2941 01:59:28,440 --> 01:59:30,400 CONTINUE TO BUILD OUR 2942 01:59:30,400 --> 01:59:33,800 UNDERSTANDING OF THE MOLECULAR 2943 01:59:33,800 --> 01:59:34,280 PHYSIOLOGIC AND GENETIC 2944 01:59:34,280 --> 01:59:37,640 MECHANISMS THAT CONTROL WHAT ARE 2945 01:59:37,640 --> 01:59:38,520 BIDIRECTIONAL RELATIONSHIPS 2946 01:59:38,520 --> 01:59:40,480 BETWEEN SLEEP APNEA AND A NUMBER 2947 01:59:40,480 --> 01:59:42,040 OF VASCULAR DISEASES. 2948 01:59:42,040 --> 01:59:43,680 I THINK THAT FUTURE WORK, AND 2949 01:59:43,680 --> 01:59:45,280 I'D LOVE TO DISCUSS THIS MORE 2950 01:59:45,280 --> 01:59:48,680 WITH YOU ALL, SHOULD SEEK TO 2951 01:59:48,680 --> 01:59:50,640 PROMOTE MULTIOMIC PROFILING AND 2952 01:59:50,640 --> 01:59:53,200 ADVANCE DISEASE MODELING SO 2953 01:59:53,200 --> 01:59:54,480 COMPUTATIONAL METHODOLOGIES IN 2954 01:59:54,480 --> 01:59:55,560 THIS SPACE TO BROADEN 2955 01:59:55,560 --> 01:59:56,320 FUNDAMENTAL UNDERSTANDING OF 2956 01:59:56,320 --> 01:59:57,120 THIS CONNECTION. 2957 01:59:57,120 --> 01:59:59,280 I THINK IT'S IMPORTANT TO 2958 01:59:59,280 --> 02:00:02,160 ACTUALLY HAVE MORE THAN JUST 2959 02:00:02,160 --> 02:00:08,280 SIMPLY IN VITRO AND TO 2960 02:00:08,280 --> 02:00:09,240 UNDERSTAND ENGINEERED SYNTHETIC 2961 02:00:09,240 --> 02:00:10,680 BIOLOGY MODELS TO ADVANCE 2962 02:00:10,680 --> 02:00:13,040 FURTHER AND THAT WOULD HOPEFULLY 2963 02:00:13,040 --> 02:00:15,640 MOVE US BEYOND AND/OR IN 2964 02:00:15,640 --> 02:00:18,480 ADDITION TO IDENTIFYING HOUSE 2965 02:00:18,480 --> 02:00:21,000 CPAP AND OTHER MULTI-MODAL 2966 02:00:21,000 --> 02:00:21,960 THERAPEUTICS MAY REDUCE 2967 02:00:21,960 --> 02:00:23,640 CARDIOVASCULAR DISEASE IN SLEEP 2968 02:00:23,640 --> 02:00:23,960 APNEA. 2969 02:00:23,960 --> 02:00:25,040 WITH THAT, I'D LIKE TO END. 2970 02:00:25,040 --> 02:00:26,560 THANK YOU FOR YOUR ATTENTION. 2971 02:00:26,560 --> 02:00:28,400 HAPPY TO TAKE QUESTIONS. 2972 02:00:28,400 --> 02:00:29,520 AND ENGAGE IN DISCUSSION WITH 2973 02:00:29,520 --> 02:00:32,360 YOU ALL. 2974 02:00:32,360 --> 02:00:33,120 THANK YOU VERY MUCH. 2975 02:00:33,120 --> 02:00:35,440 >>DR. CHAN, I FEEL LIKE I KEEP 2976 02:00:35,440 --> 02:00:37,000 REPEATING MYSELF, BUT EVERY TALK 2977 02:00:37,000 --> 02:00:39,920 HAS BEEN SO FANTASTIC, AS YOURS 2978 02:00:39,920 --> 02:00:40,200 WAS. 2979 02:00:40,200 --> 02:00:44,040 AND AGAIN, I SO APPRECIATE YOU 2980 02:00:44,040 --> 02:00:45,640 NOT ONLY ELUCIDATING SOME OF THE 2981 02:00:45,640 --> 02:00:48,280 MULTIPLE PATHWAYS BUT THESE 2982 02:00:48,280 --> 02:00:50,160 MOLECULAR MECHANISMS. 2983 02:00:50,160 --> 02:00:55,080 SO WHAT WE'LL DO NOW IS ANNA AND 2984 02:00:55,080 --> 02:00:56,520 I WILL CO-FACILITATE THIS 2985 02:00:56,520 --> 02:00:56,840 DISCUSSION. 2986 02:00:56,840 --> 02:00:59,560 WHAT WE WILL BE DOING AGAIN, IF 2987 02:00:59,560 --> 02:01:02,400 YOU CAN USE THE CHAT BOX, IF YOU 2988 02:01:02,400 --> 02:01:06,560 PREFER, BUT JUST AS EASY TO 2989 02:01:06,560 --> 02:01:07,600 RAISE YOUR HAND. 2990 02:01:07,600 --> 02:01:11,600 WE HAVE NOT ONLY THE 2991 02:01:11,600 --> 02:01:13,240 PARTICIPANTS BUT DISCUSSANTS 2992 02:01:13,240 --> 02:01:14,000 INCLUDING EARLIER STAGE 2993 02:01:14,000 --> 02:01:15,560 INVESTIGATORS AND WE WANT TO 2994 02:01:15,560 --> 02:01:17,280 HEAR YOUR VOICES AND QUESTIONS 2995 02:01:17,280 --> 02:01:17,520 TOO. 2996 02:01:17,520 --> 02:01:19,360 BUT BEFORE I OPEN THIS UP TO 2997 02:01:19,360 --> 02:01:23,080 EVERYONE LET ME GO BACK TO MY 2998 02:01:23,080 --> 02:01:27,040 PROMISE TO GIVE AN OPPORTUNITY 2999 02:01:27,040 --> 02:01:30,120 ASK HER QUESTION FROM ONE 3000 02:01:30,120 --> 02:01:30,360 BEFORE. 3001 02:01:30,360 --> 02:01:31,120 >>THANK YOU. 3002 02:01:31,120 --> 02:01:35,280 MY QUESTION FOR DR. SHAH. 3003 02:01:35,280 --> 02:01:35,800 SPECIFICALLY, AROUND THE 3004 02:01:35,800 --> 02:01:38,080 FINDINGS OF HARM WITH CPAP IN 3005 02:01:38,080 --> 02:01:40,400 PATIENTS WITH REDUCE THE HEART 3006 02:01:40,400 --> 02:01:42,680 RATE RESPONSE AFTER CERTAIN 3007 02:01:42,680 --> 02:01:43,360 EPISODES. 3008 02:01:43,360 --> 02:01:46,080 THE QUESTION COMES DOWN AROUND 3009 02:01:46,080 --> 02:01:49,600 WE KNOW PATIENTS HAVE AUTONOMIC 3010 02:01:49,600 --> 02:01:50,600 DYSFUNCTION THAT LIMITS THEIR 3011 02:01:50,600 --> 02:01:52,240 ABILITY TO MOUNT A HEART RATE 3012 02:01:52,240 --> 02:01:58,880 RESPONSE, THIS HAS BEEN WELL 3013 02:01:58,880 --> 02:01:59,200 DOCUMENTED. 3014 02:01:59,200 --> 02:02:01,320 HEART RATE VARIABILITY IN FREE 3015 02:02:01,320 --> 02:02:02,200 LIVING ENVIRONMENTS OR SLEEP, 3016 02:02:02,200 --> 02:02:04,800 BUT IN MY MIND I WOULD THINK 3017 02:02:04,800 --> 02:02:06,360 PATIENTS WITH MORE SEVERE 3018 02:02:06,360 --> 02:02:07,240 PULMONARY HYPERTENSION WOULD 3019 02:02:07,240 --> 02:02:09,200 FALL INTO THE SECOND CATEGORY OF 3020 02:02:09,200 --> 02:02:10,640 PATIENTS THAT CAN'T MOUNT A 3021 02:02:10,640 --> 02:02:13,040 HEART RATE RESPONSE AFTER 3022 02:02:13,040 --> 02:02:15,640 EPISODES WITH SLEEP, YOU KNOW, 3023 02:02:15,640 --> 02:02:18,720 AND THAT GROUP ALSO HAD WORSE 3024 02:02:18,720 --> 02:02:19,040 OUTCOMES. 3025 02:02:19,040 --> 02:02:23,080 I WAS WONDERING, NUMBER ONE, IF 3026 02:02:23,080 --> 02:02:28,680 YOU KNEW, HYPOTHESES AND 3027 02:02:28,680 --> 02:02:31,200 LOOKING AT HEART RATE RESPONSE 3028 02:02:31,200 --> 02:02:33,560 IN PRIMARY HYPERTENSION WITH 3029 02:02:33,560 --> 02:02:34,040 THESE EVENTS. 3030 02:02:34,040 --> 02:02:37,800 >>THANK YOU FOR THAT QUESTION. 3031 02:02:37,800 --> 02:02:39,520 I WAS LOOKING FOR THAT EVIDENCE 3032 02:02:39,520 --> 02:02:40,120 AS WELL. 3033 02:02:40,120 --> 02:02:43,560 THERE'S NOT A LOT FOR THE LAST 3034 02:02:43,560 --> 02:02:45,600 PART OF THE QUESTION. 3035 02:02:45,600 --> 02:02:47,920 WE WROTE AN EDITORIAL ON THIS 3036 02:02:47,920 --> 02:02:50,120 PULSE RATE RESPONSE AND I DIG 3037 02:02:50,120 --> 02:02:51,520 INTO EXACTLY YOUR QUESTION ABOUT 3038 02:02:51,520 --> 02:02:53,400 THE LOW HEART RATE RESPONSE AND 3039 02:02:53,400 --> 02:02:57,320 I THINK IT MAY BE CARDIOLOGISTS 3040 02:02:57,320 --> 02:03:00,480 HERE, FEEL FREE CHIME IN, MAY BE 3041 02:03:00,480 --> 02:03:01,840 A DEGREE OF INCOMPETENCE AND 3042 02:03:01,840 --> 02:03:04,880 THAT IS SORT OF WHAT I WAS 3043 02:03:04,880 --> 02:03:06,080 THINKING. 3044 02:03:06,080 --> 02:03:10,560 THERE'S ALSO THIS IDEA OF CPAP 3045 02:03:10,560 --> 02:03:12,320 POTENTIALLY HAVING A 3046 02:03:12,320 --> 02:03:13,320 PARASYMPATHETIC INFLUENCE, MAYBE 3047 02:03:13,320 --> 02:03:16,600 THAT'S ANOTHER WAY TO LOOK AT 3048 02:03:16,600 --> 02:03:18,480 THE RESPONSE AND HARM SIGNAL 3049 02:03:18,480 --> 02:03:20,640 WHICH MAY HAVE FURTHER DAMPENED 3050 02:03:20,640 --> 02:03:22,760 THAT RESPONSE, HEART RATE 3051 02:03:22,760 --> 02:03:23,400 RESPONSE, AND THEN 3052 02:03:23,400 --> 02:03:24,240 COMORBIDITIES, RIGHT? 3053 02:03:24,240 --> 02:03:26,320 SO INDIVIDUALS MAY HAVE OTHER 3054 02:03:26,320 --> 02:03:28,080 CO-MORBIDITIES THAT MAY BE 3055 02:03:28,080 --> 02:03:30,640 REFLECTIVE OF THAT DELTA HEART 3056 02:03:30,640 --> 02:03:32,600 RATE RESPONSE THAT'S LOWER, 3057 02:03:32,600 --> 02:03:34,240 MAYBE PHYSICAL ACTIVITY LEVELS 3058 02:03:34,240 --> 02:03:35,000 AND SEDENTARY LIFESTYLE AND 3059 02:03:35,000 --> 02:03:36,080 THINGS LIKE THAT. 3060 02:03:36,080 --> 02:03:37,480 THAT COMES TO MIND. 3061 02:03:37,480 --> 02:03:40,760 BUT I REMEMBER WE DEDICATED A 3062 02:03:40,760 --> 02:03:42,520 FEW SENTENCES OR A PARAGRAPH, WE 3063 02:03:42,520 --> 02:03:47,240 URGE YOU TO LOOK AT THAT, IN THE 3064 02:03:47,240 --> 02:03:47,960 INTEREST OF TIME. 3065 02:03:47,960 --> 02:03:52,800 >>THANKS FOR THE GREAT QUESTION 3066 02:03:52,800 --> 02:03:54,000 AND FOR THE RESPONSE. 3067 02:03:54,000 --> 02:03:56,320 THIS HAS BEEN AN AREA OUR GROUP 3068 02:03:56,320 --> 02:03:58,920 HAS BEEN PARTICULARLY INTERESTED 3069 02:03:58,920 --> 02:04:02,760 IN, AGAIN DELTA HEART RATE, THAT 3070 02:04:02,760 --> 02:04:04,960 PAPER, THOSE WITH LOWEST HEART 3071 02:04:04,960 --> 02:04:07,440 RATE TEND TO HAVE DIABETES, 3072 02:04:07,440 --> 02:04:09,120 EXISTING CARDIOVASCULAR DISEASE, 3073 02:04:09,120 --> 02:04:11,640 THEY WERE OLDER. 3074 02:04:11,640 --> 02:04:14,080 BUT VERY INTERESTINGLY, THIS IS 3075 02:04:14,080 --> 02:04:15,480 LARGELY UNPUBLISHED DATA, THE 3076 02:04:15,480 --> 02:04:17,240 INDIVIDUALS WITH THE HIGHEST 3077 02:04:17,240 --> 02:04:21,400 HEART RATE RESPONSES WERE THOSE 3078 02:04:21,400 --> 02:04:25,200 WITH THE SHORTER APNEAS. 3079 02:04:25,200 --> 02:04:30,240 THE GREATEST AND AS WELL AS 3080 02:04:30,240 --> 02:04:32,000 BLACK WOMEN IN PARTICULAR, AND 3081 02:04:32,000 --> 02:04:34,000 IN FACT HIGHEST DELTA HEART 3082 02:04:34,000 --> 02:04:36,040 RATES OCCURRED IN BLACK WOMEN 3083 02:04:36,040 --> 02:04:38,360 WHOSE APNEAS RESULTED IN A BRISK 3084 02:04:38,360 --> 02:04:41,280 HEART RATE RESPONSE BUT LITTLE 3085 02:04:41,280 --> 02:04:41,720 DESATURATION. 3086 02:04:41,720 --> 02:04:44,920 AND WHAT THOSE FINDINGS WHICH 3087 02:04:44,920 --> 02:04:46,240 WE'RE EXPLORING NOW EMPHASIZE TO 3088 02:04:46,240 --> 02:04:49,200 ME, WHICH MAY BE RELEVANT FOR 3089 02:04:49,200 --> 02:04:50,720 SOME DISCUSSIONS, REALLY IS THAT 3090 02:04:50,720 --> 02:04:54,360 IF WE THINK OF HYPOXIA AS ONE 3091 02:04:54,360 --> 02:04:56,560 DRIVER FOR PULMONARY VASCULAR 3092 02:04:56,560 --> 02:04:59,360 DISEASE AND COMORBIDITY, THEN 3093 02:04:59,360 --> 02:05:00,920 MAYBE AN ORTHOGONAL DRIVER 3094 02:05:00,920 --> 02:05:03,840 RELATED TO CARDIAC RESPONSE OR 3095 02:05:03,840 --> 02:05:05,280 AUTONOMIC NERVOUS SYSTEM 3096 02:05:05,280 --> 02:05:08,160 DYSFUNCTION THAT IS ACTUALLY 3097 02:05:08,160 --> 02:05:10,840 ORTHOGONAL, AND IN FACT THESE 3098 02:05:10,840 --> 02:05:14,280 EXPOSURES MAY BE DIFFERENTIALLY 3099 02:05:14,280 --> 02:05:16,040 DISTRIBUTED, DEEP DESATURATIONS 3100 02:05:16,040 --> 02:05:19,480 MAY TEND TO OCCUR WITH PEOPLE 3101 02:05:19,480 --> 02:05:23,680 ARE LONG APNEAS, DIFFERENCE IN 3102 02:05:23,680 --> 02:05:28,360 RECEPTOR, THE INDIVIDUALS WITH 3103 02:05:28,360 --> 02:05:30,440 MORE INHIBITION WITH THOSE 3104 02:05:30,440 --> 02:05:35,600 LONG -- WHICH HAVE INHIBITION 3105 02:05:35,600 --> 02:05:37,560 AND GREATER BASELINE STRESS, 3106 02:05:37,560 --> 02:05:40,280 WOMEN, MAYBE AFRICAN AMERICANS 3107 02:05:40,280 --> 02:05:41,840 IN PARTICULAR, MAY HAVE LESS 3108 02:05:41,840 --> 02:05:43,800 HYPOXIA BUT MORE OF THIS 3109 02:05:43,800 --> 02:05:45,320 AUTONOMIC RESPONSE. 3110 02:05:45,320 --> 02:05:47,320 I THINK THE REAL CHALLENGE IS 3111 02:05:47,320 --> 02:05:48,840 HOW WE TREAT EACH GROUP AND 3112 02:05:48,840 --> 02:05:50,920 WHETHER WE NEED TO THINK ABOUT 3113 02:05:50,920 --> 02:05:53,000 EACH GROUP AS HAVING DIFFERENCES 3114 02:05:53,000 --> 02:05:57,480 IN RISK OUTCOMES AS WELL AS 3115 02:05:57,480 --> 02:05:58,240 DIFFERENCES IN MANAGEMENT. 3116 02:05:58,240 --> 02:06:02,080 SO I DON'T KNOW IF THAT CONFUSED 3117 02:06:02,080 --> 02:06:05,000 THINGS OR ADDED INCREASED 3118 02:06:05,000 --> 02:06:05,360 COMPLEXITY. 3119 02:06:05,360 --> 02:06:07,120 HASSAN, YOUR HAND IS UP. 3120 02:06:07,120 --> 02:06:12,680 >>I HAD A QUESTION. 3121 02:06:12,680 --> 02:06:15,840 IT'S BEEN HARD TO ASSESS RHYTHM 3122 02:06:15,840 --> 02:06:20,120 BUT WITH NEW TOOLS LIKE SALIVARY 3123 02:06:20,120 --> 02:06:23,080 MELATONIN ASSAYS, PPG TO ASSESS 3124 02:06:23,080 --> 02:06:23,840 RHYTHM, TWO QUESTIONS. 3125 02:06:23,840 --> 02:06:29,200 DO YOU FEEL LIKE IT'S MORE THAN 3126 02:06:29,200 --> 02:06:31,080 IN MULTIOMIC TRIALS TO INCLUDE 3127 02:06:31,080 --> 02:06:32,600 IN MULTIOMICS IN LARGE TRIALS 3128 02:06:32,600 --> 02:06:35,560 AND IF SO DO YOU THINK THESE 3129 02:06:35,560 --> 02:06:37,760 MEASURES ARE THERE IN TERMS OF 3130 02:06:37,760 --> 02:06:41,680 ACCURACY TO BE INCLUDED IN THESE 3131 02:06:41,680 --> 02:06:42,560 LARGE PROSPECTIVE TRIALS? 3132 02:06:42,560 --> 02:06:43,560 >>YEAH, THANKS. 3133 02:06:43,560 --> 02:06:44,600 GREAT QUESTION. 3134 02:06:44,600 --> 02:06:48,040 I DO THINK IT'S IMPORTANT TO 3135 02:06:48,040 --> 02:06:49,880 MEASURE CIRCADIAN RHYTHM. 3136 02:06:49,880 --> 02:06:51,640 HOWEVER, I DON'T AT THIS POINT 3137 02:06:51,640 --> 02:06:55,040 KNOW THE BEST WAY TO DO THAT. 3138 02:06:55,040 --> 02:06:57,560 I THINK UNFORTUNATELY, YOU KNOW, 3139 02:06:57,560 --> 02:06:59,920 AS I WAS SAYING, WE HAVE CLOCKS 3140 02:06:59,920 --> 02:07:01,920 EVERYWHERE IN OUR BODIES, BUT 3141 02:07:01,920 --> 02:07:04,000 ACCESSING THE TIMING OF THOSE 3142 02:07:04,000 --> 02:07:06,400 DIFFERENT CLOCKS IS EXTREMELY 3143 02:07:06,400 --> 02:07:07,400 CHALLENGING. 3144 02:07:07,400 --> 02:07:10,120 AND EVEN OUR SO-CALLED GOLD 3145 02:07:10,120 --> 02:07:12,320 STANDARD KIND OF WHOLE BODY 3146 02:07:12,320 --> 02:07:15,400 MEASURES ARE, IN MY OPINION, 3147 02:07:15,400 --> 02:07:17,000 PRETTY SIGNIFICANTLY FLAWED. 3148 02:07:17,000 --> 02:07:21,280 IF YOU CONSIDER MELATONIN AS ONE 3149 02:07:21,280 --> 02:07:23,760 EXAMPLE, ASSAYING -- OR 3150 02:07:23,760 --> 02:07:26,880 EVALUATING MELATONIN AS A PHASED 3151 02:07:26,880 --> 02:07:28,520 MARKER OF CIRCADIAN CLOCK 3152 02:07:28,520 --> 02:07:30,280 DEPENDS CRITICALLY ON ALL SORTS 3153 02:07:30,280 --> 02:07:32,680 OF ENVIRONMENTAL AND BEHAVIORAL 3154 02:07:32,680 --> 02:07:33,880 FACTORS, RIGHT? 3155 02:07:33,880 --> 02:07:36,520 SO, THE MINUTE SOMEONE IS 3156 02:07:36,520 --> 02:07:38,760 EXPOSED TO LIGHT DURING TIME 3157 02:07:38,760 --> 02:07:40,960 THEIR MELATONIN IS RISING IT 3158 02:07:40,960 --> 02:07:42,600 SUPPRESSES MELATONIN. 3159 02:07:42,600 --> 02:07:45,480 SO I THINK THAT IN VIVO WHOLE 3160 02:07:45,480 --> 02:07:46,440 BODY PHYSIOLOGIC ASSAY IS THE 3161 02:07:46,440 --> 02:07:48,320 BEST WE CAN DO FOR NOW BUT IT'S 3162 02:07:48,320 --> 02:07:50,520 NOT NEARLY GOOD ENOUGH FOR WHAT 3163 02:07:50,520 --> 02:07:54,320 WE NEED, AND IT COULD BE THAT, 3164 02:07:54,320 --> 02:07:56,840 YOU KNOW, I THINK THERE'S 3165 02:07:56,840 --> 02:07:59,600 INITIALLY SOME GREAT PROMISE OF 3166 02:07:59,600 --> 02:08:01,320 TRANSCRIPTOMIC APPROACHES BUT I 3167 02:08:01,320 --> 02:08:02,680 THINK THAT IS MORE LIKELY TO BE 3168 02:08:02,680 --> 02:08:05,400 THE WAY THAT LEADS US FORWARD 3169 02:08:05,400 --> 02:08:11,520 THAN FRANKLY SOME OF THESE WHOLE 3170 02:08:11,520 --> 02:08:12,960 BODY PHYSIOLOGIC MEASURES. 3171 02:08:12,960 --> 02:08:14,480 >>THANKS FOR THE QUESTION AND 3172 02:08:14,480 --> 02:08:15,240 RESPONSE. 3173 02:08:15,240 --> 02:08:18,120 I BELIEVE NHLBI IS SPONSORING AN 3174 02:08:18,120 --> 02:08:20,720 UPCOMING WORKSHOP ON MEASURES OF 3175 02:08:20,720 --> 02:08:22,680 CIRCADIAN DYSFUNCTION THAT MAY 3176 02:08:22,680 --> 02:08:26,360 BE USING SOME OF THESE -- 3177 02:08:26,360 --> 02:08:28,000 DISCUSSING TRANSCRIPTOME 3178 02:08:28,000 --> 02:08:34,880 APPROACHES, SO THANK YOU. 3179 02:08:34,880 --> 02:08:35,160 DR. MATHAI? 3180 02:08:35,160 --> 02:08:37,080 >>I WANTED TO FOLLOW ON 3181 02:08:37,080 --> 02:08:39,560 COMMENTS REGARDING DURATION OF 3182 02:08:39,560 --> 02:08:49,560 HIGH -- HYPOXIA, WITH LONGER 3183 02:08:49,560 --> 02:08:52,920 PERIODS TO LEAD TO RESPONSE, SO 3184 02:08:52,920 --> 02:08:55,440 I APPRECIATE YOUR SUGGESTION, 3185 02:08:55,440 --> 02:08:56,760 THERE'S ORTHOGONAL RELATIONSHIP, 3186 02:08:56,760 --> 02:08:58,280 I'M CURIOUS WHETHER THERE'S 3187 02:08:58,280 --> 02:09:00,480 SOMETHING THAT WE'LL BE 3188 02:09:00,480 --> 02:09:02,440 DISCUSSING OR ANYONE HAS INSIGHT 3189 02:09:02,440 --> 02:09:04,960 INTO WHY THAT MECHANISM MIGHT 3190 02:09:04,960 --> 02:09:07,600 EXIST WITH SHORTER PERIODS OF 3191 02:09:07,600 --> 02:09:09,680 HYPOXIA, IT ASSOCIATES WITH 3192 02:09:09,680 --> 02:09:12,680 CARDIOVASCULAR RISK DOES THAT 3193 02:09:12,680 --> 02:09:14,320 PERTAIN TO PULMONARY VASCULATURE 3194 02:09:14,320 --> 02:09:15,160 AS WELL. 3195 02:09:15,160 --> 02:09:16,360 >>REALLY GREAT QUESTIONS. 3196 02:09:16,360 --> 02:09:19,520 AND I HOPE WE CAN GET INTO SOME 3197 02:09:19,520 --> 02:09:20,640 OF THOSE. 3198 02:09:20,640 --> 02:09:22,800 YOU KNOW, I THINK OTHERS MAY 3199 02:09:22,800 --> 02:09:30,200 HAVE SOME THOUGHTS, MY OWN 3200 02:09:30,200 --> 02:09:33,000 THOUGHT IS IN FACT THAT PERHAPS 3201 02:09:33,000 --> 02:09:35,320 MEASURING DELTA HEART RATE MAY 3202 02:09:35,320 --> 02:09:42,520 BE DOWNSTREAM TYPES OF 3203 02:09:42,520 --> 02:09:44,440 RESPONSES, AND MY COLLEAGUES 3204 02:09:44,440 --> 02:09:47,480 HAVE BEEN FOCUSING ON 3205 02:09:47,480 --> 02:09:49,240 QUANTIFYING WHAT THEY CALL THE 3206 02:09:49,240 --> 02:09:52,400 BURDEN OF EVENTS WHICH RELATES 3207 02:09:52,400 --> 02:09:54,160 TO -- THINK OF HYPOXIC BURDEN, 3208 02:09:54,160 --> 02:09:57,120 THIS IS THE CHANGE OR REDUCTION 3209 02:09:57,120 --> 02:09:59,080 IN VENTILATION AND EFFORT 3210 02:09:59,080 --> 02:10:00,720 ASSOCIATED SO BOTH THE DURATION 3211 02:10:00,720 --> 02:10:04,560 OF THE REDUCTION AND VENTILATION 3212 02:10:04,560 --> 02:10:06,200 AND DEPTH OF REDUCTION, IT MAY 3213 02:10:06,200 --> 02:10:10,680 BE AS WE PIVOT TO THAT MAYBE 3214 02:10:10,680 --> 02:10:12,360 UPSTREAM PHYSIOLOGIC PROCESS AND 3215 02:10:12,360 --> 02:10:15,400 LINK TO THE DIFFERENCES IN THESE 3216 02:10:15,400 --> 02:10:16,920 DOWNSTREAM EFFECTS WITH HYPOXIA 3217 02:10:16,920 --> 02:10:20,000 AND DELTA HEART RATE, WE MAY 3218 02:10:20,000 --> 02:10:30,480 HAVE MORE INSIGHT INTO THESE 3219 02:10:33,560 --> 02:10:33,920 MULTIPLE PHENOTYPES. 3220 02:10:33,920 --> 02:10:37,080 >>I WAS GOING ASK A QUESTION OF 3221 02:10:37,080 --> 02:10:37,960 DR. SHAH. 3222 02:10:37,960 --> 02:10:41,920 I FELT THE DISCUSSION OF SLEEP 3223 02:10:41,920 --> 02:10:44,560 PHENOTYPE WAS FASCINATING AND 3224 02:10:44,560 --> 02:10:48,120 NEW TO ME, THAT GETS INTO THE 3225 02:10:48,120 --> 02:10:50,480 NEXT POINT, WHAT IS THE BEST WAY 3226 02:10:50,480 --> 02:10:52,320 TO MEASURE A SLEEP PHENOTYPE AND 3227 02:10:52,320 --> 02:10:54,720 YOU BROUGHT UP SOME CHALLENGES 3228 02:10:54,720 --> 02:11:01,440 WITH HOME SLEEP TESTING VERSUS 3229 02:11:01,440 --> 02:11:02,760 FULL POLYSOMNOGRAPHY, MAYBE YOU 3230 02:11:02,760 --> 02:11:04,160 MIGHT COMPARE AND CONTRAST DATA 3231 02:11:04,160 --> 02:11:06,960 AND WHAT THE BENEFITS VERSUS 3232 02:11:06,960 --> 02:11:09,560 DOWN SIDES ARE TO A MORE LIMITED 3233 02:11:09,560 --> 02:11:14,200 SLEEP STUDY VERSUS MORE 3234 02:11:14,200 --> 02:11:15,120 COMPREHENSIVE ONE. 3235 02:11:15,120 --> 02:11:17,120 >>YEAH, THANKS FOR THE 3236 02:11:17,120 --> 02:11:17,520 QUESTION. 3237 02:11:17,520 --> 02:11:19,840 FEEL FREE TO CHIME IN, SUSAN, IF 3238 02:11:19,840 --> 02:11:20,960 YOU HAVE THOUGHTS. 3239 02:11:20,960 --> 02:11:22,840 I WANT TO RESPOND TO THE LAST 3240 02:11:22,840 --> 02:11:26,200 DISCUSSION IF I CAN BRIEFLY. 3241 02:11:26,200 --> 02:11:29,680 I THINK VENTILATORY BURDEN IS 3242 02:11:29,680 --> 02:11:30,320 REALLY IMPORTANT, FASCINATING, 3243 02:11:30,320 --> 02:11:38,240 I'D LIKE TO MAYBE HERE YOUR 3244 02:11:38,240 --> 02:11:39,360 THOUGHTS, SUSAN, AFTER I 3245 02:11:39,360 --> 02:11:42,600 RESPOND, HOW DO YOU TIE IN OTHER 3246 02:11:42,600 --> 02:11:52,480 SLEEP DIMENSIONS AND FEATURES WE 3247 02:11:52,480 --> 02:11:54,480 TALKED ABOUT, PARTICULARLY 3248 02:11:54,480 --> 02:11:56,520 AROUSALS, YOU KNOW, CARDIAC 3249 02:11:56,520 --> 02:11:57,160 MANIFESTATIONS, RESPONSES, 3250 02:11:57,160 --> 02:11:58,920 PHYSIOLOGIC RESPONSES THAT WE 3251 02:11:58,920 --> 02:12:03,600 MAY NOT BE FULLY CAPTURING IN 3252 02:12:03,600 --> 02:12:04,200 VENTILATORY BURDEN. 3253 02:12:04,200 --> 02:12:06,800 I THINK BASED ON MY 3254 02:12:06,800 --> 02:12:08,920 UNDERSTANDING OF THE LITERATURE, 3255 02:12:08,920 --> 02:12:10,120 AUTONOMIC RESPONSE IS 3256 02:12:10,120 --> 02:12:12,840 FASCINATING. 3257 02:12:12,840 --> 02:12:15,360 I THINK, YOU KNOW, THE -- 3258 02:12:15,360 --> 02:12:16,920 ESPECIALLY CPAP, IT HAS A 3259 02:12:16,920 --> 02:12:17,880 TREMENDOUS IMPACT ON THE HEART 3260 02:12:17,880 --> 02:12:20,400 THAT I THINK WE'RE JUST STARTING 3261 02:12:20,400 --> 02:12:23,040 TO APPRECIATE, OR I AM, WE 3262 02:12:23,040 --> 02:12:24,880 THOUGHT IT WAS BENIGN AND IT 3263 02:12:24,880 --> 02:12:28,200 STILL MAY BE BUT THERE ARE 3264 02:12:28,200 --> 02:12:29,800 INFLUENCES ON THE AUTONOMIC 3265 02:12:29,800 --> 02:12:31,360 NERVOUS SYSTEM, ON THE HEART 3266 02:12:31,360 --> 02:12:33,680 THAT MAY PLAY OUT WHEN YOU START 3267 02:12:33,680 --> 02:12:34,240 TO SUBPHENOTYPE. 3268 02:12:34,240 --> 02:12:37,640 I WANTED TO PLANT THAT IN THERE 3269 02:12:37,640 --> 02:12:39,520 AND TO RESPOND TO YOUR QUESTION, 3270 02:12:39,520 --> 02:12:42,480 I CAN CALL YOU BY YOUR FIRST 3271 02:12:42,480 --> 02:12:44,120 NAME, ANNA? 3272 02:12:44,120 --> 02:12:44,400 OKAY. 3273 02:12:44,400 --> 02:12:45,640 THIS IS EXACTLY WHERE THE 3274 02:12:45,640 --> 02:12:46,760 PROBLEM IS, RIGHT? 3275 02:12:46,760 --> 02:12:50,200 JUST TO SET THE STAGE, WE DO 3276 02:12:50,200 --> 02:12:52,600 CLINICALLY NOW IS THAT MAJORITY 3277 02:12:52,600 --> 02:12:56,480 OF THE PATIENTS WHO COME IN FOR 3278 02:12:56,480 --> 02:12:58,080 SLEEP DISORDER BREATHING 3279 02:12:58,080 --> 02:12:59,000 ESPECIALLY APNEA RELATED 3280 02:12:59,000 --> 02:13:04,360 REFERRALS HAVE EVALUATED BY 3281 02:13:04,360 --> 02:13:06,760 SLEEP PHYSICIAN AND THEN OFTEN 3282 02:13:06,760 --> 02:13:08,400 DIAGNOSED USING HOME SLEEP TEST, 3283 02:13:08,400 --> 02:13:13,520 THAT CAN VARY FROM USING A 3284 02:13:13,520 --> 02:13:18,920 COUPLE CHANNELS WHERE YOU HAVE 3285 02:13:18,920 --> 02:13:22,200 AN OXYGEN DESATURATION INDEX OR 3286 02:13:22,200 --> 02:13:25,240 MEASURE, HEART RATE MEASURE, AND 3287 02:13:25,240 --> 02:13:34,080 POTENTIALLY MAYBE THORACIC OR 3288 02:13:34,080 --> 02:13:34,880 THORACO ABDOMINAL SENSORS, I 3289 02:13:34,880 --> 02:13:38,280 WOULD SAY THREE TO FOUR 3290 02:13:38,280 --> 02:13:42,680 CHANNELINGS TO DIAGNOSE 3291 02:13:42,680 --> 02:13:43,640 OBSTRUCTIVE SLEEP APNEA USING 3292 02:13:43,640 --> 02:13:46,040 THE NUMBER OF TIMES SOMEONE 3293 02:13:46,040 --> 02:13:47,680 STOPS BREATHING PARTIALLY OR 3294 02:13:47,680 --> 02:13:48,760 COMPLETELY OVER THE RECORDED 3295 02:13:48,760 --> 02:13:54,880 TIME OR IN SOME CASES SURROGATE 3296 02:13:54,880 --> 02:13:55,880 SLEEP TIME. 3297 02:13:55,880 --> 02:13:57,400 WE WOULD HAVE PATIENTS SPEND AN 3298 02:13:57,400 --> 02:13:59,920 ENTIRE NIGHT IN THE SLEEP LAB, 3299 02:13:59,920 --> 02:14:04,640 WOULD DO A MULTI-CHANNEL UP TO 3300 02:14:04,640 --> 02:14:11,840 20 CHANNELS OF DATA, EMG, EOG, 3301 02:14:11,840 --> 02:14:17,440 I-CHANNELS, LEG MOVEMENT 3302 02:14:17,440 --> 02:14:18,000 INDICATORS, OXYGEN, PRESSURE 3303 02:14:18,000 --> 02:14:21,040 EKG, A LOT OF OTHER DATA WE JUST 3304 02:14:21,040 --> 02:14:29,600 DON'T SEE IN THE HOME SLEEP. 3305 02:14:29,600 --> 02:14:31,400 WHAT WE'RE LEARNING IS THAT 3306 02:14:31,400 --> 02:14:33,400 THERE ARE HIDDEN FEATURES THE 3307 02:14:33,400 --> 02:14:35,720 HOME SLEEP TEST IS SIMPLY NOT 3308 02:14:35,720 --> 02:14:36,120 CAPTURING. 3309 02:14:36,120 --> 02:14:38,120 PULSE RATE RESPONSE IS ONE THAT 3310 02:14:38,120 --> 02:14:39,560 POTENTIALLY YOU COULD GET FROM 3311 02:14:39,560 --> 02:14:41,080 HOME SLEEP TEST BUT THERE ARE 3312 02:14:41,080 --> 02:14:42,840 OTHERS LIKE PERIODIC LIMB 3313 02:14:42,840 --> 02:14:45,680 MOVEMENT, FOR EXAMPLE, OR SLEEP 3314 02:14:45,680 --> 02:14:47,200 STAGE DEPENDENCY, AND HOW EACH 3315 02:14:47,200 --> 02:14:48,440 OF THESE RELATE. 3316 02:14:48,440 --> 02:14:50,720 YOU HAVE AN EVENT. 3317 02:14:50,720 --> 02:14:53,000 AND THEN WORK SHOWS THE PULSE 3318 02:14:53,000 --> 02:14:54,120 RATE RESPONSE BUT MAYBE THERE'S 3319 02:14:54,120 --> 02:14:56,280 ANOTHER RESPONSE THAT WE'RE NOT 3320 02:14:56,280 --> 02:14:56,880 CAPTURING. 3321 02:14:56,880 --> 02:15:00,240 AND SO ALL OF THOSE THINGS, HOW 3322 02:15:00,240 --> 02:15:02,960 THEY FIT IN TOGETHER A HOME 3323 02:15:02,960 --> 02:15:05,160 SLEEP TEST IS NOT ABLE TO DO. 3324 02:15:05,160 --> 02:15:07,120 WHAT DOES THE FUTURE HOLD? 3325 02:15:07,120 --> 02:15:10,640 WE CONTINUE TO USE THESE 3326 02:15:10,640 --> 02:15:11,400 BEAUTIFUL EPIDEMIOLOGIC COHORTS 3327 02:15:11,400 --> 02:15:14,040 THAT SUSAN AND OTHERS ON THE 3328 02:15:14,040 --> 02:15:16,960 CALL HAVE HELPED US GET THIS 3329 02:15:16,960 --> 02:15:19,360 COMPREHENSIVE DATA, FIND SOME 3330 02:15:19,360 --> 02:15:21,680 HIDDEN FEATURES, MAYBE TAKE THEM 3331 02:15:21,680 --> 02:15:27,360 THE NEXT STEP, IN A TRIAL 3332 02:15:27,360 --> 02:15:28,960 SETTING, AND MAYBE VALIDATING 3333 02:15:28,960 --> 02:15:34,360 EHR INTERESTED IN BRIAN CADE'S 3334 02:15:34,360 --> 02:15:37,800 TALK TODAY, EHR IS GETTING 3335 02:15:37,800 --> 02:15:40,520 THERE, WE HAVE SO MUCH DATA, SO 3336 02:15:40,520 --> 02:15:41,280 I'LL STOP THERE. 3337 02:15:41,280 --> 02:15:46,440 BUT I HOPE I ADDRESSED YOUR 3338 02:15:46,440 --> 02:15:46,680 QUESTION. 3339 02:15:46,680 --> 02:15:48,400 >>THANKS, NEOMI. 3340 02:15:48,400 --> 02:15:51,240 FROM YOUR FIRST COMMENTS, I 3341 02:15:51,240 --> 02:15:51,640 COMPLETELY AGREE. 3342 02:15:51,640 --> 02:15:55,840 I THINK THERE'S SO MUCH 3343 02:15:55,840 --> 02:15:57,920 OPPORTUNITY TO BETTER 3344 02:15:57,920 --> 02:15:59,680 CHARACTERIZE THE OVERALL 3345 02:15:59,680 --> 02:16:05,680 CARDIOVASCULAR AND AUTONOMIC 3346 02:16:05,680 --> 02:16:07,320 CHANGES THAT MAY CORRELATE. 3347 02:16:07,320 --> 02:16:11,720 THERE WAS JUST THIS PAST YEAR AN 3348 02:16:11,720 --> 02:16:13,760 ARTICLE IN "NATURE" FROM A GROUP 3349 02:16:13,760 --> 02:16:15,520 OF BIOMEDICAL ENGINEERS FROM SAN 3350 02:16:15,520 --> 02:16:18,680 DIEGO THAT REPORTED THE USE -- 3351 02:16:18,680 --> 02:16:19,800 THE WEARABLE ECHO CARDIOGRAM, 3352 02:16:19,800 --> 02:16:22,080 AND I HAPPENED TO CONTACT THE 3353 02:16:22,080 --> 02:16:25,880 AUTHOR JUST THIS WEEK WHO SAID 3354 02:16:25,880 --> 02:16:29,920 SLEEP WOULD BE THE PERFECT 3355 02:16:29,920 --> 02:16:32,720 SETTING TO COLLECT DYNAMIC ECHO 3356 02:16:32,720 --> 02:16:33,040 MEASUREMENTS. 3357 02:16:33,040 --> 02:16:36,200 UNFORTUNATELY IT'S NOT AT THE 3358 02:16:36,200 --> 02:16:39,360 COST POINT MOST OF US CAN AFFORD 3359 02:16:39,360 --> 02:16:41,240 TO INTEGRATE INTO RESEARCH BUT 3360 02:16:41,240 --> 02:16:43,320 IF HE COMMERCIALIZES THAT THESE 3361 02:16:43,320 --> 02:16:44,960 ARE REALLY, REALLY EXCITING 3362 02:16:44,960 --> 02:16:51,080 OPPORTUNITIES TO GO BEYOND WHAT 3363 02:16:51,080 --> 02:16:55,240 WE ACTUALLY DO AND THINK GETTING 3364 02:16:55,240 --> 02:16:56,560 DYNAMIC MEASURES OF CARDIAC 3365 02:16:56,560 --> 02:16:58,640 DIMENSION AND VOLUME CHANGES 3366 02:16:58,640 --> 02:17:00,560 WITH EVEN OF THESE APNEAS. 3367 02:17:00,560 --> 02:17:04,880 I WANT TO BE PROVOCATIVE. 3368 02:17:04,880 --> 02:17:09,160 GETTING BACK TO DR. HILL AND DR. 3369 02:17:09,160 --> 02:17:11,640 HEMNES' QUESTION ABOUT HOME 3370 02:17:11,640 --> 02:17:12,440 VERSUS LABORATORY-BASED STUDIES 3371 02:17:12,440 --> 02:17:15,920 I THINK ONE OF THE REAL 3372 02:17:15,920 --> 02:17:17,600 OPPORTUNITIES AND CHALLENGES IS 3373 02:17:17,600 --> 02:17:19,000 TO START THINKING MORE DEEPLY 3374 02:17:19,000 --> 02:17:21,720 ABOUT WHAT WE CAN DO OVER 3375 02:17:21,720 --> 02:17:24,880 MULTIPLE NIGHTS, NOT SINGLE 3376 02:17:24,880 --> 02:17:28,280 NIGHTS, AND WITH RELATIVELY LESS 3377 02:17:28,280 --> 02:17:28,720 INVASIVE TECHNOLOGY. 3378 02:17:28,720 --> 02:17:32,680 I ACTUALLY THINK ONE OF THE 3379 02:17:32,680 --> 02:17:33,440 THINGS, BEING PROVOCATIVE, ONE 3380 02:17:33,440 --> 02:17:35,840 OF THE THINGS THAT'S KEPT US 3381 02:17:35,840 --> 02:17:38,480 BACK AS A FIELD IS THIS MOTION 3382 02:17:38,480 --> 02:17:41,880 WE HAVE TO MEASURE EEG-BASED 3383 02:17:41,880 --> 02:17:42,400 AROUSALS. 3384 02:17:42,400 --> 02:17:44,720 AND THAT THAT IS AN ESSENTIAL 3385 02:17:44,720 --> 02:17:45,960 FEATURE OF THE SLEEP 3386 02:17:45,960 --> 02:17:46,960 FRAGMENTATION, ET CETERA. 3387 02:17:46,960 --> 02:17:48,880 WE'RE BEGINNING FROM SOME WORK 3388 02:17:48,880 --> 02:17:51,640 JUST THIS PAST YEAR IN SLEEP 3389 02:17:51,640 --> 02:17:53,600 HEALTH AND COHORTS FINDING THAT 3390 02:17:53,600 --> 02:17:55,520 ACTUALLY AROUSAL INDEX WHICH IS 3391 02:17:55,520 --> 02:17:58,920 ONE REASON WE MEASURE EEG, WHICH 3392 02:17:58,920 --> 02:18:01,200 IS EASIER TO DO IN THE LAB THAN 3393 02:18:01,200 --> 02:18:04,480 AT HOME, IS ACTUALLY A TERRIBLE 3394 02:18:04,480 --> 02:18:05,800 PROGNOSTIC INDICATOR AND 3395 02:18:05,800 --> 02:18:10,520 POSSIBLY A MEASURE OF ADAPTATION 3396 02:18:10,520 --> 02:18:11,720 OVER TIME AND PATIENTS 3397 02:18:11,720 --> 02:18:15,240 DEVELOPING WHAT I CALL SLEEPY 3398 02:18:15,240 --> 02:18:17,640 BRAIN RATHER THAN SHOWING 3399 02:18:17,640 --> 02:18:18,640 PRACTICING MENTATION. 3400 02:18:18,640 --> 02:18:20,800 WITH THIS DEVELOPMENT OF 3401 02:18:20,800 --> 02:18:22,600 WEARABLES AND USE OF EVEN 3402 02:18:22,600 --> 02:18:24,240 SIGNALS THAT WE ROUTINELY 3403 02:18:24,240 --> 02:18:27,400 CAPTURE THAT WE JUST ARE NOT 3404 02:18:27,400 --> 02:18:29,680 CURATING BUT NOW WITH A.I., 3405 02:18:29,680 --> 02:18:31,440 MACHINE LEARNING, ET CETERA, WE 3406 02:18:31,440 --> 02:18:31,640 ARE. 3407 02:18:31,640 --> 02:18:33,280 ONE SIGNAL WE COULD FAIRLY 3408 02:18:33,280 --> 02:18:36,360 EASILY GET IN HOME STUDIES, FOR 3409 02:18:36,360 --> 02:18:41,520 EXAMPLE, IS THE PPG SIGNAL, 3410 02:18:41,520 --> 02:18:48,080 PHOTOGRAM SIGNAL, BEAUTIFUL WORK 3411 02:18:48,080 --> 02:18:50,960 ABOUT HOW THAT MAY -- 3412 02:18:50,960 --> 02:18:52,480 SYMPATHETIC ACTIVATION, VASCULAR 3413 02:18:52,480 --> 02:18:53,240 CHANGES AND STIFFNESS, SOMETHING 3414 02:18:53,240 --> 02:18:57,920 THAT'S BEEN IN FRONT OF OUR FACE 3415 02:18:57,920 --> 02:18:59,880 FOR YEARS. 3416 02:18:59,880 --> 02:19:01,440 UNTIL RECENTLY USED AS Q.C. 3417 02:19:01,440 --> 02:19:08,120 SIGNAL TO SEE IF OUR OXYGENATION 3418 02:19:08,120 --> 02:19:08,880 SATURATION SIGNAL WAS 3419 02:19:08,880 --> 02:19:09,400 REASONABLE. 3420 02:19:09,400 --> 02:19:10,480 AS WE THINK ABOUT CHANGES, WHAT 3421 02:19:10,480 --> 02:19:14,680 WE CAN MEASURE IN TERMS OF HEART 3422 02:19:14,680 --> 02:19:16,440 RATE, PPG, MOVEMENT-BASED 3423 02:19:16,440 --> 02:19:22,240 MEASURES OF SLEEP, WAKE, MAYBE 3424 02:19:22,240 --> 02:19:22,760 EVENTUALLY USING DYNAMIC 3425 02:19:22,760 --> 02:19:26,800 ECHOCARDIOGRAMS I THINK WE MAY 3426 02:19:26,800 --> 02:19:32,960 HAVE A DIFFERENT APPROACH THAN 3427 02:19:32,960 --> 02:19:33,320 POLYSOMNOGRAMS. 3428 02:19:33,320 --> 02:19:35,160 WE STILL NEED TO KNOW WHETHER 3429 02:19:35,160 --> 02:19:40,640 PEOPLE ARE IN REM OR SLEEP-WAKE 3430 02:19:40,640 --> 02:19:42,680 BUT NOT SUCH TERRIBLE WORK USING 3431 02:19:42,680 --> 02:19:44,040 HEART RATE VARIABILITY AND 3432 02:19:44,040 --> 02:19:50,920 MOVEMENT AND BREATHING TO EVEN 3433 02:19:50,920 --> 02:19:51,480 SLEEP STAGE. 3434 02:19:51,480 --> 02:19:55,320 >>THIS SEEMS LIKE AN IMPORTANT 3435 02:19:55,320 --> 02:19:56,360 QUESTION AND ISSUE. 3436 02:19:56,360 --> 02:19:58,000 I THINK ONCE AGAIN THERE ARE 3437 02:19:58,000 --> 02:19:59,680 MULTIPLE WAYS OF APPROACHING 3438 02:19:59,680 --> 02:20:02,280 WHAT YOU'VE MENTIONED, SUSAN, 3439 02:20:02,280 --> 02:20:05,360 THAT IF WE INTERPRET A 3440 02:20:05,360 --> 02:20:07,880 LABORATORY PSG AS REPRESENTATIVE 3441 02:20:07,880 --> 02:20:09,520 OF AN INDIVIDUAL'S USUAL SLEEP, 3442 02:20:09,520 --> 02:20:11,440 THEN THINK WE MAY BE MISTAKEN. 3443 02:20:11,440 --> 02:20:18,200 IF WE LOOK AT IT RATHER AS A 3444 02:20:18,200 --> 02:20:20,240 PARTICULAR CHALLENGE RESPONSE TO 3445 02:20:20,240 --> 02:20:21,720 THAT ENVIRONMENT, IT MAY HAVE 3446 02:20:21,720 --> 02:20:25,640 VALUABLE INFORMATION. 3447 02:20:25,640 --> 02:20:28,040 SO ULTIMATELY I THINK, YOU KNOW, 3448 02:20:28,040 --> 02:20:29,440 IT MAY BE IMPRACTICAL BUT WE 3449 02:20:29,440 --> 02:20:30,200 NEED BOTH. 3450 02:20:30,200 --> 02:20:32,400 WE NEED TO KNOW WHAT'S HAPPENING 3451 02:20:32,400 --> 02:20:34,800 IN A PERSON'S USUAL ENVIRONMENT 3452 02:20:34,800 --> 02:20:36,800 OVER YEARS OF EXPOSURE, AND 3453 02:20:36,800 --> 02:20:39,840 PERHAPS WE NEED TO KNOW HOW AN 3454 02:20:39,840 --> 02:20:41,720 INDIVIDUAL'S PHYSIOLOGY RESPONSE 3455 02:20:41,720 --> 02:20:45,000 TO A PARTICULAR TESTING OR 3456 02:20:45,000 --> 02:20:45,720 CHALLENGE SITUATION. 3457 02:20:45,720 --> 02:20:48,400 >>THANK YOU FOR THOSE REMARKS. 3458 02:20:48,400 --> 02:20:50,560 AND DAN IS TALKING ALSO AS A 3459 02:20:50,560 --> 02:20:52,240 PSYCHIATRIST WHO IS AWARE THAT 3460 02:20:52,240 --> 02:20:53,640 SOME OF THE FOLKS, WHEN YOU 3461 02:20:53,640 --> 02:20:55,400 BRING IN PATIENTS WITH INSOMNIA 3462 02:20:55,400 --> 02:20:58,480 AND HAVE SLEEP STUDIES, YOU MAY 3463 02:20:58,480 --> 02:20:59,320 GET ACTUALLY INFORMATION THAT 3464 02:20:59,320 --> 02:21:01,960 MAY IN FACT RELATE TO EITHER 3465 02:21:01,960 --> 02:21:03,360 FEELING REALLY SECURE AND 3466 02:21:03,360 --> 02:21:05,560 MONITORED IN THE LAB OR ACTUALLY 3467 02:21:05,560 --> 02:21:07,120 BEING FACED WITH A BIG 3468 02:21:07,120 --> 02:21:08,880 PSYCHOLOGIC STRESS THAT MAKES IT 3469 02:21:08,880 --> 02:21:10,040 MORE DIFFICULT TO SLEEP. 3470 02:21:10,040 --> 02:21:16,360 AND SO THANK YOU SO MUCH FOR 3471 02:21:16,360 --> 02:21:16,960 THAT. 3472 02:21:16,960 --> 02:21:19,360 >>I'M APPRECIATIVE OF THE 3473 02:21:19,360 --> 02:21:19,920 RESPONSES. 3474 02:21:19,920 --> 02:21:22,440 I ASKED IT BECAUSE I THINK AS WE 3475 02:21:22,440 --> 02:21:26,680 THINK ABOUT IDENTIFYING SLEEP 3476 02:21:26,680 --> 02:21:28,120 PHENOTYPES AND PULMONARY 3477 02:21:28,120 --> 02:21:29,000 HYPERTENSION, WHAT -- HOW BEST 3478 02:21:29,000 --> 02:21:30,840 TO DO THAT IS GOING TO BE REALLY 3479 02:21:30,840 --> 02:21:31,320 IMPORTANT. 3480 02:21:31,320 --> 02:21:33,120 SEEMS LIKE WE'RE RIGHT NOW WITH 3481 02:21:33,120 --> 02:21:36,120 TECHNOLOGY THAT WE HAVE, WE HAVE 3482 02:21:36,120 --> 02:21:38,600 HOME TESTS THAT HAVE LIMITATIONS 3483 02:21:38,600 --> 02:21:40,160 BUT ARE WIDELY AVAILABLE, 3484 02:21:40,160 --> 02:21:41,440 PERHAPS CHEAPER, YOU COULD GET 3485 02:21:41,440 --> 02:21:43,720 MORE DATA ON SLEEP DISORDERED 3486 02:21:43,720 --> 02:21:49,880 BREATHING, THEN THERE ARE 3487 02:21:49,880 --> 02:21:51,120 LAB-BASED TESTS LIKE 3488 02:21:51,120 --> 02:21:55,640 POLYSOMNOGRAMS IS, RICH DATA ON 3489 02:21:55,640 --> 02:21:59,120 FEWER PEOPLE, HARD TO OVERCOME, 3490 02:21:59,120 --> 02:22:00,120 WITH LIMITS OF STATISTICS FOR 3491 02:22:00,120 --> 02:22:01,400 INSTANCE IF YOU MEASURE HUNDREDS 3492 02:22:01,400 --> 02:22:03,280 OF THINGS AND LOOK AT 3493 02:22:03,280 --> 02:22:04,360 PHENOTYPES, YOU MAY HAVE A FALSE 3494 02:22:04,360 --> 02:22:05,000 DISCOVERY RATE. 3495 02:22:05,000 --> 02:22:07,200 YOU MAY ALSO GET RICHER 3496 02:22:07,200 --> 02:22:07,520 PHENOTYPING. 3497 02:22:07,520 --> 02:22:09,840 I THINK IT'S A REALLY 3498 02:22:09,840 --> 02:22:11,040 INTERESTING TENSION RIGHT THERE 3499 02:22:11,040 --> 02:22:13,880 AND ALSO CONCERN ABOUT HOME 3500 02:22:13,880 --> 02:22:17,040 VERSUS LAB. 3501 02:22:17,040 --> 02:22:18,040 WHAT IS TRULY REPRESENTATIVE OF 3502 02:22:18,040 --> 02:22:24,920 WHAT A PERSON IS LIVING AND 3503 02:22:24,920 --> 02:22:25,240 EXPERIENCING. 3504 02:22:25,240 --> 02:22:26,800 >>TOMORROW OR LATER TODAY WE'LL 3505 02:22:26,800 --> 02:22:28,680 TALK ABOUT HOW TO USE GENOMICS, 3506 02:22:28,680 --> 02:22:31,080 MAY BE NOT ONLY FOR MECHANISMS 3507 02:22:31,080 --> 02:22:32,920 BUT TO ACTUALLY CREATE 3508 02:22:32,920 --> 02:22:35,520 SURROGATES FOR PHENOTYPES AND I 3509 02:22:35,520 --> 02:22:37,120 KNOW DR. SOFIR HAS BEEN DOING 3510 02:22:37,120 --> 02:22:37,680 THAT. 3511 02:22:37,680 --> 02:22:40,680 THAT MAY BE A POSSIBILITY IF WE 3512 02:22:40,680 --> 02:22:45,960 COULD GET SUFFICIENT DATA TO 3513 02:22:45,960 --> 02:22:47,720 TRAIN GENETICS PANEL TO CREATE A 3514 02:22:47,720 --> 02:22:51,040 CORE FOR LIE OF HIGH LOOP GAIN 3515 02:22:51,040 --> 02:22:54,440 OR LOW AROUSAL INDEX TO LIMIT 3516 02:22:54,440 --> 02:23:02,960 NEED TO PHENOTYPE DATABASES, 3517 02:23:02,960 --> 02:23:03,320 ANOTHER THOUGHT. 3518 02:23:03,320 --> 02:23:05,280 >>THANK YOU FOR THE GREAT 3519 02:23:05,280 --> 02:23:05,640 PRESENTATIONS. 3520 02:23:05,640 --> 02:23:07,680 ONE COMMENT AND QUESTION. 3521 02:23:07,680 --> 02:23:09,120 I THINK GIVEN THERE'S MORE THAN 3522 02:23:09,120 --> 02:23:10,520 30 MILLION PEOPLE ESTIMATED TO 3523 02:23:10,520 --> 02:23:14,160 HAVE SLEEP APNEA IN THE U.S., 3524 02:23:14,160 --> 02:23:15,280 IT'S UNLIKELY THAT EVERYBODY IS 3525 02:23:15,280 --> 02:23:19,640 GOING TO HAVE LIKE AN IN LAB PSG 3526 02:23:19,640 --> 02:23:21,040 AS FIRST LINE SO HOME SLEEP 3527 02:23:21,040 --> 02:23:23,240 TESTS ARE HERE TO STAY AS FIRST 3528 02:23:23,240 --> 02:23:25,760 LINE FOR BREAD AN BUTTER CASE. 3529 02:23:25,760 --> 02:23:27,800 IF WE DEMONSTRATE THERE'S A 3530 02:23:27,800 --> 02:23:30,040 VALUE IN CERTAIN PATIENTS TO GO 3531 02:23:30,040 --> 02:23:31,560 BEYOND AND GET ADDITIONAL 3532 02:23:31,560 --> 02:23:34,040 INFORMATION, I THINK EVENTUALLY 3533 02:23:34,040 --> 02:23:37,040 ALSO LIKE CLINICS, LABS, 3534 02:23:37,040 --> 02:23:39,240 INSURERS WILL COME AROUND AND 3535 02:23:39,240 --> 02:23:40,880 ALLOW FOR WHERE THERE'S 3536 02:23:40,880 --> 02:23:41,760 POTENTIAL BENEFIT. 3537 02:23:41,760 --> 02:23:44,120 I THINK TRYING TO TEASE OUT 3538 02:23:44,120 --> 02:23:45,240 BETTER WHAT SPECIFIC FEATURES 3539 02:23:45,240 --> 02:23:49,160 FROM THE SLEEP STUDIES MIGHT BE 3540 02:23:49,160 --> 02:23:51,560 USEFUL, SPECIFICALLY FOR THIS 3541 02:23:51,560 --> 02:23:57,800 PATIENT SUBGROUP OF PATIENTS 3542 02:23:57,800 --> 02:23:59,800 WITH PULMONARY HYPERTENSION, FOR 3543 02:23:59,800 --> 02:24:01,760 DR. REDLINE, BUILDING A RESOURCE 3544 02:24:01,760 --> 02:24:04,480 FOR SO MANY COHORTS, IS THERE 3545 02:24:04,480 --> 02:24:06,120 ANOTHER AVAILABLE COHORT THAT IS 3546 02:24:06,120 --> 02:24:07,680 RICH IN PULMONARY HYPERTENSION 3547 02:24:07,680 --> 02:24:09,880 PATIENTS WHERE ONE COULD TRY TO 3548 02:24:09,880 --> 02:24:14,080 FIND OR ASSESS LIKE SOME OF 3549 02:24:14,080 --> 02:24:14,560 THESE BIOMARKERS? 3550 02:24:14,560 --> 02:24:18,880 >>THANK YOU FOR THAT QUESTION. 3551 02:24:18,880 --> 02:24:26,600 AND THE SHORT ANSWER IS WE'RE 3552 02:24:26,600 --> 02:24:28,800 LOOKING TO ENHANCE THAT, DR. 3553 02:24:28,800 --> 02:24:31,200 HILL AND DR. MIRREN AND OTHERS 3554 02:24:31,200 --> 02:24:32,520 HAVE SHOWED A LOT OF INTEREST 3555 02:24:32,520 --> 02:24:34,840 AND HAVE BEEN WORKING WITH 3556 02:24:34,840 --> 02:24:35,920 NATIONAL SLEEP RESEARCH RESOURCE 3557 02:24:35,920 --> 02:24:40,280 TO DEPOSIT THE HOME SLEEP STUDY 3558 02:24:40,280 --> 02:24:47,000 DATA INTO SLEEP DATA.ORG, NOT 3559 02:24:47,000 --> 02:24:48,840 FULL POLYSOMNOGRAMS BUT A STEP 3560 02:24:48,840 --> 02:24:50,080 IN THAT DIRECTION. 3561 02:24:50,080 --> 02:24:52,560 I'LL USE THIS AS AN OPPORTUNITY 3562 02:24:52,560 --> 02:24:54,120 TO ENCOURAGE INDIVIDUALS 3563 02:24:54,120 --> 02:24:56,760 COLLECTING ANIMAL DATA, WE NOW 3564 02:24:56,760 --> 02:24:58,400 INGESTING ANIMAL DATA, CLINICAL 3565 02:24:58,400 --> 02:24:59,480 DATA, POPULATION DATA, WE WOULD 3566 02:24:59,480 --> 02:25:01,040 LOVE TO HELP MAKE THAT AVAILABLE 3567 02:25:01,040 --> 02:25:03,200 TO THE COMMUNITY. 3568 02:25:03,200 --> 02:25:10,680 >>THANK YOU. 3569 02:25:10,680 --> 02:25:15,120 >>LET ME ASK A QUESTION TO DR. 3570 02:25:15,120 --> 02:25:16,240 BUYSSE AS WELL. 3571 02:25:16,240 --> 02:25:21,720 ONE OF THE DOMAINS IN YOUR 3572 02:25:21,720 --> 02:25:23,000 MULTI-DIMENSION SLEEP PANEL IS 3573 02:25:23,000 --> 02:25:23,320 REGULARITY. 3574 02:25:23,320 --> 02:25:28,480 HOW DO YOU DEFINE REGULARITY, 3575 02:25:28,480 --> 02:25:32,640 HOW MANY DAYS AND WHAT IS 3576 02:25:32,640 --> 02:25:33,120 STANDARD REGULAR? 3577 02:25:33,120 --> 02:25:34,800 >>YEAH, SO IT'S A FAIR 3578 02:25:34,800 --> 02:25:35,240 QUESTION. 3579 02:25:35,240 --> 02:25:37,920 I HAVE TO SAY THAT WHEN I WAS 3580 02:25:37,920 --> 02:25:40,280 ORIGINALLY THINKING ABOUT THIS I 3581 02:25:40,280 --> 02:25:41,080 DIDN'T INCLUDE REGULARITY AS ONE 3582 02:25:41,080 --> 02:25:44,040 OF THE THINGS TO THINK ABOUT 3583 02:25:44,040 --> 02:25:46,760 BECAUSE IT STANDS TO REASON THAT 3584 02:25:46,760 --> 02:25:48,680 ANYTHING YOU MEASURE ABOUT SLEEP 3585 02:25:48,680 --> 02:25:50,520 CAN BE CHARACTERIZED BY AN 3586 02:25:50,520 --> 02:25:52,520 AMOUNT OF VARIABILITY OR 3587 02:25:52,520 --> 02:25:54,280 REGULARITY ACROSS TIME, RIGHT? 3588 02:25:54,280 --> 02:25:57,080 IT'S TRUE OF SLEEP DURATION, 3589 02:25:57,080 --> 02:26:01,320 SLEEP TIMING, TRUE OF SLEEP 3590 02:26:01,320 --> 02:26:01,880 EFFICIENCY. 3591 02:26:01,880 --> 02:26:04,640 SO, TO SOME EXTENT REGULARITY IS 3592 02:26:04,640 --> 02:26:07,680 JUST A SECONDARY PROPERTY OF ALL 3593 02:26:07,680 --> 02:26:11,360 OF THOSE OTHER DIMENSIONS. 3594 02:26:11,360 --> 02:26:13,680 HOWEVER, THERE'S BEEN I THINK AN 3595 02:26:13,680 --> 02:26:15,480 INCREASING AMOUNT OF EVIDENCE 3596 02:26:15,480 --> 02:26:17,440 THAT VARIATION, SPECIFICALLY IN 3597 02:26:17,440 --> 02:26:21,560 THE TIMING AND DURATION OF SLEEP 3598 02:26:21,560 --> 02:26:24,960 ACROSS DAYS, IN ITSELF HAS SOME 3599 02:26:24,960 --> 02:26:26,080 HEALTH IMPLICATIONS. 3600 02:26:26,080 --> 02:26:29,320 THAT IS, YOU KNOW, THE DEGREE OF 3601 02:26:29,320 --> 02:26:36,280 VARIABILITY EVEN INDEPENDENT OF 3602 02:26:36,280 --> 02:26:39,160 THE MEAN TIMING IS REFERRED TO 3603 02:26:39,160 --> 02:26:42,600 AS SOCIAL JET LAG, I THINK YOU 3604 02:26:42,600 --> 02:26:45,360 CAN CERTAINLY -- 3605 02:26:45,360 --> 02:26:46,760 >>WE JUST LOST YOU. 3606 02:26:46,760 --> 02:26:49,520 >>MAKE AN ARGUMENT FOR 3607 02:26:49,520 --> 02:26:53,360 MEASURING REGULARITY, DIFFERENT 3608 02:26:53,360 --> 02:26:55,320 DIMENSIONS BUT MOST COMMON ARE 3609 02:26:55,320 --> 02:26:56,520 REGULARITY OF SLEEP TIMING FROM 3610 02:26:56,520 --> 02:26:59,200 DAY TO DAY AND REGULARITY OF 3611 02:26:59,200 --> 02:27:03,760 SLEEP DURATION FROM DAY TO DAY. 3612 02:27:03,760 --> 02:27:07,200 >>AND WHAT IS YOUR ASSESSMENT 3613 02:27:07,200 --> 02:27:09,960 OF HOW AMENABLE THIS IS TO THE 3614 02:27:09,960 --> 02:27:12,920 WEARABLES WE HAVE, AGAIN 3615 02:27:12,920 --> 02:27:14,280 THINKING ABOUT SCALING. 3616 02:27:14,280 --> 02:27:16,960 >>I'M SORRY, HOW? 3617 02:27:16,960 --> 02:27:19,040 >>AMENABLE TO QUANTIFYING TO 3618 02:27:19,040 --> 02:27:19,600 USING WEARABLES OUT THERE. 3619 02:27:19,600 --> 02:27:23,000 >>I THINK IT'S VERY AMENABLE 3620 02:27:23,000 --> 02:27:23,600 ACTUALLY. 3621 02:27:23,600 --> 02:27:26,720 SOME WORK THAT YOU'RE DOING WITH 3622 02:27:26,720 --> 02:27:31,680 MODELING DATA OVER TIME AND 3623 02:27:31,680 --> 02:27:34,120 LOOKING AT DIFFERENT PARAMETERS 3624 02:27:34,120 --> 02:27:36,920 OF 24-HOUR RHYTHMS, I THINK THAT 3625 02:27:36,920 --> 02:27:40,840 IN PART IS GOING TO SHOW US WHAT 3626 02:27:40,840 --> 02:27:47,520 MAYBE THE OPTIMAL MEASURES WILL 3627 02:27:47,520 --> 02:27:47,680 BE. 3628 02:27:47,680 --> 02:27:48,800 >>THANK YOU. 3629 02:27:48,800 --> 02:27:51,200 DO WE HAVE TIME FOR ONE OR TWO 3630 02:27:51,200 --> 02:27:52,640 MORE QUESTIONS IF ANYONE -- I 3631 02:27:52,640 --> 02:27:55,920 WANT TO NOT MISS ANYONE. 3632 02:27:55,920 --> 02:27:59,880 3633 02:27:59,880 --> 02:28:05,680 >>I I THINK A HAND IS RAISED. 3634 02:28:05,680 --> 02:28:06,680 >>GREAT DISCUSSION. 3635 02:28:06,680 --> 02:28:09,520 I WANT TO PUT OUT A WORD OF 3636 02:28:09,520 --> 02:28:10,600 CAUTION HERE BECAUSE I THINK A 3637 02:28:10,600 --> 02:28:13,120 LOT OF GREAT WORK THAT SUSAN'S 3638 02:28:13,120 --> 02:28:15,120 GROUP IS DOING WITH ALI AND 3639 02:28:15,120 --> 02:28:19,600 OTHERS LOOKING AT DIFFERENT 3640 02:28:19,600 --> 02:28:21,000 METRICS OF SEVERITY, IT WILL BE 3641 02:28:21,000 --> 02:28:24,400 IMPORTANT WE DON'T FALL INTO THE 3642 02:28:24,400 --> 02:28:28,560 TRAP NOT TESTING THOSE IN, YOU 3643 02:28:28,560 --> 02:28:30,240 KNOW, CLINICAL TRIALS WITH 3644 02:28:30,240 --> 02:28:30,760 IMPORTANT PATIENT-CENTERED 3645 02:28:30,760 --> 02:28:32,400 OUTCOMES AND I THINK THAT'S ONE 3646 02:28:32,400 --> 02:28:33,920 OF MY MAIN CONCERNS, THAT WE 3647 02:28:33,920 --> 02:28:36,360 COME UP WITH THESE IMPORTANT 3648 02:28:36,360 --> 02:28:43,520 METRICS THAT ARE MORE ROBUST 3649 02:28:43,520 --> 02:28:46,520 THAN THE SIMPLE APNEA-HYPONNEA 3650 02:28:46,520 --> 02:28:48,080 INDEX BUT WHEN IT COMES TO 3651 02:28:48,080 --> 02:28:51,200 TESTING IN LARGE CLINICAL TRIALS 3652 02:28:51,200 --> 02:28:51,840 HISTORICALLY WE'VE HAD A 3653 02:28:51,840 --> 02:28:52,960 CHALLENGE IN THE FIELD OF SLEEP 3654 02:28:52,960 --> 02:28:55,680 AND I HOPE NOW THAT ALL THESE 3655 02:28:55,680 --> 02:28:58,120 GREAT MINDS ARE HERE GATHERED, 3656 02:28:58,120 --> 02:29:01,520 TOGETHER WITH NHLBI, WE CAN COME 3657 02:29:01,520 --> 02:29:03,600 UP WITH PLANS TO TEST THESE IN 3658 02:29:03,600 --> 02:29:10,960 THE FUTURE, AND COME UP WITH 3659 02:29:10,960 --> 02:29:14,760 ROBUST OUTCOMES IN PATIENTS. 3660 02:29:14,760 --> 02:29:20,000 >>THANK YOU FOR THAT. 3661 02:29:20,000 --> 02:29:23,760 VERY IMPORTANT POINT. 3662 02:29:23,760 --> 02:29:24,040 DR. GOSS? 3663 02:29:24,040 --> 02:29:25,720 >>MAYBE THIS IS TOO EARLY TO 3664 02:29:25,720 --> 02:29:26,800 ASK THIS QUESTION. 3665 02:29:26,800 --> 02:29:28,640 WE COULD COME BACK TO IT LATER, 3666 02:29:28,640 --> 02:29:30,840 BUT WITH THE IDEA HOW WE'RE 3667 02:29:30,840 --> 02:29:33,360 TESTING PATIENTS AND FOR WHICH 3668 02:29:33,360 --> 02:29:36,240 TESTING WE'RE USING FAIRLY 3669 02:29:36,240 --> 02:29:39,400 ROUTINELY WE DO OVERNIGHT 3670 02:29:39,400 --> 02:29:41,120 OXIMETRY, OUR LEAST DETAILED 3671 02:29:41,120 --> 02:29:43,240 AMOUNT OF DATA FOR OUR PATIENTS, 3672 02:29:43,240 --> 02:29:50,320 BUT WE TEST NEARLY EVERYONE 3673 02:29:50,320 --> 02:29:51,720 COMING THROUGH P-H CLINIC. 3674 02:29:51,720 --> 02:29:54,920 IS THERE A SPECIFIC PHENOTYPE TO 3675 02:29:54,920 --> 02:29:56,680 EXTRACT FOR ADDITIONAL TESTING 3676 02:29:56,680 --> 02:29:57,760 FOR CAPTURING HIGHEST RISK 3677 02:29:57,760 --> 02:30:00,160 PATIENTS? 3678 02:30:00,160 --> 02:30:00,600 3679 02:30:00,600 --> 02:30:02,600 >>THAT'S A FANTASTIC QUESTION. 3680 02:30:02,600 --> 02:30:05,320 I THINK THAT MAY BE AN ESSENCE 3681 02:30:05,320 --> 02:30:07,600 OF ONE OF THE -- MAYBE SUMMARY 3682 02:30:07,600 --> 02:30:11,080 AREAS THAT WE REALLY WANT TO GET 3683 02:30:11,080 --> 02:30:12,200 OUR HEADS AROUND. 3684 02:30:12,200 --> 02:30:18,680 DOES ANYONE WANT TO COMMENT MORE 3685 02:30:18,680 --> 02:30:21,720 OR HAVE A SIMPLE ANSWER, WHAT IS 3686 02:30:21,720 --> 02:30:22,840 THE MOST EFFECTIVE SCREENING, 3687 02:30:22,840 --> 02:30:25,520 WHO TO TARGET AND WHAT WOULD BE 3688 02:30:25,520 --> 02:30:29,760 THE MOST EFFECTIVE SCREENING AND 3689 02:30:29,760 --> 02:30:30,760 PROCEDURES IN PULMONARY 3690 02:30:30,760 --> 02:30:33,360 HYPERTENSION SETTINGS. 3691 02:30:33,360 --> 02:30:37,960 3692 02:30:37,960 --> 02:30:39,720 I THINK WE'RE GOING TO THAT AS 3693 02:30:39,720 --> 02:30:44,720 THE DAY AND A HALF PROGRESSES. 3694 02:30:44,720 --> 02:30:46,400 WE'RE ACTUALLY -- IT'S A GREAT 3695 02:30:46,400 --> 02:30:50,080 QUESTION AND A GREAT REMINDER OF 3696 02:30:50,080 --> 02:30:52,160 WHY WE'RE HERE TODAY AND 3697 02:30:52,160 --> 02:30:52,800 TOMORROW. 3698 02:30:52,800 --> 02:30:56,240 WE'RE READY FOR A BREAK. 3699 02:30:56,240 --> 02:30:58,840 AND WE WILL HAVE A 30-MINUTE 3700 02:30:58,840 --> 02:31:01,360 LUNCH BREAK, OR OTHER PEOPLE MAY 3701 02:31:01,360 --> 02:31:03,120 HAVE JUST EARLY MORNING BREAK, 3702 02:31:03,120 --> 02:31:05,320 AND COME BACK AT 1 P.M. EASTERN 3703 02:31:05,320 --> 02:31:05,760 TIME. 3704 02:31:05,760 --> 02:31:09,000 BUT THANK YOU FOR AN AMAZING 3705 02:31:09,000 --> 02:31:10,680 DISCUSSION AND THREE INCREDIBLE 3706 02:31:10,680 --> 02:31:11,000 TALKS. 3707 02:31:11,000 --> 02:31:12,320 AND GREAT QUESTIONS. 3708 02:31:12,320 --> 02:31:16,680 SO THANK YOU ALL. 3709 02:31:16,680 --> 02:31:22,040 >>I'D LIKE TO OPEN THE NEXT 3710 02:31:22,040 --> 02:31:23,680 SESSION WHICH PARALLELS THE 3711 02:31:23,680 --> 02:31:26,640 FIRST SESSION IN THAT FIRST 3712 02:31:26,640 --> 02:31:29,840 SESSION WAS HOPING TO INTRODUCE 3713 02:31:29,840 --> 02:31:32,320 CONCEPTS OF SLEEP HEALTH AND 3714 02:31:32,320 --> 02:31:34,160 DYSFUNCTION AS THEY PERTAIN TO 3715 02:31:34,160 --> 02:31:37,080 HYPERTENSION AND PULMONARY 3716 02:31:37,080 --> 02:31:40,400 VASCULAR DISEASE. 3717 02:31:40,400 --> 02:31:42,200 NEXT SESSION WILL FOCUS ON 3718 02:31:42,200 --> 02:31:43,200 PULMONARY HYPERTENSION AND 3719 02:31:43,200 --> 02:31:44,240 RELATIONSHIP TO SLEEP HEALTH. 3720 02:31:44,240 --> 02:31:47,760 IT'S A PLEASURE TO INTRODUCE THE 3721 02:31:47,760 --> 02:31:50,160 FIRST SPEAKER, DR. DE JESUS 3722 02:31:50,160 --> 02:31:53,040 PEREZ, TO GIVE AN OVERVIEW OF 3723 02:31:53,040 --> 02:31:54,320 PULMONARY HYPERTENSION WITH 3724 02:31:54,320 --> 02:31:57,320 RELEVANCE TO SLEEP HEALTH AND 3725 02:31:57,320 --> 02:31:59,200 GENERALLY INTRODUCE THIS TOPIC 3726 02:31:59,200 --> 02:32:02,040 SO WE'RE PRIMED FOR A GOOD 3727 02:32:02,040 --> 02:32:02,760 DISCUSSION. 3728 02:32:02,760 --> 02:32:03,920 WE'LL HAVE FIVE MINUTES FOR 3729 02:32:03,920 --> 02:32:07,160 QUESTIONS OR SO AFTER EACH TALK, 3730 02:32:07,160 --> 02:32:09,800 TIME PERMITTING, AND WE'LL HAVE 3731 02:32:09,800 --> 02:32:11,880 A 25-MINUTE DISCUSSION AT THE 3732 02:32:11,880 --> 02:32:14,200 END OF THE SESSION, SO FEEL FREE 3733 02:32:14,200 --> 02:32:16,600 TO ASK QUESTIONS AS APPROPRIATE 3734 02:32:16,600 --> 02:32:16,840 FOR THAT. 3735 02:32:16,840 --> 02:32:20,400 I'LL TURN IT OVER TO YOU. 3736 02:32:20,400 --> 02:32:23,880 >>THANK YOU. 3737 02:32:23,880 --> 02:32:27,000 CAN YOU SEE MY PRESENTATION? 3738 02:32:27,000 --> 02:32:27,240 >>YES. 3739 02:32:27,240 --> 02:32:34,120 >>WONDERFUL. 3740 02:32:34,120 --> 02:32:34,960 GOOD AFTERNOON, EVERYBODY. 3741 02:32:34,960 --> 02:32:37,600 MY JOB IS TO GIVE AN OVERVIEW OF 3742 02:32:37,600 --> 02:32:46,160 THE FIELD AS INTRODUCE KEY 3743 02:32:46,160 --> 02:32:48,640 CONCEPTS RELEVANT TO SLEEP 3744 02:32:48,640 --> 02:32:49,760 DISORDERS, SOME REMINISCENT OF 3745 02:32:49,760 --> 02:32:51,400 WHAT'S BEEN PRESENTED BUT IT 3746 02:32:51,400 --> 02:33:01,920 REMAINS AN ACTIVE TOPIC OF OUR 3747 02:33:02,400 --> 02:33:03,680 DISCUSSION. 3748 02:33:03,680 --> 02:33:08,480 TWO PARTS, AN INTRODUCTION TO PH 3749 02:33:08,480 --> 02:33:10,880 DIAGNOSIS, AND OPEN QUESTIONS 3750 02:33:10,880 --> 02:33:13,160 AND RESEARCH PRIORITIES. 3751 02:33:13,160 --> 02:33:23,640 SO LET ME INTRODUCE WHAT IS 3752 02:33:24,840 --> 02:33:27,640 CURRENT STANDARD. 3753 02:33:27,640 --> 02:33:31,360 PULMONARY HYPERTENSION AFFECTS 3754 02:33:31,360 --> 02:33:34,160 1% OF THE POPULATION WORLDWIDE. 3755 02:33:34,160 --> 02:33:38,120 THERE ARE FIVE GROUPS CURRENTLY 3756 02:33:38,120 --> 02:33:41,520 IN THE CLASSIFICATION. 3757 02:33:41,520 --> 02:33:45,240 GROUP 1 I WILL BE DISCUSSING IN 3758 02:33:45,240 --> 02:33:45,880 DETAIL SHORTLY. 3759 02:33:45,880 --> 02:33:48,840 GROUP 2 IS THOSE ASSOCIATED WITH 3760 02:33:48,840 --> 02:33:51,800 LESS HEART DISEASE. 3761 02:33:51,800 --> 02:33:53,640 GROUP 3, AGAIN, WHERE SLEEP 3762 02:33:53,640 --> 02:33:57,040 DISORDERS FALL INTO ARE THOSE 3763 02:33:57,040 --> 02:34:02,080 ASSOCIATED WITH LUNG DISEASE AND 3764 02:34:02,080 --> 02:34:02,640 HYPOVENTILATION. 3765 02:34:02,640 --> 02:34:04,720 GROUP 4 ASSOCIATED WITH 3766 02:34:04,720 --> 02:34:10,640 PULMONARY ARTERIAL OBSTRUCTION 3767 02:34:10,640 --> 02:34:13,920 SUCH AS CHRONIC HYPERTENSION, 3768 02:34:13,920 --> 02:34:15,360 GROUP 5 A MIXED BAG. 3769 02:34:15,360 --> 02:34:17,560 THE MOST COMMON FORM IS GROUP 2 3770 02:34:17,560 --> 02:34:19,600 DUE TO HIGH PREVALENCE OF 3771 02:34:19,600 --> 02:34:22,000 CARDIOVASCULAR DISORDERS IN THE 3772 02:34:22,000 --> 02:34:26,760 WORLD TODAY. 