1 00:00:51,991 --> 00:00:54,894 >> TO THOSE JOINING BY VIDEOCAST 2 00:00:54,894 --> 00:00:58,397 SEND YOUR QUESTIONS USING THE 3 00:00:58,397 --> 00:01:00,032 SEND LIVE FEEDBACK AND STATE THE 4 00:01:00,032 --> 00:01:01,801 SPEAKER AND/OR TOPIC TO WHOM 5 00:01:01,801 --> 00:01:04,670 YOU'RE DIRECTING YOUR QUESTIONS. 6 00:01:04,670 --> 00:01:05,471 SPEAKERS, KEEP YOUR QUESTIONS TO 7 00:01:05,471 --> 00:01:08,174 THE ALLOTTED TIME FRAME LEAVING 8 00:01:08,174 --> 00:01:11,144 TIME FOR QUESTIONS AFTER YOUR 9 00:01:11,144 --> 00:01:11,344 TALK. 10 00:01:11,344 --> 00:01:14,447 YOU'LL RECEIVE AN AUDIBLE 11 00:01:14,447 --> 00:01:15,548 TWO-MINUTE WARNING WHERE YOU 12 00:01:15,548 --> 00:01:18,017 SHOULD WORK TO WRAP THINGS UP. 13 00:01:18,017 --> 00:01:19,218 THERE WILL BE A PANELLED Q&A 14 00:01:19,218 --> 00:01:20,987 DISCUSSION AT THE END OF EACH 15 00:01:20,987 --> 00:01:21,220 SESSION. 16 00:01:21,220 --> 00:01:22,088 ANYONE CAN SUBMIT QUESTIONS AT 17 00:01:22,088 --> 00:01:23,923 ANY TIME AND THE MODERATOR WILL 18 00:01:23,923 --> 00:01:26,125 ASK ON YOUR BEHALF DURING THE 19 00:01:26,125 --> 00:01:26,826 DISCUSSION. 20 00:01:26,826 --> 00:01:28,628 IF YOU REQUIRE CLOSED 21 00:01:28,628 --> 00:01:30,096 CAPTIONING, PLEASE CLICK ON THE 22 00:01:30,096 --> 00:01:31,464 CAPTIONS BUTTON FOUND ON THE 23 00:01:31,464 --> 00:01:33,332 BOTTOM OF YOUR SCREEN. 24 00:01:33,332 --> 00:01:34,667 IF YOU EXPERIENCE TECHNICAL 25 00:01:34,667 --> 00:01:36,135 DIFFICULTIES DURING THE WORKSHOP 26 00:01:36,135 --> 00:01:39,772 PLEASE CONTACT MYSELF OR 27 00:01:39,772 --> 00:01:42,808 BRITTANY BELAFONA. 28 00:01:42,808 --> 00:01:46,579 THE WORKSHOP IS OPEN TO THE 29 00:01:46,579 --> 00:01:48,748 PUBLIC AND AVAILABLE FOR VIEWING 30 00:01:48,748 --> 00:01:49,515 IN THE COMING WEEKS AND OPEN TO 31 00:01:49,515 --> 00:01:50,750 THE PUBLIC. 32 00:01:50,750 --> 00:01:52,118 I'D LIKE TO INTRODUCE 33 00:01:52,118 --> 00:01:55,488 DR. MARISHKA BROWN FOR THE 34 00:01:55,488 --> 00:02:00,126 OPENING REMARKS. 35 00:02:00,126 --> 00:02:05,097 DR. BROWN IS THE DIRECTOR OF 36 00:02:05,097 --> 00:02:06,599 NATIONAL CENTER OF SLEEP 37 00:02:06,599 --> 00:02:07,366 DISORDERS RESEARCH TO DISCOVER 38 00:02:07,366 --> 00:02:09,635 IN HEALTH AND HER PARTNERSHIP 39 00:02:09,635 --> 00:02:12,338 BUILDING HAS HELPED SUSTAIN A 40 00:02:12,338 --> 00:02:14,040 ROBUST RESEARCH NETWORK BRINGING 41 00:02:14,040 --> 00:02:15,808 THE BENEFITS OF NIHs RESEARCH 42 00:02:15,808 --> 00:02:17,877 AND THE MEDICINE OF PUBLIC 43 00:02:17,877 --> 00:02:18,311 HEALTH. 44 00:02:18,311 --> 00:02:20,413 NOW, DR. BROWN, THE FLOOR IS 45 00:02:20,413 --> 00:02:20,846 YOURS. 46 00:02:20,846 --> 00:02:23,516 >> THANK YOU, ALFONSO. 47 00:02:23,516 --> 00:02:24,684 CERTAINLY ANYTHING ON MY 48 00:02:24,684 --> 00:02:26,686 BACKGROUND IS AVAILABLE ONLINE. 49 00:02:26,686 --> 00:02:27,620 WE WELCOME EVERYONE TO THE 50 00:02:27,620 --> 00:02:28,120 WORKSHOP. 51 00:02:28,120 --> 00:02:29,255 WE'RE EXCITED. 52 00:02:29,255 --> 00:02:32,692 THIS IS THE NHLBI SPONSORED 53 00:02:32,692 --> 00:02:34,827 WORKSHOP ENTITLED THE 54 00:02:34,827 --> 00:02:40,132 HETEROGENEITY AND SEX AND GENDER 55 00:02:40,132 --> 00:02:43,169 DIFFERENT DIFFERENCES IN SLEEP 56 00:02:43,169 --> 00:02:45,238 APNEA AND IMPLEMENTATION AND IN 57 00:02:45,238 --> 00:02:46,005 THE AFTERNOON AND THANK YOU FOR 58 00:02:46,005 --> 00:02:49,275 JOINING US THIS MORNING, THIS 59 00:02:49,275 --> 00:02:50,776 WORKSHOP IS GOING TO EXAMINE THE 60 00:02:50,776 --> 00:02:59,619 VARIABILITY IN SLEEP APNEA 61 00:02:59,619 --> 00:03:01,554 ETIOLOGY AND LOOK AT SEX, GENDER 62 00:03:01,554 --> 00:03:03,489 AND SLEEP DISPARITIES. 63 00:03:03,489 --> 00:03:06,459 FOR INDIVIDUAL DIFFERENCES AND 64 00:03:06,459 --> 00:03:07,860 PATHOBIOLOGY AND RESPONSE TO 65 00:03:07,860 --> 00:03:09,695 TREATMENT IT'S OUR STATED 66 00:03:09,695 --> 00:03:11,631 PRIORITY IN THE NIH SLEEP 67 00:03:11,631 --> 00:03:13,799 RESEARCH PLAN THE NHLBI 68 00:03:13,799 --> 00:03:15,134 STRATEGIC VISION AS WELL AS THE 69 00:03:15,134 --> 00:03:18,771 NHLBI WIDE RESEARCH PLANS. 70 00:03:18,771 --> 00:03:22,108 THE HETEROGENEITY OF OSA AND 71 00:03:22,108 --> 00:03:24,243 IMPACT OF CHRONIC CONDITION 72 00:03:24,243 --> 00:03:25,578 SUGGEST THE PERSONALIZED 73 00:03:25,578 --> 00:03:27,780 APPROACHES ARE NEEDED FOR 74 00:03:27,780 --> 00:03:28,381 SUCCESSFUL DIAGNOSIS AND 75 00:03:28,381 --> 00:03:29,882 IMPLEMENTATION AND TREATMENT. 76 00:03:29,882 --> 00:03:34,387 TO THAT END THE GOALS ARE TO 77 00:03:34,387 --> 00:03:35,588 DELINEATE DIAGNOSIS, TREATMENT, 78 00:03:35,588 --> 00:03:36,756 IMPLEMENTATION AND HIGHLIGHTING 79 00:03:36,756 --> 00:03:38,457 RESEARCH FOCUSSED ON SEX AND 80 00:03:38,457 --> 00:03:40,126 GENDER DIFFERENCES TO DISCUSS 81 00:03:40,126 --> 00:03:42,928 PERSONALIZED CARE AND PRECISION 82 00:03:42,928 --> 00:03:44,664 MEDICINE BASED APPROACHES IN OSA 83 00:03:44,664 --> 00:03:47,033 AND TO ZBUS HOW THE 84 00:03:47,033 --> 00:03:47,600 IDENTIFICATION OF CURRENT 85 00:03:47,600 --> 00:03:51,971 RESEARCH METRICS CAN BE 86 00:03:51,971 --> 00:03:52,738 TRANSLATED TO CLINICAL PRACTICE 87 00:03:52,738 --> 00:03:55,574 ACROSS THE LIFE SPAN AND AMONG 88 00:03:55,574 --> 00:03:56,509 POPULATIONS DISPROPORTIONATELY 89 00:03:56,509 --> 00:03:56,776 IMPACTED. 90 00:03:56,776 --> 00:03:59,512 NEXT I'D LIKE TO INTRODUCE OUR 91 00:03:59,512 --> 00:04:03,015 CO-CHAIRS. 92 00:04:03,015 --> 00:04:05,818 FIRST STARTING WITH THE DIRECTOR 93 00:04:05,818 --> 00:04:09,322 OF THE U CHICAGO SLEEP PROGRAM. 94 00:04:09,322 --> 00:04:11,357 HER WORK HIGHLIGHT THE CRITICAL 95 00:04:11,357 --> 00:04:12,725 ROLE OF SLEEP AND ENERGY 96 00:04:12,725 --> 00:04:19,665 METABOLISM AND THE IMPACT OF 97 00:04:19,665 --> 00:04:23,336 SLEEP AND SLEEP APNEA AND OUR 98 00:04:23,336 --> 00:04:25,571 CURRENT CARE OF THE NIH SLEEP 99 00:04:25,571 --> 00:04:26,772 RESEARCH ADVISORY BOARD AND OUR 100 00:04:26,772 --> 00:04:29,975 NEXT MEETING IS GOING TO BE ON 101 00:04:29,975 --> 00:04:33,279 THURSDAY DECEMBER 5 STARTING AT 102 00:04:33,279 --> 00:04:34,814 11:00 A.M. AND PLACE ON OUR 103 00:04:34,814 --> 00:04:37,883 SLEEP RFA LIST SERVE FOR THOSE 104 00:04:37,883 --> 00:04:40,920 WHO ARE NOT SUB SCRIBED, PLEASE 105 00:04:40,920 --> 00:04:43,022 DO BECAUSE WE POST OUR 106 00:04:43,022 --> 00:04:44,490 ACTIVITIES AND EVENTS AS WELL AS 107 00:04:44,490 --> 00:04:45,124 FUNDING OPPORTUNITIES ON THE 108 00:04:45,124 --> 00:04:46,058 LIST SERVE. 109 00:04:46,058 --> 00:04:47,660 NEXT UP IS BOB OWENS PROFESSOR 110 00:04:47,660 --> 00:04:50,563 OF MEDICINE AT THE UNIVERSITY OF 111 00:04:50,563 --> 00:04:52,131 SAN DIEGO AND BOARD CERTIFIED 112 00:04:52,131 --> 00:04:53,799 CRITICAL CARE AND SLEEP MEDICINE 113 00:04:53,799 --> 00:04:54,767 PHYSICIAN. 114 00:04:54,767 --> 00:04:58,304 HIS RESEARCH HAS FOCUSSED ON OSA 115 00:04:58,304 --> 00:04:59,238 PATHOGENESIS INCLUDING THE 116 00:04:59,238 --> 00:05:01,607 PHYSIOLOGY OF THE UPPER AIRWAY 117 00:05:01,607 --> 00:05:04,143 AND LUNG VOLUMES AND EXPRESSION 118 00:05:04,143 --> 00:05:05,945 OF OSA. 119 00:05:05,945 --> 00:05:07,580 HE SERVES AS THE CHAIR OF SLEEP 120 00:05:07,580 --> 00:05:11,450 AND RESPIRATORY ASSEMBLY OF THE 121 00:05:11,450 --> 00:05:13,552 AMERICAN THORACIC SOCIETY. 122 00:05:13,552 --> 00:05:18,491 OUR LAST CO-CHAIR AND HE IS AN 123 00:05:18,491 --> 00:05:19,925 ASSISTANT PREVENTION WITH THE 124 00:05:19,925 --> 00:05:22,395 DEPARTMENT OF MEDICINE AND A.I. 125 00:05:22,395 --> 00:05:24,397 AND HUMAN HEALTH AND SERVES AS 126 00:05:24,397 --> 00:05:26,999 DIRECTOR OF THE SLEEP AND 127 00:05:26,999 --> 00:05:29,835 CIRCADIAN ANALYSIS GROUP AT 128 00:05:29,835 --> 00:05:31,604 MOUNT SINAI AND MATHEMATICIAN 129 00:05:31,604 --> 00:05:32,938 AND HIS RESEARCH INTERESTS ARE 130 00:05:32,938 --> 00:05:34,907 IN THE DEVELOPMENT OF MARKERS 131 00:05:34,907 --> 00:05:36,075 RELATED TO SLEEP DISORDERS AND 132 00:05:36,075 --> 00:05:36,542 SHORT AND LONG-TERM 133 00:05:36,542 --> 00:05:38,711 CONSEQUENCES. 134 00:05:38,711 --> 00:05:42,381 MORE RECENTLY, HIS WORK IS AIMED 135 00:05:42,381 --> 00:05:44,750 AT DEVELOPING METRICS OF SLEEP 136 00:05:44,750 --> 00:05:48,120 APNEA SEVERITY BEYOND THE INDEX 137 00:05:48,120 --> 00:05:49,855 USING PHYSIOLOGY GUIDED 138 00:05:49,855 --> 00:05:50,456 ARTIFICIAL INTELLIGENCE AND 139 00:05:50,456 --> 00:05:50,990 MACHINE LEARNING METHODS. 