3773 02:34:26,760 --> 02:34:29,040 FOLLOWED CLOSELY BY THAT 3774 02:34:29,040 --> 02:34:29,720 PULMONARY HYPERTENSION 3775 02:34:29,720 --> 02:34:34,920 ASSOCIATED WITH LUNG DISEASE. 3776 02:34:34,920 --> 02:34:36,920 SO, THE BEST UNDERSTOOD I SHALL 3777 02:34:36,920 --> 02:34:39,760 SAY THE ONE FORM OF PULMONARY 3778 02:34:39,760 --> 02:34:42,920 HYPERTENSION FOR WHICH WE HAVE 3779 02:34:42,920 --> 02:34:49,360 THE MOST THERAPEUTICS BOTH 3780 02:34:49,360 --> 02:34:52,560 AVAILABLE NOW AND IN THE 3781 02:34:52,560 --> 02:34:57,760 PIPELINE IS GROUP 1, A DISEASE 3782 02:34:57,760 --> 02:35:01,880 AFFECTING WOMEN PREDOMINANTLY, 3783 02:35:01,880 --> 02:35:02,840 PRESENTATION BETWEEN 50-65 3784 02:35:02,840 --> 02:35:05,160 YEARS, 14 CURRENTLY APPROVED 3785 02:35:05,160 --> 02:35:06,920 DRUGS TO TREAT THIS. 3786 02:35:06,920 --> 02:35:10,960 HOWEVER, AS I WILL TOUCH UPON 3787 02:35:10,960 --> 02:35:13,160 FEWER THAN 66% OF PATIENTS STAY 3788 02:35:13,160 --> 02:35:16,880 ALIVE AT FIVE YEARS, SO THIS IS 3789 02:35:16,880 --> 02:35:17,960 A VERY PROGRESSIVE DISEASE 3790 02:35:17,960 --> 02:35:23,120 DESPITE OUR BEST EFFORTS TO 3791 02:35:23,120 --> 02:35:23,680 TREAT. 3792 02:35:23,680 --> 02:35:24,880 PATHOBIOLOGY INVOLVES SEVERAL 3793 02:35:24,880 --> 02:35:35,280 CHANGES IN THE PULMONARY 3794 02:35:37,000 --> 02:35:38,360 VASCULATURE. 3795 02:35:38,360 --> 02:35:42,400 I WILL BE REMISS TO -- IF I 3796 02:35:42,400 --> 02:35:45,480 DON'T POINT OUT THAT THE -- MOST 3797 02:35:45,480 --> 02:35:48,720 REGISTRIES THAT DEAL WITH 3798 02:35:48,720 --> 02:35:49,400 PULMONARY HYPERTENSION COME FROM 3799 02:35:49,400 --> 02:35:50,320 UNITED STATES AND EUROPE BUT IF 3800 02:35:50,320 --> 02:35:51,800 WE LOOK AT THE REST OF THE WORLD 3801 02:35:51,800 --> 02:35:55,640 WE CAN SEE WHEN IT COMES TO 3802 02:35:55,640 --> 02:35:57,800 GROUP 1, ETIOLOGIES CAN BE QUITE 3803 02:35:57,800 --> 02:35:59,680 DIFFERENT, WHETHER YOU ARE IN 3804 02:35:59,680 --> 02:36:01,640 NORTH AMERICA OR IF YOU ARE IN 3805 02:36:01,640 --> 02:36:08,840 SOUTH AMERICA, WHERE NOW YOU SEE 3806 02:36:08,840 --> 02:36:11,400 A GREATER PREVALENCE, IN AFRICA 3807 02:36:11,400 --> 02:36:13,440 NOW YOU SEE INCREASE IN THE 3808 02:36:13,440 --> 02:36:15,560 NUMBER OF CONGENITAL HEART 3809 02:36:15,560 --> 02:36:17,920 DISEASES AS WELL AS HIV. 3810 02:36:17,920 --> 02:36:22,200 SO WHATEVER PART OF THE WORLD 3811 02:36:22,200 --> 02:36:24,400 YOU'RE IN WILL LIKELY FACE 3812 02:36:24,400 --> 02:36:26,400 DIFFERENT ETIOLOGIES AND THEY DO 3813 02:36:26,400 --> 02:36:30,560 HAVE DIFFERENT OUTCOMES WHICH IS 3814 02:36:30,560 --> 02:36:32,880 IMPORTANT FOR THE PRACTICE TO 3815 02:36:32,880 --> 02:36:33,720 RECOGNIZE. 3816 02:36:33,720 --> 02:36:36,000 GENDER IS A KEY DETERMINANT OF 3817 02:36:36,000 --> 02:36:36,360 OUTCOMES. 3818 02:36:36,360 --> 02:36:46,120 AS I TOLD YOU BEFORE, IT IS A 3819 02:36:46,120 --> 02:36:47,760 FEMALE PREDOMINANT DISEASE, BUT 3820 02:36:47,760 --> 02:36:49,280 HERE IS THE INTERESTING FACT. 3821 02:36:49,280 --> 02:36:51,840 IT IS THAT WOMEN TEND TO HAVE A 3822 02:36:51,840 --> 02:36:58,520 BETTER OUTCOME, BETTER SURVIVAL 3823 02:36:58,520 --> 02:37:00,920 COMPARED TO MEN. 3824 02:37:00,920 --> 02:37:02,200 40% OF SURVIVAL DIFFERENCE CAN 3825 02:37:02,200 --> 02:37:05,400 BE EXPLAINED BY THE STATUS OF 3826 02:37:05,400 --> 02:37:07,560 RIGHT VENTRICULAR FUNCTION. 3827 02:37:07,560 --> 02:37:10,440 SO, THE ADAPTATION OF THE RIGHT 3828 02:37:10,440 --> 02:37:12,000 VENTRICLE IN FEMALES APPEARS TO 3829 02:37:12,000 --> 02:37:13,720 BE DIFFERENT AND MORE FAVORABLE 3830 02:37:13,720 --> 02:37:16,360 COMPARED TO THAT IN MEN, AND 3831 02:37:16,360 --> 02:37:20,840 THIS IS IMPORTANT BECAUSE AS WE 3832 02:37:20,840 --> 02:37:22,280 THINK ABOUT PULMONARY 3833 02:37:22,280 --> 02:37:26,000 HYPERTENSION ASSOCIATED WITH 3834 02:37:26,000 --> 02:37:27,520 SLEEP APNEA, THESE GENDER ISSUES 3835 02:37:27,520 --> 02:37:30,920 MAY HAVE TO BE CONSIDERED AS WE 3836 02:37:30,920 --> 02:37:32,960 PROCEED FURTHER INTO PHENOTYPING 3837 02:37:32,960 --> 02:37:33,680 OUR PATIENTS. 3838 02:37:33,680 --> 02:37:37,360 WHAT YOU CAN SEE HERE AGAIN IS 3839 02:37:37,360 --> 02:37:40,480 THAT, A, INDEPENDENT OF THE AGE, 3840 02:37:40,480 --> 02:37:47,120 YOU CAN SEE THAT IT SEEMS THAT 3841 02:37:47,120 --> 02:37:50,840 WITH AGE THE DIFFERENCE IN 3842 02:37:50,840 --> 02:37:53,040 SURVIVAL ASSOCIATED WITH PH 3843 02:37:53,040 --> 02:37:54,880 AMONG GENDERS IS PREVALENT, AGE 3844 02:37:54,880 --> 02:38:00,200 AND GENDER ARE KEY 3845 02:38:00,200 --> 02:38:03,160 DETERMINANTS, INDEPENDENT OF 3846 02:38:03,160 --> 02:38:04,240 THERAPEUTICS. 3847 02:38:04,240 --> 02:38:05,880 BEYOND GENDER, THERE ARE 3848 02:38:05,880 --> 02:38:09,080 MULTIPLE MECHANISMS OF DISEASE 3849 02:38:09,080 --> 02:38:10,160 ASSOCIATED WITH PULMONARY 3850 02:38:10,160 --> 02:38:12,240 HYPERTENSION, THE LAST YEARS 3851 02:38:12,240 --> 02:38:18,600 HAVE LED US TO GO TO FOCUS ON 3852 02:38:18,600 --> 02:38:25,680 ALTERED METABOLISM, 3853 02:38:25,680 --> 02:38:31,600 INFLAMMATION, GENETICS, 3854 02:38:31,600 --> 02:38:35,760 EPIGENETICS, AS MENTIONED, AND 3855 02:38:35,760 --> 02:38:36,960 ANGIOGENESIS, MECHANISMS THE 3856 02:38:36,960 --> 02:38:39,560 FOCUS OF THERAPEUTICS. 3857 02:38:39,560 --> 02:38:41,440 NOW, THE ISSUE HERE AND GREATEST 3858 02:38:41,440 --> 02:38:42,640 CHALLENGE IS DESPITE OUR BEST 3859 02:38:42,640 --> 02:38:44,160 EFFORTS TO TREAT WITH THE 3860 02:38:44,160 --> 02:38:45,880 APPROVED THERAPIES YOU CAN SEE 3861 02:38:45,880 --> 02:38:48,160 THERE'S AN EVOLUTION IN THE 3862 02:38:48,160 --> 02:38:49,640 SEVERITY OF THE LESIONS. 3863 02:38:49,640 --> 02:39:00,160 THESE ARE LESIONS THAT IN THIS 3864 02:39:01,440 --> 02:39:10,240 CASE, REDUCING CROSS-SECTIONAL 3865 02:39:10,240 --> 02:39:11,800 AREA FOR BLOOD FLOW. 3866 02:39:11,800 --> 02:39:16,200 IF WE WERE TO LOOK AT CT 3867 02:39:16,200 --> 02:39:18,400 RECONSTRUCTION OF PULMONARY 3868 02:39:18,400 --> 02:39:20,280 CIRCULATION AS LESIONS EVOLVE WE 3869 02:39:20,280 --> 02:39:23,200 SEE VESSEL DROPOUT, A 3870 02:39:23,200 --> 02:39:26,840 COMBINATION OF INAPPROPRIATE 3871 02:39:26,840 --> 02:39:27,400 VASCULAR REPAIR, PROGRESSIVE 3872 02:39:27,400 --> 02:39:29,240 VESSEL LOSS AS WELL AS 3873 02:39:29,240 --> 02:39:31,240 OBSTRUCTION LEADING TO HEART 3874 02:39:31,240 --> 02:39:32,960 FAILURE WHICH ULTIMATELY KILLS 3875 02:39:32,960 --> 02:39:34,040 THESE PATIENTS. 3876 02:39:34,040 --> 02:39:38,000 CURRENTLY THE WAY THAT WE SEE 3877 02:39:38,000 --> 02:39:39,280 DIAGNOSIS, WHEN PATIENTS GET 3878 02:39:39,280 --> 02:39:41,400 REFERRED, THERE HAS TO BE A 3879 02:39:41,400 --> 02:39:42,400 BATTERY OF DIAGNOSTIC TESTS 3880 02:39:42,400 --> 02:39:44,280 BECAUSE IT'S IMPORTANT TO KNOW 3881 02:39:44,280 --> 02:39:47,520 WHICH OF THE FIVE TYPES THE 3882 02:39:47,520 --> 02:39:48,600 PATIENT HAS. 3883 02:39:48,600 --> 02:39:52,120 WE USE THE ECHO, I'LL TALK MORE 3884 02:39:52,120 --> 02:39:53,400 ABOUT THAT, IMAGING LIKE HIGH 3885 02:39:53,400 --> 02:39:56,040 RESOLUTION CT SCAN TO SEE 3886 02:39:56,040 --> 02:39:58,920 EVIDENCE OF GROUP 4, CLOTS, OR 3887 02:39:58,920 --> 02:40:01,080 GROUP 3, LUNG DISORDERS. 3888 02:40:01,080 --> 02:40:03,720 SLEEP STUDIES, SOMETHING THAT IS 3889 02:40:03,720 --> 02:40:09,200 RECOMMENDED BUT AS WE HAVE 3890 02:40:09,200 --> 02:40:11,360 TALKED FOR, GIVEN THE 3891 02:40:11,360 --> 02:40:12,800 OPERATIONAL -- THE OPERATIONAL 3892 02:40:12,800 --> 02:40:13,760 CHALLENGES PARTICULARLY GETTING 3893 02:40:13,760 --> 02:40:16,720 THE PATIENT TO SLEEP CLINICS, 3894 02:40:16,720 --> 02:40:19,040 THIS DOESN'T TEND TO HAPPEN 3895 02:40:19,040 --> 02:40:22,760 EARLY IN THE EVALUATION. 3896 02:40:22,760 --> 02:40:26,160 WE NEED TO DO A RIGHT HEART 3897 02:40:26,160 --> 02:40:31,520 CATHETERIZATION BECAUSE CURRENT 3898 02:40:31,520 --> 02:40:35,440 DIAGNOSIS OF PULMONARY 3899 02:40:35,440 --> 02:40:37,000 HYPERTENSION DEPENDS ON 3900 02:40:37,000 --> 02:40:38,840 DEFINITION, AND THEN ULTIMATELY 3901 02:40:38,840 --> 02:40:40,920 WE TRY TO INITIATE MANAGEMENT AS 3902 02:40:40,920 --> 02:40:44,760 SOON AS POSSIBLE, ONCE WE HAVE 3903 02:40:44,760 --> 02:40:46,160 IDENTIFIED THE TYPE OF PULMONARY 3904 02:40:46,160 --> 02:40:47,600 HYPERTENSION THE PATIENT HAS AND 3905 02:40:47,600 --> 02:40:49,720 WE SEE THE PATIENT EVERY THREE 3906 02:40:49,720 --> 02:40:51,880 MONTHS, WHAT WE WANT TO DO IS 3907 02:40:51,880 --> 02:40:55,600 TRY TO ADJUST THERAPY SO WE CAN 3908 02:40:55,600 --> 02:40:57,680 IMPROVE SYMPTOMS AS WELL AS 3909 02:40:57,680 --> 02:41:01,960 REDUCE THE RISK OF MORTALITY. 3910 02:41:01,960 --> 02:41:05,240 THE ECHO REMAINS THE OPTIMAL 3911 02:41:05,240 --> 02:41:07,200 SCREENING TOOL. 3912 02:41:07,200 --> 02:41:08,680 NOT DIAGNOSTIC BUT IT IS VERY 3913 02:41:08,680 --> 02:41:13,920 USEFUL IN TERMS OF PROVIDING US 3914 02:41:13,920 --> 02:41:15,800 INFORMATION ABOUT RIGHT 3915 02:41:15,800 --> 02:41:17,080 VENTRICULAR STRUCTURE/FUNCTION, 3916 02:41:17,080 --> 02:41:21,280 USES AN ESTIMATOR OF SYSTOLIC 3917 02:41:21,280 --> 02:41:22,360 PRESSURE, GIVES EVIDENCE OF 3918 02:41:22,360 --> 02:41:27,400 PRESSURE, ALL OF WHICH CAN BE 3919 02:41:27,400 --> 02:41:28,640 PROGNOSTIC MARKERS IN PULMONARY 3920 02:41:28,640 --> 02:41:31,680 HYPERTENSION BUT THERE ARE SOME 3921 02:41:31,680 --> 02:41:31,960 LIMITATIONS. 3922 02:41:31,960 --> 02:41:34,840 FOR EXAMPLE, THIS IS OPERATOR 3923 02:41:34,840 --> 02:41:35,960 DEPENDENT, 25% OF CIRCUMSTANCES 3924 02:41:35,960 --> 02:41:37,400 WHERE WE CANNOT REALLY GET A 3925 02:41:37,400 --> 02:41:39,560 GOOD SIGNAL AND IF WE CANNOT GET 3926 02:41:39,560 --> 02:41:41,400 GOOD IMAGES PARTICULARLY IN 3927 02:41:41,400 --> 02:41:43,600 THESE PATIENTS, PATIENTS THAT 3928 02:41:43,600 --> 02:41:51,880 HAVE COPD, FOR EXAMPLE, MAY BE 3929 02:41:51,880 --> 02:41:53,560 DIFFICULT TO REALLY ASCERTAIN 3930 02:41:53,560 --> 02:41:54,880 THE PARAMETERS WHICH IS WHY 3931 02:41:54,880 --> 02:41:56,920 RIGHT HEART CATH IS THE GOLD 3932 02:41:56,920 --> 02:41:58,120 STANDARD. 3933 02:41:58,120 --> 02:42:00,440 WE USE OF INTRODUCE CATHETER 3934 02:42:00,440 --> 02:42:03,080 THROUGH A VEIN AND ADVANCE IT 3935 02:42:03,080 --> 02:42:05,360 INTO THE LUNGS, CAPTURING 3936 02:42:05,360 --> 02:42:07,720 PRESSURES IN THE DIFFERENT 3937 02:42:07,720 --> 02:42:11,520 CHAMBERS FROM THE VENA CAVA, TO 3938 02:42:11,520 --> 02:42:13,000 THE PULMONARY ARTERY, CATCHING 3939 02:42:13,000 --> 02:42:16,880 WHAT IS CALLED PULL MOWER IN 3940 02:42:16,880 --> 02:42:17,960 WEDGE, ESTIMATE OF PRESSURE ON 3941 02:42:17,960 --> 02:42:23,880 THE LEFT SIDE OF THE HEART. 3942 02:42:23,880 --> 02:42:26,520 AND HEMODYNAMICS, ALSO 3943 02:42:26,520 --> 02:42:27,840 IDENTIFYING PRESENCE OF SHUNTS, 3944 02:42:27,840 --> 02:42:29,520 IMPORTANT IF WE'RE CONCERNED 3945 02:42:29,520 --> 02:42:32,240 ABOUT CONGENITAL HEART DISEASE, 3946 02:42:32,240 --> 02:42:34,200 CAN ALSO DO ANGIOGRAPHY BY 3947 02:42:34,200 --> 02:42:37,280 LOOKING AT VESSELS, AS ALLUDED 3948 02:42:37,280 --> 02:42:41,520 BEFORE BY DR. HEMNES VASODILATOR 3949 02:42:41,520 --> 02:42:43,000 STUDY IS DONE, 10% OF PATIENTS 3950 02:42:43,000 --> 02:42:46,160 OR LESS MAY HAVE THIS RESPONSE. 3951 02:42:46,160 --> 02:42:49,360 HOWEVER, THOSE THAT HAVE A 3952 02:42:49,360 --> 02:42:51,280 BETTER OUTCOME. 3953 02:42:51,280 --> 02:42:57,960 THIS IS THE CURRENT HEMODYNAMIC 3954 02:42:57,960 --> 02:42:58,400 DEFINITION. 3955 02:42:58,400 --> 02:43:01,800 MEAN PRESSURE GREATER THAN 20, 3956 02:43:01,800 --> 02:43:03,520 DEFINITION OF PULMONARY ARTERIAL 3957 02:43:03,520 --> 02:43:12,320 NEEDS TO MET A WEDGE LESS THAN 3958 02:43:12,320 --> 02:43:16,800 15, PVR GREATER THAN 2, CURRENT 3959 02:43:16,800 --> 02:43:17,360 UPDATE, BEING DISCUSSED. 3960 02:43:17,360 --> 02:43:20,400 IN THE CASE OF ISOLATED 3961 02:43:20,400 --> 02:43:21,600 POST-CAPILLARY, GROUP 2, LEFT 3962 02:43:21,600 --> 02:43:25,120 HEART DISEASE, IN THIS CASE THE 3963 02:43:25,120 --> 02:43:26,080 BIGGEST DIFFERENCE, BIGGEST 3964 02:43:26,080 --> 02:43:27,400 DEFINITION BETWEEN THESE TWO IS 3965 02:43:27,400 --> 02:43:30,280 THAT THE WEDGE IS NOW GREATER 3966 02:43:30,280 --> 02:43:33,880 THAN 15, WHICH INDICATES LEFT 3967 02:43:33,880 --> 02:43:35,280 HEART DYSFUNCTION AND PULMONARY 3968 02:43:35,280 --> 02:43:37,080 VASCULAR RESISTANCE LESS THAN 2. 3969 02:43:37,080 --> 02:43:40,880 YOU HAVE THIS ENTITY COMBINED 3970 02:43:40,880 --> 02:43:43,360 PRE AND POST, A PHENOTYPE WHERE 3971 02:43:43,360 --> 02:43:46,920 WE FIND FEATURES OF LEFT HEART 3972 02:43:46,920 --> 02:43:49,520 DISEASE TOGETHER WITH FEATURES 3973 02:43:49,520 --> 02:43:50,480 OF PULMONARY ARTERIAL DISEASE. 3974 02:43:50,480 --> 02:43:53,960 AND THIS IS A CHALLENGE BECAUSE 3975 02:43:53,960 --> 02:43:59,000 IT'S ONE OF THE ENTITIES FOR 3976 02:43:59,000 --> 02:44:02,000 WHICH THE GROUP 1 THERAPIES IS 3977 02:44:02,000 --> 02:44:04,080 REALLY NOT OPTIMAL AND MAY 3978 02:44:04,080 --> 02:44:06,280 ACTUALLY EVEN DO HARM. 3979 02:44:06,280 --> 02:44:08,240 WE ALSO LOOK AT EXERCISE 3980 02:44:08,240 --> 02:44:09,760 PULMONARY HYPERTENSION, AS A WAY 3981 02:44:09,760 --> 02:44:11,520 TO ALSO SCREEN SOME PATIENTS, 3982 02:44:11,520 --> 02:44:12,960 WHO MAY BE AT EARLIER STAGE OF 3983 02:44:12,960 --> 02:44:13,600 THE DISEASE. 3984 02:44:13,600 --> 02:44:16,800 WHEN IT COMES TO THERAPY WE'RE 3985 02:44:16,800 --> 02:44:19,960 TRYING TO IMPROVE HEMODYNAMICS, 3986 02:44:19,960 --> 02:44:22,400 EXERCISE CAPACITY, FUNCTIONAL 3987 02:44:22,400 --> 02:44:23,040 CLASS, PREVENT CLINICAL 3988 02:44:23,040 --> 02:44:25,000 WORSENING AND WANT OUR PATIENTS 3989 02:44:25,000 --> 02:44:25,520 TO LIVE. 3990 02:44:25,520 --> 02:44:27,960 THE 14 DRUGS I TOLD YOU CAN BE 3991 02:44:27,960 --> 02:44:37,520 BROKEN DOWN INTO THREE PATHWAYS 3992 02:44:37,520 --> 02:44:38,480 TARGETING ENDOTHELIN. 3993 02:44:38,480 --> 02:44:43,600 TODAY WE CAN TARGET THESE 3994 02:44:43,600 --> 02:44:47,240 PATHWAYS THROUGH ORAL 3995 02:44:47,240 --> 02:44:50,400 MEDICATIONS, INHALED, 3996 02:44:50,400 --> 02:45:01,120 PARENTERAL, MEDICATIONS SUCH AS 3997 02:45:01,120 --> 02:45:06,720 PDE5 INHIBITORS, RECEPTOR 3998 02:45:06,720 --> 02:45:07,040 ANTAGONISTS. 3999 02:45:07,040 --> 02:45:08,600 PROSTANOIDS CAN BE GIVEN 4000 02:45:08,600 --> 02:45:18,040 INHALED, AS WELL AS PARENTERAL 4001 02:45:18,040 --> 02:45:19,560 ROUTE, OR THROUGH INTRAVENOUS 4002 02:45:19,560 --> 02:45:20,440 CATHETER. 4003 02:45:20,440 --> 02:45:26,040 THESE DAYS WE TRY TO IMPROVE 4004 02:45:26,040 --> 02:45:27,360 CONVENIENCE BY IMPROVING THE 4005 02:45:27,360 --> 02:45:29,320 DEVICE, SO INSTEAD OF THIS 4006 02:45:29,320 --> 02:45:32,800 PATIENTS CAN NOW USE THIS, WHICH 4007 02:45:32,800 --> 02:45:35,240 IS EASIER AND PORTABLE, AND OF 4008 02:45:35,240 --> 02:45:38,080 COURSE A SMALLER PUMP. 4009 02:45:38,080 --> 02:45:40,840 THE MAIN CHALLENGE REMAINS WE 4010 02:45:40,840 --> 02:45:42,920 REALLY DESPITE OUR BEST EFFORTS 4011 02:45:42,920 --> 02:45:44,520 CANNOT PREVENT PROGRESSION OF 4012 02:45:44,520 --> 02:45:45,960 DISEASE, EVEN THOUGH WE'VE 4013 02:45:45,960 --> 02:45:47,400 IMPROVED SURVIVAL, PATIENTS ARE 4014 02:45:47,400 --> 02:45:48,800 STILL NOT DOING WELL. 4015 02:45:48,800 --> 02:45:51,000 IT'S BECAUSE NONE OF THE 4016 02:45:51,000 --> 02:45:53,840 THERAPIES ARE ACTUALLY TACKLING 4017 02:45:53,840 --> 02:45:56,560 THE VASCULAR REMODELING OR 4018 02:45:56,560 --> 02:45:57,360 IMPROVING RIGHT VENTRICULAR 4019 02:45:57,360 --> 02:45:59,320 FUNCTION IN THESE PATIENTS. 4020 02:45:59,320 --> 02:46:04,440 SO, RIGHT NOW THERE'S A PLETHORA 4021 02:46:04,440 --> 02:46:14,080 OF MEDICATIONS BEING DEVELOPED 4022 02:46:14,080 --> 02:46:18,400 TARGETING NOVEL MECHANISMS, ONE 4023 02:46:18,400 --> 02:46:24,080 BEING CONSIDERED TARGETS GENETIC 4024 02:46:24,080 --> 02:46:24,360 MECHANISMS. 4025 02:46:24,360 --> 02:46:26,040 THAT DISCUSSION GOES BEYOND THE 4026 02:46:26,040 --> 02:46:26,720 CURRENT TOPIC. 4027 02:46:26,720 --> 02:46:29,760 FOR REMAINDER OF THE TIME I HAVE 4028 02:46:29,760 --> 02:46:33,360 I'M GOING TO TALK ABOUT 4029 02:46:33,360 --> 02:46:35,000 PULMONARY HYPERTENSION 4030 02:46:35,000 --> 02:46:35,960 ASSOCIATED WITH HYPOVENTILATION, 4031 02:46:35,960 --> 02:46:38,640 SOME DISCUSSED BY MY COLLEAGUES 4032 02:46:38,640 --> 02:46:41,720 BEFORE. 4033 02:46:41,720 --> 02:46:45,280 AS I MENTIONED PREVIOUSLY, GROUP 4034 02:46:45,280 --> 02:46:50,120 3, PH ASSOCIATED DISEASE, RIGHT 4035 02:46:50,120 --> 02:46:52,320 NOW SLEEP ASSOCIATED PULMONARY 4036 02:46:52,320 --> 02:46:55,480 HYPERTENSION IS CONSIDERED A 4037 02:46:55,480 --> 02:46:56,280 HYPOVENTILATION SYNDROME. 4038 02:46:56,280 --> 02:46:58,680 BASED ON THE PUBLISHED DATA, IT 4039 02:46:58,680 --> 02:47:01,520 IS CONSIDERED TO BE UNCOMMONLY 4040 02:47:01,520 --> 02:47:03,720 IN OBSTRUCTIVE SLEEP APNEA 4041 02:47:03,720 --> 02:47:05,760 UNLESS THERE'S OTHER CONDITIONS 4042 02:47:05,760 --> 02:47:12,000 SUCH AS COPD OR DAY TIME 4043 02:47:12,000 --> 02:47:12,400 HYPOVENTILATION. 4044 02:47:12,400 --> 02:47:14,520 SOLE KNOCK THURL BE ON STRUCK 4045 02:47:14,520 --> 02:47:17,160 TIP SLEEP APNEA IS NOT A CAUSE 4046 02:47:17,160 --> 02:47:23,640 OF PH BUT IT CAN CAUSE DAY TIME 4047 02:47:23,640 --> 02:47:25,360 HYPER CAPNIA, WHICH PHENOTYPES 4048 02:47:25,360 --> 02:47:27,360 MAY PROVIDE THE GREATEST GROUNDS 4049 02:47:27,360 --> 02:47:28,800 FOR SEVERITY. 4050 02:47:28,800 --> 02:47:30,760 I'M NOT GOING INTO THIS SINCE 4051 02:47:30,760 --> 02:47:35,560 DR. CHAN DID A BEAUTIFUL JOB IN 4052 02:47:35,560 --> 02:47:37,680 PRESENTING DATA BUT IN THE CASE 4053 02:47:37,680 --> 02:47:42,280 OF GROUP 3 WE'RE TALKING ABOUT 4054 02:47:42,280 --> 02:47:43,560 SYMPATHETIC HYPOXIC REACTIONS AS 4055 02:47:43,560 --> 02:47:47,200 WELL AS CHANGES IN THE CHEMISTRY 4056 02:47:47,200 --> 02:47:49,040 SUCH AS PH, CO2, AS WELL AS 4057 02:47:49,040 --> 02:47:53,000 EFFECTS ON THE LEFT SIDE OF THE 4058 02:47:53,000 --> 02:47:56,280 HEART SO VERY COMPLEX 4059 02:47:56,280 --> 02:47:59,320 PATHOBIOLOGY, WHICH MAKES IT 4060 02:47:59,320 --> 02:48:01,640 CHALLENGING TO TREAT THIS 4061 02:48:01,640 --> 02:48:02,880 DISORDER OR EVEN CONCEIVE IT IN 4062 02:48:02,880 --> 02:48:06,840 THE SAME WAY AS WE CONCEIVE 4063 02:48:06,840 --> 02:48:08,680 OTHER PULMONARY HYPERTENSION 4064 02:48:08,680 --> 02:48:09,320 ENTITIES. 4065 02:48:09,320 --> 02:48:11,320 THE APPROACH CURRENTLY IS THAT 4066 02:48:11,320 --> 02:48:14,560 IF THE ECHO CARDIOGRAM ON OSA 4067 02:48:14,560 --> 02:48:16,560 PATIENTS SHOWS EVIDENCE OF 4068 02:48:16,560 --> 02:48:18,840 PULMONARY HYPERTENSION OR 4069 02:48:18,840 --> 02:48:21,760 SUGGESTSIVE BECAUSE OF ELEVATED 4070 02:48:21,760 --> 02:48:23,440 RVSD CURRENT RECOMMENDATION IS 4071 02:48:23,440 --> 02:48:26,720 THE PATIENT SHALL BE TREATED 4072 02:48:26,720 --> 02:48:28,240 WITH CPAP OR NON-INVASIVE 4073 02:48:28,240 --> 02:48:30,680 VENTILATION FOR 3 TO 4 MONTHS 4074 02:48:30,680 --> 02:48:32,200 AND ECHO. 4075 02:48:32,200 --> 02:48:35,560 REDUCTION IN EPA WITH CPAP 4076 02:48:35,560 --> 02:48:37,760 RANGES BETWEEN 0 AND 6 4077 02:48:37,760 --> 02:48:38,640 MILLIMETERS, SOME WILL RESPOND, 4078 02:48:38,640 --> 02:48:39,720 OTHERS DO NOT. 4079 02:48:39,720 --> 02:48:42,240 THIS GOES IN HAND WITH WHAT DR. 4080 02:48:42,240 --> 02:48:43,680 SHAH TOLD US EARLIER ON, AT 4081 02:48:43,680 --> 02:48:46,200 WHICH POINT IN TIME YOU MAY WANT 4082 02:48:46,200 --> 02:48:48,480 TO CONSIDER WHETHER TO DO A 4083 02:48:48,480 --> 02:48:49,080 RIGHT HEART CATHETERIZATION 4084 02:48:49,080 --> 02:48:50,360 BECAUSE THERE COULD BE A 4085 02:48:50,360 --> 02:48:53,200 POSSIBILITY THAT THIS IS NOT 4086 02:48:53,200 --> 02:48:56,040 JUST ACCOUNTED FOR OSA, COULD BE 4087 02:48:56,040 --> 02:48:57,360 AN OVERLAP SYNDROME WHERE THERE 4088 02:48:57,360 --> 02:48:59,880 MAY BE A RISK FACTOR FOR GROUP 4089 02:48:59,880 --> 02:49:03,640 1, SAY, FOR EXAMPLE, THIS 4090 02:49:03,640 --> 02:49:04,600 PATIENT TAKES METHAMPHETAMINE, 4091 02:49:04,600 --> 02:49:05,600 THAT'S A FACTOR. 4092 02:49:05,600 --> 02:49:08,200 SO THIS IS THE PHENOTYPE THAT IS 4093 02:49:08,200 --> 02:49:10,280 PROBABLY ONE OF THE MOST 4094 02:49:10,280 --> 02:49:14,680 FREQUENTLY SEEN IN OUR CLINIC, 4095 02:49:14,680 --> 02:49:15,320 OBESITY HYPOVENTILATION 4096 02:49:15,320 --> 02:49:18,720 SYNDROME, ALSO KNOWN AS 4097 02:49:18,720 --> 02:49:20,000 PICKWICKIAN SYNDROME, VERY 4098 02:49:20,000 --> 02:49:22,560 COMPLEX, NOT ONLY DEALING WITH 4099 02:49:22,560 --> 02:49:25,400 OBSTRUCTION BUT DEALING WITH 4100 02:49:25,400 --> 02:49:27,000 HYPOVENTILATION, OBESITY, MYRIAD 4101 02:49:27,000 --> 02:49:28,200 OF FACTORS THAT ULTIMATELY 4102 02:49:28,200 --> 02:49:30,440 AFFECT DIFFERENT PARTS OF THE 4103 02:49:30,440 --> 02:49:31,960 CARDIOPULMONARY SYSTEM. 4104 02:49:31,960 --> 02:49:34,680 YOU CAN SEE THIS IS GOING BEYOND 4105 02:49:34,680 --> 02:49:35,560 OBESITY. 4106 02:49:35,560 --> 02:49:38,840 THE COMBINATION OF OBESITY 4107 02:49:38,840 --> 02:49:40,840 HYPOVENTILATION REALLY ALTERS 4108 02:49:40,840 --> 02:49:41,880 ESSENTIALLY THE RESPIRATORY 4109 02:49:41,880 --> 02:49:44,440 VOLUMES AS YOU CAN SEE, AS YOU 4110 02:49:44,440 --> 02:49:46,280 CAN SEE HERE. 4111 02:49:46,280 --> 02:49:50,360 IT ALSO ALTERS THE VENTILATORY 4112 02:49:50,360 --> 02:49:51,680 DRIVE, MUSCLE STRENGTH, 4113 02:49:51,680 --> 02:49:52,640 INCREASES WORK OF BREATHING, ALL 4114 02:49:52,640 --> 02:49:59,200 OF WHICH LEADS TO AN INCREASE IN 4115 02:49:59,200 --> 02:50:01,280 CARBON DIOXIDE, LOW DIURNAL 4116 02:50:01,280 --> 02:50:03,400 OXYGENATION AND ULTIMATELY 4117 02:50:03,400 --> 02:50:05,320 CHANGE IN PHYSIOLOGY AND 4118 02:50:05,320 --> 02:50:09,280 NEUROVASCULAR OUTPUT FOR THESE 4119 02:50:09,280 --> 02:50:09,680 PATIENTS. 4120 02:50:09,680 --> 02:50:14,120 MOREOVER, THESE PATIENTS CAN 4121 02:50:14,120 --> 02:50:15,960 EXHIBIT PRO FOUND PULMONARY 4122 02:50:15,960 --> 02:50:17,720 VASCULAR CHANGES REMINISCENT IN 4123 02:50:17,720 --> 02:50:19,800 GROUP 1, THESE ARE TISSUES OF 4124 02:50:19,800 --> 02:50:20,840 PATIENTS WITH PICKWICKIAN WHO 4125 02:50:20,840 --> 02:50:29,120 PASSED ON AND YOU CAN SEE HOW 4126 02:50:29,120 --> 02:50:31,400 VASCULATURE LOOKS PARTICULARLY 4127 02:50:31,400 --> 02:50:41,920 MOTTELED, TO FULLY OBSTRUCTED 4128 02:50:42,280 --> 02:50:46,600 LESIONS THAT ULTIMATELY MAY 4129 02:50:46,600 --> 02:50:47,800 DEVELOP RYE MOTTELING. 4130 02:50:47,800 --> 02:50:50,640 IN TERMS OF HOW THESE PATIENTS 4131 02:50:50,640 --> 02:50:53,080 DO, HOW MUCH -- WHAT'S 4132 02:50:53,080 --> 02:50:54,880 PREVALENCE OF PH, THE PICKWICK 4133 02:50:54,880 --> 02:50:57,760 PROJECT TRIED TO ANSWER THAT. 4134 02:50:57,760 --> 02:51:00,720 IT WAS A MULTI-CENTERED TRIAL 4135 02:51:00,720 --> 02:51:07,400 COMPARING EFFICACY OF 4136 02:51:07,400 --> 02:51:10,360 NONINVASIVE, CPAP AND LIFESTYLE 4137 02:51:10,360 --> 02:51:11,040 MODIFICATION. 4138 02:51:11,040 --> 02:51:13,320 55% HAD ELEVATED PULMONARY 4139 02:51:13,320 --> 02:51:15,400 SYSTOLIC PRESSURE BY ECHO, 51 4140 02:51:15,400 --> 02:51:19,560 WITH HYPERTROPHY, NOW DEALING 4141 02:51:19,560 --> 02:51:22,280 WITH A PHENOTYPE. 4142 02:51:22,280 --> 02:51:26,040 THEY ASSUME NON-INVASIVE 4143 02:51:26,040 --> 02:51:31,160 VENTILATION WILL BE SUPERIOR TO 4144 02:51:31,160 --> 02:51:33,560 CPAP, BY TREATING THE PRIMARY 4145 02:51:33,560 --> 02:51:37,400 TRIGGER, IN THIS CASE OBESITY 4146 02:51:37,400 --> 02:51:38,400 HYPOVENTILATION, WITH DIETARY 4147 02:51:38,400 --> 02:51:39,240 MODIFICATIONS, TREATING THE LEFT 4148 02:51:39,240 --> 02:51:42,440 HEART DISEASE IF THERE'S A 4149 02:51:42,440 --> 02:51:44,640 PRESENCE OF THAT, DIABETES, AT 4150 02:51:44,640 --> 02:51:49,240 THE SAME TIME PROVIDING THE 4151 02:51:49,240 --> 02:51:53,080 PATIENT WITH NOCTURNAL PAP 4152 02:51:53,080 --> 02:51:56,480 THERAPY WITH BIPAP OR CPAP CAN 4153 02:51:56,480 --> 02:51:58,000 IMPROVE OUTCOMES. 4154 02:51:58,000 --> 02:51:59,840 AT LEAST IN THIS PARTICULAR 4155 02:51:59,840 --> 02:52:03,760 STUDY IN THE CASE OF 4156 02:52:03,760 --> 02:52:04,880 NON-INVASIVE POSITIVE PRESSURE 4157 02:52:04,880 --> 02:52:05,760 VENTILATION OVER THREE MONTHS 4158 02:52:05,760 --> 02:52:08,160 YOU CAN SEE OVER THREE MONTHS' 4159 02:52:08,160 --> 02:52:11,880 TIME THE MEAN PA PRESSURE AND 4160 02:52:11,880 --> 02:52:12,880 PULMONARY VASCULAR RESISTANCE 4161 02:52:12,880 --> 02:52:14,400 SUBSTANTIALLY IMPROVED. 4162 02:52:14,400 --> 02:52:17,160 INTERESTINGLY NOT THE CARDIAC 4163 02:52:17,160 --> 02:52:20,200 INDEX, DID NOT, SUGGESTING THAT 4164 02:52:20,200 --> 02:52:24,280 THERE MAY BE OTHER FACTORS AT 4165 02:52:24,280 --> 02:52:27,280 PLAY IN DETERMINING CAPACITY OF 4166 02:52:27,280 --> 02:52:29,400 THE RIGHT VENTRICLE TO 4167 02:52:29,400 --> 02:52:29,920 COMPENSATE. 4168 02:52:29,920 --> 02:52:36,160 HERE YOU CAN SEE, AGAIN, THERE'S 4169 02:52:36,160 --> 02:52:37,600 REALLY NO SIGNIFICANT DIFFERENCE 4170 02:52:37,600 --> 02:52:39,240 BETWEEN THE GROUP. 4171 02:52:39,240 --> 02:52:42,560 WE SHOW EITHER OF THESE 4172 02:52:42,560 --> 02:52:45,600 MODALITIES MAY ACTUALLY HAVE A 4173 02:52:45,600 --> 02:52:47,480 BENEFIT WHEN APPLIED TO OUR 4174 02:52:47,480 --> 02:52:48,120 PATIENTS. 4175 02:52:48,120 --> 02:52:51,080 IN TERMS OF THE EXERCISE 4176 02:52:51,080 --> 02:52:53,160 CAPACITY IN THIS RECENT STUDY IT 4177 02:52:53,160 --> 02:52:56,120 WAS SHOWN TREATING PATIENTS WITH 4178 02:52:56,120 --> 02:52:57,000 PULMONARY HYPERTENSION 4179 02:52:57,000 --> 02:52:58,480 ASSOCIATED WITH OBSTRUCTIVE 4180 02:52:58,480 --> 02:53:02,000 SLEEP APNEA WITH CPAP CAN 4181 02:53:02,000 --> 02:53:04,400 INCREASE THE METS, LEVEL OF 4182 02:53:04,400 --> 02:53:08,120 ACTIVITY THE PATIENT CAN CARRY, 4183 02:53:08,120 --> 02:53:13,280 COMPARED TO UNTREATED PATIENTS. 4184 02:53:13,280 --> 02:53:14,720 SO TREATING PATIENTS WITH 4185 02:53:14,720 --> 02:53:16,880 TAILORED THERAPY FOR THEIR SLEEP 4186 02:53:16,880 --> 02:53:18,760 DISORDER DOES MAKE A DIFFERENCE. 4187 02:53:18,760 --> 02:53:20,800 BUT I THINK AT THIS POINT IN 4188 02:53:20,800 --> 02:53:25,160 TIME WE'RE AT A CRUX BECAUSE FOR 4189 02:53:25,160 --> 02:53:27,640 AS LONG AS I'VE BEEN IN THE 4190 02:53:27,640 --> 02:53:33,280 FIELD, THIS HAS BEEN KIND OF AN 4191 02:53:33,280 --> 02:53:34,600 ORPHAN FROM PULMONARY 4192 02:53:34,600 --> 02:53:35,600 HYPERTENSION WHEN WE SAY SEND 4193 02:53:35,600 --> 02:53:38,120 THEM TO THE SLEEP CLINIC, LET 4194 02:53:38,120 --> 02:53:40,120 THEM TREAT IT, WE'LL FOLLOW, 4195 02:53:40,120 --> 02:53:41,920 AND, YOU KNOW, WE'LL SEE WHAT 4196 02:53:41,920 --> 02:53:43,320 HAPPENS, WE REALLY DON'T HAVE A 4197 02:53:43,320 --> 02:53:44,800 GOOD HANDLE AND I THINK THIS IS 4198 02:53:44,800 --> 02:53:48,960 THE REASON WE'RE MEETING TODAY 4199 02:53:48,960 --> 02:53:50,680 BECAUSE IT'S TIMELY TO THINK 4200 02:53:50,680 --> 02:53:53,120 ABOUT WHERE WE NEED TO GO. 4201 02:53:53,120 --> 02:53:55,840 IT'S MUCH MORE COMPLEX PHENOTYPE 4202 02:53:55,840 --> 02:53:58,920 BUT WE JUST REALLY HAVEN'T BEEN 4203 02:53:58,920 --> 02:54:00,560 TRYING TO REALLY GET A GOOD 4204 02:54:00,560 --> 02:54:01,320 HANDLE. 4205 02:54:01,320 --> 02:54:04,400 SO WHAT DO WE NEED I BELIEVE 4206 02:54:04,400 --> 02:54:06,120 MOVING FORWARD TO REALLY BE ABLE 4207 02:54:06,120 --> 02:54:08,400 TO PROVIDE THE BEST SERVICE TO 4208 02:54:08,400 --> 02:54:09,160 THESE PATIENTS? 4209 02:54:09,160 --> 02:54:13,920 I THINK WE NEED TO START PUTTING 4210 02:54:13,920 --> 02:54:14,480 TOGETHER REGISTRIES TO 4211 02:54:14,480 --> 02:54:16,480 PROSPECTIVELY SEE WHAT PATIENTS 4212 02:54:16,480 --> 02:54:19,760 DO, WHAT THEIR EVOLUTION IS. 4213 02:54:19,760 --> 02:54:20,920 WE NEED BETTER RESTRATIFICATION, 4214 02:54:20,920 --> 02:54:23,360 SIMILAR TO THE ONES FOR THE 4215 02:54:23,360 --> 02:54:27,080 GROUP 1 PATIENTS, WHERE WE CAN 4216 02:54:27,080 --> 02:54:28,920 ACTUALLY PUT TOGETHER BIOMARKERS 4217 02:54:28,920 --> 02:54:30,480 AND PARAMETERS THAT ALLOWS TO 4218 02:54:30,480 --> 02:54:33,240 ENGAGE PATIENTS THAT MAY BE 4219 02:54:33,240 --> 02:54:35,480 HIGHER RISK OF HAVING MORBIDITY 4220 02:54:35,480 --> 02:54:40,000 AND MORTALITY ASSOCIATED WITH 4221 02:54:40,000 --> 02:54:42,520 THIS. 4222 02:54:42,520 --> 02:54:43,120 GENDER DIFFERENCES AFFECTING MEN 4223 02:54:43,120 --> 02:54:44,800 MORE OFTEN THAN WOMEN. 4224 02:54:44,800 --> 02:54:46,960 DOES THAT MEAN THESE PATIENTS 4225 02:54:46,960 --> 02:54:47,640 WILL HAVE WORSE SURVIVAL 4226 02:54:47,640 --> 02:54:48,840 COMPARED TO FEMALES? 4227 02:54:48,840 --> 02:54:49,520 WE DON'T KNOW. 4228 02:54:49,520 --> 02:54:51,160 I THINK THIS IS SOMETHING THAT 4229 02:54:51,160 --> 02:54:54,880 IS GOING TO BE IMPORTANT. 4230 02:54:54,880 --> 02:54:56,200 CLINICAL PHENOTYPES IS ONE OF 4231 02:54:56,200 --> 02:55:01,200 THE -- I REALLY LIKE DR. SHAH'S 4232 02:55:01,200 --> 02:55:02,760 PRESENTATION, EMPHASIZING THE 4233 02:55:02,760 --> 02:55:09,040 FACT NOT ALL ARE CREATED EQUAL. 4234 02:55:09,040 --> 02:55:10,880 GENETICS AND GENOMICS LIKE DR. 4235 02:55:10,880 --> 02:55:12,280 SHAN POINTED OUT, IT'S REALLY 4236 02:55:12,280 --> 02:55:14,200 IMPORTANT AND WE'RE JUST 4237 02:55:14,200 --> 02:55:17,000 SCRATCHING THE SURFACE HERE. 4238 02:55:17,000 --> 02:55:21,160 I THINK UNDERSTANDING HOW RIGHT 4239 02:55:21,160 --> 02:55:23,560 VENTRICULAR FUNCTION COMPENSATES 4240 02:55:23,560 --> 02:55:25,120 FOR -- ADAPTS TO SLEEP DISORDER 4241 02:55:25,120 --> 02:55:25,880 BREATHING PARTICULARLY IN 4242 02:55:25,880 --> 02:55:29,280 PRESENCE OR ABSENCE OF LEFT 4243 02:55:29,280 --> 02:55:31,000 HEART DISEASE IS CRITICAL. 4244 02:55:31,000 --> 02:55:35,960 THE ROLE OF PH THERAPY, SOME 4245 02:55:35,960 --> 02:55:37,920 PATIENTS MAY BENEFIT FROM 4246 02:55:37,920 --> 02:55:39,640 THERAPIES CONSIDERING LEVEL OF 4247 02:55:39,640 --> 02:55:41,640 REMODELING THAT I SHOWED YOU, WE 4248 02:55:41,640 --> 02:55:43,360 DON'T KNOW. 4249 02:55:43,360 --> 02:55:44,880 IT HADN'T BEEN PROPERLY STUDIED. 4250 02:55:44,880 --> 02:55:48,400 LAST BUT NOT LEAST AS PREVIOUSLY 4251 02:55:48,400 --> 02:55:49,040 MENTIONED HEALTH DISPARITIES, I 4252 02:55:49,040 --> 02:55:50,280 WOULD BE REMISS NOT TO POINT 4253 02:55:50,280 --> 02:55:53,280 THIS OUT BECAUSE IN THE SAME WAY 4254 02:55:53,280 --> 02:55:55,320 THAT WE SHOW HOW DISPARITIES 4255 02:55:55,320 --> 02:55:56,880 INFLUENCE OUTCOMES IN PATIENTS 4256 02:55:56,880 --> 02:55:59,320 WITH GROUP 1 PULMONARY 4257 02:55:59,320 --> 02:56:00,080 HYPERTENSION FOR EXAMPLE, PRETTY 4258 02:56:00,080 --> 02:56:02,240 CERTAIN THIS IS THE MAJOR FACTOR 4259 02:56:02,240 --> 02:56:04,760 THAT'S ALSO PLAYING A ROLE IN 4260 02:56:04,760 --> 02:56:05,960 THIS PATIENT POPULATION. 4261 02:56:05,960 --> 02:56:12,440 I HOPE I'VE GIVEN YOU SOME IDEAS 4262 02:56:12,440 --> 02:56:14,240 AND GOOD BACKGROUND SO THAT 4263 02:56:14,240 --> 02:56:16,240 MOVING FORWARD WE CAN HAVE A 4264 02:56:16,240 --> 02:56:17,240 GOOD CONVERSATION AND FIGURE OUT 4265 02:56:17,240 --> 02:56:20,840 HOW AS A GROUP WE CAN TACKLE 4266 02:56:20,840 --> 02:56:31,120 THIS CHALLENGE. 4267 02:56:46,320 --> 02:56:49,040 G 4268 02:56:49,040 --> 02:56:50,480 >>THANK YOU VERY MUCH. 4269 02:56:50,480 --> 02:56:51,760 IF ANYBODY HAS TIME FOR 4270 02:56:51,760 --> 02:56:52,680 QUESTIONS, FEEL FREE TO RAISE 4271 02:56:52,680 --> 02:56:54,080 YOUR HAND. 4272 02:56:54,080 --> 02:56:55,480 WE HAVE TIME FOR ONE OR TWO 4273 02:56:55,480 --> 02:56:57,920 QUESTIONS. 4274 02:56:57,920 --> 02:56:59,120 4275 02:56:59,120 --> 02:57:07,960 OR PUT IT IN THE CHAT. 4276 02:57:07,960 --> 02:57:08,360 DR. MATHAI? 4277 02:57:08,360 --> 02:57:11,600 >>IF YOU COULD COMMENT ON THE 4278 02:57:11,600 --> 02:57:15,840 ESTROGEN, ROLE OF ESTROGEN AND 4279 02:57:15,840 --> 02:57:17,360 PARADOX AND MAYBE CONTRAST WITH 4280 02:57:17,360 --> 02:57:21,440 WHAT WE SEE IN THE PREVALENCE OF 4281 02:57:21,440 --> 02:57:29,720 SLEEP APNEA IN WOMEN PRE-VERSUS 4282 02:57:29,720 --> 02:57:30,080 POST-MENOPAUSAL. 4283 02:57:30,080 --> 02:57:32,720 >>I THINK THAT IS A VERY 4284 02:57:32,720 --> 02:57:37,200 IMPORTANT QUESTION THAT SHOULD 4285 02:57:37,200 --> 02:57:38,960 BE FURTHER EXPLORED ON A 4286 02:57:38,960 --> 02:57:39,840 CLINICAL STUDIES. 4287 02:57:39,840 --> 02:57:44,960 I WOULD GO AND SAY THAT WITH 4288 02:57:44,960 --> 02:57:47,680 POST-MENOPAUSAL THE PREVALENCE 4289 02:57:47,680 --> 02:57:51,640 OF SLEEP DISORDERS ACTUALLY 4290 02:57:51,640 --> 02:57:53,040 INCREASES. 4291 02:57:53,040 --> 02:57:55,440 THE QUESTION THEN BECOMES 4292 02:57:55,440 --> 02:57:56,720 WHETHER GENDER-SPECIFIC 4293 02:57:56,720 --> 02:57:57,960 DIFFERENCE STILL PERSISTS IN 4294 02:57:57,960 --> 02:58:02,040 TERMS OF THE SEVERITY AND 4295 02:58:02,040 --> 02:58:03,560 OUTCOMES ASSOCIATED WITH THIS 4296 02:58:03,560 --> 02:58:04,320 PARTICULAR ENTITY. 4297 02:58:04,320 --> 02:58:06,720 YOU KNOW, I THINK THAT'S 4298 02:58:06,720 --> 02:58:09,800 IMPORTANT BECAUSE AS WE 4299 02:58:09,800 --> 02:58:11,200 DISCUSSED, GROUP 1 PATIENTS IT 4300 02:58:11,200 --> 02:58:12,880 MAKES A DIFFERENCE IF YOU'RE 4301 02:58:12,880 --> 02:58:14,080 FEMALE WITH PULMONARY 4302 02:58:14,080 --> 02:58:15,840 HYPERTENSION OR MALE, EVEN IF 4303 02:58:15,840 --> 02:58:19,080 YOUR HEMODYNAMICS ARE THE SAME, 4304 02:58:19,080 --> 02:58:27,200 THE THE WAY THE RIGHT EVENTUALLY 4305 02:58:27,200 --> 02:58:36,840 KEL-- HAVEN'TRY -- VENTRICLE 4306 02:58:36,840 --> 02:58:40,680 WILL ADAPT, ROLE OF ESTROGEN 4307 02:58:40,680 --> 02:58:42,880 NEEDS TO BE FURTHER ESTABLISHED, 4308 02:58:42,880 --> 02:58:44,360 SHOULD BE ADDRESSED WITH MORE 4309 02:58:44,360 --> 02:58:44,720 RESEARCH. 4310 02:58:44,720 --> 02:58:48,600 THANK YOU FOR THAT QUESTION. 4311 02:58:48,600 --> 02:58:56,360 >>THANKS. 4312 02:58:56,360 --> 02:58:57,920 REALLY INTERESTING DISCUSSION. 4313 02:58:57,920 --> 02:58:58,840 >>THANKS. 4314 02:58:58,840 --> 02:59:01,080 CAN YOU HEAR ME? 4315 02:59:01,080 --> 02:59:01,320 >>YES. 4316 02:59:01,320 --> 02:59:05,680 >>SO, MY QUESTION IS ON OHS. 4317 02:59:05,680 --> 02:59:08,920 THANKS FOR A GREAT TALK, FIRST. 4318 02:59:08,920 --> 02:59:12,400 BUT IN PARTICULAR, I FIND IT 4319 02:59:12,400 --> 02:59:15,800 VERY DIFFICULT IN REAL TIME TO 4320 02:59:15,800 --> 02:59:18,000 PHENOTYPE PATIENTS WITH OHS 4321 02:59:18,000 --> 02:59:20,200 VERSUS SOME OF THE OTHER 4322 02:59:20,200 --> 02:59:22,160 PARTICULARLY GROUP 1 DISEASE. 4323 02:59:22,160 --> 02:59:25,120 WHEN THEY COME IN AND 4324 02:59:25,120 --> 02:59:27,960 DECOMPENSATE, TYPICALLY WHEN WE 4325 02:59:27,960 --> 02:59:32,240 SEE THEM, ON IMAGING TO ME IT 4326 02:59:32,240 --> 02:59:38,800 LOOKS QUITE SIMILAR TO GROUP 1 4327 02:59:38,800 --> 02:59:40,920 DISEASE, OFTENTIMES, AND IN 4328 02:59:40,920 --> 02:59:42,840 REALITY THE DATA BEHIND THE 4329 02:59:42,840 --> 02:59:45,800 HEALTH TRIAL, WHICH I'M NOT SURE 4330 02:59:45,800 --> 02:59:46,760 IF THAT'S BEEN SUBSTANTIATED, 4331 02:59:46,760 --> 02:59:51,560 THAT TYPE OF A TRIAL, WHICH YOU 4332 02:59:51,560 --> 02:59:59,920 REFERENCED IN REGARDS TO PAP 4333 02:59:59,920 --> 03:00:01,440 THERAPY, OHS POPULATION, 4334 03:00:01,440 --> 03:00:03,520 PROFOUND IMPROVEMENT IN 4335 03:00:03,520 --> 03:00:05,280 HEMODYNAMIC IN PAP THERAPY BUT 4336 03:00:05,280 --> 03:00:07,440 WE TYPICALLY PLACE THEM ON 4337 03:00:07,440 --> 03:00:09,440 VASODILATORS AND PAP THERAPY AND 4338 03:00:09,440 --> 03:00:12,600 THEN SEE THINGS, BUT MY 4339 03:00:12,600 --> 03:00:16,320 QUESTION, ARE YOU FAMILIAR WITH 4340 03:00:16,320 --> 03:00:18,080 ANY PHENOTYPIC DIFFERENCES THAT 4341 03:00:18,080 --> 03:00:20,720 WE CAN USE EITHER IN THE 4342 03:00:20,720 --> 03:00:25,720 RESEARCH SETTING OR EVEN 4343 03:00:25,720 --> 03:00:27,160 ANECDOTES, MAYBE ON CARDIAC 4344 03:00:27,160 --> 03:00:29,440 IMAGING OR OTHERWISE, THAT CAN 4345 03:00:29,440 --> 03:00:32,320 HELP US MAYBE DIFFERENTIATE THE 4346 03:00:32,320 --> 03:00:41,160 TWO FOR FUTURE RESEARCH AND FOR 4347 03:00:41,160 --> 03:00:41,560 CURRENT PRACTICE. 4348 03:00:41,560 --> 03:00:43,560 >>I THINK THERE ARE -- THE 4349 03:00:43,560 --> 03:00:46,720 MAJOR CHALLENGE WITH THESE 4350 03:00:46,720 --> 03:00:48,360 PATIENTS IS THAT ALSO WILL 4351 03:00:48,360 --> 03:00:50,240 LIKELY HAVE A HIGH PREVALENCE OF 4352 03:00:50,240 --> 03:00:53,880 LEFT HEART DISEASE WHICH MAKES 4353 03:00:53,880 --> 03:00:57,720 IT CHALLENGING TO TRY TO, YOU 4354 03:00:57,720 --> 03:00:59,160 KNOW, GIVE THEM VASODILATORS. 4355 03:00:59,160 --> 03:01:01,880 AS YOU ALLUDE TO THE LEVEL OF 4356 03:01:01,880 --> 03:01:05,800 RIGHT VENTRICULAR FAVOR IN THESE 4357 03:01:05,800 --> 03:01:09,080 PATIENTS IS REALLY PROFOUND, 4358 03:01:09,080 --> 03:01:17,080 USUALLY COME RIGHT HEART 4359 03:01:17,080 --> 03:01:18,520 FAILURE, SEVERE EDEMA, 4360 03:01:18,520 --> 03:01:19,520 CONGESTIVE HEPATOTHY, YOU'LL 4361 03:01:19,520 --> 03:01:21,800 HAVE TO FOCUS ON WHAT YOU -- 4362 03:01:21,800 --> 03:01:24,960 WHAT THE PRIORITY HERE IS WHICH 4363 03:01:24,960 --> 03:01:26,720 WILL BE OBVIOUSLY TRY TO DIURESE 4364 03:01:26,720 --> 03:01:29,040 THEM AND GET THEM TO RIGHT HEART 4365 03:01:29,040 --> 03:01:30,560 CATH SO YOU CAN POTENTIALLY RULE 4366 03:01:30,560 --> 03:01:32,560 OUT HOW MUCH LEFT HEART 4367 03:01:32,560 --> 03:01:34,760 DYSFUNCTION THERE IS OR NOT. 4368 03:01:34,760 --> 03:01:39,680 AND THEN, YES, YOU WANT TO PUT 4369 03:01:39,680 --> 03:01:45,040 THEM ON BIPAP OR WHATEVER IS 4370 03:01:45,040 --> 03:01:47,240 NECESSARY ACCORDING TO YOUR 4371 03:01:47,240 --> 03:01:51,120 SLEEP SPECIALIST COLLEAGUES, BUT 4372 03:01:51,120 --> 03:01:57,600 PERSONALLY I ALSO MAKE AN OFFER 4373 03:01:57,600 --> 03:01:58,280 TO PROVIDE PULMONARY 4374 03:01:58,280 --> 03:02:01,120 VASODILATORS, OF COURSE IT'S NOT 4375 03:02:01,120 --> 03:02:02,760 REALLY IN THE GUIDELINES. 4376 03:02:02,760 --> 03:02:04,400 IT'S SOMETHING THAT AS EXPERTS 4377 03:02:04,400 --> 03:02:07,240 BASED ON THE CLINICAL PHENOTYPE, 4378 03:02:07,240 --> 03:02:10,200 THE PHENOTYPE IS ONE THAT IS 4379 03:02:10,200 --> 03:02:11,760 MORE REMINISCENT TO GROUP 1 I 4380 03:02:11,760 --> 03:02:14,720 THINK THERE'S A ROLE FOR DOING 4381 03:02:14,720 --> 03:02:15,240 THAT. 4382 03:02:15,240 --> 03:02:18,320 IF A PATIENT HAS SIGNIFICANT 4383 03:02:18,320 --> 03:02:20,720 LEFT HEART DYSFUNCTION, BUT 4384 03:02:20,720 --> 03:02:22,240 SEVERE RIGHT VENTRICULAR FAILURE 4385 03:02:22,240 --> 03:02:24,240 AND THEY HAVE WHAT MAY BE 4386 03:02:24,240 --> 03:02:26,640 COMBINED PRE AND POST CAPILLARY, 4387 03:02:26,640 --> 03:02:32,720 THEN, YOU KNOW, IT IT IS 4388 03:02:32,720 --> 03:02:34,920 UNFORTUNATELY ONE OF THE AREAS 4389 03:02:34,920 --> 03:02:40,320 OF, YOU KNOW, PERSONALLY I 4390 03:02:40,320 --> 03:02:41,960 HAVEN'T SEEN ANY COMPELLING 4391 03:02:41,960 --> 03:02:43,760 STUDY THAT HAS ALLOWED TO US 4392 03:02:43,760 --> 03:02:45,680 PHENOTYPE JUST LIKE, FOR 4393 03:02:45,680 --> 03:02:48,600 EXAMPLE, WE TALK ABOUT COPD, WE 4394 03:02:48,600 --> 03:02:50,840 TALK ABOUT THOSE THAT HAVE MORE, 4395 03:02:50,840 --> 03:02:53,240 YOU KNOW, OUT OF PROPORTION 4396 03:02:53,240 --> 03:02:56,640 VERSUS NOT AND WE SORT OF LIKE 4397 03:02:56,640 --> 03:03:00,560 CAN DISTINGUISH WHICH ONE WE MAY 4398 03:03:00,560 --> 03:03:05,800 BE ABLE TO OFFER, YOU KNOW, 4399 03:03:05,800 --> 03:03:06,480 PULMONARY HYPERTENSION 4400 03:03:06,480 --> 03:03:08,120 MEDICATION OR NOT, ON THE BASIS 4401 03:03:08,120 --> 03:03:09,760 OF EXPERIMENTAL USE. 4402 03:03:09,760 --> 03:03:15,440 I HAVEN'T SEEN ANY STUDY WITH 4403 03:03:15,440 --> 03:03:19,600 SYNDROMES WHERE PHENOTYPES HAVE 4404 03:03:19,600 --> 03:03:20,800 BEEN CLEARLY IDENTIFIED WHERE WE 4405 03:03:20,800 --> 03:03:22,920 CAN SAY THERE MAY BE A ROLE FOR 4406 03:03:22,920 --> 03:03:24,240 THIS, LET'S TAKE THEM INTO A 4407 03:03:24,240 --> 03:03:27,240 STUDY AND SEE IF THAT WORKS OUT. 4408 03:03:27,240 --> 03:03:30,240 IT'S AN AREA, UNLESS I MISSED 4409 03:03:30,240 --> 03:03:33,880 ANYTHING IN THE LITERATURE, I 4410 03:03:33,880 --> 03:03:36,600 DON'T KNOW OTHER THAN MY 4411 03:03:36,600 --> 03:03:37,720 PROFESSIONAL OPINION, I'M SURE 4412 03:03:37,720 --> 03:03:38,920 OTHER PEOPLE HAVE THEIR OWN 4413 03:03:38,920 --> 03:03:40,200 EXPERIENCE, I DON'T KNOW THERE'S 4414 03:03:40,200 --> 03:03:42,480 ANYTHING IN THE LITERATURE THAT 4415 03:03:42,480 --> 03:03:43,800 WE CAN USE. 4416 03:03:43,800 --> 03:03:46,120 BUT, AGAIN, I WOULD LIKE TO HEAR 4417 03:03:46,120 --> 03:03:50,080 FROM OTHERS IF THERE'S ANY OTHER 4418 03:03:50,080 --> 03:03:50,400 VIEWPOINTS. 4419 03:03:50,400 --> 03:03:51,800 >>THAT'S A GREAT TOPIC THAT WE 4420 03:03:51,800 --> 03:03:53,480 CAN CONTINUE IN OUR EXTENDED 4421 03:03:53,480 --> 03:03:55,120 DISCUSSION AT THE END OF THIS 4422 03:03:55,120 --> 03:03:57,320 SESSION BECAUSE IT'S AN 4423 03:03:57,320 --> 03:03:57,840 IMPORTANT ONE. 4424 03:03:57,840 --> 03:03:58,640 THANKS. 4425 03:03:58,640 --> 03:04:01,440 THAT WAS A GREAT PRESENTATION, 4426 03:04:01,440 --> 03:04:01,920 AND GOOD DISCUSSION. 4427 03:04:01,920 --> 03:04:05,960 I'D LIKE TO MOVE TO THE NEXT 4428 03:04:05,960 --> 03:04:08,800 SPEAKER, DR. NICHOLAS HILL FROM 4429 03:04:08,800 --> 03:04:10,120 TUFTS UNIVERSITY. 4430 03:04:10,120 --> 03:04:12,880 AND DR. HILL IS AN EXPERT IN 4431 03:04:12,880 --> 03:04:15,120 BOTH PULMONARY HYPERTENSION AND 4432 03:04:15,120 --> 03:04:16,760 SLEEP DISORDER BREATHING AND SO 4433 03:04:16,760 --> 03:04:19,320 HE'S THE PERFECT PERSON TO GIVE 4434 03:04:19,320 --> 03:04:22,680 THE NEXT TALK, SLEEP DISORDERED 4435 03:04:22,680 --> 03:04:24,200 BREATHING IN GROUP 3 PULMONARY 4436 03:04:24,200 --> 03:04:24,680 HYPERTENSION. 4437 03:04:24,680 --> 03:04:27,720 I'LL TURN THE FLOOR OVER TO YOU, 4438 03:04:27,720 --> 03:04:28,360 DR. HILL. 4439 03:04:28,360 --> 03:04:30,040 >>THANK YOU, ANNA. 4440 03:04:30,040 --> 03:04:31,240 THANK YOU FOR THE OPPORTUNITY TO 4441 03:04:31,240 --> 03:04:32,440 SPEAK TO EVERYBODY. 4442 03:04:32,440 --> 03:04:38,760 I ASSUME YOU CAN HEAR ME OKAY. 4443 03:04:38,760 --> 03:04:40,680 >>I DON'T SEE YOUR SLIDES BUT I 4444 03:04:40,680 --> 03:04:41,160 CAN HEAR YOU. 4445 03:04:41,160 --> 03:04:48,880 >>THAT WAS MY NEXT QUESTION. 4446 03:04:48,880 --> 03:04:50,640 4447 03:04:50,640 --> 03:04:54,040 LET ME SEE WHAT HAPPENED HERE. 4448 03:04:54,040 --> 03:05:00,080 4449 03:05:00,080 --> 03:05:03,040 4450 03:05:03,040 --> 03:05:09,160 >>NOW WE SEE THEM. 4451 03:05:09,160 --> 03:05:10,520 4452 03:05:10,520 --> 03:05:12,480 >>OKAY. 4453 03:05:12,480 --> 03:05:17,280 AND YOU CAN -- OOPS. 4454 03:05:17,280 --> 03:05:21,600 YOU CAN SEE THEM ADVANCE? 4455 03:05:21,600 --> 03:05:21,840 >>YEP. 4456 03:05:21,840 --> 03:05:23,080 >>OH, EXCELLENT. 4457 03:05:23,080 --> 03:05:23,920 ALL RIGHT. 4458 03:05:23,920 --> 03:05:27,560 SO, WE WILL BE DISCUSSING SEEP 4459 03:05:27,560 --> 03:05:31,480 SLEEP DISORDERED BREATHING IN 4460 03:05:31,480 --> 03:05:34,120 GROUP 3 PULMONARY HYPERTENSION, 4461 03:05:34,120 --> 03:05:35,760 VINICIO PROVIDED A GOOD 4462 03:05:35,760 --> 03:05:37,560 FOUNDATION FOR MANY COMMENTS 4463 03:05:37,560 --> 03:05:40,440 I'LL MAKE, AND I WANTED TO PICK 4464 03:05:40,440 --> 03:05:47,680 UP WHERE HE LEFT OFF ON THE 4465 03:05:47,680 --> 03:05:48,680 CLASSIFICATION OF PULMONARY 4466 03:05:48,680 --> 03:05:52,280 HYPERTENSION, AND DATING BACK TO 4467 03:05:52,280 --> 03:05:54,920 1973, THE MEAN PULMONARY ARTERY 4468 03:05:54,920 --> 03:06:02,560 PRESSURE DEFINED BY WORLD 4469 03:06:02,560 --> 03:06:05,120 SYMPOSIUM EVERY FIVE YEARS WAS 4470 03:06:05,120 --> 03:06:07,080 DEFINED HERE, GREATER OR EQUAL 4471 03:06:07,080 --> 03:06:08,480 TO 25 MILLIMETERS OF MERCURY, 4472 03:06:08,480 --> 03:06:12,360 AND IF YOU WANTED TO DEFINE 4473 03:06:12,360 --> 03:06:13,440 PRE-CAPILLARY OF WHICH GROUP 3 4474 03:06:13,440 --> 03:06:20,440 IS ONE OF THE TYPES, THE WEDGE 4475 03:06:20,440 --> 03:06:22,640 PRESSURE WAS LESS THAN 15, 4476 03:06:22,640 --> 03:06:27,120 DEFINITION OF MODEST AS OPPOSED 4477 03:06:27,120 --> 03:06:28,440 TO SEVERE PRESSURE FOR THE MOST 4478 03:06:28,440 --> 03:06:34,640 PART LESS THAN OR GREATER THAN 4479 03:06:34,640 --> 03:06:34,800 35. 4480 03:06:34,800 --> 03:06:38,600 AND YOU WILL SEE THAT AT THE 4481 03:06:38,600 --> 03:06:40,200 SIXTH WORLD SYMPOSIUM, MEAN PA 4482 03:06:40,200 --> 03:06:42,440 PRESSURE WAS CHANGED TO 4483 03:06:42,440 --> 03:06:43,520 NEGATIVE -- RATHER GREATER THAN 4484 03:06:43,520 --> 03:06:45,040 20 MILLIMETERS OF MERCURY 4485 03:06:45,040 --> 03:06:46,400 BECAUSE THIS WAS CONSIDERED TO 4486 03:06:46,400 --> 03:06:48,880 BE MORE NORMATIVE AND THERE WAS 4487 03:06:48,880 --> 03:06:51,200 DATA TO SUGGEST PEOPLE WHOSE 4488 03:06:51,200 --> 03:06:55,240 MEAN PA PRESSURE WAS BETWEEN 21 4489 03:06:55,240 --> 03:07:02,040 AND 24 HAD WORSE OUTCOMES SO 4490 03:07:02,040 --> 03:07:05,600 THEY DIDN'T FLOOD THIS WITH TOO 4491 03:07:05,600 --> 03:07:09,560 MANY PATIENTS DEFINED PVR 4492 03:07:09,560 --> 03:07:14,600 GREATER OR EQUAL TO 3 WU, AS 4493 03:07:14,600 --> 03:07:16,240 VINICIO POINTED OUT SUBSEQUENTLY 4494 03:07:16,240 --> 03:07:17,880 QUESTIONED TO GREATER THAN 2 4495 03:07:17,880 --> 03:07:20,000 BECAUSE THEY SEEMED TO EXCLUDE 4496 03:07:20,000 --> 03:07:23,040 MORE PATIENTS THAN THEY 4497 03:07:23,040 --> 03:07:23,360 ANTICIPATED. 4498 03:07:23,360 --> 03:07:26,720 AND THEN THE DEFINITION OF 4499 03:07:26,720 --> 03:07:29,720 SEVERE HAS CHANGED TO -- AT THE 4500 03:07:29,720 --> 03:07:31,920 6th WORLD SYMPOSIUM GREATER 4501 03:07:31,920 --> 03:07:38,360 THAN 40 MILLIMETERS OF MERCURY. 4502 03:07:38,360 --> 03:07:40,120 MOST RECENTLY WITH THE 4503 03:07:40,120 --> 03:07:43,160 GUIDELINES IT WAS SUGGESTED THAT 4504 03:07:43,160 --> 03:07:45,280 A PVR GREATER THAN 5 SERVE AS 4505 03:07:45,280 --> 03:07:46,400 CUTOFF FOR SEVERE. 4506 03:07:46,400 --> 03:07:49,200 SO, PART OF THE POINT I'M GOING 4507 03:07:49,200 --> 03:07:50,520 INTO DETAIL HERE IS THAT THEY 4508 03:07:50,520 --> 03:07:52,440 HAVE BEEN CHANGING THE GUIDE 4509 03:07:52,440 --> 03:07:56,120 POSTS ON US SO THAT WHEN WE TALK 4510 03:07:56,120 --> 03:07:58,880 ABOUT THINGS LIKE PREVALENCE, A 4511 03:07:58,880 --> 03:08:05,080 LOT OF THE LITERATURE PREDATES 4512 03:08:05,080 --> 03:08:07,920 THE 2018 NICE SYMPOSIUM, SO THE 4513 03:08:07,920 --> 03:08:08,920 NUMBERS FLUCTUATE PARTLY BECAUSE 4514 03:08:08,920 --> 03:08:11,320 WE CHANGE THE GOAL POSTS. 4515 03:08:11,320 --> 03:08:15,240 ONE OTHER THING TO POINT OUT IS 4516 03:08:15,240 --> 03:08:21,040 THAT BETWEEN THE FIFTH AND SIXTH 4517 03:08:21,040 --> 03:08:24,560 WORLD SYMPOSIUM, THEY DROPPED A 4518 03:08:24,560 --> 03:08:26,320 COUPLE CATEGORIES INCLUDING 4519 03:08:26,320 --> 03:08:29,480 SLEEP DISORDERED BREATHING AND 4520 03:08:29,480 --> 03:08:33,280 CHRONIC EXPOSURE TO HIGH 4521 03:08:33,280 --> 03:08:33,560 ALTITUDE. 4522 03:08:33,560 --> 03:08:38,000 HERE YOU SEE IT WAS 3.4 AT THE 4523 03:08:38,000 --> 03:08:42,600 FIFTH, AND THEN DISAPPEARS FROM 4524 03:08:42,600 --> 03:08:44,040 THE SIXTH. 4525 03:08:44,040 --> 03:08:46,200 AND STEVE NATHAN, WHO WAS THE 4526 03:08:46,200 --> 03:08:48,520 FIRST AUTHOR OF THE CHAPTER ON 4527 03:08:48,520 --> 03:08:53,120 THE DOCUMENT FROM THE SIXTH 4528 03:08:53,120 --> 03:09:01,080 WORLD SYMPOSIUM HAD A STATEMENT 4529 03:09:01,080 --> 03:09:09,080 CHRONIC PH IS RARE AND MOST 4530 03:09:09,080 --> 03:09:09,960 COMMONLY MILD. 4531 03:09:09,960 --> 03:09:11,720 I ASKED STEVE ABOUT THIS, HE 4532 03:09:11,720 --> 03:09:14,760 SAID THEY DIDN'T REALLY MEAN TO 4533 03:09:14,760 --> 03:09:15,880 DROP SLEEP DISORDERED BREATHING 4534 03:09:15,880 --> 03:09:18,720 BUT THE TASK FORCE ON 4535 03:09:18,720 --> 03:09:20,480 CLASSIFICATION I GUESS IS 4536 03:09:20,480 --> 03:09:25,600 BECAUSE THERE WEREN'T MANY SLEEP 4537 03:09:25,600 --> 03:09:29,200 PEOPLE ON THE BOARD DROPPED IT 4538 03:09:29,200 --> 03:09:35,000 BUT EUROPEAN SOCIETY OF 4539 03:09:35,000 --> 03:09:39,600 CARDIOLOGY MEETING ADDED OBESITY 4540 03:09:39,600 --> 03:09:40,080 HYPOVENTILATION BUT 4541 03:09:40,080 --> 03:09:41,240 SLEEP-DISORDERED BREATHING IS A 4542 03:09:41,240 --> 03:09:42,120 MUCH BIGGER CATEGORY. 4543 03:09:42,120 --> 03:09:45,840 WE'RE STILL IN NEED OF A BETTER 4544 03:09:45,840 --> 03:09:47,040 CLASSIFICATION TO INCORPORATE 4545 03:09:47,040 --> 03:09:47,680 SLEEP-DISORDERED BREATHING, AND 4546 03:09:47,680 --> 03:09:49,560 I GUESS ONE OF THE ISSUES IS 4547 03:09:49,560 --> 03:09:50,760 THAT SLEEP-DISORDERED BREATHING 4548 03:09:50,760 --> 03:09:54,040 IS REALLY A VERY COMMON 4549 03:09:54,040 --> 03:09:58,200 COMORBIDITY IN ALL THE GROUPS OF 4550 03:09:58,200 --> 03:09:59,280 PULMONARY HYPERTENSION, AND 4551 03:09:59,280 --> 03:10:00,720 MAYBE DESERVES A SPECIAL 4552 03:10:00,720 --> 03:10:02,680 CATEGORY FOR THAT REASON. 4553 03:10:02,680 --> 03:10:05,760 SO TODAY I'M GOING TO SPEND TIME 4554 03:10:05,760 --> 03:10:11,320 TALKING ABOUT THE TWO MAIN 4555 03:10:11,320 --> 03:10:14,840 CATEGORIES OF LUNG DISEASE 4556 03:10:14,840 --> 03:10:21,600 RELATED GROUP 3 PH, COPD AND 4557 03:10:21,600 --> 03:10:21,760 ILD. 4558 03:10:21,760 --> 03:10:24,560 I'LL MAKE COMMENTS AT THE END 4559 03:10:24,560 --> 03:10:25,760 BECAUSE THESE HAVE LARGELY BEEN 4560 03:10:25,760 --> 03:10:27,600 COVERED IN PREVIOUS TALKS AND 4561 03:10:27,600 --> 03:10:28,560 SUBSEQUENT TALKS. 4562 03:10:28,560 --> 03:10:31,920 SO ONE POINT TO BE MADE IS THATS 4563 03:10:31,920 --> 03:10:34,000 IS A COMORBID DISEASE. 4564 03:10:34,000 --> 03:10:39,640 IT IS A SYSTEMIC DISEASE, 4565 03:10:39,640 --> 03:10:43,280 CHARACTERIZED BY INFLAMMATION 4566 03:10:43,280 --> 03:10:44,160 AND VASCULOPATHY, THIS DIAGRAM 4567 03:10:44,160 --> 03:10:46,800 SHOWS A NUMBER OF THESE 4568 03:10:46,800 --> 03:10:48,680 DIFFERENT COMORBIDITIES AND SIZE 4569 03:10:48,680 --> 03:10:51,720 OF THESE BALLOONS HAS TO DO WITH 4570 03:10:51,720 --> 03:10:52,280 PREVALENCE, SO SYSTEMIC 4571 03:10:52,280 --> 03:10:56,440 HYPERTENSION IS ONE OF THE MOST 4572 03:10:56,440 --> 03:10:59,600 COMMON COMORBIDITIES, DIABETES 4573 03:10:59,600 --> 03:11:00,560 IS VERY COMMON. 4574 03:11:00,560 --> 03:11:01,920 PULMONARY HYPERTENSION ISN'T 4575 03:11:01,920 --> 03:11:03,800 LISTED AS PARTICULARLY COMMON 4576 03:11:03,800 --> 03:11:05,320 HERE BUT AS YOU'LL SEE IT'S HARD 4577 03:11:05,320 --> 03:11:08,240 TO NAIL DOWN THE PREVALENCE. 4578 03:11:08,240 --> 03:11:10,320 AND THE CLOSER THE CENTER, THE 4579 03:11:10,320 --> 03:11:14,240 MORE LIKELY IT WAS TO BE 4580 03:11:14,240 --> 03:11:15,240 AFFILIATED WITH MORTALITY. 4581 03:11:15,240 --> 03:11:18,560 HERE IT'S A LITTLE BIT OUTSIDE 4582 03:11:18,560 --> 03:11:19,760 THE CIRCLE OF DEATH. 4583 03:11:19,760 --> 03:11:21,720 BUT IN FACT THERE ARE A NUMBER 4584 03:11:21,720 --> 03:11:25,520 OF STUDIES, I'M JUST GIVING AN 4585 03:11:25,520 --> 03:11:27,800 EXAMPLE OF ONE, THAT SHOW IN 4586 03:11:27,800 --> 03:11:32,640 PEOPLE WHO HAVE PULMONARY 4587 03:11:32,640 --> 03:11:33,320 HYPERTENSION ASSOCIATED WITH 4588 03:11:33,320 --> 03:11:35,160 COPD THE SURVIVAL IS 4589 03:11:35,160 --> 03:11:38,000 CONSIDERABLY WORSE THAN THOSE 4590 03:11:38,000 --> 03:11:40,120 WITHOUT. 