140 00:05:50,990 --> 00:05:52,391 WITH THAT I'M GOING TO TURN IT 141 00:05:52,391 --> 00:05:55,561 BACK OVER TO ALFONSO TO OPEN UP 142 00:05:55,561 --> 00:05:58,030 OUR FIRST SESSION. 143 00:05:58,030 --> 00:05:58,898 >> ALL RIGHT. 144 00:05:58,898 --> 00:06:00,633 THANK YOU DR. BROWN FOR THE 145 00:06:00,633 --> 00:06:01,066 OPENING REMARKS. 146 00:06:01,066 --> 00:06:03,669 TO KICK THINGS OFF WE'LL START 147 00:06:03,669 --> 00:06:04,236 WITH THE KEY NOTE SESSION 148 00:06:04,236 --> 00:06:05,738 INCLUDING THREE SPEAKERS. 149 00:06:05,738 --> 00:06:12,545 OUR FIRST SPEAKER IS DR. MONICA 150 00:06:12,545 --> 00:06:14,013 MALLAMPALLI AND HER PRESENTATION 151 00:06:14,013 --> 00:06:17,450 IS EXCITED EVERY BREATH COUNTS 152 00:06:17,450 --> 00:06:19,385 ADVOCATING FOR PERSONALIZED 153 00:06:19,385 --> 00:06:22,721 APPROACHES TO SLEEP APNEA CARE. 154 00:06:22,721 --> 00:06:24,123 WHEN YOU'RE READY THE MIKE IS 155 00:06:24,123 --> 00:06:24,323 YOURS. 156 00:06:24,323 --> 00:06:34,700 >> THANK YOU, ALFONSO. 157 00:06:43,642 --> 00:06:45,277 THANK YOU, I WAS DIAGNOSED 10 158 00:06:45,277 --> 00:06:48,647 YEARS AGO AND ALSO A TRAINED 159 00:06:48,647 --> 00:06:49,548 BASIC RESEARCHER. 160 00:06:49,548 --> 00:06:51,684 LEFT RESEARCH TO GO INTO POLICY 161 00:06:51,684 --> 00:06:55,488 ADVOCACY AND IN THE AREA OF 162 00:06:55,488 --> 00:06:57,056 WOMEN'S HEALTH ABOUT 15 YEARS 163 00:06:57,056 --> 00:06:58,190 NOW. 164 00:06:58,190 --> 00:06:59,525 I'M THRILLED TO BE HERE AND TALK 165 00:06:59,525 --> 00:07:01,360 ABOUT MY PERSPECTIVES COMING IN 166 00:07:01,360 --> 00:07:03,596 AS A PATIENT AND SCIENTIST AS 167 00:07:03,596 --> 00:07:04,296 WELL AS SOMEBODY WHO AS BEEN IN 168 00:07:04,296 --> 00:07:07,867 THE POLICY WORLD. 169 00:07:07,867 --> 00:07:09,935 I HAVE NO CONFLICTS OF INTEREST. 170 00:07:09,935 --> 00:07:14,273 AS FOR THE DISCLOSURE, I WANT TO 171 00:07:14,273 --> 00:07:16,075 MENTION WE HAVE A MECHANISM TO 172 00:07:16,075 --> 00:07:20,112 WORK WITH OUR INDUSTRY PARTNERS 173 00:07:20,112 --> 00:07:25,484 AND APPOINTED AS A PUBLIC MEMBER 174 00:07:25,484 --> 00:07:26,085 TO THE HHS PAIN COORDINATING 175 00:07:26,085 --> 00:07:34,193 COMMITTEE. 176 00:07:34,193 --> 00:07:37,530 AND WE'RE A NONPROFIT 501C3 177 00:07:37,530 --> 00:07:41,367 ORGANIZATION AND WE ALWAYS KEEP 178 00:07:41,367 --> 00:07:43,569 THE PATIENT IN MIND AND IT'S 179 00:07:43,569 --> 00:07:45,704 100% VOLUNTEER DRIVEN. 180 00:07:45,704 --> 00:07:46,805 FOR MORE ON OUR PROGRAMS AND 181 00:07:46,805 --> 00:07:49,441 EVERYTHING WE DO VISIT OUR 182 00:07:49,441 --> 00:07:53,679 WEBSITE AT APNEA PARTNERS.org. 183 00:07:53,679 --> 00:07:55,781 WE PROMOTE FOR SCREENING, 184 00:07:55,781 --> 00:07:59,552 MANAGEMENT AND OPTIMAL HEALTH 185 00:07:59,552 --> 00:08:06,525 FOR THOSE WHO SUFFER FROM SLEEP 186 00:08:06,525 --> 00:08:06,725 APNEA. 187 00:08:06,725 --> 00:08:09,295 WE BELIEVE THERE'S GAPS WITH 188 00:08:09,295 --> 00:08:10,896 SCREENING, DIAGNOSIS, TREATMENT 189 00:08:10,896 --> 00:08:13,566 AND MANAGEMENT AND TAKE THE 190 00:08:13,566 --> 00:08:16,135 EQUITY LENS TO EVERYTHING WE DO 191 00:08:16,135 --> 00:08:18,404 AND THE SEX AND GENDER LENS AND 192 00:08:18,404 --> 00:08:20,139 SPEAK TO A BROADER AUDIENCE 193 00:08:20,139 --> 00:08:21,707 BECAUSE THERE'S STILL PEOPLE YET 194 00:08:21,707 --> 00:08:22,841 TO BE DIAGNOSED AND PEOPLE 195 00:08:22,841 --> 00:08:28,180 DIAGNOSED ARE YET TO GET TREAT 196 00:08:28,180 --> 00:08:38,657 ED -- TREATED AND SOME HAVE 197 00:08:39,258 --> 00:08:40,726 DIFFICULTY GETTING TREATMENT. 198 00:08:40,726 --> 00:08:42,161 ONE SIZE DOES NOT FIT ALL. 199 00:08:42,161 --> 00:08:45,397 WE CANNOT TAKE THAT APPROACH AND 200 00:08:45,397 --> 00:08:46,632 THIS IS WHAT WE NEED TO THINK 201 00:08:46,632 --> 00:08:50,202 FOR A WHILE AND THERE'S A 202 00:08:50,202 --> 00:08:50,803 DIFFERENCE BETWEEN EQUALITY 203 00:08:50,803 --> 00:08:54,039 VERSUS EQUITY. 204 00:08:54,039 --> 00:08:55,574 ON THE TOP OF THE DIAGRAM YOU 205 00:08:55,574 --> 00:08:57,643 CAN SEE WHEN YOU HAVE TREATMENT 206 00:08:57,643 --> 00:09:00,879 YOU ASSUME WORKS FOR EVERYBODY, 207 00:09:00,879 --> 00:09:06,018 THAT'S WHAT LEADS TO 208 00:09:06,018 --> 00:09:16,228 DISPARITIES. 209 00:09:30,075 --> 00:09:33,846 AND THERE'S VARIABLES THAT ARE 210 00:09:33,846 --> 00:09:36,782 IMPORTANT TO KEEP IN MIND, SEX, 211 00:09:36,782 --> 00:09:39,051 GENDER, ABLE AND RACE. 212 00:09:39,051 --> 00:09:40,953 UNLIKE OTHER VARIABLES, SEX IS 213 00:09:40,953 --> 00:09:43,422 BINARY AND THIS IS IMPORTANT 214 00:09:43,422 --> 00:09:45,491 WHEN YOU THINK OF PERSONIZED OR 215 00:09:45,491 --> 00:09:48,327 INDIVIDUALIZED APPROACH TO 216 00:09:48,327 --> 00:09:49,028 TREATMENT. 217 00:09:49,028 --> 00:09:51,664 AGAIN, I WANT TO REITERATE WHAT 218 00:09:51,664 --> 00:09:52,965 SOME KNOW AND SOME DON'T BUT SEX 219 00:09:52,965 --> 00:09:56,201 AND GENDER ARE NOT THE SAME. 220 00:09:56,201 --> 00:10:05,310 SEX IS A BIOLOGICAL VARIABLE AT 221 00:10:05,310 --> 00:10:08,480 THE CHROMOSOMAL COMPLEMENT AND 222 00:10:08,480 --> 00:10:18,223 ACCORDING TO SEXUAL ORGANS AND 223 00:10:18,223 --> 00:10:23,095 WHEN WE TALK ABOUT THE SEX 224 00:10:23,095 --> 00:10:26,899 DIFFERENCES THE BIOLOGICAL AND 225 00:10:26,899 --> 00:10:31,203 GENDER IS SOCIAL AND CULTURAL 226 00:10:31,203 --> 00:10:37,276 INFLUENCES IN BIOLOGICAL FACTORS 227 00:10:37,276 --> 00:10:40,713 AND YOU'LL SEE WHEN IT COMES TO 228 00:10:40,713 --> 00:10:42,514 METABOLISM AND RENAL FUNCTION 229 00:10:42,514 --> 00:10:45,150 AND PHARMACO DYNAMICS AND 230 00:10:45,150 --> 00:10:46,485 EFFICACY AND SAFETY. 231 00:10:46,485 --> 00:10:50,956 ESSENTIALLY FROM HEAD TO TOE AS 232 00:10:50,956 --> 00:10:52,558 DEPICTED ON THE RIGHT BY OFFICE 233 00:10:52,558 --> 00:10:55,627 OF RESEARCH ON WOMEN'S HEALTH. 234 00:10:55,627 --> 00:10:59,665 30 YEARS AGO WOMEN WERE NOT 235 00:10:59,665 --> 00:11:03,068 INCLUDED IN BIOMEDICAL RESEARCH. 236 00:11:03,068 --> 00:11:06,705 ESSENTIALLY SPECIFIC BIOLOGY AND 237 00:11:06,705 --> 00:11:11,076 ANATOMY AND PHYSIOLOGY WAS 238 00:11:11,076 --> 00:11:11,510 IGNORED. 239 00:11:11,510 --> 00:11:12,611 THEREFORE TREATMENTS AROUND DID 240 00:11:12,611 --> 00:11:15,247 NOT WORK WELL FOR WOMEN AND THIS 241 00:11:15,247 --> 00:11:17,149 CARTOON DEPICTS IT WELL. 242 00:11:17,149 --> 00:11:20,119 WE HAVE STUDIES ON FRUIT FLIES, 243 00:11:20,119 --> 00:11:23,122 MICE, HAMSTERS, FROGS, MONKEYS 244 00:11:23,122 --> 00:11:25,557 MEN WITH THIS CONDITION AND 245 00:11:25,557 --> 00:11:27,292 WOMEN AS MEDICAL SUBJECTS NEVER 246 00:11:27,292 --> 00:11:28,727 OCCURRED TO ANYBODY AND WE STILL 247 00:11:28,727 --> 00:11:31,296 HAVE A LONG WAY TO GO IN 248 00:11:31,296 --> 00:11:31,864 ENSURING WE HAVE EQUITABLE 249 00:11:31,864 --> 00:11:42,274 DIAGNOSIS AND TREATMENT. 250 00:11:45,878 --> 00:11:49,248 THIS IS THE NATIONAL ACADEMY OF 251 00:11:49,248 --> 00:11:49,515 MEDICINE. 252 00:11:49,515 --> 00:11:54,820 EVERY CELL AS A SEX. 253 00:11:54,820 --> 00:11:58,957 MEDICAL PRODUCTS VARY FROM MEN 254 00:11:58,957 --> 00:12:01,160 TO WOMEN THE FIRST STEP TO 255 00:12:01,160 --> 00:12:01,794 INDIVIDUALIZED TREATMENT. 256 00:12:01,794 --> 00:12:03,362 UNDERSTANDING THE SEX 257 00:12:03,362 --> 00:12:04,696 DIFFERENCES IN DISEASE 258 00:12:04,696 --> 00:12:05,998 PREVENTION, DIAGNOSIS AND 259 00:12:05,998 --> 00:12:07,833 TREATMENT WILL TRANSFORM DISEASE 260 00:12:07,833 --> 00:12:09,568 RESEARCH TO IMPROVE CARE FOR 261 00:12:09,568 --> 00:12:09,968 BOTH. 262 00:12:09,968 --> 00:12:12,004 AGAIN, I SAY BOTH WOMEN AND MEN 263 00:12:12,004 --> 00:12:13,672 SO WE'RE NOT EXCLUDING EITHER OF 264 00:12:13,672 --> 00:12:17,976 THOSE SEXES. 265 00:12:17,976 --> 00:12:20,078 SO WHAT HAPPENS WHEN YOU IGNORE 266 00:12:20,078 --> 00:12:22,047 SEX AND GENDER DIFFERENCES? 267 00:12:22,047 --> 00:12:24,249 IT LEADS TO HEALTH DISPARITIES. 268 00:12:24,249 --> 00:12:28,086 THERE'S AN OVERUSE OF MALE 269 00:12:28,086 --> 00:12:29,655 ANIMAL MODELS AND CAN IGNORE 270 00:12:29,655 --> 00:12:30,722 SPECIFIC RESEARCH. 271 00:12:30,722 --> 00:12:32,558 IT'S HARD TO DEFINE MECHANISMS 272 00:12:32,558 --> 00:12:34,259 IN HEALTH AND DISEASE. 273 00:12:34,259 --> 00:12:36,461 IT'S DIFFICULT TO REPORT 274 00:12:36,461 --> 00:12:38,030 EFFECTIVENESS OF AN INTERVENTION 275 00:12:38,030 --> 00:12:39,765 FOR WOMEN AND WOMEN HAVE MORE 276 00:12:39,765 --> 00:12:42,367 ADVERSE EVENTS TO MEDICATIONS 277 00:12:42,367 --> 00:12:45,671 BUT UNREPORTED AND WOMEN HAVE 278 00:12:45,671 --> 00:12:49,508 TROUBLE ACCESSING HEALTH CARE 279 00:12:49,508 --> 00:12:52,110 AND FACE GENDER BIAS. 280 00:12:52,110 --> 00:12:55,147 THIS IS A WORKSHOP FROM 2012 ON 281 00:12:55,147 --> 00:12:55,681 SCIENTIFIC REPORTING OF 282 00:12:55,681 --> 00:12:56,081 RESEARCH. 283 00:12:56,081 --> 00:13:02,221 I'M NOT GOING TO GET IN THE 284 00:13:02,221 --> 00:13:04,089 PRECLINICAL SIDE EXCEPT BY 285 00:13:04,089 --> 00:13:05,357 SAYING IT'S ESSENTIAL TO INCLUDE 286 00:13:05,357 --> 00:13:07,426 THE SEX OF ANIMALS OR CELLS YOUR 287 00:13:07,426 --> 00:13:08,227 STUDYING AND REPORTING THAT IN 288 00:13:08,227 --> 00:13:10,495 THE LITERATURE IS IMPORTANT. 289 00:13:10,495 --> 00:13:12,297 I DO WANT TO POINT OUT A COUPLE 290 00:13:12,297 --> 00:13:15,400 THINGS WHEN IT COMES TO CLINICAL 291 00:13:15,400 --> 00:13:17,669 STUDY DESIGN. 292 00:13:17,669 --> 00:13:21,740 THE STUDY SHOULD BE DESIGN FOR 293 00:13:21,740 --> 00:13:25,544 STRATIFIED RANDOMIZATION BY SEX 294 00:13:25,544 --> 00:13:28,881 AND ALSO IT TELL US THAT STUDIES 295 00:13:28,881 --> 00:13:33,952 SHOULD BE DESIGN WITH ADEQUATE 296 00:13:33,952 --> 00:13:35,053 STATISTICAL POWER WITH SUBGROUP 297 00:13:35,053 --> 00:13:37,022 DESIGN AND BEFORE YOU START YOUR 298 00:13:37,022 --> 00:13:39,725 STUDY AND ONE REASON FOR 299 00:13:39,725 --> 00:13:42,127 REPORTING SEX SPECIFIC RESULTS 300 00:13:42,127 --> 00:13:44,830 SHOULD INCLUDE A REASONABLE 301 00:13:44,830 --> 00:13:46,465 LIKELIHOOD SEX-BASED 302 00:13:46,465 --> 00:13:46,999 ASSOCIATIONS MUST EXIST. 303 00:13:46,999 --> 00:13:50,869 IT'S CRITICAL AND IMPORTANT WHEN 304 00:13:50,869 --> 00:13:52,104 RESEARCHERS START TO DESIGN 305 00:13:52,104 --> 00:13:53,338 THEIR EXPERIMENTS OR STUDIES. 306 00:13:53,338 --> 00:13:58,310 IT'S EQUALLY IMPORTANT HOW YOU 307 00:13:58,310 --> 00:13:59,077 REPORT YOUR RESULTS INCLUDING IN 308 00:13:59,077 --> 00:14:01,179 THE TITLE ABSTRACT AND IN THE 309 00:14:01,179 --> 00:14:02,547 RESEARCH PAPER. 310 00:14:02,547 --> 00:14:04,249 I'M NOT GOING TO GO INTO MORE 311 00:14:04,249 --> 00:14:06,051 DETAILS BUT I'LL ENCOURAGE 312 00:14:06,051 --> 00:14:16,595 EVERYONE TO LOOK AT THIS REPORT. 313 00:14:17,396 --> 00:14:25,537 YOU KNOW 2014 THERE WAS A SEX AS 314 00:14:25,537 --> 00:14:27,673 VARIABLE POLICY AND NOW MAKE A 315 00:14:27,673 --> 00:14:31,510 CASE WHY YOU USE ONE SEX AND NOT 316 00:14:31,510 --> 00:14:31,910 BOTH. 317 00:14:31,910 --> 00:14:33,378 AND THERE'S REAL WORLD POLICY 318 00:14:33,378 --> 00:14:34,846 IMPLICATIONS FOR NOT STUDYING 319 00:14:34,846 --> 00:14:36,615 SEX DIFFERENCES. 320 00:14:36,615 --> 00:14:38,750 THE SLEEP COMMUNITY IS AWARE OF 321 00:14:38,750 --> 00:14:42,187 THE OPEN-END STORY WHERE FDA 322 00:14:42,187 --> 00:14:47,559 RECOMMENDED LOWER DOSE OF AMBIEN 323 00:14:47,559 --> 00:14:52,864 FOR WOMEN AND SAW WOMEN WERE 324 00:14:52,864 --> 00:14:54,666 METABOLIZING THE SAME DOSE 325 00:14:54,666 --> 00:14:56,468 SLOWER THAN WOMEN AND FDA 2014 326 00:14:56,468 --> 00:14:58,904 CAME UP WITH THE FIRST SEX 327 00:14:58,904 --> 00:14:59,938 SPECIFIC GUIDELINES. 328 00:14:59,938 --> 00:15:01,440 IT'S IMPORTANT TO NOTE THERE 329 00:15:01,440 --> 00:15:07,546 WERE A LOT OF PUBLICATIONS BY 330 00:15:07,546 --> 00:15:13,318 DR. TOMORR ROWE AND IT'S IMPORT 331 00:15:13,318 --> 00:15:15,854 TO KNOW WHERE THE LITERATURE IS 332 00:15:15,854 --> 00:15:16,822 AND WHAT INFORMATION WE HAVE 333 00:15:16,822 --> 00:15:21,526 WHILE DESIGNING TREATMENTS. 334 00:15:21,526 --> 00:15:24,062 ALL THIS IS HAPPENING DURING THE 335 00:15:24,062 --> 00:15:25,263 OPEN ENDED STORY. 336 00:15:25,263 --> 00:15:27,399 I WAS AT THE SOCIETY FOR WOMEN'S 337 00:15:27,399 --> 00:15:28,800 HEALTH RESEARCH AND LAUNCH THE 338 00:15:28,800 --> 00:15:30,135 SLEEP AND SEX DIFFERENCES 339 00:15:30,135 --> 00:15:31,136 PROGRAM BECAUSE WE REALIZED 340 00:15:31,136 --> 00:15:32,904 THERE WAS A NEED TO HAVE THE 341 00:15:32,904 --> 00:15:33,872 CONVERSATIONS AROUND SEX 342 00:15:33,872 --> 00:15:35,741 DIFFERENCES AND SLEEP. 343 00:15:35,741 --> 00:15:37,542 WE DID A ROUNDTABLE DISCUSSION 344 00:15:37,542 --> 00:15:40,112 IN 2013 AND RELEASED A REPORT 345 00:15:40,112 --> 00:15:41,546 EXPLORING SEX AND DIFFERENCES OF 346 00:15:41,546 --> 00:15:44,082 SLEEP HEALTH. 347 00:15:44,082 --> 00:15:47,285 THIS REPORT WILL RECEIVE 348 00:15:47,285 --> 00:15:48,020 NATIONAL ATTENTION AND ANOTHER 349 00:15:48,020 --> 00:15:50,222 REPORT ON WOMEN AND SLEEP AND 350 00:15:50,222 --> 00:15:55,961 FIND ALL THIS AT SWHR.org. 351 00:15:55,961 --> 00:15:57,729 SO COMING TO SLEEP APNEA, 352 00:15:57,729 --> 00:15:59,164 THERE'S A SEX GAP THAT CURRENTLY 353 00:15:59,164 --> 00:16:00,766 EXISTS AND DISPARITIES WHEN IT 354 00:16:00,766 --> 00:16:03,902 COMES TO DIAGNOSIS AND 355 00:16:03,902 --> 00:16:04,169 TREATMENT. 356 00:16:04,169 --> 00:16:06,972 PRACTICE GAPS AND SLEEP APNEA 357 00:16:06,972 --> 00:16:11,510 CARE TO TREATMENT EXIST AND ARE 358 00:16:11,510 --> 00:16:12,077 IMPACTING WOMEN. 359 00:16:12,077 --> 00:16:14,079 IT PRESENTS DIFFERENT IN FEMALES 360 00:16:14,079 --> 00:16:15,147 COMPARED TO THEIR UNIQUE BIOLOGY 361 00:16:15,147 --> 00:16:16,581 COMPARED TO MALES. 362 00:16:16,581 --> 00:16:18,216 WOMEN REPORT SYMPTOMS 363 00:16:18,216 --> 00:16:19,518 DIFFERENTLY SUBJECTING THE NEED 364 00:16:19,518 --> 00:16:20,952 FOR SEX SPECIFIC SCREENING 365 00:16:20,952 --> 00:16:22,387 TOOLS. 366 00:16:22,387 --> 00:16:25,524 SEX DIFFERENCES AND ANATOMY 367 00:16:25,524 --> 00:16:26,291 CONTRIBUTE TO HIGHER ASSOCIATED 368 00:16:26,291 --> 00:16:31,296 SLEEP APNEA IN FEMALES AND 369 00:16:31,296 --> 00:16:32,664 CHALLENGES IN QUALITY AND 370 00:16:32,664 --> 00:16:33,598 EQUITABLE CARE IN WOMEN. 371 00:16:33,598 --> 00:16:36,101 NOT ENOUGH CARE IS FOCUSSED ON 372 00:16:36,101 --> 00:16:38,837 FEMALE PATIENTS DUE TO THE 373 00:16:38,837 --> 00:16:42,007 EXISTING MYTHS AND THESE ARE THE 374 00:16:42,007 --> 00:16:52,451 MYTHS WE NEED TO OVERCOME. 375 00:16:59,191 --> 00:17:01,493 THIS GIVES YOU A REAL WORLD 376 00:17:01,493 --> 00:17:04,496 EVIDENCE OF WHAT WE'RE HEARING 377 00:17:04,496 --> 00:17:07,332 DIRECTLY FROM PEOPLE WHO WITH 378 00:17:07,332 --> 00:17:08,533 LIVED EXPERIENCES AND STRUGGLING 379 00:17:08,533 --> 00:17:15,640 WITH OR LIVING WITH OSA. 380 00:17:15,640 --> 00:17:17,609 SOME INDICATE GENDER 381 00:17:17,609 --> 00:17:17,909 DIFFERENCES. 382 00:17:17,909 --> 00:17:22,881 WOMEN REPORT HIGHER RATES OF OSA 383 00:17:22,881 --> 00:17:24,883 SYMPTOMS THAN MEN AND WOMEN WERE 384 00:17:24,883 --> 00:17:26,618 EXPERIENCING FATIGUE COMPARED TO 385 00:17:26,618 --> 00:17:27,752 70% OF WOMEN. 386 00:17:27,752 --> 00:17:30,055 THE WORK IN PRODUCTIVITY WAS 387 00:17:30,055 --> 00:17:31,923 HINDERED AND MORE IMPACTFUL IN 388 00:17:31,923 --> 00:17:36,094 WOMEN WITH 92% OF WOMEN SAID IT 389 00:17:36,094 --> 00:17:39,464 IMPACTED THEIR ACTIVITIES AND 390 00:17:39,464 --> 00:17:44,102 ALSO THERE WAS AN IMPACT ON THE 391 00:17:44,102 --> 00:17:46,071 RELATIONSHIPS WHERE WOMEN 392 00:17:46,071 --> 00:17:49,107 EXPRESSING THEY WERE MORE 393 00:17:49,107 --> 00:17:52,077 EFFECTED BY SOME OF THESE OR NOT 394 00:17:52,077 --> 00:17:54,212 BEING ABLE TO FULLY PRESENT AND 395 00:17:54,212 --> 00:17:55,013 REPORTED MORE EXHAUSTION 396 00:17:55,013 --> 00:17:55,514 INTERFERING WITH THEIR 397 00:17:55,514 --> 00:17:58,783 RELATIONSHIPS. 398 00:17:58,783 --> 00:18:01,520 I ALSO WANT TO HIGHLIGHT A 399 00:18:01,520 --> 00:18:05,824 COUPLE OF THESE ABSTRACTS 400 00:18:05,824 --> 00:18:07,526 PRESENTED IN 2022 AND THERE ARE 401 00:18:07,526 --> 00:18:09,127 A FEW OTHERS THAT I DIDN'T SHARE 402 00:18:09,127 --> 00:18:11,763 HERE TODAY BUT WANTED TO AGAIN 403 00:18:11,763 --> 00:18:14,132 EMPHASIZE THERE'S DATA COMING 404 00:18:14,132 --> 00:18:18,069 OUT OF SOME OF THESE COMPANIES 405 00:18:18,069 --> 00:18:18,937 ALSO STUDIES AND SHOWING THERE 406 00:18:18,937 --> 00:18:21,373 ARE GENDER DIFFERENCES. 