4591 03:11:40,120 --> 03:11:44,600 AND PREVALENCE OF PH IN COPD 4592 03:11:44,600 --> 03:11:48,520 RANGES FROM 20 TO 91% IN 4593 03:11:48,520 --> 03:11:54,040 LITERATURE, AND A COUPLE OF THE 4594 03:11:54,040 --> 03:11:55,080 LARGER STUDIES OUT OF FRANCE DID 4595 03:11:55,080 --> 03:11:58,080 A LOT OF WORK ON THIS IN THE 4596 03:11:58,080 --> 03:11:59,160 '80s AND '90s, COMMONLY 4597 03:11:59,160 --> 03:12:02,320 CITED, BUT IN ONE OF THE STUDIES 4598 03:12:02,320 --> 03:12:12,400 OF 175 PATIENTS WITH SEVERE COPD 4599 03:12:12,400 --> 03:12:18,320 30% ARE GREATER THAN 35 4600 03:12:18,320 --> 03:12:21,280 MILLIMETERS OF MERCURY, AND 91% 4601 03:12:21,280 --> 03:12:24,480 WAS THE NETT TRIAL, TO GET IN 4602 03:12:24,480 --> 03:12:26,560 YOU WERE BEING CONSIDERED FOR 4603 03:12:26,560 --> 03:12:28,480 LUNG VOLUME REDUCTION TREATMENT 4604 03:12:28,480 --> 03:12:31,840 AND THEREFORE HAD VERY ADVANCED 4605 03:12:31,840 --> 03:12:35,320 COPD BUT STILL ONLY A MINORITY 4606 03:12:35,320 --> 03:12:41,240 HAD MEAN PRESSURE GREATER THAN 4607 03:12:41,240 --> 03:12:42,960 35%, IN OTHER STUDIES EVEN LESS. 4608 03:12:42,960 --> 03:12:44,800 THIS IS THE DISTRIBUTION OF 4609 03:12:44,800 --> 03:12:50,040 PRESSURES IN A SIZEABLE GROUP OF 4610 03:12:50,040 --> 03:13:00,560 COPD PATIENTS WHICH IS PART OF 4611 03:13:04,920 --> 03:13:06,840 WHITESSENBOUND'S FRENCH GROUP, A 4612 03:13:06,840 --> 03:13:07,120 BELL CURVE. 4613 03:13:07,120 --> 03:13:10,120 THE ARROW IS THE OLDER 4614 03:13:10,120 --> 03:13:15,800 DEFINITION, A MEAN PRESSURE OF 4615 03:13:15,800 --> 03:13:16,040 25. 4616 03:13:16,040 --> 03:13:21,000 IF WE INSERT ARROW FOR NEW 4617 03:13:21,000 --> 03:13:22,400 DEFINITION, SIZEABLE BARS, SO 4618 03:13:22,400 --> 03:13:26,320 PREVALENCE OF COPD IS GOING UP 4619 03:13:26,320 --> 03:13:29,160 CONSIDERABLY BASED ON NEW 4620 03:13:29,160 --> 03:13:31,920 DEFINITION, ESPECIALLY KNEW THAT 4621 03:13:31,920 --> 03:13:33,320 PVR RECOMMENDATION IS LOWERED TO 4622 03:13:33,320 --> 03:13:33,680 2. 4623 03:13:33,680 --> 03:13:36,400 AND THEN IF WE LOOK AT 4624 03:13:36,400 --> 03:13:38,560 DEFINITIONS FOR SEVERE, YOU CAN 4625 03:13:38,560 --> 03:13:42,320 SEE THERE'S JUST A TAIL HERE, 4626 03:13:42,320 --> 03:13:52,760 RELATIVELY SMALL GROUP OF 4627 03:13:53,640 --> 03:13:57,960 PATIENTS, AND VINICIO ALLUDED TO 4628 03:13:57,960 --> 03:13:59,240 OVERLAPS, CLASSIFICATION FOR PH, 4629 03:13:59,240 --> 03:14:00,480 AND ONE ASKS WHETHER SOME 4630 03:14:00,480 --> 03:14:05,200 PATIENTS MAY BE AN OVERLAP OF 4631 03:14:05,200 --> 03:14:10,240 GROUP 1 AND 3, GIVING RISE TO 4632 03:14:10,240 --> 03:14:12,360 THE CONCEPT THERE'S A PHENOTYPE 4633 03:14:12,360 --> 03:14:19,840 FIRST IDENTIFIED BY ONE OF THE 4634 03:14:19,840 --> 03:14:21,800 STUDIES, BUT WAS MENTIONED IN 4635 03:14:21,800 --> 03:14:26,120 THE WORLD SYMPOSIUM DOCUMENT 4636 03:14:26,120 --> 03:14:27,320 AUTHORED BY STEVE NACEM, LESS 4637 03:14:27,320 --> 03:14:32,240 AIR WAY OBSTRUCTION THAN THOSE 4638 03:14:32,240 --> 03:14:40,040 WITH LOWER P.A. PRESSURES, LOWER 4639 03:14:40,040 --> 03:14:50,400 DLCO, MORE HYPOXEMIC. 4640 03:14:52,160 --> 03:14:54,080 THIS MIGHT BE SUBPHENOTYPE THAT 4641 03:14:54,080 --> 03:14:57,800 WOULD RESPOND TO TREATMENT. 4642 03:14:57,800 --> 03:15:00,400 WE'VE SEEN THIS DIAGRAM BEFORE. 4643 03:15:00,400 --> 03:15:07,760 I WILL NOT BELABOR THIS, BUT THE 4644 03:15:07,760 --> 03:15:09,360 MECHANISMS THAT ARE ASCRIBED TO 4645 03:15:09,360 --> 03:15:13,240 THE DEVELOPMENT OF PULMONARY 4646 03:15:13,240 --> 03:15:17,360 HYPERTENSION FOR COPD INCLUDE 4647 03:15:17,360 --> 03:15:20,480 HYPOXIC VASOCONSTRUCTION, AND 4648 03:15:20,480 --> 03:15:23,160 NEGATIVE INTERTHORACIC PRESSURE 4649 03:15:23,160 --> 03:15:27,360 SWINGS, AND BOTH COPD AND SEVERE 4650 03:15:27,360 --> 03:15:32,040 ILD WILL INTENSIFY THE SWINGS OF 4651 03:15:32,040 --> 03:15:33,920 INTERTHORACIC PRESSURE, WHICH 4652 03:15:33,920 --> 03:15:36,880 HAVE ADVERSE EFFECTS ON LV 4653 03:15:36,880 --> 03:15:42,320 COMPLIANCE, AND THEN ALSO THE 4654 03:15:42,320 --> 03:15:44,640 ISSUES OF ENDOTHELIAL 4655 03:15:44,640 --> 03:15:45,200 DYSFUNCTION, HEIGHTENED 4656 03:15:45,200 --> 03:15:46,800 INFLAMMATORY STATE AND PRO 4657 03:15:46,800 --> 03:15:48,320 COAGULANT STATE WE'VE HEARD 4658 03:15:48,320 --> 03:15:52,200 ABOUT. 4659 03:15:52,200 --> 03:15:54,920 I'VE INSERTED SLEEP APNEA IN 4660 03:15:54,920 --> 03:15:56,360 HERE, AN IMPORTANT COMORBIDITY 4661 03:15:56,360 --> 03:16:01,160 LIKELY INTENSIFIES A LOT OF 4662 03:16:01,160 --> 03:16:03,560 THESE MECHANISMS BECAUSE IT WILL 4663 03:16:03,560 --> 03:16:07,840 LEAD TO INCREASED SWINGS IN 4664 03:16:07,840 --> 03:16:17,480 INTERTHORACIC PRESSURE AS WELL 4665 03:16:17,480 --> 03:16:21,320 AS THESE OTHER MECHANISMS AND 4666 03:16:21,320 --> 03:16:23,520 WHEN SUPERIMPOSED IT IS LIKELY 4667 03:16:23,520 --> 03:16:24,840 TO INTENSIFY MECHANISMS AND LEAD 4668 03:16:24,840 --> 03:16:25,960 TO WORSE OUTCOMES. 4669 03:16:25,960 --> 03:16:29,320 WE'VE KNOWN FOR A LONG TIME THAT 4670 03:16:29,320 --> 03:16:32,640 SLEEP DISORDERED BREATHING IS 4671 03:16:32,640 --> 03:16:34,360 COMMON IN COPD, AND SOME OF THE 4672 03:16:34,360 --> 03:16:35,640 EARLIER STUDIES, THIS IS ONE 4673 03:16:35,640 --> 03:16:41,000 FROM OVER 40 YEARS AGO, VERY 4674 03:16:41,000 --> 03:16:43,520 WIDELY CITED, BY JOHN FLEETHAM. 4675 03:16:43,520 --> 03:16:48,440 ON THE LEFT IS SLEEP STAGES, AND 4676 03:16:48,440 --> 03:16:50,080 THE CROSSHATCH BAR IS FOR A 4677 03:16:50,080 --> 03:16:52,600 SMALL GROUP OF NORMALS. 4678 03:16:52,600 --> 03:16:59,720 THE MORE WIDELY SPACED IN THE 4679 03:16:59,720 --> 03:17:03,520 MIDDLE CROSS-HATCH BAR FOR COPD 4680 03:17:03,520 --> 03:17:05,120 PATIENTS BREATHING AIR AND OPEN 4681 03:17:05,120 --> 03:17:07,520 BAR FOR THOSE BREATHING OXYGEN. 4682 03:17:07,520 --> 03:17:09,560 BASICALLY IT SHOWS THE SLEEP 4683 03:17:09,560 --> 03:17:11,760 QUALITY IS QUITE POOR, AND 4684 03:17:11,760 --> 03:17:13,840 THERE'S THIS SUBSTANTIAL 4685 03:17:13,840 --> 03:17:15,920 DECREASE IN REM SLEEP, TOTAL 4686 03:17:15,920 --> 03:17:18,880 SLEEP TIME REDUCED IN COPD 4687 03:17:18,880 --> 03:17:20,760 PATIENTS COMPARED TO NORMALS AND 4688 03:17:20,760 --> 03:17:25,080 SHIFTS, STAGE SHIFTS WHICH 4689 03:17:25,080 --> 03:17:27,520 CORRESPOND TO FRAGMENTATION ARE 4690 03:17:27,520 --> 03:17:29,360 MUCH MORE FREQUENT, AND OXYGEN 4691 03:17:29,360 --> 03:17:33,520 APPEARS TO HAVE NEW BENEFICIAL 4692 03:17:33,520 --> 03:17:38,960 EFFECT ON THESE ASPECTS OF 4693 03:17:38,960 --> 03:17:39,720 SLEEP-DISORDERED BREATHING. 4694 03:17:39,720 --> 03:17:40,880 A NUMBER OF STUDIES TRIED TO 4695 03:17:40,880 --> 03:17:41,960 LOOK AT THIS. 4696 03:17:41,960 --> 03:17:43,520 AGAIN, THERE'S A TREMENDOUS 4697 03:17:43,520 --> 03:17:45,600 RANGE OF THE ESTIMATED 4698 03:17:45,600 --> 03:17:46,920 PREVALENCE AND IT DEPENDS ON 4699 03:17:46,920 --> 03:17:49,600 MANY FACTORS INCLUDING THE 4700 03:17:49,600 --> 03:17:57,720 PATIENT DEMOGRAPHICS, SEVERITY 4701 03:17:57,720 --> 03:17:59,480 OF COPD, TOOLS, SHIFTING GOAL 4702 03:17:59,480 --> 03:18:03,760 POSTS. 4703 03:18:03,760 --> 03:18:06,040 IN A RECENT STUDY OF 100 4704 03:18:06,040 --> 03:18:09,520 PATIENTS, ONE OF THE THINGS THEY 4705 03:18:09,520 --> 03:18:11,640 FOUND IDENTIFYING PROBLEMS WITH 4706 03:18:11,640 --> 03:18:13,800 SLEEP USING GLOBAL SLEEP 4707 03:18:13,800 --> 03:18:15,080 ASSESSMENT QUESTIONNAIRE WAS 4708 03:18:15,080 --> 03:18:18,400 THAT INSOMNIA WAS THE MOST 4709 03:18:18,400 --> 03:18:22,360 COMMON MANIFESTATION OF A SLEEP 4710 03:18:22,360 --> 03:18:28,720 DISORDER, RESTLESS LEG SYNDROME 4711 03:18:28,720 --> 03:18:36,120 NEXT, OBSTRUCTIVE SLEEP SLEEP 4712 03:18:36,120 --> 03:18:38,760 APNEA IN 13%, WITH MORE SEVERE 4713 03:18:38,760 --> 03:18:45,560 AND SOMEWHAT LESS SEVERE COPD. 4714 03:18:45,560 --> 03:18:52,160 THE COME BIN OSA AND COPD, 4715 03:18:52,160 --> 03:18:54,360 OVERLAP SYNDROME, A TERM COINED 4716 03:18:54,360 --> 03:18:56,000 IN THIS ARTICLE IN 85, IS 4717 03:18:56,000 --> 03:18:58,480 IMPORTANT, ASSOCIATED WITH MORE 4718 03:18:58,480 --> 03:19:02,440 SYMPTOMS, WORSE OUTCOMES, CO2 4719 03:19:02,440 --> 03:19:06,920 RETENTION, MORE SEVERE 4720 03:19:06,920 --> 03:19:08,320 EXACERBATIONS. 4721 03:19:08,320 --> 03:19:10,520 HYPOXEMIA IS ANOTHER 4722 03:19:10,520 --> 03:19:13,720 MANIFESTATION, AND MOST IS NOT 4723 03:19:13,720 --> 03:19:16,240 ACTUALLY ASSOCIATED WITH 4724 03:19:16,240 --> 03:19:19,760 OBSTRUCTIONS BUT RATHER THERE 4725 03:19:19,760 --> 03:19:29,800 MAY BE HYPOVENTILATION, MAY BE 4726 03:19:29,800 --> 03:19:31,880 VENTILATION PERFUSION MISMATCH 4727 03:19:31,880 --> 03:19:33,960 AND DIAGRAM DYSFUNCTION MAY BE 4728 03:19:33,960 --> 03:19:35,120 AN ASPECT. 4729 03:19:35,120 --> 03:19:38,760 YOU CAN SEE AS FAR AS THE 4730 03:19:38,760 --> 03:19:39,960 NOCTURNAL HYPOXEMIA IS 4731 03:19:39,960 --> 03:19:41,720 CONCERNED, SUPPLEMENTING WITH 4732 03:19:41,720 --> 03:19:47,000 OXYGEN AS IN THESE CROSS-HATCH 4733 03:19:47,000 --> 03:19:50,080 BARS ACTUALLY IS USEFUL IN 4734 03:19:50,080 --> 03:19:51,720 CORRECTING HYPOXEMIA, THIS 4735 03:19:51,720 --> 03:19:56,520 FIGURE SHOWS THAT IN THIS RATHER 4736 03:19:56,520 --> 03:20:01,320 SEVERELY IMPAIRED COPD GROUP THE 4737 03:20:01,320 --> 03:20:04,640 INCREASE IN CO2 THAT WAS SEEN IS 4738 03:20:04,640 --> 03:20:07,040 CONSIDERABLY SMALLER THAN THE 4739 03:20:07,040 --> 03:20:09,760 DROP IN OXYGEN, AND HENCE 4740 03:20:09,760 --> 03:20:13,280 SUGGESTIVE OF SOME KIND OF 4741 03:20:13,280 --> 03:20:15,480 VENTILATION PERFUSION PROBLEM. 4742 03:20:15,480 --> 03:20:18,520 NOW, THE FACT THAT OXYGEN 4743 03:20:18,520 --> 03:20:19,720 THERAPY DOES IMPROVE OXYGENATION 4744 03:20:19,720 --> 03:20:21,360 RAISES THE QUESTION HOW 4745 03:20:21,360 --> 03:20:23,000 EFFECTIVE IT IS, AND I THINK 4746 03:20:23,000 --> 03:20:28,480 WE'RE PROBABLY ALL FAMILIAR WITH 4747 03:20:28,480 --> 03:20:29,800 THE TRIALS THAT ARE THE MOST 4748 03:20:29,800 --> 03:20:34,600 IMPORTANT DONE WITH REGARD TO 4749 03:20:34,600 --> 03:20:37,240 OXYGEN TREATMENT DATING BACK TO 4750 03:20:37,240 --> 03:20:39,440 THE EARLY 1980s, AND THIS IS 4751 03:20:39,440 --> 03:20:41,440 BASED ON THE HEMODYNAMIC DATA IN 4752 03:20:41,440 --> 03:20:44,880 THE NOTT TRIAL IN A SUBGROUP OF 4753 03:20:44,880 --> 03:20:46,680 PATIENTS WHO UNDERWENT PRE AND 4754 03:20:46,680 --> 03:20:47,440 POST RIGHT HEART 4755 03:20:47,440 --> 03:20:48,280 CATHETERIZATIONS AND DID 4756 03:20:48,280 --> 03:20:50,920 DOCUMENT IN THIS STUDY THERE WAS 4757 03:20:50,920 --> 03:20:53,240 A DROP IN PULMONARY VASCULAR 4758 03:20:53,240 --> 03:20:55,200 RESISTANCE AT REST AND EXERCISE, 4759 03:20:55,200 --> 03:20:59,560 AFTER SIX MONTHS OF TREATMENT, 4760 03:20:59,560 --> 03:21:00,480 THAT WAS STATISTICALLY 4761 03:21:00,480 --> 03:21:03,960 SIGNIFICANT, AND IT DID NOT 4762 03:21:03,960 --> 03:21:04,960 NORMALIZE THE ABNORMALITIES, 4763 03:21:04,960 --> 03:21:05,480 HOWEVER. 4764 03:21:05,480 --> 03:21:14,760 THIS WAS A PARTIAL CORRECTION. 4765 03:21:14,760 --> 03:21:22,560 AND WEITDENBLUM HAD PATIENTS 4766 03:21:22,560 --> 03:21:26,080 TREATED WITH A DROP FROM 28 TO 4767 03:21:26,080 --> 03:21:30,000 24 AND RECENTLY THE LOTT STUDY 4768 03:21:30,000 --> 03:21:32,080 OF MODERATE OXYGEN SATURATION IN 4769 03:21:32,080 --> 03:21:35,360 THE NEW ENGLAND JOURNAL OF 2016 4770 03:21:35,360 --> 03:21:39,400 ON PATIENTS WHO EITHER HAD 4771 03:21:39,400 --> 03:21:41,720 NORMAL RESTING O2 OR MILDLY 4772 03:21:41,720 --> 03:21:47,440 REDUCED O2 SATS AT REST AND THEN 4773 03:21:47,440 --> 03:21:49,400 MORE WITH EXERTION SHOWED 4774 03:21:49,400 --> 03:21:52,080 OVER -- AVERAGE OF 6-YEAR PERIOD 4775 03:21:52,080 --> 03:21:54,200 WITH NO BENEFIT IN MEAN OUTCOME 4776 03:21:54,200 --> 03:21:56,480 VARIABLE TIME TO HOSPITALIZATION 4777 03:21:56,480 --> 03:22:01,640 OR DEATH, AND NOTHING WITH 4778 03:22:01,640 --> 03:22:03,080 QUALITY OF LIFE, NEGATIVE TRIAL 4779 03:22:03,080 --> 03:22:06,760 DIFFICULT TO DO, BUT MILDER 4780 03:22:06,760 --> 03:22:07,360 PATIENTS PERHAPS NOT 4781 03:22:07,360 --> 03:22:08,760 SURPRISINGLY DO NOT SEEM TO 4782 03:22:08,760 --> 03:22:12,960 RESPOND AND THEY DID NOT LOOK AT 4783 03:22:12,960 --> 03:22:14,920 PULMONARY HEMODYNAMICS BUT ONE 4784 03:22:14,920 --> 03:22:16,560 HAS TO SURMISE THERE PROBABLY 4785 03:22:16,560 --> 03:22:17,640 WASN'T A LOT. 4786 03:22:17,640 --> 03:22:22,040 A NUMBER OF STUDIES LOOKED AT 4787 03:22:22,040 --> 03:22:23,600 PHARMACOTHERAPY, IN BRIEF THEY 4788 03:22:23,600 --> 03:22:28,080 HAVE NOT SHOWN ANY CONSISTENT 4789 03:22:28,080 --> 03:22:33,440 IMPROVEMENT, THIS TAPIT-1 STUDY 4790 03:22:33,440 --> 03:22:35,160 OF INHALED TREPROSTINIL, THERE 4791 03:22:35,160 --> 03:22:38,480 WAS A DROP FROM 43 TO 37%, AND 4792 03:22:38,480 --> 03:22:40,320 THE PERFECT TRIAL THAT UNITED 4793 03:22:40,320 --> 03:22:47,560 THERAPEUTICS WAS DOING ON 4794 03:22:47,560 --> 03:22:50,080 INHALED WAS STOPPED BY DSMB, 4795 03:22:50,080 --> 03:22:52,040 WE'VE NOT BEEN TOLD UNITED 4796 03:22:52,040 --> 03:22:53,680 THERAPEUTICS SAYS IT WILL 4797 03:22:53,680 --> 03:22:54,640 PROVIDE FINDINGS TO THE 4798 03:22:54,640 --> 03:22:57,840 SCIENTIFIC COMMUNITY IN DUE 4799 03:22:57,840 --> 03:22:59,920 COURSE, ACCORDING TO PRESS 4800 03:22:59,920 --> 03:23:01,120 RELEASE. 4801 03:23:01,120 --> 03:23:02,200 ILD I'M SHOWING THIS BECAUSE 4802 03:23:02,200 --> 03:23:05,720 THAT ARE LOT OF DIFFERENT 4803 03:23:05,720 --> 03:23:07,000 ILDs, IT'S AN ENORMOUS 4804 03:23:07,000 --> 03:23:10,320 CATEGORY WITH A LOT OF DIFFERENT 4805 03:23:10,320 --> 03:23:11,280 PATHOPHYSIOLOGIES, SO LUMPING 4806 03:23:11,280 --> 03:23:13,360 THEM TOGETHER AND TRYING TO DO 4807 03:23:13,360 --> 03:23:18,600 STUDIES ON THEM NOT SURPRISINGLY 4808 03:23:18,600 --> 03:23:22,040 SHOWS A LOT OF VARIABILITY, THE 4809 03:23:22,040 --> 03:23:23,120 MECHANISMS ARE NOT WELL 4810 03:23:23,120 --> 03:23:26,840 UNDERSTOOD PARTLY BECAUSE THERE 4811 03:23:26,840 --> 03:23:30,400 ARE SO MANY SUBCATEGORIES, BUT 4812 03:23:30,400 --> 03:23:33,880 THEY DO OVERLAP WITH COPD WITH 4813 03:23:33,880 --> 03:23:35,160 THE MECHANISTIC PATHWAYS SHOWN 4814 03:23:35,160 --> 03:23:35,840 PREVIOUSLY. 4815 03:23:35,840 --> 03:23:39,120 THE INCIDENCE AND PREVALENCE OF 4816 03:23:39,120 --> 03:23:41,200 PH IS VERY VARIABLE, AND FOR 4817 03:23:41,200 --> 03:23:43,160 QUITE A NUMBER OF REASONS BUT 4818 03:23:43,160 --> 03:23:44,720 JUST IT'S SUCH A BROAD CATEGORY 4819 03:23:44,720 --> 03:23:47,320 AND REALLY HAS NOT BEEN WELL 4820 03:23:47,320 --> 03:23:47,880 STUDIED. 4821 03:23:47,880 --> 03:23:51,480 IN A DANISH COHORT OF 212 4822 03:23:51,480 --> 03:23:57,280 PATIENTS, 14% HAD PH ASSOCIATED 4823 03:23:57,280 --> 03:23:57,920 WITH LOWER FUNCTION PARAMETERS, 4824 03:23:57,920 --> 03:24:02,760 AND IT WAS A MARKER OF 4825 03:24:02,760 --> 03:24:03,080 MORTALITY. 4826 03:24:03,080 --> 03:24:04,400 THE PREVALENCE OF SLEEP 4827 03:24:04,400 --> 03:24:07,360 DISORDERED BREATHING IS ALSO 4828 03:24:07,360 --> 03:24:09,320 HIGHLY VARIABLE IN THIS 4829 03:24:09,320 --> 03:24:11,280 POPULATION, AND IT HAS THE SAME 4830 03:24:11,280 --> 03:24:14,600 PATTERNS OF SLEEP DISRUPTION AS 4831 03:24:14,600 --> 03:24:15,560 COPD DOES. 4832 03:24:15,560 --> 03:24:16,520 PARTICULARLY POOR QUALITY SLEEP 4833 03:24:16,520 --> 03:24:19,000 AND A LOT OF AROUSALS. 4834 03:24:19,000 --> 03:24:28,400 AND IN 31 CONSECUTIVE PATIENTS 4835 03:24:28,400 --> 03:24:30,120 WITH IPF, OBSTRUCTIVE SLEEP 4836 03:24:30,120 --> 03:24:36,160 APNEA WAS FOUND IN 90%, AND 4837 03:24:36,160 --> 03:24:38,360 SEVERE DROPS IN OXYGEN 4838 03:24:38,360 --> 03:24:40,440 SATURATION THAT CORRELATED WITH 4839 03:24:40,440 --> 03:24:44,160 MORTALITY, IN 50 PATIENTS, IN 4840 03:24:44,160 --> 03:24:50,040 IPF STUDY, ILD STUDY THAT 4841 03:24:50,040 --> 03:24:52,360 INCLUDED IPF, SARCOID, 4842 03:24:52,360 --> 03:24:53,360 SCLERODERMA AND OTHER ILDs, 4843 03:24:53,360 --> 03:24:55,120 IPF SEEMED TO HAVE A GREATER 4844 03:24:55,120 --> 03:24:57,760 PREVALENCE OF OSA. 4845 03:24:57,760 --> 03:25:01,560 THERE'S A THEORY MECHANICAL 4846 03:25:01,560 --> 03:25:07,720 SHRINKAGE OF THE IPF AND OTHER 4847 03:25:07,720 --> 03:25:09,000 ILD LUNGS PLACES MECHANICAL 4848 03:25:09,000 --> 03:25:11,640 STRESS ON THE UPPER AIRWAY THAT 4849 03:25:11,640 --> 03:25:16,240 MIGHT PREDISPOSE TO OBSTRUCTIVE 4850 03:25:16,240 --> 03:25:17,320 SLEEP APNEA. 4851 03:25:17,320 --> 03:25:19,520 HYPOXEMIA IS COMMON IN SLEEP AND 4852 03:25:19,520 --> 03:25:19,840 ILD. 4853 03:25:19,840 --> 03:25:28,160 WE SEE THESE PATIENTS WHO GET 4854 03:25:28,160 --> 03:25:32,240 SEVERE DESATURATIONS WITH 4855 03:25:32,240 --> 03:25:33,320 EXERTION OR FRAGMENTATION 4856 03:25:33,320 --> 03:25:34,960 MEANTED SLEEP, STUDIES IN A LUMP 4857 03:25:34,960 --> 03:25:36,400 ILDs TOGETHER. 4858 03:25:36,400 --> 03:25:41,000 IN ONE LARGER STUDY WITH ILD, 4859 03:25:41,000 --> 03:25:47,120 37% HAD SIGNIFICANT NOCTURNAL 4860 03:25:47,120 --> 03:25:49,520 DESATURATION, THE GREATER 4861 03:25:49,520 --> 03:25:52,080 HYPOXIC BURDEN, PH ON ECHO, 4862 03:25:52,080 --> 03:25:55,680 HIGHER PREDICTORS OF MORTALITY. 4863 03:25:55,680 --> 03:25:58,600 OXYGEN TREATMENT IN ILD HAS NOT 4864 03:25:58,600 --> 03:26:01,160 BEEN VERY WELL STUDIED. 4865 03:26:01,160 --> 03:26:03,400 THERE IS A SYSTEMIC REVIEW THAT 4866 03:26:03,400 --> 03:26:06,240 SHOWED THAT AMONGST ABOUT A 4867 03:26:06,240 --> 03:26:09,560 DOZEN STUDIES USING SHORT-TERM 4868 03:26:09,560 --> 03:26:12,000 APPLICATIONS THERE WAS RELIEF OF 4869 03:26:12,000 --> 03:26:20,280 BREATHNESSES IN -- 4870 03:26:20,280 --> 03:26:21,920 BREATHLESSNESS, BUT OTHER 4871 03:26:21,920 --> 03:26:22,880 STUDIES DRAW NO CONCLUSIONS. 4872 03:26:22,880 --> 03:26:25,920 AND THEN AS FAR AS THE 4873 03:26:25,920 --> 03:26:27,160 PHARMACOTHERAPY IS CONCERNED, 4874 03:26:27,160 --> 03:26:29,480 THERE ARE MULTIPLE SMALL COHORTS 4875 03:26:29,480 --> 03:26:34,800 WITH SOME PROMISING RESULTS. 4876 03:26:34,800 --> 03:26:36,440 THE STEP IPF SHOWED SOME 4877 03:26:36,440 --> 03:26:37,960 IMPROVEMENT IN O2 SAT QUALITY OF 4878 03:26:37,960 --> 03:26:40,840 LIFE BUT NOT MEAN OUTCOME 4879 03:26:40,840 --> 03:26:42,600 VARIABILITY, 6-MINUTE WALK 4880 03:26:42,600 --> 03:26:47,960 DISTANCE, BUT SUBSEQUENT 4881 03:26:47,960 --> 03:26:53,760 STUDIES, A COUPLE HAD 4882 03:26:53,760 --> 03:26:56,480 DISAPPOINTING RESULTS. 4883 03:26:56,480 --> 03:26:59,480 RCTs SHOWED WORSE OUTCOMES AND 4884 03:26:59,480 --> 03:26:59,920 CONTRAINDICATED. 4885 03:26:59,920 --> 03:27:03,520 RECENTLY REBUILD STUDY OF 4886 03:27:03,520 --> 03:27:06,000 INHALED NITRIC OXIDE IN PH-ILD 4887 03:27:06,000 --> 03:27:08,120 REPORTED NO INCREASE IN MODERATE 4888 03:27:08,120 --> 03:27:10,400 TO VIGOROUS PHYSICAL ACTIVITY AS 4889 03:27:10,400 --> 03:27:18,520 PER ACTIGRAPHY, ITS MAIN OUTCOME 4890 03:27:18,520 --> 03:27:19,320 VARIABLE. 4891 03:27:19,320 --> 03:27:21,960 FINALLY THE INCREASE TRIAL DID 4892 03:27:21,960 --> 03:27:24,680 SHOW AN IMPROVEMENT AND HAS 4893 03:27:24,680 --> 03:27:31,760 BEEN GIVEN LABEL TO TREAT THE 4894 03:27:31,760 --> 03:27:35,000 ILDs, NOT COPD, AND SO IT IS 4895 03:27:35,000 --> 03:27:37,600 NOW AVAILABLE FOR THAT 4896 03:27:37,600 --> 03:27:38,160 APPLICATION. 4897 03:27:38,160 --> 03:27:42,680 WE'VE ALREADY HEARD A FAIR 4898 03:27:42,680 --> 03:27:43,400 AMOUNT ABOUT THE MECHANISMS. 4899 03:27:43,400 --> 03:27:46,600 THERE ARE A NUMBER OF STUDIES, 4900 03:27:46,600 --> 03:27:50,840 STEVE CHAN ALLUDED TO THEM ON 4901 03:27:50,840 --> 03:27:52,480 RODENTS AND INTERMITTENT 4902 03:27:52,480 --> 03:27:57,840 HYPOXEMIA SHOWING MOLECULAR 4903 03:27:57,840 --> 03:28:00,040 MECHANISMS BUT THE EXPOSURE TO 4904 03:28:00,040 --> 03:28:05,840 HYPOXIA INTERMITTENTLY MAY NOT 4905 03:28:05,840 --> 03:28:11,680 REPRESENT ACCURATELY ALL THE 4906 03:28:11,680 --> 03:28:12,880 ASPECTS OF HUMAN EXPOSURE AND SO 4907 03:28:12,880 --> 03:28:15,840 WE HAVE TO BE CAUTIOUS ABOUT 4908 03:28:15,840 --> 03:28:17,360 EXTRAPOLATING RESULTS BUT I 4909 03:28:17,360 --> 03:28:19,120 WOULD AGREE WITH HIM THAT THIS 4910 03:28:19,120 --> 03:28:20,320 IS AN IMPORTANT ADVANCE. 4911 03:28:20,320 --> 03:28:28,520 WE'VE HEARD QUITE A BIT ABOUT 4912 03:28:28,520 --> 03:28:30,360 THE MECHANISM BUT THE PREVALENCE 4913 03:28:30,360 --> 03:28:31,200 AGAIN IS VARIABLE. 4914 03:28:31,200 --> 03:28:35,320 YOU CAN SEE HOW WIDE THE RANGE 4915 03:28:35,320 --> 03:28:37,080 IS, 14 TO 89%, AND ONE OF THE 4916 03:28:37,080 --> 03:28:38,920 REASONS THE RANGE IS SO VARIABLE 4917 03:28:38,920 --> 03:28:42,680 IS BECAUSE THE PATIENTS WERE NOT 4918 03:28:42,680 --> 03:28:43,640 NECESSARILY VERY WELL 4919 03:28:43,640 --> 03:28:48,920 PHENOTYPED, AND THERE'S A STUDY, 4920 03:28:48,920 --> 03:28:52,320 17% IN 220 PATIENTS, BUT A LOT 4921 03:28:52,320 --> 03:28:54,160 OF THESE PATIENTS LOOK LIKE THEY 4922 03:28:54,160 --> 03:28:57,200 HAD COPD, WERE NOT CAREFULLY 4923 03:28:57,200 --> 03:28:58,760 PHENOTYPED SO THIS PROBABLY IS 4924 03:28:58,760 --> 03:29:02,040 REPRESENTATIVE OF PATIENTS WITH 4925 03:29:02,040 --> 03:29:04,120 OVERLAP SYNDROME. 4926 03:29:04,120 --> 03:29:06,960 THIS STUDY WITH 27% IN 44 4927 03:29:06,960 --> 03:29:09,600 PATIENTS HAD PATIENTS THAT WE 4928 03:29:09,600 --> 03:29:14,520 MIGHT CONSIDER AS HAVING 4929 03:29:14,520 --> 03:29:16,360 OBESITY, HYPOVENTILATION, AND 4930 03:29:16,360 --> 03:29:20,960 THIS STUDY BY MINAI FOUND 70% 4931 03:29:20,960 --> 03:29:24,240 PREVALENCE BUT EXCLUDING 4932 03:29:24,240 --> 03:29:25,600 PATIENTS WITH WEDGE PRESSURE 4933 03:29:25,600 --> 03:29:28,720 GREATER THAN 15 DROPPED TO 22%, 4934 03:29:28,720 --> 03:29:30,680 A LOT OF PATIENTS ARE MIX GROUP 4935 03:29:30,680 --> 03:29:34,440 2 AND 3, THIS ILLUSTRATES THE 4936 03:29:34,440 --> 03:29:36,480 IMPORTANCE OF UNDERSTANDING THE 4937 03:29:36,480 --> 03:29:37,480 COMORBIDITIES AND CAREFULLY 4938 03:29:37,480 --> 03:29:40,520 PHENOTYPING THESE PATIENTS. 4939 03:29:40,520 --> 03:29:42,640 NONETHELESS, PH ACCORDING TO THE 4940 03:29:42,640 --> 03:29:45,040 STUDY IS A RISK FACTOR FOR 4941 03:29:45,040 --> 03:29:52,040 SURVIVAL IN PATIENTS WITH SLEEP 4942 03:29:52,040 --> 03:29:52,240 APNEA. 4943 03:29:52,240 --> 03:29:55,960 AND VINICIO WENT OVER THE 4944 03:29:55,960 --> 03:29:56,520 OBESITY HYPOVENTILATION 4945 03:29:56,520 --> 03:29:59,400 SYNDROME, I WILL NOT BELABOR 4946 03:29:59,400 --> 03:29:59,800 THAT. 4947 03:29:59,800 --> 03:30:02,440 AND RATHER MOVE TO MY SUMMARY 4948 03:30:02,440 --> 03:30:05,720 WHICH IS THE DEFINITION AND 4949 03:30:05,720 --> 03:30:07,240 CLASSIFICATION HAVE BEEN 4950 03:30:07,240 --> 03:30:10,760 SHIFTING OF THESE VARIOUS GROUP 4951 03:30:10,760 --> 03:30:13,400 3 CATEGORIES, MAKING IT 4952 03:30:13,400 --> 03:30:15,680 DIFFICULT TO COME UP WITH 4953 03:30:15,680 --> 03:30:17,440 ACCURATE PREVALENCE DATA 4954 03:30:17,440 --> 03:30:19,720 MECHANISMS OF DISEASE, SIMILAR 4955 03:30:19,720 --> 03:30:22,320 ACROSS THE SPECTRUM AND THUS 4956 03:30:22,320 --> 03:30:28,560 WHEN THEY ARE LUMPED TOGETHER AS 4957 03:30:28,560 --> 03:30:30,440 CO-MORBIDITIES THEY INTENSIFY 4958 03:30:30,440 --> 03:30:31,360 THE MORBIDITY AND POTENTIAL 4959 03:30:31,360 --> 03:30:34,000 MORTALITY OF THE DISEASE. 4960 03:30:34,000 --> 03:30:40,040 THE PRESENCE WORSENS PROGNOSIS 4961 03:30:40,040 --> 03:30:42,120 AND OXYGEN SUPPLEMENTATION 4962 03:30:42,120 --> 03:30:52,640 IMPROVES OUTCOMES IN HYPOXEMIC 4963 03:31:05,520 --> 03:31:05,880 PATIENTS. 4964 03:31:05,880 --> 03:31:09,160 THERE ARE MANY KNOWLEDGE GAPS. 4965 03:31:09,160 --> 03:31:13,000 WE NEED TO LEARN ABOUT 4966 03:31:13,000 --> 03:31:15,080 MECHANISMS, STEVE CHAN RECOUNTED 4967 03:31:15,080 --> 03:31:17,600 A NUMBER OF THE OMIC PATHWAYS 4968 03:31:17,600 --> 03:31:20,360 THAT NEED TO BE EXPLORED. 4969 03:31:20,360 --> 03:31:22,640 BUT WE NEED TO UNDERSTAND HOW 4970 03:31:22,640 --> 03:31:23,840 BETTER TO PHENOTYPE THESE 4971 03:31:23,840 --> 03:31:26,480 PATIENTS SO WE CAN STUDY THEM 4972 03:31:26,480 --> 03:31:28,200 BETTER, AND WE NEED TO LOOK AT 4973 03:31:28,200 --> 03:31:29,640 THE POTENTIAL ROLE OF NEW 4974 03:31:29,640 --> 03:31:33,480 TREATMENTS, AND I THINK THE 4975 03:31:33,480 --> 03:31:36,880 SGLT2 AN TACK NIST AND GLP-1 4976 03:31:36,880 --> 03:31:37,960 CONSIDERING MANY HAVE 4977 03:31:37,960 --> 03:31:44,000 CO-MORBIDITIES AS WELL AS 4978 03:31:44,000 --> 03:31:45,440 METABOLIC DERANGEMENTS WITH 4979 03:31:45,440 --> 03:31:47,640 DIABETES AND OBESITY AND SO 4980 03:31:47,640 --> 03:31:51,640 FORTH, THESE PERHAPS DESERVE A 4981 03:31:51,640 --> 03:31:53,200 LOOK AT LEAST WELL-PHENOTYPED 4982 03:31:53,200 --> 03:31:54,240 SUBGROUPS IN THIS CATEGORY. 4983 03:31:54,240 --> 03:31:56,160 I'LL STOP THERE AND I DON'T KNOW 4984 03:31:56,160 --> 03:31:58,240 IF THERE'S QUESTIONS OR RATHER 4985 03:31:58,240 --> 03:32:02,920 TIME FOR QUESTIONS. 4986 03:32:02,920 --> 03:32:13,000 4987 03:32:13,280 --> 03:32:14,280 >>GREAT TALK. 4988 03:32:14,280 --> 03:32:15,960 WE HAVE TIME FOR ONE QUESTION IF 4989 03:32:15,960 --> 03:32:19,040 THERE IS ONE OUT THERE. 4990 03:32:19,040 --> 03:32:21,640 4991 03:32:21,640 --> 03:32:23,080 I DON'T SEE ANYBODY RAISING A 4992 03:32:23,080 --> 03:32:24,480 HAND SO I HAVE A QUESTION BUT 4993 03:32:24,480 --> 03:32:26,560 I'M GOING TO SAVE IT FOR THE 4994 03:32:26,560 --> 03:32:30,480 GENERAL DISCUSSION TO KEEP US ON 4995 03:32:30,480 --> 03:32:30,720 TIME. 4996 03:32:30,720 --> 03:32:32,000 THANKS VERY MUCH. 4997 03:32:32,000 --> 03:32:34,320 >>GOOD DEAL. 4998 03:32:34,320 --> 03:32:35,080 THANK YOU, ANNA. 4999 03:32:35,080 --> 03:32:36,520 >>SURE. 5000 03:32:36,520 --> 03:32:45,520 OUR NEXT SPEAKER IS DR. REENA 5001 03:32:45,520 --> 03:32:50,000 MEHRA, SHE DIRECTED OUR SLEEP 5002 03:32:50,000 --> 03:32:51,200 CORE, EXCITED SHE'S ABLE TO TALK 5003 03:32:51,200 --> 03:32:57,840 TO US TODAY ON HER TOPIC, GROUP 5004 03:32:57,840 --> 03:32:59,200 1 AND GROUP 2 PULMONARY 5005 03:32:59,200 --> 03:32:59,640 HYPERTENSION. 5006 03:32:59,640 --> 03:33:09,120 PLEASE TAKE OVER THE FLOOR. 5007 03:33:09,120 --> 03:33:11,000 >>CAN YOU HEAR ME OKAY? 5008 03:33:11,000 --> 03:33:13,240 >>YES AND SEE YOUR SLIDES TO. 5009 03:33:13,240 --> 03:33:14,520 >>OKAY, PERFECT. 5010 03:33:14,520 --> 03:33:16,560 WELL, THANK YOU FOR THIS 5011 03:33:16,560 --> 03:33:16,880 OPPORTUNITY. 5012 03:33:16,880 --> 03:33:19,200 IT'S A PLEASURE TO BE HERE FOR 5013 03:33:19,200 --> 03:33:21,960 THIS WORKSHOP AND THANKS TO THE 5014 03:33:21,960 --> 03:33:23,920 NIH FOR RECOGNIZING THIS 5015 03:33:23,920 --> 03:33:27,040 IMPORTANT TOPIC AND TO DR. 5016 03:33:27,040 --> 03:33:29,040 HEMNES AND DR. REDLINE FOR 5017 03:33:29,040 --> 03:33:30,160 SERVING AS CHAIRS AND THE 5018 03:33:30,160 --> 03:33:32,800 SUPPORT STAFF TO MAKE THIS A 5019 03:33:32,800 --> 03:33:33,400 GREAT SUCCESS. 5020 03:33:33,400 --> 03:33:35,360 AND SO MY CHARGE TODAY IS TO 5021 03:33:35,360 --> 03:33:36,800 FOCUS ON SLEEP HEALTH AND 5022 03:33:36,800 --> 03:33:39,680 DISORDERS IN GROUP 1 AND GROUP 2 5023 03:33:39,680 --> 03:33:41,440 PULMONARY HYPERTENSION. 5024 03:33:41,440 --> 03:33:44,800 WE'LL REVIEW SOME OF THE, YOU 5025 03:33:44,800 --> 03:33:49,200 KNOW, PRELIMINARY DATA FROM 5026 03:33:49,200 --> 03:33:50,080 PB-OMICS AS RELATES AND 5027 03:33:50,080 --> 03:33:54,920 HOPEFULLY DESCRIBE THE CO-HOFORT 5028 03:33:54,920 --> 03:33:59,600 -- COHORT AND HOW IT SERVES AS 5029 03:33:59,600 --> 03:34:04,280 A RESOURCE. 5030 03:34:04,280 --> 03:34:08,680 THE WAY THAT THE PRESENTATION IS 5031 03:34:08,680 --> 03:34:10,120 DISCUSSED, OVERVIEW OF 5032 03:34:10,120 --> 03:34:11,400 INTERSECTING PATHOPHYSIOLOGY. 5033 03:34:11,400 --> 03:34:13,640 WE'LL BRIEFLY DO THAT. 5034 03:34:13,640 --> 03:34:15,320 OTHERS HAVE NICELY ALREADY 5035 03:34:15,320 --> 03:34:17,920 DESCRIBED THIS. 5036 03:34:17,920 --> 03:34:20,640 WE'LL DELVE INTO GROUP 1 AND 5037 03:34:20,640 --> 03:34:23,800 GROUP 2 PULMONARY HYPERTENSION, 5038 03:34:23,800 --> 03:34:25,800 AS RELATES TO DISORDERS, AND 5039 03:34:25,800 --> 03:34:29,280 THEN END WITH KNOWLEDGE GAPS AND 5040 03:34:29,280 --> 03:34:30,160 SCIENTIFIC OPPORTUNITIES AND 5041 03:34:30,160 --> 03:34:34,800 CAVEATS TO BE AWARE OF, WE'LL BE 5042 03:34:34,800 --> 03:34:36,960 FOCUSING ON DISORDERED 5043 03:34:36,960 --> 03:34:40,040 BREATHING, ACTUALLY THERE'S VERY 5044 03:34:40,040 --> 03:34:41,000 LITTLE LITERATURE, AN 5045 03:34:41,000 --> 03:34:45,080 OPPORTUNITY ON THE AREA OF SLEEP 5046 03:34:45,080 --> 03:34:46,160 DISRUPTION AND SLEEP 5047 03:34:46,160 --> 03:34:48,680 DISTURBANCE, ASPECTS OF SLEEP 5048 03:34:48,680 --> 03:34:50,480 HEALTH, SLEEP QUALITY RELATED TO 5049 03:34:50,480 --> 03:34:52,720 GROUP 1 AND 2 PULMONARY 5050 03:34:52,720 --> 03:34:59,080 HYPERTENSION AND WE'LL ALSO 5051 03:34:59,080 --> 03:35:02,120 DESCRIBE AGAIN THE RESOURCE. 5052 03:35:02,120 --> 03:35:05,080 WE'LL FOCUS ON GROUP 1, 5053 03:35:05,080 --> 03:35:10,120 RECOGNIZING THERE ARE MANY 5054 03:35:10,120 --> 03:35:12,280 CONTRIBUTING FACTORS TO THIS 5055 03:35:12,280 --> 03:35:13,400 CATEGORIZATION OF PULMONARY 5056 03:35:13,400 --> 03:35:15,040 HYPERTENSION. 5057 03:35:15,040 --> 03:35:18,040 AND GROUP 2, LEFT HEART DISEASE, 5058 03:35:18,040 --> 03:35:18,520 POST-CAPILLARY PULMONARY 5059 03:35:18,520 --> 03:35:20,840 HYPERTENSION, THAT WILL BE THE 5060 03:35:20,840 --> 03:35:21,360 FOCUS. 5061 03:35:21,360 --> 03:35:23,320 IN TERMS OF OBSTRUCTIVE SLEEP 5062 03:35:23,320 --> 03:35:26,720 APNEA, WE'VE TALKED ABOUT THIS, 5063 03:35:26,720 --> 03:35:29,240 HIGHLY PREVALENT WITH 1 BILLION 5064 03:35:29,240 --> 03:35:33,320 PEOPLE WORLDWIDE AFFECTED, ALSO 5065 03:35:33,320 --> 03:35:34,200 QUITE UNDERRECOGNIZED, BASED 5066 03:35:34,200 --> 03:35:39,240 UPON EPIDEMIOLOGIC DATA THAT 5067 03:35:39,240 --> 03:35:46,760 UNCOVERED NEW DIAGNOSES AND A 5068 03:35:46,760 --> 03:35:49,080 LOT OF UNDERDIAGNOSIS FOCUSED ON 5069 03:35:49,080 --> 03:35:49,840 UNDERREPRESENTED MINORITIES, 5070 03:35:49,840 --> 03:35:52,360 CLAIMS DATA SHOW A DIFFERENT 5071 03:35:52,360 --> 03:35:54,440 LENS IN TERMS OF INCREASING 5072 03:35:54,440 --> 03:35:56,200 PREVALENCE OF SLEEP APNEA 5073 03:35:56,200 --> 03:35:57,720 DIAGNOSIS, PARALLELED BY THE 5074 03:35:57,720 --> 03:35:58,960 HOME SLEEP APNEA TESTING 5075 03:35:58,960 --> 03:36:02,640 INCREASES AS WELL, THAT WAS WORK 5076 03:36:02,640 --> 03:36:06,120 PUBLISHED IN 2020. 5077 03:36:06,120 --> 03:36:10,520 ALSO, GOING BACK TO THE 1970s 5078 03:36:10,520 --> 03:36:14,680 IT'S BEEN RECOGNIZED IN THIS 5079 03:36:14,680 --> 03:36:19,720 PARTICULAR STUDY, OBSTRUCTIVE 5080 03:36:19,720 --> 03:36:21,040 APNEA, OXYGEN DESATURATION, YOU 5081 03:36:21,040 --> 03:36:24,280 CAN SEE WITH THE BALLOON 5082 03:36:24,280 --> 03:36:26,840 MONITORING INCREASES IN 5083 03:36:26,840 --> 03:36:28,480 PRESSURE, THERE'S PROGRESSIVE 5084 03:36:28,480 --> 03:36:30,320 INCREASE IN SYSTOLIC PRESSURE 5085 03:36:30,320 --> 03:36:33,160 AND DIASTOLIC PRESSURE THAT'S 5086 03:36:33,160 --> 03:36:39,120 OCCURRING CONCORDANTLY. 5087 03:36:39,120 --> 03:36:40,400 THE PATHOPHYSIOLOGY, WHEN WE 5088 03:36:40,400 --> 03:36:41,920 INTERPRET SLEEP STUDIES WE CAN 5089 03:36:41,920 --> 03:36:44,360 SEE THERE'S JUST SO MUCH THAT IS 5090 03:36:44,360 --> 03:36:46,000 GOING ON FROM A PATHOPHYSIOLOGIC 5091 03:36:46,000 --> 03:36:48,520 STANDPOINT IN TERMS OF AUTONOMIC 5092 03:36:48,520 --> 03:36:52,480 NERVOUS SYSTEM DISTURBANCES WITH 5093 03:36:52,480 --> 03:36:57,680 A RELATIVE BRADYCARDIA, 5094 03:36:57,680 --> 03:36:58,400 TACHYCARDY SUBSEQUENT, 5095 03:36:58,400 --> 03:37:02,720 PUNCTUATED BY INCREASES IN BLOOD 5096 03:37:02,720 --> 03:37:04,800 PRESSURE, RISE IN CO2, 5097 03:37:04,800 --> 03:37:05,320 INTERMITTENT HYPOXIA ARE 5098 03:37:05,320 --> 03:37:08,760 RESATURATION WHICH MAY BE THE 5099 03:37:08,760 --> 03:37:10,280 PERIOD OF OXIDATIVE STRESS 5100 03:37:10,280 --> 03:37:14,600 LEADING TO GLOBAL LEVELS OF 5101 03:37:14,600 --> 03:37:15,520 INHANSED INFLAMMATION AND 5102 03:37:15,520 --> 03:37:17,560 OXIDATIVE STRESS. 5103 03:37:17,560 --> 03:37:18,480 UPPER AIRWAY OCCLUSION IT'S 5104 03:37:18,480 --> 03:37:21,240 IMPORTANT TO NOTE IN TERMS OF 5105 03:37:21,240 --> 03:37:27,480 ITS EFFECTS IN TERMS OF 5106 03:37:27,480 --> 03:37:28,880 INTERTHORACIC PRESSURES, AND 5107 03:37:28,880 --> 03:37:31,200 INTRAPLEURAL PRESSURES, SHIFTING 5108 03:37:31,200 --> 03:37:34,920 THE SEPTUM AND THEN REDUCTION, 5109 03:37:34,920 --> 03:37:37,000 EFFECTS ON CARDIAC OUTPUT, 5110 03:37:37,000 --> 03:37:40,280 INCREASES IN VENOUS RETURN, 5111 03:37:40,280 --> 03:37:42,720 HYPOXIC VASOCONSTRUCTION, AND 5112 03:37:42,720 --> 03:37:46,520 ANOTHER EXAMPLE SHOWING THAT 5113 03:37:46,520 --> 03:37:50,560 DURING AN OBSTRUCTIVE APNIC 5114 03:37:50,560 --> 03:37:59,320 EVENT, CESSATION OF BREATHING, 5115 03:37:59,320 --> 03:38:00,000 INCREASINGLY NEGATIVE 5116 03:38:00,000 --> 03:38:01,080 INTRATHORACIC PRESSURES AND 5117 03:38:01,080 --> 03:38:08,840 INCREASE IN ARTERIAL PRESSURE AS 5118 03:38:08,840 --> 03:38:09,080 WELL. 5119 03:38:09,080 --> 03:38:11,480 I THOUGHT IT WAS INTERESTING 5120 03:38:11,480 --> 03:38:14,560 BECAUSE THEY LOOKED CONCORDANTLY 5121 03:38:14,560 --> 03:38:18,160 AT EPISODES OF APNEA, 5122 03:38:18,160 --> 03:38:19,160 OBSTRUCTIVE APNEA, INTRAVASCULAR 5123 03:38:19,160 --> 03:38:20,880 PRESSURE IN TANDEM. 5124 03:38:20,880 --> 03:38:23,040 AND THEY LOOKED AT THE DISCRETE 5125 03:38:23,040 --> 03:38:24,720 EPISODES AND SO IN THIS PANEL C 5126 03:38:24,720 --> 03:38:26,880 HERE YOU CAN SEE THE OPEN DOT IS 5127 03:38:26,880 --> 03:38:30,040 THE BEGINNING OF THE APNIC 5128 03:38:30,040 --> 03:38:32,160 EVENT, CLOSED IS TERMINATION OF 5129 03:38:32,160 --> 03:38:32,800 EVENT. 5130 03:38:32,800 --> 03:38:37,160 WITH THE CHANGES IN OXYGEN 5131 03:38:37,160 --> 03:38:38,080 SATURATION, THERE ARE INCREASES 5132 03:38:38,080 --> 03:38:42,880 THAT ARE OCCURRING IN REAL TIME 5133 03:38:42,880 --> 03:38:43,880 IN THE PULMONARY PRESSURE WITH 5134 03:38:43,880 --> 03:38:47,280 DIPS AND YOU CAN SEE OVER TIME 5135 03:38:47,280 --> 03:38:51,840 THERE'S FAST CHANGE IMMEDIATELY 5136 03:38:51,840 --> 03:38:55,360 AND ALSO OVER TIME 5137 03:38:55,360 --> 03:38:56,200 PROGRESSESSIVE INCREASE IN 5138 03:38:56,200 --> 03:39:01,840 ARTERIAL PRESSURE WITH THESE 5139 03:39:01,840 --> 03:39:02,040 EVENTS. 5140 03:39:02,040 --> 03:39:05,320 IT'S INTERESTING TO THINK ABOUT 5141 03:39:05,320 --> 03:39:08,280 THE INTERMITTENT NATURE OF 5142 03:39:08,280 --> 03:39:09,920 HYPOXIA WITH SLEEP 5143 03:39:09,920 --> 03:39:10,480 APNEA-SPECIFIC HYPOXIC 5144 03:39:10,480 --> 03:39:12,320 MECHANISMS, AS WELL AS SUSTAINED 5145 03:39:12,320 --> 03:39:15,520 HYPOXIA WHICH CAN BE DUE TO 5146 03:39:15,520 --> 03:39:21,320 VARIETY OF REASONS, VENTILATION 5147 03:39:21,320 --> 03:39:22,560 PERFUSION MISMATCH, DESCRIBED IN 5148 03:39:22,560 --> 03:39:25,600 THE PLEXIFORM LESIONS IN THE 5149 03:39:25,600 --> 03:39:32,040 PATHOPHYSIOLOGY IN THE 5150 03:39:32,040 --> 03:39:34,920 VASCULATURE REMODELING AND 5151 03:39:34,920 --> 03:39:36,320 UPREGULATION AND MOLECULAR 5152 03:39:36,320 --> 03:39:38,200 MECHANISMS THAT HAVE IMPACT ON 5153 03:39:38,200 --> 03:39:41,680 THE CARDIAC FUNCTION, NAMELY 5154 03:39:41,680 --> 03:39:43,880 RIGHT VENTRICULAR FUNCTION IN 5155 03:39:43,880 --> 03:39:44,880 ADAPTIVE AND MALADAPTIVE 5156 03:39:44,880 --> 03:39:48,120 RESPONSES THAT LEAD TO RIGHT 5157 03:39:48,120 --> 03:39:48,800 VENTRICULAR FAILURE, INCREASED 5158 03:39:48,800 --> 03:39:50,680 MORTALITY. 5159 03:39:50,680 --> 03:39:57,120 AT THE LEVEL OF THE MOLECULAR 5160 03:39:57,120 --> 03:39:58,080 MECHANISMS, PATHWAYS HAVE BEEN 5161 03:39:58,080 --> 03:40:03,200 SHOWED TO LEAD TO REMODELING 5162 03:40:03,200 --> 03:40:05,120 INCLUDING SEROTONIN, AND VARIOUS 5163 03:40:05,120 --> 03:40:06,840 PATHWAYS CONSIDERED AS WE ARE 5164 03:40:06,840 --> 03:40:09,640 THINKING ABOUT HOW SLEEP 5165 03:40:09,640 --> 03:40:11,040 DISORDERED BREATHING AND 5166 03:40:11,040 --> 03:40:13,240 SLEEP-RELATED HYPOXIA CAN FIT IN 5167 03:40:13,240 --> 03:40:14,960 THE PARADIGMS. 5168 03:40:14,960 --> 03:40:17,480 FAIRLY RECENT DATA HAS SHOWN 5169 03:40:17,480 --> 03:40:24,040 ALVEOLAR HYPOXIA CAN LEAD TO 5170 03:40:24,040 --> 03:40:27,640 POOR HYPERTENSION THROUGH HIF-1 5171 03:40:27,640 --> 03:40:28,720 ALPHA DEPENDENT MECHANISMS, 5172 03:40:28,720 --> 03:40:30,280 SYSTEMIC HYPOXEMIA LEADS TO 5173 03:40:30,280 --> 03:40:34,320 ACTIVATION OF HIF-1 AND HIF 2 5174 03:40:34,320 --> 03:40:36,920 ALPHA IN THE RIGHT VENTRICLE, 5175 03:40:36,920 --> 03:40:38,800 AFFECTING REMODELING RESPONSE. 5176 03:40:38,800 --> 03:40:41,640 YOU CAN SEE CHRONIC HYPOXIA 5177 03:40:41,640 --> 03:40:43,200 ALTERS GENE RESPONSES IN RIGHT 5178 03:40:43,200 --> 03:40:48,600 EVENTUALLY -- VENTRICLE WITH 5179 03:40:48,600 --> 03:40:50,520 PATTERNING OF GENE EXPRESSION 5180 03:40:50,520 --> 03:40:52,720 THAT OCCURS. 5181 03:40:52,720 --> 03:40:55,560 CHRONIC HYPOXIA PATHOLOGICALLY 5182 03:40:55,560 --> 03:40:57,800 CAN LEAD TO PULMONARY VASCULAR 5183 03:40:57,800 --> 03:41:00,480 REMODELING AS SHOWN ON THE RIGHT 5184 03:41:00,480 --> 03:41:01,920 PART OF THE SLIDE. 5185 03:41:01,920 --> 03:41:04,440 AND THIS IS A POPULAR DIAGRAM 5186 03:41:04,440 --> 03:41:07,200 FROM DR. HILL AND HIS PAPER THAT 5187 03:41:07,200 --> 03:41:10,560 I THINK NICELY KIND OF GOES OVER 5188 03:41:10,560 --> 03:41:15,360 GROUP 1 VERSUS GROUP 2, GROUP 1 5189 03:41:15,360 --> 03:41:18,440 BEING PRE-CAPILLARY, AND GROUP 2 5190 03:41:18,440 --> 03:41:20,160 POST-CAPILLARY, MORE PRONE 5191 03:41:20,160 --> 03:41:23,280 PERHAPS TO INFLUENCES OF THE 5192 03:41:23,280 --> 03:41:23,840 INTRATHORACIC PRESSURES AND 5193 03:41:23,840 --> 03:41:29,080 EFFECTSS ON THE HEART AS WELL. 5194 03:41:29,080 --> 03:41:33,880 THIS IS A PROGRAM THAT WAS 5195 03:41:33,880 --> 03:41:37,720 ESTABLISHED BY THE NHLBI, AND 5196 03:41:37,720 --> 03:41:40,880 EXTENSIVELY WELL PHENOTYPED 5197 03:41:40,880 --> 03:41:42,200 COHORT FROM DR. HEMNES' PAPER. 5198 03:41:42,200 --> 03:41:44,800 HERE THAT DESCRIBES THE COHORT, 5199 03:41:44,800 --> 03:41:46,800 YOU CAN SEE AS SHE HAD MENTIONED 5200 03:41:46,800 --> 03:41:48,440 EARLIER THAT THERE ARE DISEASE 5201 03:41:48,440 --> 03:41:50,960 COMPARATORS AND CONTROLS FOR 5202 03:41:50,960 --> 03:41:54,760 EACH OF THE GROUPS, IT WAS VERY 5203 03:41:54,760 --> 03:41:56,600 RICHLY COLLECTED DATA IN TERMS 5204 03:41:56,600 --> 03:42:00,040 OF CHEST IMAGING, IN TERMS OF 5205 03:42:00,040 --> 03:42:03,960 CARDIAC IMAGING WITH ECHO AND, 5206 03:42:03,960 --> 03:42:07,160 VENTILATION PERFUSION SCANS, 5207 03:42:07,160 --> 03:42:08,920 PHYSIOLOGIC MEASURES THROUGH 5208 03:42:08,920 --> 03:42:09,760 SPIROMETRY, RIGHT HEART 5209 03:42:09,760 --> 03:42:11,320 CATHETERIZATION, INTEGRATED WITH 5210 03:42:11,320 --> 03:42:12,840 THAT WE'RE FORTUNATE TO HAVE 5211 03:42:12,840 --> 03:42:15,160 SLEEP DATA AS WELL SO OCCURRED 5212 03:42:15,160 --> 03:42:21,480 OVER SEVEN SITES, COMPREHENSIVE 5213 03:42:21,480 --> 03:42:22,360 PHENOTYPING, 1200 PARTICIPANTS. 5214 03:42:22,360 --> 03:42:24,240 THESE ARE EXAMPLES. 5215 03:42:24,240 --> 03:42:28,480 YOU CAN SEE REPETITIVE EPISODES 5216 03:42:28,480 --> 03:42:30,760 OF RESPIRATORY EVENTS AND BOUTS 5217 03:42:30,760 --> 03:42:32,200 OF HYPOXIA. 5218 03:42:32,200 --> 03:42:41,360 WE COLLECTED EKG DATA AS WELL 5219 03:42:41,360 --> 03:42:44,440 AND THIS ALLOWS TO REDUCE HEART 5220 03:42:44,440 --> 03:42:51,800 VARIABILITY AND HEART RATE 5221 03:42:51,800 --> 03:42:53,640 AROUSAL AS WELL. 5222 03:42:53,640 --> 03:42:55,240 IN SPIDER PLOTS, EXAMPLES OF 5223 03:42:55,240 --> 03:42:56,720 CLINICAL CHARACTERISTICS IN THE 5224 03:42:56,720 --> 03:42:58,920 COHORT, AND WITH PERCENTAGE OF 5225 03:42:58,920 --> 03:43:00,880 TIME SPENT BELOW 90% OXYGEN 5226 03:43:00,880 --> 03:43:03,000 SATURATION THERE'S -- YOU CAN 5227 03:43:03,000 --> 03:43:05,360 SEE THERE'S QUITE A LOT OF 5228 03:43:05,360 --> 03:43:07,000 VARIABILITY ACROSS THE GROUPS IN 5229 03:43:07,000 --> 03:43:10,120 TERMS OF THAT DEGREE OF HYPOXIA. 5230 03:43:10,120 --> 03:43:13,040 AND AS WE LOOK ACROSS THE 5231 03:43:13,040 --> 03:43:15,360 GROUPS, SO ALL GROUPS WERE, 5232 03:43:15,360 --> 03:43:17,160 AGAIN, REPRESENTED IN THE 5233 03:43:17,160 --> 03:43:22,880 COHORT, AND AS WE LOOK AT THE 5234 03:43:22,880 --> 03:43:23,880 FREQUENCY OF RESPIRATORY 5235 03:43:23,880 --> 03:43:25,280 DISTURBANCES AS THEY OCCUR PER 5236 03:43:25,280 --> 03:43:27,040 HOUR YOU CAN SEE THAT VARIES 5237 03:43:27,040 --> 03:43:29,000 ACROSS THE GROUPS AND AS WE'RE 5238 03:43:29,000 --> 03:43:31,000 TALKING ABOUT GROUPS 1 AND 2 YOU 5239 03:43:31,000 --> 03:43:33,400 CAN SEE HIGHER IN GROUP 2 THAN 5240 03:43:33,400 --> 03:43:36,120 SOME OTHER GROUPS, AND GROUP 1 5241 03:43:36,120 --> 03:43:37,880 YOU CAN SEE HYPOXIA APPEARS TO 5242 03:43:37,880 --> 03:43:40,200 BE HIGHEST IN GROUP 1 AND GROUP 5243 03:43:40,200 --> 03:43:42,160 5, IN PARTICULAR. 5244 03:43:42,160 --> 03:43:43,920 AND THEN AS ALSO WAS MENTIONED, 5245 03:43:43,920 --> 03:43:45,560 WE HAVE TO TAKE INTO 5246 03:43:45,560 --> 03:43:47,560 CONSIDERATION THOSE WHO ARE ON 5247 03:43:47,560 --> 03:43:49,600 CONTINUOUS POSITIVE AIRWAY 5248 03:43:49,600 --> 03:43:57,200 PRESSURE AN SUPPLEMENTAL OXYGEN, 5249 03:43:57,200 --> 03:44:01,480 VARIATION IN SLEEP APNEA AND 5250 03:44:01,480 --> 03:44:02,800 HYPOXIA ACROSS THE CATEGORIES. 5251 03:44:02,800 --> 03:44:06,520 WITH THAT PICTURE IN MIND, INTO 5252 03:44:06,520 --> 03:44:08,560 GROUP 1, AS DR. HILL MENTIONED 5253 03:44:08,560 --> 03:44:11,000 WITH GROUP 3 THE SAME IS THE 5254 03:44:11,000 --> 03:44:14,440 CASE WITH GROUP 1 IN TERMS OF 5255 03:44:14,440 --> 03:44:17,920 VARYING AMOUNTS OF PREVALENCE 5256 03:44:17,920 --> 03:44:22,000 THAT HAVE BEEN RECOGNIZED, IN 5257 03:44:22,000 --> 03:44:24,760 THIS STUDY 90% WITH MAJORITY 5258 03:44:24,760 --> 03:44:26,800 HAVING MILD BUT FAIR NUMBER 5259 03:44:26,800 --> 03:44:28,240 ABOUT 50% HAVING MODERATE TO 5260 03:44:28,240 --> 03:44:31,560 SEVERE DEGREE OF SLEEP APNEA 5261 03:44:31,560 --> 03:44:34,400 DEFINED BY THE INDEX. 5262 03:44:34,400 --> 03:44:36,440 PARTICULARLY FOUND AS HAVE MANY 5263 03:44:36,440 --> 03:44:38,200 STUDIES CONSISTENTLY FOUND THERE 5264 03:44:38,200 --> 03:44:40,160 ARE ASSOCIATIONS IN PARTICULAR 5265 03:44:40,160 --> 03:44:42,880 WITH NOCTURNAL HYPOXIA WITH MEAN 5266 03:44:42,880 --> 03:44:50,120 OXYGEN SATURATION IN THIS CASE 5267 03:44:50,120 --> 03:44:54,520 ASSOCIATED WITH SYSTOLIC VOLUME, 5268 03:44:54,520 --> 03:44:56,800 INVOLVING 71 INDIVIDUALS, ALONG 5269 03:44:56,800 --> 03:44:58,000 WITH 35 MATCHED CONTROLS. 5270 03:44:58,000 --> 03:45:02,640 AS WE KNOW THE SLEEP APNEA IS 5271 03:45:02,640 --> 03:45:03,960 OUR STANDARD INSTRUMENT TO 5272 03:45:03,960 --> 03:45:06,040 SCREEN, THEY DO NOT WORK WELL IN 5273 03:45:06,040 --> 03:45:06,680 THE CARDIOVASCULAR POPULATION. 5274 03:45:06,680 --> 03:45:08,800 THE SAME LIKE I HAD HOLDES 5275 03:45:08,800 --> 03:45:10,640 THROUGH FOR PULMONARY 5276 03:45:10,640 --> 03:45:12,920 HYPERTENSION. 5277 03:45:12,920 --> 03:45:14,800 THEY ELECTED TO IDENTIFY AN 5278 03:45:14,800 --> 03:45:17,200 APPROACH TO SCREENING FOR SLEEP 5279 03:45:17,200 --> 03:45:19,520 APNEA AND PULMONARY HYPERTENSION 5280 03:45:19,520 --> 03:45:20,400 AND FOUND VARIOUS 5281 03:45:20,400 --> 03:45:21,360 CHARACTERISTICS OF THE 5282 03:45:21,360 --> 03:45:24,200 INDIVIDUALS AS WELL AS 5283 03:45:24,200 --> 03:45:25,880 CIRCULATING BIOMARKERS THAT 5284 03:45:25,880 --> 03:45:30,280 APPEAR TO BE EFFECTIVE IN TERMS 5285 03:45:30,280 --> 03:45:34,040 OF ASCERTAINING OBSTRUCTIVE 5286 03:45:34,040 --> 03:45:35,440 SLEEP APNEA AND PULMONARY 5287 03:45:35,440 --> 03:45:36,600 HYPERTENSION AND PERFORMS WELL 5288 03:45:36,600 --> 03:45:40,520 AS THEY LOOKED AT IN THIS 5289 03:45:40,520 --> 03:45:42,280 PARTICULAR STUDY. 5290 03:45:42,280 --> 03:45:47,080 THIS HAS LOOKED AT HOW WE SCREEN 5291 03:45:47,080 --> 03:45:49,280 FOR SLEEP APNEA IN PULMONARY 5292 03:45:49,280 --> 03:45:49,880 HYPERTENSION. 5293 03:45:49,880 --> 03:45:57,160 IN THIS STATEMENT FROM THE 5294 03:45:57,160 --> 03:45:59,920 GERMAN GROUP, AS PERTAINS TO 5295 03:45:59,920 --> 03:46:01,560 PULMONARY HYPERTENSION, IN 5296 03:46:01,560 --> 03:46:02,640 PRE-CAPILLARY HYPERTENSION THEY 5297 03:46:02,640 --> 03:46:03,760 IDENTIFIED OVERALL INCREASED 5298 03:46:03,760 --> 03:46:06,240 RISK OF SLEEP APNEA AND HYPOXIA 5299 03:46:06,240 --> 03:46:07,800 AS WE'VE OBSERVED IN LITERATURE 5300 03:46:07,800 --> 03:46:09,560 BUT THEY HIGHLIGHT THERE'S NO 5301 03:46:09,560 --> 03:46:10,760 STUDIES AVAILABLE ON SLEEP 5302 03:46:10,760 --> 03:46:12,920 DURATION IN PATIENTS WITH 5303 03:46:12,920 --> 03:46:13,600 PRE-CAPILLARY PULMONARY 5304 03:46:13,600 --> 03:46:14,560 HYPERTENSION, THERE IS A STUDY 5305 03:46:14,560 --> 03:46:19,600 THAT LOOKED AT SLEEP QUALITY AND 5306 03:46:19,600 --> 03:46:20,680 FOUND IDIOPATHIC PULMONARY 5307 03:46:20,680 --> 03:46:21,480 HYPERTENSION, SELF-REPORTED 5308 03:46:21,480 --> 03:46:23,680 SLEEP QUALITY WAS ASSOCIATED 5309 03:46:23,680 --> 03:46:25,080 WITH MORE SEVERE EXERCISE 5310 03:46:25,080 --> 03:46:28,280 LIMITATION IN THIS COHORT OF 52 5311 03:46:28,280 --> 03:46:28,600 INDIVIDUALS. 5312 03:46:28,600 --> 03:46:32,320 THERE ARE LIMITED DATA ON SLEEP 5313 03:46:32,320 --> 03:46:34,360 QUALITY, INTERESTINGLY, RELATING 5314 03:46:34,360 --> 03:46:36,920 TO EXERCISE LIMITATION IN 5315 03:46:36,920 --> 03:46:38,480 PULMONARY HYPERTENSION. 5316 03:46:38,480 --> 03:46:41,960 AGAIN IN THIS SMALLER STUDY OF 5317 03:46:41,960 --> 03:46:44,160 39 INDIVIDUALS THEY LOOKED AT 5318 03:46:44,160 --> 03:46:45,360 DIFFERENCES IN OBSTRUCTIVE 5319 03:46:45,360 --> 03:46:49,160 VERSUS CENTRAL SLEEP APNEA, 5320 03:46:49,160 --> 03:46:51,480 FOUND MORE PRE-DOMMANCE, THAT'S 5321 03:46:51,480 --> 03:46:54,880 WHAT WE'VE IDENTIFIED IN THE 5322 03:46:54,880 --> 03:46:55,280 PVD-OMICS COHORT. 5323 03:46:55,280 --> 03:47:05,800 HALF HAD NOCTURNAL DESATURATION. 5324 03:47:11,360 --> 03:47:15,120 WE ALSO ELECTED TO LOOK AT 5325 03:47:15,120 --> 03:47:17,280 PULMONARY HYPERTENSION AND SLEEP 5326 03:47:17,280 --> 03:47:19,920 APNEA BASED UPON REGISTRY THAT'S 5327 03:47:19,920 --> 03:47:24,400 BEEN DEVELOPED AT THE CLEVELAND 5328 03:47:24,400 --> 03:47:26,600 CLINIC, STARLIT REGISTRY, BASIS 5329 03:47:26,600 --> 03:47:28,880 OF A RECENT IBM DISCOVERY 5330 03:47:28,880 --> 03:47:30,200 ACCELERATOR AWARD WHERE WE'RE, 5331 03:47:30,200 --> 03:47:32,160 AS MANY OTHERS, TRYING TO LOOK 5332 03:47:32,160 --> 03:47:35,120 FOR BETTER WAYS TO ASCERTAIN 5333 03:47:35,120 --> 03:47:37,080 SLEEP DISORDERED BREATHING AND 5334 03:47:37,080 --> 03:47:38,920 PREDICTION OF CLINICAL OUTCOMES 5335 03:47:38,920 --> 03:47:41,560 AND TREATMENT RESPONSIVENESS. 5336 03:47:41,560 --> 03:47:44,320 SO, AS WE MERGED SOME OF OUR 5337 03:47:44,320 --> 03:47:45,520 SLEEP REGISTRY DATA WITH 5338 03:47:45,520 --> 03:47:48,000 PULMONARY HYPERTENSION REGISTRY 5339 03:47:48,000 --> 03:47:49,600 THAT WE HAVE, WE WERE INTERESTED 5340 03:47:49,600 --> 03:47:54,600 IN LOOKING AT SOME OF THESE 5341 03:47:54,600 --> 03:47:56,240 RELATIONSHIPS WITH MEAN ARTERIAL 5342 03:47:56,240 --> 03:47:59,920 PRESSURE AND HEMO HEMODYNAMIC 5343 03:47:59,920 --> 03:48:03,120 MEASURES AND FOUND THESE ARE 5344 03:48:03,120 --> 03:48:07,920 ASSOCIATED WITH LONGER DURATION 5345 03:48:07,920 --> 03:48:10,360 OF NOCTURNAL HYPOXIA WITH NO 5346 03:48:10,360 --> 03:48:14,160 ASSOCIATION WITH HEMO 5347 03:48:14,160 --> 03:48:14,720 HEMODYNAMIC MEASURES. 5348 03:48:14,720 --> 03:48:18,880 THIS WAS IN A GROUP OF CLOSE TO 5349 03:48:18,880 --> 03:48:20,200 500 INDIVIDUALS. 5350 03:48:20,200 --> 03:48:24,600 SO SOME COMMON THEMES WE'RE 5351 03:48:24,600 --> 03:48:28,800 SEEING HERE IN STUDIES DONE, IN 5352 03:48:28,800 --> 03:48:33,000 PVDOMICS WE TRIED TO LOOK AT 5353 03:48:33,000 --> 03:48:39,000 RELATIONSHIPS WITH THESE 5354 03:48:39,000 --> 03:48:42,640 FREQUENCY OF APNEA PER HOUR, AS 5355 03:48:42,640 --> 03:48:44,520 RELATED TO RIGHT VENTRICULAR 5356 03:48:44,520 --> 03:48:46,680 FUNCTION, WITH THOSE WHO HAVE 5357 03:48:46,680 --> 03:48:49,400 CARDIAC MRI WE WERE ABLE TO LOOK 5358 03:48:49,400 --> 03:48:52,480 AT RIGHT EJECTION FRACTION AND 5359 03:48:52,480 --> 03:48:53,160 FOUND SOME SIGNIFICANT 5360 03:48:53,160 --> 03:48:54,360 ASSOCIATIONS IN PARTICULAR WITH 5361 03:48:54,360 --> 03:48:56,840 PERCENTAGE OF TIME SPENT BELOW 5362 03:48:56,840 --> 03:48:59,840 90% AS RELATED TO RIGHT 5363 03:48:59,840 --> 03:49:02,080 VENTRICULAR EJECTION FRACTION, 5364 03:49:02,080 --> 03:49:04,280 RIGHT SYSTOLIC -- RIGHT 5365 03:49:04,280 --> 03:49:05,920 VENTRICULAR PRESSURE AND MEAN 5366 03:49:05,920 --> 03:49:10,640 PULMONARY PRESSURE IN FINDINGS 5367 03:49:10,640 --> 03:49:13,920 NOT OBSERVED WITH APNEA 5368 03:49:13,920 --> 03:49:16,120 HIGHPOPNE INDEX. 5369 03:49:16,120 --> 03:49:20,040 IN GROUP 1 FOR ARTERIAL 5370 03:49:20,040 --> 03:49:21,800 HYPERTENSION HOW SLEEP APNEA 5371 03:49:21,800 --> 03:49:26,600 PREDICTS OUTCOMES, IN THIS 5372 03:49:26,600 --> 03:49:28,920 COHORT OF 150 SURROUNDS OF 5373 03:49:28,920 --> 03:49:30,760 INDIVIDUALS FOUND SLEEP APNEA IN 5374 03:49:30,760 --> 03:49:32,640 A THIRD OF INDIVIDUALS, AND 5375 03:49:32,640 --> 03:49:36,320 THERE WAS NO SIGNIFICANT 5376 03:49:36,320 --> 03:49:37,360 DIFFERENCE, IN THOSE VERSUS 5377 03:49:37,360 --> 03:49:41,480 THOSE WITHOUT OBSTRUCTIVE SLEEP 5378 03:49:41,480 --> 03:49:43,880 OF A KNEE A. 5379 03:49:43,880 --> 03:49:44,760 WHEN LOOKING AT OXYGEN 5380 03:49:44,760 --> 03:49:47,880 SATURATION WITH HIGHER DEGREE OF 5381 03:49:47,880 --> 03:49:50,120 HYPOXIA HAD WORSE SURVIVAL 5382 03:49:50,120 --> 03:49:52,480 COMPARED TO THOSE WITH LESSER 5383 03:49:52,480 --> 03:49:55,960 DEGREE OF HYPOXIA AND APPEARED 5384 03:49:55,960 --> 03:50:02,600 TO BE ASSOCIATED WITH POOR 5385 03:50:02,600 --> 03:50:02,880 PROGNOSIS. 5386 03:50:02,880 --> 03:50:07,800 THIS WAS OVER A 3-YEAR PERIOD OF 5387 03:50:07,800 --> 03:50:08,040 TIME. 5388 03:50:08,040 --> 03:50:10,640 WE LOOKED AT THESE RELATIONSHIPS 5389 03:50:10,640 --> 03:50:13,920 IN A MORE PROSPECTIVE FASHION, 5390 03:50:13,920 --> 03:50:15,240 APPROACHING WITH ENHANCED RIGOR 5391 03:50:15,240 --> 03:50:17,760 IN TERMS OF TAKING IT TO 5392 03:50:17,760 --> 03:50:18,400 CONSIDERATION, CONFOUNDING 5393 03:50:18,400 --> 03:50:22,760 FACTORS, SUCH AS AGE, SEX, BODY 5394 03:50:22,760 --> 03:50:25,080 MASS INDEX, DLCO IS A WAY TO GET 5395 03:50:25,080 --> 03:50:28,680 AT MASS MICHIGAN AND MEDICATIONS 5396 03:50:28,680 --> 03:50:30,320 AS WELL. 5397 03:50:30,320 --> 03:50:33,480 OVER FOUR-YEAR PERIOD OF TIME 5398 03:50:33,480 --> 03:50:37,320 WE'RE IDENTIFYING THAT DEGREE OF 5399 03:50:37,320 --> 03:50:39,280 HYPOXIA WAS ASSOCIATED WITH 17% 5400 03:50:39,280 --> 03:50:41,800 INCREASED RISK OF DEATH OR 5401 03:50:41,800 --> 03:50:43,800 TRANSPLANT, THIS WAS OVER ABOUT 5402 03:50:43,800 --> 03:50:45,320 APPROXIMATELY A 4-YEAR PERIOD OF 5403 03:50:45,320 --> 03:50:47,280 TIME, AND IT'S A GREAT PLATFORM 5404 03:50:47,280 --> 03:50:50,120 FOR OUR EARLY CAREER 5405 03:50:50,120 --> 03:50:52,520 INVESTIGATORS WITH DR. LOWRY 5406 03:50:52,520 --> 03:50:54,960 LEADING THIS WORK, CURRENTLY 5407 03:50:54,960 --> 03:50:55,840 UNDER REVIEW. 5408 03:50:55,840 --> 03:50:59,680 WE ALSO TRIED TO LOOK AT THINGS 5409 03:50:59,680 --> 03:51:02,080 RATHER THAN JUST DICHOTOMIZING 5410 03:51:02,080 --> 03:51:04,560 AT MEDIAN VALUE OF DEGREE OF 5411 03:51:04,560 --> 03:51:08,840 HYPOXIA LOOKING FOR LINEAR, 5412 03:51:08,840 --> 03:51:10,240 NON-LINEAR RELATIONSHIPS, AND 5413 03:51:10,240 --> 03:51:13,880 FOUND NO EVIDENCE OF NON-LINEAR 5414 03:51:13,880 --> 03:51:14,960 RELATIONSHIPS, LOOKED AT 5415 03:51:14,960 --> 03:51:15,840 RELATIONSHIPS ACROSS QUARTILES 5416 03:51:15,840 --> 03:51:18,400 AND FOUND THAT THIS WAS A 5417 03:51:18,400 --> 03:51:19,560 SIGNIFICANT LINEAR TREND, IN 5418 03:51:19,560 --> 03:51:23,480 TERMS OF INCREASING DEGREE OF 5419 03:51:23,480 --> 03:51:26,240 HYPOXIA, ASSOCIATED WITH WORSE 5420 03:51:26,240 --> 03:51:31,360 SURVIVAL IN GROUP 1 PULMONARY 5421 03:51:31,360 --> 03:51:31,720 HYPERTENSION. 5422 03:51:31,720 --> 03:51:33,120 WE CAN SURMISE SLEEP RELATED 5423 03:51:33,120 --> 03:51:43,600 HIGH -- HYPOXIA, POTENTIAL 5424 03:51:47,120 --> 03:51:49,200 LOCAL MOLECULAR INFLUENCES, AT 5425 03:51:49,200 --> 03:51:50,840 THE LEVEL OF PULMONARY ARTERY 5426 03:51:50,840 --> 03:51:54,320 LEADING TO PROGRESSION OF RIGHT 5427 03:51:54,320 --> 03:51:54,880 VENTRICULAR DYSFUNCTION, TO 5428 03:51:54,880 --> 03:51:57,280 SUMMARIZE IT WAS MORE -- THERE'S 5429 03:51:57,280 --> 03:51:59,720 MORBID ASSOCIATION WITH DEGREE 5430 03:51:59,720 --> 03:52:03,120 OF NOCTURNAL HYPOXIA WITH RIGHT 5431 03:52:03,120 --> 03:52:04,520 VENTRICULAR MEASURES, APNEA 5432 03:52:04,520 --> 03:52:07,560 INDEX WAS ASSOCIATED WITH RIGHT 5433 03:52:07,560 --> 03:52:09,440 VENTRICULAR EJECTION FRACTION, 5434 03:52:09,440 --> 03:52:12,160 MORE OF REDUCTION THERE, AND 5435 03:52:12,160 --> 03:52:13,920 OVERALL HYPOXIA WAS REALLY 5436 03:52:13,920 --> 03:52:15,560 DRIVING THE POORER SURVIVAL THAT 5437 03:52:15,560 --> 03:52:18,840 WAS SEEN IN THIS COHORT. 5438 03:52:18,840 --> 03:52:25,640 WE ELECTED TO GO DEEPER AND 5439 03:52:25,640 --> 03:52:28,080 LEVERAGE METABOLOMICS DATA. 5440 03:52:28,080 --> 03:52:31,360 METABOLIC ALTERATIONS ARE DRIVER 5441 03:52:31,360 --> 03:52:33,000 EVER PATHOGENESIS, AND WE KNOW 5442 03:52:33,000 --> 03:52:35,920 SLEEP DISORDERED BREATHING IS 5443 03:52:35,920 --> 03:52:38,120 ASSOCIATED WITH METABOLIC 5444 03:52:38,120 --> 03:52:39,480 DYSFUNCTION, AND IMPLICATED IN 5445 03:52:39,480 --> 03:52:42,640 HYPERTENSION, AND SINCE WE 5446 03:52:42,640 --> 03:52:45,720 IDENTIFIED HYPOXIA WAS 5447 03:52:45,720 --> 03:52:46,680 ASSOCIATED WITH RIGHT 5448 03:52:46,680 --> 03:52:51,520 VENTRICULAR DYSFUNCTION THE IDEA 5449 03:52:51,520 --> 03:52:53,480 TO SEE WHETHER BIOMARKERS CAN 5450 03:52:53,480 --> 03:52:55,560 SHED LIGHT ON WHAT CONNECTS 5451 03:52:55,560 --> 03:52:57,440 THEM, SLEEP APNEA, DEGREE OF 5452 03:52:57,440 --> 03:52:58,840 HYPOXIA AS RELATES TO POOR 5453 03:52:58,840 --> 03:52:59,160 SURVIVAL. 5454 03:52:59,160 --> 03:53:01,800 AS WE LOOKED AT THESE 5455 03:53:01,800 --> 03:53:04,880 METABOLITES WE FOUND SOME COMMON 5456 03:53:04,880 --> 03:53:07,520 THEMES WITH CERTAIN PATHWAYS 5457 03:53:07,520 --> 03:53:10,480 THAT WERE DYSREGULATED, AS IT 5458 03:53:10,480 --> 03:53:12,760 RELATES TO SLEEP-RELATED 5459 03:53:12,760 --> 03:53:14,840 HYPOXIA, SO SPECIFICALLY WE 5460 03:53:14,840 --> 03:53:21,840 FOUND DISRUPTION OF THE POLY 5461 03:53:21,840 --> 03:53:24,240 AMINE METABOLISM, FATTY ACID 5462 03:53:24,240 --> 03:53:25,440 AROUND PREGNANOLONE STEROIDS, 5463 03:53:25,440 --> 03:53:30,640 SEEMED LIKE MEN, THOSE WERE 5464 03:53:30,640 --> 03:53:33,240 YOUNGER, GREATER GRIEF 5465 03:53:33,240 --> 03:53:34,760 ALTERATIONS IN THE PREGNANOLONE 5466 03:53:34,760 --> 03:53:36,280 METABOLOME PATHWAYS. 5467 03:53:36,280 --> 03:53:38,480 WE THEN TRIED TO IDENTIFY THOSE 5468 03:53:38,480 --> 03:53:42,000 THAT WERE SIGNIFICANT IN TERMS 5469 03:53:42,000 --> 03:53:44,080 OF ASSOCIATION WITH HYPOXIA AND 5470 03:53:44,080 --> 03:53:47,240 SEE IF THE TOP CANDIDATE 5471 03:53:47,240 --> 03:53:49,640 BIOMARKERS WERE RELATED TO 5472 03:53:49,640 --> 03:53:50,960 ABNORMALITIES IN RIGHT 5473 03:53:50,960 --> 03:53:52,160 VENTRICULAR FUNCTION BASED 5474 03:53:52,160 --> 03:53:55,800 UPON -- THESE ARE MAINLY ECHO 5475 03:53:55,800 --> 03:53:56,040 MEASURES. 5476 03:53:56,040 --> 03:54:00,640 AND FOUND THAT IN PARTICULAR, 5477 03:54:00,640 --> 03:54:01,840 THE POLYAMINE METABOLITES WERE 5478 03:54:01,840 --> 03:54:05,240 ALTERED IN THE SETTING OF RIGHT 5479 03:54:05,240 --> 03:54:09,280 VENTRICULAR FUNCTION AND SIZE. 5480 03:54:09,280 --> 03:54:10,800 AND SO CAN POTENTIALLY ALLOW FOR 5481 03:54:10,800 --> 03:54:16,800 INSIGHT ON MECHANIC ISM AND 5482 03:54:16,800 --> 03:54:17,920 WE'RE DOING ANALYSES TO 5483 03:54:17,920 --> 03:54:18,640 INVESTIGATE THAT. 5484 03:54:18,640 --> 03:54:22,320 RECENTLY THIS YEAR IN TERMS OF 5485 03:54:22,320 --> 03:54:23,720 POLYAMINE METABOLISM IDENTIFIED 5486 03:54:23,720 --> 03:54:26,000 BY THE UNIVERSITY OF WASHINGTON 5487 03:54:26,000 --> 03:54:29,080 GROUP, IN TERMS OF IDENTIFYING 5488 03:54:29,080 --> 03:54:31,200 INDIVIDUALS AT HIGHER RISK FOR 5489 03:54:31,200 --> 03:54:34,240 POORER OUTCOMES IN PULMONARY 5490 03:54:34,240 --> 03:54:35,840 HYPERTENSION, AS POTENTIAL 5491 03:54:35,840 --> 03:54:39,920 IMPORTANT BIOMARKERS OF DISEASE 5492 03:54:39,920 --> 03:54:47,120 PROGRESSION, AND RIGHT 5493 03:54:47,120 --> 03:54:48,520 VENTRICULAR ADAPTATION. 5494 03:54:48,520 --> 03:54:49,520 SHIFTING TO TREATMENT THERE'S 5495 03:54:49,520 --> 03:54:53,040 DATA IN A SMALLER SAMPLE OF 23 5496 03:54:53,040 --> 03:54:55,240 INDIVIDUALS SHOWING SOME 5497 03:54:55,240 --> 03:54:58,240 IMPROVEMENT IN PULMONARY 5498 03:54:58,240 --> 03:54:59,800 ARTERIAL SYSTOLIC PRESSURE, IN 5499 03:54:59,800 --> 03:55:03,440 PARTICULAR THEY IDENTIFY THOSE 5500 03:55:03,440 --> 03:55:04,560 INTERESTINGLY WITH LEFT 5501 03:55:04,560 --> 03:55:05,280 VENTRICULAR DIASTOLIC FUNCTION 5502 03:55:05,280 --> 03:55:11,360 HAVE MORE IMPROVEMENT IN DEGREE 5503 03:55:11,360 --> 03:55:11,960 OF PULMONARY HYPERTENSION 5504 03:55:11,960 --> 03:55:13,240 PRESSURE REDUCTION. 5505 03:55:13,240 --> 03:55:18,040 IN THIS TRIAL THEY LOOKED AT 5506 03:55:18,040 --> 03:55:19,320 NOCTURNAL OXYGEN IN 5507 03:55:19,320 --> 03:55:21,200 PRE-CAPILLARY HYPERTENSION AND 5508 03:55:21,200 --> 03:55:23,080 FOUND BENEFITS WITH SUPPLEMENTAL 5509 03:55:23,080 --> 03:55:26,920 OXYGEN IN TERMS OF 6-MINUTE WALK 5510 03:55:26,920 --> 03:55:28,840 DISTANCE, RIGHT VENTRICULAR 5511 03:55:28,840 --> 03:55:30,400 FRACTION AREA CHANGE. 5512 03:55:30,400 --> 03:55:32,360 THAT PROVIDES A SUMMARY OF GROUP 5513 03:55:32,360 --> 03:55:32,920 1. 5514 03:55:32,920 --> 03:55:33,680 IN TERMS OF GROUP 2 5515 03:55:33,680 --> 03:55:35,200 UNFORTUNATELY THERE'S A LITTLE 5516 03:55:35,200 --> 03:55:38,800 BIT LESS LITERATURE IN THIS 5517 03:55:38,800 --> 03:55:40,040 AREA. 5518 03:55:40,040 --> 03:55:41,720 YOU KNOW THERE'S BIOLOGIC 5519 03:55:41,720 --> 03:55:44,640 PLAUSIBILITY FOR THERE TO BE 5520 03:55:44,640 --> 03:55:45,280 INTERRELATIONSHIPS WITH SLEEP 5521 03:55:45,280 --> 03:55:46,280 APNEA, PULMONARY HYPERTENSION, 5522 03:55:46,280 --> 03:55:47,560 AND HEART FAILURE. 5523 03:55:47,560 --> 03:55:50,200 WE KNOW IN SLEEP APNEA BECAUSE 5524 03:55:50,200 --> 03:55:53,520 OF THE MECHANISMS THAT HAVE BEEN 5525 03:55:53,520 --> 03:55:56,760 HIGHLIGHTED AS WELL AS ROSTRAL 5526 03:55:56,760 --> 03:55:59,120 FLUID SHIFT THAT CAN INCREASE 5527 03:55:59,120 --> 03:56:03,240 EDEMA, UPPER AIR WAY EDEMA, 5528 03:56:03,240 --> 03:56:05,360 PULMONARY CONGESTION, CAN LEAD 5529 03:56:05,360 --> 03:56:07,080 TO CENTRAL SLEEP APNEA. 5530 03:56:07,080 --> 03:56:12,360 DATA AT MOLECULAR LEVEL SHOW 5531 03:56:12,360 --> 03:56:19,800 INTERMITTENT HYPOXIA CAN INDUCE 5532 03:56:19,800 --> 03:56:21,720 CARDIOMYOCYTE DEATH, DIFFERENCE 5533 03:56:21,720 --> 03:56:24,040 IN TRANSCRIPTOME, EPIGENETIC 5534 03:56:24,040 --> 03:56:24,680 PROGRAMS, POST-TRANSLATIONAL 5535 03:56:24,680 --> 03:56:26,680 MODIFICATION IN TERMS OF 5536 03:56:26,680 --> 03:56:29,920 INTERMITTENT HYPOXIA AND DEFECT 5537 03:56:29,920 --> 03:56:32,120 ON CARDIOMYOCYTE DEATH WHICH HAS 5538 03:56:32,120 --> 03:56:33,640 DIRECT IMPLICATION TERMS OF 5539 03:56:33,640 --> 03:56:35,960 HEART FAILURE AND PULMONARY 5540 03:56:35,960 --> 03:56:36,520 HYPERTENSION. 5541 03:56:36,520 --> 03:56:39,480 ALSO RECENT DATA SHOWING THAT 5542 03:56:39,480 --> 03:56:41,880 INTERMITTENT HYPOXIA INDUCES 5543 03:56:41,880 --> 03:56:42,840 CARDIAC REMODELING, CONTRACTILE 5544 03:56:42,840 --> 03:56:44,320 DYSFUNCTION IN RODENTS, MIGHT 5545 03:56:44,320 --> 03:56:50,840 RIGGER -- TRIGGER OTHER 5546 03:56:50,840 --> 03:56:52,000 AGGRAVATE CHRONIC HEART FAILURE, 5547 03:56:52,000 --> 03:56:53,680 OPPORTUNITIES TO LOOK MORE 5548 03:56:53,680 --> 03:56:54,280 CLOSELY. 5549 03:56:54,280 --> 03:56:56,800 WITH SLEEP APNEA AND HEART 5550 03:56:56,800 --> 03:57:05,320 FAILURE, ACUTE DECOMPENSATED, 5551 03:57:05,320 --> 03:57:07,720 POOR SURVIVAL AND TREATMENT 5552 03:57:07,720 --> 03:57:09,800 POST-DISCHARGE IN THOSE WITH 5553 03:57:09,800 --> 03:57:11,360 SLEEP DISORDERED BREATHING 5554 03:57:11,360 --> 03:57:14,800 APPEARS TO IMPROVE SURVIVAL IN 5555 03:57:14,800 --> 03:57:16,480 THE POST-DISCHARGE PHASE. 5556 03:57:16,480 --> 03:57:19,200 AND THERE IS ONE TRIAL PUBLISHED 5557 03:57:19,200 --> 03:57:23,520 TO ACTUALLY LOOK AT TREATMENT OF 5558 03:57:23,520 --> 03:57:25,480 SLEEP APNEA, VIA AUTOPOSITIVE 5559 03:57:25,480 --> 03:57:30,720 AIR WAY PRESSURE, AND HOW THAT 5560 03:57:30,720 --> 03:57:31,680 IMPACTS PULMONARY ARTERIAL 5561 03:57:31,680 --> 03:57:34,120 PRESSURES IN THOSE ADMITTED WITH 5562 03:57:34,120 --> 03:57:35,640 HEART FAILURE, GROUP 2 PULMONARY 5563 03:57:35,640 --> 03:57:37,520 HYPERTENSION AND THEY IDENTIFY 5564 03:57:37,520 --> 03:57:40,160 IN THE INTERVENTION ARM WITH 5565 03:57:40,160 --> 03:57:41,800 POSITIVE AIRWAY PRESSURE THERE 5566 03:57:41,800 --> 03:57:45,840 WAS REDUCTION IN THE MEAN 5567 03:57:45,840 --> 03:57:47,160 PRESSURE AND IMPROVEMENT IN 5568 03:57:47,160 --> 03:57:49,000 EJECTION FRACTION THAT WAS 5569 03:57:49,000 --> 03:57:49,280 OBSERVED. 5570 03:57:49,280 --> 03:57:51,320 SO A SMALL CLINICAL TRIAL BUT 5571 03:57:51,320 --> 03:57:54,160 WITH SOME INTERESTING AND 5572 03:57:54,160 --> 03:57:56,240 PROMISING FINDINGS NONETHELESS. 5573 03:57:56,240 --> 03:57:57,440 TO SUMMARIZE, OVERALL THERE ARE 5574 03:57:57,440 --> 03:57:59,720 EXPERIMENT WRAL AND HUMAN 5575 03:57:59,720 --> 03:58:06,640 PHYSIOLOGIC DATA THAT ACTUALLY 5576 03:58:06,640 --> 03:58:08,160 IDENTIFY IMMEDIATE TEMPORALITY 5577 03:58:08,160 --> 03:58:13,160 IN THE PRESSURE, HYPOXIA EXPERTS 5578 03:58:13,160 --> 03:58:14,760 DETRIMENT AT LEVELS OF 5579 03:58:14,760 --> 03:58:15,600 VASCULATURE AND FUNCTION, 5580 03:58:15,600 --> 03:58:16,800 VARIOUS PATHWAYS DIDN'T HAVE 5581 03:58:16,800 --> 03:58:21,200 TIME TO REVIEW BUT VARIOUS 5582 03:58:21,200 --> 03:58:22,640 PATHWAYS IDENTIFIED FROM 5583 03:58:22,640 --> 03:58:25,160 MOLECULAR LEVEL, AND THAT GROUP 5584 03:58:25,160 --> 03:58:27,640 1 APPEARS TO HAVE HIGHER DEGREE 5585 03:58:27,640 --> 03:58:29,640 OF HYPOXIA, PERHAPS GREATER 5586 03:58:29,640 --> 03:58:33,280 DEGREE OF SLEEP APNEA. 5587 03:58:33,280 --> 03:58:35,240 AND WITH GROUP 1, THERE'S A WIDE 5588 03:58:35,240 --> 03:58:37,000 VARIETY AND WIDE RANGE I SHOULD 5589 03:58:37,000 --> 03:58:41,920 SAY OF PREVALENCE IN TERMS OF 5590 03:58:41,920 --> 03:58:44,400 OBSTRUCTIVE APNEA, AND 5591 03:58:44,400 --> 03:58:46,040 PREDOMINANCE VERSUS CENTRAL, 5592 03:58:46,040 --> 03:58:47,560 DATA SHOWING PERHAPS COMPOSITE 5593 03:58:47,560 --> 03:58:49,000 OF CLINICAL AND CIRCULATING 5594 03:58:49,000 --> 03:58:50,640 BIOMARKERS THAT MAY CHARACTERIZE 5595 03:58:50,640 --> 03:58:55,480 SLEEP APNEA IN A BETTER WAY IN 5596 03:58:55,480 --> 03:58:56,800 PULMONARY ARTERIAL HYPERTENSION, 5597 03:58:56,800 --> 03:59:07,280 POOR SLEEP QUALITY ASSOCIATED 5598 03:59:08,000 --> 03:59:09,280 WITH EXERCISE LIMITATION. 5599 03:59:09,280 --> 03:59:12,400 THERE'S DATA ON TO SHOW 5600 03:59:12,400 --> 03:59:13,920 SLEEP-RELATED HYPOXIA ASSOCIATED 5601 03:59:13,920 --> 03:59:15,400 WITH WORSE TRANSPLANT FREE 5602 03:59:15,400 --> 03:59:17,560 SURVIVAL EVEN AFTER 5603 03:59:17,560 --> 03:59:19,760 CONSIDERATION OF CONFOUNDING 5604 03:59:19,760 --> 03:59:21,600 FACTORS, THE POLYAMINE 5605 03:59:21,600 --> 03:59:23,680 METABOLITES AND THEIR ALTERATION 5606 03:59:23,680 --> 03:59:26,400 MAY PROVIDE SOME CLUES IN TERMS 5607 03:59:26,400 --> 03:59:27,440 OF THE MECHANISMS THAT ARE 5608 03:59:27,440 --> 03:59:29,400 INVOLVED AND THERE'S SOME SMALL 5609 03:59:29,400 --> 03:59:30,440 INTERVENTIONAL STUDIES THAT 5610 03:59:30,440 --> 03:59:32,880 SUGGEST THAT TREATMENT WITH 5611 03:59:32,880 --> 03:59:36,240 POSITIVE AIRWAY PRESSURE THERAPY 5612 03:59:36,240 --> 03:59:41,520 AND NOCTURNAL SUPPLEMENTAL 5613 03:59:41,520 --> 03:59:43,080 OXYGEN MAY BE FAVORABLE. 5614 03:59:43,080 --> 03:59:48,080 A SMALL TRIAL SEEMS TO SHOW SOME 5615 03:59:48,080 --> 03:59:53,800 IMPROVEMENT IN DEGREE OF 5616 03:59:53,800 --> 03:59:55,200 PULMONARY HEMODYNAMICS. 5617 03:59:55,200 --> 03:59:56,560 AS WAS MENTIONED, THERE ARE 5618 03:59:56,560 --> 03:59:57,760 OPPORTUNITIES TO DELVE FURTHER 5619 03:59:57,760 --> 03:59:59,960 TO LOOK AT SUBTYPE OF HYPOXIA 5620 03:59:59,960 --> 04:00:03,000 AND HOW THIS RELATES TO 5621 04:00:03,000 --> 04:00:03,240 OUTCOMES. 5622 04:00:03,240 --> 04:00:06,840 WE'VE BEEN DELVING IN FURTHER IN 5623 04:00:06,840 --> 04:00:09,680 THE PVDOMICS DATA TO IDENTIFY 5624 04:00:09,680 --> 04:00:10,440 DIFFERENT PATTERNINGS OF 5625 04:00:10,440 --> 04:00:10,760 HYPOXIA. 5626 04:00:10,760 --> 04:00:14,720 YOU CAN SEE IT'S MORE 5627 04:00:14,720 --> 04:00:15,800 PRECIPITOUS, SOMETIMES MORE 5628 04:00:15,800 --> 04:00:16,400 PROLONGED. 5629 04:00:16,400 --> 04:00:17,680 RELATED IN PART TO CIRCULATION 5630 04:00:17,680 --> 04:00:18,800 TIME BUT THIS AND INTEGRATED 5631 04:00:18,800 --> 04:00:24,720 MEASURES WITH THE HEART RATE 5632 04:00:24,720 --> 04:00:28,480 AROUSAL RESPONSE MAY PROVIDE 5633 04:00:28,480 --> 04:00:30,560 GREATER MEASURES. 5634 04:00:30,560 --> 04:00:31,760 PATHOPHYSIOLOGY OF SLEEP 5635 04:00:31,760 --> 04:00:36,000 DISTURBANCES INCLUDING ZIP 5636 04:00:36,000 --> 04:00:37,560 DISORDERED BREATHING IN GROUP 1, 5637 04:00:37,560 --> 04:00:43,880 WHAT IS DRIVING THAT IN TERMS OF 5638 04:00:43,880 --> 04:00:50,480 SLEEP DISORDERED BREATHING IS OF 5639 04:00:50,480 --> 04:00:52,680 INTEREST. 5640 04:00:52,680 --> 04:00:54,840 UNDERSTANDING HOW THESE 5641 04:00:54,840 --> 04:00:55,920 AUTONOMIC DYSFUNCTION IS 5642 04:00:55,920 --> 04:01:06,480 AFFECTING THE RIGHT VENTRICLE IS 5643 04:01:07,160 --> 04:01:07,520 INTERESTING. 5644 04:01:07,520 --> 04:01:08,840 AND CIRCULATING BIOMARKERS IS OF 5645 04:01:08,840 --> 04:01:11,360 INTEREST IN BOTH GROUPS. 5646 04:01:11,360 --> 04:01:15,640 OTHER IMPORTANT AREAS HAVE BEEN 5647 04:01:15,640 --> 04:01:16,400 MENTIONED, UNDERSTANDING 5648 04:01:16,400 --> 04:01:17,880 INFLUENCE OF INTERVENTIONS BUT 5649 04:01:17,880 --> 04:01:18,600 UNDERSTANDING THE SUBTYPES I 5650 04:01:18,600 --> 04:01:22,280 THINK IS THE FIRST STEP BEFORE 5651 04:01:22,280 --> 04:01:25,800 WE EMBARK ON UNDERSTANDING HOW 5652 04:01:25,800 --> 04:01:26,800 INTERVENTIONS TO UNDERSTAND WHO 5653 04:01:26,800 --> 04:01:30,080 IS GOING TO RESPOND BEST TO 5654 04:01:30,080 --> 04:01:30,520 TREATMENTS. 5655 04:01:30,520 --> 04:01:33,280 THANK YOU SO MUCH. 5656 04:01:33,280 --> 04:01:36,360 5657 04:01:36,360 --> 04:01:36,880 5658 04:01:36,880 --> 04:01:39,360 >>GREAT REVIEW OF THE STATE OF 5659 04:01:39,360 --> 04:01:45,200 KNOWLEDGE HERE AND RECENT 5660 04:01:45,200 --> 04:01:45,520 CONTRIBUTIONS. 5661 04:01:45,520 --> 04:01:50,040 WE HAVE TIME FOR ONE QUESTION 5662 04:01:50,040 --> 04:01:51,440 FOR DR. MEHRA AND OPEN UP TO 5663 04:01:51,440 --> 04:01:52,640 GENERAL DISCUSSION OF THE LAST 5664 04:01:52,640 --> 04:01:55,360 THREE TALKS. 5665 04:01:55,360 --> 04:02:00,320 5666 04:02:00,320 --> 04:02:03,720 I HAVE ONE FOR YOU. 5667 04:02:03,720 --> 04:02:07,880 WHEN I PRESENTED A LITTLE BIT OF 5668 04:02:07,880 --> 04:02:13,440 THE POLY AMINE DATA, PVD OMICS 5669 04:02:13,440 --> 04:02:15,680 AT APS, LAST, SOMEBODY IN THE 5670 04:02:15,680 --> 04:02:17,400 AUDIENCE CAME UP TO ME AND SAID 5671 04:02:17,400 --> 04:02:18,960 TO ME, YOU ARE AWARE THERE'S 5672 04:02:18,960 --> 04:02:22,880 LIKE A WHOLE LARGE BASIC SCIENCE 5673 04:02:22,880 --> 04:02:23,600 LITERATURE ABOUT POLYAMINES 5674 04:02:23,600 --> 04:02:26,240 DATING BACK TO THE EARLY 5675 04:02:26,240 --> 04:02:29,880 2000s, I WAS NOT. 5676 04:02:29,880 --> 04:02:31,640 SO I DID A DEEP DIVE. 5677 04:02:31,640 --> 04:02:34,600 YOU MAY BE AWARE, BUT THERE WAS 5678 04:02:34,600 --> 04:02:37,360 SOME PUBLICATIONS FROM THE FOLKS 5679 04:02:37,360 --> 04:02:41,720 NOW AT UNIVERSITY OF SOUTH 5680 04:02:41,720 --> 04:02:43,440 ALABAMA LOOKING AT POLYAMINE 5681 04:02:43,440 --> 04:02:44,160 DISTURBANCE IN RODENT MODELS, 5682 04:02:44,160 --> 04:02:44,960 PULMONARY HYPERTENSION, IT 5683 04:02:44,960 --> 04:02:47,400 DAWNED ON ME NOW THAT THE RODENT 5684 04:02:47,400 --> 04:02:48,800 MODELS OF PULMONARY HYPERTENSION 5685 04:02:48,800 --> 04:02:51,200 THEY WERE USING WERE HYPOXIA AT 5686 04:02:51,200 --> 04:02:53,280 THE TIME SO I JUST WENT BACK AND 5687 04:02:53,280 --> 04:02:57,040 DID SOME RESEARCH ON THAT AND I 5688 04:02:57,040 --> 04:02:59,760 THINK IT SPEAKS TO COMMENTS THAT 5689 04:02:59,760 --> 04:03:00,880 STEVE CHAN MADE EARLIER THAT WE 5690 04:03:00,880 --> 04:03:02,920 HAVE TO BE VERY CAREFUL ABOUT 5691 04:03:02,920 --> 04:03:05,320 WHAT RODENT MODELS WE'RE USING 5692 04:03:05,320 --> 04:03:07,720 BECAUSE WE MAY BE MAKING 5693 04:03:07,720 --> 04:03:09,560 IMPORTANT FINDINGS BUT NOT 5694 04:03:09,560 --> 04:03:16,400 NECESSARILY INTERPRETING THEM 5695 04:03:16,400 --> 04:03:20,880 100% FULLY, FOR INSTANCE HYPOXIA 5696 04:03:20,880 --> 04:03:24,720 MAY BE AFFECTING SPERMINE 5697 04:03:24,720 --> 04:03:25,560 METABOLISM, WE MAY INTERPRET BUT 5698 04:03:25,560 --> 04:03:28,000 PERHAPS IT'S A FUNCTION OF 5699 04:03:28,000 --> 04:03:28,240 HYPOXIA. 5700 04:03:28,240 --> 04:03:30,480 ANYWAY, JUST INTERESTING IN THE 5701 04:03:30,480 --> 04:03:31,240 CONTEXT OF YOUR FINDINGS. 5702 04:03:31,240 --> 04:03:34,000 >>THAT WAS MARK GILLESPIE'S 5703 04:03:34,000 --> 04:03:34,560 WORK, RIGHT? 5704 04:03:34,560 --> 04:03:35,520 >>YES. 5705 04:03:35,520 --> 04:03:38,360 AS I'M NOW MORE FAMILIAR WITH 5706 04:03:38,360 --> 04:03:38,520 IT. 5707 04:03:38,520 --> 04:03:41,120 >>THAT'S A GREAT COMMENT. 5708 04:03:41,120 --> 04:03:43,200 I THINK, YEAH, IT'S IMPORTANT TO 5709 04:03:43,200 --> 04:03:47,800 PUT THINGS INTO CONTEXT IN TERMS 5710 04:03:47,800 --> 04:03:49,640 OF WHAT PHYSIOLOGIC MODEL IS 5711 04:03:49,640 --> 04:03:50,560 BEING USED AND IMPACTING 5712 04:03:50,560 --> 04:03:50,880 SIGNATURES. 5713 04:03:50,880 --> 04:03:53,240 WE HAVE TO DO MORE VALIDATION 5714 04:03:53,240 --> 04:03:55,800 WORK AND ENSURE WHAT WE'RE 5715 04:03:55,800 --> 04:03:59,760 SEEING, AND WE'RE FORTUNATE TO 5716 04:03:59,760 --> 04:04:03,160 HAVE GENOMICS AND MULTIOMICS 5717 04:04:03,160 --> 04:04:03,560 CHARACTERIZATIONS. 5718 04:04:03,560 --> 04:04:08,400 YEAH, GREAT POINT. 5719 04:04:08,400 --> 04:04:10,360 >>WE CAN OPEN TO GENERAL 5720 04:04:10,360 --> 04:04:11,080 DISCUSSION. 5721 04:04:11,080 --> 04:04:14,640 DR. SWEATT HAS A HAND RAISED FOR 5722 04:04:14,640 --> 04:04:15,080 COMMENT OR QUESTION. 5723 04:04:15,080 --> 04:04:20,440 >>YES, MY QUESTION IS MORE 5724 04:04:20,440 --> 04:04:21,920 DIRECTLY RELEVANT TO PVD-OMICS 5725 04:04:21,920 --> 04:04:24,920 DATA, ONE OF THE MAIN FINDINGS 5726 04:04:24,920 --> 04:04:27,880 WAS THAT HYPOXIC BURDEN 5727 04:04:27,880 --> 04:04:30,400 ASSOCIATED WITH OVERALL OUTCOMES 5728 04:04:30,400 --> 04:04:32,680 MORE SO THAN AHI, WITHIN THAT 5729 04:04:32,680 --> 04:04:35,640 COHORT DID YOU FIND A 5730 04:04:35,640 --> 04:04:36,960 SIGNIFICANT SUBSET OF PATIENTS 5731 04:04:36,960 --> 04:04:41,480 WHO DOES NOT MEET DIAGNOSTIC 5732 04:04:41,480 --> 04:04:43,960 CRITERIA FOR SLEEP DISORDERED 5733 04:04:43,960 --> 04:04:46,680 BREATHING OR OSA YET 5734 04:04:46,680 --> 04:04:47,360 DEMONSTRATED SIGNIFICANT HYPOXIC 5735 04:04:47,360 --> 04:04:48,000 BURDEN? 5736 04:04:48,000 --> 04:04:49,440 IS THIS A SIZEABLE GROUP OF 5737 04:04:49,440 --> 04:04:52,600 PATIENTS WE'RE MISSING, MAYBE 5738 04:04:52,600 --> 04:04:53,920 WE'RE UNDERTREATING WITH 5739 04:04:53,920 --> 04:04:54,560 SUPPLEMENTAL OXYGEN? 5740 04:04:54,560 --> 04:04:56,320 >>YEAH, THAT'S A GREAT 5741 04:04:56,320 --> 04:04:56,560 QUESTION. 5742 04:04:56,560 --> 04:04:58,400 YOU KNOW, WE'RE IN THE PROCESS 5743 04:04:58,400 --> 04:05:00,480 OF KIND OF GOING THROUGH AND 5744 04:05:00,480 --> 04:05:04,000 FIGURING OUT HOW MUCH OF THIS IS 5745 04:05:04,000 --> 04:05:05,360 REALLY SLEEP APNEA SPECIFIC 5746 04:05:05,360 --> 04:05:07,040 INTERMITTENT HYPOXIA, THAT'S 5747 04:05:07,040 --> 04:05:10,200 WHAT THE SLEEP APNEA SPECIFIC 5748 04:05:10,200 --> 04:05:13,480 BURDEN ALLOWS US TO GET AT. 5749 04:05:13,480 --> 04:05:15,560 IT'S TRUE THERE'S THIS MAYBE 5750 04:05:15,560 --> 04:05:19,920 LEVEL OF HYPOXIA AND THEN 5751 04:05:19,920 --> 04:05:22,800 SUPER-IMPOSED BOUTS THAT MAY BE 5752 04:05:22,800 --> 04:05:23,920 EXPERTING EVEN GREATER 5753 04:05:23,920 --> 04:05:24,160 DETRIMENT. 5754 04:05:24,160 --> 04:05:25,720 ONE FINDING WHICH WAS OF 5755 04:05:25,720 --> 04:05:31,880 INTEREST WAS THAT THE DAY TIME 5756 04:05:31,880 --> 04:05:33,200 OXYGEN SATURATION, IT WASN'T 5757 04:05:33,200 --> 04:05:35,040 REALLY CORRELATED WITH OUTCOMES. 5758 04:05:35,040 --> 04:05:37,360 THERE'S SOMETHING UNIQUE AND 5759 04:05:37,360 --> 04:05:40,000 SPECIFIC TO THE NOCTURNAL OXYGEN 5760 04:05:40,000 --> 04:05:41,280 DESATURATION, BUT THAT'S A GREAT 5761 04:05:41,280 --> 04:05:47,200 POINT IN TERMS OF TRYING TO 5762 04:05:47,200 --> 04:05:49,160 DISENTANGLE THESE, YOU KNOW, 5763 04:05:49,160 --> 04:05:51,560 INFLUENCES OF SLEEP DISORDERED 5764 04:05:51,560 --> 04:05:59,520 BREATHING VERSUS THE BACKGROUND 5765 04:05:59,520 --> 04:05:59,760 HYPOXIA. 5766 04:05:59,760 --> 04:06:03,960 >>THANK YOU FOR A FANTASTIC 5767 04:06:03,960 --> 04:06:06,920 TALK AND STIMULATING DATA. 5768 04:06:06,920 --> 04:06:07,920 MAYBE ALSO POTENTIALLY TO FOLLOW 5769 04:06:07,920 --> 04:06:09,920 UP ON SOME OF THE LAST COMMENTS, 5770 04:06:09,920 --> 04:06:12,280 I THOUGHT ONE OF THE REALLY 5771 04:06:12,280 --> 04:06:15,360 UNIQUE THINGS THAT YOU AND YOUR 5772 04:06:15,360 --> 04:06:17,320 GROUP HAVE ARE MEASUREMENTS, YOU 5773 04:06:17,320 --> 04:06:19,200 KNOW, REALLY DETAILED DEEP 5774 04:06:19,200 --> 04:06:20,440 PHENOTYPING MEASUREMENTS, AND I 5775 04:06:20,440 --> 04:06:23,720 SAW THAT IN YOUR MODELS YOU 5776 04:06:23,720 --> 04:06:25,760 ADJUSTED FOR DLCL FOR EXAMPLE 5777 04:06:25,760 --> 04:06:27,520 AND OTHER RISK FACTORS. 5778 04:06:27,520 --> 04:06:30,360 AS WE GRAPPLE WITH THE CHICKEN 5779 04:06:30,360 --> 04:06:33,640 VERSUS THE EGG IS THIS, YOU 5780 04:06:33,640 --> 04:06:34,280 KNOW, AVERAGE HYPOXEMIA DRIVING 5781 04:06:34,280 --> 04:06:37,680 PULMONARY HYPERTENSION OR IS THE 5782 04:06:37,680 --> 04:06:41,080 PULMONARY HYPERTENSION OR IS 5783 04:06:41,080 --> 04:06:43,360 HYPOXEMIA A MANIFESTATION OF ONE 5784 04:06:43,360 --> 04:06:43,600 DISEASE. 5785 04:06:43,600 --> 04:06:45,760 AND I SAW, YOU KNOW, WHEN YOU 5786 04:06:45,760 --> 04:06:47,320 ADJUSTED THESE FACTORS YOU STILL 5787 04:06:47,320 --> 04:06:48,720 SAW RELATIONSHIPS BUT I WAS 5788 04:06:48,720 --> 04:06:51,880 WONDERING IF YOU TRIED TO MAYBE 5789 04:06:51,880 --> 04:06:54,640 SORT OF TEASE APART THE RELATIVE 5790 04:06:54,640 --> 04:06:58,360 CONTRIBUTIONS OF MAYBE WHAT 5791 04:06:58,360 --> 04:07:01,320 MIGHT BE RISK FACTORS, YOU NEED 5792 04:07:01,320 --> 04:07:02,920 TEMPORAL DATA TO DO THIS VERSUS 5793 04:07:02,920 --> 04:07:06,640 WHAT MIGHT BE SLEEP APNEA 5794 04:07:06,640 --> 04:07:07,560 SPECIFIC RESPONSES, LIKE FOR 5795 04:07:07,560 --> 04:07:09,720 EXAMPLE HOW IMPORTANT WAS THE 5796 04:07:09,720 --> 04:07:11,800 DLCO VERSUS MAYBE SOME OF THE 5797 04:07:11,800 --> 04:07:15,640 OTHER FACTORS IN PREDICTING 5798 04:07:15,640 --> 04:07:16,840 MORTALITY, WHAT PROPORTION, I 5799 04:07:16,840 --> 04:07:18,600 WAS JUST WONDERING IF THAT WOULD 5800 04:07:18,600 --> 04:07:24,200 BE HELPFUL, WHETHER YOU COULD DO 5801 04:07:24,200 --> 04:07:25,080 THAT. 5802 04:07:25,080 --> 04:07:26,920 >>SORRY, I'M MUTED. 5803 04:07:26,920 --> 04:07:29,440 THANK YOU, DR. REDLINE. 5804 04:07:29,440 --> 04:07:31,480 THAT'S A FANTASTIC IDEA, 5805 04:07:31,480 --> 04:07:33,360 SOMETHING WE REALLY ARE TRYING 5806 04:07:33,360 --> 04:07:34,640 TO BETTER UNDERSTAND, THE 5807 04:07:34,640 --> 04:07:35,880 DIRECTIONALITY AND I THINK 5808 04:07:35,880 --> 04:07:38,920 THAT'S A GOOD SEGUE INTO SOME OF 5809 04:07:38,920 --> 04:07:41,560 THE NEXT TALKS, BUT, YEAH, TO 5810 04:07:41,560 --> 04:07:43,440 THE EXTENT WE CAN LEVERAGE DATA 5811 04:07:43,440 --> 04:07:45,840 TO UNDERSTAND THE STRENGTH OF 5812 04:07:45,840 --> 04:07:47,600 THE ASSOCIATION, SAY, BETWEEN, 5813 04:07:47,600 --> 04:07:51,120 YOU KNOW, THE INTERMITTENT 5814 04:07:51,120 --> 04:07:55,360 HYPOXIA, VERSUS THE DLCO AS 5815 04:07:55,360 --> 04:07:57,320 REFLECTION OF MEASURES, AND 5816 04:07:57,320 --> 04:07:59,640 PERHAPS TRYING TO SEE IF THERE 5817 04:07:59,640 --> 04:08:01,720 ARE DIFFERENTIAL RELATIONSHIPS 5818 04:08:01,720 --> 04:08:02,920 THERE WITH CLINICAL OUTCOMES, 5819 04:08:02,920 --> 04:08:05,000 YOU KNOW, WE HAVEN'T DONE ANY 5820 04:08:05,000 --> 04:08:06,880 DIRECT COMPARISONS AS OF YET. 5821 04:08:06,880 --> 04:08:08,240 BUT THAT WAS OUR INITIAL ATTEMPT 5822 04:08:08,240 --> 04:08:11,040 TO TRY TO TAKE IT INTO ACCOUNT, 5823 04:08:11,040 --> 04:08:14,880 RECOGNIZING THERE'S PROBABLY 5824 04:08:14,880 --> 04:08:15,760 RESIDUAL CONFOUNDING BUT THERE'S 5825 04:08:15,760 --> 04:08:22,080 OPPORTUNITY TO DELVE INTO THAT 5826 04:08:22,080 --> 04:08:22,320 FURTHER. 5827 04:08:22,320 --> 04:08:26,840 >>DR. LEOPOLD HAS A HAND UP. 5828 04:08:26,840 --> 04:08:29,520 >>I HAD A QUESTION FOR NICK, 5829 04:08:29,520 --> 04:08:33,600 INTRIGUED BY YOUR FINAL COMMENT 5830 04:08:33,600 --> 04:08:34,880 TALKING ABOUT THE SGLT2 5831 04:08:34,880 --> 04:08:37,160 INHIBITORS AND HOW THEY COULD BE 5832 04:08:37,160 --> 04:08:40,800 BENEFICIAL, THERE'S BEEN SMALLER 5833 04:08:40,800 --> 04:08:46,720 REPORTS SHOWING THAT THEY REDUCE 5834 04:08:46,720 --> 04:08:48,200 SEVERE COPD EXACERBATIONS, AND 5835 04:08:48,200 --> 04:08:51,960 DAYS AGO THE EUROPEAN SOCIETY OF 5836 04:08:51,960 --> 04:08:54,680 CARDIOLOGY JUST RELEASED THEIR 5837 04:08:54,680 --> 04:08:56,080 UPDATED HEART FAILURE 5838 04:08:56,080 --> 04:08:58,600 GUIDELINES, UPGRADED THE USE OF 5839 04:08:58,600 --> 04:09:00,040 THESE DRUGS AMONG PATIENTS WITH 5840 04:09:00,040 --> 04:09:00,840 HEART FAILURE. 5841 04:09:00,840 --> 04:09:04,640 SO I GUESS THE QUESTION IS 5842 04:09:04,640 --> 04:09:07,640 BECAUSE ALL OF THESE DISEASES 5843 04:09:07,640 --> 04:09:11,040 AND CO-MORBIDITIES ALL SEEM TO 5844 04:09:11,040 --> 04:09:12,640 TRAVEL TOGETHER DO YOU THINK 5845 04:09:12,640 --> 04:09:18,120 WE'LL BE ABLE TO TEASE THIS OUT, 5846 04:09:18,120 --> 04:09:19,520 HOW WELL THE SGLT INHIBITORS 5847 04:09:19,520 --> 04:09:21,120 WORK AND WHETHER THEY ARE 5848 04:09:21,120 --> 04:09:24,040 AFFECTING SOMETHING ELSE THAT IN 5849 04:09:24,040 --> 04:09:28,840 TURN AFFECTS, YOU KNOW, THE 5850 04:09:28,840 --> 04:09:31,400 EXACERBATIONS OR SLEEP DISORDERS 5851 04:09:31,400 --> 04:09:33,040 ASSOCIATED WITH GROUP 3 PH? 5852 04:09:33,040 --> 04:09:35,000 >>I THINK IT'S GOING TO BE 5853 04:09:35,000 --> 04:09:37,160 PRETTY CHALLENGING TO DO THAT. 5854 04:09:37,160 --> 04:09:39,120 BUT BECAUSE AS YOU POINT OUT 5855 04:09:39,120 --> 04:09:42,800 THERE'S A LOT OF OVERLAP. 5856 04:09:42,800 --> 04:09:44,360 >>YEAH. 5857 04:09:44,360 --> 04:09:45,880 >>OVERLAP SYNDROME ITSELF, BUT, 5858 04:09:45,880 --> 04:09:50,360 YOU KNOW, THE MECHANISMS OF 5859 04:09:50,360 --> 04:09:55,240 THESE CONDITIONS CERTAINLY, YOU 5860 04:09:55,240 --> 04:09:58,360 KNOW, SHARE METABOLIC PATHWAYS, 5861 04:09:58,360 --> 04:10:00,280 AND SO FROM PRAGMATIC POINT OF 5862 04:10:00,280 --> 04:10:05,800 VIEW IF YOU HAVE SOMETHING THAT 5863 04:10:05,800 --> 04:10:07,680 CAN IMPROVE METABOLIC FUNCTION, 5864 04:10:07,680 --> 04:10:12,040 HELP PATIENTS LOSE WEIGHT 5865 04:10:12,040 --> 04:10:14,600 BECAUSE -- BMI BEING -- OBESITY 5866 04:10:14,600 --> 04:10:18,080 BEING, NO PUN INTENDED, A BIG 5867 04:10:18,080 --> 04:10:19,600 COMORBIDITY AS WELL. 5868 04:10:19,600 --> 04:10:21,520 DOES IT REALLY MAKE A DIFFERENCE 5869 04:10:21,520 --> 04:10:23,680 IF YOU CAN TEASE IT OUT? 5870 04:10:23,680 --> 04:10:30,920 BUT ON THE OTHER HAND, IT WOULD 5871 04:10:30,920 --> 04:10:34,880 BE HELPFUL IN TERMS OF TAILORING 5872 04:10:34,880 --> 04:10:35,760 THERAPY AND PRACTICING PRECISION 5873 04:10:35,760 --> 04:10:37,280 MEDICINE TO TRY TO DO THAT, BUT 5874 04:10:37,280 --> 04:10:41,720 WE'LL HAVE TO SEE HOW THAT GOES. 5875 04:10:41,720 --> 04:10:43,240 GREAT QUESTION. 5876 04:10:43,240 --> 04:10:44,320 THANK YOU. 5877 04:10:44,320 --> 04:10:46,880 >>I'M JUST CURIOUS, HAVE ANY OF 5878 04:10:46,880 --> 04:10:48,160 THE SLEEP MEDICINE PHYSICIANS 5879 04:10:48,160 --> 04:10:54,240 CELINE ANY CHANGES -- SEEN ANY 5880 04:10:54,240 --> 04:10:55,440 DIFFERENCE IN PATIENTS WHO HAVE 5881 04:10:55,440 --> 04:10:58,120 GONE ON THESE DRUGS? 5882 04:10:58,120 --> 04:11:01,000 5883 04:11:01,000 --> 04:11:06,560 >>I GUESS I CAN SAY TO REENA. 5884 04:11:06,560 --> 04:11:11,720 >>I CAN'T SAY THAT I HAVE BUT I 5885 04:11:11,720 --> 04:11:14,240 DON'T PERHAPS SEE AS MANY 5886 04:11:14,240 --> 04:11:24,760 PATIENTS WHO ARE ON THESE SCLT 2 5887 04:11:25,320 --> 04:11:25,560 INHIBITORS. 5888 04:11:25,560 --> 04:11:27,920 >>JANE, HAVE YOU BEEN USING 5889 04:11:27,920 --> 04:11:28,120 THEM? 5890 04:11:28,120 --> 04:11:29,760 >>THE PATIENTS WITH HEART 5891 04:11:29,760 --> 04:11:32,600 FAILURE, RIGHT NOW THE 5892 04:11:32,600 --> 04:11:36,880 INDICATION IS HEART FAILURE AND 5893 04:11:36,880 --> 04:11:37,840 DIABETICS, MAYBE ELDRIN WHEN 5894 04:11:37,840 --> 04:11:40,360 HE'S ON CAN TALK ABOUT THAT TOO. 5895 04:11:40,360 --> 04:11:42,680 SO WE'RE SEEING -- WE HAVE A LOT 5896 04:11:42,680 --> 04:11:44,280 OF PATIENTS GOING ON THEM. 5897 04:11:44,280 --> 04:11:50,520 WE'VE HAD A LOT OF PATIENTS, YOU 5898 04:11:50,520 --> 04:11:51,960 KNOW, DOING BETTER. 5899 04:11:51,960 --> 04:11:54,600 THEY ARE OBVIOUSLY LOSING WEIGHT 5900 04:11:54,600 --> 04:11:59,200 BUT THERE WAS JUST A VERY LARGE 5901 04:11:59,200 --> 04:12:03,480 CLINICAL TRIAL THAT WAS REPORTED 5902 04:12:03,480 --> 04:12:08,600 AGAIN AT ESC CALLED STEP-HF, ALL 5903 04:12:08,600 --> 04:12:11,680 THESE MORBIDLY OBESE PEOPLE 5904 04:12:11,680 --> 04:12:13,560 WITHOUT DIABETES WERE IN AN RCT 5905 04:12:13,560 --> 04:12:18,240 AND THOSE THAT GOT THE SGLT2 5906 04:12:18,240 --> 04:12:20,560 INHIBITOR LOST WEIGHT, HAD 5907 04:12:20,560 --> 04:12:23,040 MARKED IMPROVEMENTS IN 6-MINUTE 5908 04:12:23,040 --> 04:12:24,480 WALK DISTANCE, IMPROVED QUALITY 5909 04:12:24,480 --> 04:12:26,800 OF LIFE, AND, YOU KNOW, THE LIST 5910 04:12:26,800 --> 04:12:28,320 GOES ON AND ON. 5911 04:12:28,320 --> 04:12:31,160 AND IN THESE GROUPS OF PEOPLE 5912 04:12:31,160 --> 04:12:34,000 WE'RE STARTING TO SEE, YOU KNOW, 5913 04:12:34,000 --> 04:12:38,720 MORE EXERCISE, LESS ANGINA AMONG 5914 04:12:38,720 --> 04:12:40,520 THOSE WITH CAD, AND I THINK AS 5915 04:12:40,520 --> 04:12:43,880 YOU SAID, IT'S HARD TO KNOW HOW 5916 04:12:43,880 --> 04:12:50,520 MUCH OF THIS IS WEIGHT LOSS, 5917 04:12:50,520 --> 04:12:51,640 INCREASED PHYSICAL ACTIVITY, HOW 5918 04:12:51,640 --> 04:12:54,040 MUCH IS A DIRECT MECHANISM ON 5919 04:12:54,040 --> 04:12:55,040 THE VASCULATURE, THE HEART, ET 5920 04:12:55,040 --> 04:12:57,320 CETERA. 5921 04:12:57,320 --> 04:13:03,360 5922 04:13:03,360 --> 04:13:04,360 5923 04:13:04,360 --> 04:13:05,880 >>YEAH, I THINK THIS IS ANOTHER 5924 04:13:05,880 --> 04:13:09,400 TOPIC THAT I THOUGHT WAS WORTHY 5925 04:13:09,400 --> 04:13:11,360 OF DISCUSSION, FOR ME, THAT WHEN 5926 04:13:11,360 --> 04:13:13,040 YOU IDENTIFY A PROBLEM, LIKE I 5927 04:13:13,040 --> 04:13:16,400 THINK THERE IS AT LEAST SOME 5928 04:13:16,400 --> 04:13:20,920 DATA THAT PULMONARY HYPERTENSION 5929 04:13:20,920 --> 04:13:23,200 IS A PROBLEM, SORRY, THAT SLEEP 5930 04:13:23,200 --> 04:13:26,000 DISORDERS ARE A PROBLEM IN 5931 04:13:26,000 --> 04:13:27,400 INDIVIDUALS WITH PULMONARY 5932 04:13:27,400 --> 04:13:28,080 HYPERTENSION. 5933 04:13:28,080 --> 04:13:29,920 BUT HOW TO FIX IT BEST WITHOUT 5934 04:13:29,920 --> 04:13:34,400 HURTING THE PATIENT IS THE NEXT 5935 04:13:34,400 --> 04:13:35,080 QUESTION. 5936 04:13:35,080 --> 04:13:36,480 AND THE SGLT2 INHIBITORS SEEM 5937 04:13:36,480 --> 04:13:40,440 LIKE ONE WAY TO ADDRESS PEOPLE 5938 04:13:40,440 --> 04:13:41,320 WHO HAVE OBESITY-RELATED 5939 04:13:41,320 --> 04:13:41,880 PROBLEMS. 5940 04:13:41,880 --> 04:13:43,920 BUT I WAS WONDERING IF ANYBODY, 5941 04:13:43,920 --> 04:13:45,360 NICK, YOU MAY HAVE THOUGHT ABOUT 5942 04:13:45,360 --> 04:13:51,080 THIS, WHAT ARE THE SORT OF -- 5943 04:13:51,080 --> 04:13:55,880 ARE THERE ACUTE HEMODYNAMIC 5944 04:13:55,880 --> 04:13:57,720 CONCERNS WITH PEOPLE WITH 5945 04:13:57,720 --> 04:13:59,240 POSITIVE AIRWAY PRESSURE WHEN WE 5946 04:13:59,240 --> 04:14:00,080 THINK ABOUT INTERVENTIONS? 5947 04:14:00,080 --> 04:14:02,320 I WANT TO MAKE SURE IF WE THINK 5948 04:14:02,320 --> 04:14:04,080 ABOUT MOVING THE FIELD FORWARD 5949 04:14:04,080 --> 04:14:10,080 WITH INTERVENTION TRIALS WE 5950 04:14:10,080 --> 04:14:11,080 DON'T HURT PEOPLE. 5951 04:14:11,080 --> 04:14:14,040 >>WELL, IF ANYTHING, THE DATA 5952 04:14:14,040 --> 04:14:21,040 ON SEVERE COPD AND USE OF 5953 04:14:21,040 --> 04:14:21,920 NON-INVASIVE VENTILATION IS 5954 04:14:21,920 --> 04:14:26,520 EITHER -- FOR A LONG TIME WE 5955 04:14:26,520 --> 04:14:27,800 WERE GETTING NO DEMONSTRABLE 5956 04:14:27,800 --> 04:14:33,400 BENEFIT BUT WE DISCOVERED THAT 5957 04:14:33,400 --> 04:14:34,960 WEREN'T USING ENOUGH PRESSURE, 5958 04:14:34,960 --> 04:14:36,680 AND HALF A DOZEN -- WELL, NINE 5959 04:14:36,680 --> 04:14:38,640 YEARS AGO NOW THERE WAS A STUDY 5960 04:14:38,640 --> 04:14:42,840 OUT OF GERMANY THAT SHOWED A 5961 04:14:42,840 --> 04:14:44,360 RATHER IMPRESSIVE SURVIVAL 5962 04:14:44,360 --> 04:14:46,560 BENEFIT IN PATIENTS WITH SEVERE 5963 04:14:46,560 --> 04:14:48,320 COPD TREATED WITH NON-INVASIVE 5964 04:14:48,320 --> 04:14:48,880 VENTILATION. 5965 04:14:48,880 --> 04:14:52,560 AND AS I SAID, IT ACTUALLY WAS 5966 04:14:52,560 --> 04:14:54,760 AN INCREASE IN PRESSURES THAT 5967 04:14:54,760 --> 04:14:57,160 SEEMED TO BE ASSOCIATED WITH THE 5968 04:14:57,160 --> 04:14:58,360 GREATER BENEFIT. 5969 04:14:58,360 --> 04:15:03,600 THEY SEEMED TO GET BETTER REST 5970 04:15:03,600 --> 04:15:05,120 OF MUSCLES AND THERE'S ALSO BEEN 5971 04:15:05,120 --> 04:15:08,560 A STUDY OUT OF THE U.K. USING 5972 04:15:08,560 --> 04:15:12,240 SLIGHTLY LOWER PRESSURES BUT 5973 04:15:12,240 --> 04:15:16,080 SHOWING THAT EXACERBATION RATE 5974 04:15:16,080 --> 04:15:17,880 AND THE HOSPITALIZATION RATE WAS 5975 04:15:17,880 --> 04:15:20,240 LESS AS WELL. 5976 04:15:20,240 --> 04:15:22,880 SO, IT LOOKS LIKE THIS APPROACH 5977 04:15:22,880 --> 04:15:25,400 IS GOING TO BE BENEFICIAL. 5978 04:15:25,400 --> 04:15:27,040 THESE PATIENTS WERE NOT 5979 04:15:27,040 --> 04:15:30,200 PHENOTYPED AS FAR AS THEIR P.A. 5980 04:15:30,200 --> 04:15:32,520 PRESSURES WERE CONCERNED, SO I 5981 04:15:32,520 --> 04:15:35,120 CAN'T SAY WHAT EFFECT THAT WOULD 5982 04:15:35,120 --> 04:15:39,720 HAVE, BUT IT LOOKS LIKE THEY ARE 5983 04:15:39,720 --> 04:15:47,040 PROBABLY SAFE AND EFFECTIVE IN 5984 04:15:47,040 --> 04:15:47,920 PEOPLE CHRONICALLY 5985 04:15:47,920 --> 04:15:48,480 HYPOVENTILATING WITH COPD. 5986 04:15:48,480 --> 04:15:54,080 >>CAN I COMMENT FROM A SLIGHTLY 5987 04:15:54,080 --> 04:15:57,760 DIFFERENT PER SPIC R. -- 5988 04:15:57,760 --> 04:16:01,520 PERSPECTIVE TO YOUR QUESTION, 5989 04:16:01,520 --> 04:16:04,920 ALSO GETTING NEOMI TO CHIME IN. 5990 04:16:04,920 --> 04:16:06,320 IN SLEEP APNEA, YOU KNOW, I 5991 04:16:06,320 --> 04:16:12,760 THINK WE ALL ARE AWARE THAT CPAP 5992 04:16:12,760 --> 04:16:14,200 HAS NOT YIELDED IN LARGE 5993 04:16:14,200 --> 04:16:15,480 CLINICAL TRIALS THE BENEFITS 5994 04:16:15,480 --> 04:16:22,840 THAT WE EXPECTED AND IN FACT IN 5995 04:16:22,840 --> 04:16:25,320 HEART FAILURE, VENTILATION WAS 5996 04:16:25,320 --> 04:16:28,720 EVEN INCREASED MORTALITY, ONE 5997 04:16:28,720 --> 04:16:33,520 HYPOTHESIS MAYBE HIGHER 5998 04:16:33,520 --> 04:16:35,760 PRESSURES BY PAP MACHINES IN 5999 04:16:35,760 --> 04:16:37,600 CERTAIN PATIENTS MAY HAVE 6000 04:16:37,600 --> 04:16:38,480 DELETERIOUS EFFECTS, MANY 6001 04:16:38,480 --> 04:16:41,000 PATHWAYS THAT COULD HAPPEN, BUT 6002 04:16:41,000 --> 04:16:46,240 THERE IS NOW SOME PUBLISHED DATA 6003 04:16:46,240 --> 04:16:52,800 THAT, YOU KNOW, THAT 6004 04:16:52,800 --> 04:16:54,480 (INDISCERNIBLE) LEVELS GO UP IN 6005 04:16:54,480 --> 04:16:59,880 RELATION TO POSITIVE AIRWAY 6006 04:16:59,880 --> 04:17:01,720 PRESSURE AND CPAP VERSUS USUAL 6007 04:17:01,720 --> 04:17:07,360 CARE WILL BE ASSOCIATED IN 6008 04:17:07,360 --> 04:17:09,000 GENERAL WITH HIGHER ANGIOPOINTEN 6009 04:17:09,000 --> 04:17:10,200 2, AT COLUMBIA ALSO EVIDENCE 6010 04:17:10,200 --> 04:17:19,040 THAT THERE MAY BE SOME ADVERSE, 6011 04:17:19,040 --> 04:17:22,360 YOU KNOW, MARKERS OF ENDOTHELIA 6012 04:17:22,360 --> 04:17:24,960 FUNCTION ASSOCIATE WITH PAP 6013 04:17:24,960 --> 04:17:25,240 PRESSURE. 6014 04:17:25,240 --> 04:17:26,600 NEOMI HAS HER DATA TO SUGGEST 6015 04:17:26,600 --> 04:17:31,520 THERE MAY BE SUBGROUPS THAT HAVE 6016 04:17:31,520 --> 04:17:33,840 A NEGATIVE MAYBE, YOU KNOW, 6017 04:17:33,840 --> 04:17:34,920 PULMONARY OR INFLAMMATORY 6018 04:17:34,920 --> 04:17:36,480 RESPONSE TO POSITIVE PRESSURE. 6019 04:17:36,480 --> 04:17:38,920 THESE ARE ALL FAIRLY NEW DATA 6020 04:17:38,920 --> 04:17:45,040 THAT NEED CONFIRMATION, BUT 6021 04:17:45,040 --> 04:17:46,680 NEOMI, WOULD YOU LIKE TO SAY 6022 04:17:46,680 --> 04:17:47,000 ANYTHING? 6023 04:17:47,000 --> 04:17:50,440 NONE HAVE LOOKED AT THE OVERLAP. 6024 04:17:50,440 --> 04:17:51,480 >>YEAH, ABSOLUTELY. 6025 04:17:51,480 --> 04:17:53,880 I APPRECIATE YOU BRINGING THIS 6026 04:17:53,880 --> 04:17:54,240 POINT UP. 6027 04:17:54,240 --> 04:17:56,640 THERE'S A LOT MORE THAT WE NEED 6028 04:17:56,640 --> 04:18:00,560 TO LEARN ABOUT THIS SIGNAL BUT I 6029 04:18:00,560 --> 04:18:02,680 THINK IT MAKES ME PAUSE AND, YOU 6030 04:18:02,680 --> 04:18:06,120 KNOW, WHEN I'M SEEING PATIENTS 6031 04:18:06,120 --> 04:18:08,000 THAT ARE ASYMPTOMATIC, AND HAVE 6032 04:18:08,000 --> 04:18:11,600 BEEN PLACED ON CPAP BECAUSE OF A 6033 04:18:11,600 --> 04:18:16,880 HOME SLEEP TEST DONE YEARS AGO, 6034 04:18:16,880 --> 04:18:19,560 THOSE ARE THE PATIENTS THAT I'M 6035 04:18:19,560 --> 04:18:22,560 SORT OF AGAIN HAVING THESE 6036 04:18:22,560 --> 04:18:23,840 DISCUSSIONS AND MAKING DECISIONS 6037 04:18:23,840 --> 04:18:29,560 WITH THE EVIDENCE IN MIND WITH 6038 04:18:29,560 --> 04:18:32,600 THE PATIENT'S PRIORITY AND 6039 04:18:32,600 --> 04:18:32,880 PREFERENCE. 6040 04:18:32,880 --> 04:18:35,240 ABSOLUTELY, THE WORK PRESENTED 6041 04:18:35,240 --> 04:18:37,000 AT ATF, I BELIEVE CPAP PRESSURE 6042 04:18:37,000 --> 04:18:39,400 OF 7 IS WHERE SHE SAW THAT 6043 04:18:39,400 --> 04:18:43,120 DICHOTOMY PLAY OUT WITH HIGHER 6044 04:18:43,120 --> 04:18:46,520 CPAP PRESSURES, YOU KNOW, 6045 04:18:46,520 --> 04:18:48,800 IMPLICATED IN MORE LUNG STRETCH 6046 04:18:48,800 --> 04:18:51,320 AND THEN MARKER, BIOMARKERS OF 6047 04:18:51,320 --> 04:18:52,400 INFLAMMATION, MEASURED AND THEN 6048 04:18:52,400 --> 04:18:55,800 IF I RECALL CORRECTLY THE DATA 6049 04:18:55,800 --> 04:18:57,560 SHOWED INCREASED RISK FOR 6050 04:18:57,560 --> 04:18:58,840 CARDIOVASCULAR DISEASE OUTCOMES 6051 04:18:58,840 --> 04:19:00,200 IN THOSE WITH HIGHER CPAP 6052 04:19:00,200 --> 04:19:00,720 PRESSURE. 6053 04:19:00,720 --> 04:19:03,440 I THINK AGAIN WE'RE INTERESTING 6054 04:19:03,440 --> 04:19:07,160 A NEW AREA WHERE WE MAY NEED TO 6055 04:19:07,160 --> 04:19:09,280 BE MORE CAUTIOUS WITH CPAP AND 6056 04:19:09,280 --> 04:19:10,680 IDENTIFY PATIENTS WHERE THAT 6057 04:19:10,680 --> 04:19:12,200 SIGNAL IS CLEAN AND CLEAR AS IT 6058 04:19:12,200 --> 04:19:14,640 CAN BE THAT THERE'S NO HARM, 6059 04:19:14,640 --> 04:19:15,920 BECAUSE, AGAIN, THAT'S THE LAST 6060 04:19:15,920 --> 04:19:20,520 THING WE WOULD WANT TO DO AS 6061 04:19:20,520 --> 04:19:21,160 PROVIDERS AND CLINICIANS. 6062 04:19:21,160 --> 04:19:23,160 >>IF I COULD COMMENT ON THAT, I 6063 04:19:23,160 --> 04:19:25,120 DO THINK YOU HAVE TO BE VERY 6064 04:19:25,120 --> 04:19:27,440 CAREFUL ABOUT WHAT PATIENT 6065 04:19:27,440 --> 04:19:29,960 POPULATION YOU'RE TALKING ABOUT. 6066 04:19:29,960 --> 04:19:33,640 AND AS I SAID, IN COPD, 6067 04:19:33,640 --> 04:19:34,640 NON-INVASIVE VENTILATION HAS 6068 04:19:34,640 --> 04:19:36,200 BEEN STUDIED FOR YEARS, AND 6069 04:19:36,200 --> 04:19:38,160 THERE REALLY HAS NOT BEEN SIGNAL 6070 04:19:38,160 --> 04:19:39,680 FOR HARM. 6071 04:19:39,680 --> 04:19:40,440 AND, YOU KNOW, RECENTLY 6072 04:19:40,440 --> 04:19:42,440 THERE'S -- IN THE PAST DECADE 6073 04:19:42,440 --> 04:19:44,840 WE'VE BEEN SEEING SOME CLEARER 6074 04:19:44,840 --> 04:19:46,120 SIGNALS FOR BENEFIT. 6075 04:19:46,120 --> 04:19:48,000 BUT IF YOU LOOK AT HEART 6076 04:19:48,000 --> 04:19:50,920 FAILURE, IT'S KIND OF A 6077 04:19:50,920 --> 04:19:52,120 DIFFERENT STORY. 6078 04:19:52,120 --> 04:19:56,200 DOUG BRADLEY YEARS AGO DID A FEW 6079 04:19:56,200 --> 04:19:58,320 STUDIES SHOWING THAT USING CPAP 6080 04:19:58,320 --> 04:20:03,200 IN PEOPLE WITH HEART FAILURE 6081 04:20:03,200 --> 04:20:04,360 IMPROVED EJECTION FRACTION IN 6082 04:20:04,360 --> 04:20:06,760 SHORT-TERM STUDIES, AND THEN DID 6083 04:20:06,760 --> 04:20:08,040 THE CAM PAP TRIAL, WHICH WAS 6084 04:20:08,040 --> 04:20:11,240 GOING TO BE HIS LARGER TRIAL 6085 04:20:11,240 --> 04:20:14,880 NAILING THAT AND FOUND NEW 6086 04:20:14,880 --> 04:20:15,160 BENEFIT. 6087 04:20:15,160 --> 04:20:18,040 ADVENT-HF TRIAL, WHICH WAS USING 6088 04:20:18,040 --> 04:20:25,480 THE ASV WHICH WAS SUPPOSED TO BE 6089 04:20:25,480 --> 04:20:27,000 KIND OF DIRECTED TOWARD CHAIN 6090 04:20:27,000 --> 04:20:29,280 STOKES KIND OF BREATHING SHOWED 6091 04:20:29,280 --> 04:20:31,160 SURPRISING INCREASED MORTALITY 6092 04:20:31,160 --> 04:20:33,760 EVEN COMPARED TO CPAP IN THAT 6093 04:20:33,760 --> 04:20:40,680 STUDY, IN PATIENTS WITH 6094 04:20:40,680 --> 04:20:42,000 DIMINISHED EJECTION FRACTION. 6095 04:20:42,000 --> 04:20:44,400 ASV IS STILL USED IN COMPLEX 6096 04:20:44,400 --> 04:20:45,600 SLEEP APNEA, DOESN'T APPEAR 6097 04:20:45,600 --> 04:20:47,640 THERE'S HARM IDENTIFIABLE THERE. 6098 04:20:47,640 --> 04:20:49,880 IT DOES SEEM AS THOUGH IT'S -- 6099 04:20:49,880 --> 04:20:54,480 I'M NOT FAMILIAR WITH THIS MOST 6100 04:20:54,480 --> 04:20:55,760 RECENT STUDY MENTIONED BUT IT 6101 04:20:55,760 --> 04:20:57,320 DOES APPEAR THIS IS SOMETHING 6102 04:20:57,320 --> 04:21:01,680 HAPPENING IN THE MORE HEART 6103 04:21:01,680 --> 04:21:02,960 FAILURE TYPE PATIENT, AND THERE 6104 04:21:02,960 --> 04:21:05,520 MAY BE SOMETHING A LITTLE 6105 04:21:05,520 --> 04:21:12,200 DIFFERENT ABOUT THESE POSITIVE 6106 04:21:12,200 --> 04:21:17,240 PRESSURES IN THOSE PATIENTS. 6107 04:21:17,240 --> 04:21:18,000 >>THANKS. 6108 04:21:18,000 --> 04:21:19,520 I FEEL LIKE THAT'S A REALLY 6109 04:21:19,520 --> 04:21:20,640 IMPORTANT DISCUSSION POINT TO 6110 04:21:20,640 --> 04:21:22,840 BRING OUT, NOT JUST BENEFITS 6111 04:21:22,840 --> 04:21:25,000 THAT POTENTIALLY EXIST BUT ALSO 6112 04:21:25,000 --> 04:21:25,440 THE DOWN SIDE. 6113 04:21:25,440 --> 04:21:27,840 I'M LOOKING IN THE CHAT. 6114 04:21:27,840 --> 04:21:29,720 THERE'S ONE FROM ANDREW BRYAN. 6115 04:21:29,720 --> 04:21:31,680 DO YOU WANT TO READ YOUR 6116 04:21:31,680 --> 04:21:35,160 QUESTION YOURSELF OR I CAN READ 6117 04:21:35,160 --> 04:21:35,560 IT. 6118 04:21:35,560 --> 04:21:37,360 HE'S STRUGGLING WITH THE 6119 04:21:37,360 --> 04:21:38,960 INTERNET AND THE HURRICANE. 6120 04:21:38,960 --> 04:21:41,080 >>I CAN BUT THERE'S A CHANCE 6121 04:21:41,080 --> 04:21:42,840 I'LL HAVE A HALF NAKED 6122 04:21:42,840 --> 04:21:44,000 9-YEAR-OLD RUNNING THROUGH, SO 6123 04:21:44,000 --> 04:21:47,120 FORGIVE ME AHEAD OF TIME. 6124 04:21:47,120 --> 04:21:49,400 YEAH, SO MY QUESTION PERTAINS TO 6125 04:21:49,400 --> 04:21:52,040 REALLY GETTING AT THIS TEASING 6126 04:21:52,040 --> 04:21:53,960 OUT SLEEP FRAGMENTATION, FIRST 6127 04:21:53,960 --> 04:21:56,200 GREAT TALK, REENA, THANK YOU SO 6128 04:21:56,200 --> 04:21:56,480 MUCH. 6129 04:21:56,480 --> 04:21:57,600 AND WHETHER OR NOT YOU WERE ABLE 6130 04:21:57,600 --> 04:22:02,640 TO LOOK AT ANY OF THE OTHER 6131 04:22:02,640 --> 04:22:04,920 SLEEP DISORDERS THAT DANIEL 6132 04:22:04,920 --> 04:22:08,640 DESCRIBED FROM BEFORE IN PH 6133 04:22:08,640 --> 04:22:09,640 POPULATION. 6134 04:22:09,640 --> 04:22:12,480 EXAMPLE I GAVE WAS, YOU KNOW, WE 6135 04:22:12,480 --> 04:22:14,240 WERE PROGRAMMED TO CHECK FOR 6136 04:22:14,240 --> 04:22:15,880 IRON DEFICIENCY IN OUR PATIENT 6137 04:22:15,880 --> 04:22:17,520 POPULATION, THAT BEING A RISK 6138 04:22:17,520 --> 04:22:18,960 FACTOR FOR RESTLESS LEG SYNDROME 6139 04:22:18,960 --> 04:22:19,480 AS WELL. 6140 04:22:19,480 --> 04:22:21,800 I DIDN'T KNOW IF THERE WAS ANY 6141 04:22:21,800 --> 04:22:26,040 WAY TO LOOK AT THOSE DIAGNOSES 6142 04:22:26,040 --> 04:22:28,360 AND OUTCOMES, AND THE CHRONOTYPE 6143 04:22:28,360 --> 04:22:31,480 SHIFT AS WELL, ESPECIALLY IN THE 6144 04:22:31,480 --> 04:22:32,160 AGING POPULATION. 6145 04:22:32,160 --> 04:22:34,320 I THINK IT'S SOMETHING THAT I AT 6146 04:22:34,320 --> 04:22:37,960 LEAST DON'T READ A LOT ABOUT OR 6147 04:22:37,960 --> 04:22:38,120 SEE. 6148 04:22:38,120 --> 04:22:43,680 >>THANK YOU SO MUCH, ANDREW. 6149 04:22:43,680 --> 04:22:45,760 HOPE EVERYTHING FARES WELL. 6150 04:22:45,760 --> 04:22:46,720 YOU'RE ABSOLUTELY RIGHT. 6151 04:22:46,720 --> 04:22:49,680 I THINK WITH THE TESTING THAT WE 6152 04:22:49,680 --> 04:22:52,320 DID, IT WAS ESSENTIALLY THE TYPE 6153 04:22:52,320 --> 04:22:53,600 3 APNEA TEST, RIGHT? 6154 04:22:53,600 --> 04:22:58,240 SO WE'RE KIND OF RELYING ON THAT 6155 04:22:58,240 --> 04:22:58,640 DATA. 6156 04:22:58,640 --> 04:23:02,160 AND WE ACTUALLY HAVE EKG DATA 6157 04:23:02,160 --> 04:23:05,880 THERE AS WELL THAT CAN BE 6158 04:23:05,880 --> 04:23:06,680 LEVERAGED. 6159 04:23:06,680 --> 04:23:08,000 WE DIDN'T SYSTEMATICALLY COLLECT 6160 04:23:08,000 --> 04:23:09,720 DATA, I DON'T THINK, ON RESTLESS 6161 04:23:09,720 --> 04:23:13,760 LEG SYNDROME BUT DR. HEMNES CAN 6162 04:23:13,760 --> 04:23:15,520 COLLECT ME IF I'M WRONG. 6163 04:23:15,520 --> 04:23:18,680 WE MAY BE ABLE TO PICK UP ON IT 6164 04:23:18,680 --> 04:23:24,160 A CO-MORBIDITIES THAT WERE 6165 04:23:24,160 --> 04:23:25,480 COLLECTED, SO THAT COULD PRESENT 6166 04:23:25,480 --> 04:23:26,560 AN OPPORTUNITY. 6167 04:23:26,560 --> 04:23:35,520 DID YOU DIRECT MEASURES OF 6168 04:23:35,520 --> 04:23:38,160 FRAGMENTATION WERE NOT 6169 04:23:38,160 --> 04:23:39,480 COLLECTED, OPPORTUNITY TO 6170 04:23:39,480 --> 04:23:40,680 UNDERSTAND CIRCADIAN RHYTHM 6171 04:23:40,680 --> 04:23:42,120 BIOLOGY AS WELL, IF FOLKS 6172 04:23:42,120 --> 04:23:47,000 HAVEN'T READ A WRINKLE IN TIME, 6173 04:23:47,000 --> 04:23:49,560 CIRCADIAN BIOLOGY, IT'S A GREAT 6174 04:23:49,560 --> 04:23:52,760 REVIEW BY DR. BRYANT, 6175 04:23:52,760 --> 04:23:54,000 PERSPECTIVE BY DR. BRYANT. 6176 04:23:54,000 --> 04:23:58,280 I HOPE THAT ADDRESSES YOUR 6177 04:23:58,280 --> 04:23:58,680 QUESTION. 6178 04:23:58,680 --> 04:23:58,920 THANKS. 6179 04:23:58,920 --> 04:24:01,040 >>SUBJECTS COULD HAVE AN 6180 04:24:01,040 --> 04:24:04,800 OPPORTUNITY, ONES THAT ENROLLED 6181 04:24:04,800 --> 04:24:11,320 IN THE OMICS, TO ROLE IN A TRIAL 6182 04:24:11,320 --> 04:24:14,360 THAT EVAN BRITAIN IS RUNNING, 6183 04:24:14,360 --> 04:24:16,480 USING FITBIT DATA NOT INTENDED 6184 04:24:16,480 --> 04:24:17,920 TO COLLECT CIRCADIAN DATA BUT BY 6185 04:24:17,920 --> 04:24:20,520 VIRTUE OF WEARING 24 HOURS A DAY 6186 04:24:20,520 --> 04:24:22,680 SOME DATA WILL ULTIMATELY BE 6187 04:24:22,680 --> 04:24:22,960 AVAILABLE. 6188 04:24:22,960 --> 04:24:24,360 IT'S ALSO ENROLLING THROUGH THE 6189 04:24:24,360 --> 04:24:26,600 FAR REGISTRY BUT THERE ALREADY 6190 04:24:26,600 --> 04:24:30,800 DATA, WHAT TIMES SLEEP IS 6191 04:24:30,800 --> 04:24:31,840 OCCURRING, FOR HOW LONG. 6192 04:24:31,840 --> 04:24:35,840 >>JUST SO YOU KNOW, THE 6193 04:24:35,840 --> 04:24:37,440 PATIENTS IN PVD-OMICS DID ANSWER 6194 04:24:37,440 --> 04:24:39,640 A SURVEY AFTER THEY DID DO THE 6195 04:24:39,640 --> 04:24:42,160 SLEEP STUDY THEY WERE SUPPOSED 6196 04:24:42,160 --> 04:24:43,480 TO COME AND COMMENT HOW MANY 6197 04:24:43,480 --> 04:24:46,320 TIMES THEY GOT UP DURING THE 6198 04:24:46,320 --> 04:24:48,440 NIGHT, WHEN THEY GO TO SLEEP, 6199 04:24:48,440 --> 04:24:52,320 GET UP, GET OUT OF BED, BUT IT'S 6200 04:24:52,320 --> 04:24:55,960 ALL PATIENT REPORTED AND IT'S, 6201 04:24:55,960 --> 04:24:58,960 YOU KNOW, QUITE LIKELY TO BE 6202 04:24:58,960 --> 04:25:00,200 LESS RELIABLE THAN WHAT EVAN 6203 04:25:00,200 --> 04:25:03,400 WILL BE COLLECTING. 6204 04:25:03,400 --> 04:25:04,080 >>YES, YES. 6205 04:25:04,080 --> 04:25:05,480 GREAT POINT. 6206 04:25:05,480 --> 04:25:15,840 WE LISTED THAT DATA 6207 04:25:19,240 --> 04:25:21,840 ARE DATA THAT COULD BE LOOKED 6208 04:25:21,840 --> 04:25:22,000 AT. 6209 04:25:22,000 --> 04:25:28,280 >>RIGHT. 6210 04:25:28,280 --> 04:25:32,560 >>I SEE A HAND RAISED FOR 6211 04:25:32,560 --> 04:25:33,360 QUESTION OR COMMENT. 6212 04:25:33,360 --> 04:25:35,720 >>YEAH, A QUESTION, MAYBE I 6213 04:25:35,720 --> 04:25:36,920 MISSED THIS, REENA. 6214 04:25:36,920 --> 04:25:42,600 GREAT TALK, BY THE WAY. 6215 04:25:42,600 --> 04:25:45,240 FOR THE PVD OMICS WAS THE 6216 04:25:45,240 --> 04:25:49,160 OXIMETER OR HOME SLEEP TESTING 6217 04:25:49,160 --> 04:25:49,400 DEVICE? 6218 04:25:49,400 --> 04:26:00,040 >>YEAH, SORRY FOR NOT OXIMETRA 6219 04:26:09,480 --> 04:26:13,240 COLLECTED, NOT TYPE 3 STUDY. 6220 04:26:13,240 --> 04:26:16,640 YEAH, THESE WERE USING NOTT T3 6221 04:26:16,640 --> 04:26:19,400 DEVICES. 6222 04:26:19,400 --> 04:26:25,400 6223 04:26:25,400 --> 04:26:31,000 6224 04:26:31,000 --> 04:26:33,280 >>ANY OTHER QUESTIONS OR 6225 04:26:33,280 --> 04:26:36,160 COMMENTS FROM AUDIENCE OR 6226 04:26:36,160 --> 04:26:36,480 DISCUSSANTS? 6227 04:26:36,480 --> 04:26:42,480 >>THERE IS THE ADAGE THAT THE 6228 04:26:42,480 --> 04:26:44,320 PULMONARY THERAPY DOES NOT WORK 6229 04:26:44,320 --> 04:26:45,760 AS WELL, UNTREATED SLEEP APNEA 6230 04:26:45,760 --> 04:26:48,040 PATIENTS, I DON'T KNOW IF THAT'S 6231 04:26:48,040 --> 04:26:50,240 BEEN EXAMINED IN ANY COHORTS TO 6232 04:26:50,240 --> 04:26:51,360 SEE IF THERE'S DIFFERENTIAL 6233 04:26:51,360 --> 04:26:53,080 EFFECT, RESPONSE TO THERAPY 6234 04:26:53,080 --> 04:26:57,040 PATIENTS WITH SLEEP APNEA 6235 04:26:57,040 --> 04:26:59,640 ADHERENT WITH PRESCRIBED 6236 04:26:59,640 --> 04:27:00,880 THERAPIES FOR SLEEP APNEA OR 6237 04:27:00,880 --> 04:27:06,320 NOT. 6238 04:27:06,320 --> 04:27:07,960 >>EXCELLENT POINT. 6239 04:27:07,960 --> 04:27:08,840 WE-- YEAH, THAT'S SOMETHING THAT 6240 04:27:08,840 --> 04:27:14,200 COULD BE LOOKED AT. 6241 04:27:14,200 --> 04:27:16,440 WE'RE SOME WHAT LIMITED IN 6242 04:27:16,440 --> 04:27:17,280 STRATIFICATION BUT DEPENDING HOW 6243 04:27:17,280 --> 04:27:21,120 MANY PARTICIPANTS ARE IN THOSE 6244 04:27:21,120 --> 04:27:22,760 CATEGORIES OF VASODILATOR USE WE 6245 04:27:22,760 --> 04:27:24,040 COULD LOOK INTO THAT MORE 6246 04:27:24,040 --> 04:27:25,040 CAREFULLY, SO THAT'S AN 6247 04:27:25,040 --> 04:27:28,320 OPPORTUNITY. 6248 04:27:28,320 --> 04:27:29,000 6249 04:27:29,000 --> 04:27:33,320 >>ONE QUICK QUESTION, I ALSO 6250 04:27:33,320 --> 04:27:35,240 HAVE FOR YOU, I DON'T KNOW IF 6251 04:27:35,240 --> 04:27:38,520 THE SAMPLE SIZE IS BIG ENOUGH 6252 04:27:38,520 --> 04:27:40,040 BUT ESPECIALLY IN YOUR 6253 04:27:40,040 --> 04:27:42,920 METABOLOMICS WORK ARE YOU ABLE 6254 04:27:42,920 --> 04:27:45,760 TO STRATIFY BY GENDER? 