407 00:18:21,373 --> 00:18:22,774 FOR EXAMPLE, WOMEN WITH OSA HAVE 408 00:18:22,774 --> 00:18:26,511 A HIGHER PREVALENCE OF THE 409 00:18:26,511 --> 00:18:28,413 CONDITIONS, MOOD DISORDERS AND 410 00:18:28,413 --> 00:18:30,182 INSOMNIA DIFFERENT THAN MEN AND 411 00:18:30,182 --> 00:18:34,319 IN THE OTHER ABSTRACT THERE WERE 412 00:18:34,319 --> 00:18:37,522 GENDER DIFFERENCES WITH COMORBID 413 00:18:37,522 --> 00:18:38,290 CONDITIONS. 414 00:18:38,290 --> 00:18:40,625 HOW DO WE THEN GO ABOUT CLOSING 415 00:18:40,625 --> 00:18:42,661 THE GAP IN SLEEP APNEA? 416 00:18:42,661 --> 00:18:44,229 WE WANTED TO USE THE HEALTH 417 00:18:44,229 --> 00:18:46,898 EQUITY LENS IN CLINICAL PRACTICE 418 00:18:46,898 --> 00:18:49,234 AND DISMANTLED THE CURRENT 419 00:18:49,234 --> 00:18:52,003 SYSTEMS THAT CONTINUE TO 420 00:18:52,003 --> 00:18:54,105 PERPETUATE THE EXISTING 421 00:18:54,105 --> 00:18:54,406 INEQUITIES. 422 00:18:54,406 --> 00:18:56,074 HIGHLIGHT THE CONSEQUENCES OF 423 00:18:56,074 --> 00:18:57,275 FAILING TO ADDRESS SOCIAL ISSUES 424 00:18:57,275 --> 00:18:58,977 AND MAKE SURE THE BASELINE OF 425 00:18:58,977 --> 00:19:00,779 NEEDS ARE MET AND TRAIN 426 00:19:00,779 --> 00:19:02,547 CLINICIANS ON WOMEN-SPECIFIC 427 00:19:02,547 --> 00:19:03,982 HEALTH ISSUES SO WE CAN 428 00:19:03,982 --> 00:19:06,218 ELIMINATE THE BIAS. 429 00:19:06,218 --> 00:19:07,319 CONTINUE TO EDUCATE AND EMPOWER 430 00:19:07,319 --> 00:19:09,087 POPULATIONS TO ENABLE THEM TO 431 00:19:09,087 --> 00:19:11,356 TAKE AN ACTIVE ROLE IN THEIR 432 00:19:11,356 --> 00:19:11,923 HEALTH. 433 00:19:11,923 --> 00:19:15,060 TO SOME EXTENT ALSO FALLS ON 434 00:19:15,060 --> 00:19:16,094 ADVOCACY ORGANIZATIONS SUCH AS 435 00:19:16,094 --> 00:19:18,863 OURS. 436 00:19:18,863 --> 00:19:19,798 WE'LL CONTINUE TO DO ADVOCACY 437 00:19:19,798 --> 00:19:23,068 AND ENSURE WE CONTINUE TO 438 00:19:23,068 --> 00:19:25,537 EDUCATE PATIENTS ON THESE 439 00:19:25,537 --> 00:19:25,770 ISSUES. 440 00:19:25,770 --> 00:19:28,106 WE'RE DOING OUR PART ALREADY AS 441 00:19:28,106 --> 00:19:28,940 YOU KNOW. 442 00:19:28,940 --> 00:19:30,208 WE HAVE BEEN CREATING 443 00:19:30,208 --> 00:19:31,543 WOMEN-SPECIFIC RESOURCES AND 444 00:19:31,543 --> 00:19:35,046 WE'LL CONTINUE TO DO THAT. 445 00:19:35,046 --> 00:19:36,581 ALSO ADD SOME PERHAPS MEN 446 00:19:36,581 --> 00:19:38,650 SPECIFIC RESOURCES AS WELL SINCE 447 00:19:38,650 --> 00:19:43,054 WE KNOW THERE'S GENDER 448 00:19:43,054 --> 00:19:43,855 DIFFERENCES THAT EXIST. 449 00:19:43,855 --> 00:19:46,057 I WANT TO LEAVE YOU WITH A 450 00:19:46,057 --> 00:19:46,625 COUPLE SLIDES. 451 00:19:46,625 --> 00:19:48,593 I HOPE YOU DO YOUR PART AS WE DO 452 00:19:48,593 --> 00:19:54,132 OUR PART BUT I WANTED TO SORT OF 453 00:19:54,132 --> 00:20:02,240 SHARE THIS FROM A PAPER FROM 454 00:20:02,240 --> 00:20:04,776 2016 AND ONLY 76% OF THE CELLS 455 00:20:04,776 --> 00:20:05,510 ARE UNSPECIFIED. 456 00:20:05,510 --> 00:20:06,811 WE DON'T KNOW THE SELF. 457 00:20:06,811 --> 00:20:10,582 WE KNOW 80% OF ANIMAL STUDIES 458 00:20:10,582 --> 00:20:12,550 USE MALE MICE. 459 00:20:12,550 --> 00:20:15,353 67% OF HUMAN TRIALS INCLUDE ONLY 460 00:20:15,353 --> 00:20:15,553 MALES. 461 00:20:15,553 --> 00:20:16,888 ALL THE NUMBERS ARE CHANGING. 462 00:20:16,888 --> 00:20:22,427 I THINK WE'RE EDGING CLOSER TO 463 00:20:22,427 --> 00:20:22,594 50%. 464 00:20:22,594 --> 00:20:24,095 51% OF THE GLOBAL FEEL 465 00:20:24,095 --> 00:20:27,065 POPULATION IS FEMALES AND 80% OF 466 00:20:27,065 --> 00:20:27,732 HEALTH CARE CONSUMERS ARE WOMEN 467 00:20:27,732 --> 00:20:29,901 WHEN IT COMES TO CLINICAL CARE. 468 00:20:29,901 --> 00:20:33,338 SO I ENCOURAGE EVERYONE TO 469 00:20:33,338 --> 00:20:34,439 CONSIDER THE BIOLOGICAL 470 00:20:34,439 --> 00:20:35,707 POSSIBILITY WHICH AGAIN I 471 00:20:35,707 --> 00:20:37,776 MENTIONED BEFORE TO ENSURE THERE 472 00:20:37,776 --> 00:20:42,180 IS AN ASSOCIATION THAT COULD BE 473 00:20:42,180 --> 00:20:45,183 BIOLOGICALLY BELIEVABLE IF 474 00:20:45,183 --> 00:20:48,019 YOU'RE A BASIC RESEARCHER DOING 475 00:20:48,019 --> 00:20:49,721 CELL BASED STUDY OR HUMAN 476 00:20:49,721 --> 00:20:51,589 RESEARCH BUT TO KEEP THAT IN 477 00:20:51,589 --> 00:20:52,090 MIND. 478 00:20:52,090 --> 00:20:55,527 I WANT TO ALSO EMPHASIZE THE 479 00:20:55,527 --> 00:20:58,430 FOUR Cs THE OFFICE OF RESEARCH 480 00:20:58,430 --> 00:20:59,664 ON WOMEN'S HEALTH. 481 00:20:59,664 --> 00:21:02,734 DESIGN YOUR STUDIES TAKING SEX 482 00:21:02,734 --> 00:21:05,236 INTO ACCOUNT AND TABULATE THE 483 00:21:05,236 --> 00:21:07,439 DATA BY SEX AND ANALYZE BY SEX 484 00:21:07,439 --> 00:21:10,475 AND FINALLY REPORT AND PUBLISH 485 00:21:10,475 --> 00:21:10,842 SEX-BASED DATA. 486 00:21:10,842 --> 00:21:15,246 I LEAVE YOU WITH THE ONE EXAMPLE 487 00:21:15,246 --> 00:21:20,585 BY FROM THE PAIN RESEARCH WHICH 488 00:21:20,585 --> 00:21:22,120 CLEARLY SHOWS THE PAPER AND 489 00:21:22,120 --> 00:21:23,688 REPORTING PAIN DIFFERENCES AND 490 00:21:23,688 --> 00:21:25,523 SHOWS THE SEX DIFFERENCES IN THE 491 00:21:25,523 --> 00:21:27,459 TITLE, THE ABSTRACT IS CLEAR 492 00:21:27,459 --> 00:21:31,529 INDICATING WHAT'S BEING STUDIED. 493 00:21:31,529 --> 00:21:33,398 THE METHODS ALSO INDICATES WHAT 494 00:21:33,398 --> 00:21:37,635 IS STUDIED AND THE RESULTS WERE 495 00:21:37,635 --> 00:21:39,170 REPORTED DIFFERENTLY FOR FEMALES 496 00:21:39,170 --> 00:21:40,972 AND MALES AND AGAIN IF YOU HAVE 497 00:21:40,972 --> 00:21:43,541 NOT DONE THAT, YOU WOULD NOT 498 00:21:43,541 --> 00:21:47,412 HAVE SEEN ANY DIFFERENCE HERE 499 00:21:47,412 --> 00:21:48,079 AND THANK YOU OPEN TO SOCIAL 500 00:21:48,079 --> 00:21:50,782 MEDIA SO ALSO VISIT OUR WEBSITE. 501 00:21:50,782 --> 00:22:01,259 HAPPY IT TAKE ANY QUESTIONS. 502 00:22:11,236 --> 00:22:14,239 >> THANK YOU, NEXT IS 503 00:22:14,239 --> 00:22:24,783 DR. PUNJABI IN HETEROGENEITY IN 504 00:22:28,186 --> 00:22:30,021 PERSONAL I'VEED CARE IN OSA. 505 00:22:30,021 --> 00:22:36,094 >> I'VE BEEN GIVEN CHARGE TO 506 00:22:36,094 --> 00:22:43,935 FOLLOW IN DR. MALLAMPALLI'S 507 00:22:43,935 --> 00:22:46,438 STEPS AND LOOK AT THE RESEARCH 508 00:22:46,438 --> 00:22:52,043 GAPS AND HOW TO ADVANCE THE 509 00:22:52,043 --> 00:22:53,178 FIELD AND MOST HAVE BEEN 510 00:22:53,178 --> 00:22:56,080 INVOLVED IN GENERATING THE DATA 511 00:22:56,080 --> 00:23:04,189 I'LL PRESENT AND I'LL ADDRESS 512 00:23:04,189 --> 00:23:06,124 CHALLENGES AND THEY'RE FAR ALONG 513 00:23:06,124 --> 00:23:09,961 WITH THE ISSUE OF CARE AND 514 00:23:09,961 --> 00:23:10,361 HYPERTENSION. 515 00:23:10,361 --> 00:23:13,064 WITH EVERY POINT WE'LL DRAW HOW 516 00:23:13,064 --> 00:23:14,732 HYPERTENSION IS INVOLVED IN THE 517 00:23:14,732 --> 00:23:16,334 CHALLENGES WE HAVE IN THE FIELD 518 00:23:16,334 --> 00:23:26,344 OF SLEEP APNEA. 519 00:23:26,344 --> 00:23:28,947 THERE'S VARIABILITY IN SYMPTOMS 520 00:23:28,947 --> 00:23:32,116 AND TREATMENT RESPONSE WITH 521 00:23:32,116 --> 00:23:36,087 SLEEP APNEA AND THERE'S FACTORS, 522 00:23:36,087 --> 00:23:39,357 DEMOGRAPHIC, PHYSIOLOGIC AND 523 00:23:39,357 --> 00:23:43,027 ENVIRONMENTAL AND I'LL LET OTHER 524 00:23:43,027 --> 00:23:43,995 SPEAKERS GET INTO SPECIFIC 525 00:23:43,995 --> 00:23:45,630 DIFFERENCES OR SEX DIFFERENCES 526 00:23:45,630 --> 00:23:49,534 AND WHY ARE SOME FACTORS ISSUES 527 00:23:49,534 --> 00:23:52,103 HERE AND WE'RE IN CONSIDERATION 528 00:23:52,103 --> 00:23:53,838 OF BIOLOGICAL AGE AND AGE IS 529 00:23:53,838 --> 00:23:54,973 IMPORTANT FOR HETEROGENEITY, THE 530 00:23:54,973 --> 00:23:59,777 RACIAL AND ETHNIC DIFFERENCES 531 00:23:59,777 --> 00:24:02,313 AND UNDERLYING GENETIC 532 00:24:02,313 --> 00:24:04,082 DISPOSITION AND DATA ON 533 00:24:04,082 --> 00:24:05,750 GEOGRAPHIC LOCATIONS AND OSA CAN 534 00:24:05,750 --> 00:24:06,518 INFLUENCE THE RISK AND 535 00:24:06,518 --> 00:24:07,519 EXPRESSION OF DISEASE ITSELF. 