6255 04:27:45,760 --> 04:27:49,800 6256 04:27:49,800 --> 04:27:52,200 >>YES, WE ACTUALLY -- THE WAY 6257 04:27:52,200 --> 04:27:54,280 ANALYSES WERE CONDUCTED TRYING 6258 04:27:54,280 --> 04:27:57,800 TO LOOK AT SEX-SPECIFIC AND EVEN 6259 04:27:57,800 --> 04:28:03,360 ACROSS AGE DIFFERENCES, AND WITH 6260 04:28:03,360 --> 04:28:05,120 PREGNANOLONE METABOLITES IN 6261 04:28:05,120 --> 04:28:07,280 PARTICULAR SEEMED TO BE MORE OF 6262 04:28:07,280 --> 04:28:09,080 A PREDELICTION TO ALTERATIONS OF 6263 04:28:09,080 --> 04:28:13,200 METABOLITES TO MALES AND YOUNGER 6264 04:28:13,200 --> 04:28:13,520 INDIVIDUALS. 6265 04:28:13,520 --> 04:28:15,080 WE HAVEN'T DELVED VERY DEEPLY 6266 04:28:15,080 --> 04:28:18,160 INTO THAT BUT I DO THINK THAT'S 6267 04:28:18,160 --> 04:28:22,080 A REALLY IMPORTANT AREA GIVEN 6268 04:28:22,080 --> 04:28:23,400 THE SEX-SPECIFIC DIFFERENCES 6269 04:28:23,400 --> 04:28:25,400 THAT HAVE BEEN HIGHLIGHTED IN 6270 04:28:25,400 --> 04:28:25,880 PULMONARY HYPERTENSION. 6271 04:28:25,880 --> 04:28:26,200 >>THANK YOU. 6272 04:28:26,200 --> 04:28:28,800 >>THANKS. 6273 04:28:28,800 --> 04:28:33,040 >>WE HAVE TIME FOR ONE LAST 6274 04:28:33,040 --> 04:28:38,440 QUESTION IF YOU'D LIKE TO 6275 04:28:38,440 --> 04:28:38,680 UNMUTE. 6276 04:28:38,680 --> 04:28:39,080 >>SURE. 6277 04:28:39,080 --> 04:28:42,200 MORE ON THE SLEEP SIDE, I WONDER 6278 04:28:42,200 --> 04:28:45,440 WHETHER ONE OF THE IMPORTANT 6279 04:28:45,440 --> 04:28:47,720 TAKEAWAYS CONSIDERING COMPLEXITY 6280 04:28:47,720 --> 04:28:54,240 OF WONDERFUL TALKS AND THINGS, 6281 04:28:54,240 --> 04:28:54,760 REENA AND VINICA 6282 04:28:54,760 --> 04:28:59,560 MAYBE ONE OF THE TAKEAWAYS ARE 6283 04:28:59,560 --> 04:29:00,560 ACTIONABLE ITEM FOR THE WORKSHOP 6284 04:29:00,560 --> 04:29:06,960 SHOULD BE WAY OF PRIORITIZING 6285 04:29:06,960 --> 04:29:10,480 THE MOST PROMISING SUBPHENOTYPE 6286 04:29:10,480 --> 04:29:12,280 OF PULMONARY HYPERTENSION TIMES 6287 04:29:12,280 --> 04:29:14,280 SUBPHENOTYPES THE MOST PROMISING 6288 04:29:14,280 --> 04:29:16,920 AND MOST IMMEDIATELY ACTIONABLE 6289 04:29:16,920 --> 04:29:18,120 FOR SLEEP-BASED INTERVENTIONS, I 6290 04:29:18,120 --> 04:29:22,920 JUST WANTED TO PARK THAT ON THE 6291 04:29:22,920 --> 04:29:27,600 BACK OF PEOPLE'S MINDS, A VERY 6292 04:29:27,600 --> 04:29:30,160 NICE DELIVERABLE AS TO WHAT IS 6293 04:29:30,160 --> 04:29:32,080 PROBABLY THE MOST PROMISING, 6294 04:29:32,080 --> 04:29:33,600 ESPECIALLY I THINK THE NEWEST 6295 04:29:33,600 --> 04:29:39,240 KIDS ON THE BLOCK LIKE THE SGL 2 6296 04:29:39,240 --> 04:29:40,440 INNOVATORS SEEMS LIKE THEY MAY 6297 04:29:40,440 --> 04:29:41,880 ACTUALLY BE EVEN MORE PROMISING 6298 04:29:41,880 --> 04:29:44,880 BASED ON THE NEW TRIALS THAT ARE 6299 04:29:44,880 --> 04:29:48,760 BEING PUBLISHED, AND, YOU KNOW, 6300 04:29:48,760 --> 04:29:54,240 VIS-A-VIS GOING BACK TO 1950s 6301 04:29:54,240 --> 04:29:57,360 STUDIES, FOLKS SAYING THE 6302 04:29:57,360 --> 04:29:58,800 ADIPOSITY ON THE VASCULATURE 6303 04:29:58,800 --> 04:29:59,800 CANNOT BE IGNORED EITHER, SO 6304 04:29:59,800 --> 04:30:03,600 JUST THROWING THAT OUT THERE, 6305 04:30:03,600 --> 04:30:06,040 SUBPHENOTYPE OF OBESITY-RELATED 6306 04:30:06,040 --> 04:30:07,160 SYNDROME ASSOCIATED PULMONARY 6307 04:30:07,160 --> 04:30:09,320 HYPERTENSION, AND EFFECTS ON THE 6308 04:30:09,320 --> 04:30:10,440 RIGHT HEART AND DIASTOLIC 6309 04:30:10,440 --> 04:30:13,440 DYSFUNCTION WE SEE IN PEOPLE 6310 04:30:13,440 --> 04:30:18,200 WITH OBESITY, MAYBE WE'RE 6311 04:30:18,200 --> 04:30:20,280 LOOKING AT SUBPHENOTYPES MOST 6312 04:30:20,280 --> 04:30:20,520 AMENABLE. 6313 04:30:20,520 --> 04:30:22,560 I WANTED TO THROW THAT OUT THERE 6314 04:30:22,560 --> 04:30:23,480 TO BE SOMETHING ACTIONABLE TO 6315 04:30:23,480 --> 04:30:27,240 THINK ABOUT AT THE WORKSHOP. 6316 04:30:27,240 --> 04:30:29,120 >>THAT'S A GREAT COMMENT. 6317 04:30:29,120 --> 04:30:32,240 I THINK THAT SHOULD BE A TOPIC 6318 04:30:32,240 --> 04:30:33,600 OF DISCUSSION TOMORROW. 6319 04:30:33,600 --> 04:30:35,640 >>I AGREE. 6320 04:30:35,640 --> 04:30:36,840 >>SO, WITH THAT WE'VE COME TO 6321 04:30:36,840 --> 04:30:39,360 THE END OF THIS SESSION. 6322 04:30:39,360 --> 04:30:41,440 WE HAVE NOW A 15-MINUTE BRIEF 6323 04:30:41,440 --> 04:30:44,480 BREAK, SO WE'LL COME BACK AT 6324 04:30:44,480 --> 04:30:45,840 3:15 EASTERN TIME. 6325 04:30:45,840 --> 04:30:46,840 AND MOVE TO SESSION 3. 6326 04:30:46,840 --> 04:30:48,280 I'D LIKE TO THANK ALL THE 6327 04:30:48,280 --> 04:30:52,040 SPEAKERS IN THE LAST SESSION AND 6328 04:30:52,040 --> 04:30:53,480 DISCUSSANTS, AND EVERYBODY FOR A 6329 04:30:53,480 --> 04:30:55,920 ROBUST SESSION. 6330 04:30:55,920 --> 04:30:56,880 THANK VERY MUCH. 6331 04:30:56,880 --> 04:30:59,200 WELCOME BACK. 6332 04:30:59,200 --> 04:31:01,480 I HOPE EVERYONE HAD A LITTLE 6333 04:31:01,480 --> 04:31:01,920 REFRESHER. 6334 04:31:01,920 --> 04:31:03,800 IT'S REALLY MY PLEASURE TO 6335 04:31:03,800 --> 04:31:05,000 INTRODUCE THIS SESSION, AND NOW 6336 04:31:05,000 --> 04:31:09,400 WHAT WE'LL BE DOING IS EXAMINING 6337 04:31:09,400 --> 04:31:12,120 HOW SLEEP DISORDERS AND 6338 04:31:12,120 --> 04:31:22,400 PULMONARY HYPERTENSION 6339 04:31:22,400 --> 04:31:25,800 CO-AGGREGATE LOOKING ACROSS 6340 04:31:25,800 --> 04:31:27,360 PATIENT GROUPS, LOOKING AT 6341 04:31:27,360 --> 04:31:28,440 SPECIAL POPULATIONS, WE HAVE A 6342 04:31:28,440 --> 04:31:29,960 PEDIATRICIAN AS ONE OF OUR 6343 04:31:29,960 --> 04:31:32,600 SPEAKERS WHO WILL GIVE US THAT 6344 04:31:32,600 --> 04:31:35,880 VERY SPECIFIC LIFE COURSE 6345 04:31:35,880 --> 04:31:36,400 PERSPECTIVE. 6346 04:31:36,400 --> 04:31:39,520 WE WILL WRAP UP WITH A 6347 04:31:39,520 --> 04:31:41,000 MULTIOMICS APPROACH AS A WINDOW 6348 04:31:41,000 --> 04:31:51,480 INTO LOOKING AT SOME OF THE 6349 04:31:52,360 --> 04:31:52,760 MECHANISMS. 6350 04:31:52,760 --> 04:31:59,520 IT'S A PLEASURE TO INTRODUCE DR. 6351 04:31:59,520 --> 04:32:02,480 PUNJABI, LEADING STUDIES WHICH 6352 04:32:02,480 --> 04:32:03,920 INCLUDE SLEEP APNEA ASSOCIATIONS 6353 04:32:03,920 --> 04:32:07,560 ACROSS THE LIFESPAN AND SPECIAL 6354 04:32:07,560 --> 04:32:08,760 POPULATIONS INCLUDING PATIENTS 6355 04:32:08,760 --> 04:32:12,040 WITH HIV, HE'S ALSO NOT ONLY 6356 04:32:12,040 --> 04:32:14,200 DOES EPIDEMIOLOGIC WORK BUT HAS 6357 04:32:14,200 --> 04:32:19,800 DONE TRANSLATIONAL AND BASIC 6358 04:32:19,800 --> 04:32:25,080 WORK AND ACTUALLY HE'S ALSO DONE 6359 04:32:25,080 --> 04:32:27,760 EXPERIMENTS OF N-of-1s, 6360 04:32:27,760 --> 04:32:31,920 WHERE HE WAS THE 1. 6361 04:32:31,920 --> 04:32:33,520 DR. PUNJABI, TAKE IT AWAY. 6362 04:32:33,520 --> 04:32:38,400 >>THANKS FOR THE INTRODUCTION. 6363 04:32:38,400 --> 04:32:40,040 I'M SURPRISED YOU REMEMBER MY 6364 04:32:40,040 --> 04:32:40,720 EXPERIMENTS OF N-of-1. 6365 04:32:40,720 --> 04:32:43,320 THANK YOU FOR INCLUDING ME. 6366 04:32:43,320 --> 04:32:45,000 LET ME SHARE MY SCREEN AND MOVE 6367 04:32:45,000 --> 04:32:47,400 TO PRESENTATION AND PUT IT IN 6368 04:32:47,400 --> 04:32:49,240 PRESENTER MODE AT THIS POINT. 6369 04:32:49,240 --> 04:32:51,440 I THINK IT PROJECTS WELL. 6370 04:32:51,440 --> 04:32:53,280 I THANK YOU FOR ORGANIZING THIS 6371 04:32:53,280 --> 04:32:54,240 AND INCLUDING ME. 6372 04:32:54,240 --> 04:32:56,800 WHEN I GOT YOUR E-MAIL, SUSAN, I 6373 04:32:56,800 --> 04:32:59,200 SAW THE TITLE YOU PUT ON FOR ME 6374 04:32:59,200 --> 04:33:02,800 I THOUGHT IT WAS AN ENORMOUS 6375 04:33:02,800 --> 04:33:04,880 TEST, THE CONCEPT OF VARIATION 6376 04:33:04,880 --> 04:33:06,120 AND PULMONARY HYPERTENSION WHICH 6377 04:33:06,120 --> 04:33:09,360 I DO NOT THINK A THE LOW ABOUT, 6378 04:33:09,360 --> 04:33:10,560 TO THINK ABOUT AGE, SEX, RACE 6379 04:33:10,560 --> 04:33:12,440 AND ETHNICITY, WHAT HAVE I 6380 04:33:12,440 --> 04:33:14,560 GOTTEN MYSELF INTO IN I TOOK ON 6381 04:33:14,560 --> 04:33:17,040 THE CHALLENGE, THANKS FOR DOING 6382 04:33:17,040 --> 04:33:20,360 THAT, AND PUTTING ME IN THAT 6383 04:33:20,360 --> 04:33:20,600 SPOT. 6384 04:33:20,600 --> 04:33:23,960 IT MADE ME THINK ABOUT WHAT TO 6385 04:33:23,960 --> 04:33:27,600 TALK ABOUT, HOW TO REALLY PUSH 6386 04:33:27,600 --> 04:33:29,440 KNOWLEDGE GAP HERE, WHAT CAN WE 6387 04:33:29,440 --> 04:33:32,480 LEARN FROM ONE DISEASE AND WHAT 6388 04:33:32,480 --> 04:33:34,360 DOES IT OVERLAP WITH THE OTHER. 6389 04:33:34,360 --> 04:33:36,240 LET'S SEE IF I MET THE 6390 04:33:36,240 --> 04:33:37,320 CHALLENGE, SUSAN, WITH REGARDS 6391 04:33:37,320 --> 04:33:38,440 TO TALKING ABOUT SLEEP DISORDERS 6392 04:33:38,440 --> 04:33:42,760 AND I DON'T KNOW IF PEOPLE KNOW 6393 04:33:42,760 --> 04:33:44,440 THAT NOSOLOGY INCLUDES 100 6394 04:33:44,440 --> 04:33:45,640 DISORDERS IN THE ICSD THAT WE 6395 04:33:45,640 --> 04:33:46,160 HAVE. 6396 04:33:46,160 --> 04:33:49,600 HERE IS WHAT I DECIDED TO DO. 6397 04:33:49,600 --> 04:33:51,120 I'LL TALK ABOUT EPIDEMIOLOGY OF 6398 04:33:51,120 --> 04:33:52,840 SLEEP DISORDERS IN GENERAL. 6399 04:33:52,840 --> 04:33:58,560 WE'VE HEARD A LOT ALREADY, I'LL 6400 04:33:58,560 --> 04:34:00,840 FOCUS ON SLEEP APNEA, SLEEP 6401 04:34:00,840 --> 04:34:02,040 ONSET AND MAINTENANCE INSOMNIA. 6402 04:34:02,040 --> 04:34:03,440 DAN WILL DO A BETTER JOB BUT 6403 04:34:03,440 --> 04:34:07,400 I'LL GIVE IT A SHOT AND SHORT 6404 04:34:07,400 --> 04:34:07,960 SLEEP DURATION. 6405 04:34:07,960 --> 04:34:12,680 I THINK IT'S IMPORTANT TO THINK 6406 04:34:12,680 --> 04:34:14,160 ABOUT EFFECTS OF SHORT SLEEP 6407 04:34:14,160 --> 04:34:20,440 DURATION AND HOW THEY PERVASIVE 6408 04:34:20,440 --> 04:34:23,800 THINGS AFFECTS OUTCOMES OF pH. 6409 04:34:23,800 --> 04:34:24,800 I'LL FOCUS ON THINGS SUSAN 6410 04:34:24,800 --> 04:34:30,840 PUSHED ME TO THINK ABOUT, AGE, 6411 04:34:30,840 --> 04:34:32,160 SEX, ETHNICITY, I KNEW WHAT I 6412 04:34:32,160 --> 04:34:37,200 WAS GOING TO DO BUT DOVE IN AND 6413 04:34:37,200 --> 04:34:41,800 WAS SURPRISED TO LEARN THINGS I 6414 04:34:41,800 --> 04:34:45,520 BELIEVE IN, I WILL CAUTIOUSLY, I 6415 04:34:45,520 --> 04:34:48,040 USE THAT WORD CAUTIOUSLY, TO 6416 04:34:48,040 --> 04:34:50,880 TRAVERSE THE WATERS ON 6417 04:34:50,880 --> 04:34:52,520 EPIDEMIOLOGY OF PH, VERY BROAD, 6418 04:34:52,520 --> 04:34:54,920 AND THINK ABOUT THE OVERLAP 6419 04:34:54,920 --> 04:34:56,520 BETWEEN WHAT WE SEE IN SLEEP AND 6420 04:34:56,520 --> 04:35:02,600 WHAT YOU ALL IN THE PH WORLD 6421 04:35:02,600 --> 04:35:04,240 THINK ABOUT COMPONENTS OR TIMES 6422 04:35:04,240 --> 04:35:04,440 OF PH. 6423 04:35:04,440 --> 04:35:06,080 I WANT TO THINK ABOUT I KNOW ALL 6424 04:35:06,080 --> 04:35:07,640 OF US WANT TO THINK ABOUT OR 6425 04:35:07,640 --> 04:35:10,440 SOME WANT TO THINK ABOUT CAUSAL 6426 04:35:10,440 --> 04:35:14,440 EFFECTS, DOES SLEEP APNEA DO 6427 04:35:14,440 --> 04:35:16,400 THIS, DOES HYPOXEMIA DO THIS OR 6428 04:35:16,400 --> 04:35:20,640 THAT, BUT RATHER I PIVOTED AS I 6429 04:35:20,640 --> 04:35:23,080 STARTED WORKING ON THIS, MAYBE 6430 04:35:23,080 --> 04:35:24,560 IT'S A TWO-HIT PROBLEM. 6431 04:35:24,560 --> 04:35:28,080 WHAT HAVE YOU A HABITUAL SLEEP 6432 04:35:28,080 --> 04:35:30,720 DURATION AND GROUP 1 PH, WHAT 6433 04:35:30,720 --> 04:35:32,040 DOES THAT MEAN? 6434 04:35:32,040 --> 04:35:36,400 WE KNOW IF YOU'RE HABITUALLY 6435 04:35:36,400 --> 04:35:38,040 SHORT, WELL DEFINED, WHAT DOES 6436 04:35:38,040 --> 04:35:40,800 THAT DO WHEN YOU HAVE ONE PH OR 6437 04:35:40,800 --> 04:35:43,200 TWO, WHATEVER IT MAY BE, I 6438 04:35:43,200 --> 04:35:43,880 STARTED THINKING ABOUT 6439 04:35:43,880 --> 04:35:44,160 RELEVANCE. 6440 04:35:44,160 --> 04:35:50,600 IS IT A DIRECT CAUSAL EFFECT OF 6441 04:35:50,600 --> 04:35:52,200 SOMETHING, CLEARLY GROUP 3 CAN 6442 04:35:52,200 --> 04:35:53,200 TALK ABOUT CAUSALITY ISSUES BUT 6443 04:35:53,200 --> 04:35:55,280 I WANT TO THINK ABOUT AND PUSH 6444 04:35:55,280 --> 04:35:57,000 US TO THINK ABOUT MODIFICATION. 6445 04:35:57,000 --> 04:36:00,240 IT'S FINE TO HAVE TWO DISORDERS 6446 04:36:00,240 --> 04:36:03,160 BUT CUSS ONE MODIFY THE EFFECT 6447 04:36:03,160 --> 04:36:04,400 OF OTHERS? 6448 04:36:04,400 --> 04:36:08,200 WE'VE HEARD ABOUT THIS. 6449 04:36:08,200 --> 04:36:16,280 THE OBVIOUS FIGURE HERE IS 6450 04:36:16,280 --> 04:36:17,800 SHOWN, INCREASED ESOPHAGEAL 6451 04:36:17,800 --> 04:36:19,040 AIRWAYS, CLOSED AIRWAYS, BUT I 6452 04:36:19,040 --> 04:36:20,480 LOVE THE NICK HILL BROUGHT 6453 04:36:20,480 --> 04:36:21,880 THINGS IN, OTHERS BROUGHT THINGS 6454 04:36:21,880 --> 04:36:25,400 IN, LOOK, IT'S ONE THING TO 6455 04:36:25,400 --> 04:36:28,560 THINK ABOUT HYPOXEMIA BUT THAT'S 6456 04:36:28,560 --> 04:36:29,760 NOT ALL WE SEE. 6457 04:36:29,760 --> 04:36:32,080 HERE IS A PATIENT WITH COPD. 6458 04:36:32,080 --> 04:36:33,160 LOOK AT WHAT HAPPENS. 6459 04:36:33,160 --> 04:36:36,680 THIS DOES NOT HAVE THE VERY 6460 04:36:36,680 --> 04:36:41,240 TYPICAL THING WE SEE WITH SLEEP 6461 04:36:41,240 --> 04:36:44,840 APNEA. 6462 04:36:44,840 --> 04:36:46,840 HYPOXEMIA IS SLOW, PROGRESSIVE 6463 04:36:46,840 --> 04:36:48,160 AND SUSTAINED. 6464 04:36:48,160 --> 04:36:53,000 BOB AND NICK TALKED ABOUT 6465 04:36:53,000 --> 04:36:53,280 COMPONENTS. 6466 04:36:53,280 --> 04:36:57,800 SLEEP APNEA IS THERE. 6467 04:36:57,800 --> 04:37:01,080 IT'S IMPORTANT, EFFECTS OF 6468 04:37:01,080 --> 04:37:02,080 SOMETHING INTERMITTENTLY, 6469 04:37:02,080 --> 04:37:03,600 HYPOXEMIA, VERSUS MORE SUSTAINED 6470 04:37:03,600 --> 04:37:06,200 WAY WHETHER IT'S SUSTAINED OR 6471 04:37:06,200 --> 04:37:09,840 LONG PERIODS OF NIGHT, 6472 04:37:09,840 --> 04:37:11,280 THROUGHOUT THE 24-HOUR PERIOD 6473 04:37:11,280 --> 04:37:12,680 MAY HAVE DIFFERENT EFFECTS. 6474 04:37:12,680 --> 04:37:15,960 WE NEED TO BE CAREFUL ABOUT WHAT 6475 04:37:15,960 --> 04:37:16,880 IS IT PHYSIOLOGICALLY THAT 6476 04:37:16,880 --> 04:37:20,240 MOTIVATES US TO THINK ABOUT 6477 04:37:20,240 --> 04:37:21,880 CAUSALITY OR MODIFICATION? 6478 04:37:21,880 --> 04:37:24,280 SO, NO BRAINER HERE. 6479 04:37:24,280 --> 04:37:25,160 SLEEP APNEA COMMON, MEN AND 6480 04:37:25,160 --> 04:37:27,240 WOMEN HAVE IT. 6481 04:37:27,240 --> 04:37:28,320 THERE'S A GENDER DIFFERENCE 6482 04:37:28,320 --> 04:37:30,840 WHICH WE'LL GET INTO A LITTLE 6483 04:37:30,840 --> 04:37:31,080 BIT. 6484 04:37:31,080 --> 04:37:33,120 EFFECT ON AGE, OBESITY IS ONE OF 6485 04:37:33,120 --> 04:37:37,760 THE TOP MAJOR DETERMINANTS OF 6486 04:37:37,760 --> 04:37:37,960 DISEASE. 6487 04:37:37,960 --> 04:37:42,640 AND TWO DECADES WHERE MANY OF 6488 04:37:42,640 --> 04:37:45,960 YOU HAVE CONTRIBUTED ALL YOUR 6489 04:37:45,960 --> 04:37:47,480 LIFE, AND HYPERTENSION, THAT'S 6490 04:37:47,480 --> 04:37:51,080 ACCEPTED FACT THAT UNTREATED 6491 04:37:51,080 --> 04:37:53,920 SLEEP APNEA AND HYPERTENSION. 6492 04:37:53,920 --> 04:37:55,680 CORONARY ARTERY DISEASE, 6493 04:37:55,680 --> 04:37:57,080 POTENTIAL EFFECT OF CPAP STILL 6494 04:37:57,080 --> 04:37:59,160 UNKNOWN, TO BE WRITTEN IN FINE 6495 04:37:59,160 --> 04:37:59,400 FORM. 6496 04:37:59,400 --> 04:38:02,880 BUT AT LEAST HEALTH OUTSOME OF 6497 04:38:02,880 --> 04:38:04,000 HYPERTENSION AND 6498 04:38:04,000 --> 04:38:05,320 PATIENT-REPORTED OUTCOMES WELL 6499 04:38:05,320 --> 04:38:07,320 DEFINED. 6500 04:38:07,320 --> 04:38:11,360 GLOBAL BURDEN, THIS IS WORK FROM 6501 04:38:11,360 --> 04:38:12,760 BENJAFIELD, CONVEYS OBVIOUS 6502 04:38:12,760 --> 04:38:13,080 TOPIC. 6503 04:38:13,080 --> 04:38:14,080 IT'S COMMON. 6504 04:38:14,080 --> 04:38:19,560 EVEN IF THERE'S NO CAUSAL 6505 04:38:19,560 --> 04:38:21,400 EFFECTS, MEANING SLEEP APNEA, 6506 04:38:21,400 --> 04:38:23,480 ANY FORM OF PH EXTREMELY COMMON 6507 04:38:23,480 --> 04:38:24,960 PROBLEM, THE BURDEN NICK WAS 6508 04:38:24,960 --> 04:38:27,120 TALKING ABOUT, A LOT OF THE 6509 04:38:27,120 --> 04:38:27,720 VARIABILITY, PREVALENCE, 6510 04:38:27,720 --> 04:38:30,320 DETERMINED BY THINGS SUCH AS HOW 6511 04:38:30,320 --> 04:38:31,960 YOU DEFINE DISEASE, ONE DISEASE 6512 04:38:31,960 --> 04:38:33,480 THAT IS CLEARLY EVIDENT, YOU CAN 6513 04:38:33,480 --> 04:38:35,760 DEFINE IT ANY WAY YOU WANT, HERE 6514 04:38:35,760 --> 04:38:38,760 IT WAS DONE IN TWO WAYS, ANY 6515 04:38:38,760 --> 04:38:42,240 DEGREE OF APNEA, THE LAST -- YOU 6516 04:38:42,240 --> 04:38:44,200 SEE A HEAT MAP OF INDIVIDUALS, 6517 04:38:44,200 --> 04:38:46,360 YOU CAN LOOK AT REGIONS AND THE 6518 04:38:46,360 --> 04:38:48,720 PREVALENCE ESTIMATES ARE IN THE 6519 04:38:48,720 --> 04:38:51,320 VERY ORANGE ZONE, METRICS HERE, 6520 04:38:51,320 --> 04:38:55,000 ORANGE IS IN THE 70s. 6521 04:38:55,000 --> 04:38:58,240 THE U.S. IS IN THE MIDDLE, 6522 04:38:58,240 --> 04:38:59,640 RATCHET UP TO AHI OF 15 YOU 6523 04:38:59,640 --> 04:39:05,040 STILL HAVE A LOT OF COUNTRIES, 6524 04:39:05,040 --> 04:39:10,880 PARTICULARLY MIDDLE EAST AND 6525 04:39:10,880 --> 04:39:12,120 ASIAN CONTINENT. 6526 04:39:12,120 --> 04:39:13,000 THIS IS COMMON. 6527 04:39:13,000 --> 04:39:13,880 IT'S COMMON EVERYWHERE. 6528 04:39:13,880 --> 04:39:19,440 HERE ARE THE TOP TEN COUNTRIES. 6529 04:39:19,440 --> 04:39:27,560 U.S., INDIA, 54 MILLION WITH ANY 6530 04:39:27,560 --> 04:39:28,960 GRIEF APNEA, THIS IS OF COURSE 6531 04:39:28,960 --> 04:39:31,160 PREVALENT AND NOTHING NEW TO ANY 6532 04:39:31,160 --> 04:39:32,360 OF US. 6533 04:39:32,360 --> 04:39:34,560 HERE IS SOMETHING I FOUND 6534 04:39:34,560 --> 04:39:35,200 INTERESTING. 6535 04:39:35,200 --> 04:39:42,080 THIS IS A REANALYSIS OF THE SAME 6536 04:39:42,080 --> 04:39:42,440 DATA. 6537 04:39:42,440 --> 04:39:45,560 THEY TOOK THE SAME DATA IN THE 6538 04:39:45,560 --> 04:39:49,120 ARTICLE, AND PLOTTED THIS AS 6539 04:39:49,120 --> 04:39:51,520 FUNCTION OF TIME, WHAT THEY DID 6540 04:39:51,520 --> 04:39:54,240 TWO DEGREES OF DEFINITION, FIVE 6541 04:39:54,240 --> 04:39:57,600 AND TEN THRESHOLDS, WHAT'S GOING 6542 04:39:57,600 --> 04:39:59,160 ON TEMPORALLY, THERE'S NO DOUBT, 6543 04:39:59,160 --> 04:40:00,360 AGAIN MAYBE I'M MISINTERPRETING 6544 04:40:00,360 --> 04:40:03,760 THIS GRAPH, THERE IS A TREND. 6545 04:40:03,760 --> 04:40:06,360 THEY KIND OF MODEL LINEAR TREND, 6546 04:40:06,360 --> 04:40:07,800 IF THAT'S OKAY, SURE, YOU CAN 6547 04:40:07,800 --> 04:40:09,960 SEE THERE'S A GENDER DIFFERENCE, 6548 04:40:09,960 --> 04:40:10,160 RIGHT? 6549 04:40:10,160 --> 04:40:12,280 MEN AND WOMEN CLEARLY HAVE 6550 04:40:12,280 --> 04:40:12,600 DIFFERENCES. 6551 04:40:12,600 --> 04:40:14,160 WE'LL GET INTO THAT IN A MINUTE. 6552 04:40:14,160 --> 04:40:19,720 BUT ALSO THERE IS SEEMS TO BE 6553 04:40:19,720 --> 04:40:21,560 TEMPORAL TREND, WHETHER IT 6554 04:40:21,560 --> 04:40:23,000 PARALLELS OBESITY, OTHER FACTORS 6555 04:40:23,000 --> 04:40:23,360 UNKNOWN. 6556 04:40:23,360 --> 04:40:26,960 YES, IT'S COMMON BUT IT'S 6557 04:40:26,960 --> 04:40:29,000 BECOMING MORE COMMON, I FOUND 6558 04:40:29,000 --> 04:40:30,000 THIS FASCINATING. 6559 04:40:30,000 --> 04:40:31,000 THIS CAME OUT RECENTLY. 6560 04:40:31,000 --> 04:40:32,560 A FEW MONTHS AGO. 6561 04:40:32,560 --> 04:40:34,520 THIS IS A UNIQUE APPROACH. 6562 04:40:34,520 --> 04:40:36,480 I'M NOW GETTING INTO EFFECTS OF 6563 04:40:36,480 --> 04:40:36,840 AGE. 6564 04:40:36,840 --> 04:40:40,640 WHAT DO WE KNOW ABOUT AGE? 6565 04:40:40,640 --> 04:40:41,840 INTERESTING TO SHARE. 6566 04:40:41,840 --> 04:40:44,360 WELL, IT'S A GROUP OF 6567 04:40:44,360 --> 04:40:46,120 INDIVIDUALS CLUSTERED TOGETHER, 6568 04:40:46,120 --> 04:40:48,640 THREE COHORTS, HERE THEY ARE. 6569 04:40:48,640 --> 04:40:51,560 THERE'S A CHIME COHORT, THESE 6570 04:40:51,560 --> 04:40:53,240 ARE PEDIATRIC, YOUNGER 6571 04:40:53,240 --> 04:40:55,960 POPULATIONS, AND THEN MGH COHORT 6572 04:40:55,960 --> 04:40:59,160 FROM STANDPOINT OF POLY 6573 04:40:59,160 --> 04:41:00,880 SOMNOGRAPHIC DATABASE. 6574 04:41:00,880 --> 04:41:01,640 AHI DISTRIBUTION, WHAT IT SHOWS 6575 04:41:01,640 --> 04:41:04,320 IF YOU LOOK AT FUNCTION OF AGE 6576 04:41:04,320 --> 04:41:06,240 BEYOND LET'S SAY 18 THERE'S A 6577 04:41:06,240 --> 04:41:08,760 VERY NICE TREND THAT GOES UP. 6578 04:41:08,760 --> 04:41:11,840 AGAIN, I WANT TO HIGHLIGHT THIS. 6579 04:41:11,840 --> 04:41:14,440 GRAPHICALLY IT SHOWS A LOT OF 6580 04:41:14,440 --> 04:41:16,320 WHAT WE KNOW BUT DISPLAYED IN A 6581 04:41:16,320 --> 04:41:19,840 NEAT WAY. 6582 04:41:19,840 --> 04:41:21,360 YEAH, BMI IS HIGH BUT RELATIVELY 6583 04:41:21,360 --> 04:41:24,400 FLAT EVEN FOR CLINICAL COHORT. 6584 04:41:24,400 --> 04:41:26,160 THERE ARE ISSUES, BIAS, ET 6585 04:41:26,160 --> 04:41:26,520 CETERA. 6586 04:41:26,520 --> 04:41:30,360 THEY LOOKED AT STAGES OF SLEEP, 6587 04:41:30,360 --> 04:41:30,960 SPECTRAL DENSITY ANALYSES, 6588 04:41:30,960 --> 04:41:31,320 ARCHITECTURE. 6589 04:41:31,320 --> 04:41:34,040 BUT THE KEY THING TO POINT OUT 6590 04:41:34,040 --> 04:41:35,360 SOMETHING THAT WE'VE KNOWN, 6591 04:41:35,360 --> 04:41:36,880 APNEA AND AGE ARE RELATED. 6592 04:41:36,880 --> 04:41:40,600 THIS IS A COMMON DISORDER, AS WE 6593 04:41:40,600 --> 04:41:42,800 GET OLDER. 6594 04:41:42,800 --> 04:41:43,440 HERE'S ANOTHER INTERESTING 6595 04:41:43,440 --> 04:41:45,520 ARTICLE TO SHARE WITH YOU. 6596 04:41:45,520 --> 04:41:49,800 THIS IS A REVIEW OF ALL THE 6597 04:41:49,800 --> 04:41:51,400 PUBLISHED LITERATURE, COMPARING 6598 04:41:51,400 --> 04:41:53,360 MEN, WOMEN, AND DEGREES OF SLEEP 6599 04:41:53,360 --> 04:41:56,840 APNEA DEPENDING ON HOW YOU 6600 04:41:56,840 --> 04:41:57,080 DEFINE. 6601 04:41:57,080 --> 04:42:00,600 MY CHARGE WAS DESCRIBE AGE 6602 04:42:00,600 --> 04:42:01,880 EFFECT, GENDER EFFECT, 6603 04:42:01,880 --> 04:42:02,240 RACE/ETHNICITY. 6604 04:42:02,240 --> 04:42:03,960 THIS REALLY DOES A GREAT JOB. 6605 04:42:03,960 --> 04:42:05,520 IT DOES AT LEAST TWO OF THE 6606 04:42:05,520 --> 04:42:07,240 THREE FACTORS THAT I WAS 6607 04:42:07,240 --> 04:42:07,520 ASSIGNED. 6608 04:42:07,520 --> 04:42:09,320 WHAT DO YOU SEE HERE? 6609 04:42:09,320 --> 04:42:13,800 WELL, FIRST ON THE Y-AXIS THESE 6610 04:42:13,800 --> 04:42:15,560 HAVE PLOTTED DIFFERENT COHORTS 6611 04:42:15,560 --> 04:42:16,560 AND DIFFERENT PUBLICATIONS. 6612 04:42:16,560 --> 04:42:20,040 EACH COLOR IS A DIFFERENT 6613 04:42:20,040 --> 04:42:21,240 COHORT, AND THEREFORE DIFFERENT 6614 04:42:21,240 --> 04:42:24,880 PUBLICATION, WHAT THEY DID IS 6615 04:42:24,880 --> 04:42:26,400 THEY PLOTTED GENDER ISSUES, MALE 6616 04:42:26,400 --> 04:42:30,000 ON THE BOTTOM, FEMALE ON TOP, 6617 04:42:30,000 --> 04:42:31,520 WENT ACROSS THE BOARD, ACROSS 6618 04:42:31,520 --> 04:42:32,600 DISEASE SEVERITY. 6619 04:42:32,600 --> 04:42:35,480 AGAIN, YOU SEE THE SAME TREND. 6620 04:42:35,480 --> 04:42:39,320 AGE SEEMS TO PREDICT 6621 04:42:39,320 --> 04:42:44,360 IRRESPECTIVE OF GENDER OR HOW 6622 04:42:44,360 --> 04:42:46,960 YOU DEFINE IT, MILD, MODERATE, 6623 04:42:46,960 --> 04:42:47,720 SEVERE, ALL PROGRESSIVELY 6624 04:42:47,720 --> 04:42:49,400 INCREASING WITH AGE, A NICE 6625 04:42:49,400 --> 04:42:55,920 SUMMARY 20 TO 30 YEARS OF 6626 04:42:55,920 --> 04:42:57,360 LITERATURE OUT OF WISCONSIN, 6627 04:42:57,360 --> 04:42:58,240 PENN, VARIOUS COHORTS. 6628 04:42:58,240 --> 04:43:01,280 WHEN YOU LOOK AT POPULATIONS 6629 04:43:01,280 --> 04:43:02,920 COMMUNITY SAMPLES THERE'S A 6630 04:43:02,920 --> 04:43:03,800 DIRECTS RELATIONSHIP WITH AGE, 6631 04:43:03,800 --> 04:43:05,120 NOTHING NEW FOR MOST OF YOU, 6632 04:43:05,120 --> 04:43:07,640 IT'S FOR THE SLEEP FOLKS. 6633 04:43:07,640 --> 04:43:09,920 SO WHAT THE NUMBERS OF THIS 6634 04:43:09,920 --> 04:43:12,760 GROUP RECORDED A FEW YEARS BACK, 6635 04:43:12,760 --> 04:43:14,280 WE ARE SOMEWHERE IN THE 9 TO 30, 6636 04:43:14,280 --> 04:43:18,600 IF YOU LOOK AT THE METRIC. 6637 04:43:18,600 --> 04:43:22,360 MEN HAVING MORE, 10 TO 30%, 6638 04:43:22,360 --> 04:43:26,600 WOMEN 5 TO 20%. 6639 04:43:26,600 --> 04:43:28,680 MOVE IT UP, PREVALENCE IS LOWER, 6640 04:43:28,680 --> 04:43:29,560 HIGHER THRESHOLD. 6641 04:43:29,560 --> 04:43:32,520 IF YOU GO INTO HIGHER AGE 6642 04:43:32,520 --> 04:43:34,160 GROUPS, 50s AND 60s, YOU'LL 6643 04:43:34,160 --> 04:43:36,680 GOAT A HIGHER PREVALENCE. 6644 04:43:36,680 --> 04:43:38,640 SO, AGE AND GENDER, WELL KNOWN, 6645 04:43:38,640 --> 04:43:39,840 WELL DESCRIBED, THESE ARE THE 6646 04:43:39,840 --> 04:43:41,720 SUMMARIES OF WHAT I'VE BEEN ABLE 6647 04:43:41,720 --> 04:43:49,080 TO PULL FROM LITERATURE THAT 6648 04:43:49,080 --> 04:43:52,120 THAT BRING TOGETHER HISTORICAL 6649 04:43:52,120 --> 04:43:52,600 VARIATION. 6650 04:43:52,600 --> 04:43:53,560 THERE IS SEX-RELATED VARIATION, 6651 04:43:53,560 --> 04:43:54,880 SOME ISSUES WE NEED TO THINK 6652 04:43:54,880 --> 04:43:56,600 ABOUT BECAUSE THIS MATTERS FROM 6653 04:43:56,600 --> 04:43:58,640 THE STANDPOINT WHAT COULD 6654 04:43:58,640 --> 04:44:00,160 HAPPEN, THINK ABOUT EFFECT 6655 04:44:00,160 --> 04:44:00,480 MODIFICATION 6656 04:44:00,480 --> 04:44:02,440 WHAT COULD HAPPEN TO WHETHER YOU 6657 04:44:02,440 --> 04:44:04,840 LOOK AT GROUP 1, GROUP 3, IT 6658 04:44:04,840 --> 04:44:06,480 MATTERS THAT THERE'S GOING TO BE 6659 04:44:06,480 --> 04:44:10,680 DIFFERENCES OF AT LEAST PURE 6660 04:44:10,680 --> 04:44:12,280 GENDER-RELATED EXPOSITION OF 6661 04:44:12,280 --> 04:44:13,720 DISEASE. 6662 04:44:13,720 --> 04:44:14,560 THERE ARE ANATOMICAL 6663 04:44:14,560 --> 04:44:15,240 CONSIDERATIONS MANY SLEEP FOLKS 6664 04:44:15,240 --> 04:44:15,760 KNOW ABOUT. 6665 04:44:15,760 --> 04:44:20,480 THERE MAY BE ISSUES OF SHORTER 6666 04:44:20,480 --> 04:44:21,760 UPPER AIRWAY, COLLAPSABILITY, 6667 04:44:21,760 --> 04:44:23,560 ALLOWED FOR GENDER DIFFERENCES 6668 04:44:23,560 --> 04:44:25,440 BUT PRESENTATION IS EXTREMELY 6669 04:44:25,440 --> 04:44:26,840 DIFFERENT IN MANY CASE. 6670 04:44:26,840 --> 04:44:29,240 WOMEN TEND TO NOT PRESENT WITH 6671 04:44:29,240 --> 04:44:30,360 CLASSICAL SYMPTOMS AND WE'VE 6672 04:44:30,360 --> 04:44:35,040 KNOWN THIS FOR SOME TIME. 6673 04:44:35,040 --> 04:44:36,240 POLYSOMNOGRAPHY IS VARIED. 6674 04:44:36,240 --> 04:44:38,240 IT WAS MENTIONED THERE'S LOWER 6675 04:44:38,240 --> 04:44:39,440 DEGREE OF APNEA SEVERITY, 6676 04:44:39,440 --> 04:44:40,320 PERIODS MAY BE LOWER. 6677 04:44:40,320 --> 04:44:42,920 ALL OF THESE ARE RELEVANT, IF 6678 04:44:42,920 --> 04:44:45,800 ONE IS TO TEASE OUT, IF EFFECT 6679 04:44:45,800 --> 04:44:47,120 MODIFICATION OF A DISORDER OF 6680 04:44:47,120 --> 04:44:48,840 SLEEP, I'M PICKING ON SLEEP 6681 04:44:48,840 --> 04:44:50,960 APNEA HERE, IT'S GOING TO MATTER 6682 04:44:50,960 --> 04:44:52,240 HOW WE CHARACTERIZE THESE. 6683 04:44:52,240 --> 04:44:57,640 YOU CAN CALL THIS WHATEVER YOU 6684 04:44:57,640 --> 04:44:58,840 WANT, PHYSIOLOGICAL 6685 04:44:58,840 --> 04:44:59,560 CHARACTERIZATION OF HYPOXEMIC 6686 04:44:59,560 --> 04:45:02,360 BURDEN, MANY WAYS TO DO IT. 6687 04:45:02,360 --> 04:45:05,640 YOU CAN USE MEASURE OF AHI, 6688 04:45:05,640 --> 04:45:07,280 THINK ABOUT DURATION, LOOK AT 6689 04:45:07,280 --> 04:45:08,480 DEGREES, SLEEP STAGES. 6690 04:45:08,480 --> 04:45:10,120 THERE'S GOING TO BE A LOT OF 6691 04:45:10,120 --> 04:45:11,440 VARIABILITY BETWEEN MEN AND 6692 04:45:11,440 --> 04:45:12,000 WOMEN. 6693 04:45:12,000 --> 04:45:13,520 THAT'S VERY WELL DEFINED. 6694 04:45:13,520 --> 04:45:14,480 AS WE MOVE FORWARD I THINK 6695 04:45:14,480 --> 04:45:17,320 PEOPLE HAVE TO THINK ABOUT HOW 6696 04:45:17,320 --> 04:45:19,840 DO THESE THINGS TRANSLATE INTO 6697 04:45:19,840 --> 04:45:23,360 OUTCOMES-RELATED PH OR PH ITSELF 6698 04:45:23,360 --> 04:45:23,720 WORSENING. 6699 04:45:23,720 --> 04:45:25,880 SO THIS SUMMARIZES IT ALL, WHAT 6700 04:45:25,880 --> 04:45:26,960 DO WE KNOW ABOUT GENDER? 6701 04:45:26,960 --> 04:45:30,480 IF YOU LOOK AT THAT THRESHOLD OF 6702 04:45:30,480 --> 04:45:32,440 5, 10, 15, 20, 30, NO MATTER HOW 6703 04:45:32,440 --> 04:45:35,080 YOU LOOK AT IT MEN, THE DARK 6704 04:45:35,080 --> 04:45:37,160 BLUE BAR, ARE ALWAYS 6705 04:45:37,160 --> 04:45:40,080 CONSISTENTLY HIGHER. 6706 04:45:40,080 --> 04:45:42,240 LOOKING AT PREVALENCE OVERALL, 6707 04:45:42,240 --> 04:45:43,680 SOMETIMES ESTIMATES OF 85, 6708 04:45:43,680 --> 04:45:43,920 RIGHT? 6709 04:45:43,920 --> 04:45:48,280 WHAT'S INTERESTING ABOUT THIS 6710 04:45:48,280 --> 04:45:50,320 GROUP OF INDIVIDUALS, DESCRIBED 6711 04:45:50,320 --> 04:45:50,840 MENOPAUSAL STATE. 6712 04:45:50,840 --> 04:45:53,120 THIS WAS BROUGHT UP. 6713 04:45:53,120 --> 04:45:55,320 WHAT ACTUALLY HAPPENS WITH WOMEN 6714 04:45:55,320 --> 04:45:57,520 THAT HAVE ANY DISORDER, IN THIS 6715 04:45:57,520 --> 04:45:59,160 CASE SLEEP APNEA, ANY DISORDER 6716 04:45:59,160 --> 04:46:01,400 WHERE IT IS WITH REGARDS TO 6717 04:46:01,400 --> 04:46:03,080 MENOPAUSAL STATUS, AND YOU CAN 6718 04:46:03,080 --> 04:46:06,560 SEE CONSISTENTLY WHEN YOU LOOK 6719 04:46:06,560 --> 04:46:07,760 AT PRE-/POST, POSTMENOPAUSAL 6720 04:46:07,760 --> 04:46:13,360 WOMEN WILL HAVE A HIGHER 6721 04:46:13,360 --> 04:46:13,720 PREDISPOSITION. 6722 04:46:13,720 --> 04:46:15,840 SO, YES, AGE AND SEX ARE 6723 04:46:15,840 --> 04:46:16,200 RELEVANT. 6724 04:46:16,200 --> 04:46:17,480 WE'VE KNOWN THIS. 6725 04:46:17,480 --> 04:46:21,560 THIS IS AGAIN DEMONSTRATING IT 6726 04:46:21,560 --> 04:46:23,840 IN A MORE RECENT COHORT. 6727 04:46:23,840 --> 04:46:26,120 THEY ARE ALSO DESCRIBING 6728 04:46:26,120 --> 04:46:27,800 MENOPAUSAL EFFECTS. 6729 04:46:27,800 --> 04:46:30,200 THOSE HAVE DIRECT RELEVANCE FROM 6730 04:46:30,200 --> 04:46:33,800 PHYSIOLOGY, WHAT MAY BE 6731 04:46:33,800 --> 04:46:35,680 HAPPENING IN PH, WHAT'S 6732 04:46:35,680 --> 04:46:38,320 HAPPENING WITH REPRODUCTIVE 6733 04:46:38,320 --> 04:46:44,160 HORMONES AND THEIR EFFECTS ON 6734 04:46:44,160 --> 04:46:45,000 PULMONARY HYPERTENSION. 6735 04:46:45,000 --> 04:46:47,840 THIS IS AN OLD SLIDE FROM 6736 04:46:47,840 --> 04:46:48,600 WISCONSIN, 20 YEARS. 6737 04:46:48,600 --> 04:46:54,600 WHEN YOU LOOK AT WOMEN, BROKEN 6738 04:46:54,600 --> 04:46:59,880 INTO PRE, PERI, AND POST, 6739 04:46:59,880 --> 04:47:01,160 INCLINE WITH AGE, WOMEN AND MEN, 6740 04:47:01,160 --> 04:47:03,720 A RELATIONSHIP WITH BODY MASS 6741 04:47:03,720 --> 04:47:05,360 INDEX. 6742 04:47:05,360 --> 04:47:06,760 THERE IS CLEAR-CUT DIFFERENCES, 6743 04:47:06,760 --> 04:47:07,640 OVERLAPPING AGE RANGE. 6744 04:47:07,640 --> 04:47:10,680 IF YOU LOOK AT THIS OVERLAP, 6745 04:47:10,680 --> 04:47:12,200 POST MENOPAUSAL WOMEN ARE IN 6746 04:47:12,200 --> 04:47:14,800 FACT AT HIGHER RISK, FOR THIS 6747 04:47:14,800 --> 04:47:16,440 DISORDER. 6748 04:47:16,440 --> 04:47:21,840 NOW, MAYBE I'LL BET INTO -- GET 6749 04:47:21,840 --> 04:47:23,160 INTO THIS LATER. 6750 04:47:23,160 --> 04:47:25,120 I'M NOT DESCRIBING ANY NEW, 6751 04:47:25,120 --> 04:47:26,000 REMINDING OURSELVES WHAT WE'VE 6752 04:47:26,000 --> 04:47:31,240 LEARNED OVER THE LAST FEW 6753 04:47:31,240 --> 04:47:32,560 DECADES, DIFFERENCES WITH AGE, 6754 04:47:32,560 --> 04:47:35,160 BUT WITHIN A PARTICULAR SEX 6755 04:47:35,160 --> 04:47:39,360 THERE ARE ISSUES ABOUT MENOPAUSE 6756 04:47:39,360 --> 04:47:42,600 OF RELEVANCE. 6757 04:47:42,600 --> 04:47:43,120 YEAH, POLYSOMNOGRAPHIC 6758 04:47:43,120 --> 04:47:43,920 DIFFERENCES, SAID EARLIER TODAY. 6759 04:47:43,920 --> 04:47:47,880 THIS IS AN OLD STUDY THAT 6760 04:47:47,880 --> 04:47:50,040 CHARACTERIZED WHAT IS THE 6761 04:47:50,040 --> 04:47:55,440 DISTRIBUTION OF SEVERITY OF 6762 04:47:55,440 --> 04:47:56,480 SLEEP APNEA. 6763 04:47:56,480 --> 04:48:03,200 MY JOB WAS EPI, AGE, SEX, BMI, 6764 04:48:03,200 --> 04:48:04,080 BUT SEX DIFFERENCES, WOMEN, 6765 04:48:04,080 --> 04:48:07,320 BLACK BARS ON THIS SLIDE, HAVE 6766 04:48:07,320 --> 04:48:11,040 LOWER SORT OF INDEX FOR SEVERITY 6767 04:48:11,040 --> 04:48:11,560 NON-REM. 6768 04:48:11,560 --> 04:48:14,200 WHEN YOU LOOK AT REM HIGHER 6769 04:48:14,200 --> 04:48:16,640 PREDISPOSITION FOR WOMEN. 6770 04:48:16,640 --> 04:48:17,600 THERE IS REM PREDOMINANCE, OF 6771 04:48:17,600 --> 04:48:19,600 COURSE THAT'S GOING TO GET 6772 04:48:19,600 --> 04:48:20,680 MODIFIED BY AGE, OBESITY, ET 6773 04:48:20,680 --> 04:48:21,200 CETERA. 6774 04:48:21,200 --> 04:48:24,720 BUT AT LEAST GLOBALLY WE KNOW 6775 04:48:24,720 --> 04:48:26,600 THERE ARE DIFFERENCES BY SLEEP 6776 04:48:26,600 --> 04:48:26,800 STATE. 6777 04:48:26,800 --> 04:48:30,000 THIS GOES BACK TO THE QUESTION 6778 04:48:30,000 --> 04:48:31,280 OF, YOU KNOW, POLYSOMNOGRAPHY, 6779 04:48:31,280 --> 04:48:32,840 HOME SLEEP TESTING. 6780 04:48:32,840 --> 04:48:37,320 IF YOU DON'T HAVE NON-REM YOU 6781 04:48:37,320 --> 04:48:45,200 WON'T CHARACTERIZES COURSE AS 6782 04:48:45,200 --> 04:48:45,400 WELL. 6783 04:48:45,400 --> 04:48:46,560 WITHOUT THAT CHARACTERIZATION AS 6784 04:48:46,560 --> 04:48:47,920 WE MOVE FORWARD I THINK WE'LL 6785 04:48:47,920 --> 04:48:50,320 MISS OUT ON SOME OF THE 6786 04:48:50,320 --> 04:48:52,400 UNDERLYING PHYSIOLOGY OF WHAT A 6787 04:48:52,400 --> 04:48:53,880 DISORDER LIKE SLEEP APNEA MAY BE 6788 04:48:53,880 --> 04:48:59,440 DOING TO ANY OF THE GROUPS IN 6789 04:48:59,440 --> 04:49:00,400 REGARDS TO PH. 6790 04:49:00,400 --> 04:49:03,440 I THOUGHT I KNEW EVERYTHING WILL 6791 04:49:03,440 --> 04:49:05,120 RACE/ETHNICITY. 6792 04:49:05,120 --> 04:49:07,400 THIS CAME OUT RECENTLY. 6793 04:49:07,400 --> 04:49:11,000 I HAD TO RETHINK THIS ONE OUT. 6794 04:49:11,000 --> 04:49:12,320 SUSAN HAS DONE A TREMENDOUS 6795 04:49:12,320 --> 04:49:13,960 AMOUNT OF WORK OVER THREE 6796 04:49:13,960 --> 04:49:15,360 DECADES ON THE TOPIC OF RACE, 6797 04:49:15,360 --> 04:49:18,560 I'LL SHOW YOU SOME OF THIS. 6798 04:49:18,560 --> 04:49:20,280 IT GAVE ME TIME TO THINK ABOUT 6799 04:49:20,280 --> 04:49:23,720 AND SAY, WAIT A MINUTE, WILL ME 6800 04:49:23,720 --> 04:49:25,800 PRECONCEIVED NOTIONS BY RACE, 6801 04:49:25,800 --> 04:49:28,800 ETHNICITY, AND SLEEP APNEA BE 6802 04:49:28,800 --> 04:49:29,040 CORRECT? 6803 04:49:29,040 --> 04:49:31,240 WHAT DO WE KNOW ABOUT RACE. 6804 04:49:31,240 --> 04:49:32,600 IT'S MIXED, THAT'S THE BEST I 6805 04:49:32,600 --> 04:49:34,320 CAN TELL YOU. 6806 04:49:34,320 --> 04:49:36,400 WE DON'T I THINK UNDERSTAND. 6807 04:49:36,400 --> 04:49:38,800 I BET THERE ARE ARGUMENTS ON 6808 04:49:38,800 --> 04:49:42,200 BOTH SIDES, I'LL PRESENT SOME. 6809 04:49:42,200 --> 04:49:45,160 FEW STUDIES CLEARLY DEMONSTRATE 6810 04:49:45,160 --> 04:49:48,200 THAT IF YOU ARE ETHNIC MINORITY, 6811 04:49:48,200 --> 04:49:51,360 SUSAN HAS DONE THIS WORK, YOU'LL 6812 04:49:51,360 --> 04:49:53,920 BE AT HIGH RISK FOR SLEEP AP. 6813 04:49:53,920 --> 04:49:56,760 THIS HAS BEEN TALKED ABOUT, 6814 04:49:56,760 --> 04:49:57,600 WRITTEN ABOUT, SUBSTANTIALLY. 6815 04:49:57,600 --> 04:50:02,800 BUT ON THE OTHER HAND LITERATURE 6816 04:50:02,800 --> 04:50:04,760 SAYS WAIT A MINUTE, IT DOES NOT 6817 04:50:04,760 --> 04:50:06,640 SEEM TO ASSOCIATE WITH REGARDS 6818 04:50:06,640 --> 04:50:07,640 TO SLEEP APNEA. 6819 04:50:07,640 --> 04:50:09,040 I WANT TO REMIND THIS GROUP I 6820 04:50:09,040 --> 04:50:10,880 DON'T THINK, AGAIN, THIS IS MY 6821 04:50:10,880 --> 04:50:13,920 VIEWPOINT, I'M SURE PEOPLE HAVE 6822 04:50:13,920 --> 04:50:15,280 DIFFERENT VIEWS, I DON'T THINK 6823 04:50:15,280 --> 04:50:17,280 THE RACE/ETHNICITY IS COMPLETELY 6824 04:50:17,280 --> 04:50:19,000 SETTLED AT THIS POINT. 6825 04:50:19,000 --> 04:50:20,640 I HAD TO TAKE A SECOND LOOK. 6826 04:50:20,640 --> 04:50:23,360 I THOUGHT I KNEW ABOUT THIS. 6827 04:50:23,360 --> 04:50:29,960 I DID NOT. 6828 04:50:29,960 --> 04:50:33,000 SO, THE SWAN STUDY, THEY DIDN'T 6829 04:50:33,000 --> 04:50:36,280 FIND DIFFERENCES IN THE INDEX. 6830 04:50:36,280 --> 04:50:38,600 WHATEVER YOU THINK ABOUT THAT 6831 04:50:38,600 --> 04:50:40,880 METRIC THEY DIDN'T FIND 6832 04:50:40,880 --> 04:50:42,640 DIFFERENCES IN AHI BETWEEN 6833 04:50:42,640 --> 04:50:44,840 GROUPS IN THEIR COHORT BUT I 6834 04:50:44,840 --> 04:50:47,040 KNOW THERE ARE STUDIES THAT DO 6835 04:50:47,040 --> 04:50:47,800 SHOW DIFFERENCES. 6836 04:50:47,800 --> 04:50:49,200 I'LL SHOW YOU SOME. 6837 04:50:49,200 --> 04:50:52,920 WE SLEEP HEART HEALTH GROUP, 6838 04:50:52,920 --> 04:50:56,440 SOME ON THE CALL WERE ON THAT 6839 04:50:56,440 --> 04:50:58,760 COHORT STUDY SHOWED DIFFERENCES, 6840 04:50:58,760 --> 04:50:59,760 COMPARED CAUCASIANS, AFRICAN 6841 04:50:59,760 --> 04:51:00,800 AMERICAN, AFTER YOU CONTROL FOR 6842 04:51:00,800 --> 04:51:05,200 AGE AND SEX. 6843 04:51:05,200 --> 04:51:07,400 WHAT'S INTERESTING, MESA YEAH, 6844 04:51:07,400 --> 04:51:09,880 THERE ARE DIFFERENCES BUT HERE 6845 04:51:09,880 --> 04:51:11,080 IS SOMETHING INTERESTING. 6846 04:51:11,080 --> 04:51:13,040 THIS REVIEW POINTED THIS OUT. 6847 04:51:13,040 --> 04:51:14,480 I APPRECIATE IT. 6848 04:51:14,480 --> 04:51:16,240 BOTH STUDIES LACK CONTROL FOR 6849 04:51:16,240 --> 04:51:19,080 SOME IMPORTANT FACTORS THAT 6850 04:51:19,080 --> 04:51:20,160 COULD POTENTIALLY EXPLAIN RACIAL 6851 04:51:20,160 --> 04:51:22,800 DISPARITY THAT HAS BEEN 6852 04:51:22,800 --> 04:51:25,640 DOCUMENTED WITH REGARDS TO OSA 6853 04:51:25,640 --> 04:51:25,960 PROBLEMS. 6854 04:51:25,960 --> 04:51:27,800 I WANTED TO END THIS CONCEPT OF 6855 04:51:27,800 --> 04:51:30,520 RACE BY SAYING I DON'T THINK THE 6856 04:51:30,520 --> 04:51:32,760 ANSWER IS SO WELL DEFINED AS THE 6857 04:51:32,760 --> 04:51:36,160 AGE OR BMI OR SEX ISSUE. 6858 04:51:36,160 --> 04:51:43,800 I THINK THE RACE ISSUE, AT LEAST 6859 04:51:43,800 --> 04:51:48,840 IN SOME, COULD BE EXPLAINED. 6860 04:51:48,840 --> 04:51:52,120 GENETICS, THERE HAS TO BE AND IS 6861 04:51:52,120 --> 04:51:54,200 SOME EXPLANATION WHY WE SEE 6862 04:51:54,200 --> 04:51:55,200 HEAVY CLUSTERING CHARACTERIZED 6863 04:51:55,200 --> 04:51:55,960 IN SOME. 6864 04:51:55,960 --> 04:52:00,240 AGAIN, IT COULD BE BECAUSE OF 6865 04:52:00,240 --> 04:52:00,920 THE OBESITY DISTRIBUTION, 6866 04:52:00,920 --> 04:52:04,400 PARTICULARLY IF YOU THINK ABOUT 6867 04:52:04,400 --> 04:52:06,480 THE ASIAN CONTINENT, CONTROL 6868 04:52:06,480 --> 04:52:07,760 FACTORS MENTIONED, THAT MAYBE 6869 04:52:07,760 --> 04:52:09,440 HERITABLE, ET CETERA. 6870 04:52:09,440 --> 04:52:11,400 TO ME I WANT TO LEAVE THIS 6871 04:52:11,400 --> 04:52:13,600 CONCEPT OF RACE FOR THIS GROUP 6872 04:52:13,600 --> 04:52:16,320 SAYING I REALLY ONCE I LOOKED AT 6873 04:52:16,320 --> 04:52:17,960 EVIDENCE I WAS PRESENTED, THIS 6874 04:52:17,960 --> 04:52:19,360 GROUP DID A NICE JOB PUTTING IT 6875 04:52:19,360 --> 04:52:21,120 TOGETHER AT THE TIME, I'M 6876 04:52:21,120 --> 04:52:23,600 SURPRISED WHEN YOU LOOK AT THE 6877 04:52:23,600 --> 04:52:25,400 EVIDENCE IN TOTALITY, I DON'T 6878 04:52:25,400 --> 04:52:29,000 THINK WE'RE THERE YET AS FAR AS 6879 04:52:29,000 --> 04:52:30,640 DEFINITIVE ANSWER. 6880 04:52:30,640 --> 04:52:32,360 I APOLOGIZE TO THOSE WHO FEEL 6881 04:52:32,360 --> 04:52:34,280 THE ANSWER IS WELL KNOWN. 6882 04:52:34,280 --> 04:52:40,520 I HAD TO RETHINK MY VIEWS. 6883 04:52:40,520 --> 04:52:42,560 SWITCHING GEARS TO INSOMNIA, 6884 04:52:42,560 --> 04:52:46,000 SECOND DISORDER I WAS CHARGED 6885 04:52:46,000 --> 04:52:50,800 WITH, DAN WILL DO A BETTER JOB. 6886 04:52:50,800 --> 04:52:54,160 INSOMNIA, WHAT ABOUT OTHER SLEEP 6887 04:52:54,160 --> 04:52:54,480 DISORDERS? 6888 04:52:54,480 --> 04:52:56,880 ANDREW BRYAN TALKED ABOUT IT. 6889 04:52:56,880 --> 04:52:58,680 INSOMNIA IS COMMON. 6890 04:52:58,680 --> 04:53:01,600 NOT ONE PERSON ON THIS ZOOM, 6891 04:53:01,600 --> 04:53:06,120 WHETHER PARTICIPANT OR JUST 6892 04:53:06,120 --> 04:53:08,160 ATTENDING OR PRESENTING, NOT ONE 6893 04:53:08,160 --> 04:53:10,600 PERSON HAS NOT HAD DIFFICULTY 6894 04:53:10,600 --> 04:53:11,520 WITH INSOMNIA. 6895 04:53:11,520 --> 04:53:14,400 THIS IS A CLINICAL DIAGNOSIS, 6896 04:53:14,400 --> 04:53:16,240 COULD ENTAIL ONE OF THREE OR ALL 6897 04:53:16,240 --> 04:53:19,640 THREE, TROUBLE GOING TO SLEEP, 6898 04:53:19,640 --> 04:53:21,960 TROUBLE MAINTAINING SLEEP, OR 6899 04:53:21,960 --> 04:53:22,800 EARLY MORNING AWAKENINGS. 6900 04:53:22,800 --> 04:53:26,520 OR ALL THREE. 6901 04:53:26,520 --> 04:53:28,400 SO, THE ICSD REQUIRES AT LEAST 6902 04:53:28,400 --> 04:53:32,560 ONE, AND THERE BE AT LEAST ONE 6903 04:53:32,560 --> 04:53:33,200 CONSEQUENCE. 6904 04:53:33,200 --> 04:53:34,520 SOMETHING ABOUT FATIGUE, 6905 04:53:34,520 --> 04:53:35,480 COGNITIVE IMPAIRMENT, MOOD 6906 04:53:35,480 --> 04:53:36,920 ISSUES, ET CETERA. 6907 04:53:36,920 --> 04:53:39,760 THAT'S CLINICAL VIEW OF THIS 6908 04:53:39,760 --> 04:53:40,040 DISORDER. 6909 04:53:40,040 --> 04:53:41,720 AND DURATION OF AT LEAST THREE 6910 04:53:41,720 --> 04:53:45,680 MONTHS TO THINK ABOUT INSOMNIA 6911 04:53:45,680 --> 04:53:47,400 AS A DIAGNOSIS. 6912 04:53:47,400 --> 04:53:48,440 RISK FACTORS, THERE'S SO MUCH 6913 04:53:48,440 --> 04:53:50,640 WRITTEN ABOUT THIS. 6914 04:53:50,640 --> 04:53:52,800 THIS REALLY SUMS IT UP. 6915 04:53:52,800 --> 04:53:55,760 THERE'S EVERYTHING YOU CAN 6916 04:53:55,760 --> 04:53:59,160 IMAGINE LISTED ON THIS GRAPHIC. 6917 04:53:59,160 --> 04:54:03,840 HOST FACTORS, AGE, HERE WE GO 6918 04:54:03,840 --> 04:54:06,040 AGAIN, COMMON AGE. 6919 04:54:06,040 --> 04:54:06,840 COGNITIVE IMPAIRMENTS, 6920 04:54:06,840 --> 04:54:11,160 ENVIRONMENT PLAYS A ROLE, 6921 04:54:11,160 --> 04:54:12,080 MEDICATIONS. 6922 04:54:12,080 --> 04:54:13,600 SUBSTANCE ABUSE VERY CRITICAL. 6923 04:54:13,600 --> 04:54:17,400 OTHER SLEEP DISORDERS, THAT 6924 04:54:17,400 --> 04:54:20,040 COULD MANIFEST AS CHALLENGES 6925 04:54:20,040 --> 04:54:23,360 WITH MAINTAINING, EARLY MORNING 6926 04:54:23,360 --> 04:54:24,000 AWAKENING, BREATHING DISORDERS, 6927 04:54:24,000 --> 04:54:25,120 UNDERLYING CIRCADIAN ISSUES. 6928 04:54:25,120 --> 04:54:27,080 THINKING ABOUT A DISORDER LIKE 6929 04:54:27,080 --> 04:54:32,000 INSOMNIA WHAT IS IT GOING TO 6930 04:54:32,000 --> 04:54:34,120 SOMEONE WITH PH, NOT TO SAY IT 6931 04:54:34,120 --> 04:54:39,320 PAUSES PH BUT IF YOU HAVE 6932 04:54:39,320 --> 04:54:40,720 UNDERLYING SLEEP DIFFICULTY, 6933 04:54:40,720 --> 04:54:42,600 INSOMNIA FROM SOME ETIOLOGY, 6934 04:54:42,600 --> 04:54:43,880 WHATEVER IT MAY BE, WHAT DOES 6935 04:54:43,880 --> 04:54:47,680 THAT DO FROM THE STANDPOINT OF 6936 04:54:47,680 --> 04:54:48,800 YOU UNDERLYING PRIMARY DISORDER, 6937 04:54:48,800 --> 04:54:49,600 PULMONARY HYPERTENSION, WHICH 6938 04:54:49,600 --> 04:54:51,760 EVER GROUP YOU MAY FALL IN. 6939 04:54:51,760 --> 04:54:54,640 I LIKE THIS GRAPHIC BECAUSE THIS 6940 04:54:54,640 --> 04:54:56,360 GRAPHIC SAYS A LOT. 6941 04:54:56,360 --> 04:54:58,720 THE FOLKS THAT THINK ABOUT 6942 04:54:58,720 --> 04:55:01,800 INSOMNIA, THE WAY WE THINK ABOUT 6943 04:55:01,800 --> 04:55:04,280 NATURAL HISTORY, THERE'S GOT TO 6944 04:55:04,280 --> 04:55:07,040 BE A PREDISPOSING FACTOR, SOME 6945 04:55:07,040 --> 04:55:07,400 PREDISPOSITION. 6946 04:55:07,400 --> 04:55:09,200 SOMETHING TRIGGERS IT. 6947 04:55:09,200 --> 04:55:12,040 SOME PRECIPITATING FACTOR AND 6948 04:55:12,040 --> 04:55:13,560 SOMETHING TO PERPETUATE. 6949 04:55:13,560 --> 04:55:16,200 AGE IS CLEARLY AN IMPORTANT 6950 04:55:16,200 --> 04:55:16,480 DETERMINANT. 6951 04:55:16,480 --> 04:55:18,840 THERE'S HIGHER PREVALENCE OF 6952 04:55:18,840 --> 04:55:20,720 SLEEP-RELATED DIFFICULTY, I'LL 6953 04:55:20,720 --> 04:55:23,960 LEAVE IT AT THAT, IN OLDER 6954 04:55:23,960 --> 04:55:24,640 ADULTS. 6955 04:55:24,640 --> 04:55:26,800 SEX, HERE WE GO AGAIN WITH THE 6956 04:55:26,800 --> 04:55:30,560 MENOPAUSE ISSUE, FEMALE SEX IS 6957 04:55:30,560 --> 04:55:33,160 CLEAR-CUT UNDERLYING RISK 6958 04:55:33,160 --> 04:55:33,480 FACTOR. 6959 04:55:33,480 --> 04:55:35,000 MEDICAL CONDITIONS, PATIENTS 6960 04:55:35,000 --> 04:55:45,560 WITH HEART FAILURE, OF ANY SORT 6961 04:55:48,280 --> 04:55:51,320 , PSYCHIATRIC CONDITIONS, 6962 04:55:51,320 --> 04:55:52,960 PRESCRIPTION, SMOKING, ALCOHOL 6963 04:55:52,960 --> 04:55:54,720 OR DRUG USE, PSYCHOSOCIAL 6964 04:55:54,720 --> 04:55:58,480 STRESS, MANY IN COMBINATION OR 6965 04:55:58,480 --> 04:56:00,560 IN SOLITUDE CAN PREDISPOSE TO 6966 04:56:00,560 --> 04:56:01,080 INSOMNIA. 6967 04:56:01,080 --> 04:56:03,160 HOW COMMON? 6968 04:56:03,160 --> 04:56:04,200 TOO COMMON. 6969 04:56:04,200 --> 04:56:06,800 THE GRAPHIC IN THE MIDDLE FROM 6970 04:56:06,800 --> 04:56:08,320 NHLBI WEBSITE, YOU CAN BELIEVE 6971 04:56:08,320 --> 04:56:12,480 THESE DATA, ALMOST HALF OF US 6972 04:56:12,480 --> 04:56:16,960 HAVE SOME PROBLEM WITH 6973 04:56:16,960 --> 04:56:17,520 INSOMNIA. 6974 04:56:17,520 --> 04:56:21,480 PREGNANCY OF COURSE MAJOR ISSUE. 6975 04:56:21,480 --> 04:56:23,440 AGAIN PREVALENCE NEEDS TO EXCEED 6976 04:56:23,440 --> 04:56:26,280 THAT OF DISORDERED BREATHING 6977 04:56:26,280 --> 04:56:26,920 DISSLEEP. 6978 04:56:26,920 --> 04:56:28,120 HERE'S THE DEEP DOWN IN ALL 6979 04:56:28,120 --> 04:56:29,000 THIS. 6980 04:56:29,000 --> 04:56:32,040 THESE ARE DATA FROM THE NATIONAL 6981 04:56:32,040 --> 04:56:33,560 CENTER FOR HEALTH STATISTICS, 6982 04:56:33,560 --> 04:56:35,560 AVAILABLE ON THE WEB AND CDC 6983 04:56:35,560 --> 04:56:36,360 WEBSITE. 6984 04:56:36,360 --> 04:56:40,600 YOU CAN BREAK IT INTO SLEEP 6985 04:56:40,600 --> 04:56:41,600 ONSET INSOMNIA. 6986 04:56:41,600 --> 04:56:42,680 FALL ASLEEP MOST DAYS OR EVERY 6987 04:56:42,680 --> 04:56:45,640 DAY IN THE PAST 30 DAYS. 6988 04:56:45,640 --> 04:56:49,040 THERE'S CLEARLY AN AGE TREND, SO 6989 04:56:49,040 --> 04:56:51,000 SOME ISSUES ARE LESS COMMON, 6990 04:56:51,000 --> 04:56:53,400 WOMEN, HERE WE GO AGAIN WITH 6991 04:56:53,400 --> 04:56:55,480 GENDER DIFFERENCE, SEX 6992 04:56:55,480 --> 04:56:57,120 DIFFERENCE, CLEARLY RACE 6993 04:56:57,120 --> 04:56:57,560 DIFFERENCES. 6994 04:56:57,560 --> 04:56:58,400 NON-HISPANIC ASIANS DON'T HAVE 6995 04:56:58,400 --> 04:57:00,520 AS MUCH OF THIS PROBLEM AS SO 6996 04:57:00,520 --> 04:57:03,120 MANY OTHER RACIAL GROUPS. 6997 04:57:03,120 --> 04:57:08,360 NOW, THE STORY IS DIFFERENT WITH 6998 04:57:08,360 --> 04:57:09,280 MAINTENANCE INSOMNIA, OLDER AGE 6999 04:57:09,280 --> 04:57:11,360 GROUPS POP UP AND HOW COMMON 7000 04:57:11,360 --> 04:57:12,440 THIS IS. 7001 04:57:12,440 --> 04:57:16,600 THERE WE GO AGAIN WITH SEX, 7002 04:57:16,600 --> 04:57:18,600 WOMEN WITH HIGHER PREVALENCE OR 7003 04:57:18,600 --> 04:57:21,040 DIFFICULTY THAN OTHERS. 7004 04:57:21,040 --> 04:57:22,840 RACIAL DIFFERENCES EXIST. 7005 04:57:22,840 --> 04:57:25,920 NON-HISPANIC WHITES HIGHEST 7006 04:57:25,920 --> 04:57:27,760 PREVALENCE OF MAINTENANCE 7007 04:57:27,760 --> 04:57:29,720 PROBLEMS COMPARED TO OTHER 7008 04:57:29,720 --> 04:57:31,400 RACE/ETHNICITY GROUPS. 7009 04:57:31,400 --> 04:57:35,200 YOU CAN LOOK AT INSOMNIA BASED 7010 04:57:35,200 --> 04:57:37,080 ON SYMPTOMS AND PEOPLE HAVE DONE 7011 04:57:37,080 --> 04:57:39,360 THIS, USE OF SLEEP MEDICATIONS. 7012 04:57:39,360 --> 04:57:41,760 THIS IS, AGAIN, THE SAME 7013 04:57:41,760 --> 04:57:43,520 DATASETS WHERE YOU LOOK AT THE 7014 04:57:43,520 --> 04:57:44,840 USE OF MEDICATIONS EVERY DAY OR 7015 04:57:44,840 --> 04:57:48,480 MOST DAYS IN THE PAST 30 DAYS, 7016 04:57:48,480 --> 04:57:50,640 LOOKING AT AGE DISTRIBUTION. 7017 04:57:50,640 --> 04:57:52,040 VERY SIMPLE. 7018 04:57:52,040 --> 04:57:55,560 MEN VERSUS WOMEN, USE OF SLEEP 7019 04:57:55,560 --> 04:57:58,000 MEDICATIONS IS HIGHER, AS WE GET 7020 04:57:58,000 --> 04:57:58,640 OLDER. 7021 04:57:58,640 --> 04:58:00,840 WOMEN TEND TO BE HIGHER 7022 04:58:00,840 --> 04:58:02,480 UTILIZERS OF SLEEP MEDICATIONS 7023 04:58:02,480 --> 04:58:03,080 THAN MEN. 7024 04:58:03,080 --> 04:58:07,120 GLOBALLY IF YOU THINK ABOUT IT. 7025 04:58:07,120 --> 04:58:08,360 IT'S INTERESTING. 7026 04:58:08,360 --> 04:58:10,120 THERE ARE CORE COMPONENTS, 7027 04:58:10,120 --> 04:58:12,320 WHETHER AGE, SEX, AND THEY 7028 04:58:12,320 --> 04:58:13,840 PERMEATE THROUGH. 7029 04:58:13,840 --> 04:58:17,240 HERE THERE ARE CLEAR-CUT RACE 7030 04:58:17,240 --> 04:58:18,560 AND ETHNIC DIFFERENCE. 7031 04:58:18,560 --> 04:58:21,320 THERE'S A LOT OF SES FACTORS, 7032 04:58:21,320 --> 04:58:23,400 AND TAKE INTO ACCOUNT, BUT 7033 04:58:23,400 --> 04:58:26,440 CLEARLY THERE ARE VARIATIONS. 7034 04:58:26,440 --> 04:58:27,760 SAME DATA, SLEEP MEDICATIONS, IN 7035 04:58:27,760 --> 04:58:30,240 THE PAST 30 DAYS, NOW AS 7036 04:58:30,240 --> 04:58:32,480 FUNCTION OF RACE BUT IN MEN AND 7037 04:58:32,480 --> 04:58:32,880 WOMEN. 7038 04:58:32,880 --> 04:58:33,880 THERE ARE RACIAL DIFFERENCES IN 7039 04:58:33,880 --> 04:58:35,920 USE OF THESE. 7040 04:58:35,920 --> 04:58:37,720 AGAIN, SURROGATE MEASURE FOR 7041 04:58:37,720 --> 04:58:38,920 SLEEP-RELATED ISSUES. 7042 04:58:38,920 --> 04:58:40,440 THE POINT HERE IS EXACTLY WHAT 7043 04:58:40,440 --> 04:58:44,160 SUSAN AND ANNA WANTED ME TO DO, 7044 04:58:44,160 --> 04:58:45,760 WHAT IS THE DEMOGRAPHY OF 7045 04:58:45,760 --> 04:58:48,800 DISORDERS AND FACTORS WHEN YOU 7046 04:58:48,800 --> 04:58:50,640 THINK ABOUT THE PH WORLD MAYBE 7047 04:58:50,640 --> 04:58:53,400 MANY DON'T MATTER, MAYBE THEY 7048 04:58:53,400 --> 04:58:54,240 DO. 7049 04:58:54,240 --> 04:58:58,440 IT'S A DETERMINANT FROM 7050 04:58:58,440 --> 04:58:59,000 MODIFICATION. 7051 04:58:59,000 --> 04:59:01,840 HERE IS SOMETHING INTERESTING. 7052 04:59:01,840 --> 04:59:04,680 THESE ARE TRENDS, TREND AND 7053 04:59:04,680 --> 04:59:10,680 DISTURBANCES ON OLDER ADULTS, 60 7054 04:59:10,680 --> 04:59:12,760 OR MORE, WHAT'S FASCINATING, MEN 7055 04:59:12,760 --> 04:59:14,320 AND WOMEN, THERE SEEMS TO BE 7056 04:59:14,320 --> 04:59:15,920 AGAIN THAT TIME TREND. 7057 04:59:15,920 --> 04:59:18,320 THINGS ARE HAPPENING THAT ARE 7058 04:59:18,320 --> 04:59:21,800 MUCH MORE COMMONLY REPORTED OR 7059 04:59:21,800 --> 04:59:23,360 DIAGNOSED, IN ALL AGE GROUPS, 7060 04:59:23,360 --> 04:59:25,240 AND THERE'S A TREND WITH AGE AND 7061 04:59:25,240 --> 04:59:26,560 TREND WITH TIME. 7062 04:59:26,560 --> 04:59:31,160 THE BURDEN OF SLEEP DISORDER IS 7063 04:59:31,160 --> 04:59:32,880 IRRESPECTIVE OF MAN OR WOMEN, 7064 04:59:32,880 --> 04:59:35,840 THESE ARE DATA ALMOST A DECADE 7065 04:59:35,840 --> 04:59:36,160 OLD. 7066 04:59:36,160 --> 04:59:39,280 LET'S TRANSITION TO THE THIRD 7067 04:59:39,280 --> 04:59:40,120 DISORDER, SOMETHING THAT I 7068 04:59:40,120 --> 04:59:43,280 SUSPECT ALL OF US DO. 7069 04:59:43,280 --> 04:59:46,080 NOT SLEEP ENOUGH. 7070 04:59:46,080 --> 04:59:48,480 HERE IS WHAT'S THE RECOMMENDED 7071 04:59:48,480 --> 04:59:53,320 AMOUNT OF SLEEP ACROSS THE AGE 7072 04:59:53,320 --> 04:59:54,160 SPAN. 7073 04:59:54,160 --> 04:59:57,040 ADULTS, WHERE WE FALL, BETWEEN 7 7074 04:59:57,040 --> 04:59:59,520 OR 8, 8 1/2 KIND OF THING. 7075 04:59:59,520 --> 05:00:02,160 THERE'S A DOWNWARD TREND OVER 7076 05:00:02,160 --> 05:00:02,600 TIME. 7077 05:00:02,600 --> 05:00:04,880 THERE'S MAYBE APPROPRIATE, WHOLE 7078 05:00:04,880 --> 05:00:06,120 GRAY ZONE ABOUT NOT GETTING 7079 05:00:06,120 --> 05:00:07,840 ENOUGH OR GETTING TOO MUCH. 7080 05:00:07,840 --> 05:00:11,320 THIS IS A NICE PICTORIAL TO TALK 7081 05:00:11,320 --> 05:00:14,080 ABOUT WHERE WE NEED TO BE WITH 7082 05:00:14,080 --> 05:00:16,920 REGARDS TO EXPECTED OR HEALTHY 7083 05:00:16,920 --> 05:00:27,120 SLEEP DURATION. 7084 05:00:27,120 --> 05:00:29,720 YOU CAN SEE ABOUT 20 TO 30%, ON 7085 05:00:29,720 --> 05:00:31,920 THE LEFT SIDE, 30% OF US IN THE 7086 05:00:31,920 --> 05:00:38,240 U.S. POPULATION DO NOT HAVE 7087 05:00:38,240 --> 05:00:39,680 ENOUGH SLEEP, AND A PORTION OF 7088 05:00:39,680 --> 05:00:40,760 US GETTING TOO MUCH. 7089 05:00:40,760 --> 05:00:42,520 WE HAVE TO BE CAREFUL WHAT TOO 7090 05:00:42,520 --> 05:00:43,160 MUCH MEANS. 7091 05:00:43,160 --> 05:00:48,000 IS THAT JUST A MARKER OF 7092 05:00:48,000 --> 05:00:48,280 SOMETHING? 7093 05:00:48,280 --> 05:00:50,920 ON THE LEFT SIDE IS THE MORE 7094 05:00:50,920 --> 05:00:54,440 ACTION PLAY HERE, WHAT HAPPENS 7095 05:00:54,440 --> 05:00:57,600 WHEN A PATIENT FALLS IN THIS 7096 05:00:57,600 --> 05:01:01,320 GROUP, A PERSON WITH PH, WHERE 7097 05:01:01,320 --> 05:01:04,280 ARE EFFECTS OF CHRONICALLY SLEEP 7098 05:01:04,280 --> 05:01:06,160 DEPRIVED? 7099 05:01:06,160 --> 05:01:08,760 IT IS NOT WITHOUT ITS 7100 05:01:08,760 --> 05:01:09,080 CONSEQUENCES. 