536 00:24:07,519 --> 00:24:08,686 I THINK UNDERSTANDING ALL OF 537 00:24:08,686 --> 00:24:11,589 THIS AND THE MOTIVATION FOR THIS 538 00:24:11,589 --> 00:24:14,225 IS OF COURSE TO DETERMINE HOW WE 539 00:24:14,225 --> 00:24:15,860 ADDRESS DISPARITIES AND OPTIMIZE 540 00:24:15,860 --> 00:24:17,829 TREATMENT WITH THE GOAL OF 541 00:24:17,829 --> 00:24:19,697 INDIVIDUALIZING CARE. 542 00:24:19,697 --> 00:24:22,667 MY DISCLOSURES ARE NONE. 543 00:24:22,667 --> 00:24:27,572 THIS FIGURE FROM A PAPER IN THE 544 00:24:27,572 --> 00:24:30,942 LANCET SORT OF 10 YEARS OKAY 545 00:24:30,942 --> 00:24:32,243 SUMMARIZED THINGS I WANT TO 546 00:24:32,243 --> 00:24:33,478 EMPHASIZE IN THE BRIEF TIME 547 00:24:33,478 --> 00:24:34,112 HERE. 548 00:24:34,112 --> 00:24:35,547 IT ALL THE KEY FEATURES. 549 00:24:35,547 --> 00:24:38,983 IF YOU THINK OF THE PATHOGENIC 550 00:24:38,983 --> 00:24:41,352 MECHANISMS THERE'S A LOT KNOWN 551 00:24:41,352 --> 00:24:42,086 ABOUT MUSCLE FUNCTION AND 552 00:24:42,086 --> 00:24:50,061 AROUGHING -- AROUSAL FUNCTIONS 553 00:24:50,061 --> 00:24:51,429 AND THERE'S UPSTREAM EVENTS THAT 554 00:24:51,429 --> 00:24:53,631 LEAD TO THESE MECHANISMS FROM 555 00:24:53,631 --> 00:24:55,567 THE STANDPOINT OF THE 556 00:24:55,567 --> 00:24:56,234 MANIFESTATION AND THEN THERE'S 557 00:24:56,234 --> 00:24:58,303 WHAT TO DO ABOUT THEM. 558 00:24:58,303 --> 00:24:59,871 I THINK WHAT I WANT TO FOCUS ON 559 00:24:59,871 --> 00:25:04,075 IS THE FIRST TWO PANELS IS HOW 560 00:25:04,075 --> 00:25:06,344 SOME RISK FACTORS CONTRIBUTE TO 561 00:25:06,344 --> 00:25:07,345 THE HETEROGENEITY 562 00:25:07,345 --> 00:25:08,413 MECHANISTICALLY AND TALK ABOUT 563 00:25:08,413 --> 00:25:12,750 PHYSIOLOGY AND WHAT WE KNOW 564 00:25:12,750 --> 00:25:14,552 ABOUT HOW HETEROGENEITY AND WHAT 565 00:25:14,552 --> 00:25:17,589 ABOUT OBESITY AND SEX AND AGE IS 566 00:25:17,589 --> 00:25:20,892 CONTRIBUTING TO THIS THAT WE'RE 567 00:25:20,892 --> 00:25:21,292 OBSERVING. 568 00:25:21,292 --> 00:25:26,164 SO SEX DIFFERENCES IS A NATURAL 569 00:25:26,164 --> 00:25:26,564 TRANSITION. 570 00:25:26,564 --> 00:25:29,667 MEN ARE MORE LIKELY TO HAVE 571 00:25:29,667 --> 00:25:31,536 SLEEP APNEA BUT WOMEN GOING 572 00:25:31,536 --> 00:25:35,607 THROUGH MENOPAUSE THE RISK IS 573 00:25:35,607 --> 00:25:36,074 HIGHER. 574 00:25:36,074 --> 00:25:41,379 THERE'S DISTRIBUTION AND AFLAT 575 00:25:41,379 --> 00:25:46,184 -- ANATOMY AND HORMONAL AFFECTS 576 00:25:46,184 --> 00:25:48,386 AND IT CONTRIBUTES TO THE 577 00:25:48,386 --> 00:25:49,354 DISPARITY AND CASE 578 00:25:49,354 --> 00:25:50,788 IDENTIFICATION OF THE DISORDER. 579 00:25:50,788 --> 00:25:52,290 AND THIS IS A NICE GRAPHIC THAT 580 00:25:52,290 --> 00:25:54,859 SUMMARIZES WHAT I SAID. 581 00:25:54,859 --> 00:25:58,329 THERE'S AN UNDERDIAGNOSED WELL 582 00:25:58,329 --> 00:26:00,798 ESTABLISHED WOMEN ARE LIKELY 583 00:26:00,798 --> 00:26:02,166 UNDER OR MISS DIAGNO 584 00:26:02,166 --> 00:26:04,202 THERE'S DIFFERENCES IN 585 00:26:04,202 --> 00:26:07,038 PREVALENCE AND IN PRESENTATIONS, 586 00:26:07,038 --> 00:26:08,072 INSOMNIA, A LITTLE MORE 587 00:26:08,072 --> 00:26:11,476 DEPRESSION, FATIGUE, HEADACHES 588 00:26:11,476 --> 00:26:13,044 ONE IS MORE BIOLOGICAL THAN THE 589 00:26:13,044 --> 00:26:13,244 OTHER. 590 00:26:13,244 --> 00:26:16,314 WHEN YOU LOOK AT THE PHYSIOLOGIC 591 00:26:16,314 --> 00:26:19,484 EXPRESSION OF THE DISEASE 592 00:26:19,484 --> 00:26:20,885 THERE'S DIFFERENCES. 593 00:26:20,885 --> 00:26:21,853 STATE DEPENDENT DIFFERENCES WHEN 594 00:26:21,853 --> 00:26:27,992 IT COMES TO REM ANDNON-REM AND 595 00:26:27,992 --> 00:26:28,760 COMORBIDITIES LOOK DIFFERENT IN 596 00:26:28,760 --> 00:26:31,195 MEN AND WOMEN. 597 00:26:31,195 --> 00:26:34,532 QUALITY OF LIFE, FEMALE PATIENTS 598 00:26:34,532 --> 00:26:36,000 REPORT WORSE QUALITY OF LIFE 599 00:26:36,000 --> 00:26:39,937 WITH SYMPTOMS OF SLEEPINESS 600 00:26:39,937 --> 00:26:40,972 INSOMNIA THEN MEN DO AND THINK 601 00:26:40,972 --> 00:26:42,640 OF TREATMENT RESPONSES. 602 00:26:42,640 --> 00:26:47,979 IF SOME OF THESE BIOLOGICAL SEX 603 00:26:47,979 --> 00:26:49,447 ISSUES HOW IT PRESENTS, 604 00:26:49,447 --> 00:26:51,416 TREATMENT MAY NEED TO BE OCCUR 605 00:26:51,416 --> 00:26:52,383 TRAILED WHERE FOCUSSING ON 606 00:26:52,383 --> 00:26:53,051 ISSUES THAT MATTER IN THE 607 00:26:53,051 --> 00:26:56,254 INDIVIDUAL ITSELF. 608 00:26:56,254 --> 00:26:57,555 SO LET'S START WITH WHAT 609 00:26:57,555 --> 00:26:59,290 POSSIBLY ARE SOME SEX 610 00:26:59,290 --> 00:26:59,657 DIFFERENCES. 611 00:26:59,657 --> 00:27:02,860 THESE ARE DATA FROM A STUDY 612 00:27:02,860 --> 00:27:07,432 PUBLISHED LOOKING AT HOW 613 00:27:07,432 --> 00:27:12,270 DIFFERENCES IN THE X AXIS AND 614 00:27:12,270 --> 00:27:14,939 SEVERITY BASED ON THE ACTUATIONS 615 00:27:14,939 --> 00:27:16,607 AND HOW THEY DIFFER BETWEEN MEN 616 00:27:16,607 --> 00:27:23,414 AND WOMEN AND FROM THE 617 00:27:23,414 --> 00:27:24,749 STANDPOINT OF NREM. 618 00:27:24,749 --> 00:27:27,218 LOOKING AT WOMEN THE DARK LINE, 619 00:27:27,218 --> 00:27:32,857 WOMEN TEND TO HAVE LESS DISEASE 620 00:27:32,857 --> 00:27:35,293 SEVERITY AND THIS IS BREATHING 621 00:27:35,293 --> 00:27:38,629 RATES IN WOMEN RIGHT HERE AND 622 00:27:38,629 --> 00:27:38,796 MEN. 623 00:27:38,796 --> 00:27:40,064 SO MEN AND WOMEN OVERLAP BUT 624 00:27:40,064 --> 00:27:44,035 WHEN YOU LOOK ATNON-REM INDEXES 625 00:27:44,035 --> 00:27:50,408 THEY MEN HAVE A HIGHER NON-REM 626 00:27:50,408 --> 00:27:52,643 INDEX THAN WOMEN AND THERE'S SEX 627 00:27:52,643 --> 00:27:53,411 INTERACTIONS IN THE SLEEP 628 00:27:53,411 --> 00:27:54,512 BREATHING. 629 00:27:54,512 --> 00:27:57,582 WHAT'S THE PATHOPHYSIOLOGY OF 630 00:27:57,582 --> 00:27:57,915 THAT? 631 00:27:57,915 --> 00:27:59,250 I'LL REPORT TO THE STUDY WHICH 632 00:27:59,250 --> 00:28:01,119 LOOKED AT A NUMBER OF FACTORS 633 00:28:01,119 --> 00:28:02,553 NOT JUST BIOLOGICAL SEX BUT 634 00:28:02,553 --> 00:28:05,590 OTHER FACTORS AND I'LL PRESENT 635 00:28:05,590 --> 00:28:06,691 MORE KEY FIGURES HIGHLIGHTING 636 00:28:06,691 --> 00:28:07,859 THESE ISSUES AND I'LL PICK ON 637 00:28:07,859 --> 00:28:13,364 THE FIRST TOPIC OF SEX CLEARLY 638 00:28:13,364 --> 00:28:15,900 MALES VERSUS FEMALES HIGHER ROOM 639 00:28:15,900 --> 00:28:21,939 INDEX AND WHEN YOU LOOK AT 640 00:28:21,939 --> 00:28:23,741 TRAITS FROM VENTILATION AND 641 00:28:23,741 --> 00:28:26,310 NASAL PRESSURE YOU CAN LOOK AT 642 00:28:26,310 --> 00:28:26,944 COLLAPSIBILITY, COLLAPSIBILITY 643 00:28:26,944 --> 00:28:30,148 IS HIGHER IN MEN THAN WOMEN. 644 00:28:30,148 --> 00:28:31,783 YOU CAN LOOK AMOUNT COMPENSATION 645 00:28:31,783 --> 00:28:33,351 FROM THE STANDPOINT ON WHAT 646 00:28:33,351 --> 00:28:34,852 HAPPENS WHEN IT GOES UP. 647 00:28:34,852 --> 00:28:36,254 IT'S DIFFERENT IN MEN THAN 648 00:28:36,254 --> 00:28:36,888 WOMEN. 649 00:28:36,888 --> 00:28:39,791 FEMALES HAVE A HIGHER 650 00:28:39,791 --> 00:28:40,958 COMPENSATORY DRIVE. 651 00:28:40,958 --> 00:28:42,593 FINALLY, THE BOUNDARY RESPONSE 652 00:28:42,593 --> 00:28:45,463 TO REDUCED VENTILATION, NOT MUCH 653 00:28:45,463 --> 00:28:47,598 DIFFERENCE BUT STILL MAY BE SOME 654 00:28:47,598 --> 00:28:49,367 BORDERLINE DIFFERENCES IN MEN 655 00:28:49,367 --> 00:28:50,868 VERSUS WOMEN. 656 00:28:50,868 --> 00:28:51,903 KEEP THIS IN MIND BECAUSE I'LL 657 00:28:51,903 --> 00:28:54,605 KEEP COMING BACK TO THIS AND AGE 658 00:28:54,605 --> 00:28:55,940 DIFFERENCES AND OBESITY RELATED 659 00:28:55,940 --> 00:29:04,682 DIFFERENCES AND RACE-BASED FFER. 660 00:29:04,682 --> 00:29:06,818 THIS COULD BE PARTLY FROM THE 661 00:29:06,818 --> 00:29:08,653 GEOGRAPHY OF HOW FAT IS 662 00:29:08,653 --> 00:29:10,888 DISTRIBUTED AND NOT JUST 663 00:29:10,888 --> 00:29:11,189 ANATOMICAL. 664 00:29:11,189 --> 00:29:14,992 THERE'S A LOT GOING ON IN FAT 665 00:29:14,992 --> 00:29:19,230 DISTRIBUTION VARIES AND IT'S 666 00:29:19,230 --> 00:29:21,666 DOWN STREAM SIGNAL PATHWAYS TO 667 00:29:21,666 --> 00:29:24,235 CONTROL VENTILATION AND UPPER 668 00:29:24,235 --> 00:29:24,468 AIRWAY. 669 00:29:24,468 --> 00:29:29,040 LET ME SWITCH TO HYPERTENSION. 670 00:29:29,040 --> 00:29:32,043 THIS IS A SLIDE FROM 671 00:29:32,043 --> 00:29:33,044 HYPERTENSION IN THE UNITED 672 00:29:33,044 --> 00:29:34,545 STATES COMPARING MEN VERSUS 673 00:29:34,545 --> 00:29:34,745 WOMEN. 