7101 05:01:09,080 --> 05:01:14,040 THERE'S SO MUCH KNOWN ABOUT 7102 05:01:14,040 --> 05:01:15,120 SYMPATHETIC ACTIVATION, 7103 05:01:15,120 --> 05:01:18,080 INFLAMMATORY RESPONSE, WEIGHT 7104 05:01:18,080 --> 05:01:22,320 GAIN, TONS, RISK FOR 7105 05:01:22,320 --> 05:01:23,440 HYPERTENSION, ET CETERA. 7106 05:01:23,440 --> 05:01:26,200 THE IDEA OF SHAPE DURATION IS 7107 05:01:26,200 --> 05:01:28,720 NOT A TRIVIAL THING THINKING 7108 05:01:28,720 --> 05:01:30,240 ABOUT OTHER COMORBID DISORDERS. 7109 05:01:30,240 --> 05:01:32,840 AGAIN, STAYING ON THE THEME OF 7110 05:01:32,840 --> 05:01:36,800 AGE, SEX, RACE, HOW DOES SLEEP 7111 05:01:36,800 --> 05:01:39,560 DURATION VARY AS A FUNCTION OF 7112 05:01:39,560 --> 05:01:40,000 AGE? 7113 05:01:40,000 --> 05:01:41,600 INSUFFICIENT SLEEP, AT LEAST 30% 7114 05:01:41,600 --> 05:01:45,240 OF US, UP TO 35% DEPENDING WHICH 7115 05:01:45,240 --> 05:01:50,920 AGE GROUP. 7116 05:01:50,920 --> 05:01:51,480 THERE'S AN AGE-RELATED 7117 05:01:51,480 --> 05:01:53,000 ASSOCIATION BETWEEN AMOUNT OF 7118 05:01:53,000 --> 05:01:56,480 SLEEP WE GET. 7119 05:01:56,480 --> 05:02:01,360 THIS MATTERS BECAUSE SOME PH 7120 05:02:01,360 --> 05:02:04,200 FALLS IN THIS CATEGORIZATION. 7121 05:02:04,200 --> 05:02:08,040 THIS IS A NICE GRAPHIC LOOKING 7122 05:02:08,040 --> 05:02:14,280 AT WHAT DOES THE WORLD DO? 7123 05:02:14,280 --> 05:02:16,000 MUCH OF EUROPE SEEMS TO BE 7124 05:02:16,000 --> 05:02:18,520 HANGING AROUND 7 OR SO HOURS. 7125 05:02:18,520 --> 05:02:19,960 YEAH, THERE ARE SOME AREAS 7126 05:02:19,960 --> 05:02:25,240 DIPPING DOWN TO LESS THAN 7, NOW 7127 05:02:25,240 --> 05:02:30,360 LET'S LOOK AT ASIAN CONTINENT. 7128 05:02:30,360 --> 05:02:36,160 INDIA 6 1/2. 7129 05:02:36,160 --> 05:02:38,360 6.4, JAPAN 6.3. 7130 05:02:38,360 --> 05:02:39,760 I'M SORRY, 6.2. 7131 05:02:39,760 --> 05:02:41,080 YOU CAN IMAGINE IF YOU START 7132 05:02:41,080 --> 05:02:42,200 GETTING DOWN TO AVERAGES BEING 7133 05:02:42,200 --> 05:02:44,080 THIS LOW THERE ARE GOING TO BE 7134 05:02:44,080 --> 05:02:45,360 SUBSETS MUCH LOWER THAN THAT. 7135 05:02:45,360 --> 05:02:47,080 WHAT ABOUT THE U.S.? 7136 05:02:47,080 --> 05:02:48,840 IT'S INTERESTING. 7137 05:02:48,840 --> 05:02:51,800 THIS IS IMPORTANT. 7138 05:02:51,800 --> 05:02:54,760 THERE ARE NOT JUST AGE-RELATED 7139 05:02:54,760 --> 05:02:56,600 TRENDS WITH SLEEP BUT ALSO 7140 05:02:56,600 --> 05:02:57,360 GEOGRAPHIC VARIATION. 7141 05:02:57,360 --> 05:03:00,240 WHAT YOU ALL MAY SEE IN THE 7142 05:03:00,240 --> 05:03:03,080 NORTH-NORTHEAST, WE MAY NOT 7143 05:03:03,080 --> 05:03:06,720 BECAUSE LOOK AT HOW -- PERCENT 7144 05:03:06,720 --> 05:03:08,120 OF ADULTS, FEWER THAN 7 HOURS ON 7145 05:03:08,120 --> 05:03:10,200 AVERAGE, LOOK AT THE HEAT MAP. 7146 05:03:10,200 --> 05:03:11,520 THERE'S A HUGE DENSE ACTIVE 7147 05:03:11,520 --> 05:03:13,920 INDIVIDUALS NOT SLEEPING ENOUGH 7148 05:03:13,920 --> 05:03:14,680 IN THIS AREA. 7149 05:03:14,680 --> 05:03:17,320 IF YOU LOOK AT MIDDLE AMERICA 7150 05:03:17,320 --> 05:03:19,040 YOU'RE LOOKING AT LOWER. 7151 05:03:19,040 --> 05:03:20,800 WHATEVER WE STUDY, WHEREVER WE 7152 05:03:20,800 --> 05:03:22,840 GO, THERE IS THIS REAL HARD CORE 7153 05:03:22,840 --> 05:03:24,840 ISSUE THAT'S GOING TO BE DOES IT 7154 05:03:24,840 --> 05:03:28,560 MATTER WHERE YOU ARE 7155 05:03:28,560 --> 05:03:29,040 GEOGRAPHICALLY? 7156 05:03:29,040 --> 05:03:30,880 DO TO PATIENTS WITH SIMILAR 7157 05:03:30,880 --> 05:03:32,560 DEGREE OF pH FOR EXAMPLE IN 7158 05:03:32,560 --> 05:03:34,160 MISSISSIPPI, IS THAT THE SAME 7159 05:03:34,160 --> 05:03:36,560 THING AS NEVADA WHERE THE 7160 05:03:36,560 --> 05:03:38,520 DENSITY OF SHORT SLEEP VERSUS 7161 05:03:38,520 --> 05:03:39,320 LESS? 7162 05:03:39,320 --> 05:03:42,240 SOMETHING TO THINK ABOUT. 7163 05:03:42,240 --> 05:03:47,040 HERE ARE THE MOST IMPORTANT, THE 7164 05:03:47,040 --> 05:03:48,040 HIGHEST AND LOWEST GETTING 7 7165 05:03:48,040 --> 05:03:51,800 HOURS OF SLEEP. 7166 05:03:51,800 --> 05:03:53,320 HIGHEST OVER WEST VIRGINIA, 7167 05:03:53,320 --> 05:03:56,480 KENTUCKY, HAWAII OF ALL PLACES. 7168 05:03:56,480 --> 05:03:58,040 PEOPLE IN COLORADO OR MINNESOTA 7169 05:03:58,040 --> 05:04:04,360 AND VERMONT SEEM TO BE NOT 7170 05:04:04,360 --> 05:04:04,760 AFFECTED. 7171 05:04:04,760 --> 05:04:07,280 AGAIN, THIS IS NOT JUST OLDER 7172 05:04:07,280 --> 05:04:07,840 INDIVIDUALS. 7173 05:04:07,840 --> 05:04:09,680 LOOK AT OUR TEENAGERS. 7174 05:04:09,680 --> 05:04:13,120 AGE 4 TO 17 BY STATE. 7175 05:04:13,120 --> 05:04:14,720 THIS IS HUGE DENSITY OF 7176 05:04:14,720 --> 05:04:15,920 TEENAGERS NOT SLEEPING ENOUGH, 7177 05:04:15,920 --> 05:04:18,360 AND THIS LOWER REGION OF THE 7178 05:04:18,360 --> 05:04:20,560 UNITED STATES. 7179 05:04:20,560 --> 05:04:22,720 SO REGIONAL DIFFERENCES IN WHAT 7180 05:04:22,720 --> 05:04:24,680 WE SEE, WHAT WE CHARACTERIZE, IF 7181 05:04:24,680 --> 05:04:26,560 YOU ARE GOING TO STUDY SLEEP AND 7182 05:04:26,560 --> 05:04:29,720 WHATEVER ELSE, IT'S GOING TO 7183 05:04:29,720 --> 05:04:29,960 MATTER. 7184 05:04:29,960 --> 05:04:32,440 I FOUND THIS TO BE FASCINATING, 7185 05:04:32,440 --> 05:04:35,280 TEMPORAL TRENDS OVER TIME BY ONE 7186 05:04:35,280 --> 05:04:37,360 OF MY OLD FELLOWS, AT WashU 7187 05:04:37,360 --> 05:04:39,240 NOW, DID WORK WITH THE ALAMEDA 7188 05:04:39,240 --> 05:04:42,760 COUNTY DATA LOOKING AT WHAT 7189 05:04:42,760 --> 05:04:44,080 HAPPENED FROM 1965 TO 1999. 7190 05:04:44,080 --> 05:04:47,000 AND WHAT SHE DID WAS REALLY 7191 05:04:47,000 --> 05:04:47,560 INTERESTING. 7192 05:04:47,560 --> 05:04:54,000 PLOTTED DATA AS FUNCTION OF 7193 05:04:54,000 --> 05:04:55,000 RACE, ETHNICITY, SOCIOECONOMIC 7194 05:04:55,000 --> 05:04:56,560 STATUS USING HIGH SCHOOL AS A 7195 05:04:56,560 --> 05:04:56,960 MARKER. 7196 05:04:56,960 --> 05:04:58,600 YOU SEE A PERFECT TEMPORAL 7197 05:04:58,600 --> 05:04:58,960 TREND. 7198 05:04:58,960 --> 05:05:03,080 LOOK AT THE GRAFT AND SEE. 7199 05:05:03,080 --> 05:05:03,840 SHORT SLEEPERS INCREASING, 7200 05:05:03,840 --> 05:05:05,040 WHETHER YOU'RE AN AFRICAN 7201 05:05:05,040 --> 05:05:06,840 AMERICAN, HISPANIC, THERE'S A 7202 05:05:06,840 --> 05:05:08,120 TEMPORAL TREND OVER TIME IN 7203 05:05:08,120 --> 05:05:09,240 SHORT SLEEP DURATION. 7204 05:05:09,240 --> 05:05:14,480 SLEEP FOLKS KNOW THIS WELL. 7205 05:05:14,480 --> 05:05:16,880 THERE ARE RACIAL DIFFERENCES AND 7206 05:05:16,880 --> 05:05:17,440 TEMPORAL TRENDS. 7207 05:05:17,440 --> 05:05:19,920 THERE'S A SHORT SLEEPER WITH A 7208 05:05:19,920 --> 05:05:21,920 COMPONENT OF SES STATUS AT LEAST 7209 05:05:21,920 --> 05:05:23,000 AS DETERMINED BY EDUCATION, 7210 05:05:23,000 --> 05:05:24,680 USING HIGH SCHOOL GRADUATION 7211 05:05:24,680 --> 05:05:27,520 VERSUS NOT, YOU CAN SEE HIGHER 7212 05:05:27,520 --> 05:05:29,240 SES STATUS USING HIGH SCHOOL 7213 05:05:29,240 --> 05:05:31,120 MEASUREMENT ASSOCIATED WITH 7214 05:05:31,120 --> 05:05:35,080 LOWER PREVALENCE OF SHORT SLEEP 7215 05:05:35,080 --> 05:05:35,360 DURATION. 7216 05:05:35,360 --> 05:05:37,120 >>WE'RE RUNNING LATE. 7217 05:05:37,120 --> 05:05:40,040 WOULD YOU ABLE TO QUICKLY WRAP 7218 05:05:40,040 --> 05:05:40,240 UP. 7219 05:05:40,240 --> 05:05:42,840 >>MY LAST ONE OR TWO SLIDES AND 7220 05:05:42,840 --> 05:05:48,200 I WILL WRAP UP. 7221 05:05:48,200 --> 05:05:50,600 SES, RACIAL DIFFERENCES, WE'RE 7222 05:05:50,600 --> 05:05:51,800 WATCHING TV AND STREAMING. 7223 05:05:51,800 --> 05:05:53,920 IT'S GOING TO GET WORSE. 7224 05:05:53,920 --> 05:05:58,800 JUST QUICKLY IN THE LAST MINUTE, 7225 05:05:58,800 --> 05:06:02,080 I HAVE NO EXPERTISE IN PH, 7226 05:06:02,080 --> 05:06:07,440 THERE'S RACIAL DIFFERENCES AT 7227 05:06:07,440 --> 05:06:08,800 GROUP 1, FEMALE PREDOMINANCE BUT 7228 05:06:08,800 --> 05:06:11,640 WE DON'T KNOW MUCH ELSE ABOUT 7229 05:06:11,640 --> 05:06:14,040 THE DEMOGRAPHY. 7230 05:06:14,040 --> 05:06:16,840 HERE IS RACIAL DATA. 7231 05:06:16,840 --> 05:06:18,840 IF YOU LOOK, THERE'S SOME 7232 05:06:18,840 --> 05:06:20,680 DISTRIBUTION BUT THERE'S NOT 7233 05:06:20,680 --> 05:06:22,200 CONSISTENCY AMONG WHAT'S 7234 05:06:22,200 --> 05:06:24,080 HAPPENING WITH MINORITY GROUPS. 7235 05:06:24,080 --> 05:06:29,440 MY LAST TWO SLIDES GROUP 3 7236 05:06:29,440 --> 05:06:30,840 DEMOGRAPHY OF THIS PH IS TOUGH, 7237 05:06:30,840 --> 05:06:32,600 HOW DO YOU DESCRIBE THE 7238 05:06:32,600 --> 05:06:35,680 DEMOGRAPHY OF COPD AND ALL THE 7239 05:06:35,680 --> 05:06:38,520 DIFFERENT THINGS THAT HAVE BEEN 7240 05:06:38,520 --> 05:06:39,200 DISCUSSED. 7241 05:06:39,200 --> 05:06:40,280 CLEARLY AGE, SEX, RACE, MATTER 7242 05:06:40,280 --> 05:06:42,160 FOR ALL THESE THINGS. 7243 05:06:42,160 --> 05:06:48,040 I THINK THE GROUP 3, AN EXAMPLE 7244 05:06:48,040 --> 05:06:51,760 OF PH RELATED TO PNEUMONIAS, 7245 05:06:51,760 --> 05:06:54,200 GROUP 3, DEMOGRAPHY WILL MATTER. 7246 05:06:54,200 --> 05:06:57,120 I'LL SAY, LOOK, WE KNOW 7247 05:06:57,120 --> 05:06:58,440 EPIDEMIOLOGY OF SLEEP DISORDERS, 7248 05:06:58,440 --> 05:07:01,520 THINGS THAT DETERMINE SOME OF 7249 05:07:01,520 --> 05:07:02,600 THESE THINGS, APNEA, INSOMNIA, 7250 05:07:02,600 --> 05:07:03,800 SHORT SLEEP DURATION. 7251 05:07:03,800 --> 05:07:05,160 WE DON'T HAVE AS MUCH 7252 05:07:05,160 --> 05:07:05,760 UNDERSTANDING WHAT'S HAPPENING 7253 05:07:05,760 --> 05:07:07,880 WITH GROUP 1. 7254 05:07:07,880 --> 05:07:09,960 WE HAVE SOME IDEAP GROUP 3 7255 05:07:09,960 --> 05:07:10,520 BECAUSE IT'S DIVERSE. 7256 05:07:10,520 --> 05:07:13,120 I WANT TO LEAVE YOU WITH I'M 7257 05:07:13,120 --> 05:07:15,840 CURIOUS WHEN YOU HAVE THESE 7258 05:07:15,840 --> 05:07:18,160 DISORDERS DOES IT MAKE THE 7259 05:07:18,160 --> 05:07:19,240 OUTCOMES WORSE? 7260 05:07:19,240 --> 05:07:21,120 THANK YOU, SORRY FOR RUNNING 7261 05:07:21,120 --> 05:07:21,320 OVER. 7262 05:07:21,320 --> 05:07:24,440 >>THANK YOU. 7263 05:07:24,440 --> 05:07:26,480 THAT WAS A VERY FORWARD AND 7264 05:07:26,480 --> 05:07:28,040 PROVOCATIVE TALK. 7265 05:07:28,040 --> 05:07:28,880 WE APPRECIATE IT. 7266 05:07:28,880 --> 05:07:31,480 PROBABLY I'M TO BLAME FOR THE 7267 05:07:31,480 --> 05:07:34,040 CHARGE WE GAVE YOU BUT HOPE WE 7268 05:07:34,040 --> 05:07:36,240 CAN BRING YOUR GREAT IDEAS INTO 7269 05:07:36,240 --> 05:07:37,640 THE DISCUSSION, ESPECIALLY HOW 7270 05:07:37,640 --> 05:07:39,760 WE THINK ABOUT RACE, ETHNICITY, 7271 05:07:39,760 --> 05:07:40,720 SES, SOCIAL DETERMINANTS OF 7272 05:07:40,720 --> 05:07:43,000 HEALTH, DEAL WITH THAT LATER. 7273 05:07:43,000 --> 05:07:46,200 BECAUSE WE'RE RUNNING OUT OF 7274 05:07:46,200 --> 05:07:56,640 TIME LET'S MOVE TO DR. KARA 7275 05:07:57,840 --> 05:08:03,480 GOSS, PEDIATRICIAN, LIFETIME 7276 05:08:03,480 --> 05:08:03,720 APPROACH. 7277 05:08:03,720 --> 05:08:04,280 >>THANK YOU. 7278 05:08:04,280 --> 05:08:10,080 I HAD A LITTLE BIT OF SIMILAR 7279 05:08:10,080 --> 05:08:12,280 FEELINGS ABOUT THE SCOPE OF THE 7280 05:08:12,280 --> 05:08:13,680 TOPIC, THINKING ABOUT TALKING 7281 05:08:13,680 --> 05:08:14,360 ABOUT DEVELOPMENTAL LUNG DISEASE 7282 05:08:14,360 --> 05:08:20,240 AND HOW THAT WAS GOING TO IMPACT 7283 05:08:20,240 --> 05:08:28,800 THE RISK FOR PULMONARY VASCULAR 7284 05:08:28,800 --> 05:08:29,280 DEVELOPMENT. 7285 05:08:29,280 --> 05:08:31,200 ADULT PULMONARY TRAINED, FOCUS 7286 05:08:31,200 --> 05:08:32,480 ON LIFESPAN IMPACT, PARTICULARLY 7287 05:08:32,480 --> 05:08:35,800 PRE-TERM BIRTH, HOW I ENDED UP 7288 05:08:35,800 --> 05:08:37,000 IN THESE TRANSITIONAL TOPICS. 7289 05:08:37,000 --> 05:08:38,520 WHEN I STARTED THINKING ABOUT 7290 05:08:38,520 --> 05:08:41,840 THE TOPIC AT HAND, INITIALLY I 7291 05:08:41,840 --> 05:08:45,880 TURNED TO THE PARADIGM PUT 7292 05:08:45,880 --> 05:08:48,520 TOGETHER SEVERAL YEARS AGO, THIS 7293 05:08:48,520 --> 05:08:51,160 IDEA THAT EARLY LIFE INSULT OR 7294 05:08:51,160 --> 05:08:53,920 INJURIES COULD IMPACT TOTAL 7295 05:08:53,920 --> 05:08:55,320 OVERALL PULMONARY VASCULAR 7296 05:08:55,320 --> 05:08:55,600 ENDOWMENT. 7297 05:08:55,600 --> 05:08:59,360 THIS IDEA NORMAL INDIVIDUAL 7298 05:08:59,360 --> 05:09:01,840 WOULD HAVE NORMAL GROWTH AND 7299 05:09:01,840 --> 05:09:06,280 AGING, BUT THOSE WITH EARLIER 7300 05:09:06,280 --> 05:09:07,200 VASCULAR DEVELOPMENT, PERINATAL 7301 05:09:07,200 --> 05:09:09,240 OR GENETIC OR EPIGENETIC RISK 7302 05:09:09,240 --> 05:09:14,480 FACTORS, EPIGENETIC GOT ME 7303 05:09:14,480 --> 05:09:17,120 THINKING ABOUT THE INTRACELLULAR 7304 05:09:17,120 --> 05:09:19,840 CLOCK AND SUSCEPTIBLE TO 7305 05:09:19,840 --> 05:09:21,160 SECONDARY INSULT, HYPOXIA BEING 7306 05:09:21,160 --> 05:09:25,760 ONE WE PROPOSED EVEN LED TO LEAD 7307 05:09:25,760 --> 05:09:27,720 ON DECREASE IN ADULT PULMONARY 7308 05:09:27,720 --> 05:09:29,920 VASCULAR ENDOWMENT AND RISK FOR 7309 05:09:29,920 --> 05:09:30,600 DISEASE. 7310 05:09:30,600 --> 05:09:32,320 THIS IS THE PARADIGM TO THINK 7311 05:09:32,320 --> 05:09:32,520 ABOUT. 7312 05:09:32,520 --> 05:09:37,240 BEFORE I CAN GO ON I WANT TO PUT 7313 05:09:37,240 --> 05:09:39,240 FORTH A COUPLE CAFFANTS. 7314 05:09:39,240 --> 05:09:41,080 FIRST THAT FIGURE IS A 7315 05:09:41,080 --> 05:09:43,200 HYPOTHETICAL FIGURE THAT I WOULD 7316 05:09:43,200 --> 05:09:46,560 SAY MIRRORS WHAT WE KNOW ABOUT 7317 05:09:46,560 --> 05:09:48,200 BUNKS FUNCTION DATA, SPIRO 7318 05:09:48,200 --> 05:09:51,520 METRIC DATA, BECAUSE WE'RE 7319 05:09:51,520 --> 05:09:53,480 FAIRLY LACKING IN NORMATIVE 7320 05:09:53,480 --> 05:09:56,560 PULMONARY GROWTH DATA, WE DON'T 7321 05:09:56,560 --> 05:09:59,080 CT SCAN CHILDREN ROUTINELY, 7322 05:09:59,080 --> 05:10:02,000 DON'T HAVE GREAT METRICS, TO 7323 05:10:02,000 --> 05:10:03,240 TRACK EVEN NORMAL PULMONARY 7324 05:10:03,240 --> 05:10:04,400 VASCULAR GROWTH OVER TIME. 7325 05:10:04,400 --> 05:10:07,200 BUT WE DO KNOW VERY WELL FROM 7326 05:10:07,200 --> 05:10:09,280 ANIMAL STUDIES IN PARTICULAR 7327 05:10:09,280 --> 05:10:11,040 THAT PULMONARY VASCULAR AND 7328 05:10:11,040 --> 05:10:13,000 ALVEOLAR GROWTH ARE INTEGRALLY 7329 05:10:13,000 --> 05:10:13,240 LINKED. 7330 05:10:13,240 --> 05:10:17,040 IF WE INHIBIT AIR SPACE, WE ALSO 7331 05:10:17,040 --> 05:10:22,520 INHIBIT VASCULAR DEVELOPMENT AND 7332 05:10:22,520 --> 05:10:27,560 VICE VERSA AND PRESUME THEY TACK 7333 05:10:27,560 --> 05:10:29,520 TOGETHER AND WOULD MIRROR OUR 7334 05:10:29,520 --> 05:10:37,600 SPIROMETRIC DATA WE HAVE MORE 7335 05:10:37,600 --> 05:10:38,480 READILY AVAILABLE. 7336 05:10:38,480 --> 05:10:40,440 WE CAN THINK ABOUT DISEASE 7337 05:10:40,440 --> 05:10:42,840 STATES IMPACTING US, FOCUS THE 7338 05:10:42,840 --> 05:10:43,720 SECOND TRIMESTER ONWARD BECAUSE 7339 05:10:43,720 --> 05:10:46,480 THAT'S WHERE WE END UP WITH 7340 05:10:46,480 --> 05:10:48,000 BABIES BORN PRE-TERM WITH 7341 05:10:48,000 --> 05:10:52,840 VIABILITY BEING AT 22 WEEKS, AT 7342 05:10:52,840 --> 05:10:55,680 THAT 22+ WEEK TIME POINT, WE'VE 7343 05:10:55,680 --> 05:10:58,600 GOT ALVEOLAR DUCTS AND AIR 7344 05:10:58,600 --> 05:11:07,480 SPACES, AIRWAYS FORMED, A 7345 05:11:07,480 --> 05:11:08,360 FAIRLY IMMATURE PULMONARY TREE, 7346 05:11:08,360 --> 05:11:10,000 VASCULAR TREE. 7347 05:11:10,000 --> 05:11:12,400 I ALSO ADDED IN HERE CONTROL OF 7348 05:11:12,400 --> 05:11:15,240 BREATHING, HOW IMPAIRED THAT IS 7349 05:11:15,240 --> 05:11:17,320 IN THE CONTEXT OF OUR EXTREMELY 7350 05:11:17,320 --> 05:11:18,960 PRE-TERM BABIES. 7351 05:11:18,960 --> 05:11:21,600 SO THEY DO HAVE DIAPHRAGMATIC 7352 05:11:21,600 --> 05:11:23,360 MOVEMENT STARTING EARLY ON BUT 7353 05:11:23,360 --> 05:11:25,240 AS THE SECOND TRIMESTER TIME 7354 05:11:25,240 --> 05:11:27,720 THEY ARE JUST DEVELOPING CHEMO 7355 05:11:27,720 --> 05:11:29,080 RECEPTOR SENSITIVITY TO CO2, 7356 05:11:29,080 --> 05:11:29,680 THAT CONTINUES TO PROGRESS 7357 05:11:29,680 --> 05:11:33,760 THROUGH THE END OF THE THIRD 7358 05:11:33,760 --> 05:11:34,320 TRIMESTER. 7359 05:11:34,320 --> 05:11:36,960 THEY WON'T DEVELOP NORMAL CHEMO 7360 05:11:36,960 --> 05:11:38,360 RECEPTOR SENSITIVITY TO OXYGEN 7361 05:11:38,360 --> 05:11:39,280 UNTIL BIRTH. 7362 05:11:39,280 --> 05:11:41,760 SO FOR A NORMAL TERM BORN BABY 7363 05:11:41,760 --> 05:11:43,520 THAT'S HAPPENING AT BIRTH. 7364 05:11:43,520 --> 05:11:46,040 FOR PRE-TERM THEY HAVE TO BEGIN 7365 05:11:46,040 --> 05:11:48,320 TO DEVELOP SENSITIVITY TO OXYGEN 7366 05:11:48,320 --> 05:11:50,640 WHICH I THINK IMPARTS SOME 7367 05:11:50,640 --> 05:11:52,080 BREATHING AND SLEEP DISORDERED 7368 05:11:52,080 --> 05:11:54,880 ISSUES THAT WE SEE LATER. 7369 05:11:54,880 --> 05:11:56,280 HOWEVER, AS THESE BABIES AGE WE 7370 05:11:56,280 --> 05:12:00,040 END UP WITH A SINGLE LAYER 7371 05:12:00,040 --> 05:12:01,560 CAPILLARY NETWORK, WITHIN THE 7372 05:12:01,560 --> 05:12:03,520 PULMONARY VASCULAR TREE MORE 7373 05:12:03,520 --> 05:12:05,760 EFFICIENT FOR GAS EXCHANGE 7374 05:12:05,760 --> 05:12:06,600 ESSENTIALLY SHORTENING DIFFUSION 7375 05:12:06,600 --> 05:12:09,360 SPACE THERE AND AS THESE BABIES 7376 05:12:09,360 --> 05:12:11,760 ARE AGING INTO EARLY CHILDHOOD 7377 05:12:11,760 --> 05:12:13,760 WE HAVE MORE SOMATIC GROWTH 7378 05:12:13,760 --> 05:12:17,000 WHICH IS VOLUMETRIC OF AIR 7379 05:12:17,000 --> 05:12:17,720 SPACES AND PRESUME SIMILARLY 7380 05:12:17,720 --> 05:12:19,080 WHAT'S HAPPENING IN THE BLOOD 7381 05:12:19,080 --> 05:12:20,720 VESSELS BUT REALLY DON'T HAVE A 7382 05:12:20,720 --> 05:12:21,840 LOT OF NORMATIVE DATA THERE SO 7383 05:12:21,840 --> 05:12:23,800 THAT REALLY IS A FAIRLY LARGE 7384 05:12:23,800 --> 05:12:25,320 KNOWLEDGE GAP TO BE ABLE TO 7385 05:12:25,320 --> 05:12:28,400 THINK ABOUT EARLY LIFE EVENTS 7386 05:12:28,400 --> 05:12:29,600 IMPACTING OVERALL DEVELOPMENT. 7387 05:12:29,600 --> 05:12:32,120 I WANT TO PROPOSE THAT TIMING OF 7388 05:12:32,120 --> 05:12:34,280 INJURY IS KEY HERE. 7389 05:12:34,280 --> 05:12:38,120 SO BREAK THIS DOWN IN TWO 7390 05:12:38,120 --> 05:12:39,000 POTENTIAL WINDOWS. 7391 05:12:39,000 --> 05:12:40,760 FIRST IS THAT FOR IMPAIRED 7392 05:12:40,760 --> 05:12:43,360 DEVELOPMENT, THIS IS DURING THAT 7393 05:12:43,360 --> 05:12:45,360 EARLY WINDOW IN UTERO WHERE WE 7394 05:12:45,360 --> 05:12:49,480 HAVE REALLY OUR ACTIVE AND 7395 05:12:49,480 --> 05:12:50,800 ONGOING PULMONARY ALVEOLAR AND 7396 05:12:50,800 --> 05:12:52,600 CONTROL OF BREATHING 7397 05:12:52,600 --> 05:12:53,080 DEVELOPMENT. 7398 05:12:53,080 --> 05:12:55,080 SO THE INJURY PATTERNS THAT WE 7399 05:12:55,080 --> 05:12:56,760 WOULD SEE DISEASE STATES IN THAT 7400 05:12:56,760 --> 05:13:03,480 CASE WOULD BE EXTREME 7401 05:13:03,480 --> 05:13:04,800 PREMATURITY, BRONCHOPULMONARY 7402 05:13:04,800 --> 05:13:06,720 DYSPLASIA, NOT OCCURRING WITH 7403 05:13:06,720 --> 05:13:11,120 ALL INFANTS, DOWN SYNDROME AN 7404 05:13:11,120 --> 05:13:12,120 CONGENITAL DIAPHRAGMATIC HERNIA 7405 05:13:12,120 --> 05:13:14,560 AND FROM AGE 2 TO 3 UP TO AGE 20 7406 05:13:14,560 --> 05:13:19,000 WHERE WE HAVE A REALLY RAPID 7407 05:13:19,000 --> 05:13:20,440 PERIOD OF LUNG GROWTH, PROPOSED 7408 05:13:20,440 --> 05:13:22,040 POTENTIAL DISEASE STATES THAT WE 7409 05:13:22,040 --> 05:13:25,840 COULD SEE IMPAIRED GROWTH BEING 7410 05:13:25,840 --> 05:13:27,840 INVOLVED WOULD BE SICKLE CELL 7411 05:13:27,840 --> 05:13:29,240 DISEASE, CHILD INTERSTITIAL LUNG 7412 05:13:29,240 --> 05:13:29,520 DISEASES. 7413 05:13:29,520 --> 05:13:33,200 WE'RE GOING TO FOCUS ON TWO 7414 05:13:33,200 --> 05:13:36,680 EXAMPLES OF DISEASES, STARTING 7415 05:13:36,680 --> 05:13:38,880 WITH BRONCHOPULMONARY DYSPLASIA. 7416 05:13:38,880 --> 05:13:41,920 SORT OF THIS IDEA, PARADIGM 7417 05:13:41,920 --> 05:13:44,920 SHIFTS TO DISRUPTED VASCULAR 7418 05:13:44,920 --> 05:13:46,960 DEVELOPMENT, DISRUPTED VASCULAR 7419 05:13:46,960 --> 05:13:48,600 GROWTH, AND POTENTIAL FOR SLEEP 7420 05:13:48,600 --> 05:13:49,480 DISORDERED BREATHING IN EITHER 7421 05:13:49,480 --> 05:13:50,920 ONE OF THE TIME PERIODS WHEN WE 7422 05:13:50,920 --> 05:13:59,560 SEE THAT OR TO OCCUR LATE. 7423 05:13:59,560 --> 05:14:01,320 FOLKS TO BE SYNERGISTIC IN 7424 05:14:01,320 --> 05:14:02,520 PATHOGENESIS FOR EITHER ONE OF 7425 05:14:02,520 --> 05:14:05,800 THE TWO DISEASES THAT WE'RE 7426 05:14:05,800 --> 05:14:06,560 DISCUSSING. 7427 05:14:06,560 --> 05:14:08,880 WE'LL TALK ABOUT BPD FIRST, NOT 7428 05:14:08,880 --> 05:14:10,400 TOO MANY PEDIATRICIANS ON THE 7429 05:14:10,400 --> 05:14:14,640 CALL AND SO VERY BRIEFLY TO 7430 05:14:14,640 --> 05:14:16,120 UNDERSTAND WHAT IT IS, AT THE 7431 05:14:16,120 --> 05:14:21,560 MOST BASIC LEVEL THIS IS A REST 7432 05:14:21,560 --> 05:14:25,760 IN ALVEOLAR AND VASCULAR 7433 05:14:25,760 --> 05:14:26,800 DEVELOPMENT, 22, 23, 24 WEEKS 7434 05:14:26,800 --> 05:14:29,400 BEING OUR MOST COMMON GROUP TO 7435 05:14:29,400 --> 05:14:32,360 DEVELOP THIS, AND DECREASING IN 7436 05:14:32,360 --> 05:14:35,880 FREQUENCY AS WE APPROACH SORT OF 7437 05:14:35,880 --> 05:14:37,520 EARLY TO MID-30s FOR 7438 05:14:37,520 --> 05:14:39,160 GESTATIONAL AGE. 7439 05:14:39,160 --> 05:14:42,920 IT'S DEFINED CLINICALLY BY THE 7440 05:14:42,920 --> 05:14:46,200 OXYGEN REQUIREMENTS, THE DISEASE 7441 05:14:46,200 --> 05:14:47,200 DIAGNOSTIC THRESHOLDS HAVE 7442 05:14:47,200 --> 05:14:53,200 VARIED OVER TIME BUT THESE ARE 7443 05:14:53,200 --> 05:14:54,840 BABIES REQUIRING OXYGEN AND THEY 7444 05:14:54,840 --> 05:14:58,240 SHOULD BE DEVELOPING NORMAL AIR 7445 05:14:58,240 --> 05:14:59,120 SPACES, AIR DUCTS, VASCULATURE 7446 05:14:59,120 --> 05:15:00,400 AND SO FORTH. 7447 05:15:00,400 --> 05:15:06,240 THESE BABIES ARE EXPOSED TO 7448 05:15:06,240 --> 05:15:07,120 VENTILATION OXIDATIVE STRESS, 7449 05:15:07,120 --> 05:15:10,720 GOING ON TO DEVELOP ABNORMAL 7450 05:15:10,720 --> 05:15:13,760 VASCULATURE AND AIR SPACES HERE 7451 05:15:13,760 --> 05:15:15,880 SHOWN LOOKS LIKE ADULT COPD, 7452 05:15:15,880 --> 05:15:18,600 ENLARGED AIR SPACES THAT THESE 7453 05:15:18,600 --> 05:15:21,000 BABIES CAN DEVELOP. 7454 05:15:21,000 --> 05:15:23,400 THAT'S BPD 7455 05:15:23,400 --> 05:15:25,960 WHAT ABOUT BPD AND PULMONARY 7456 05:15:25,960 --> 05:15:29,320 HYPERTENSION IN PRE-TERM BIRTH? 7457 05:15:29,320 --> 05:15:31,960 THERE IS THE COLORADO AND 7458 05:15:31,960 --> 05:15:33,360 INDIANA DATA COMBINED. 7459 05:15:33,360 --> 05:15:35,400 WITH BABIES WHO ARE BORN 7460 05:15:35,400 --> 05:15:37,280 GENERALLY LESS THAN 32 WEEKS, 7461 05:15:37,280 --> 05:15:40,200 LESS THAN 1500 GRAMS, IF YOU 7462 05:15:40,200 --> 05:15:41,440 LOOK OVERALL THERE ARE A 7463 05:15:41,440 --> 05:15:44,160 PERCENTAGE OF THEM WHO DO NOT 7464 05:15:44,160 --> 05:15:47,280 HAVE BPD AND DEVELOP PULMONARY 7465 05:15:47,280 --> 05:15:50,080 HYPERTENSION ANYWAYS BUT OVERALL 7466 05:15:50,080 --> 05:15:56,440 PBD AND PH CO-ASSOCIATE 7467 05:15:56,440 --> 05:15:56,720 FREQUENTLY. 7468 05:15:56,720 --> 05:16:00,160 IF YOU TAKE ALL COMERS HERE, 7469 05:16:00,160 --> 05:16:01,920 SOME IN THE MID-TEENS AS FAR AS 7470 05:16:01,920 --> 05:16:04,760 INCIDENCE RATE IN THESE BABIES. 7471 05:16:04,760 --> 05:16:07,400 WHAT ABOUT SLEEP DISORDER 7472 05:16:07,400 --> 05:16:08,560 BREATHING? 7473 05:16:08,560 --> 05:16:09,600 IT'S UBIQUITOUS. 7474 05:16:09,600 --> 05:16:12,560 I MENTIONED CONTROL OF BREATHING 7475 05:16:12,560 --> 05:16:13,200 IS PRE-DEVELOPMENTAL AND THERE'S 7476 05:16:13,200 --> 05:16:15,400 A LOT OF REASONS FOR THESE 7477 05:16:15,400 --> 05:16:18,880 BABIES TO HAVE ISSUES, PERIODIC 7478 05:16:18,880 --> 05:16:24,480 BREATHING CAN COMMON, ABNORMAL 7479 05:16:24,480 --> 05:16:26,760 BREATHING PATTERNS, APNEA 7480 05:16:26,760 --> 05:16:27,880 PREMATURITY, A 20-SECOND PAUSE, 7481 05:16:27,880 --> 05:16:30,920 MOST OF THESE ARE CENTRAL 7482 05:16:30,920 --> 05:16:40,120 APNEAS, AGAIN LARGELY RELATED TO 7483 05:16:40,120 --> 05:16:41,760 CHEMO RECEPTOR SENSITIVITY. 7484 05:16:41,760 --> 05:16:45,520 POTENTIAL OBSTRUCTIVE BE A KNEE 7485 05:16:45,520 --> 05:16:56,080 A, NASAL BREATHERS, THEY -- TWO 7486 05:16:59,120 --> 05:16:59,520 DISEASES. 7487 05:16:59,520 --> 05:17:00,960 WHAT HAPPENS WHEN THEY CONVERGE? 7488 05:17:00,960 --> 05:17:03,560 A NICE PAPER OUT FROM EARLIER 7489 05:17:03,560 --> 05:17:08,360 THIS YEAR STUDYING 40 PATIENTS 7490 05:17:08,360 --> 05:17:13,240 WITH BPD AND DIAGNOSIS OF 7491 05:17:13,240 --> 05:17:14,840 PULMONARY HYPERTENSION. 7492 05:17:14,840 --> 05:17:16,400 THEY ARE WATCHING DESATURATION 7493 05:17:16,400 --> 05:17:20,320 RATE ON THE MONITORS, RATES OF 7494 05:17:20,320 --> 05:17:20,960 INTERMITTENT HYPOXIA. 7495 05:17:20,960 --> 05:17:23,600 WHEN THEY LOOK AT FREQUENCY THEY 7496 05:17:23,600 --> 05:17:25,680 WERE SIMILAR BETWEEN THE TWO 7497 05:17:25,680 --> 05:17:28,280 GROUPS, BUT THOSE BABIES WHO HAD 7498 05:17:28,280 --> 05:17:30,880 BPD WITH PULMONARY HYPERTENSION 7499 05:17:30,880 --> 05:17:32,520 HAD SIGNIFICANTLY LONGER 7500 05:17:32,520 --> 05:17:33,880 DURATION OF HYPOXIA, AND 7501 05:17:33,880 --> 05:17:36,160 ACTUALLY THIS WAS A MORTALITY 7502 05:17:36,160 --> 05:17:38,240 PREDICTOR AS WELL, SO DEPENDING 7503 05:17:38,240 --> 05:17:41,760 HOW THEY SET THE THRESHOLD WITH 7504 05:17:41,760 --> 05:17:43,360 EVENT DURATION, SATURATIONS LESS 7505 05:17:43,360 --> 05:17:45,160 THAN 70% HERE, THEY HAVE A 7506 05:17:45,160 --> 05:17:47,000 PRETTY GOOD AREA UNDER THE CURVE 7507 05:17:47,000 --> 05:17:50,960 TO BE ABLE TO DETECT INFANTS WHO 7508 05:17:50,960 --> 05:17:54,640 WOULD NOT SURVIVE NEONATAL TIME 7509 05:17:54,640 --> 05:17:54,840 FRAME. 7510 05:17:54,840 --> 05:17:57,400 FORTUNATELY MANY OF THESE BABIES 7511 05:17:57,400 --> 05:17:59,040 DO SURVIVE NEONATAL TIME FRAME, 7512 05:17:59,040 --> 05:18:01,120 AND THIS IS A STUDY I WANTED TO 7513 05:18:01,120 --> 05:18:09,320 SHARE, ONE OF THE LARGER 7514 05:18:09,320 --> 05:18:11,840 STUDIES, CHILDREN WHO HAD ALSO 7515 05:18:11,840 --> 05:18:15,200 HAD AN ECHO RECENTLY, THEY 7516 05:18:15,200 --> 05:18:16,320 LOOKED AT INDIVIDUALSA PULMONARY 7517 05:18:16,320 --> 05:18:21,280 HYPERTENSION WAS PRESENT IN 4%, 7518 05:18:21,280 --> 05:18:23,000 ECHO-BASED METRICS SUGGESTIVE OF 7519 05:18:23,000 --> 05:18:24,640 4% OF CHILDREN, NOT COMMON 7520 05:18:24,640 --> 05:18:26,520 COMORBIDITY IN ALL CHILDREN AT 7521 05:18:26,520 --> 05:18:28,600 LARGE BUT WHEN THEY LOOKED 7522 05:18:28,600 --> 05:18:30,560 SPECIFICALLY AT PULMONARY 7523 05:18:30,560 --> 05:18:33,840 HYPERTENSION WAS A MAJOR RISK 7524 05:18:33,840 --> 05:18:36,360 FACTOR FOR PULMONARY 7525 05:18:36,360 --> 05:18:39,400 HYPERTENSION IN A GROUP WITH 7526 05:18:39,400 --> 05:18:40,520 SLEEP DISORDERED BREATHING AND 7527 05:18:40,520 --> 05:18:40,720 OSA. 7528 05:18:40,720 --> 05:18:43,320 WHAT HAPPENS TO THE KIDS FROM AN 7529 05:18:43,320 --> 05:18:44,480 OUTCOMES STANDPOINT? 7530 05:18:44,480 --> 05:18:49,520 I LIKE THIS NEAP WAS RECENT -- 7531 05:18:49,520 --> 05:18:53,400 PAPER PUBLISHED FROM THE NETWORK 7532 05:18:53,400 --> 05:18:53,640 REGISTRY. 7533 05:18:53,640 --> 05:18:58,600 THEY HAD ALMOST 1500 PEDIATRIC 7534 05:18:58,600 --> 05:18:59,760 PULMONARY HYPERTENSION PATIENTS, 7535 05:18:59,760 --> 05:19:02,640 AND ABOUT HALF OF THE KIDS IN 7536 05:19:02,640 --> 05:19:04,480 THE REGISTRY WERE GROUP 3. 7537 05:19:04,480 --> 05:19:07,120 AMONG THE GROUP 3, HALF WERE 7538 05:19:07,120 --> 05:19:07,880 BPD. 7539 05:19:07,880 --> 05:19:10,080 NOW IN THIS GROUP 3 GROUP OVER 7540 05:19:10,080 --> 05:19:13,160 HERE, THIS IS HALF BPD PH KIDS 7541 05:19:13,160 --> 05:19:16,200 AND IF YOU LOOK AT TIME SINCE 7542 05:19:16,200 --> 05:19:21,480 DIAGNOSIS, THE LAST CURVE IS 7543 05:19:21,480 --> 05:19:22,920 INDIVIDUALS OFF PULMONARY 7544 05:19:22,920 --> 05:19:23,920 HYPERTENSION MEDICATION. 7545 05:19:23,920 --> 05:19:27,400 WHAT'S INTERESTING TO ME LOOKING 7546 05:19:27,400 --> 05:19:29,240 AT THESE -- MANY BABIES IF YOU 7547 05:19:29,240 --> 05:19:30,440 SUPPORT THEM LONG ENOUGH, IF 7548 05:19:30,440 --> 05:19:34,200 THEY DON'T DIE EARLY ON, THEY 7549 05:19:34,200 --> 05:19:39,680 HAVE AN OPPORTUNITY TO GROW AND 7550 05:19:39,680 --> 05:19:46,000 PULMONARY VASCULAR DISEASE AS 7551 05:19:46,000 --> 05:19:47,080 VASCULATURE DEVELOPS WITH TIME, 7552 05:19:47,080 --> 05:19:48,400 MANY TAKEN OFF PULMONARY 7553 05:19:48,400 --> 05:19:50,600 HYPERTENSION MEDICATION AND 7554 05:19:50,600 --> 05:19:53,360 FOLLOWED LONGER TERM. 7555 05:19:53,360 --> 05:19:55,280 I'M NOT SURE THAT MEANS 7556 05:19:55,280 --> 05:19:56,280 PULMONARY VASCULAR DISEASE IS 7557 05:19:56,280 --> 05:19:57,600 COMPLETELY GONE. 7558 05:19:57,600 --> 05:20:00,880 THESE ARE TWO STUDIES LOOKING AT 7559 05:20:00,880 --> 05:20:03,000 ADOLESCENTS AND ADULTS, STUDY ON 7560 05:20:03,000 --> 05:20:06,040 THE LEFT IS ECHO-BASED STUDY IN 7561 05:20:06,040 --> 05:20:09,320 ADOLESCENTS LOOKING AT RATES OF 7562 05:20:09,320 --> 05:20:12,280 PULMONARY HYPERTENSION, OVERALL 7563 05:20:12,280 --> 05:20:16,000 MEAN ARTERY PRESSURE OF 19, SO 7564 05:20:16,000 --> 05:20:18,840 JUST UNDER HALF OF THEM WOULD 7565 05:20:18,840 --> 05:20:22,120 MEET CURRENT CRITERIA FOR 7566 05:20:22,120 --> 05:20:23,760 PULMONARY HYPERTENSION, GREATER 7567 05:20:23,760 --> 05:20:24,880 THAN 20. 7568 05:20:24,880 --> 05:20:26,080 ECHO-BASED STUDY, IT'S ABOUT THE 7569 05:20:26,080 --> 05:20:31,120 SAME, JUST UNDER HALF WOULD MEET 7570 05:20:31,120 --> 05:20:32,400 THE 20 MILLIMETERS OF MERCURY 7571 05:20:32,400 --> 05:20:40,200 CUT OFF. 7572 05:20:40,200 --> 05:20:42,720 WE'RE ESTIMATING MILD PULMONARY 7573 05:20:42,720 --> 05:20:46,680 HYPERTENSION, LIKELY TO BE 7574 05:20:46,680 --> 05:20:49,600 SUBCLINICAL LESS LIKELY TO BE 7575 05:20:49,600 --> 05:20:50,960 DIAGNOSED. 7576 05:20:50,960 --> 05:20:52,120 AS THESE INDIVIDUALS AGE, 7577 05:20:52,120 --> 05:20:53,400 PRE-TERM BORN INDIVIDUALS ARE 7578 05:20:53,400 --> 05:20:56,280 ALSO AT INCREASED RISK FOR 7579 05:20:56,280 --> 05:20:58,120 DEVELOPMENT OF SLEEP DISORDERED 7580 05:20:58,120 --> 05:20:59,680 BREATHING, A LARGE POPULATION 7581 05:20:59,680 --> 05:21:02,720 BASED REGISTRY STUDY FROM SWEDEN 7582 05:21:02,720 --> 05:21:04,480 LOOKING AT POPULATION AND 7583 05:21:04,480 --> 05:21:06,880 DIAGNOSIS OF SLEEP DISORDERED 7584 05:21:06,880 --> 05:21:09,080 BREATHING OR SYMPTOMATIC SNORING 7585 05:21:09,080 --> 05:21:10,240 ESSENTIALLY. 7586 05:21:10,240 --> 05:21:15,040 AND THOSE EXTREMELY PRE-TERM HAD 7587 05:21:15,040 --> 05:21:17,480 2.6-FOLD HIGHER RISK, CLEARLY 7588 05:21:17,480 --> 05:21:18,240 DOSE-RESPONSE TO EXTREMELY 7589 05:21:18,240 --> 05:21:19,280 PRE-TERM BORN HERE. 7590 05:21:19,280 --> 05:21:23,080 THIS PLAYS IN THE MIDDLE, WE CAN 7591 05:21:23,080 --> 05:21:25,600 TALK ABOUT AGE AND DEVELOPMENT 7592 05:21:25,600 --> 05:21:27,760 AND PUBERTY EFFECTS, ANOTHER 7593 05:21:27,760 --> 05:21:31,520 DISCUSSION, BUT YOU CAN SEE 7594 05:21:31,520 --> 05:21:33,480 ACROSS THE LIFESPAN INDIVIDUALS 7595 05:21:33,480 --> 05:21:35,480 BORN EXTREMELY PRE-TERM AT 7596 05:21:35,480 --> 05:21:37,200 INCREASED WELCOME FOR SLEEP 7597 05:21:37,200 --> 05:21:37,840 DISORDERED BREATHING. 7598 05:21:37,840 --> 05:21:40,800 THERE'S NOT DATA ON HOW THEY 7599 05:21:40,800 --> 05:21:41,920 INTERACT, RISK FOR PULMONARY 7600 05:21:41,920 --> 05:21:43,640 VASCULAR DISEASE AND IMPACT OF 7601 05:21:43,640 --> 05:21:45,520 SLEEP DIS ORDERED BREATHING ON 7602 05:21:45,520 --> 05:21:45,840 THAT. 7603 05:21:45,840 --> 05:21:47,720 THIS IS EARLY DATA OUT OF OUR 7604 05:21:47,720 --> 05:21:47,880 LAB. 7605 05:21:47,880 --> 05:21:49,240 I'M HOPING WE'LL BE ABLE TO 7606 05:21:49,240 --> 05:21:52,200 ADDRESS THIS IN THE FUTURE 7607 05:21:52,200 --> 05:21:58,320 BECAUSE WE DO HAVE ECHO 7608 05:21:58,320 --> 05:21:58,960 PULMONARY FUNCTIONS, OVERNIGHT 7609 05:21:58,960 --> 05:22:01,400 OXIMETRY, 150 BORN PRE-TERM NOW, 7610 05:22:01,400 --> 05:22:03,480 HOPEFULLY CAN SEE HOW THESE 7611 05:22:03,480 --> 05:22:05,000 FINDINGS INTERACT IN FUTURE 7612 05:22:05,000 --> 05:22:07,400 STUDIES. 7613 05:22:07,400 --> 05:22:10,760 WE'RE GOING QUICK SHIFT GEARS TO 7614 05:22:10,760 --> 05:22:12,120 SICKLE CELL DISEASE. 7615 05:22:12,120 --> 05:22:13,320 YOU'RE MAGNIFY FACULTY WITH 7616 05:22:13,320 --> 05:22:15,520 SICKLE CELL, YOU SEE A HANDFUL 7617 05:22:15,520 --> 05:22:16,360 OF PATIENTS IN CLINICAL 7618 05:22:16,360 --> 05:22:16,600 PRACTICE. 7619 05:22:16,600 --> 05:22:18,640 WHAT I WANT TO POINT OUT THE 7620 05:22:18,640 --> 05:22:21,200 AVERAGE AGE OF FIRST DATES OF 7621 05:22:21,200 --> 05:22:22,840 OCCLUSIVE CRIES SIS AT 2 TO 5 7622 05:22:22,840 --> 05:22:27,320 YEARS OLD. 7623 05:22:27,320 --> 05:22:31,560 WE'RE GETTING INTO A LONG GROWTH 7624 05:22:31,560 --> 05:22:31,800 PHASE. 7625 05:22:31,800 --> 05:22:32,760 THEORETICALLY INSULT OR INJURY 7626 05:22:32,760 --> 05:22:34,880 IS OCCURRING IN THE EARLY GROWTH 7627 05:22:34,880 --> 05:22:35,120 PHASE. 7628 05:22:35,120 --> 05:22:39,160 SO CAN I TELL YOU THAT THE 7629 05:22:39,160 --> 05:22:40,440 PULMONARY VASCULATURE DOES NOT 7630 05:22:40,440 --> 05:22:41,400 GROW NORMALLY? 7631 05:22:41,400 --> 05:22:42,840 ACTUALLY NO BECAUSE THAT'S NOT 7632 05:22:42,840 --> 05:22:43,680 BEEN ASSESSED. 7633 05:22:43,680 --> 05:22:46,600 IF WE GO BACK TO OUR CAVEAT 7634 05:22:46,600 --> 05:22:49,320 NUMBER 1 EARLY ON, HOW THE 7635 05:22:49,320 --> 05:22:54,600 ALVEOLAR AND VASCULAR SPACES 7636 05:22:54,600 --> 05:22:57,080 WITH LINK, THERE'S IMPAIRED 7637 05:22:57,080 --> 05:23:02,640 GROWTH IN PULMONARY FUNCTION, 7638 05:23:02,640 --> 05:23:03,680 SPIRO METRIC MEASURES, SICKLE 7639 05:23:03,680 --> 05:23:07,040 CELL IS THE SOLID LINE, BOYS AND 7640 05:23:07,040 --> 05:23:09,480 GIRLS. 7641 05:23:09,480 --> 05:23:10,520 PERHAPS, STICK WITH ME, 7642 05:23:10,520 --> 05:23:13,320 PULMONARY HYPERTENSION IN SICKLE 7643 05:23:13,320 --> 05:23:16,800 CELL IS VERY MULTI-FACTORIAL, 7644 05:23:16,800 --> 05:23:17,960 CONSIDERED GROUP 5 PULMONARY 7645 05:23:17,960 --> 05:23:21,400 HYPERTENSION WHICH WE HAVEN'T 7646 05:23:21,400 --> 05:23:22,400 TALKED ABOUT YET TODAY. 7647 05:23:22,400 --> 05:23:23,600 BURDEN OF PULMONARY HYPERTENSION 7648 05:23:23,600 --> 05:23:30,160 INCREASES WITH AGE SO IT'S 7649 05:23:30,160 --> 05:23:32,520 PRIMARILY -- STUDIED USING ECHO. 7650 05:23:32,520 --> 05:23:35,280 OBVIOUSLY THE BEST DIAGNOSIS IS 7651 05:23:35,280 --> 05:23:39,320 CATH. 7652 05:23:39,320 --> 05:23:40,960 BUT ELEVATED VELOCITIES ARE 7653 05:23:40,960 --> 05:23:43,480 DOCUMENTED, CLOSE TO A THIRD OF 7654 05:23:43,480 --> 05:23:53,440 ADULTS, DEFINITELY ASSOCIATED 7655 05:23:53,440 --> 05:23:54,800 WITH INCREASED MORTALITY. 7656 05:23:54,800 --> 05:24:00,560 WHEN YOU LOOK AT AUTOPSY STUDIES 7657 05:24:00,560 --> 05:24:03,520 INCLUDING INDIVIDUALS WHO DIED 7658 05:24:03,520 --> 05:24:07,480 NOT JUST PULMONARY COMPLICATIONS 7659 05:24:07,480 --> 05:24:09,320 BUT EXTRA-PULMONARY 7660 05:24:09,320 --> 05:24:10,080 COMPLICATION, INVOLVEMENT OF 7661 05:24:10,080 --> 05:24:11,280 VASCULATURE IS ALMOST UNIFORM 7662 05:24:11,280 --> 05:24:16,520 WITH A MYRIAD OF PATHOLOGIES 7663 05:24:16,520 --> 05:24:20,040 SEEN, ARTERIAL THICKENING, ACUTE 7664 05:24:20,040 --> 05:24:22,240 AND CHRONIC THROMBOSIS, VEIN 7665 05:24:22,240 --> 05:24:24,400 THICKENING, EVEN THOUGH THEY MAY 7666 05:24:24,400 --> 05:24:25,960 DIE FROM SOMETHING NOT PULMONARY 7667 05:24:25,960 --> 05:24:29,560 SPECIFIC, MOST OF THEM HAVE SOME 7668 05:24:29,560 --> 05:24:30,120 DEGREE OF PULMONARY VASCULAR 7669 05:24:30,120 --> 05:24:31,760 DISEASE AT THE TIME OF DEATH. 7670 05:24:31,760 --> 05:24:34,680 ANYTHING WE CAN DO TO ALLEVIATE 7671 05:24:34,680 --> 05:24:35,840 THAT IN THIS PARTICULAR 7672 05:24:35,840 --> 05:24:40,880 POPULATION IS LIKELY TO BE 7673 05:24:40,880 --> 05:24:41,560 IMPACTFUL. 7674 05:24:41,560 --> 05:24:43,560 WHAT ABOUT SLEEP DISORDERED 7675 05:24:43,560 --> 05:24:45,200 BREATHING IN KIDS WITH SICKLE 7676 05:24:45,200 --> 05:24:45,680 CELL? 7677 05:24:45,680 --> 05:24:48,080 EXACT NUMBERS ARE DIFFICULT TO 7678 05:24:48,080 --> 05:24:50,480 PIN DOWN AND DEPENDS HOW YOU 7679 05:24:50,480 --> 05:24:51,920 DEFINE THIS. 7680 05:24:51,920 --> 05:24:54,200 ABOUT 20% WILL REPORT SLEEP 7681 05:24:54,200 --> 05:24:55,560 DISORDERED BREATHING. 7682 05:24:55,560 --> 05:24:59,560 OR SYMPTOMS OF IMPAIRED SLEEP. 7683 05:24:59,560 --> 05:25:01,640 WHEN IT'S BEEN STUDIED LOWER 7684 05:25:01,640 --> 05:25:05,800 THEY TEND TO HAVE LOWER MEAN AND 7685 05:25:05,800 --> 05:25:09,320 OXYGEN SATURATION, MORE 7686 05:25:09,320 --> 05:25:10,440 PROLONGRD NOCTURNAL 7687 05:25:10,440 --> 05:25:12,400 DESATURATION, THESE ARE THE 7688 05:25:12,400 --> 05:25:13,920 INDIVIDUALS WE'RE ALREADY 7689 05:25:13,920 --> 05:25:15,240 RECOGNIZING TODAY HIGHEST RISK, 7690 05:25:15,240 --> 05:25:19,400 WHO HAVE THE MORE PROLONGED 7691 05:25:19,400 --> 05:25:20,800 NOCTURNAL DESATURATION AND 7692 05:25:20,800 --> 05:25:21,040 HYPOXIA. 7693 05:25:21,040 --> 05:25:24,840 IF WE LOOK AT THOSE WHO HAVE 7694 05:25:24,840 --> 05:25:28,800 COMPLETED SLEEP STUDIES IN 7695 05:25:28,800 --> 05:25:30,200 RELATION TO ECHO METRICS, SICKLE 7696 05:25:30,200 --> 05:25:34,800 CELL WITH DIAGNOSIS OF SLEEP 7697 05:25:34,800 --> 05:25:45,240 APNEA MORE LIKELY TO HAVE 7698 05:25:45,600 --> 05:25:53,720 ELEVATED TRICUSPID REGURGITANT 7699 05:25:53,720 --> 05:25:54,320 DISEASE. 7700 05:25:54,320 --> 05:25:57,560 MOST WHO COMPLETED PSG AND ECHO 7701 05:25:57,560 --> 05:25:59,640 2/3 ARE ELEVATED AHI, GREATER 7702 05:25:59,640 --> 05:26:03,800 THAN 1 IS ABNORMAL FOR THIS AGE. 7703 05:26:03,800 --> 05:26:05,760 WE SEE AHI INCREASES OVER TIME. 7704 05:26:05,760 --> 05:26:07,400 I DON'T THINK THAT SIMPLY JUST 7705 05:26:07,400 --> 05:26:09,400 IS A REFLECTION OF AGING, 7706 05:26:09,400 --> 05:26:12,000 CERTAINLY THAT CAN BE 7707 05:26:12,000 --> 05:26:12,320 IMPLICATED. 7708 05:26:12,320 --> 05:26:15,840 LIKELY A REFLECTION OF DISEASE 7709 05:26:15,840 --> 05:26:18,040 PROGRESSION AS WELL. 7710 05:26:18,040 --> 05:26:19,360 AHI CORRELATED WITH TR 7711 05:26:19,360 --> 05:26:20,200 VELOCITIES. 7712 05:26:20,200 --> 05:26:21,200 THIS WAS THE SECOND STUDY 7713 05:26:21,200 --> 05:26:23,920 SIMILAR HOW IT WAS DONE BUT THIS 7714 05:26:23,920 --> 05:26:26,120 TIME FOCUSED ON NOCTURNAL 7715 05:26:26,120 --> 05:26:28,320 HYPOXIA AND THOSE INDIVIDUALS 7716 05:26:28,320 --> 05:26:33,240 WITH GREATER NOCTURNAL HYPOXIA 7717 05:26:33,240 --> 05:26:37,720 HAD HIGHER TR AND LESS 7718 05:26:37,720 --> 05:26:42,680 VENTRICULAR FUNCTION AND 7719 05:26:42,680 --> 05:26:43,840 DILATION, BIVENTRICULAR IMPACT 7720 05:26:43,840 --> 05:26:44,760 HERE. 7721 05:26:44,760 --> 05:26:46,120 TREATED LOTS OF WAYS, 7722 05:26:46,120 --> 05:26:47,600 TONSILLECTOMY IS ONE OF THE 7723 05:26:47,600 --> 05:26:49,800 INITIAL TREATMENTS FOR MOST KIDS 7724 05:26:49,800 --> 05:26:53,720 WHO HAVE SLEEP DISORDERED 7725 05:26:53,720 --> 05:27:00,040 BREATHING, SLEEP APNEA. 7726 05:27:00,040 --> 05:27:02,120 HYDROXYUREA IS IMPORTANT, 7727 05:27:02,120 --> 05:27:03,320 ADMINISTRATION OF OXYGEN 7728 05:27:03,320 --> 05:27:03,680 IMPROVES. 7729 05:27:03,680 --> 05:27:09,800 THERE'S NOT GREAT DATA THAT THIS 7730 05:27:09,800 --> 05:27:12,960 TRULY IMPACTS PAIN EVENTS, 7731 05:27:12,960 --> 05:27:16,920 VASO-OCCLUSIVE OR ACUTE CHEST 7732 05:27:16,920 --> 05:27:17,600 SYNDROME EVENTS. 7733 05:27:17,600 --> 05:27:21,520 DATA JUST ISN'T THERE AS OF 7734 05:27:21,520 --> 05:27:22,960 RIGHT NOW. 7735 05:27:22,960 --> 05:27:24,800 QUICK SUMMARY, I'VE GIVEN 7736 05:27:24,800 --> 05:27:27,080 EXAMPLE OF IMPAIRMENT IN 7737 05:27:27,080 --> 05:27:27,720 DEVELOPMENT, IMPAIRMENT IN 7738 05:27:27,720 --> 05:27:28,640 GROWTH, HOPEFULLY THIS IS 7739 05:27:28,640 --> 05:27:30,480 SOMETHING YOU CAN THINK ABOUT IN 7740 05:27:30,480 --> 05:27:32,240 OTHER DISEASE STATES AS WELL. 7741 05:27:32,240 --> 05:27:34,640 WE DIDN'T HAVE A LOT OF TIME TO 7742 05:27:34,640 --> 05:27:36,720 GO INTO DIRECT MECHANISMS BUT 7743 05:27:36,720 --> 05:27:39,360 YOU COULD SEE OVERLAP BETWEEN 7744 05:27:39,360 --> 05:27:40,160 MECHANISM FOR DEVELOPMENT OF 7745 05:27:40,160 --> 05:27:41,440 PULMONARY HYPERTENSION AND ALSO 7746 05:27:41,440 --> 05:27:42,760 FOR DEVELOPMENT OF SLEEP 7747 05:27:42,760 --> 05:27:43,360 DISORDERED BREATHING. 7748 05:27:43,360 --> 05:27:50,600 I WOULD ARGUE BOTH ARE 7749 05:27:50,600 --> 05:27:51,280 POTENTIATORS, POTENTIAL TO 7750 05:27:51,280 --> 05:27:53,840 WORSEN IN EACH OTHER, SO 7751 05:27:53,840 --> 05:27:54,880 UNDERSTANDING HOW WE SHOULD 7752 05:27:54,880 --> 05:27:56,560 INTERVENE IS IMPORTANT. 7753 05:27:56,560 --> 05:27:59,400 THESE ARE THE KNOWLEDGE GAPS I 7754 05:27:59,400 --> 05:28:01,600 SUBMITTED BUT I'LL STOP THERE IN 7755 05:28:01,600 --> 05:28:03,760 THE INTEREST OF TIME. 7756 05:28:03,760 --> 05:28:07,520 >>THANK YOU FOR THE FASCINATING 7757 05:28:07,520 --> 05:28:09,920 TALK, WONDERFUL PERSPECTIVE AND 7758 05:28:09,920 --> 05:28:14,720 I'M SURE WE'LL GET INTO THE 7759 05:28:14,720 --> 05:28:15,000 DISCUSSION. 7760 05:28:15,000 --> 05:28:18,000 FOR THE PURPOSES OF TIME, WE'LL 7761 05:28:18,000 --> 05:28:22,920 GO RIGHT TO THE NEXT TWO 7762 05:28:22,920 --> 05:28:24,240 SPEAKERS AND WE'LL BRING BACK 7763 05:28:24,240 --> 05:28:25,760 ANY OF THE SPECIFIC QUESTIONS AS 7764 05:28:25,760 --> 05:28:28,560 WELL AS MORE GENERAL SESSIONS 7765 05:28:28,560 --> 05:28:30,480 DURING THE DISCUSSION WRAP-UP. 7766 05:28:30,480 --> 05:28:34,440 LAST TWO SPEAKERS ARE GOING TO 7767 05:28:34,440 --> 05:28:37,920 DO A -- THEY COORDINATED. 7768 05:28:37,920 --> 05:28:40,760 FIRST DR. DANIEL KATZ WILL GIVE 7769 05:28:40,760 --> 05:28:43,960 AN OVERVIEW OF HOW TO APPROACH 7770 05:28:43,960 --> 05:28:46,920 METABOLOMICS DATA WITH EMERGING 7771 05:28:46,920 --> 05:28:50,080 DATABASES AND TOOLS AND DR. 7772 05:28:50,080 --> 05:28:51,840 SOFER WILL GIVE SPECIFIC 7773 05:28:51,840 --> 05:28:55,640 EXEMPLARS OF THE USE OF THOSE 7774 05:28:55,640 --> 05:28:58,200 TYPES OF DATA, SLEEP AND 7775 05:28:58,200 --> 05:28:58,920 CIRCADIAN HEALTH AND 7776 05:28:58,920 --> 05:29:01,240 RELATIONSHIPS TO OTHER HEALTH 7777 05:29:01,240 --> 05:29:03,640 OUTCOMES. 7778 05:29:03,640 --> 05:29:08,800 7779 05:29:08,800 --> 05:29:10,440 >>THANK YOU. 7780 05:29:10,440 --> 05:29:11,840 HOPEFULLY YOU'RE SEEING MY 7781 05:29:11,840 --> 05:29:13,760 SLIDES AND NOT NECESSARILY MY 7782 05:29:13,760 --> 05:29:14,120 PRESENTER MODE. 7783 05:29:14,120 --> 05:29:16,920 THANK YOU VERY MUCH FOR THE 7784 05:29:16,920 --> 05:29:20,840 OPPORTUNITY TO PRESENT HERE. 7785 05:29:20,840 --> 05:29:24,680 I'M DAN KATZ, HEART FAILURE 7786 05:29:24,680 --> 05:29:26,680 CARDIOLOGIST AT STANFORD, 7787 05:29:26,680 --> 05:29:27,280 RESEARCH LEVERAGES MULTIOMIC 7788 05:29:27,280 --> 05:29:30,120 DATA TO UNDERSTAND HEART 7789 05:29:30,120 --> 05:29:31,320 FAILURE. 7790 05:29:31,320 --> 05:29:32,640 NOT NECESSARILY SLEEP DISORDERED 7791 05:29:32,640 --> 05:29:33,840 BREATHING OR PVD. 7792 05:29:33,840 --> 05:29:37,160 I'M HERE TO PROVIDE AN 7793 05:29:37,160 --> 05:29:40,040 INTRODUCTION, MULTIOMIC DATA IN 7794 05:29:40,040 --> 05:29:42,080 COMPLEX DISEASE WITH EYE TOWARD 7795 05:29:42,080 --> 05:29:43,960 BETTER UNDERSTANDING INTERPLAY 7796 05:29:43,960 --> 05:29:46,360 OF SLEEP AND PULMONARY VASCULAR 7797 05:29:46,360 --> 05:29:46,600 DISEASE. 7798 05:29:46,600 --> 05:29:48,000 THIS IS SOMETHING I THOUGHT I 7799 05:29:48,000 --> 05:29:49,720 WAS GOING TO HAVE TO DO 7800 05:29:49,720 --> 05:29:51,160 CONVINCING BUT THERE'S BEEN SOME 7801 05:29:51,160 --> 05:29:53,480 PEOPLE THAT HAVE SPOKEN THAT 7802 05:29:53,480 --> 05:29:55,960 ALLUDED TO SOME DATA GENERATED. 7803 05:29:55,960 --> 05:29:58,720 I THINK WE HAVE A LOT OF 7804 05:29:58,720 --> 05:30:01,040 INTERESTED, WHICH IS GREAT. 7805 05:30:01,040 --> 05:30:05,200 MY HOPE IS TO PIQUE YOUR 7806 05:30:05,200 --> 05:30:07,400 INTEREST IN MULTIOMICS AND THINK 7807 05:30:07,400 --> 05:30:11,040 ABOUT HOW YOU MIGHT INCORPORATE 7808 05:30:11,040 --> 05:30:15,600 OMICS IN YOUR NEXT STUDY. 7809 05:30:15,600 --> 05:30:17,360 HERE ARE MY GOALS, SCRATCHING 7810 05:30:17,360 --> 05:30:19,520 THE SURFACE, SOME ADDRESSED IN 7811 05:30:19,520 --> 05:30:30,080 THE NEXT TALK BY DR. SOFER, AL. 7812 05:30:33,280 --> 05:30:34,400 FIRST WE'LL DESCRIBE AVAILABLE 7813 05:30:34,400 --> 05:30:42,840 OMICS PLAT FORMS AND COSTS, 7814 05:30:42,840 --> 05:30:45,480 BENEFITS, PITFALLS, EXPLORE 7815 05:30:45,480 --> 05:30:48,320 TECHNIQUES OR ANALYSIS AND 7816 05:30:48,320 --> 05:30:51,080 IDENTIFY EXISTING DATA SOURCES 7817 05:30:51,080 --> 05:30:53,800 USEFUL IN SLEEP AND PH WORK. 7818 05:30:53,800 --> 05:30:57,080 BEFORE WE BEGIN WE SHOULD TOUCH 7819 05:30:57,080 --> 05:30:58,840 WHAT MULTIOMICS IS. 7820 05:30:58,840 --> 05:31:03,120 TO ME MULTI-OMICS IS THE 7821 05:31:03,120 --> 05:31:04,520 COLLECTION OF BIOMOLECULAR 7822 05:31:04,520 --> 05:31:04,960 MEASURE. 7823 05:31:04,960 --> 05:31:12,040 S ACROSS TWO OMICS CATEGORIES. 7824 05:31:12,040 --> 05:31:15,440 WE NOW GENOMIC DATA IS 7825 05:31:15,440 --> 05:31:18,360 TRANSLATED TO PROTEIN PRODUCING 7826 05:31:18,360 --> 05:31:19,280 PHENOTYPES, MULTIOMICS SEEKS TO 7827 05:31:19,280 --> 05:31:23,880 UNDERSTAND IN A DATA DRIVEN 7828 05:31:23,880 --> 05:31:25,080 MATTER BY GATHERING INFORMATION 7829 05:31:25,080 --> 05:31:27,160 AND STUDYING HOW THEY BEHAVE. 7830 05:31:27,160 --> 05:31:29,800 WE HAVE ABILITY TO CAPTURE A 7831 05:31:29,800 --> 05:31:34,840 WIDE VARIETY OF MULTIOMIC DATA, 7832 05:31:34,840 --> 05:31:37,240 ALSO GENERATING DATA ON DIVERSE 7833 05:31:37,240 --> 05:31:37,560 POPULATIONS. 7834 05:31:37,560 --> 05:31:39,400 THE REAL DEFINITION IS 7835 05:31:39,400 --> 05:31:41,160 INTEGRATION OF MULTIPLE STREAMS 7836 05:31:41,160 --> 05:31:42,920 OF OMIC DATA FROM MULTIPLE 7837 05:31:42,920 --> 05:31:45,320 COHORTS IN AN EFFORT TO DO 7838 05:31:45,320 --> 05:31:46,440 THINGS LIKE BETTER UNDERSTAND 7839 05:31:46,440 --> 05:31:48,040 PATHOPHYSIOLOGY OF DISEASE SO WE 7840 05:31:48,040 --> 05:31:50,040 CAN IDENTIFY PATHWAYS THAT CAN 7841 05:31:50,040 --> 05:31:53,080 BE TARGETED BY DRUG THERAPY, OR 7842 05:31:53,080 --> 05:31:54,720 SEPARATELY, PERHAPS MORE 7843 05:31:54,720 --> 05:31:56,160 UNSUPERVISED WAY, TO LEVERAGE 7844 05:31:56,160 --> 05:31:58,240 THIS HIGH DIMENSIONAL DATA FOR 7845 05:31:58,240 --> 05:31:59,560 PATTERN INSIGHT INTO DISEASE SO 7846 05:31:59,560 --> 05:32:01,840 WE CAN MAKE BETTER DECISIONS AT 7847 05:32:01,840 --> 05:32:05,480 THE BEDSIDE BEFORE PERHAPS WE 7848 05:32:05,480 --> 05:32:06,240 UNDERSTAND UNDERLYING 7849 05:32:06,240 --> 05:32:06,840 PATHOPHYSIOLOGY. 7850 05:32:06,840 --> 05:32:08,880 SO THERE ARE VERY WIDE VARIETY 7851 05:32:08,880 --> 05:32:11,280 OF TOOLS FOR GATHERING MULTIOMIC 7852 05:32:11,280 --> 05:32:12,760 DATA, AND SPECIAL FEATURES OF 7853 05:32:12,760 --> 05:32:14,240 EACH IS MAYBE A LITTLE OUTSIDE 7854 05:32:14,240 --> 05:32:16,760 THE SCOPE OF THIS TALK BUT I DID 7855 05:32:16,760 --> 05:32:18,800 INCLUDE A SAMPLE TO GIVE YOU A 7856 05:32:18,800 --> 05:32:20,440 SENSE OF WHAT'S AVAILABLE, WHAT 7857 05:32:20,440 --> 05:32:24,280 IT MIGHT COST TO DO SORT OF A 7858 05:32:24,280 --> 05:32:26,360 COMPREHENSIVE MULTIOMIC STUDY. 7859 05:32:26,360 --> 05:32:28,440 ON THE GENOMIC SIDE, WHILE GOOD 7860 05:32:28,440 --> 05:32:37,960 DATA CAN BE GATHERED USING SNP 7861 05:32:37,960 --> 05:32:40,720 ARRAY DATA, THERE'S A SUBSET 7862 05:32:40,720 --> 05:32:44,000 DOING LONG READ FOR MORE 7863 05:32:44,000 --> 05:32:45,760 DETAILED INFORMATION. 7864 05:32:45,760 --> 05:32:47,040 EPIGENETIC PLATFORMS PROVIDE 7865 05:32:47,040 --> 05:32:49,000 INSIGHT ABOUT OPEN CHROMATIN, 7866 05:32:49,000 --> 05:32:50,000 AVAILABLE DNA FOR TRANSCRIPTION, 7867 05:32:50,000 --> 05:32:52,840 SOME OF THE MORE POPULAR ONES 7868 05:32:52,840 --> 05:32:56,800 ARE ATAC-SEQ, METHYL CAPTURE, 7869 05:32:56,800 --> 05:33:00,000 WHICH CAN PROVIDE INFORMATION ON 7870 05:33:00,000 --> 05:33:02,160 THE MODERATELY COSTLY SIDE. 7871 05:33:02,160 --> 05:33:05,320 RNAseq DATA MAY BE THE MOST 7872 05:33:05,320 --> 05:33:06,440 READILY AVAILABLE, ALSO PROBABLY 7873 05:33:06,440 --> 05:33:09,160 MOST COST EFFICIENT BECAUSE IT'S 7874 05:33:09,160 --> 05:33:11,480 BEEN SO WELL ESTABLISHED. 7875 05:33:11,480 --> 05:33:14,640 PROTEOMEICS I BREAK INTO TWO 7876 05:33:14,640 --> 05:33:17,920 COMPETING APPROACHES, THIS BEING 7877 05:33:17,920 --> 05:33:21,160 AFFINITY APPROACH, WHICH HAS 7878 05:33:21,160 --> 05:33:22,840 GAINED TRACTION AND MASS 7879 05:33:22,840 --> 05:33:25,160 SPECTROMETRY PLATFORMS ALLOWING 7880 05:33:25,160 --> 05:33:31,440 ADDED BENEFITS OF EVALUATING 7881 05:33:31,440 --> 05:33:32,280 POST-TRANSLATIONAL 7882 05:33:32,280 --> 05:33:33,080 MODIFICATIONS. 7883 05:33:33,080 --> 05:33:34,640 METABOLOMICS PROVIDES TARGETED 7884 05:33:34,640 --> 05:33:35,480 PLATFORMS FOR KNOWN METABOLITES 7885 05:33:35,480 --> 05:33:36,800 AND OPTION TO CAPTURE AND 7886 05:33:36,800 --> 05:33:39,640 ATTEMPT TO NAME THOUSANDS OF 7887 05:33:39,640 --> 05:33:40,640 UNKNOWN METABOLITES. 7888 05:33:40,640 --> 05:33:41,840 THAT'S PARTICULARLY AN EXCITING 7889 05:33:41,840 --> 05:33:43,680 AREA OF RESEARCH BECAUSE WHEN 7890 05:33:43,680 --> 05:33:44,840 YOU COMBINE OMIC DATA TOGETHER 7891 05:33:44,840 --> 05:33:47,600 YOU CAN TAKE SOME OF THESE 7892 05:33:47,600 --> 05:33:51,000 UNKNOWN METABOLITES, YET TO BE 7893 05:33:51,000 --> 05:33:54,520 DESCRIBED, AND USE SOME 7894 05:33:54,520 --> 05:33:56,200 MULTIOMIC DATA TO IDENTIFY, 7895 05:33:56,200 --> 05:34:04,400 WHICH MAY BE IMPORTANT. 7896 05:34:04,400 --> 05:34:05,480 TARGETED PLATFORMS ARE AVAILABLE 7897 05:34:05,480 --> 05:34:07,880 ON AND OFF THE SHELF. 7898 05:34:07,880 --> 05:34:12,280 PUT THIS TOGETHER, INCLUDING 7899 05:34:12,280 --> 05:34:19,320 ELEMENTS FROM ALL, COULD RUN UP 7900 05:34:19,320 --> 05:34:25,200 TO 12$0,000 TO 14 -- $1,200 TO 7901 05:34:25,200 --> 05:34:27,800 $1,400 A SAMPLE. 7902 05:34:27,800 --> 05:34:30,440 I DON'T THINK MULTI-OMICS WOULD 7903 05:34:30,440 --> 05:34:32,640 BE COMPLETE OUT IT, THIS DOESN'T 7904 05:34:32,640 --> 05:34:35,600 INCLUDE SPATIAL OR SINGLE CELL 7905 05:34:35,600 --> 05:34:36,240 OMICS ALLOWING FOR PROFILING 7906 05:34:36,240 --> 05:34:38,360 ACROSS VARIETY OF CELLS IN A 7907 05:34:38,360 --> 05:34:40,720 TISSUE SAMPLE SO RATHER THAN 7908 05:34:40,720 --> 05:34:49,480 DESCRIBING A TISSUE HOMOGENATE 7909 05:34:49,480 --> 05:34:58,200 WE'LL DO A MUSCLE BIOPSY, AFTER 7910 05:34:58,200 --> 05:35:03,240 A BOUT OF EXERCISE, BOY A LOT OF 7911 05:35:03,240 --> 05:35:04,800 INFLAMMATORY MARKERS GO UP, IT 7912 05:35:04,800 --> 05:35:07,200 MIGHT BE INFLUX INTO THE TISSUE, 7913 05:35:07,200 --> 05:35:12,040 AND THAT EXPLAINS THE CHANGE. 7914 05:35:12,040 --> 05:35:13,120 SPECIAL AND SINGLE CELLS COULD 7915 05:35:13,120 --> 05:35:14,320 GET A LARGE AMOUNT OF 7916 05:35:14,320 --> 05:35:16,360 INFORMATION BUT WILL ALSO SET 7917 05:35:16,360 --> 05:35:19,800 YOU BACK ANOTHER ONE TO SIX 7918 05:35:19,800 --> 05:35:22,320 THOUSAND ADDITIONAL DOLLARS PER 7919 05:35:22,320 --> 05:35:22,640 SAMPLE. 7920 05:35:22,640 --> 05:35:26,640 SO, I PUT IT TOGETHER THIS WAY, 7921 05:35:26,640 --> 05:35:31,280 MUCH LIKE HEALTH CARE ITSELF. 7922 05:35:31,280 --> 05:35:32,560 I THINK THAT MULTIOMIC DATA 7923 05:35:32,560 --> 05:35:35,880 BALANCE OUT ACROSS THE TRIANGLE. 7924 05:35:35,880 --> 05:35:39,160 YOU'RE CONSTANTLY TRYING TO 7925 05:35:39,160 --> 05:35:42,880 BALANCE SPECIFICITY AND 7926 05:35:42,880 --> 05:35:46,440 THROUGHPUT AND COST. 7927 05:35:46,440 --> 05:35:49,320 SO TAKE THE TWO ALTERNATIVE 7928 05:35:49,320 --> 05:35:49,960 APPROACHES FOR PROTEOMICS. 7929 05:35:49,960 --> 05:35:54,760 SHOWN ON THE SLIDE ARE TWO 7930 05:35:54,760 --> 05:35:58,320 POPULAR AFFINITY PLATFORMS. 7931 05:35:58,320 --> 05:36:00,480 COMPARED TO MORE TRADITIONAL 7932 05:36:00,480 --> 05:36:03,960 MASS SPECTROMETRY-BASED METHODS, 7933 05:36:03,960 --> 05:36:07,280 AFFINITY PLATFORMS ARE HIGHER 7934 05:36:07,280 --> 05:36:08,480 THROUGHPUT. 