674 00:29:34,745 --> 00:29:37,215 WOMEN HAVE A HIGHER PREVALENCE 675 00:29:37,215 --> 00:29:40,651 OF HYPERTENSION PARTICULARLY 676 00:29:40,651 --> 00:29:43,621 18-39 THERE'S A DIFFERENCE OF 677 00:29:43,621 --> 00:29:48,359 ALMOST TWOFOLD AND WHE YOU LOOK 678 00:29:48,359 --> 00:29:50,728 AT MEN VERSE US WOMEN THERE'S 679 00:29:50,728 --> 00:29:52,763 SOME EQUALIZATION BUT MEN ARE 680 00:29:52,763 --> 00:29:55,199 LEAD FROM THE STANDPOINT OF 681 00:29:55,199 --> 00:29:58,803 OF HYPERTENSION AND 60 OR 682 00:29:58,803 --> 00:30:00,705 MORE, THERE'S SOME EQUALIZATION 683 00:30:00,705 --> 00:30:02,707 AT THAT POINT. 684 00:30:02,707 --> 00:30:03,941 GENDER DIFFERENCES BUT NOT JUST 685 00:30:03,941 --> 00:30:05,476 GENDER BUT AGE DIFFERENCES. 686 00:30:05,476 --> 00:30:08,913 SO WHAT ABOUT AGE-RELATED 687 00:30:08,913 --> 00:30:09,413 VARIABILITY. 688 00:30:09,413 --> 00:30:11,616 WE ALL KNOW IT INCREASES WITH 689 00:30:11,616 --> 00:30:13,217 AGE AND THERE MAY BE DIFFERENCES 690 00:30:13,217 --> 00:30:15,686 IN PRESENTATION AND CHANGES IN 691 00:30:15,686 --> 00:30:19,490 UPPER AIRWAY ANATOMY AND MUSCLE 692 00:30:19,490 --> 00:30:21,826 FUNCTION AND ADULTS MAY HAVE 693 00:30:21,826 --> 00:30:24,528 APNEA PROLONGED AND WE HAVE DATA 694 00:30:24,528 --> 00:30:28,666 FROM THE HEALTH STUDY TWO 695 00:30:28,666 --> 00:30:31,168 DECADES AGO SHOWING WITH 696 00:30:31,168 --> 00:30:34,672 INCREASED AGE THERE'S HIGHER 697 00:30:34,672 --> 00:30:36,507 DISPOSITION OF INCREASED SLEEP 698 00:30:36,507 --> 00:30:38,676 APNEA WITH A PLATEAU AROUND 65 699 00:30:38,676 --> 00:30:40,711 AND LOOKING AT THE UPPER AIRWAY 700 00:30:40,711 --> 00:30:45,850 MECHANICS AND THIS IS A SMALL 701 00:30:45,850 --> 00:30:48,452 SAMPLE BUT AS AGE INCREASES 702 00:30:48,452 --> 00:30:51,422 THERE'S AN INCREASE IN THE 703 00:30:51,422 --> 00:30:53,791 STRUCTURE SUGGESTING AGE-RELATED 704 00:30:53,791 --> 00:30:56,661 VULNERABILITY IS A PHYSIOLOGIC 705 00:30:56,661 --> 00:30:59,563 PHENOMENON AND CAN BE EXPLAINED 706 00:30:59,563 --> 00:31:01,098 AND WHAT THE DETERMINATES ARE 707 00:31:01,098 --> 00:31:01,832 REMAIN UNKNOWN. 708 00:31:01,832 --> 00:31:04,068 I'LL GO BACK TO ANOTHER STUDY 709 00:31:04,068 --> 00:31:06,003 WHICH ISH A CANADIAN STUDY 710 00:31:06,003 --> 00:31:06,470 SHOWING IT'S 711 00:31:06,470 --> 00:31:08,239 'S NOT JUST IN THE 712 00:31:08,239 --> 00:31:10,408 U.S. BUT ALSO WORLDWIDE, THAT 713 00:31:10,408 --> 00:31:13,044 THE PREVALENCE OF SLEEP APNEA AS 714 00:31:13,044 --> 00:31:17,515 A PROMINENCE OF AGE IS DIFFERENT 715 00:31:17,515 --> 00:31:19,350 AND EVERY AGE WOMEN HAVE A LOWER 716 00:31:19,350 --> 00:31:20,017 PREVALENCE. 717 00:31:20,017 --> 00:31:21,585 IT INCREASED OVER TIME AS YOU 718 00:31:21,585 --> 00:31:24,622 GET TO THE HIGHER DECILES AND 719 00:31:24,622 --> 00:31:26,424 CONVERGES OR STARTS TO CONVERGE 720 00:31:26,424 --> 00:31:29,160 IN THE 70s AND 80s. 721 00:31:29,160 --> 00:31:32,096 BUT AGAIN, GENDER BY AGE 722 00:31:32,096 --> 00:31:32,596 DIFFERENCES. 723 00:31:32,596 --> 00:31:35,466 AND HYPERTENSION, SAME THING. 724 00:31:35,466 --> 00:31:38,302 WE SEE THE SAME THING IN MEN 725 00:31:38,302 --> 00:31:42,373 THERE'S SOMEWHAT OF A CE AND 726 00:31:42,373 --> 00:31:46,477 CONVERGENCE GOING TO 70 PLUS BUT 727 00:31:46,477 --> 00:31:47,411 AGE RELATED PREDISPOSITION IS 728 00:31:47,411 --> 00:31:52,450 SIMILAR TO AGE-RELATED 729 00:31:52,450 --> 00:31:53,117 PREDISPOSITION TO SLEEP APNEA. 730 00:31:53,117 --> 00:31:55,052 WHAT ABOUT RACE AND ETHNICITY. 731 00:31:55,052 --> 00:31:56,620 AFRICAN AMERICANS AND ASIANS 732 00:31:56,620 --> 00:31:59,223 HAVE A HIGHER RISK COMPARED TO 733 00:31:59,223 --> 00:32:06,731 CAUCASIANS DESPITE SIMILAR BMI 734 00:32:06,731 --> 00:32:08,833 AND THERE'S GENETIC 735 00:32:08,833 --> 00:32:09,200 PREDISPOSITION. 736 00:32:09,200 --> 00:32:12,870 AND THESE FACTORS LOOKKT TO THE 737 00:32:12,870 --> 00:32:15,339 RISK AND THE COMORBIDITIES 738 00:32:15,339 --> 00:32:15,639 ASSOCIATED. 739 00:32:15,639 --> 00:32:17,341 GOING BACK TO THE SLIDE LOOKING 740 00:32:17,341 --> 00:32:18,843 AT THINGS SUCH AS RACE. 741 00:32:18,843 --> 00:32:23,347 NO MATTER YOU LOOK AT IT WHETHER 742 00:32:23,347 --> 00:32:26,317 SEVERE APNEA INDEX OR 743 00:32:26,317 --> 00:32:27,918 COLLAPSIBILITY MEASURE THERE'S 744 00:32:27,918 --> 00:32:30,454 RELATE-RELATED DIFFERENCES IN 745 00:32:30,454 --> 00:32:34,425 WHAT HAPPENS WITH REGARDS TO THE 746 00:32:34,425 --> 00:32:35,359 UNDERLYING PATHOPHYSIOLOGY WIN 747 00:32:35,359 --> 00:32:36,861 SLEEP APNEA AND IT'S IMPORTANT 748 00:32:36,861 --> 00:32:39,997 WITH HYPERTENSION. 749 00:32:39,997 --> 00:32:40,698 . 750 00:32:40,698 --> 00:32:42,700 LOOKING IRRESPECTIVE OF WHEN 751 00:32:42,700 --> 00:32:47,738 WERE DIAGNOSED HAVE HIGHER 752 00:32:47,738 --> 00:32:58,249 HYPERTENSION THAN CAUCASIAN. 753 00:32:58,582 --> 00:33:01,452 AND THERE'S VARIANCES AND SLEEP 754 00:33:01,452 --> 00:33:04,355 APNEA COULD BE DUE TO LIFESTYLE, 755 00:33:04,355 --> 00:33:07,792 OBESITY RATES AND ACCESS TO 756 00:33:07,792 --> 00:33:08,626 HEALTH CARE AND SLOWER SOCIO 757 00:33:08,626 --> 00:33:10,795 ECONOMIC STATUS IS ASSOCIATED 758 00:33:10,795 --> 00:33:12,029 WITH HIGHER PROPENSITY OF SLEEP 759 00:33:12,029 --> 00:33:12,763 APNEA AND DIAGNOSIS AND 760 00:33:12,763 --> 00:33:13,998 TREATMENT. 761 00:33:13,998 --> 00:33:15,366 THAT WOULD BE PART BECAUSE 762 00:33:15,366 --> 00:33:18,869 THERE'S DISPARITIES IN ACCESS TO 763 00:33:18,869 --> 00:33:22,273 DIAGNOSTIC TESTING AND THERAPY. 764 00:33:22,273 --> 00:33:24,909 THERE'S A SUBSTANTIAL GEOGRAPHIC 765 00:33:24,909 --> 00:33:27,011 AND SOCIO ECONOMIC VARIABILITY. 766 00:33:27,011 --> 00:33:28,746 HERE'S HEAT MAPS PUBLISHED FROM 767 00:33:28,746 --> 00:33:32,283 A VARIETY OF AUTHORS LOOKING AT 768 00:33:32,283 --> 00:33:36,787 HOW SLEEP APNEA VARIES AS A 769 00:33:36,787 --> 00:33:39,156 FUNCTION OF WHERE WE ARE YOU'VE 770 00:33:39,156 --> 00:33:43,828 SEEN ESTIMATES THAT RANGE FROM 771 00:33:43,828 --> 00:33:46,263 5-15% AND SIMILAR ESTIMATES HAVE 772 00:33:46,263 --> 00:33:47,331 BEEN FROM SPAIN AND THAT WAS IN 773 00:33:47,331 --> 00:33:48,732 THE U.S. AND THERE'S A HIGHER 774 00:33:48,732 --> 00:33:54,772 PROPENSITY IN BRAZIL. 775 00:33:54,772 --> 00:33:57,708 MALES 25% ARE AFFECTED BY AGE OF 776 00:33:57,708 --> 00:34:00,077 15 OR MORE. 777 00:34:00,077 --> 00:34:01,412 THERE'S OCCURRENCES THAT OCCUR 778 00:34:01,412 --> 00:34:02,746 ACROSS TRE GLOBE ANDNDS IS A 779 00:34:02,746 --> 00:34:05,316 SLIDE OF A HEAT MAP 780 00:34:05,316 --> 00:34:06,717 DEMONSTRATING DIFFERENCES THAT 781 00:34:06,717 --> 00:34:09,653 OCCUR GEOGRAPHICALLY. 782 00:34:09,653 --> 00:34:11,155 AGAIN IT'S NOT A HOMOGENEOUS 783 00:34:11,155 --> 00:34:12,957 DISEASE WHETHER YOU LOOK AT 784 00:34:12,957 --> 00:34:15,993 DEMOGRAPHICS OR GLOBAL FACTORS. 785 00:34:15,993 --> 00:34:17,094 TURNS OUT, HYPERTENSION HAS THE 786 00:34:17,094 --> 00:34:17,495 SAME EFFECT. 787 00:34:17,495 --> 00:34:22,700 IF YOU LOOK AT DETERMINATES OF 788 00:34:22,700 --> 00:34:23,300 HIGH BLOOD PRESSURE IN THE 789 00:34:23,300 --> 00:34:24,368 UNITED STATES THERE'S 790 00:34:24,368 --> 00:34:25,302 RACE-RELATED DIFFERENCES IN THIS 791 00:34:25,302 --> 00:34:35,212 ASSESSMENT OF THE REGARD STUDIO, 792 00:34:35,212 --> 00:34:44,522 HYPERTENSIONS IS MORE PROMINENT 793 00:34:44,522 --> 00:34:49,627 IN CERTAIN GROUPS AND I LOOKED 794 00:34:49,627 --> 00:34:54,732 AT HYPERTENSION IN LOW AND 795 00:34:54,732 --> 00:35:05,142 MIDDLE INCOME COUNTRIES. 796 00:35:05,142 --> 00:35:07,244 THIS PREDICTS HYPERTENSION WITH 797 00:35:07,244 --> 00:35:12,116 THE WEALTHIEST HAVE MORE 798 00:35:12,116 --> 00:35:13,984 HYPERTENSION AND THAT HELD 799 00:35:13,984 --> 00:35:15,252 THROUGH THE CONTINENTS ASSESSED 800 00:35:15,252 --> 00:35:25,496 IN THIS STUDY. 801 00:35:28,299 --> 00:35:31,235 WE HAVE MONITORS OUT THERE AND 802 00:35:31,235 --> 00:35:35,206 THE STUDY LOOKED AT THAT AND 803 00:35:35,206 --> 00:35:36,407 NUMEROUS STUDIES LOOK AT THE 804 00:35:36,407 --> 00:35:38,676 DIFFERENT CLASSIFICATION. 