7935 05:36:08,480 --> 05:36:10,880 THEY CAN HAVE ISSUES WITH 7936 05:36:10,880 --> 05:36:12,320 ACCURACY WHICH WE'VE EXPLORED 7937 05:36:12,320 --> 05:36:12,640 EXTENSIVELY. 7938 05:36:12,640 --> 05:36:16,600 THEY DON'T COVER THE ENTIRE 7939 05:36:16,600 --> 05:36:19,840 PROTEOME AND ULTIMATELY HAVE 7940 05:36:19,840 --> 05:36:20,400 INTERFERENCE FROM 7941 05:36:20,400 --> 05:36:21,040 POST-TRANSLATIONAL INTERFERENCE 7942 05:36:21,040 --> 05:36:27,520 I CAN WITH INTERFERE WITH 7943 05:36:27,520 --> 05:36:28,320 BINDING. 7944 05:36:28,320 --> 05:36:32,600 WE SWAP ACCURACY FOR HIGHER 7945 05:36:32,600 --> 05:36:35,400 THROUGHPUT AND BETTER COST. 7946 05:36:35,400 --> 05:36:42,320 NOW WE CAN LEVERAGE TO ANSWER 7947 05:36:42,320 --> 05:36:44,040 KEY QUESTIONS, POSITING 7948 05:36:44,040 --> 05:36:45,680 QUESTIONS TO SHOW SCHEMATICALLY 7949 05:36:45,680 --> 05:36:46,440 AND PRACTICALLY HOW SUCH 7950 05:36:46,440 --> 05:36:50,400 QUESTIONS CAN BE TAKEN ON WITH 7951 05:36:50,400 --> 05:36:51,400 MULTIOMICS. 7952 05:36:51,400 --> 05:36:52,440 I'LL BORROW MORE FROM 7953 05:36:52,440 --> 05:36:55,200 CARDIOVASCULAR DISEASE. 7954 05:36:55,200 --> 05:36:58,080 WE'RE ALREADY SEEN SOME EXAMPLES 7955 05:36:58,080 --> 05:37:01,920 OF STRATEGIES BEING USED BUT DR. 7956 05:37:01,920 --> 05:37:03,440 SOFER WILL DEMONSTRATE HOW 7957 05:37:03,440 --> 05:37:05,920 APPROACHES ARE ALREADY BEING 7958 05:37:05,920 --> 05:37:08,040 USED IN THE SLEEP WORLD. 7959 05:37:08,040 --> 05:37:11,320 I'LL FOCUS MORE ON STRATEGIES 7960 05:37:11,320 --> 05:37:13,840 HERE THAN FINDINGS. 7961 05:37:13,840 --> 05:37:15,480 FIRST, WE'LL BEGIN WITH AN 7962 05:37:15,480 --> 05:37:16,480 IMPORTANT AND SIMPLY STATED 7963 05:37:16,480 --> 05:37:20,200 QUESTION, WHAT IS THE MOLECULAR 7964 05:37:20,200 --> 05:37:23,480 BASIS FOR PULMONARY VASCULAR 7965 05:37:23,480 --> 05:37:23,720 DISEASE. 7966 05:37:23,720 --> 05:37:25,120 CARDIOMETABOLIC DISEASE MIGHT 7967 05:37:25,120 --> 05:37:26,680 ASK THE SAME, HYPERTENSION, DATA 7968 05:37:26,680 --> 05:37:28,720 CAN COME FROM CASE CONTROL, 7969 05:37:28,720 --> 05:37:31,040 COHORT STUDIES, EVEN WITH JUST 7970 05:37:31,040 --> 05:37:32,680 ONE OMIC PLATFORM ATTACHED. 7971 05:37:32,680 --> 05:37:34,960 THE WAY THIS WORKS WE PLEASURE 7972 05:37:34,960 --> 05:37:36,520 ONE OR MORE OMICS SETS, LOOKING 7973 05:37:36,520 --> 05:37:39,240 TO SEE HOW THE FEATURES RELATE 7974 05:37:39,240 --> 05:37:41,200 TO PHENOTYPE OF INTEREST USING 7975 05:37:41,200 --> 05:37:42,080 STATISTICAL TESTING. 7976 05:37:42,080 --> 05:37:43,560 IF WE HAVE MANY FEATURES LINKED 7977 05:37:43,560 --> 05:37:45,440 TO THE SAME SITE OF INTEREST WE 7978 05:37:45,440 --> 05:37:49,520 CAN COMBINE INTO A SCORE AND SEE 7979 05:37:49,520 --> 05:37:51,160 IF MEASUREMENT ENHANCES 7980 05:37:51,160 --> 05:37:52,080 PREDICTIVE CAPABILITIES WITHIN 7981 05:37:52,080 --> 05:37:52,480 THE PHENOTYPE. 7982 05:37:52,480 --> 05:38:00,480 THIS IS A GREAT EXAMPLE, 7983 05:38:00,480 --> 05:38:02,000 PERFORMED PLASMA PROTEOMICS, 7984 05:38:02,000 --> 05:38:04,000 THEY FOUND DOWNREGULATION OF 19 7985 05:38:04,000 --> 05:38:05,720 PROTEINS AND UPREGULATION OF 8 7986 05:38:05,720 --> 05:38:07,400 ASSOCIATED WITH HIGHER 7987 05:38:07,400 --> 05:38:09,280 PROBABILITY OF HYPERTENSION, 7988 05:38:09,280 --> 05:38:10,440 AUTHORS COMBINED INTO A 7989 05:38:10,440 --> 05:38:13,320 MULTIOMICS SCORE AND SOW GOOD 7990 05:38:13,320 --> 05:38:14,960 PREDICTIVE POWER. 7991 05:38:14,960 --> 05:38:17,920 THE NICE THING, DE-IDENTIFIED 7992 05:38:17,920 --> 05:38:22,840 PROTEINS CAN PROVIDE INSIGHTS 7993 05:38:22,840 --> 05:38:25,120 INTO MOLECULAR PATHWAYS, SOME 7994 05:38:25,120 --> 05:38:28,080 PLAY ROLES IN CALCIUM 7995 05:38:28,080 --> 05:38:28,560 METABOLISM. 7996 05:38:28,560 --> 05:38:39,040 NEXT QUESTION, WHAT ARE THE 7997 05:38:39,760 --> 05:38:41,800 SHARED MOLECULAR SIGNATURES? 7998 05:38:41,800 --> 05:38:45,200 LOOKING AT DIABETES AND 7999 05:38:45,200 --> 05:38:46,080 HYPERLIPIDEMIA, IN MULTIPLE 8000 05:38:46,080 --> 05:38:48,720 STREAMS OF OMICS DATA ARE 8001 05:38:48,720 --> 05:38:50,120 ANALYZED TOGETHER, SO HERE 8002 05:38:50,120 --> 05:38:55,360 INSTEAD OF RELATINGOMES, WE 8003 05:38:55,360 --> 05:38:57,560 RELATIVELY TO TWO AND LOOK AT 8004 05:38:57,560 --> 05:38:58,360 SHARED FEATURES, FURTHER 8005 05:38:58,360 --> 05:39:00,760 SUMMARIZING TO SEE WHAT 8006 05:39:00,760 --> 05:39:02,160 BIOMOLECULAR PATHWAYS ARE 8007 05:39:02,160 --> 05:39:02,400 SHARED. 8008 05:39:02,400 --> 05:39:04,560 THIS IS A PORTION WHERE YOU LOOK 8009 05:39:04,560 --> 05:39:07,440 AT PATHWAYS AND THESE PROTEINS 8010 05:39:07,440 --> 05:39:11,800 AND METABOLITES WITH PART OF A 8011 05:39:11,800 --> 05:39:12,560 COMMON PATHWAY. 8012 05:39:12,560 --> 05:39:16,920 THIS IS A SEPARATE WAY RELATED 8013 05:39:16,920 --> 05:39:18,800 TO A AND B. 8014 05:39:18,800 --> 05:39:20,360 FOR THE RELATIONSHIP BETWEEN LP 8015 05:39:20,360 --> 05:39:24,320 AND I GLUCOSE CONTROL BY 8016 05:39:24,320 --> 05:39:26,360 CONSTRUCTING NETWORK MODELS WITH 8017 05:39:26,360 --> 05:39:28,680 SEQUENCING DATA FROM SEVEN 8018 05:39:28,680 --> 05:39:31,520 CARDIOMETABOLIC TISSUES OBTAINED 8019 05:39:31,520 --> 05:39:36,120 FROM CORONARY ARTERY DISEASE IN 8020 05:39:36,120 --> 05:39:38,720 BYPASS, BY INTEGRATING GENETIC, 8021 05:39:38,720 --> 05:39:41,280 THEY IDENTIFIED A REGULATORY NET 8022 05:39:41,280 --> 05:39:42,800 WORK WITH INVERSE RELATIONSHIP 8023 05:39:42,800 --> 05:39:45,800 TO EACH LIPID AND GLUCOSE. 8024 05:39:45,800 --> 05:39:47,800 NORMALLY THEY TRAVEL IN THE SAME 8025 05:39:47,800 --> 05:39:48,600 DIRECTION. 8026 05:39:48,600 --> 05:39:53,160 WHAT THEY FOUND ONE OF THE 8027 05:39:53,160 --> 05:39:55,040 MASTER REGULATORS, LSF, 8028 05:39:55,040 --> 05:39:56,360 CONFIRMED WHAT THEY FOUND IN THE 8029 05:39:56,360 --> 05:39:57,840 OMICS DATA. 8030 05:39:57,840 --> 05:39:59,800 THAT LEADS TO SOME NOVEL 8031 05:39:59,800 --> 05:40:05,000 MECHANISTIC INSIGHTS AROUND THE 8032 05:40:05,000 --> 05:40:06,080 TWO DISEASES. 8033 05:40:06,080 --> 05:40:10,800 A KEY INTEREST IN MULTIOMICS 8034 05:40:10,800 --> 05:40:12,840 STUDIES IS IDENTIFYING 8035 05:40:12,840 --> 05:40:15,840 ENDOTYPES, SUBGROUPS THAT MAY 8036 05:40:15,840 --> 05:40:17,680 BEHAVE DIFFERENTLY. 8037 05:40:17,680 --> 05:40:20,000 CAN MOLECULAR SIGNALS IDENTIFY 8038 05:40:20,000 --> 05:40:20,880 SUBGROUPS ANALOGOUS TO A 8039 05:40:20,880 --> 05:40:26,240 QUESTION WE WORKED ON TO 8040 05:40:26,240 --> 05:40:27,240 IDENTIFY PHENOTYPIC SIGNATURES. 8041 05:40:27,240 --> 05:40:28,760 THERE ARE MANY METHODS BUT ONE 8042 05:40:28,760 --> 05:40:31,040 OF THE MOST BASIC IS CLUSTERING, 8043 05:40:31,040 --> 05:40:33,160 BROUGHT UP IN ONE OF THE TALKS 8044 05:40:33,160 --> 05:40:34,560 ALREADY TODAY. 8045 05:40:34,560 --> 05:40:36,080 SO THIS APPROACH LEVERAGES LARGE 8046 05:40:36,080 --> 05:40:38,120 DATASETS BY TAKING THE FEATURES 8047 05:40:38,120 --> 05:40:40,160 AND LINKING THEM TO THE WAY WE 8048 05:40:40,160 --> 05:40:43,080 DID BEFORE, BUT NOW TO SOME 8049 05:40:43,080 --> 05:40:44,000 DIFFERENTIAL FEATURE, AS A 8050 05:40:44,000 --> 05:40:47,680 RESULT FEATURES CAN BE USED TO 8051 05:40:47,680 --> 05:40:48,560 PREDICT BEHAVIOR, PROGNOSIS, 8052 05:40:48,560 --> 05:40:50,120 TREATMENT RESPONSE. 8053 05:40:50,120 --> 05:40:53,280 YOU CAN DO THIS CLUSTERING IN A 8054 05:40:53,280 --> 05:40:54,400 SUPERVISED WAY, YOU KNOW 8055 05:40:54,400 --> 05:40:57,480 DIFFERENTIAL OUTCOME YOU'RE 8056 05:40:57,480 --> 05:41:00,200 INTERESTED IN, SAY PULL 8057 05:41:00,200 --> 05:41:01,960 PULMONARY VASCULAR DISEASE 8058 05:41:01,960 --> 05:41:02,960 PATIENTS THAT DEVELOP HEART 8059 05:41:02,960 --> 05:41:04,480 FAILURE AND THOSE THAT DON'T. 8060 05:41:04,480 --> 05:41:06,400 OR TYPES YOU MIGHT NOT HAVE 8061 05:41:06,400 --> 05:41:07,400 PREDICTED USING UNSUPERVISED 8062 05:41:07,400 --> 05:41:08,360 APPROACH TO IDENTIFY PATTERNS IN 8063 05:41:08,360 --> 05:41:09,480 THE DATA. 8064 05:41:09,480 --> 05:41:12,640 THIS WAS THE APPROACH THAT WE 8065 05:41:12,640 --> 05:41:13,840 ADVANCED FIRST USING PHENOTYPIC 8066 05:41:13,840 --> 05:41:16,480 DATA IN PATIENTS WITH HEART 8067 05:41:16,480 --> 05:41:17,920 FAILURE, UNSUPERVISED CLUSTERING 8068 05:41:17,920 --> 05:41:20,080 OF DENSE PHENOTYPIC DATA I WAS 8069 05:41:20,080 --> 05:41:22,280 THREE PHENOGROUPS WITHIN HEART 8070 05:41:22,280 --> 05:41:25,400 FAILURE WITH PRESERVED EJECTION 8071 05:41:25,400 --> 05:41:29,000 FRACTION WITH HIGHLY 8072 05:41:29,000 --> 05:41:33,600 DIFFERENTIAL OUTCOMES, THIS IS 8073 05:41:33,600 --> 05:41:35,760 AN UNSUPERVISED ANALYSIS. 8074 05:41:35,760 --> 05:41:37,120 TRULY MULTIOMIC WORK IS SPARSE 8075 05:41:37,120 --> 05:41:41,280 BUT I DID WANT TO HIGHLIGHT THIS 8076 05:41:41,280 --> 05:41:48,160 EFFORT FROM SOME OF MY 8077 05:41:48,160 --> 05:41:52,640 COLLEAGUES AT STANFORD. 8078 05:41:52,640 --> 05:41:55,280 THEY SHOWED 385 PERSON CENTER, 8079 05:41:55,280 --> 05:41:56,400 MARKERS WERE ABLE TO 8080 05:41:56,400 --> 05:41:59,240 DIFFERENTIATE PATIENTS INTO FOUR 8081 05:41:59,240 --> 05:42:00,240 CLUSTERS WITH DIFFERENTIAL 8082 05:42:00,240 --> 05:42:01,880 PROGNOSIS, FIVE YEAR TRANSPLANT 8083 05:42:01,880 --> 05:42:03,840 FREE SURVIVAL RATES UNFAVORABLE 8084 05:42:03,840 --> 05:42:06,680 FOR CLUSTER 1, FAVORABLE FOR 8085 05:42:06,680 --> 05:42:08,320 CLUSTER 3, SIMILAR WORK SHOWING 8086 05:42:08,320 --> 05:42:12,920 HETEROGENEITY OF RESPONSE TO 8087 05:42:12,920 --> 05:42:13,240 FEEDBACK. 8088 05:42:13,240 --> 05:42:15,800 THIS NEXT ONE IS OF PARTICULAR 8089 05:42:15,800 --> 05:42:18,040 INTEREST TO ME, ILLUSTRATED IN 8090 05:42:18,040 --> 05:42:21,240 THE CPAP STUDY I MENTIONED, TO 8091 05:42:21,240 --> 05:42:24,000 USE MULTIOMICS TO UNDERSTAND 8092 05:42:24,000 --> 05:42:25,080 INTERVENTIONAL EFFECTS. 8093 05:42:25,080 --> 05:42:27,400 HOW DOES INTERVENTION LIKE CPAP 8094 05:42:27,400 --> 05:42:28,800 AFFECT SYSTEMIC BIOLOGY? 8095 05:42:28,800 --> 05:42:30,480 THIS IS ANALOGOUS TO ANOTHER 8096 05:42:30,480 --> 05:42:32,880 TREATMENT WITH WIDE RANGING 8097 05:42:32,880 --> 05:42:34,320 SYSTEMIC EFFECTS, PHYSICAL 8098 05:42:34,320 --> 05:42:38,800 EXERCISE, FOR THESE QUESTIONS WE 8099 05:42:38,800 --> 05:42:40,880 CAN PAIR MULTIOMIC DATA 8100 05:42:40,880 --> 05:42:43,520 COLLECTION WITH CLINICAL TRIAL, 8101 05:42:43,520 --> 05:42:44,680 FOR ANIMAL EXPERIMENT. 8102 05:42:44,680 --> 05:42:46,560 THERE'S A HUGE NUMBER OF 8103 05:42:46,560 --> 05:42:47,880 ANALYSES THAT CAN COME OUT OF 8104 05:42:47,880 --> 05:42:49,960 DATA IN A TRIAL OR EXPECT, 8105 05:42:49,960 --> 05:42:52,600 SIMPLE TO SEE HOW LEVELS OF 8106 05:42:52,600 --> 05:42:54,640 MULTIOMIC MARKERS CHANGE WITH 8107 05:42:54,640 --> 05:42:58,480 INTERVENTION OF INTEREST BUT 8108 05:42:58,480 --> 05:43:00,200 MORE SOPHISTICATED APPROACH HOW 8109 05:43:00,200 --> 05:43:01,080 MULTIOMIC FEATURES CORRELATE 8110 05:43:01,080 --> 05:43:02,640 BEFORE AND AFTER INTERVENTION 8111 05:43:02,640 --> 05:43:05,640 SUCH AS CPAP OR EXERCISE, THIS 8112 05:43:05,640 --> 05:43:06,560 MULTIOMIC REWIRING WE CALL IT 8113 05:43:06,560 --> 05:43:09,720 CAN POINT US TO SOME OF THE KEY 8114 05:43:09,720 --> 05:43:12,280 PLAYERS IN THE MOLECULAR SPOTS 8115 05:43:12,280 --> 05:43:13,720 FOR THE INTERVENTION. 8116 05:43:13,720 --> 05:43:18,840 SHOWING HERE FROM A PRE-PRINT 8117 05:43:18,840 --> 05:43:21,160 FROM A MULTI-TISSUE MULTIOMIC 8118 05:43:21,160 --> 05:43:23,560 STUDY OF EXERCISE RESPONSE, DATA 8119 05:43:23,560 --> 05:43:26,520 FROM YOUNG RATS, 8 WEEKS OF 8120 05:43:26,520 --> 05:43:28,160 EXERCISE TRAINING, HOW TRAINING 8121 05:43:28,160 --> 05:43:33,640 INDUCED IMMUNE RESPONSES ACROSS 8122 05:43:33,640 --> 05:43:35,920 MULTIPLE TISSUES AND ENRICHMENT 8123 05:43:35,920 --> 05:43:39,000 ANALYSIS AT 8 WEEKS, IN KEG 8124 05:43:39,000 --> 05:43:41,520 IMMUNE SYSTEM PATHWAYS, 8125 05:43:41,520 --> 05:43:43,120 COMPREHENSIVE PICTURE OF 8126 05:43:43,120 --> 05:43:48,120 BIOMOLECULAR CHOREOGRAPHY OF 8127 05:43:48,120 --> 05:43:50,560 INTERVENTION GRADUALLY 8128 05:43:50,560 --> 05:43:50,840 UNTANGLED. 8129 05:43:50,840 --> 05:43:52,560 IT SUMMARIZES MOVEMENTS MULTIPLE 8130 05:43:52,560 --> 05:43:57,600 OMIC FEATURES ACCORDING TO KNOWN 8131 05:43:57,600 --> 05:43:58,440 PARTICIPATION AND BIOLOGIC 8132 05:43:58,440 --> 05:43:58,840 PATHWAYS. 8133 05:43:58,840 --> 05:44:01,320 A CLINICAL TRIAL IS USEFUL BUT 8134 05:44:01,320 --> 05:44:03,400 EXPENSIVE APPROACH TO ALLOWING 8135 05:44:03,400 --> 05:44:06,320 FOR CAUSAL INFERENCE AND AS WE 8136 05:44:06,320 --> 05:44:08,080 WORK OUR WAY IN COMPLEXITY AND 8137 05:44:08,080 --> 05:44:12,560 WANT TO DO MORE CAUSAL 8138 05:44:12,560 --> 05:44:14,000 INFREQUENCE WE CAN TAKE 8139 05:44:14,000 --> 05:44:17,200 ADVANTAGE TO HELP US INFER 8140 05:44:17,200 --> 05:44:19,480 CAUSALITY, USING TECHNIQUE OF 8141 05:44:19,480 --> 05:44:20,240 MENDELIAN RANDOMIZATION TO 8142 05:44:20,240 --> 05:44:22,440 ADDRESS CAN WE IDENTIFY CAUSAL 8143 05:44:22,440 --> 05:44:24,600 PATHWAYS FOR SLEEP DISORDERED 8144 05:44:24,600 --> 05:44:25,800 BREATHING OR PH AND 8145 05:44:25,800 --> 05:44:27,680 CARDIOVASCULAR DISEASE THIS 8146 05:44:27,680 --> 05:44:38,280 QUESTION IS SIMILARLY ASKED FOR. 8147 05:44:39,040 --> 05:44:41,520 SO MENDELIAN RANDOMIZATION DOES 8148 05:44:41,520 --> 05:44:47,680 NOT REQUIRE MULTIOMIC DATA, BUT 8149 05:44:47,680 --> 05:44:49,320 TO THE EXTENT VARIATION IS 8150 05:44:49,320 --> 05:44:55,360 LINKED TO OTHER FEATURES OR 8151 05:44:55,360 --> 05:45:00,040 PHENOTYPES MULTIOMIC CAN 8152 05:45:00,040 --> 05:45:01,920 ENHANCE, ALLOWING TO SHOW 8153 05:45:01,920 --> 05:45:05,280 CAUSALLY RELATED AND MIGHT GIVE 8154 05:45:05,280 --> 05:45:06,280 METABOLOMIC MEDIATOR AND 8155 05:45:06,280 --> 05:45:08,960 BIOMARKER IN THE SAME ANALYSIS. 8156 05:45:08,960 --> 05:45:11,440 THIS IS WHAT WAS DONE IN WORK 8157 05:45:11,440 --> 05:45:17,080 FROM OUR GROUP THAT PERFORMED MR 8158 05:45:17,080 --> 05:45:19,400 AND MULTIOMIC IN THE JACKSON 8159 05:45:19,400 --> 05:45:20,960 HEART STUDY, VALIDATING 8160 05:45:20,960 --> 05:45:23,920 DISCOVERED PATHWAYS IN MICE. 8161 05:45:23,920 --> 05:45:25,320 RESULTS IDENTIFIED NOVEL PROTEIN 8162 05:45:25,320 --> 05:45:27,160 PATHWAYS LINKED TO DISEASE WHICH 8163 05:45:27,160 --> 05:45:29,800 MIGHT RELIABLY BE THE TARGET OF 8164 05:45:29,800 --> 05:45:30,960 EFFECTIVE THERAPY WAS AVAILABLE 8165 05:45:30,960 --> 05:45:38,760 BIOMARKERS BUILT RIGHT IN TO 8166 05:45:38,760 --> 05:45:41,480 MONITOR TREATMENT EFFECT. 8167 05:45:41,480 --> 05:45:43,600 TAKEN TOGETHER, HAS POSSIBILITY 8168 05:45:43,600 --> 05:45:45,560 OF PRODUCING NOVEL PREDICTIVE 8169 05:45:45,560 --> 05:45:47,280 INSIGHTS ACROSS MULTIPLE COMPLEX 8170 05:45:47,280 --> 05:45:47,560 DISEASES. 8171 05:45:47,560 --> 05:45:49,080 THIS IS A MOMENT TO HIGHLIGHT 8172 05:45:49,080 --> 05:45:51,120 THERE ARE LOTS OF WAYS TO TIE 8173 05:45:51,120 --> 05:45:52,120 THESE METHODS TOGETHER SO, FOR 8174 05:45:52,120 --> 05:45:54,440 EXAMPLE, YOU MIGHT IDENTIFY 8175 05:45:54,440 --> 05:45:57,160 OMICS SIGNATURES IN COHORT STUDY 8176 05:45:57,160 --> 05:45:58,480 PREDICTIVE OF OUTCOME OF 8177 05:45:58,480 --> 05:46:01,000 INTEREST, MIGHT USE MARKERS AS 8178 05:46:01,000 --> 05:46:02,840 INCLUSION CRITERIA FOR PRECISION 8179 05:46:02,840 --> 05:46:04,040 TRIAL, ITSELF ENRICHED WITH 8180 05:46:04,040 --> 05:46:06,280 MULTIOMIC DATA TO TRACK 8181 05:46:06,280 --> 05:46:09,560 TREATMENT ADHERENCE, PREDICT 8182 05:46:09,560 --> 05:46:09,800 OUTCOMES. 8183 05:46:09,800 --> 05:46:15,240 HELPING US BE MORE EFFICIENT IN 8184 05:46:15,240 --> 05:46:19,280 TARGET PRECISION MEDICINE. 8185 05:46:19,280 --> 05:46:21,280 ALL THIS IS RAPID, PARTICULARLY 8186 05:46:21,280 --> 05:46:24,320 IN LARGE SCALE PRECISION HEALTH 8187 05:46:24,320 --> 05:46:28,400 EFFORTS, LARGE BIOBANKS, U.K. 8188 05:46:28,400 --> 05:46:30,720 BIOBANK, VETERANS PROGRAM AND 8189 05:46:30,720 --> 05:46:33,440 "ALL OF US," A COME AN APPROACH 8190 05:46:33,440 --> 05:46:36,600 TO BIOBANK UP FRONT AND OVER 8191 05:46:36,600 --> 05:46:38,360 TIME AS FUNDING AND ANALYTIC 8192 05:46:38,360 --> 05:46:46,800 TIME BECOMES AVAILABLE ADD OMICS 8193 05:46:46,800 --> 05:46:48,080 MEASUREMENTS TO DATASETS. 8194 05:46:48,080 --> 05:46:50,840 MV PARKS IS PARTNERS TO ADD 8195 05:46:50,840 --> 05:46:52,360 METABOLOMICS DATA, ALL OF US 8196 05:46:52,360 --> 05:46:58,240 ADDING DATA AS WELL IN THE 8197 05:46:58,240 --> 05:47:01,000 FUTURE. 8198 05:47:01,000 --> 05:47:04,600 IS IT FOR SLEEP AVAILABLE NOW? 8199 05:47:04,600 --> 05:47:08,440 I DID WANT TO HIGHLIGHT AN 8200 05:47:08,440 --> 05:47:11,320 EFFORT IN THE MoTrPAC STUDY, 8201 05:47:11,320 --> 05:47:13,720 GATHERING SLEEP DATA IN 8202 05:47:13,720 --> 05:47:17,840 PEDIATRIC PATIENTS WITH DENSE 8203 05:47:17,840 --> 05:47:24,320 SLEEP DATA, EEG, ECG, EMG, AS 8204 05:47:24,320 --> 05:47:28,480 WELL AS ACCELEROMETRY DATA, I R. 8205 05:47:28,480 --> 05:47:30,320 A RICH DATASET PAIRED WITH 8206 05:47:30,320 --> 05:47:34,240 MULTIOMIC EXERCISE RESPONSE DATA 8207 05:47:34,240 --> 05:47:36,280 AS WELL, EXCITING DOWN THE ROAD. 8208 05:47:36,280 --> 05:47:39,000 I'LL WRAP UP BY SAYING IF YOU'RE 8209 05:47:39,000 --> 05:47:41,400 THINKING ABOUT ADDING OMICS TO A 8210 05:47:41,400 --> 05:47:44,360 STUDY, PARTICULARLY A LARGE 8211 05:47:44,360 --> 05:47:46,120 STUDY OR DENSITY MULTIOMIC DATA, 8212 05:47:46,120 --> 05:47:49,000 IT'S IMPORTANT TO THINK UP FRONT 8213 05:47:49,000 --> 05:47:52,400 ABOUT THE RATHER LARGE AMOUNTS 8214 05:47:52,400 --> 05:47:53,240 OF BIOINFORMATIC MANAGEMENT AND 8215 05:47:53,240 --> 05:47:56,960 DATA WORK THAT GOES INTO THIS, 8216 05:47:56,960 --> 05:48:00,600 TRUE FOR RESEARCHERS AND FOR 8217 05:48:00,600 --> 05:48:02,760 FUNDING OFFICES, NIH, NHLBI TO 8218 05:48:02,760 --> 05:48:04,280 THINK ABOUT STUFF UP FRONT WHEN 8219 05:48:04,280 --> 05:48:07,360 DATA IS GENERATED WE NEED TO 8220 05:48:07,360 --> 05:48:10,320 INGEST, GENERATE DATA MANAGEMENT 8221 05:48:10,320 --> 05:48:11,960 PIPELINE, NORMALIZE, ANALYZE, 8222 05:48:11,960 --> 05:48:16,240 SHARE IT. 8223 05:48:16,240 --> 05:48:17,280 IN ADDITION TO ACCOUNTING FOR 8224 05:48:17,280 --> 05:48:18,960 DATA THERE NEEDS TO BE A 8225 05:48:18,960 --> 05:48:22,920 MECHANISM TO STORE RAW DATA BUT 8226 05:48:22,920 --> 05:48:24,680 ANALYSIS, THAT'S QUITE COSTLY 8227 05:48:24,680 --> 05:48:26,760 WITH CLOUD STORAGE AND 8228 05:48:26,760 --> 05:48:30,480 FORTUNATELY NIH HAS THE STRIDES 8229 05:48:30,480 --> 05:48:30,720 PROGRAM. 8230 05:48:30,720 --> 05:48:33,080 ALL THE EFFORTS THAT GO INTO 8231 05:48:33,080 --> 05:48:35,520 CREATING MOLECULAR MAPS OF WHAT 8232 05:48:35,520 --> 05:48:37,920 YOU'RE STUDYING NEED TO BE 8233 05:48:37,920 --> 05:48:39,560 DISSEMINATED THROUGH OUR 8234 05:48:39,560 --> 05:48:41,880 PACKAGES OR GITHUB SO DATA AND 8235 05:48:41,880 --> 05:48:44,160 ANALYSIS ARE SORT OF FOLLOWING 8236 05:48:44,160 --> 05:48:45,280 THE FAIR GUIDELINES. 8237 05:48:45,280 --> 05:48:48,120 DATA SHOULD BE DEPOSITED AND 8238 05:48:48,120 --> 05:48:53,160 CONNECTED IN OTHER DATABASES SO 8239 05:48:53,160 --> 05:48:55,360 YOU'VE GOT GEO, METABOLOMICS 8240 05:48:55,360 --> 05:48:57,000 WORKBENCH, WE KNOW ABOUT dbGAP 8241 05:48:57,000 --> 05:48:59,240 BUT WE'RE TRYING TO CREATE CLOUD 8242 05:48:59,240 --> 05:49:00,920 RESOURCES TO LINK DATASETS 8243 05:49:00,920 --> 05:49:01,880 TOGETHER AND ALLOW PEOPLE TO 8244 05:49:01,880 --> 05:49:03,640 EXPLORE THEM ON THE FLY AND 8245 05:49:03,640 --> 05:49:05,160 THROUGH THE WEB. 8246 05:49:05,160 --> 05:49:07,880 SO, WITH THAT I'LL WRAP UP AND 8247 05:49:07,880 --> 05:49:09,560 APPRECIATE EVERYONE AND TURN IT 8248 05:49:09,560 --> 05:49:11,520 OVER TO DR. SOFER TO GO INTO 8249 05:49:11,520 --> 05:49:14,360 MUCH MORE DETAIL. 8250 05:49:14,360 --> 05:49:20,400 8251 05:49:20,400 --> 05:49:21,160 8252 05:49:21,160 --> 05:49:29,600 >>THANKS, DAN, A WONDERFUL 8253 05:49:29,600 --> 05:49:29,800 TALK. 8254 05:49:29,800 --> 05:49:30,440 IT'S 4:34. 8255 05:49:30,440 --> 05:49:33,840 WE HAVE THE NEXT SESSION, THE 8256 05:49:33,840 --> 05:49:35,400 DISCUSSION, AND SO I WOULD -- 8257 05:49:35,400 --> 05:49:36,600 WE'LL CUT INTO THE DISCUSSION A 8258 05:49:36,600 --> 05:49:37,240 LITTLE BIT. 8259 05:49:37,240 --> 05:49:41,600 WE WANT TO HEAR YOUR FULL TALK. 8260 05:49:41,600 --> 05:49:44,120 >>OKAY. 8261 05:49:44,120 --> 05:49:52,480 SO, MY TALK IS ABOUT USE OF 8262 05:49:52,480 --> 05:49:54,440 MULTIOMICS, AND I'LL START WITH 8263 05:49:54,440 --> 05:49:59,360 THIS SLIDE THAT I BORROWED FROM 8264 05:49:59,360 --> 05:50:04,200 DAN'S TALK, THIS IS THE 8265 05:50:04,200 --> 05:50:05,120 RELATIONSHIP BETWEEN DIFFERENT 8266 05:50:05,120 --> 05:50:05,440 OMICS. 8267 05:50:05,440 --> 05:50:09,840 AT THE END HERE WE SEE THE 8268 05:50:09,840 --> 05:50:10,120 PHENOTYPE. 8269 05:50:10,120 --> 05:50:13,120 IT CAN BE USED AS OUTCOME OF THE 8270 05:50:13,120 --> 05:50:15,880 PROCESSES BUT CAN BE USED AS THE 8271 05:50:15,880 --> 05:50:16,880 ENVIRONMENT RIGHT HERE. 8272 05:50:16,880 --> 05:50:20,040 IF WE THINK ABOUT THE 8273 05:50:20,040 --> 05:50:20,920 RELATIONSHIP BETWEEN TWO 8274 05:50:20,920 --> 05:50:22,520 PHENOTYPES WE CAN THINK ABOUT 8275 05:50:22,520 --> 05:50:26,360 THEM SIDE BY SIDE, EACH ONE OF 8276 05:50:26,360 --> 05:50:30,640 THEM IS THE OUTCOME OF THE 8277 05:50:30,640 --> 05:50:32,480 COMPLEX GENETIC AND OMICS AND 8278 05:50:32,480 --> 05:50:33,920 ENVIRONMENTAL PROCESSES OR WE 8279 05:50:33,920 --> 05:50:38,840 CAN THINK OF ONE BEING THE 8280 05:50:38,840 --> 05:50:40,000 ENVIRONMENT, MODIFYING THESE 8281 05:50:40,000 --> 05:50:42,600 EFFECTS IN THE WAY THEY LEAD TO 8282 05:50:42,600 --> 05:50:43,800 THE SECOND PHENOTYPE. 8283 05:50:43,800 --> 05:50:48,280 SO, I WILL GIVE EXAMPLES, RUN 8284 05:50:48,280 --> 05:50:51,680 THROUGH THE TWO TYPES OF 8285 05:50:51,680 --> 05:50:53,200 ASSOCIATION OMICS ASSOCIATION, 8286 05:50:53,200 --> 05:50:56,040 LEADING TO RELATIONSHIP BETWEEN 8287 05:50:56,040 --> 05:50:57,240 TWO PHENOTYPES. 8288 05:50:57,240 --> 05:51:01,760 SO, I WAS TRYING TO FIND 8289 05:51:01,760 --> 05:51:04,480 EXAMPLES RELATED TO SLEEP. 8290 05:51:04,480 --> 05:51:05,360 AND PULMONARY VASCULAR DISEASE 8291 05:51:05,360 --> 05:51:07,120 THAT RELATES THE TWO. 8292 05:51:07,120 --> 05:51:08,320 IT WAS VERY, VERY DIFFICULT 8293 05:51:08,320 --> 05:51:11,240 BECAUSE THIS FIELD IS STILL IN 8294 05:51:11,240 --> 05:51:14,000 THE INFANCY SO THESE EXAMPLES 8295 05:51:14,000 --> 05:51:23,440 ARE NOT AS NICE AS WE WOULD 8296 05:51:23,440 --> 05:51:24,080 HOPE. 8297 05:51:24,080 --> 05:51:25,640 SO FIRST EXAMPLE, USING GENETICS 8298 05:51:25,640 --> 05:51:28,920 TO LINK TWO CONDITIONS. 8299 05:51:28,920 --> 05:51:31,840 GENETICS IS VERY POWERFUL. 8300 05:51:31,840 --> 05:51:34,560 IT'S THE MOST ABUNDANT OF ALL 8301 05:51:34,560 --> 05:51:36,560 THE OMICS DATA BECAUSE WE'VE 8302 05:51:36,560 --> 05:51:38,640 BEEN STUDYING FOR IT FOR A WHILE 8303 05:51:38,640 --> 05:51:41,800 IN LARGE SAMPLE SIZES. 8304 05:51:41,800 --> 05:51:43,440 IT'S ALSO POWERFUL BECAUSE IT'S 8305 05:51:43,440 --> 05:51:46,960 FIXED AT BIRTH. 8306 05:51:46,960 --> 05:51:49,560 HERE WHEN WE LINK TO TWO 8307 05:51:49,560 --> 05:51:53,160 CONDITIONS WE OFTEN USE KNOWN 8308 05:51:53,160 --> 05:51:54,040 GENETIC ASSOCIATIONS, FOR 8309 05:51:54,040 --> 05:51:55,600 EXAMPLE WE MAY ALREADY KNOW WE 8310 05:51:55,600 --> 05:51:57,800 HAVE SOME GENETIC VARIANTS 8311 05:51:57,800 --> 05:52:00,560 ASSOCIATED WITH WHATEVER SLEEP 8312 05:52:00,560 --> 05:52:05,120 OUTCOME, AND WE WANT TO ASK, 8313 05:52:05,120 --> 05:52:05,880 UTILIZE GENETIC VARIANTS, 8314 05:52:05,880 --> 05:52:06,840 ASSOCIATED WITH THE FIRST 8315 05:52:06,840 --> 05:52:09,480 CONDITION, TO ASK QUESTIONS 8316 05:52:09,480 --> 05:52:11,440 ABOUT THE SECOND CONDITION AND 8317 05:52:11,440 --> 05:52:13,520 LEARN FROM THIS ABOUT 8318 05:52:13,520 --> 05:52:17,360 ASSOCIATION BETWEEN THE TWO 8319 05:52:17,360 --> 05:52:18,200 CONDITIONS. 8320 05:52:18,200 --> 05:52:19,520 EXAMPLES FOUND WITH THAT, 2020 8321 05:52:19,520 --> 05:52:20,960 ASSOCIATION OF CARDIOVASCULAR 8322 05:52:20,960 --> 05:52:27,520 RISK FACTORS AND LIFESTYLE 8323 05:52:27,520 --> 05:52:31,280 BEHAVIORS WITH HYPERTENSION, 8324 05:52:31,280 --> 05:52:32,760 MENDELIAN RANDOMIZATION STUDY, 8325 05:52:32,760 --> 05:52:39,760 HERE GWAS STATICS FROM THE U.K. 8326 05:52:39,760 --> 05:52:41,200 BIOBANK, OPEN ACCESS DATASETS OR 8327 05:52:41,200 --> 05:52:48,400 THERE ARE OPEN ACCESS COMPONENTS 8328 05:52:48,400 --> 05:52:50,800 TO THEM. 8329 05:52:50,800 --> 05:52:55,440 CONCLUDED GENETIC PREDICTED 8330 05:52:55,440 --> 05:53:04,720 INSOMNIA INCREASES RISK OF 8331 05:53:04,720 --> 05:53:05,080 HYPERTENSION. 8332 05:53:05,080 --> 05:53:09,320 FINDINGS RELATE TO THE CAUSAL 8333 05:53:09,320 --> 05:53:12,360 ASSOCIATION BETWEEN TWO 8334 05:53:12,360 --> 05:53:12,800 PHENOTYPES. 8335 05:53:12,800 --> 05:53:16,680 ANOTHER EXAMPLE WE'LL BE MORE 8336 05:53:16,680 --> 05:53:18,760 ELABORATE USING SIMILAR 8337 05:53:18,760 --> 05:53:22,880 TECHNIQUE, DIABETIC PHENOTYPES, 8338 05:53:22,880 --> 05:53:26,160 LATE LIFE DEMENTIA RISK, 8339 05:53:26,160 --> 05:53:29,240 SPECIFIC MENDELIAN STUDY, IT 8340 05:53:29,240 --> 05:53:31,080 MEANS THEY SELECTED VARIANTS 8341 05:53:31,080 --> 05:53:32,840 CORRESPONDING TO SPECIFIC 8342 05:53:32,840 --> 05:53:36,600 FUNCTIONS, BETA CELL FUNCTION, 8343 05:53:36,600 --> 05:53:38,760 INSULIN SENSITIVITY, ADIPOSITY. 8344 05:53:38,760 --> 05:53:41,440 HERE FOUND SUGGESTIVE EVIDENCE 8345 05:53:41,440 --> 05:53:44,320 THAT INSULIN-SENSITIVITY SCORE 8346 05:53:44,320 --> 05:53:46,440 IS ASSOCIATED WITH DEMENTIA. 8347 05:53:46,440 --> 05:53:48,760 FINDINGS RELATE TO CAUSAL 8348 05:53:48,760 --> 05:53:51,800 ASSOCIATION INFERENCE WITH 8349 05:53:51,800 --> 05:53:52,520 SPECIFIC WELL-DEFINED 8350 05:53:52,520 --> 05:53:56,000 GENETICALLY REGULATED MECHANISM 8351 05:53:56,000 --> 05:54:00,680 OF THE FIRST PHENOTYPE. 8352 05:54:00,680 --> 05:54:03,840 SUBTYPE OF DIABETES. 8353 05:54:03,840 --> 05:54:07,920 STANDARD WAY TO USE OMICS TO 8354 05:54:07,920 --> 05:54:10,680 PERFORM ASSOCIATION, FIRST THING 8355 05:54:10,680 --> 05:54:11,960 YOU WOULD DO. 8356 05:54:11,960 --> 05:54:16,480 ASSOCIATION ANALYSIS WITH SOME 8357 05:54:16,480 --> 05:54:22,320 OMICS, WITH FIRST CONDITION, AND 8358 05:54:22,320 --> 05:54:26,120 YOU CAN IDENTIFY FOR EXAMPLE 8359 05:54:26,120 --> 05:54:27,080 PATHWAY BASED ON RESULTS. 8360 05:54:27,080 --> 05:54:28,600 MAY BE KNOWN TO RELATE TO 8361 05:54:28,600 --> 05:54:29,480 CONDITION 2. 8362 05:54:29,480 --> 05:54:32,240 YOU MAY NOT EVEN HAVE DATA WITH 8363 05:54:32,240 --> 05:54:34,840 CONDITION 2 BUT THIS IS A VERY 8364 05:54:34,840 --> 05:54:39,040 STRAIGHTFORWARD WAY TO RELATE 8365 05:54:39,040 --> 05:54:40,560 THE TWO CONDITIONS. 8366 05:54:40,560 --> 05:54:43,280 HERE IN THIS STUDY THIS SHOWS 8367 05:54:43,280 --> 05:54:44,160 PROLONGED SLEEP RESTRICTION 8368 05:54:44,160 --> 05:54:46,040 INDUCES CHANGES IN PATHWAYS 8369 05:54:46,040 --> 05:54:48,440 INVOLVED IN CHOLESTEROL 8370 05:54:48,440 --> 05:54:49,720 METABOLISM AND INFLAMMATORY 8371 05:54:49,720 --> 05:54:50,080 RESPONSES. 8372 05:54:50,080 --> 05:54:53,560 AUTHORS DID EXPERIMENTAL SLEEP 8373 05:54:53,560 --> 05:54:56,640 RESTRICTION STUDY, COMBINED WITH 8374 05:54:56,640 --> 05:54:58,600 EPIDEMIOLOGICAL COHORTS, SLEEP 8375 05:54:58,600 --> 05:55:01,760 SUFFICIENCY QUESTIONS, AND THEY 8376 05:55:01,760 --> 05:55:03,400 ON AD BLOOD TRANSCRIPTOMICS TO 8377 05:55:03,400 --> 05:55:07,800 DO PATHWAY ANALYSIS AND FIND 8378 05:55:07,800 --> 05:55:09,000 HIGHLIGHTED LIPID PATHWAYS AND 8379 05:55:09,000 --> 05:55:18,080 FOUND ASSOCIATION WHEN THEY USED 8380 05:55:18,080 --> 05:55:18,960 METABOLITES. 8381 05:55:18,960 --> 05:55:20,480 OR TWO-STEP ANALYSIS FIRST 8382 05:55:20,480 --> 05:55:21,800 PERFORMED ASSOCIATION ANALYSIS 8383 05:55:21,800 --> 05:55:28,160 USING CONDITION 1, AND THEN YOU 8384 05:55:28,160 --> 05:55:31,840 USE YOUR FINDINGS, METABOLITES, 8385 05:55:31,840 --> 05:55:36,040 AND THEN TEST WITH SECOND 8386 05:55:36,040 --> 05:55:38,320 CONDITION OF INTEREST. 8387 05:55:38,320 --> 05:55:40,800 SO, WHAT ABOUT OMICS BEYOND 8388 05:55:40,800 --> 05:55:41,160 ASSOCIATION? 8389 05:55:41,160 --> 05:55:44,000 OMICS IS USED TO EXPLAIN 8390 05:55:44,000 --> 05:55:46,840 MECHANISM, IF YOU CAN EXPLAIN 8391 05:55:46,840 --> 05:55:48,080 BIOLOGY THEY ARE MORE LIKELY TO 8392 05:55:48,080 --> 05:55:50,560 BE TRUE. 8393 05:55:50,560 --> 05:55:53,040 IT CAN BE USED TO DETERMINE 8394 05:55:53,040 --> 05:55:58,560 RESPONSE TO THERAPY, AS A 8395 05:55:58,560 --> 05:56:01,600 BIOMARKER, HELPS ASSESS 8396 05:56:01,600 --> 05:56:03,480 RESPONSE, IDENTIFY SUBTYPES, 8397 05:56:03,480 --> 05:56:04,800 MORE LIKELY TO DEVELOP SECOND 8398 05:56:04,800 --> 05:56:08,760 CONDITION, THOSE LIKELY TO 8399 05:56:08,760 --> 05:56:16,960 RESPOND TO TREATMENT, AND OTHER 8400 05:56:16,960 --> 05:56:26,160 BRIEF EXAMPLES FROM 2021, 8401 05:56:26,160 --> 05:56:30,240 CHRONIC THROMBOEMBOLIC PULMONARY 8402 05:56:30,240 --> 05:56:32,720 HYPERTENSION, TO PERFORM 8403 05:56:32,720 --> 05:56:39,200 UNTARGETED ANALYSIS IN CTEPH 8404 05:56:39,200 --> 05:56:39,560 PATIENTS. 8405 05:56:39,560 --> 05:56:41,400 EVALUATED RESPONSE TO TREATMENT. 8406 05:56:41,400 --> 05:56:44,800 AND OF THE METABOLITES. 8407 05:56:44,800 --> 05:56:48,040 AND THEY FOUND MOST METABOLITE 8408 05:56:48,040 --> 05:56:50,040 LEVELS ARE SIMILAR BUT THEY 8409 05:56:50,040 --> 05:56:51,640 IDENTIFY SOME METABOLITES THAT 8410 05:56:51,640 --> 05:56:53,840 DIFFER BETWEEN THEM. 8411 05:56:53,840 --> 05:56:59,440 YOU CAN POTENTIALLY BE USED TO 8412 05:56:59,440 --> 05:57:02,600 IDENTIFY THE TWO, UNDERSTAND THE 8413 05:57:02,600 --> 05:57:02,840 BIOLOGY. 8414 05:57:02,840 --> 05:57:06,880 AND THEY CAN BE USED TO ASSESS 8415 05:57:06,880 --> 05:57:07,880 RESPONSE TO TREATMENT, THEY 8416 05:57:07,880 --> 05:57:09,720 OBSERVED RESPONSE TO TREATMENT 8417 05:57:09,720 --> 05:57:11,560 OF THESE METABOLITES THAT 8418 05:57:11,560 --> 05:57:12,800 DEFERRED BETWEEN THEM AND 8419 05:57:12,800 --> 05:57:14,200 SUGGEST THOSE ARE STILL NEED 8420 05:57:14,200 --> 05:57:15,800 WORK TO BE DONE. 8421 05:57:15,800 --> 05:57:19,240 THEY SUGGEST METABOLITES CAN BE 8422 05:57:19,240 --> 05:57:22,760 USED TO EVALUATE RESPONSIVE OF 8423 05:57:22,760 --> 05:57:26,040 OTHER NON-INVASIVE TREATMENT. 8424 05:57:26,040 --> 05:57:28,880 ANOTHER EXAMPLE, TO SHOW 8425 05:57:28,880 --> 05:57:31,920 MULTIOMICS MAY EXPLAIN BETTER 8426 05:57:31,920 --> 05:57:34,920 BIOLOGY, SO PROTEIN BIOMARKERS 8427 05:57:34,920 --> 05:57:42,200 AND RISK SCORES, ASSOCIATED WITH 8428 05:57:42,200 --> 05:57:47,000 VENTRICULAR SEPTAL DEFECT, 8429 05:57:47,000 --> 05:57:48,600 PERFORMED ANALYSIS, AND 8430 05:57:48,600 --> 05:57:50,000 INTEGRATED THEM BY MAPPING 8431 05:57:50,000 --> 05:57:52,960 ASSOCIATED PROTEINS INTO KNOWN 8432 05:57:52,960 --> 05:57:53,360 PATHWAYS. 8433 05:57:53,360 --> 05:57:56,360 REALLY THE MULTIOMICS SPACE IS 8434 05:57:56,360 --> 05:57:56,760 IN ITS INFANCY. 8435 05:57:56,760 --> 05:57:59,040 A LOT OF METHODS ARE BASICALLY 8436 05:57:59,040 --> 05:58:04,760 DOING EACH ONE SEPARATELY AND 8437 05:58:04,760 --> 05:58:08,360 THEN TRYING TO USES INFORMATION 8438 05:58:08,360 --> 05:58:10,440 FROM THE TWO, TOGETHER. 8439 05:58:10,440 --> 05:58:13,320 I STILL WANTED TO GIVE EXAMPLES 8440 05:58:13,320 --> 05:58:15,240 FROM OUR OWN RESEARCH. 8441 05:58:15,240 --> 05:58:18,120 SO I'LL DESCRIBE TWO STUDIES, 8442 05:58:18,120 --> 05:58:22,040 ONE IS OBSTRUCTIVE SLEEP APNEA, 8443 05:58:22,040 --> 05:58:24,120 CARDIOMETABOLIC PHENOTYPE, A 8444 05:58:24,120 --> 05:58:28,480 FORMER POSTDOC WHO WORKED ON 8445 05:58:28,480 --> 05:58:29,840 GENETIC DETERMINANTS, 8446 05:58:29,840 --> 05:58:34,640 OBSTRUCTIVE SLEEP APNEA IN THE 8447 05:58:34,640 --> 05:58:36,480 HISPANIC COMMUNITY HEALTH STUDY, 8448 05:58:36,480 --> 05:58:39,440 STUDYING ASSOCIATION BETWEEN OSA 8449 05:58:39,440 --> 05:58:40,520 AND PHENOTYPES. 8450 05:58:40,520 --> 05:58:42,400 TOOLS INCLUDE GENETIC 8451 05:58:42,400 --> 05:58:44,360 CORRELATION ESTIMATION, 8452 05:58:44,360 --> 05:58:46,320 POLYGENIC RISK SCORES, MENDELIAN 8453 05:58:46,320 --> 05:58:47,840 RANDOMIZATION ANALYSIS THAT WAS 8454 05:58:47,840 --> 05:58:51,480 MENTIONED BEFORE. 8455 05:58:51,480 --> 05:58:52,600 THIS IS THE DESIGN. 8456 05:58:52,600 --> 05:58:57,080 WE'LL WALK YOU THROUGH IT. 8457 05:58:57,080 --> 05:59:00,040 THE FIRST STEP ESTIMATED GENETIC 8458 05:59:00,040 --> 05:59:01,800 CORRELATION USING INDIVIDUAL 8459 05:59:01,800 --> 05:59:03,960 LEVEL DATA. 8460 05:59:03,960 --> 05:59:06,160 GENETIC CORRELATION BETWEEN TWO 8461 05:59:06,160 --> 05:59:07,360 TRAITS IS CORRELATION BETWEEN 8462 05:59:07,360 --> 05:59:10,880 EFFECTS OF GENETIC CARANTS 8463 05:59:10,880 --> 05:59:15,240 ON -- VARIANTS ON EACH OF THE 8464 05:59:15,240 --> 05:59:16,320 TRAITS, CORRELATION BETWEEN 8465 05:59:16,320 --> 05:59:19,840 GENETIC COMPONENTS OF THESE 8466 05:59:19,840 --> 05:59:20,400 TRAITS. 8467 05:59:20,400 --> 05:59:23,560 HERE WE USE RESPIRATORY EVENT 8468 05:59:23,560 --> 05:59:26,840 INDEX, 54 OTHER PHENOTYPES 8469 05:59:26,840 --> 05:59:32,080 RELATED TO ANTHROPO METRIC, 8470 05:59:32,080 --> 05:59:33,200 CARDIOMETABOLIC, ESTIMATED 8471 05:59:33,200 --> 05:59:34,840 GENETIC CORRELATION, GIVES US A 8472 05:59:34,840 --> 05:59:41,720 HINT, A GRIEF SHARED GENETICS 8473 05:59:41,720 --> 05:59:43,480 BETWEEN THEM. 8474 05:59:43,480 --> 05:59:47,720 WE NARROWED DOWN TO 22 8475 05:59:47,720 --> 05:59:48,960 PHENOTYPES, TRAITS INCLUDED 8476 05:59:48,960 --> 05:59:49,720 PULMONARY, CHOLESTEROL, BLOOD 8477 05:59:49,720 --> 05:59:50,280 COUNT. 8478 05:59:50,280 --> 06:00:00,760 WE MOVED TO THE NEXT STEPS, 8479 06:00:05,560 --> 06:00:07,240 USING POLYGENIC RISK SCORES 8480 06:00:07,240 --> 06:00:10,280 COMBINING ACROSS THE GENOME. 8481 06:00:10,280 --> 06:00:13,440 TO USE POLYGENIC RISK SCORES YOU 8482 06:00:13,440 --> 06:00:15,880 NEED SOME ESTIMATES OF RATE 8483 06:00:15,880 --> 06:00:16,320 ASSOCIATION. 8484 06:00:16,320 --> 06:00:18,400 THIS IS SOMETHING WE TAKE FROM 8485 06:00:18,400 --> 06:00:19,720 AN OUTSIDE STUDY. 8486 06:00:19,720 --> 06:00:21,800 AND THEN WE USE THIS INFORMATION 8487 06:00:21,800 --> 06:00:26,400 FROM AN OUTSIDE STUDY TO 8488 06:00:26,400 --> 06:00:26,920 CONSTRUCT. 8489 06:00:26,920 --> 06:00:28,920 HERE WE CONSTRUCTED POLYGENIC 8490 06:00:28,920 --> 06:00:32,200 RISK FOR FOR CORRELATED TRAITS 8491 06:00:32,200 --> 06:00:39,680 AND 22 YEARS AN OBSTRUCTIVE 8492 06:00:39,680 --> 06:00:41,280 SLEEP APNEA, STUDYING 8493 06:00:41,280 --> 06:00:42,040 ASSOCIATION. 8494 06:00:42,040 --> 06:00:43,240 THESE ARE THE RESULTS. 8495 06:00:43,240 --> 06:00:48,280 SO LET ME WALK YOU THROUGH THIS. 8496 06:00:48,280 --> 06:00:51,160 HERE WE SEE ALL THE PHENOTYPES 8497 06:00:51,160 --> 06:00:54,120 WITH EVIDENCE OF GENT 8498 06:00:54,120 --> 06:00:59,040 CORRELATION, SHARED GENETIC 8499 06:00:59,040 --> 06:00:59,240 BASIS. 8500 06:00:59,240 --> 06:01:01,640 BMI, RESPIRATION, SO ON. 8501 06:01:01,640 --> 06:01:03,080 WE SEE THEIR ASSOCIATION WITH 8502 06:01:03,080 --> 06:01:10,840 ONE OUTCOME. 8503 06:01:10,840 --> 06:01:13,680 HERE OUTCOME RESPIRATORY INDEX, 8504 06:01:13,680 --> 06:01:17,520 AND BMI ADJUSTED MODEL. 8505 06:01:17,520 --> 06:01:20,560 OSA DEFINED BASED ON RESPIRATORY 8506 06:01:20,560 --> 06:01:22,320 EVENT INDEX, SIMILAR BUT IF 8507 06:01:22,320 --> 06:01:24,400 THERE'S MEASUREMENT ERROR, WHICH 8508 06:01:24,400 --> 06:01:27,480 THERE IS, MAY BE SLIGHTLY MORE 8509 06:01:27,480 --> 06:01:28,320 POWERFUL. 8510 06:01:28,320 --> 06:01:33,600 AND THEN WE DID BMI ADJUSTED. 8511 06:01:33,600 --> 06:01:36,560 AND EACH POINT CORRESPONDS TO 8512 06:01:36,560 --> 06:01:39,520 ESTIMATED SIZE AND CONFIDENCE 8513 06:01:39,520 --> 06:01:40,040 INTERVAL. 8514 06:01:40,040 --> 06:01:43,680 WE COLOR CODED ACCORDING TO 8515 06:01:43,680 --> 06:01:47,280 THIS -- WHERE THE ASSOCIATION 8516 06:01:47,280 --> 06:01:50,040 WAS SIGNIFICANT. 8517 06:01:50,040 --> 06:01:55,600 HERE AFTER ADJUSTING FOR BMI 8518 06:01:55,600 --> 06:01:59,320 POLYGENIC RISK FOR INSOMNIA, 8519 06:01:59,320 --> 06:02:01,920 HBA1C, SHOW EVIDENCE OF 8520 06:02:01,920 --> 06:02:06,760 ASSOCIATION WITH RESPIRATORY 8521 06:02:06,760 --> 06:02:11,000 EVENT INDEX FOR OSA. 8522 06:02:11,000 --> 06:02:15,960 IT WAS ASSOCIATED WITH HBA1C AND 8523 06:02:15,960 --> 06:02:16,920 BMI-ADJUSTED ANALYSIS. 8524 06:02:16,920 --> 06:02:19,000 THE FOLLOWING STEP WAS TO LOOK 8525 06:02:19,000 --> 06:02:23,640 AT CAUSALITY OF ASSOCIATION 8526 06:02:23,640 --> 06:02:26,800 USING MENDELIAN RANDOMIZATION 8527 06:02:26,800 --> 06:02:27,040 ANALYSIS. 8528 06:02:27,040 --> 06:02:30,080 THE GOAL IS STUDY ASSOCIATION 8529 06:02:30,080 --> 06:02:31,680 BETWEEN EXPOSURE ANDOUT COME. 8530 06:02:31,680 --> 06:02:34,800 HERE COMPOSURE COULD BE 8531 06:02:34,800 --> 06:02:42,680 OBSTRUCTIVE SLEEP APNEA. 8532 06:02:42,680 --> 06:02:45,400 AND USUALLY THERE ARE CONFOUNDED 8533 06:02:45,400 --> 06:02:46,600 ASSOCIATIONS BETWEEN THE TWO, 8534 06:02:46,600 --> 06:02:47,800 FOR EXAMPLE BMI. 8535 06:02:47,800 --> 06:02:51,000 THE GOAL OF USING GENETIC 8536 06:02:51,000 --> 06:02:53,840 INSTRUMENT HERE INSTRUMENTAL 8537 06:02:53,840 --> 06:02:56,440 VARIABLES, GENOTYPES, IS TO 8538 06:02:56,440 --> 06:02:57,880 ASSESS THE EXPOSURE OUTCOME 8539 06:02:57,880 --> 06:03:00,280 ASSOCIATION IN A WAY THAT KIND 8540 06:03:00,280 --> 06:03:05,320 OF REMOVES THE BIAS FROM 8541 06:03:05,320 --> 06:03:05,680 CONFOUNDING. 8542 06:03:05,680 --> 06:03:09,280 WE NEED TO TAKE VARIANTS 8543 06:03:09,280 --> 06:03:10,280 ASSOCIATED WITH EXPOSURE, 8544 06:03:10,280 --> 06:03:17,600 HOPEFULLY NOT ASSOCIATED WITH 8545 06:03:17,600 --> 06:03:21,200 OUTCOME VIA OTHER PATHWAYS. 8546 06:03:21,200 --> 06:03:24,400 THERE ARE MANY METHODS USING 8547 06:03:24,400 --> 06:03:29,000 MANY GENETIC VARIANTS, SOMEHOW 8548 06:03:29,000 --> 06:03:30,760 CAN IDENTIFY PROCEDURES EVEN IF 8549 06:03:30,760 --> 06:03:35,760 THIS IS VIOLATED, SOMETIMES, YOU 8550 06:03:35,760 --> 06:03:36,760 CAN STILL OBTAIN UNBIASED 8551 06:03:36,760 --> 06:03:41,360 ESTIMATES OF EXPOSURE OUTSOME 8552 06:03:41,360 --> 06:03:41,920 ASSOCIATION. 8553 06:03:41,920 --> 06:03:45,520 IT HAS TO HAVE ESTIMATES OF 8554 06:03:45,520 --> 06:03:48,800 ASSOCIATION, YOU NEED HAVE 8555 06:03:48,800 --> 06:03:51,440 ESTIMATES OF GENETIC ASSOCIATION 8556 06:03:51,440 --> 06:03:52,560 WITH EXPOSURES AND OUTCOME. 8557 06:03:52,560 --> 06:03:56,360 IF YOU HAVE THAT, YOU CAN 8558 06:03:56,360 --> 06:03:59,320 PERFORM MENDELIAN ANALYSIS. 8559 06:03:59,320 --> 06:04:03,160 HERE WE FOCUSED ON THE 11 8560 06:04:03,160 --> 06:04:05,000 TRAITS, WITH SOME EVIDENCE OF 8561 06:04:05,000 --> 06:04:07,520 PEER ASSOCIATION WITH OSA OR 8562 06:04:07,520 --> 06:04:08,040 REI. 8563 06:04:08,040 --> 06:04:09,680 WE'RE NOT SHOWING RESULTS FORT 8564 06:04:09,680 --> 06:04:13,960 OSA HERE BECAUSE THERE WAS NO 8565 06:04:13,960 --> 06:04:15,840 EVIDENCE OF CAUSAL ASSOCIATION. 8566 06:04:15,840 --> 06:04:20,960 BUT WE HAVE EVIDENCE OF CAUSAL 8567 06:04:20,960 --> 06:04:22,160 ASSOCIATION, PHENOTYPES, TWO 8568 06:04:22,160 --> 06:04:24,480 FIGURES HERE ONE SHOWS RESULTS 8569 06:04:24,480 --> 06:04:26,440 FROM PRIMARY ANALYSIS, HERE WE 8570 06:04:26,440 --> 06:04:28,080 HAVE RESULTS FROM SENSITIVITY AM 8571 06:04:28,080 --> 06:04:30,240 SIS. 8572 06:04:30,240 --> 06:04:36,720 REMEMBER I MENTIONED WE HAVE 8573 06:04:36,720 --> 06:04:41,760 VARIOUS METHODS TO DEAL WITH 8574 06:04:41,760 --> 06:04:42,960 DEVIATIONS, STANDARD ANALYSIS 8575 06:04:42,960 --> 06:04:43,840 DOES SOMETHING PRELIMINARY AND 8576 06:04:43,840 --> 06:04:47,240 IF YOU SEE EVIDENCE THEN YOU GO, 8577 06:04:47,240 --> 06:04:48,640 TAKE ASSOCIATION AND RUN IT 8578 06:04:48,640 --> 06:04:54,040 THROUGH A BUNCH OF SENSITIVITY 8579 06:04:54,040 --> 06:04:55,000 ANALYSES. 8580 06:04:55,000 --> 06:05:05,200 WE FOUND EVIDENCE OF CAUSAL 8581 06:05:05,200 --> 06:05:05,800 EFFECTS. 8582 06:05:05,800 --> 06:05:07,600 LIMITATIONS IS MAINLY DATA. 8583 06:05:07,600 --> 06:05:12,320 GENETIC ANALYSIS METHODS RELY ON 8584 06:05:12,320 --> 06:05:14,640 INDIVIDUAL-LEVEL DATA, INCLUDING 8585 06:05:14,640 --> 06:05:15,880 COLLECTED TRAITS, SUMMARY 8586 06:05:15,880 --> 06:05:17,120 STATISTICS FROM ANALYSIS THAT 8587 06:05:17,120 --> 06:05:19,200 SOMEONE ELSE DID, USUALLY BOTH. 8588 06:05:19,200 --> 06:05:22,920 USUALLY YOU USE SOME INFORMATION 8589 06:05:22,920 --> 06:05:26,400 FROM PAST ANALYSES AND TRY TO 8590 06:05:26,400 --> 06:05:29,160 APPLY USING INDIVIDUAL LEVEL 8591 06:05:29,160 --> 06:05:29,480 DATA. 8592 06:05:29,480 --> 06:05:31,240 EITHER WAY, THE RIGHT PHENOTYPE 8593 06:05:31,240 --> 06:05:33,080 OR OTHER MEASURES ARE AVAILABLE. 8594 06:05:33,080 --> 06:05:36,400 AND YOU NEED LARGE SAMPLE SIZES. 8595 06:05:36,400 --> 06:05:38,440 IF THE OSA PHENOTYPE THAT WAS 8596 06:05:38,440 --> 06:05:40,840 USED IN THE GENOME WIDE 8597 06:05:40,840 --> 06:05:41,960 ASSOCIATION ANNUAL SILLS THAT 8598 06:05:41,960 --> 06:05:44,800 YOU TOOK FROM THE LITERATURE IS 8599 06:05:44,800 --> 06:05:50,080 NOT GOOD, IF YOU HAVE HIGH RISK 8600 06:05:50,080 --> 06:05:52,680 OR LOW SAMPLE SIZES, IT LIMITS 8601 06:05:52,680 --> 06:05:56,200 CONCLUSION FROM RESULTS. 8602 06:05:56,200 --> 06:05:58,280 THIS INCLUDES CONCLUSION, LIKELY 8603 06:05:58,280 --> 06:05:59,800 LIMITED BECAUSE OF THE SPECIFIC 8604 06:05:59,800 --> 06:06:07,240 RESULTS THAT WE USE THAT WE TOOK 8605 06:06:07,240 --> 06:06:17,640 FROM THE LITERATURE. 8606 06:06:17,640 --> 06:06:19,760 ANOTHER ANALYSIS WITH 8607 06:06:19,760 --> 06:06:20,400 METABOLOMICS, ASSESSED 8608 06:06:20,400 --> 06:06:24,320 ASSOCIATION WITH INCIDENT 8609 06:06:24,320 --> 06:06:25,880 DIABETES AND HYPERTENSION. 8610 06:06:25,880 --> 06:06:28,280 THIS PAPER IS IN REVIEW 8611 06:06:28,280 --> 06:06:29,040 CURRENTLY. 8612 06:06:29,040 --> 06:06:32,520 WE CREATED NEW MEASURE OF SLEEP 8613 06:06:32,520 --> 06:06:37,360 DISORDERED BREATHING USING 8614 06:06:37,360 --> 06:06:40,160 PRINCIPAL COMPONENTS ANALYSIS, 8615 06:06:40,160 --> 06:06:44,000 MAXIMIZING VARIANCE ACROSS 7 SDB 8616 06:06:44,000 --> 06:06:45,360 PHENOTYPES, INCLUDING MEASURES 8617 06:06:45,360 --> 06:06:46,360 OF SATURATION AND EVENT 8618 06:06:46,360 --> 06:06:47,000 DURATION. 8619 06:06:47,000 --> 06:06:50,680 THE GOAL WAS NOT TO BUILD THE 8620 06:06:50,680 --> 06:06:53,240 BEST AVAILABLE MEASURE OF SDB. 8621 06:06:53,240 --> 06:06:58,880 IT WAS TO MAXIMIZE VARIANCE 8622 06:06:58,880 --> 06:06:59,360 EXPLAINED. 8623 06:06:59,360 --> 06:07:06,800 AND TO REDUCE (INDISCERNIBLE). 8624 06:07:06,800 --> 06:07:09,320 SUMMARIZING THE TWO, SBD 8625 06:07:09,320 --> 06:07:09,760 PHENOTYPES, METABOLIC 8626 06:07:09,760 --> 06:07:11,320 ENVIRONMENT, ONE INDEX EACH. 8627 06:07:11,320 --> 06:07:19,960 WE STUDY ASSOCIATION OF THESE. 8628 06:07:19,960 --> 06:07:21,720 THIS FIGURE SHOWS ESTIMATED 8629 06:07:21,720 --> 06:07:27,480 CORRELATION BETWEEN THE TWO 8630 06:07:27,480 --> 06:07:30,000 SDB-PCS AND PHENOTYPE USED HERE. 8631 06:07:30,000 --> 06:07:32,640 WE HAD THESE PHENOTYPES, 8632 06:07:32,640 --> 06:07:39,200 RESPIRATORY EVENT INDEX WITH 3% 8633 06:07:39,200 --> 06:07:44,920 SATURATION, ZERO HYPOXIC BURDEN, 8634 06:07:44,920 --> 06:07:47,960 OXYGEN SATURATION DURING SLEEP 8635 06:07:47,960 --> 06:07:52,000 AND THEN WE HAVE SDB PC1, THE 8636 06:07:52,000 --> 06:07:58,760 FIRST PC IS HIGHLY ASSOCIATED 8637 06:07:58,760 --> 06:08:01,200 WITH STANDARD, YOU KNOW, 8638 06:08:01,200 --> 06:08:05,920 MEASURES OF OSA. 8639 06:08:05,920 --> 06:08:09,200 AND SECOND EXPLAINS LOWER 8640 06:08:09,200 --> 06:08:10,160 PROPORTION -- 8641 06:08:10,160 --> 06:08:11,120 >>TWO-MINUTE WARNING. 8642 06:08:11,120 --> 06:08:12,040 >>WHAT HAPPENED? 8643 06:08:12,040 --> 06:08:12,880 >>TWO-MINUTE WARNING. 8644 06:08:12,880 --> 06:08:13,360 >>OKAY. 8645 06:08:13,360 --> 06:08:15,680 OH, THANK YOU. 8646 06:08:15,680 --> 06:08:23,000 YES, SO IT'S MAINLY EVENT LINES. 8647 06:08:23,000 --> 06:08:25,400 LINEAR COMBINATIONS OF 8648 06:08:25,400 --> 06:08:26,160 METABOLITE CONCENTRATIONS, BASED 8649 06:08:26,160 --> 06:08:28,000 ON 112 METABOLITES, IT'S OTHER 8650 06:08:28,000 --> 06:08:31,760 BASED ON 57, SOME OVERLAP. 8651 06:08:31,760 --> 06:08:37,320 WE LOOKED AT ASSOCIATION OF SDB 8652 06:08:37,320 --> 06:08:41,800 MRS WITH INCIDENT OUTCOMES. 8653 06:08:41,800 --> 06:08:45,200 THIS IS -- SO EACH POINT 8654 06:08:45,200 --> 06:08:46,840 PROVIDES ESTIMATED INCIDENT 8655 06:08:46,840 --> 06:08:48,720 RATIO OF MEASURE EITHER 8656 06:08:48,720 --> 06:08:50,760 METABOLITE RISK SCORES, SECOND, 8657 06:08:50,760 --> 06:08:53,880 FIRST, OR HYPOXIC BURDEN, 8658 06:08:53,880 --> 06:08:57,000 RESPIRATORY EVENT INDEX, 95 8659 06:08:57,000 --> 06:08:59,000 INTERVALS, ASSOCIATION WITH 8660 06:08:59,000 --> 06:09:01,960 INCIDENT DIABETES OR INCIDENT 8661 06:09:01,960 --> 06:09:02,720 HYPERTENSION, IN COMBINED 8662 06:09:02,720 --> 06:09:07,520 POPULATION MALE AND FEMALE. 8663 06:09:07,520 --> 06:09:09,400 BUT LET'S FOCUS ON EVIDENCE OF 8664 06:09:09,400 --> 06:09:12,000 SEX DIFFERENCES NOT BEING 8665 06:09:12,000 --> 06:09:12,480 STRONG. 8666 06:09:12,480 --> 06:09:15,320 WE SEE METABOLITE RISK SCORE HAS 8667 06:09:15,320 --> 06:09:16,400 STRONGER ASSOCIATION, FEELS 8668 06:09:16,400 --> 06:09:18,720 EXACTLY THE SAME DATASET, SAME 8669 06:09:18,720 --> 06:09:21,240 SET OF INDIVIDUALS. 8670 06:09:21,240 --> 06:09:22,760 ASSOCIATIONS WITH COMPARABLE TO 8671 06:09:22,760 --> 06:09:27,240 STRONGER ASSOCIATION COMPARED TO 8672 06:09:27,240 --> 06:09:29,440 PHYSIOLOGICAL MEASURES. 8673 06:09:29,440 --> 06:09:34,240 WHICH THIS IS WHAT I JUST SAID. 8674 06:09:34,240 --> 06:09:37,080 SOMETHING I HID HERE, SIMILAR 8675 06:09:37,080 --> 06:09:39,400 SCORE, RECONSTRUCTED BASED ON 8676 06:09:39,400 --> 06:09:41,120 OSA HAD STRONGER ASSOCIATION 8677 06:09:41,120 --> 06:09:43,320 WITH INCIDENT DIABETES AND 8678 06:09:43,320 --> 06:09:44,280 HYPERTENSION. 8679 06:09:44,280 --> 06:09:48,240 IT'S NOT CLEAR YET THAT USING 8680 06:09:48,240 --> 06:09:51,920 PC-BASED APPROACH IS GETTER THAN 8681 06:09:51,920 --> 06:10:00,560 USING STANDARD MEASURES OF OSA 8682 06:10:00,560 --> 06:10:04,640 OR SDB. 8683 06:10:04,640 --> 06:10:07,160 WE USED BIOMARKERS, I JUST 8684 06:10:07,160 --> 06:10:08,680 DIDN'T PRESENT IT HERE. 8685 06:10:08,680 --> 06:10:16,480 MRS IS GENERATED BASED ON A FEW 8686 06:10:16,480 --> 06:10:17,320 TRAITS. 8687 06:10:17,320 --> 06:10:20,080 THERE ARE MANY POTENTIAL FACTORS 8688 06:10:20,080 --> 06:10:21,720 FOR WHY ONE PERFORMS BETTER THAN 8689 06:10:21,720 --> 06:10:25,120 THE OTHER, EVEN THOUGH OSA 8690 06:10:25,120 --> 06:10:27,840 PERFORMS BETTER IT USED MUCH 8691 06:10:27,840 --> 06:10:31,760 SMALLER NUMBER OF METABOLITES. 8692 06:10:31,760 --> 06:10:33,640 IT WAS CONSTRUCTED BASED ON 8693 06:10:33,640 --> 06:10:34,520 DIFFERENT TOOL OF METABOLITES, 8694 06:10:34,520 --> 06:10:35,400 THAT MAY HAVE SOMETHING TO DO 8695 06:10:35,400 --> 06:10:36,240 WITH IT. 8696 06:10:36,240 --> 06:10:40,720 IT COULD BE THE PHENOTYPE, COULD 8697 06:10:40,720 --> 06:10:42,640 BE METABOLITES, SOME MAY BE MORE 8698 06:10:42,640 --> 06:10:42,880 RELIABLE. 8699 06:10:42,880 --> 06:10:45,440 SOMETHING WE STILL NEED TO 8700 06:10:45,440 --> 06:10:46,120 STUDY. 8701 06:10:46,120 --> 06:10:48,000 FINAL NOTE, BIG VERSUS SMALL 8702 06:10:48,000 --> 06:10:48,320 DATA. 8703 06:10:48,320 --> 06:10:51,840 WE HAVE TWO MAJOR APPROACHES FOR 8704 06:10:51,840 --> 06:10:52,800 LINKING TWO CONDITIONS. 8705 06:10:52,800 --> 06:10:56,040 ONE ONE IS LINK USING LARGE 8706 06:10:56,040 --> 06:10:57,400 OBSERVATIONAL DATASETS FOCUSING 8707 06:10:57,400 --> 06:11:00,280 ON PATHWAYS AND/OR OMICS-BASED 8708 06:11:00,280 --> 06:11:02,040 BIOMARKERS BASED ON FIRST STUDY 8709 06:11:02,040 --> 06:11:03,560 FOCUSING ON ONE CONDITION. 8710 06:11:03,560 --> 06:11:06,640 THIS IS WHAT I CALL HERE THE BIG 8711 06:11:06,640 --> 06:11:08,160 DATA APPROACH. 8712 06:11:08,160 --> 06:11:09,480 SECOND CAREFULLY DESIGNED STUDY 8713 06:11:09,480 --> 06:11:12,320 BASED ON SPECIFIC HYPOTHESES 8714 06:11:12,320 --> 06:11:13,960 RELATING TWO CONDITIONS. 8715 06:11:13,960 --> 06:11:16,800 THIS IS MUCH BETTER FOR 8716 06:11:16,800 --> 06:11:19,760 CAUSALITY INFERENCE, AND FOR 8717 06:11:19,760 --> 06:11:20,720 LIMITING REALIZED INTERVENTION. 8718 06:11:20,720 --> 06:11:23,880 IN PRACTICE THIS IS SMALL DATA 8719 06:11:23,880 --> 06:11:24,560 APPROACH. 8720 06:11:24,560 --> 06:11:26,440 SO HIGH FOCUS HERE ON BIG DATA 8721 06:11:26,440 --> 06:11:28,640 APPROACH BUT IDEALLY THE TWO 8722 06:11:28,640 --> 06:11:31,040 APPROACHES WILL BE COMBINED. 8723 06:11:31,040 --> 06:11:36,040 BIG DATA APPROACH IS VERY, VERY 8724 06:11:36,040 --> 06:11:38,240 POWERFUL NARROWING DOWN ON A FEW 8725 06:11:38,240 --> 06:11:44,280 OUT OF MANY CANDIDATE MARKERS. 8726 06:11:44,280 --> 06:11:48,760 AND THAT'S IT. 8727 06:11:48,760 --> 06:11:49,400 SO THANK YOU. 8728 06:11:49,400 --> 06:11:52,480 >>THANK YOU. 8729 06:11:52,480 --> 06:11:54,520 WE KNOW IT'S A CHALLENGE AT THIS 8730 06:11:54,520 --> 06:11:57,080 LATE HOUR, BEING A LITTLE BIT 8731 06:11:57,080 --> 06:12:01,120 BEHIND, BUT THOSE WERE SUPERB 8732 06:12:01,120 --> 06:12:01,480 PRESENTATIONS. 8733 06:12:01,480 --> 06:12:04,320 AT THIS POINT, ANNA AND I WILL 8734 06:12:04,320 --> 06:12:07,800 MAYBE FACILITATE MAYBE AN 8735 06:12:07,800 --> 06:12:09,480 OVERALL WRAP-UP SESSION, MAYBE 8736 06:12:09,480 --> 06:12:15,040 WE CAN BEFORE WE TRY TO THINK OF 8737 06:12:15,040 --> 06:12:16,400 OUR DISCUSSANT THEMES MAYBE I'LL 8738 06:12:16,400 --> 06:12:18,680 OPEN UP FOR ANY QUESTIONS OR 8739 06:12:18,680 --> 06:12:20,920 COMMENTS ANYONE HAS FOR ANY OF 8740 06:12:20,920 --> 06:12:22,000 THE THREE SPEAKERS TO BEGIN 8741 06:12:22,000 --> 06:12:30,200 WITH. 8742 06:12:30,200 --> 06:12:30,880 8743 06:12:30,880 --> 06:12:33,360 DR. SHAH? 8744 06:12:33,360 --> 06:12:34,920 8745 06:12:34,920 --> 06:12:37,120 >>THANK YOU FOR THOSE REALLY 8746 06:12:37,120 --> 06:12:39,840 GREAT TALKS. 8747 06:12:39,840 --> 06:12:42,160 I HAD QUESTIONS FOR TWO 8748 06:12:42,160 --> 06:12:47,600 SPEAKERS. 8749 06:12:47,600 --> 06:12:51,320 ONE WAS DR. KATZ, AND ONE FOR 8750 06:12:51,320 --> 06:12:51,840 DR. PUNJABI. 8751 06:12:51,840 --> 06:12:53,520 GREAT TALK. 8752 06:12:53,520 --> 06:12:54,520 I ENJOYED IT. 8753 06:12:54,520 --> 06:12:56,920 I WANTED TO FIND OUT SORT OF 8754 06:12:56,920 --> 06:12:59,080 WHAT YOU WOULD RECOMMEND FOR THE 8755 06:12:59,080 --> 06:13:03,680 FIELD IN TERMS OF INCORPORATING 8756 06:13:03,680 --> 06:13:05,480 MULTIOMICS AND THE PHENOTYPES 8757 06:13:05,480 --> 06:13:06,640 WE'VE BEEN DISCUSSING TO BETTER, 8758 06:13:06,640 --> 06:13:09,080 AGAIN, FIND A WAY FOR 8759 06:13:09,080 --> 06:13:17,800 SPECIALIZED AND PRECISION 8760 06:13:17,800 --> 06:13:18,760 MEDICINE APPROACHES. 8761 06:13:18,760 --> 06:13:20,640 >>I THINK I'LL PUT THIS INTO 8762 06:13:20,640 --> 06:13:24,920 SOMETHING I TOUCHED ON, 8763 06:13:24,920 --> 06:13:25,360 BIOBANKING. 8764 06:13:25,360 --> 06:13:28,320 BIOBANKING, BIOBANKING, 8765 06:13:28,320 --> 06:13:28,600 BIOBANKING. 8766 06:13:28,600 --> 06:13:31,920 THE FACT THAT THE BIOBANKING IS 8767 06:13:31,920 --> 06:13:33,160 RELATIVELY SPEAKING INEXPENSIVE 8768 06:13:33,160 --> 06:13:34,240 RELATIVE TO MULTIOMIC WORK 8769 06:13:34,240 --> 06:13:34,520 NECESSARY. 8770 06:13:34,520 --> 06:13:38,000 SO IF YOU CAN PLAN AHEAD, AND 8771 06:13:38,000 --> 06:13:39,400 COLLECT SAMPLES, AND THAT 8772 06:13:39,400 --> 06:13:41,160 INCLUDES TISSUES NOT JUST PLASMA 8773 06:13:41,160 --> 06:13:42,480 WHICH IS STRAIGHTFORWARD AND 8774 06:13:42,480 --> 06:13:44,960 EASY BUT ALSO TISSUES IF 8775 06:13:44,960 --> 06:13:48,160 POSSIBLE, AND SAVE THEM FOR THE 8776 06:13:48,160 --> 06:13:49,360 TIME THERE'S FUNDING AND BAND 8777 06:13:49,360 --> 06:13:51,640 WIDE THERE TO DO MULTIOMIC WORK 8778 06:13:51,640 --> 06:13:53,520 WILL BE HELPFUL. 