805 00:35:38,676 --> 00:35:40,044 VARIANCE WILL VARY ON WHAT TESTS 806 00:35:40,044 --> 00:35:42,346 YOU USE AND SO FORM. 807 00:35:42,346 --> 00:35:43,614 THIS PROBLEM OF VARIABILITY 808 00:35:43,614 --> 00:35:47,218 DATES BACK ALMOST 20 YEARS WHEN 809 00:35:47,218 --> 00:35:51,055 AN ARTICLE BY A GROUP LOOKED AT 810 00:35:51,055 --> 00:35:53,691 HOW AHI VARIOUS WHEN YOU KEEP 811 00:35:53,691 --> 00:35:54,692 CHANGING DEFINITIONS. 812 00:35:54,692 --> 00:35:56,794 IT'S NOT A KNEW PHENOMENA. 813 00:35:56,794 --> 00:35:58,629 IT'S AN ONGOING DEBATE FOR WELL 814 00:35:58,629 --> 00:36:00,497 OVER TWO DECADES. 815 00:36:00,497 --> 00:36:02,132 THIS SHOWS WHAT MATTERS. 816 00:36:02,132 --> 00:36:07,271 IF YOU THINK ABOUT WHETHER YOU 817 00:36:07,271 --> 00:36:13,477 USE SOMNOGRAPHY YOU'LL SEE THE 818 00:36:13,477 --> 00:36:15,312 PREVALENCE CHANGES WHERE THE 819 00:36:15,312 --> 00:36:16,714 TECHNOLOGY IS USED AND I'LL COME 820 00:36:16,714 --> 00:36:20,651 BACK TO LOTS OF PATHOGENIC 821 00:36:20,651 --> 00:36:20,951 MECHANISMS. 822 00:36:20,951 --> 00:36:22,286 THERE'S UPSTREAM RISK FACTORS 823 00:36:22,286 --> 00:36:25,422 AND HAVE TO UNDERSTAND THEM TO 824 00:36:25,422 --> 00:36:33,631 UNDERSTAND THE BEST WAY TO 825 00:36:33,631 --> 00:36:35,432 PERSONALIZE IT AND THERE'S 826 00:36:35,432 --> 00:36:39,136 DIFFERENT HYPERTENSION AND ALL 827 00:36:39,136 --> 00:36:40,738 UT THINGS. 828 00:36:40,738 --> 00:36:44,642 WHAT THEY'VE DONE IS EMBRACED 829 00:36:44,642 --> 00:36:46,644 THE HETEROGENEITY AND SHOW THE 830 00:36:46,644 --> 00:36:47,111 SPECIFIC 831 00:36:47,111 --> 00:36:50,347 TARGETS AND DRUGS FOR 832 00:36:50,347 --> 00:36:52,349 AMERICAN PATIENTS SHOULD FOCUS 833 00:36:52,349 --> 00:36:57,121 ON CALCIUM BLOCKERS AND THERAPY 834 00:36:57,121 --> 00:37:01,225 AND OLDER ADULTS FOCUS ON 835 00:37:01,225 --> 00:37:03,060 CALCIUM CHANNEL TO REDUCE STROKE 836 00:37:03,060 --> 00:37:08,565 YOUNG ADULTS, DIFFERENT 837 00:37:08,565 --> 00:37:08,866 APPROACH. 838 00:37:08,866 --> 00:37:10,200 HYPERTENSION HAS COME AND THIS 839 00:37:10,200 --> 00:37:11,969 SAYS IT THE BEST. 840 00:37:11,969 --> 00:37:13,671 WE HAVE TO BE REALLY CAREFUL. 841 00:37:13,671 --> 00:37:15,572 WE CANNOT GO TO A STATE OF 842 00:37:15,572 --> 00:37:17,975 INFORMATION OVERLOAD. 843 00:37:17,975 --> 00:37:19,877 THIS GRAPHIC SHOWS THAT WHEN YOU 844 00:37:19,877 --> 00:37:24,481 THINK ABOUT HOW YOU'LL PRESCRIBE 845 00:37:24,481 --> 00:37:27,117 SOMETHING YOU CAN DO IT BY 846 00:37:27,117 --> 00:37:29,086 DIAGNOSIS OR INCORPORATE AGE, 847 00:37:29,086 --> 00:37:30,354 SEX, OTHER DETERMINATES AND 848 00:37:30,354 --> 00:37:31,221 FIGURE OUT WHAT THE RIGHT THING 849 00:37:31,221 --> 00:37:34,391 IS BUT WE DON'T WANT TO GET INTO 850 00:37:34,391 --> 00:37:37,027 A HIGH INFORMATI STATE BECAUSE 851 00:37:37,027 --> 00:37:43,901 WE'LL GET TO A FIELD OF DIMMISH 852 00:37:43,901 --> 00:37:45,536 -- DIMINISHING RETURNS AND YOU 853 00:37:45,536 --> 00:37:46,770 HAVE TO BE CAREFUL WITH THE 854 00:37:46,770 --> 00:37:49,106 DIAGRAM AND HAVE TO FIND THE 855 00:37:49,106 --> 00:37:50,741 PERFECT SWEET SPOT WITH THE 856 00:37:50,741 --> 00:37:54,211 BENEFIT TO COST RATIO IS 857 00:37:54,211 --> 00:37:58,115 OR THETREATMENT. 858 00:37:58,115 --> 00:38:02,586 HYPERTENSION HAS SO MANY NO 859 00:38:02,586 --> 00:38:05,456 NOMENCLA 860 00:38:05,456 --> 00:38:05,789 NOMENCLATURES. 861 00:38:05,789 --> 00:38:08,892 THERE'S DIFFERENT TYPES AND 862 00:38:08,892 --> 00:38:11,028 PATTERNS AND SYSTOLIC, 863 00:38:11,028 --> 00:38:13,030 SECONDARY, RESISTANT, WHITE 864 00:38:13,030 --> 00:38:15,466 COAT, THE LIST GOES ON AND ON 865 00:38:15,466 --> 00:38:18,569 BUT SO DOES OUR LIST. 866 00:38:18,569 --> 00:38:21,338 I COULD GO ON AN ON. 867 00:38:21,338 --> 00:38:24,775 WE HAVE TO MINIMIZE SOME OF THIS 868 00:38:24,775 --> 00:38:25,008 STUFF. 869 00:38:25,008 --> 00:38:27,578 YES, WE MACHINE LEARNING IS 870 00:38:27,578 --> 00:38:29,079 COMING AND HERE AND CAN MAKE E 871 00:38:29,079 --> 00:38:31,415 PREDICT BUT WE HAVE TO BE 872 00:38:31,415 --> 00:38:32,383 CAREFUL. 873 00:38:32,383 --> 00:38:34,718 WE CAN'T MAKE IT SO COMPLEX 874 00:38:34,718 --> 00:38:36,086 BECAUSE MACHINE LEARNING SHOULD 875 00:38:36,086 --> 00:38:39,123 BE TRAINED ON HIGH QUALITY DATA 876 00:38:39,123 --> 00:38:40,758 INTERPRETABLE AND WITH RELIABLE 877 00:38:40,758 --> 00:38:40,991 DATA. 878 00:38:40,991 --> 00:38:42,526 DATA QUALITY WITH E.H.R. IS A 879 00:38:42,526 --> 00:38:42,926 CONCERN. 880 00:38:42,926 --> 00:38:46,563 WE HAVE TO THINK ABOUT THESE 881 00:38:46,563 --> 00:38:50,501 MELD -- MODELS TO UNDERSTAND 882 00:38:50,501 --> 00:38:51,268 CLINICAL VARIANTS. 883 00:38:51,268 --> 00:38:53,070 THEY COULD BE MISSINGTHATA IN 884 00:38:53,070 --> 00:38:54,905 SOME OF THESE THINGS. 885 00:38:54,905 --> 00:38:58,275 AS WE MOVE FROM THE POINT OF 886 00:38:58,275 --> 00:38:59,543 VALIDATING SOME HETEROGENEITY 887 00:38:59,543 --> 00:39:02,479 METRIC WE HAVE TO BE CAREFUL 888 00:39:02,479 --> 00:39:03,881 IT'S DONE WITH CAUTION 889 00:39:03,881 --> 00:39:06,016 UNDERSTANDING THE LIMITATION OF 890 00:39:06,016 --> 00:39:06,917 DATA ITSELF. 891 00:39:06,917 --> 00:39:10,487 I'LL END THERE AND THANK YOU FOR 892 00:39:10,487 --> 00:39:20,664 YOUR TIME. 893 00:39:23,534 --> 00:39:28,772 >> THANK YOU, DR. PUNJABI. 894 00:39:28,772 --> 00:39:29,173 NEX 895 00:39:29,173 --> 00:39:34,211 NEXT I DR. OWENS WITH HOW DO WE 896 00:39:34,211 --> 00:39:36,046 GET PERSONALIZED MEDICINE WITH 897 00:39:36,046 --> 00:39:36,246 OSA. 898 00:39:36,246 --> 00:39:37,881 >> THANK YOU FOR ORGANIZING 899 00:39:37,881 --> 00:39:38,916 THIS. 900 00:39:38,916 --> 00:39:41,452 THANK YOU TO MONICA AND NARESH 901 00:39:41,452 --> 00:39:42,152 FOR THEIR TALKS AS WELL. 902 00:39:42,152 --> 00:39:43,821 YOU CAN SEE I WAS HOPING TO 903 00:39:43,821 --> 00:39:45,422 CREATE A FRAMING TALK FOR THE 904 00:39:45,422 --> 00:39:47,891 NEXT 10 MINUTES OR SO. 905 00:39:47,891 --> 00:39:52,029 I THINK WE'VE HEARD QUITE A BIT 906 00:39:52,029 --> 00:39:54,631 ABOUT THE PERSPECTIVES FROM 907 00:39:54,631 --> 00:39:54,898 PATIENTS. 908 00:39:54,898 --> 00:39:55,566 I THINK WE HEARD A LITTLE BIT 909 00:39:55,566 --> 00:39:56,767 ABOUT THE RESEARCH. 910 00:39:56,767 --> 00:39:58,268 I WANT TO TALK ABOUT HOW THIS 911 00:39:58,268 --> 00:40:03,373 PLAYS OUT IN THE CLINIC AND HOW 912 00:40:03,373 --> 00:40:05,275 WE HAVE SLEEP APNEA NOW AND WE 913 00:40:05,275 --> 00:40:07,344 HAVE THIS ONE SIZE FITS ALL 914 00:40:07,344 --> 00:40:07,611 APPROACH. 915 00:40:07,611 --> 00:40:09,980 WE HAVE PATIENTS LIKE A 916 00:40:09,980 --> 00:40:11,715 40-YEAR-OLD MAN, SNORING, APNEA 917 00:40:11,715 --> 00:40:21,892 AND A -- OBESITY AND ORDER A 918 00:40:21,892 --> 00:40:25,195 TEST AND YOU ORDER PEP AND HE 919 00:40:25,195 --> 00:40:26,897 FEELS GREAT BUT WE HAVE OTHER 920 00:40:26,897 --> 00:40:27,931 PATIENTS WHO COME IN WHO ARE 921 00:40:27,931 --> 00:40:30,100 KIND OF SIMILAR. 922 00:40:30,100 --> 00:40:32,369 THIS TIME IT'S A 41-YEAR-OLD 923 00:40:32,369 --> 00:40:33,804 WOMEN WITH SOME OF THE SAME 924 00:40:33,804 --> 00:40:37,708 SYMPTOMS BUT NOW MORE OF 925 00:40:37,708 --> 00:40:39,042 INSOMNIA AND HER CHIEF COMPLAINT 926 00:40:39,042 --> 00:40:41,211 IS I WAKE UP A LOT AT NIGHT. 927 00:40:41,211 --> 00:40:44,147 YOU ORDER A SLEEP STUDY, 928 00:40:44,147 --> 00:40:47,351 DIAGNOSIS SLEEP APNEA AND TRY C 929 00:40:47,351 --> 00:40:51,255 PAP AND THE PATIENT SAYS I FEEL 930 00:40:51,255 --> 00:40:52,689 WORSE THAN BEFORE AND CAN'T USE 931 00:40:52,689 --> 00:40:57,361 ITS SO WE'RE LEFT THINKING. 932 00:40:57,361 --> 00:40:59,730 SOME COME IN WITH NO REAL 933 00:40:59,730 --> 00:41:03,967 SYMPTOMS BUT SENT IN BY THEIR 934 00:41:03,967 --> 00:41:06,270 CARDIOLOGIST AND THEIR CHIEF 935 00:41:06,270 --> 00:41:09,840 COMPLAINT IS MY DOCTOR SENT ME 936 00:41:09,840 --> 00:41:18,015 AND YOU DO A TEST AND ORDER THE 937 00:41:18,015 --> 00:41:20,350 C PAP AND PATIENT SAYS DO I NEED 938 00:41:20,350 --> 00:41:20,717 THIS. 939 00:41:20,717 --> 00:41:23,954 WHAT WOULD BE A BETTER FUTURE 940 00:41:23,954 --> 00:41:25,923 FOR SLEEP APNEA MANAGEMENT? 941 00:41:25,923 --> 00:41:27,691 WE'RE TALKING ABOUT PERSONALIZED 942 00:41:27,691 --> 00:41:27,958 MEDICINE. 