8779 06:13:53,520 --> 06:13:56,000 EVEN ON STUDIES WHERE WE HAVE 8780 06:13:56,000 --> 06:13:57,520 ENOUGH MONEY TO DO THE TRIAL OR 8781 06:13:57,520 --> 06:14:00,400 ENOUGH MONEY TO DO THE STUDY BUT 8782 06:14:00,400 --> 06:14:03,600 NOT ENOUGH TO DO SPATIAL OMICS, 8783 06:14:03,600 --> 06:14:04,880 IT'S AN OPPORTUNITY TO STILL TRY 8784 06:14:04,880 --> 06:14:08,840 TO SEE IF YOU CAN GET JUST 8785 06:14:08,840 --> 06:14:12,560 ENOUGH TO BIOBANK AND LATER ON 8786 06:14:12,560 --> 06:14:14,240 FUNDING FOR MULTI OMICS. 8787 06:14:14,240 --> 06:14:20,680 STARTING WITH A FEW, GENETICS 8788 06:14:20,680 --> 06:14:22,080 AND TRANSCRIPTOMICS, PROTEOMICS 8789 06:14:22,080 --> 06:14:24,040 IS GREAT BUT TRANSCRIPTOMICS IS 8790 06:14:24,040 --> 06:14:27,000 MORE COST EFFECTIVE AS GETS 8791 06:14:27,000 --> 06:14:28,120 IMPORTANT BIOLOGY SO THAT'S 8792 06:14:28,120 --> 06:14:30,200 WHERE I WOULD START BUT I THINK 8793 06:14:30,200 --> 06:14:33,800 HAVING THE DENSITY OF DATA IS 8794 06:14:33,800 --> 06:14:34,800 REALLY VALUABLE. 8795 06:14:34,800 --> 06:14:37,840 IT MIGHT HAVE TO BE AVAILABLE 8796 06:14:37,840 --> 06:14:38,200 LATER. 8797 06:14:38,200 --> 06:14:42,360 HOPEFULLY THAT ANSWERS YOUR 8798 06:14:42,360 --> 06:14:42,680 QUESTION. 8799 06:14:42,680 --> 06:14:44,880 >>YES, THANK YOU. 8800 06:14:44,880 --> 06:14:48,680 AND I WANTED TO ASK THOUGHTS 8801 06:14:48,680 --> 06:14:51,480 WITH THE INSOMNIA, YOU KNOW, YOU 8802 06:14:51,480 --> 06:14:53,440 MENTIONED THAT BEAUTIFULLY 8803 06:14:53,440 --> 06:14:59,040 COVERED IT, WONDERING HOW YOU 8804 06:14:59,040 --> 06:15:01,000 SEE WEARABLES AND WEARABLES, 8805 06:15:01,000 --> 06:15:04,800 TECHNOLOGY USE BY PATIENTS, 8806 06:15:04,800 --> 06:15:05,360 DRIVING INSOMNIA, DRIVING 8807 06:15:05,360 --> 06:15:07,000 FURTHER, IF YOU HAD THOUGHTS ON 8808 06:15:07,000 --> 06:15:07,200 THAT. 8809 06:15:07,200 --> 06:15:11,440 >>I DIDN'T BUT WHAT A GREAT 8810 06:15:11,440 --> 06:15:12,240 QUESTION. 8811 06:15:12,240 --> 06:15:14,040 YOU KNOW, LOOK. 8812 06:15:14,040 --> 06:15:17,640 OUR GROUP, THE SLEEP GROUP ON 8813 06:15:17,640 --> 06:15:19,480 THIS PANEL, RECOGNIZES THAT ONE 8814 06:15:19,480 --> 06:15:21,880 TIME POINT MEASUREMENTS AS WE DO 8815 06:15:21,880 --> 06:15:25,400 IN THE LAB OR EVEN THE HOME SET 8816 06:15:25,400 --> 06:15:28,480 IS NOT ENOUGH TO THINK ABOUT 8817 06:15:28,480 --> 06:15:30,200 WHAT HAPPENS WITH EXPOSURE, 8818 06:15:30,200 --> 06:15:31,320 WHETHER IT'S SLEEP APNEA OR 8819 06:15:31,320 --> 06:15:33,160 SLEEP IN GENERAL. 8820 06:15:33,160 --> 06:15:34,720 CONCEPT OF HAVING SOMETHING THAT 8821 06:15:34,720 --> 06:15:37,880 CAN PROVIDE A REAL TRUE EXPOSURE 8822 06:15:37,880 --> 06:15:39,400 ASSESSMENT OVER TIME IS 8823 06:15:39,400 --> 06:15:39,720 BENEFICIAL. 8824 06:15:39,720 --> 06:15:42,800 AND AS YOU KNOW, MOST OF THE 8825 06:15:42,800 --> 06:15:45,520 FOLKS HERE KNOW TECHNOLOGY IS 8826 06:15:45,520 --> 06:15:46,520 GETTING CONVENIENT, EASY, 8827 06:15:46,520 --> 06:15:51,480 RELATIVELY CHEAP AND QUITE 8828 06:15:51,480 --> 06:15:53,440 EXPANSIVE, SURE, MONITORS ARE 8829 06:15:53,440 --> 06:15:55,280 SURROGATES, NOT NECESSARILY 8830 06:15:55,280 --> 06:15:57,120 MEASURING SLEEP PER SE, BUT WE 8831 06:15:57,120 --> 06:15:58,760 GET AN IDEA WHAT'S HAPPENING 8832 06:15:58,760 --> 06:16:03,200 OVER TIME IN A REPEATED FASHION, 8833 06:16:03,200 --> 06:16:04,360 MORE REFLECTIVE. 8834 06:16:04,360 --> 06:16:07,320 THE QUESTION ASKED EARLIER, 8835 06:16:07,320 --> 06:16:09,840 DAN'S CONVERSATION ABOUT WHAT IS 8836 06:16:09,840 --> 06:16:12,200 TRUE EXPOSURE ABOUT SLEEP, 8837 06:16:12,200 --> 06:16:13,360 DURATION, TIMING, IS IT 8838 06:16:13,360 --> 06:16:15,800 VARIATION, ALL OF THE ABOVE? 8839 06:16:15,800 --> 06:16:20,560 PROBABLY ALL OF THE ABOVE. 8840 06:16:20,560 --> 06:16:22,480 WEARABLES WILL HELP. 8841 06:16:22,480 --> 06:16:24,880 WE'RE LEARNING IN OUR OWN FIELD, 8842 06:16:24,880 --> 06:16:25,600 WE'RE LEARNING. 8843 06:16:25,600 --> 06:16:30,960 IF THE JUMP HAS TO OCCUR FROM US 8844 06:16:30,960 --> 06:16:33,280 TO THEM, WE HAVE TO HELP THEM 8845 06:16:33,280 --> 06:16:34,480 THINK ABOUT THESE THINGS AS 8846 06:16:34,480 --> 06:16:36,800 WE'VE LEARNED A LOT OURSELVES. 8847 06:16:36,800 --> 06:16:38,640 IT'S GOT A CRITICAL CENTRAL 8848 06:16:38,640 --> 06:16:42,160 FEATURE BUT HOW WE CHARACTERIZE 8849 06:16:42,160 --> 06:16:42,600 SLEEP. 8850 06:16:42,600 --> 06:16:49,160 EVEN HOME SLEEP APNEA, WE CAN DO 8851 06:16:49,160 --> 06:16:49,320 MORE 8852 06:16:49,320 --> 06:16:50,160 MULTIPLE NIGHTS, YEAH. 8853 06:16:50,160 --> 06:16:53,080 >>THANK YOU. 8854 06:16:53,080 --> 06:16:58,480 8855 06:16:58,480 --> 06:16:59,480 >>A QUESTION, STEVE? 8856 06:16:59,480 --> 06:17:03,520 >>I ENJOYED THE TALKS. 8857 06:17:03,520 --> 06:17:04,920 MY QUESTIONS ARE GEARED TOWARDS 8858 06:17:04,920 --> 06:17:10,360 OMICS AND DR. KATZ AND SOFIR, IF 8859 06:17:10,360 --> 06:17:12,960 YOU COULD COMMENT ON ADDITIONAL 8860 06:17:12,960 --> 06:17:14,080 COMPUTATIONAL METHODOLOGIES THAT 8861 06:17:14,080 --> 06:17:17,920 COULD BE UTILIZED AS THIS 8862 06:17:17,920 --> 06:17:20,800 INFORMATION EXPANDS, IN ADDITION 8863 06:17:20,800 --> 06:17:22,960 TO OMICS AND POLYGENIC RISK 8864 06:17:22,960 --> 06:17:23,920 SCORES AND ASSOCIATIONS THAT WE 8865 06:17:23,920 --> 06:17:26,240 TEND TO SEE IN THE LITERATURE 8866 06:17:26,240 --> 06:17:33,240 MORE, WE'VE BEEN INTERESTED ON 8867 06:17:33,240 --> 06:17:34,560 THE PULMONARY HYPERTENSION SIDE 8868 06:17:34,560 --> 06:17:38,720 OF STATES AT OMICS LEVEL, A.I. 8869 06:17:38,720 --> 06:17:40,720 AND MACHINE LEARNING TO PREDICT 8870 06:17:40,720 --> 06:17:43,320 STATES OF DISEASE AS A PERSON 8871 06:17:43,320 --> 06:17:44,400 GOES THROUGH DIFFERENT EXPOSURES 8872 06:17:44,400 --> 06:17:45,840 THROUGH TIME AND SO FORTH, SEEMS 8873 06:17:45,840 --> 06:17:51,320 LIKE A LITTLE BIT OF A PIE IN 8874 06:17:51,320 --> 06:17:52,200 THE SKY POSSIBILITY, IF YOU 8875 06:17:52,200 --> 06:17:54,920 COULD COMMENT ON HOW CLOSE OR 8876 06:17:54,920 --> 06:17:59,080 FAR AWAY ARE WE FROM THAT IN 8877 06:17:59,080 --> 06:18:01,360 THIS FIELD OF SLEEP DISORDERS 8878 06:18:01,360 --> 06:18:03,400 GIVEN THE FACT WE DON'T 8879 06:18:03,400 --> 06:18:04,960 TYPICALLY HAVE AS MUCH 8880 06:18:04,960 --> 06:18:13,200 INFORMATION AS WHAT WE WOULD SEE 8881 06:18:13,200 --> 06:18:15,400 IN CANCER, CARDIOVASCULAR 8882 06:18:15,400 --> 06:18:15,680 DISEASES? 8883 06:18:15,680 --> 06:18:18,480 >>I THINK THE LIMITATION IS THE 8884 06:18:18,480 --> 06:18:19,560 DATA. 8885 06:18:19,560 --> 06:18:21,960 THE ANALYTIC METHODS ARE THERE 8886 06:18:21,960 --> 06:18:23,840 IN THEORY BUT IT'S GOING 8887 06:18:23,840 --> 06:18:25,600 THROUGH -- IT'S OBTAINING THE 8888 06:18:25,600 --> 06:18:27,640 DATA, DYNAMIC DATA YOU NEED, THE 8889 06:18:27,640 --> 06:18:32,600 QUANTITY OF DATA THAT YOU WOULD 8890 06:18:32,600 --> 06:18:32,800 NEED. 8891 06:18:32,800 --> 06:18:35,000 >>YEAH, I COMPLETELY AGREE. 8892 06:18:35,000 --> 06:18:36,880 I THINK THAT WHAT I'VE SEEN IN 8893 06:18:36,880 --> 06:18:38,680 WORKING IN EVERY LARGER DATASETS 8894 06:18:38,680 --> 06:18:39,800 STARTING TO COME UP AGAINST 8895 06:18:39,800 --> 06:18:41,240 DENSITY OF DATA YOU WOULD NEED 8896 06:18:41,240 --> 06:18:45,160 TO DO THAT KIND OF STUFF YOU ARE 8897 06:18:45,160 --> 06:18:47,800 COMPOUNDED BY THE COMPLEXITY OF 8898 06:18:47,800 --> 06:18:51,080 HANDLING THAT DATA AS IT GROWS. 8899 06:18:51,080 --> 06:18:52,800 THAT'S THE COMPUTATIONAL COSTS, 8900 06:18:52,800 --> 06:18:56,560 CLOUD COSTS, BUT THAT'S ALSO THE 8901 06:18:56,560 --> 06:18:58,400 SORT OF ACCURACY COST BECAUSE 8902 06:18:58,400 --> 06:18:59,920 WHEN YOU ARE TRYING TO DO 8903 06:18:59,920 --> 06:19:02,000 STATISTICAL MODELING ON A ONCE 8904 06:19:02,000 --> 06:19:03,760 OF THOUSANDS OF INHERENTLY 8905 06:19:03,760 --> 06:19:05,040 INACCURATE MEASUREMENTS, YOU 8906 06:19:05,040 --> 06:19:07,360 START TO GET INTO A FACT WHERE 8907 06:19:07,360 --> 06:19:08,880 YOU'RE MODELING CHANGES OF ALL 8908 06:19:08,880 --> 06:19:10,320 OF THEM, USING ONE MODEL THAT 8909 06:19:10,320 --> 06:19:14,920 MAY NOT BE APPROPRIATE FOR ALL 8910 06:19:14,920 --> 06:19:15,920 OF THEM. 8911 06:19:15,920 --> 06:19:17,040 COMPLEXITY GROWS. 8912 06:19:17,040 --> 06:19:19,520 I'M EXCITED ABOUT THAT KIND OF 8913 06:19:19,520 --> 06:19:22,040 THING AND I THINK INTERVENTIONAL 8914 06:19:22,040 --> 06:19:25,880 OMICS WHERE YOU ACTUALLY APPLY 8915 06:19:25,880 --> 06:19:27,840 SOME STIMULUS, EXERCISE, WHETHER 8916 06:19:27,840 --> 06:19:30,600 IT'S CPAP, SOMETHING LIKE THAT, 8917 06:19:30,600 --> 06:19:33,280 CAN HELP BECAUSE IT KNOCKS OMICS 8918 06:19:33,280 --> 06:19:34,720 INTO ALIGNMENT AROUND THAT 8919 06:19:34,720 --> 06:19:35,800 PARTICULAR INTERVENTION AND 8920 06:19:35,800 --> 06:19:37,240 BECOMES EASIER TO STUDY WITH 8921 06:19:37,240 --> 06:19:38,560 SMALLER NUMBERS SO I THINK TO DO 8922 06:19:38,560 --> 06:19:41,080 THAT KIND OF THING WHICH I THINK 8923 06:19:41,080 --> 06:19:42,880 IS SUPER EXCITING REQUIRES SOME 8924 06:19:42,880 --> 06:19:45,160 OF THAT ASSISTANCE FROM THE 8925 06:19:45,160 --> 06:19:45,440 APPROACH. 8926 06:19:45,440 --> 06:19:53,680 >>THANK YOU. 8927 06:19:53,680 --> 06:19:58,520 8928 06:19:58,520 --> 06:20:00,800 >>I KNOW ONE OF THE I THINK 8929 06:20:00,800 --> 06:20:03,000 CHALLENGES IN DOING THOSE 8930 06:20:03,000 --> 06:20:06,240 INTERVENTIONS IS THAT TO BE MOST 8931 06:20:06,240 --> 06:20:08,120 RIGOROUS YOU WOULD HAVE MAYBE 8932 06:20:08,120 --> 06:20:09,440 CONTROL GROUP WITH NO 8933 06:20:09,440 --> 06:20:09,880 INTERVENTION. 8934 06:20:09,880 --> 06:20:14,360 AND YET THAT CAN BE PRETTY 8935 06:20:14,360 --> 06:20:14,680 CUMBERSOME. 8936 06:20:14,680 --> 06:20:16,680 HOW, YOU KNOW, WELL WHAT DO YOU 8937 06:20:16,680 --> 06:20:19,280 THINK THE BEST DESIGN IN TERMS 8938 06:20:19,280 --> 06:20:21,560 OF LOOKING AT OMICS RESPONSES TO 8939 06:20:21,560 --> 06:20:27,520 INTERVENTION DO WE NEED TO LOOK 8940 06:20:27,520 --> 06:20:30,160 AT TYPICAL RANDOMIZED CONTROL 8941 06:20:30,160 --> 06:20:33,760 LENS OR ALTERNATIVE AND MORE 8942 06:20:33,760 --> 06:20:34,240 EFFICIENT APPROACHES. 8943 06:20:34,240 --> 06:20:36,480 >>YEAH, I WAS HAVING A MEETING 8944 06:20:36,480 --> 06:20:38,320 ABOUT THAT YESTERDAY. 8945 06:20:38,320 --> 06:20:40,760 THIS IS A COMPLICATED ISSUE. 8946 06:20:40,760 --> 06:20:43,240 AND I THINK WE'VE SEEN REAL 8947 06:20:43,240 --> 06:20:46,240 BENEFITS IN HAVING THE CONTROL 8948 06:20:46,240 --> 06:20:46,640 GROUP. 8949 06:20:46,640 --> 06:20:54,440 IT IS -- AS MUCH AS IT ADDS 8950 06:20:54,440 --> 06:20:56,720 COMPLEXITY, YOU'RE MAYBE ADDING 8951 06:20:56,720 --> 06:20:59,920 IN A LAYER OF DSMB REQUIREMENTS 8952 06:20:59,920 --> 06:21:01,880 HOW YOU'RE ANALYZING DATA WHICH 8953 06:21:01,880 --> 06:21:04,080 CAN ADD DIFFICULTY BUT IT'S 8954 06:21:04,080 --> 06:21:05,960 VALUABLE. 8955 06:21:05,960 --> 06:21:08,200 A SIMPLE BIOPSY THAT LOOKS AT 8956 06:21:08,200 --> 06:21:09,840 MUSCLE, WE CAN SEE STRESS 8957 06:21:09,840 --> 06:21:10,960 RESPONSE IN THE CONTROLS, THAT 8958 06:21:10,960 --> 06:21:13,400 IF YOU DON'T HAVE THEM, YOU WILL 8959 06:21:13,400 --> 06:21:18,200 ATTRIBUTE TO YOUR INTERVENTION. 8960 06:21:18,200 --> 06:21:20,680 AND SO THAT I THINK HAVING 8961 06:21:20,680 --> 06:21:22,600 CONTROLS IS IMPORTANT, JUST AS 8962 06:21:22,600 --> 06:21:24,240 IT IS IN REALLY ANY TRIAL. 8963 06:21:24,240 --> 06:21:26,200 CAN YOU GEAT WITH USING PEOPLE 8964 06:21:26,200 --> 06:21:27,480 AS THEIR OWN CONTROL? 8965 06:21:27,480 --> 06:21:27,920 SURE. 8966 06:21:27,920 --> 06:21:33,520 BUT THERE COMES WITH THAT TYPE 8967 06:21:33,520 --> 06:21:37,960 OF RISK ABOUT (INDISCERNIBLE). 8968 06:21:37,960 --> 06:21:40,560 >>AND DR. SWEATT? 8969 06:21:40,560 --> 06:21:43,160 >>YES, I HAVE A FEW 8970 06:21:43,160 --> 06:21:45,240 QUESTIONS/COMMENTS FOR THE OMICS 8971 06:21:45,240 --> 06:21:46,200 FOLKS, MAYBE FOOD FOR THOUGHT 8972 06:21:46,200 --> 06:21:48,520 FOR THE GROUP IN GENERAL BECAUSE 8973 06:21:48,520 --> 06:21:53,120 I THINK I'M STILL VERY 8974 06:21:53,120 --> 06:21:54,640 EARLY-STAGE INVESTIGATOR, AND I 8975 06:21:54,640 --> 06:21:56,920 WAS -- I'M ALREADY GETTING AGED 8976 06:21:56,920 --> 06:22:00,760 IN MY EARLY RESEARCH CAREER, IN 8977 06:22:00,760 --> 06:22:02,960 DEALING WITH SINGLE OMIC 8978 06:22:02,960 --> 06:22:04,520 RESEARCH IN MAINLY PROTEOMICS 8979 06:22:04,520 --> 06:22:07,320 STUFF I'VE DONE IN GROUP 1 PH 8980 06:22:07,320 --> 06:22:12,920 NARROWING DOWN TO THAT POINT. 8981 06:22:12,920 --> 06:22:14,560 ALREADY, I SEE SUBSTANTIAL 8982 06:22:14,560 --> 06:22:15,880 COMPLEXITIES THAT MAY MAKE IT 8983 06:22:15,880 --> 06:22:17,800 DIFFICULT IN THE NEAR TERM TO 8984 06:22:17,800 --> 06:22:19,600 ACHIEVE SOME PIE IN THE SKY 8985 06:22:19,600 --> 06:22:21,240 VISIONS THAT WE HAVE. 8986 06:22:21,240 --> 06:22:22,800 I THINK SOME UNIQUE CHALLENGES 8987 06:22:22,800 --> 06:22:26,400 THAT WE FACE ARE, A, IT'S A RARE 8988 06:22:26,400 --> 06:22:31,240 DISEASE AND SO EVEN WHEN WE PUT 8989 06:22:31,240 --> 06:22:32,720 TOGETHER MULTI-CENTER 8990 06:22:32,720 --> 06:22:34,600 COLLABORATIVE EFFORTS WE 8991 06:22:34,600 --> 06:22:37,440 STILL -- SAMPLE SIZES ARE LOW. 8992 06:22:37,440 --> 06:22:40,920 B, THE SECOND ONE IS WE NEVER 8993 06:22:40,920 --> 06:22:42,480 HAVE DISEASE TISSUE AT OUR 8994 06:22:42,480 --> 06:22:45,120 DISPOSAL AND THAT CAN BE SAID 8995 06:22:45,120 --> 06:22:48,560 FOR THE SLEEP DISORDERED 8996 06:22:48,560 --> 06:22:53,000 BREATHING BIOBANKING TOO, WE'RE 8997 06:22:53,000 --> 06:22:54,080 STUCK DEALING WITH BLOOD AS A 8998 06:22:54,080 --> 06:22:56,240 WINDOW TO THE LUNG. 8999 06:22:56,240 --> 06:23:00,320 I CLEARLY UNDERSTAND THE PH 9000 06:23:00,320 --> 06:23:01,280 RESEARCHER IMMENSE HETEROGENEITY 9001 06:23:01,280 --> 06:23:04,560 OF PULMONARY HYPERTENSION IN 9002 06:23:04,560 --> 06:23:09,040 GROUP 1 AND I COME TO APPRECIATE 9003 06:23:09,040 --> 06:23:10,120 HETEROGENEITY OF OSA, AND SO 9004 06:23:10,120 --> 06:23:11,920 PART OF THE PATH FORWARD IS WE 9005 06:23:11,920 --> 06:23:14,080 REALLY NEED TO BE CAREFUL WITH 9006 06:23:14,080 --> 06:23:16,400 OUR CLINICAL DATA COLLECTION AND 9007 06:23:16,400 --> 06:23:17,360 CLINICAL PHENOTYPING OF THESE 9008 06:23:17,360 --> 06:23:20,640 PATIENTS BECAUSE THERE'S A LOT 9009 06:23:20,640 --> 06:23:22,080 OF POTENTIAL NOISE THAT WE'RE 9010 06:23:22,080 --> 06:23:25,800 PICKING UP IN THE BLOOD FROM 9011 06:23:25,800 --> 06:23:28,440 WHETHER IT BE CO-MORBIDITIES, 9012 06:23:28,440 --> 06:23:29,200 BACKGROUND MEDITATIONS, OTHER 9013 06:23:29,200 --> 06:23:32,920 THINGS THAT MIGHT NOT REFLECT 9014 06:23:32,920 --> 06:23:36,720 THE DISEASES WE'RE INTERESTED IN 9015 06:23:36,720 --> 06:23:37,240 THEMSELVES. 9016 06:23:37,240 --> 06:23:41,000 I WORRY IF WE HAVE THE VISION OF 9017 06:23:41,000 --> 06:23:41,960 UNDERSTANDING PATHOBIOLOGY, 9018 06:23:41,960 --> 06:23:43,960 DEVELOPING NEW DRUG TARGETS 9019 06:23:43,960 --> 06:23:46,120 BASED ON THE BLOOD, WE MAY BE UP 9020 06:23:46,120 --> 06:23:47,440 AGAINST IT. 9021 06:23:47,440 --> 06:23:51,600 IT MAY BE SIMPLER TO HAVE TOOLS 9022 06:23:51,600 --> 06:23:53,160 TO IDENTIFY CERTAIN CLINICAL 9023 06:23:53,160 --> 06:23:54,240 PHENOTYPES OR PREDICT RESPONSE 9024 06:23:54,240 --> 06:23:56,640 TO THERAPY OR RISK STRATIFIED, 9025 06:23:56,640 --> 06:23:58,080 MAYBE THAT'S MORE FORESEEABLE. 9026 06:23:58,080 --> 06:23:59,400 WE DON'T KNOW THAT REFLECTS 9027 06:23:59,400 --> 06:24:02,880 WHAT'S GOING ON IN THE LUNG 9028 06:24:02,880 --> 06:24:04,400 PATHOBIOLOGICALLY SPEAKING. 9029 06:24:04,400 --> 06:24:05,680 SO THERE'S THOSE COMMENTS. 9030 06:24:05,680 --> 06:24:09,560 MY FINAL ONE WITHIN THE SINGLE 9031 06:24:09,560 --> 06:24:10,760 OMIC DOMAIN, PROTEOMICS FOR 9032 06:24:10,760 --> 06:24:12,880 EXAMPLE IN OUR COHORT OF 400 9033 06:24:12,880 --> 06:24:18,640 SOME ODD PATIENTS AT STANFORD 9034 06:24:18,640 --> 06:24:22,360 WITH GOOD SAMPLES ON STARTED TO 9035 06:24:22,360 --> 06:24:25,760 HAVE SOME OVERLAPPING PROTEOMIC 9036 06:24:25,760 --> 06:24:28,720 DATASETS ACROSS LIKE MULTIPLEX 9037 06:24:28,720 --> 06:24:30,240 IMMUNOASSAY, MASS SPECTROMETRY, 9038 06:24:30,240 --> 06:24:39,920 SOMA SCANS, SOME DIFFERENT 9039 06:24:39,920 --> 06:24:41,520 PLATFORMS, CONCERNED ABOUT LACK 9040 06:24:41,520 --> 06:24:43,160 OF CORRELATION ACROSS PLATFORMS. 9041 06:24:43,160 --> 06:24:44,560 MY ULTIMATE QUESTIONS FOR YOU, 9042 06:24:44,560 --> 06:24:47,120 WHAT DO WE DO IN A RARE DISEASE 9043 06:24:47,120 --> 06:24:49,080 WHERE WE DON'T HAVE TISSUE AT 9044 06:24:49,080 --> 06:24:53,120 THE DISEASE SITE, AND THEN, B, 9045 06:24:53,120 --> 06:24:55,640 DO WE NEED TO GET IT RIGHT, 9046 06:24:55,640 --> 06:24:59,560 WHAT'S THE GROUND TRUTH WITHIN A 9047 06:24:59,560 --> 06:25:00,920 SINGLE OMIC DOMAIN WITH 9048 06:25:00,920 --> 06:25:08,160 DIFFERENT PLATFORMS, BEFORE WE 9049 06:25:08,160 --> 06:25:09,400 GET TO INTEGRATED OMICS. 9050 06:25:09,400 --> 06:25:11,880 >>SO, I MEAN, OMICS IS NOT THE 9051 06:25:11,880 --> 06:25:13,040 ONLY WAY. 9052 06:25:13,040 --> 06:25:16,120 I DON'T KNOW, I KNOW NOTHING 9053 06:25:16,120 --> 06:25:18,080 ABOUT THE FIELD, BUT THERE ARE 9054 06:25:18,080 --> 06:25:19,480 IMAGING AND OTHER THOUGHTS BUT 9055 06:25:19,480 --> 06:25:21,280 BLOOD GIVES YOU A LOT. 9056 06:25:21,280 --> 06:25:23,920 I THINK BLOOD CAN GIVE YOU A 9057 06:25:23,920 --> 06:25:25,120 LOT. 9058 06:25:25,120 --> 06:25:33,560 SO I DON'T, YOU KNOW -- DON'T 9059 06:25:33,560 --> 06:25:39,120 GIVE UP YET. 9060 06:25:39,120 --> 06:25:39,800 >>THANK YOU. 9061 06:25:39,800 --> 06:25:47,680 >>THERE'S STILL MULTIOMICS THAT 9062 06:25:47,680 --> 06:25:49,440 USES GENETICS, IF YOU HAVE A 9063 06:25:49,440 --> 06:25:52,120 REALLY STRONG INSTRUMENT FOR THE 9064 06:25:52,120 --> 06:25:53,800 PROTEINS AND METABOLITES, SOME 9065 06:25:53,800 --> 06:25:57,320 OF THEM, PEOPLE ARE STUDYING HOW 9066 06:25:57,320 --> 06:25:58,480 WELL THEY TRANSLATE BETWEEN 9067 06:25:58,480 --> 06:26:01,120 TISSUES OUTSIDE OF THE ONE. 9068 06:26:01,120 --> 06:26:03,680 I THINK THAT THE INFORMATION IS 9069 06:26:03,680 --> 06:26:09,160 SLOWLY ACCUMULATING BUT IT'S A 9070 06:26:09,160 --> 06:26:11,320 SLOW PROCESS, SO MUCH IS GOING 9071 06:26:11,320 --> 06:26:11,560 ON. 9072 06:26:11,560 --> 06:26:12,600 IT'S GOING TO GET THERE. 9073 06:26:12,600 --> 06:26:14,360 WE LEARN MORE ABOUT TRANSITION 9074 06:26:14,360 --> 06:26:16,080 BETWEEN TISSUES AT LEAST FOR 9075 06:26:16,080 --> 06:26:21,360 SOME OF THESE COMPONENTS, LIKE 9076 06:26:21,360 --> 06:26:23,440 CAN WE USE SOMETHING FOR PROTEIN 9077 06:26:23,440 --> 06:26:26,920 AND BLOOD, IN LUNGS, I BELIEVE 9078 06:26:26,920 --> 06:26:29,000 WE'LL KNOW MORE IN THE FUTURE, 9079 06:26:29,000 --> 06:26:36,240 IN THE NEAR FUTURE. 9080 06:26:36,240 --> 06:26:39,560 WHAT WAS ANOTHER QUESTION? 9081 06:26:39,560 --> 06:26:40,040 >>DIFFERENT CLASS ONES. 9082 06:26:40,040 --> 06:26:43,240 >>THIS IS ANOTHER ISSUE THAT IS 9083 06:26:43,240 --> 06:26:44,600 ADDRESSED, FOR EXAMPLE 9084 06:26:44,600 --> 06:26:46,760 RESEARCHERS COLLECT THE DATA, ON 9085 06:26:46,760 --> 06:26:50,280 THE SAME INDIVIDUAL, SOMA SCAN, 9086 06:26:50,280 --> 06:26:52,120 USING OLINK, AND WE WILL KNOW 9087 06:26:52,120 --> 06:26:54,200 MORE IN THE FUTURE WHICH 9088 06:26:54,200 --> 06:26:55,440 PROTEINS WE CAN HARMONIZE 9089 06:26:55,440 --> 06:26:57,080 BETWEEN PLATFORMS AND WHICH WE 9090 06:26:57,080 --> 06:26:57,520 CANNOT. 9091 06:26:57,520 --> 06:27:00,520 AND MAYBE THERE'S SOME PLACES 9092 06:27:00,520 --> 06:27:03,080 STATISTICAL METHODOLOGY CAN HELP 9093 06:27:03,080 --> 06:27:04,360 US CALIBRATE BETWEEN PLATFORMS 9094 06:27:04,360 --> 06:27:08,440 AND MAYBE SOME PROTEINS WE 9095 06:27:08,440 --> 06:27:11,080 CANNOT CALIBRATE BETWEEN 9096 06:27:11,080 --> 06:27:11,360 PLATFORMS. 9097 06:27:11,360 --> 06:27:12,160 >>TWO ADDITIONAL COMMENTS. 9098 06:27:12,160 --> 06:27:15,000 I SPENT TIME THINKING ABOUT THE 9099 06:27:15,000 --> 06:27:17,280 PROTEOMIC DISAGREEMENTS BETWEEN 9100 06:27:17,280 --> 06:27:20,680 SOMA SCAN AND OLINK, AND A 9101 06:27:20,680 --> 06:27:21,800 COMPARISON USED GENETICS, TO TRY 9102 06:27:21,800 --> 06:27:23,760 TO FIGURE OUT WHICH WAS RIGHT. 9103 06:27:23,760 --> 06:27:26,600 AND IT CAN BE USEFUL THAT WAY. 9104 06:27:26,600 --> 06:27:27,800 I THINK OUR TAKEAWAY FROM THE 9105 06:27:27,800 --> 06:27:28,880 WORK WAS YOU DON'T WANT TO THROW 9106 06:27:28,880 --> 06:27:31,520 THE BABY OUT WITH THE BATH WATER 9107 06:27:31,520 --> 06:27:33,800 BECAUSE, YES, THERE MAY BE SOME 9108 06:27:33,800 --> 06:27:34,800 DISAGREEMENTS AND ACCURACY 9109 06:27:34,800 --> 06:27:36,960 ISSUES BUT THOSE CAN BE SOLVED 9110 06:27:36,960 --> 06:27:39,040 ON THE BACK END, AFFINITY 9111 06:27:39,040 --> 06:27:40,160 PLATFORMS, YOU MENTIONED SOMA 9112 06:27:40,160 --> 06:27:41,160 SCAN, THEY ARE BINDING 9113 06:27:41,160 --> 06:27:41,640 SOMETHING. 9114 06:27:41,640 --> 06:27:44,520 IF THEY ARE ASSOCIATED WITH 9115 06:27:44,520 --> 06:27:45,520 SOMETHING, YOU'RE DOUBTING 9116 06:27:45,520 --> 06:27:46,800 ACCURACY, NUMBER ONE, CHECK IT. 9117 06:27:46,800 --> 06:27:48,560 NUMBER TWO, THERE ARE WAYS TO GO 9118 06:27:48,560 --> 06:27:51,760 IN SAND FIGURE OUT WHAT REALLY 9119 06:27:51,760 --> 06:27:53,040 IT'S BINDING TO, IF YOU HAVE A 9120 06:27:53,040 --> 06:27:53,680 STRONG ASSOCIATION YOU CAN 9121 06:27:53,680 --> 06:27:56,040 FIGURE OUT ON THE BACK END. 9122 06:27:56,040 --> 06:27:59,760 AND IN TERMS OF THE SMALL 9123 06:27:59,760 --> 06:28:06,240 STUDIES, WHAT WE COULD DO, 9124 06:28:06,240 --> 06:28:08,480 WE'RE GETTING PRE AND POST BLOOD 9125 06:28:08,480 --> 06:28:09,520 THAT WE COULD SAMPLE DURING 9126 06:28:09,520 --> 06:28:11,160 EXERCISE INTERVENTION AND THAT 9127 06:28:11,160 --> 06:28:12,880 CAN START TO UNTANGLE SOME OF 9128 06:28:12,880 --> 06:28:14,200 THE THINGS MORE ORGAN SPECIFIC 9129 06:28:14,200 --> 06:28:17,280 EVEN IF YOU ONLY HAVE BLOOD. 9130 06:28:17,280 --> 06:28:18,600 THAT'S ANOTHER AMOVIE THAT WE'VE 9131 06:28:18,600 --> 06:28:22,600 USED IN THE PAST USING -- IN THE 9132 06:28:22,600 --> 06:28:25,240 CASE OF KIDNEYS, PRE AND POST 9133 06:28:25,240 --> 06:28:27,280 KIDNEY BLOOD SAMPLES AND 9134 06:28:27,280 --> 06:28:28,240 COMPARED THEM. 9135 06:28:28,240 --> 06:28:30,680 THERE ARE WAYS OF GETTING AROUND 9136 06:28:30,680 --> 06:28:32,440 THE SPECIFICITY ISSUE. 9137 06:28:32,440 --> 06:28:38,760 >>THANK YOU FOR ADDRESSING 9138 06:28:38,760 --> 06:28:40,400 THOSE CHALLENGING ISSUES. 9139 06:28:40,400 --> 06:28:41,800 THERE'S A RELATED COMMENT AND 9140 06:28:41,800 --> 06:28:42,200 QUESTION. 9141 06:28:42,200 --> 06:28:45,800 WOULD YOU LIKE TO SPEAK UP RIGHT 9142 06:28:45,800 --> 06:28:45,960 NOW? 9143 06:28:45,960 --> 06:28:50,360 >>CAN YOU HEAR ME? 9144 06:28:50,360 --> 06:28:50,600 >>YES. 9145 06:28:50,600 --> 06:28:58,680 >>SO, THIS RELATES TO SOME 9146 06:28:58,680 --> 06:29:00,320 TOPICS RAISED ABOUT 9147 06:29:00,320 --> 06:29:08,320 PATHOPHYSIOLOGY AND FINDINGS 9148 06:29:08,320 --> 06:29:12,800 FROM HYPOXIC MODELS, SOME WAS 9149 06:29:12,800 --> 06:29:15,760 DONE IN CELL CULTURES, REALLY 9150 06:29:15,760 --> 06:29:18,040 DOESN'T RECAPITULATE THE HUMAN 9151 06:29:18,040 --> 06:29:19,680 DISEASE AT ALL, WONDERING IF 9152 06:29:19,680 --> 06:29:22,000 ANYONE HAS THOUGHTS ABOUT HOW WE 9153 06:29:22,000 --> 06:29:25,160 CAN MODEL PULMONARY HYPERTENSION 9154 06:29:25,160 --> 06:29:30,440 SPECIFICALLY WITH OSA AND 9155 06:29:30,440 --> 06:29:33,040 MODELING AND JUST A SHORT 9156 06:29:33,040 --> 06:29:35,880 TRIBUTE TO TOMORROW'S TALK, FROM 9157 06:29:35,880 --> 06:29:38,600 MY OWN EXPERIENCE, EVEN IF IT'S 9158 06:29:38,600 --> 06:29:42,440 SEVERE, DOES NOT RESULT IN 9159 06:29:42,440 --> 06:29:46,120 CLINICALLY RELEVANT OR AT LEAST 9160 06:29:46,120 --> 06:29:47,320 RIGHT HEART HYPERTROPHY AND 9161 06:29:47,320 --> 06:29:48,680 HYPERTENSION IN A MOUSE MODEL, 9162 06:29:48,680 --> 06:29:55,920 SOMETHING I WOULD LIKE TO HEAR 9163 06:29:55,920 --> 06:30:03,040 THE PANEL'S THOUGHTS ABOUT. 9164 06:30:03,040 --> 06:30:04,640 >>ANDREW BRYANT IS ON, IF YOU 9165 06:30:04,640 --> 06:30:09,120 WANT TO RESPOND, YOU MIGHT BE 9166 06:30:09,120 --> 06:30:09,400 EQUIPPED. 9167 06:30:09,400 --> 06:30:11,040 >>YEAH, YEAH. 9168 06:30:11,040 --> 06:30:16,040 HOPEFULLY I'LL ADDRESS THESE 9169 06:30:16,040 --> 06:30:17,920 ISSUES TOMORROW MORNING, WHEN I 9170 06:30:17,920 --> 06:30:19,320 TALK ABOUT THE ANIMAL MODELING 9171 06:30:19,320 --> 06:30:20,320 OF DISEASE. 9172 06:30:20,320 --> 06:30:24,240 YOU BRING UP GOOD POINTS. 9173 06:30:24,240 --> 06:30:25,960 A LOT OF WHAT, YOU KNOW, WE 9174 06:30:25,960 --> 06:30:27,600 TALKED ABOUT TODAY ADDRESSES THE 9175 06:30:27,600 --> 06:30:31,600 ISSUE OF HYPOXIA OR MAYBE EVEN 9176 06:30:31,600 --> 06:30:33,080 SLEEP FRAGMENTATION OR BOTH. 9177 06:30:33,080 --> 06:30:36,040 BUT I THINK A REALLY GOOD POINT 9178 06:30:36,040 --> 06:30:39,760 THAT ANNA BROUGHT UP WAS NONE OF 9179 06:30:39,760 --> 06:30:43,800 THESE REALLY ADDRESSED CHANGES 9180 06:30:43,800 --> 06:30:45,280 IN PRESSURE, INTRATHORACIC 9181 06:30:45,280 --> 06:30:48,080 PRESSURE, BASICS OF PHYSIOLOGY 9182 06:30:48,080 --> 06:30:51,280 THAT GO ALONG WITH NORMAL 9183 06:30:51,280 --> 06:30:52,920 BREATHING, NEGATIVE PRESSURE, 9184 06:30:52,920 --> 06:30:55,360 PULMONARY EDEMA, WHATEVER 9185 06:30:55,360 --> 06:30:56,960 CONTRIBUTES TO THIS OVERALL 9186 06:30:56,960 --> 06:30:57,600 PHENOTYPE, THAT'S SOME OF THE 9187 06:30:57,600 --> 06:30:59,360 POINTS THAT I WAS GOING TO TRY 9188 06:30:59,360 --> 06:31:01,880 TO BRING UP TOMORROW. 9189 06:31:01,880 --> 06:31:03,760 THERE ARE PRETTY GOOD ANIMAL 9190 06:31:03,760 --> 06:31:06,160 MODELS, I BROUGHT UP ONE OF THEM 9191 06:31:06,160 --> 06:31:08,440 TO -- AS AN EXPERIMENT OF 9192 06:31:08,440 --> 06:31:10,960 NATURE, SO TO SPEAK, AND MY 9193 06:31:10,960 --> 06:31:11,840 COLLEAGUE SAID THERE'S NOTHING 9194 06:31:11,840 --> 06:31:13,360 NATURAL ABOUT THAT. 9195 06:31:13,360 --> 06:31:17,440 YOU KNOW, WITH ANIMAL HUSBANDRY 9196 06:31:17,440 --> 06:31:22,000 IF YOU HAVE A COLLEGE OF 9197 06:31:22,000 --> 06:31:23,520 VETERINARY MEDICINE 9198 06:31:23,520 --> 06:31:25,920 >>FRENCH BULLDOG, YEAH. 9199 06:31:25,920 --> 06:31:30,480 >>OLD STUDIES FROM 9200 06:31:30,480 --> 06:31:31,160 GROUP-RANDOMIZED BLUE JOURNAL, 9201 06:31:31,160 --> 06:31:32,920 YOU HAVE A BUILT-IN PATIENT 9202 06:31:32,920 --> 06:31:36,120 POPULATION IF YOU HAVE A 9203 06:31:36,120 --> 06:31:37,880 VETERINARY MEDICINE COLLEGE, AT 9204 06:31:37,880 --> 06:31:39,200 LEAST FOR BIOBANKING, ALL 9205 06:31:39,200 --> 06:31:43,440 NATURAL DEATH, NO ONE IS GOING 9206 06:31:43,440 --> 06:31:46,000 TO DONATE THEIR PET, BUT THERE'S 9207 06:31:46,000 --> 06:31:49,040 A LOT OF THOSE THINGS TO 9208 06:31:49,040 --> 06:31:49,360 DISCUSS. 9209 06:31:49,360 --> 06:31:51,560 YEAH, IT'S COMPLICATED. 9210 06:31:51,560 --> 06:31:52,080 I AGREE. 9211 06:31:52,080 --> 06:31:55,280 PART OF THE PROBLEM IS WITH 9212 06:31:55,280 --> 06:31:56,840 INTERMITTENT HYPOXIA THAT CAN -- 9213 06:31:56,840 --> 06:31:58,120 IF YOU GET TEN SCIENTISTS 9214 06:31:58,120 --> 06:32:03,160 TOGETHER THAT MEANS TEN 9215 06:32:03,160 --> 06:32:05,560 DIFFERENT THINGS. 9216 06:32:05,560 --> 06:32:07,000 BUT YEAH, TOMORROW, 10:45 I 9217 06:32:07,000 --> 06:32:07,200 THINK. 9218 06:32:07,200 --> 06:32:08,400 >>YES, THANK YOU. 9219 06:32:08,400 --> 06:32:10,400 WE'RE LOOKING FORWARD TO THAT. 9220 06:32:10,400 --> 06:32:14,240 DR. HILL HAD HIS HAND UP. 9221 06:32:14,240 --> 06:32:17,040 >>YES, I DID. 9222 06:32:17,040 --> 06:32:22,520 I HAD A QUESTION FOR NURESH. 9223 06:32:22,520 --> 06:32:24,280 I REALLY ENJOYED YOUR TALK. 9224 06:32:24,280 --> 06:32:28,400 BUT MY QUESTION HAS TO DO WITH 9225 06:32:28,400 --> 06:32:32,120 SLEEP WITH AGING, AS IT BECOMES 9226 06:32:32,120 --> 06:32:35,000 MORE PERTINENT TO ME. 9227 06:32:35,000 --> 06:32:35,640 >>ME TOO. 9228 06:32:35,640 --> 06:32:38,160 >>THE EVIDENCE IS VERY CLEAR 9229 06:32:38,160 --> 06:32:39,560 THAT THERE ARE INCREASING 9230 06:32:39,560 --> 06:32:44,600 PROBLEMS WITH SLEEP DURING 9231 06:32:44,600 --> 06:32:44,800 AGING. 9232 06:32:44,800 --> 06:32:47,000 AND AS PEOPLE AGE THEY GET LESS 9233 06:32:47,000 --> 06:32:47,800 SLEEP. 9234 06:32:47,800 --> 06:32:53,040 THE QUESTION I HAVE IS, IT'S 9235 06:32:53,040 --> 06:32:54,120 COMMONLY STATED THAT PEOPLE 9236 06:32:54,120 --> 06:32:56,200 DON'T NEED AS MUCH SLEEP AS THEY 9237 06:32:56,200 --> 06:32:58,480 AGE, I'M WONDERING WHETHER THEY 9238 06:32:58,480 --> 06:33:00,360 ARE GETTING CONFUSED WITH WHAT 9239 06:33:00,360 --> 06:33:01,240 OLDER PEOPLE ARE ACTUALLY 9240 06:33:01,240 --> 06:33:03,200 GETTING AS THEY AGE AS OPPOSED 9241 06:33:03,200 --> 06:33:05,400 TO WHAT THEY TRULY NEED, AND CAN 9242 06:33:05,400 --> 06:33:07,680 YOU COMMENT ON THAT? 9243 06:33:07,680 --> 06:33:10,080 >>YEAH, I'M SURE THE OTHERS ON 9244 06:33:10,080 --> 06:33:12,280 THE CALL CAN DO A BETTER JOB BUT 9245 06:33:12,280 --> 06:33:13,800 I'LL TAKE A STAB. 9246 06:33:13,800 --> 06:33:16,560 I THINK THE ISSUE OF NEED SLEEP 9247 06:33:16,560 --> 06:33:18,840 PERHAPS A MYTH, STANDPOINT OF 9248 06:33:18,840 --> 06:33:20,280 OLDER INDIVIDUALS NEEDING LESS. 9249 06:33:20,280 --> 06:33:22,680 I THINK SLEEP IS CLEARLY 9250 06:33:22,680 --> 06:33:24,240 DISRUPTED, YOU AND I ARE FEELING 9251 06:33:24,240 --> 06:33:25,720 IT, WE'VE GOT A LOT OF GRAY 9252 06:33:25,720 --> 06:33:27,400 HAIR, FEELING THE DISRUPTION IN 9253 06:33:27,400 --> 06:33:28,600 MY OWN SLEEP. 9254 06:33:28,600 --> 06:33:30,680 I THINK, YEAH, LOOK, I DON'T 9255 06:33:30,680 --> 06:33:33,480 KNOW HOW TO ANSWER THAT BUT 9256 06:33:33,480 --> 06:33:35,160 MAYBE SAY THE NEED FOR SLEEP IS 9257 06:33:35,160 --> 06:33:36,840 NOT GOING TO DECREASE. 9258 06:33:36,840 --> 06:33:38,040 I THINK THEY HAVE POOR QUALITY 9259 06:33:38,040 --> 06:33:41,000 SLEEP FOR A VARIETY OF REASONS, 9260 06:33:41,000 --> 06:33:42,320 FUNDAMENTALLY RELATED TO AGE 9261 06:33:42,320 --> 06:33:45,480 AFFECTED CELLS OR COMORBIDITY 9262 06:33:45,480 --> 06:33:48,560 THAT COMES ALONG WITH THE AGING 9263 06:33:48,560 --> 06:33:49,080 PROCESS. 9264 06:33:49,080 --> 06:33:52,440 SO, YEAH, VERY RELEVANT. 9265 06:33:52,440 --> 06:33:53,160 IF SLEEP QUALITY DETERIORATES, 9266 06:33:53,160 --> 06:33:56,000 IF DAN IS ON HE CAN CHIME IN 9267 06:33:56,000 --> 06:33:58,600 BETTER THAN I CAN, IF SLEEP 9268 06:33:58,600 --> 06:34:00,240 QUALITY DETERIORATES AND SLEEP 9269 06:34:00,240 --> 06:34:01,640 IS IMPORTANT FOR BIOLOGICAL 9270 06:34:01,640 --> 06:34:04,400 PROCESSES WHICH WE THINK IT IS, 9271 06:34:04,400 --> 06:34:05,720 COGNITION, WE'VE GOT AN ANIMAL 9272 06:34:05,720 --> 06:34:08,120 MODEL THAT WE LOOKED AT SLEEP 9273 06:34:08,120 --> 06:34:13,040 AND MUSCLE FUNCTION, AND IF WE 9274 06:34:13,040 --> 06:34:16,240 DISRUPT AS C57 SLEEP IT ACTUALLY 9275 06:34:16,240 --> 06:34:17,200 HAS IMPAIRED MUSCULAR ACTIVITY. 9276 06:34:17,200 --> 06:34:18,960 IT CAN'T DO MANY OF THE THINGS 9277 06:34:18,960 --> 06:34:22,680 IT USED TO DO. 9278 06:34:22,680 --> 06:34:24,000 SO, CLEARLY THERE ARE AFFECTS OF 9279 06:34:24,000 --> 06:34:26,600 QUALITY OF SLEEP. 9280 06:34:26,600 --> 06:34:28,480 WIFE BEEN INTERESTED IN ICU, 9281 06:34:28,480 --> 06:34:31,000 MODELED IN THE ANIMAL MODEL, 9282 06:34:31,000 --> 06:34:34,680 EFFECT OF SLEEP ON MUSCLE 9283 06:34:34,680 --> 06:34:38,640 FUNCTION, SO AGE EFFECTS OF 9284 06:34:38,640 --> 06:34:39,640 SLEEP CLEARLY IMPORTANT BUT I 9285 06:34:39,640 --> 06:34:42,040 DON'T THINK THE NEED FOR SLEEP 9286 06:34:42,040 --> 06:34:42,360 DECREASES. 9287 06:34:42,360 --> 06:34:46,320 I'D LOVE TO HEAR THOUGHTS ON 9288 06:34:46,320 --> 06:34:46,840 THAT COMMENT. 9289 06:34:46,840 --> 06:34:49,000 >>I MAY CHIME IN BRIEFLY. 9290 06:34:49,000 --> 06:34:51,680 I THINK SLEEP NEED IS ATTRACTIVE 9291 06:34:51,680 --> 06:34:54,760 CONCEPT THAT'S VERY HARD TO 9292 06:34:54,760 --> 06:34:56,000 ACTUALLY DEFINE AND DETERMINE. 9293 06:34:56,000 --> 06:34:59,200 IF YOU KIND OF FLIP IT ON ITS 9294 06:34:59,200 --> 06:35:02,280 HEAD, I THINK THAT IT'S SAFE TO 9295 06:35:02,280 --> 06:35:05,520 SAY THAT NO MATTER WHAT THE AGE 9296 06:35:05,520 --> 06:35:09,320 OF THE PERSON WHEN YOU -- IF 9297 06:35:09,320 --> 06:35:13,560 SLEEP IS DISRUPTED IN SOME WAY, 9298 06:35:13,560 --> 06:35:15,880 EXPERIMENTALLY, YOU'LL SEE WORSE 9299 06:35:15,880 --> 06:35:18,120 FUNCTION OF ALL SORTS EMANATING 9300 06:35:18,120 --> 06:35:18,520 FROM THAT. 9301 06:35:18,520 --> 06:35:20,480 CONVERSELY WHEN YOU IMPROVE OR 9302 06:35:20,480 --> 06:35:23,640 MAXIMIZE THE QUALITY OF SLEEP, 9303 06:35:23,640 --> 06:35:25,040 YOU'LL SEE IMPROVED FUNCTION BUT 9304 06:35:25,040 --> 06:35:29,560 IN TERMS OF LIKE DEFINING 9305 06:35:29,560 --> 06:35:32,920 ABSOLUTE LEVEL, THAT'S VERY, 9306 06:35:32,920 --> 06:35:33,800 VERY CHALLENGING. 9307 06:35:33,800 --> 06:35:35,640 I GUESS MAYBE THE BEST THING TO 9308 06:35:35,640 --> 06:35:38,040 THINK ABOUT IS IF YOU JUST GET 9309 06:35:38,040 --> 06:35:41,360 VERY REDUCTIONISTIC ABOUT IT AND 9310 06:35:41,360 --> 06:35:42,880 LOOK AT WHAT SLEEP DURATION 9311 06:35:42,880 --> 06:35:49,120 SEEMS TO BE ASSOCIATED WITH THE 9312 06:35:49,120 --> 06:35:50,240 LEAST AMOUNT OF MORBIDITY, IT 9313 06:35:50,240 --> 06:35:53,400 SEEMS TO BE A LITTLE BIT LOWER 9314 06:35:53,400 --> 06:35:55,960 IN OLDER PEOPLE BUT, AGAIN, IT'S 9315 06:35:55,960 --> 06:35:59,200 A VERY UNSATISFYING WAY OF 9316 06:35:59,200 --> 06:36:00,840 ANSWERING THE QUESTION BECAUSE 9317 06:36:00,840 --> 06:36:03,600 IF OLDER ADULTS ARE CAPABLE OF 9318 06:36:03,600 --> 06:36:05,640 GETTING LESS SLEEP THAT MAY 9319 06:36:05,640 --> 06:36:09,200 EXPLAIN WHY THE CURVE SHIFTS A 9320 06:36:09,200 --> 06:36:10,280 LITTLE BIT. 9321 06:36:10,280 --> 06:36:13,480 ANYWAY, VERY CHALLENGING BUT 9322 06:36:13,480 --> 06:36:14,360 GOOD QUESTION. 9323 06:36:14,360 --> 06:36:17,480 >>I WANT TO ADD MAYBE WIDENING 9324 06:36:17,480 --> 06:36:19,280 OUR LENS ACROSS THE LIFE COURSE, 9325 06:36:19,280 --> 06:36:27,480 AND I THINK WHAT WE CAN SAY FOR 9326 06:36:27,480 --> 06:36:28,440 SURE INFANTS AND YOUNG CHILDREN 9327 06:36:28,440 --> 06:36:30,400 NEED MORE SLEEP. 9328 06:36:30,400 --> 06:36:34,040 WE ALL KNOW INFANT SLEEPING 12 9329 06:36:34,040 --> 06:36:36,880 HOURS, 10 HOURS, 9 HOURS, 8 9330 06:36:36,880 --> 06:36:38,520 HOURS, ADOLESCENTS NEED MORE 9331 06:36:38,520 --> 06:36:39,840 SLEEP THAN YOUNG ADULTS BUT AS 9332 06:36:39,840 --> 06:36:42,240 WE GET INTO AGING IT BECOMES 9333 06:36:42,240 --> 06:36:43,800 MUCH MORE COMPLICATED. 9334 06:36:43,800 --> 06:36:46,400 AND THEN I WANTED TO MENTION, I 9335 06:36:46,400 --> 06:36:49,280 DON'T THINK WE WENT INTO THIS, 9336 06:36:49,280 --> 06:36:52,400 THERE IS THIS UNKNOWN ABOUT THE 9337 06:36:52,400 --> 06:36:53,960 SO-CALLED LONG SLEEPERS, DAN 9338 06:36:53,960 --> 06:36:56,480 TALKED ABOUT THE PHENOTYPE OF 9339 06:36:56,480 --> 06:36:57,800 HIGH SLEEP PROPENSITY PEOPLE WHO 9340 06:36:57,800 --> 06:37:01,200 SLEEP LONG AND YET MAY STILL BE 9341 06:37:01,200 --> 06:37:01,520 TIRED. 9342 06:37:01,520 --> 06:37:03,920 AND THAT MAY -- THAT APPEARS TO 9343 06:37:03,920 --> 06:37:05,560 HAVE GENETIC MARKERS TO IT. 9344 06:37:05,560 --> 06:37:09,400 AND ALSO MAY BE A MARKER OF 9345 06:37:09,400 --> 06:37:15,200 ACCELERATED AGING, BIOLOGICAL 9346 06:37:15,200 --> 06:37:22,480 AGING, THOSE ARE COMPLICATED 9347 06:37:22,480 --> 06:37:22,720 QUESTIONS. 9348 06:37:22,720 --> 06:37:28,840 >>I'M STILL GETTING OLDER BUT I 9349 06:37:28,840 --> 06:37:30,200 APPRECIATE THE DISCUSSION. 9350 06:37:30,200 --> 06:37:32,840 >>IF YOU NEED HELP WITH SLEEP, 9351 06:37:32,840 --> 06:37:34,280 THERE ARE SLEEP DOCTORS YOU KNOW 9352 06:37:34,280 --> 06:37:35,480 VERY WELL THAT WILL HELP YOU 9353 06:37:35,480 --> 06:37:35,960 WITH YOUR SLEEP. 9354 06:37:35,960 --> 06:37:39,080 >>THEY ALREADY HAVE. 9355 06:37:39,080 --> 06:37:44,560 I'M ON CPAP. 9356 06:37:44,560 --> 06:37:45,400 >>DR. GOSS? 9357 06:37:45,400 --> 06:37:46,960 >>THIS QUESTION GOES BACK TO 9358 06:37:46,960 --> 06:37:49,240 SOME OF THE OMICS INTEGRATION 9359 06:37:49,240 --> 06:37:51,040 AND SUPPORT. 9360 06:37:51,040 --> 06:37:53,440 FORGIVE MY IGNORANCE IF THIS IS 9361 06:37:53,440 --> 06:37:54,280 WELL ESTABLISHED BECAUSE IT'S 9362 06:37:54,280 --> 06:37:56,480 NOT WHERE I SPEND MY LIFE 9363 06:37:56,480 --> 06:37:59,280 THINKING ABOUT BUT TO WHAT 9364 06:37:59,280 --> 06:38:01,280 EXTENT DO WE HAVE MORE 9365 06:38:01,280 --> 06:38:04,320 STANDARDIZED TOOLS TO BE ABLE TO 9366 06:38:04,320 --> 06:38:06,520 INTEGRATE STUDIES? 9367 06:38:06,520 --> 06:38:09,280 YOU KNOW, SORT OF THE FAD THING 9368 06:38:09,280 --> 06:38:12,240 TO DO, EVERYBODY BIOBANKS, YOU 9369 06:38:12,240 --> 06:38:14,640 MAY RUN OMICS OR TWO, AND I 9370 06:38:14,640 --> 06:38:18,160 GUESS WHAT I WORRY ABOUT IS TO 9371 06:38:18,160 --> 06:38:20,440 THE EXTENT WHEN YOU COLLECT THE 9372 06:38:20,440 --> 06:38:23,280 BIOBANK IF YOU'RE NOT CAPTURING 9373 06:38:23,280 --> 06:38:28,640 KEY METRICS TO CHARACTERIZE YOUR 9374 06:38:28,640 --> 06:38:32,080 BIOBANK, THEN YOU RUN OF RISK OF 9375 06:38:32,080 --> 06:38:34,120 NOT HAVING A USEFUL LEADER OR 9376 06:38:34,120 --> 06:38:35,320 ASKING QUESTIONS THAT YOU'RE NOT 9377 06:38:35,320 --> 06:38:39,040 SET UP FULLY TO ANSWER SO ARE 9378 06:38:39,040 --> 06:38:42,000 THERE TOOLS AND IF NOT COULD THE 9379 06:38:42,000 --> 06:38:48,440 NIH HELP AND GUIDE THAT TO 9380 06:38:48,440 --> 06:38:49,560 CAPTURE PHENOTYPES OF PATIENTS 9381 06:38:49,560 --> 06:38:51,080 WE'RE ENROLLING, I WOULD ARGUE 9382 06:38:51,080 --> 06:38:53,160 FOR ANY GIVEN AGE POPULATION IF 9383 06:38:53,160 --> 06:38:55,480 THERE'S A DISEASE THAT AFFECTS A 9384 06:38:55,480 --> 06:38:56,360 CERTAIN PERCENTAGE OF THAT 9385 06:38:56,360 --> 06:38:57,560 POPULATION WE SHOULD KNOW YES OR 9386 06:38:57,560 --> 06:38:58,760 NO WHETHER THEY HAVE THAT 9387 06:38:58,760 --> 06:39:00,080 DISEASE OR THINGS LIKE THAT, 9388 06:39:00,080 --> 06:39:10,480 THAT I THINK COULD BE 9389 06:39:14,800 --> 06:39:15,040 STANDARDIZE 9390 06:39:15,040 --> 06:39:17,240 >>VERY COMPLEX ISSUE. 9391 06:39:17,240 --> 06:39:20,760 MY TWO CENTS REALLY THAT IT'S 9392 06:39:20,760 --> 06:39:23,600 VERY HARD AND THERE ARE STUDIES 9393 06:39:23,600 --> 06:39:28,280 LIKE THE U.K. BIOBANK WHERE IT'S 9394 06:39:28,280 --> 06:39:30,120 BASED ON A COMPILATION BUT IT IS 9395 06:39:30,120 --> 06:39:34,640 ALSO A STUDY AT THE SAME TIME, 9396 06:39:34,640 --> 06:39:38,160 SO COLLECT DATA FROM STANDARD 9397 06:39:38,160 --> 06:39:40,520 ELECTRONIC HEALTH RECORD BUT 9398 06:39:40,520 --> 06:39:44,920 ALSO DEPENDS UPON COMPREHENSIVE 9399 06:39:44,920 --> 06:39:48,960 STUDIES AND COHORT-LIKE MANNER. 9400 06:39:48,960 --> 06:39:50,400 I THINK "ALL OF US" MAY BE 9401 06:39:50,400 --> 06:39:52,920 TRYING TO DO THAT BUT NOT TO THE 9402 06:39:52,920 --> 06:39:53,880 SAME EXTENT. 9403 06:39:53,880 --> 06:39:56,520 I'M A PARTICIPANT IN "ALL OF 9404 06:39:56,520 --> 06:39:56,680 US." 9405 06:39:56,680 --> 06:39:59,800 I CAME FOR 30 MINUTES OR SO. 9406 06:39:59,800 --> 06:40:07,360 ANSWERED QUESTIONNAIRES IN A 9407 06:40:07,360 --> 06:40:08,000 COMPUTER. 9408 06:40:08,000 --> 06:40:09,200 MVP, VETERANS PROGRAM ALSO BASED 9409 06:40:09,200 --> 06:40:10,960 ON ELECTRONIC HEALTH RECORD, AND 9410 06:40:10,960 --> 06:40:13,680 DO YOU HAVE DIFFERENT SETS, 9411 06:40:13,680 --> 06:40:16,120 ELECTRONIC HEALTH RECORD 9412 06:40:16,120 --> 06:40:18,880 SYSTEMS, I DON'T KNOW WHAT IS 9413 06:40:18,880 --> 06:40:22,320 THE EXTENT TO POSSIBILITY OF 9414 06:40:22,320 --> 06:40:25,920 HARMONIZING ACROSS THEM, THAT'S 9415 06:40:25,920 --> 06:40:28,760 BEYOND MY LEVEL. 9416 06:40:28,760 --> 06:40:30,280 ALSO I HAVE SOME EXPERIENCE 9417 06:40:30,280 --> 06:40:33,000 WHERE WE HAVE MANY STUDIES THAT 9418 06:40:33,000 --> 06:40:34,640 CONTRIBUTED TO THIS DATA, AND 9419 06:40:34,640 --> 06:40:38,920 SOMETIMES WE STILL EVEN THOUGH 9420 06:40:38,920 --> 06:40:41,560 WE HAVE AGGREGATE GENETIC DATA, 9421 06:40:41,560 --> 06:40:46,360 WHEN WE DO OMICS ANALYSIS, WE 9422 06:40:46,360 --> 06:40:48,880 OFTEN DO IT SEPARATELY IN EACH 9423 06:40:48,880 --> 06:40:49,200 STUDY. 9424 06:40:49,200 --> 06:40:50,520 SO THERE'S LIMITATION TO HOW 9425 06:40:50,520 --> 06:40:55,880 MUCH WE COMBINE, IT'S KNOWSLY 9426 06:40:55,880 --> 06:40:59,720 -- NECESSARILY BAD, AND 9427 06:40:59,720 --> 06:41:01,000 AGGREGATE LATER, VIA 9428 06:41:01,000 --> 06:41:03,120 META-ANALYSIS OR OTHER WAYS. 9429 06:41:03,120 --> 06:41:06,840 I THINK THIS GIVES SOME ANSWER. 9430 06:41:06,840 --> 06:41:07,800 IT'S NOT PERFECT. 9431 06:41:07,800 --> 06:41:12,440 I THINK IT'S A CHALLENGE WE'LL 9432 06:41:12,440 --> 06:41:14,360 HAVE TO LIVE WITH. 9433 06:41:14,360 --> 06:41:15,680 >>I AGREE THAT THE DATA 9434 06:41:15,680 --> 06:41:19,280 INTEGRATION CAN BE LARD FROM -- 9435 06:41:19,280 --> 06:41:23,680 HARD FROM A BATCH EFFECT ISSUE, 9436 06:41:23,680 --> 06:41:24,480 HAVING TO META ANALYZE IS THE 9437 06:41:24,480 --> 06:41:28,280 NAME OF THE GAME, YOU CAN'T 9438 06:41:28,280 --> 06:41:30,560 ACROSS RAW BATCHES BUT IT'S AN 9439 06:41:30,560 --> 06:41:33,760 INTERESTING POINT ABOUT 9440 06:41:33,760 --> 06:41:35,000 STANDARDIZING BIOBANKING 9441 06:41:35,000 --> 06:41:36,120 APPROACHES, I'M NOT AWARE OF 9442 06:41:36,120 --> 06:41:39,200 THOSE BUT THAT WOULD BE QUITE 9443 06:41:39,200 --> 06:41:39,440 USEFUL. 9444 06:41:39,440 --> 06:41:42,920 >>THE WHOLE NOTION OF DOING 9445 06:41:42,920 --> 06:41:43,920 MUCH MORE COORDINATED GLOBAL 9446 06:41:43,920 --> 06:41:47,320 WORK AND I DON'T KNOW IF MAYBE 9447 06:41:47,320 --> 06:41:51,600 WELLCOME TRUST AND OTHERS. 9448 06:41:51,600 --> 06:41:53,320 WE HAVE A FEW MINUTES. 9449 06:41:53,320 --> 06:41:57,360 I WANT TO GO BACK TO AN ISSUE 9450 06:41:57,360 --> 06:41:59,360 DR. PUNJABI BROUGHT UP, NOTING 9451 06:41:59,360 --> 06:42:01,320 CONTROVERSIES OF EVEN I THINK 9452 06:42:01,320 --> 06:42:03,400 THE BROADER CONTROVERSY, EVEN 9453 06:42:03,400 --> 06:42:05,720 USING THE TERM RACIST ETHNICITY, 9454 06:42:05,720 --> 06:42:08,120 AND REALLY THE -- YOU KNOW, I 9455 06:42:08,120 --> 06:42:10,840 GUESS THE BOTTOM LINE IS I THINK 9456 06:42:10,840 --> 06:42:13,160 WE'RE ALL EDUCATED NOW THAT IN 9457 06:42:13,160 --> 06:42:16,520 GENERAL IN OUR EPI WORK WHEN WE 9458 06:42:16,520 --> 06:42:18,920 USE RACE/ETHNICITY IT'S A PROXY 9459 06:42:18,920 --> 06:42:19,920 FOR SOCIAL DETERMINANTS OF 9460 06:42:19,920 --> 06:42:29,560 HEALTH AND EXPERIENCES OF 9461 06:42:29,560 --> 06:42:32,280 DISCRIMINATION, STRUCTURAL 9462 06:42:32,280 --> 06:42:32,520 RACISM. 9463 06:42:32,520 --> 06:42:35,240 SOMETIMES THERE'S ATTEMPT TO GET 9464 06:42:35,240 --> 06:42:36,480 AT ANCESTRY AND GENETIC VARIANTS 9465 06:42:36,480 --> 06:42:38,520 BUT I THINK I WOULD LIKE US 9466 06:42:38,520 --> 06:42:41,000 MAYBE TO THINK ABOUT MAYBE WE'LL 9467 06:42:41,000 --> 06:42:43,560 BRING IT UP MORE TOMORROW IS 9468 06:42:43,560 --> 06:42:50,320 SOMETHING WE DID NOT DISCUSS 9469 06:42:50,320 --> 06:42:52,520 EXPLICITLY ABOUT THE LIFESPAN 9470 06:42:52,520 --> 06:42:53,840 AND SLEEP DISORDERS AND 9471 06:42:53,840 --> 06:43:01,040 PULMONARY HYPERTENSION MIGHT 9472 06:43:01,040 --> 06:43:02,240 AGGREGATE, SOME MAY BE RELATED 9473 06:43:02,240 --> 06:43:05,520 TO SOCIAL DETERMINANTS OF HEALTH 9474 06:43:05,520 --> 06:43:09,160 LIKE AIR POLLUTION, PM2.5 9475 06:43:09,160 --> 06:43:10,160 LEVELS, TOBACCO SMOKING. 9476 06:43:10,160 --> 06:43:13,400 AND I HAVE TO SAY THAT I'M -- 9477 06:43:13,400 --> 06:43:17,000 EVEN SLEEP APNEA WHICH WE'VE 9478 06:43:17,000 --> 06:43:20,280 THOUGHT OF AS A DISORDER 9479 06:43:20,280 --> 06:43:22,400 ASSOCIATED ANATOMIC FEATURES AND 9480 06:43:22,400 --> 06:43:26,440 OBESITY, ET CETERA, I'VE BECOME 9481 06:43:26,440 --> 06:43:27,960 INCREASINGLY INTERESTED IN HOW 9482 06:43:27,960 --> 06:43:30,600 PRO-INFLAMMATORY EXPOSURES TO 9483 06:43:30,600 --> 06:43:31,680 POLLUTION, INDOORS AND OUTDOORS, 9484 06:43:31,680 --> 06:43:34,880 MAY IN FACT BE A CONTRIBUTOR 9485 06:43:34,880 --> 06:43:35,560 ESPECIALLY IN CHILDREN. 9486 06:43:35,560 --> 06:43:39,240 SO I DON'T KNOW IF ANY -- WE 9487 06:43:39,240 --> 06:43:41,640 HAVE JUST A COUPLE MINUTES, IN 9488 06:43:41,640 --> 06:43:43,760 ANYONE WOULD LIKE TO EVEN SAY 9489 06:43:43,760 --> 06:43:47,760 THE POTENTIAL -- THE RELEVANCE 9490 06:43:47,760 --> 06:43:49,200 AM SOME EXPOSURES LINKING SLEEP 9491 06:43:49,200 --> 06:43:49,840 DISORDERS TO PULMONARY 9492 06:43:49,840 --> 06:43:52,400 HYPERTENSION AND THE ROLE OF 9493 06:43:52,400 --> 06:44:02,320 SUCH EXPOSURES IN THE VARIOUS 9494 06:44:02,320 --> 06:44:03,040 PULMONARY HYPERTENSION GROUPS. 9495 06:44:03,040 --> 06:44:05,280 >>I'LL TAKE A SHOT, I'M OPEN TO 9496 06:44:05,280 --> 06:44:06,480 COMMENTS FROM COLLEAGUES. 9497 06:44:06,480 --> 06:44:08,480 WE KNOW VERY LITTLE ABOUT 9498 06:44:08,480 --> 06:44:09,440 PULMONARY HYPERTENSION, AT THE 9499 06:44:09,440 --> 06:44:10,680 EXTREMES OF AGE. 9500 06:44:10,680 --> 06:44:12,280 I'M GOING TO RESTRICT COMMENTS 9501 06:44:12,280 --> 06:44:15,240 TO OLDER POPULATION BECAUSE OF 9502 06:44:15,240 --> 06:44:16,600 EXPOSURE QUESTION. 9503 06:44:16,600 --> 06:44:22,560 AND WE GENERALLY EXCLUDE FROM 9504 06:44:22,560 --> 06:44:23,920 STUDIES OF PHENOTYPING PATIENTS 9505 06:44:23,920 --> 06:44:25,600 OLDER THAN 70 OR 80. 9506 06:44:25,600 --> 06:44:29,440 PEOPLE DIDN'T BELIEVE YOU COULD 9507 06:44:29,440 --> 06:44:30,800 GET PULMONARY ARTERIAL 9508 06:44:30,800 --> 06:44:31,760 HYPERTENSION AT OLDER 9509 06:44:31,760 --> 06:44:32,080 TIMEFRAMES. 9510 06:44:32,080 --> 06:44:34,480 BUT I THINK WE'RE NOW BEGINNING 9511 06:44:34,480 --> 06:44:35,440 TO APPRECIATE THERE IS PULMONARY 9512 06:44:35,440 --> 06:44:36,480 HYPERTENSION, WHAT KIND OF GROUP 9513 06:44:36,480 --> 06:44:39,200 IT IS, WE DON'T REALLY KNOW, 9514 06:44:39,200 --> 06:44:42,040 PEOPLE WHO ARE OLDER THAN 9515 06:44:42,040 --> 06:44:44,760 TRADITIONAL MEAN AGE OF PH, LIKE 9516 06:44:44,760 --> 06:44:45,240 51. 9517 06:44:45,240 --> 06:44:46,960 SO I WOULD HYPOTHESIZE THAT MOST 9518 06:44:46,960 --> 06:44:49,520 OF THE PULMONARY HYPERTENSION IN 9519 06:44:49,520 --> 06:44:53,120 PEOPLE WHO ARE, SAY, 75 TO 85, 9520 06:44:53,120 --> 06:44:55,720 95, IS NOT GROUP 1, PROBABLY 9521 06:44:55,720 --> 06:44:58,680 GROUP 2 AND GROUP 3, MIX OF 9522 06:44:58,680 --> 06:44:59,120 BOTH. 9523 06:44:59,120 --> 06:45:01,080 WE HAVE SEEN SOMEBODY, SOME 9524 06:45:01,080 --> 06:45:05,440 FOLKS WHO HAVE CHRONIC 9525 06:45:05,440 --> 06:45:06,680 THROMBOEMBOLIC HYPERTENSION AT 9526 06:45:06,680 --> 06:45:08,840 THAT RANGE, INTERESTING TO THINK 9527 06:45:08,840 --> 06:45:12,920 HOW EXPOSURES MAY CREATE RISK 9528 06:45:12,920 --> 06:45:15,960 FOR PULMONARY HYPERTENSION AND 9529 06:45:15,960 --> 06:45:17,960 SLEEP DISORDER BREATHING AND MAY 9530 06:45:17,960 --> 06:45:22,560 ENERGY SIZE, I DON'T KNOW WHAT 9531 06:45:22,560 --> 06:45:23,640 OTHER PEOPLE THINK. 9532 06:45:23,640 --> 06:45:25,920 >>SO, I MEAN, IT IS AN 9533 06:45:25,920 --> 06:45:27,760 INTERESTING POINT AND I'M GOING 9534 06:45:27,760 --> 06:45:31,360 TO TALK ABOUT THIS TOMORROW. 9535 06:45:31,360 --> 06:45:33,280 BUT ONE OF THE THINGS WE DID DO 9536 06:45:33,280 --> 06:45:35,480 IS WE DID NOT PUT AN AGE LIMIT 9537 06:45:35,480 --> 06:45:36,680 ON WHO WE ENROLLED. 9538 06:45:36,680 --> 06:45:39,520 I THINK WE DO HAVE SOME PEOPLE 9539 06:45:39,520 --> 06:45:48,280 WHO PEOPLE WHO ARE PURE 9540 06:45:48,280 --> 06:45:50,080 CAPILLARY GROUP 1 PH THAT DID 9541 06:45:50,080 --> 06:45:51,480 NOT HAVE OTHER COMORBIDITIES TO 9542 06:45:51,480 --> 06:45:57,080 PUT THEM IN OTHER GROUPS BUT I 9543 06:45:57,080 --> 06:45:58,360 WONDER IF THEY ARE 9544 06:45:58,360 --> 06:45:58,960 PHENOTYPICALLY DIFFERENT THAN 9545 06:45:58,960 --> 06:46:02,080 SOME OF THE OTHER PEOPLE, LIKE 9546 06:46:02,080 --> 06:46:04,200 YOU SAID, ANNA, THAT THEY DO 9547 06:46:04,200 --> 06:46:05,360 HAVE SOME EXPOSURES THAT WE 9548 06:46:05,360 --> 06:46:07,800 HAVEN'T FIGURED OUT YET THAT 9549 06:46:07,800 --> 06:46:13,040 MAKE THEM LOOK SIMILAR TO THE 9550 06:46:13,040 --> 06:46:15,680 TYPICAL YOUNGER EITHER HERITABLE 9551 06:46:15,680 --> 06:46:19,400 OR IDIOPATHIC PH WE SEE. 9552 06:46:19,400 --> 06:46:21,120 9553 06:46:21,120 --> 06:46:21,880 >>THANK YOU. 9554 06:46:21,880 --> 06:46:25,280 MAYBE AS WE WERE TALKING A LOT 9555 06:46:25,280 --> 06:46:28,120 ABOUT THE MULTIOMICS OF THOSE 9556 06:46:28,120 --> 06:46:30,360 OMIC EXPOSOMES, WE HAVE TO THINK 9557 06:46:30,360 --> 06:46:31,640 ABOUT THE ENVIRONMENTAL 9558 06:46:31,640 --> 06:46:33,720 EXPOSOMES TOO. 9559 06:46:33,720 --> 06:46:35,880 AND THOSE ARE ALSO POTENTIALLY 9560 06:46:35,880 --> 06:46:36,200 MODIFIABLE. 9561 06:46:36,200 --> 06:46:41,480 WE'RE ACTUALLY OUT OF TIME FOR 9562 06:46:41,480 --> 06:46:41,680 TODAY. 9563 06:46:41,680 --> 06:46:47,840 WE DO HAVE UNFORTUNATELY ONE 9564 06:46:47,840 --> 06:46:50,040 ONE OF OUR MORNING SPEAKERS IS 9565 06:46:50,040 --> 06:46:50,200 ILL. 9566 06:46:50,200 --> 06:46:51,440 THE GOOD NEWS EVERYONE GETS TO 9567 06:46:51,440 --> 06:46:54,080 SLEEP IN A LITTLE BIT AND WE'LL 9568 06:46:54,080 --> 06:46:56,920 BEGIN AT 10:20 TOMORROW SHARPLY. 9569 06:46:56,920 --> 06:47:00,440 I JUST WANT TO THANK EVERYONE 9570 06:47:00,440 --> 06:47:03,400 FOR A FANTASTIC DAY, VERY 9571 06:47:03,400 --> 06:47:06,480 STIMULATING, LOTS OF THINGS TO 9572 06:47:06,480 --> 06:47:09,320 NOODLE OVERNIGHT, LET OUR SLOW 9573 06:47:09,320 --> 06:47:10,400 WAVES PROCESS AND CONSOLIDATE 9574 06:47:10,400 --> 06:47:13,560 THE IMPORTANT THINGS THAT COME 9575 06:47:13,560 --> 06:47:15,200 UP WITH CREATIVE TID-BITS FOR 9576 06:47:15,200 --> 06:47:15,760 TOMORROW. 9577 06:47:15,760 --> 06:47:18,480 ANNA, WOULD YOU LIKE TO SAY 9578 06:47:18,480 --> 06:47:18,920 ANYTHING? 9579 06:47:18,920 --> 06:47:19,160 AND LEI? 9580 06:47:19,160 --> 06:47:20,120 >>THANK YOU. 9581 06:47:20,120 --> 06:47:21,560 IT'S BEEN A GREAT STIMULATING 9582 06:47:21,560 --> 06:47:22,000 DAY. 9583 06:47:22,000 --> 06:47:22,880 WE APPRECIATE IT. 9584 06:47:22,880 --> 06:47:28,120 IT'S A LONG TIME TO STARE AT 9585 06:47:28,120 --> 06:47:29,960 YOUR COMPUTER BUT NICE TO SHARE 9586 06:47:29,960 --> 06:47:30,520 THOUGHTS. 9587 06:47:30,520 --> 06:47:32,600 THANK YOU FOR PARTICIPATING IN A 9588 06:47:32,600 --> 06:47:33,200 STIMULATING DISCUSSION, LOOK 9589 06:47:33,200 --> 06:47:34,920 FORWARD TO SEEING YOU TOMORROW 9590 06:47:34,920 --> 06:47:35,720 AT 10:20. 9591 06:47:35,720 --> 06:47:37,400 >>THANK YOU. 9592 06:47:37,400 --> 06:47:39,280 LEI OR NIH, DID YOU WANT TO SAY 9593 06:47:39,280 --> 06:47:41,840 ANYTHING BEFORE WE WRAP UP? 9594 06:47:41,840 --> 06:47:44,200 >>YOU COVERED EVERYTHING. 9595 06:47:44,200 --> 06:47:48,680 JUST ONE TO MENTION THAT WE WILL 9596 06:47:48,680 --> 06:47:51,760 PROBABLY START AT 10:20 9597 06:47:51,760 --> 06:47:53,160 TOMORROW, SO I THINK BRITTANY OR 9598 06:47:53,160 --> 06:47:57,440 SUPPORT TEAM WILL SEND OUT 9599 06:47:57,440 --> 06:48:01,520 UPDATED INVITE LATER TODAY, SO 9600 06:48:01,520 --> 06:48:03,720 EVERYBODY CAN SLEEP ANOTHER 20 9601 06:48:03,720 --> 06:48:06,640 MINUTES FOR THE WEST COAST 9602 06:48:06,640 --> 06:48:06,880 FOLKS. 9603 06:48:06,880 --> 06:48:08,520 THIS IS A GREAT MEETING. 9604 06:48:08,520 --> 06:48:10,520 I LEARNED A LOT. 9605 06:48:10,520 --> 06:48:13,920 THANK YOU, EVERYONE. 9606 06:48:13,920 --> 06:48:15,680 WE'LL TALK TOMORROW. 9607 06:48:15,680 --> 06:48:15,920 BYE-BYE. 9608 06:48:15,920 --> 00:00:00,000 >>BYE.