943 00:41:27,958 --> 00:41:31,261 YOU SAW AMY JORDAN AND OTHERS 944 00:41:31,261 --> 00:41:34,464 THOUGHT ABOUT THIS AND ALLAN 945 00:41:34,464 --> 00:41:35,232 PACK THOUGHT ABOUT THIS AND 946 00:41:35,232 --> 00:41:37,134 HE'LL BE SPEAKING AND WE HAVE 947 00:41:37,134 --> 00:41:38,669 BEEN TALKING ABOUT EACH 948 00:41:38,669 --> 00:41:39,570 INDIVIDUAL HAS GENETICS AND 949 00:41:39,570 --> 00:41:46,209 ENVIRONMENT AND END UP WITH 950 00:41:46,209 --> 00:41:56,720 THESE PERSONALIZED PHENOTYPES. 951 00:41:57,321 --> 00:42:00,257 YOU TAKE VARIABLES FROM THE PSG 952 00:42:00,257 --> 00:42:02,092 AND MAYBE TAKE BLOOD WORK AND 953 00:42:02,092 --> 00:42:04,895 LOOK AT BLOOD PRESSURE AND HAVE 954 00:42:04,895 --> 00:42:05,729 THE PATIENT FILL OUT 955 00:42:05,729 --> 00:42:07,297 QUESTIONNAIRES TO GET AN IDEA 956 00:42:07,297 --> 00:42:10,500 HOW AN INDIVIDUAL PATIENT IS 957 00:42:10,500 --> 00:42:11,435 IMPACTS. 958 00:42:11,435 --> 00:42:12,836 THE EUROPEAN SLEEP RESEARCH 959 00:42:12,836 --> 00:42:14,237 SOCIETY SAID LET'S TAKE SOME 960 00:42:14,237 --> 00:42:16,173 CLINICAL TRAITS, MAYBE TRY TO 961 00:42:16,173 --> 00:42:18,375 COMBINE THEM WITH THE UNDERLYING 962 00:42:18,375 --> 00:42:28,919 CAUSES AND LINK UP WITH THERAPY. 963 00:42:30,387 --> 00:42:32,289 STO GET TO PERSONALIZED MEDICINE 964 00:42:32,289 --> 00:42:33,690 YOU HAVE TO RECOGNIZE NOT ALL 965 00:42:33,690 --> 00:42:34,758 PATIENTS WITH A CONDITION LOOK 966 00:42:34,758 --> 00:42:35,125 THE SAME. 967 00:42:35,125 --> 00:42:36,927 I'M GOING TO CALL THAT A 968 00:42:36,927 --> 00:42:37,194 PHENOTYPE. 969 00:42:37,194 --> 00:42:38,862 YOU HAVE TO HAVE AN 970 00:42:38,862 --> 00:42:41,164 UNDERSTANDING OF THE DIFFERENT 971 00:42:41,164 --> 00:42:45,636 MECHANISTIC PATHWAYS OR ENDOTYPE 972 00:42:45,636 --> 00:42:47,738 AND DIFFERENTIATE THE PATHWAYS 973 00:42:47,738 --> 00:42:50,007 AND HOPEFULLY HAVE A THERAPY TO 974 00:42:50,007 --> 00:42:51,908 MANIPULATE THE PATHWAY AND 975 00:42:51,908 --> 00:42:54,044 CHOOSE THE RIGHT OUTCOME TO SHOW 976 00:42:54,044 --> 00:42:55,912 AN EFFECT. 977 00:42:55,912 --> 00:42:57,414 FOR EXAMPLE I'LL LOOK AT ASTHMA 978 00:42:57,414 --> 00:42:59,750 AND SHOW HOW IT HAS MOVED TO A 979 00:42:59,750 --> 00:43:01,685 PERSONALIZED MEDICINE APPROACH. 980 00:43:01,685 --> 00:43:03,587 IT'S NO LONGER EVERYBODY GETS 981 00:43:03,587 --> 00:43:14,064 THE SAME IN HALERS AND THE 982 00:43:18,168 --> 00:43:19,269 RECOGNITION WAS SOME DEVELOPED 983 00:43:19,269 --> 00:43:21,038 ASTHMA AS CHILDREN ASSOCIATED 984 00:43:21,038 --> 00:43:24,374 WITH ATP AND A LOT OF ALLERGIC 985 00:43:24,374 --> 00:43:25,075 SYMPTOMS AND OTHERS DEVELOPED IT 986 00:43:25,075 --> 00:43:27,778 AS OLDER ADULTS, OFTEN WOMEN, 987 00:43:27,778 --> 00:43:36,286 OFTEN ASSOCIATED WITH OBESITY. 988 00:43:36,286 --> 00:43:40,257 AND THIS ANTIBIOTIC -- ANTIBODY 989 00:43:40,257 --> 00:43:42,459 IF YOU GIVE IT AND LOOK AT THE 990 00:43:42,459 --> 00:43:45,629 OUTCOME OF FEB1 THE DRUG DOESN'T 991 00:43:45,629 --> 00:43:46,630 SEEM TO DO ANYTHING. 992 00:43:46,630 --> 00:43:48,799 IT'S ONLY WHEN YOU GIVE IT TO 993 00:43:48,799 --> 00:43:51,702 SELECTED ASTHMA PATIENTS AND 994 00:43:51,702 --> 00:43:53,770 LOOK AT ASTHMA EXACERBATIONS IT 995 00:43:53,770 --> 00:43:55,872 HAS A BIG EFFECT. 996 00:43:55,872 --> 00:43:59,409 I THINK WE NEED TO DO THE SAME 997 00:43:59,409 --> 00:44:00,777 IN O SLEEP APNEA NOT 998 00:44:00,777 --> 00:44:01,978 ALL PATIENTS WITH OSA LOOK THE 999 00:44:01,978 --> 00:44:05,582 SAME AND NEED TO UNDERSTAND THE 1000 00:44:05,582 --> 00:44:08,719 DIFFERENT MECHANISTIC PATHWAYS. 1001 00:44:08,719 --> 00:44:11,121 I BORROWED THE SLIDE AND WHAT 1002 00:44:11,121 --> 00:44:15,292 WARE TALKING ABOUT HERE TODAY 1003 00:44:15,292 --> 00:44:18,929 ARE PHENOTYPES SLEEP APNEA CAN 1004 00:44:18,929 --> 00:44:20,097 PRESENT DIFFERENTLY AND WOMEN 1005 00:44:20,097 --> 00:44:22,032 TEND TO REPORT SYMPTOMS 1006 00:44:22,032 --> 00:44:29,673 DIFFERENTLY THAN MEN AND ALSO 1007 00:44:29,673 --> 00:44:30,107 THE DEF 1008 00:44:33,210 --> 00:44:36,780 ENDOTYPES AND PHYSIOLOGY ARE 1009 00:44:36,780 --> 00:44:37,881 DIFFERENT BETWEEN MEN AND WOMEN. 1010 00:44:37,881 --> 00:44:43,620 IF YOU HAVE A PATIENT WHO HAS A 1011 00:44:43,620 --> 00:44:48,825 LOT OF SYMPTOMS WE'LL TREAT AND 1012 00:44:48,825 --> 00:44:50,927 AND IF THERE'SERY SYMPTOMATIC 1013 00:44:50,927 --> 00:44:52,796 EVEN IF ADHERENCE IS LOW YOU'LL 1014 00:44:52,796 --> 00:44:53,864 PERSIST WITH THERAPY. 1015 00:44:53,864 --> 00:44:56,032 A BIG CHANGE IN THE LAST 10-15 1016 00:44:56,032 --> 00:44:57,701 YEARS IS PATIENTS WHO DON'T HAVE 1017 00:44:57,701 --> 00:44:59,669 A LOT OF SYMPTOMS YOU PROBABLY 1018 00:44:59,669 --> 00:45:02,005 DON'T NEED TO BE AGGRESSIVE 1019 00:45:02,005 --> 00:45:04,708 ABOUT DIAGNOSING SLEEP APNEA AND 1020 00:45:04,708 --> 00:45:07,644 MAY NOT NEED TO TREAT. 1021 00:45:07,644 --> 00:45:12,382 WE'RE USING ENDOTYPES IN A CRUDE 1022 00:45:12,382 --> 00:45:15,418 WAY WITH AND YOU'LL THINK OF C 1023 00:45:15,418 --> 00:45:18,855 PAP AND WEIGHT MANAGEMENT AND 1024 00:45:18,855 --> 00:45:20,524 NOT SEND THEM FOR NERVE 1025 00:45:20,524 --> 00:45:22,025 STIMULATOR THERAPY AND IF YOU 1026 00:45:22,025 --> 00:45:24,895 HAVE A PATIENT WITH A LOW BMI 1027 00:45:24,895 --> 00:45:26,363 AND THIS ANATOMICAL AIRWAY 1028 00:45:26,363 --> 00:45:30,000 YOU'LL THINK OF SURGICAL 1029 00:45:30,000 --> 00:45:31,234 MANAGEMENT. 1030 00:45:31,234 --> 00:45:34,437 IT'S EASY TO INCORPORATE THE 1031 00:45:34,437 --> 00:45:35,572 ENDOTYPES BUT HARD TO KNOW WHAT 1032 00:45:35,572 --> 00:45:38,942 TO DO WITH PATIENTS IN THE 1033 00:45:38,942 --> 00:45:41,611 MIDDLE AND THOUGHT TO LOOK AT 1034 00:45:41,611 --> 00:45:51,855 OTHER FIELDS. 1035 00:46:15,846 --> 00:46:17,347 IS MOST DON'T MEASURE HORMONE 1036 00:46:17,347 --> 00:46:19,516 LEVELS BECAUSE WE HAVE A LOT OF 1037 00:46:19,516 --> 00:46:21,985 OUTCOME DATA AND COMPARATIVE 1038 00:46:21,985 --> 00:46:22,552 EFFECTIVENESS STUDIES IN 1039 00:46:22,552 --> 00:46:23,019 DIFFERENT GROUPS. 1040 00:46:23,019 --> 00:46:28,491 WE KNOW IF YOU HAVE DIABETES, 1041 00:46:28,491 --> 00:46:35,532 YOU SHOULD USE ACE-ARB. 1042 00:46:35,532 --> 00:46:41,104 AND I THINK CANCER IS THE BEST 1043 00:46:41,104 --> 00:46:42,305 EXAMPLE OF PERSONALIZED 1044 00:46:42,305 --> 00:46:42,806 MEDICINE. 1045 00:46:42,806 --> 00:46:44,808 YOU WOULD LOOK AT CELLS UNDER A 1046 00:46:44,808 --> 00:46:47,544 MICROSCOPE AND DESCRIBE WHAT YOU 1047 00:46:47,544 --> 00:46:48,078 SEE. 1048 00:46:48,078 --> 00:46:49,512 NOW THE MEASUREMENT OF CANCER IS 1049 00:46:49,512 --> 00:46:50,580 GETTING TO INDIVIDUAL ANTIGENS 1050 00:46:50,580 --> 00:47:00,824 AND GENETICS. 1051 00:47:02,058 --> 00:47:04,327 NOW YOU HAVE CAR T THERAPY FOR A 1052 00:47:04,327 --> 00:47:05,528 SOLUTION FOR THAT INDIVIDUAL AND 1053 00:47:05,528 --> 00:47:08,999 WITH PROSTATE AND BREAST CANCER 1054 00:47:08,999 --> 00:47:10,934 LARGE STUDIES FOCUS ON 1055 00:47:10,934 --> 00:47:11,534 PATIENT-CENTRIC OUTCOMES. 1056 00:47:11,534 --> 00:47:15,505 SHOULD WE DO SURGERY, RADIATION? 1057 00:47:15,505 --> 00:47:16,840 AND THERE'S A RECOGNITION SOME 1058 00:47:16,840 --> 00:47:18,008 OUTCOMES ARE IMPORTANT FOR 1059 00:47:18,008 --> 00:47:20,377 RESEARCHERS LIKE 1060 00:47:20,377 --> 00:47:21,344 PROGRESSION-FREE SURVIVAL IS NOT 1061 00:47:21,344 --> 00:47:22,512 NECESSARILY IMPORTANT FOR 1062 00:47:22,512 --> 00:47:22,879 PATIENTS. 1063 00:47:22,879 --> 00:47:32,789 SO WHAT'S THAT MANE FOR 1064 00:47:32,789 --> 00:47:33,290 OBSTRUCTIVE SLEEP APNEA. 1065 00:47:33,290 --> 00:47:37,427 THIS IS WHERE THIS CATHEDRAL 1066 00:47:37,427 --> 00:47:40,497 WHERE MY WIFE'S FAMILY IS FROM. 1067 00:47:40,497 --> 00:47:43,300 THESE ARE STANDARDIZED 1068 00:47:43,300 --> 00:47:44,868 MEASUREMENTS EVERYONE AGREED TO 1069 00:47:44,868 --> 00:47:50,540 THIS IS HOW BIG A LOAF OF BREAD 1070 00:47:50,540 --> 00:47:53,343 SHOULD BE AND WHAT IS OUR 1071 00:47:53,343 --> 00:47:56,079 MEASUREMENT IN SLEEP APNEA? 1072 00:47:56,079 --> 00:47:59,516 WHAT ABOUT THE ALL THESE THINGS 1073 00:47:59,516 --> 00:48:01,217 AND LIMITATION AND HYPOXIC 1074 00:48:01,217 --> 00:48:01,451 BURDEN. 1075 00:48:01,451 --> 00:48:02,752 HOW MUCH DO WE NEED TO THINK 1076 00:48:02,752 --> 00:48:03,520 ABOUT? 1077 00:48:03,520 --> 00:48:06,089 AND OUTCOMES OF COURSE WE HAVE A 1078 00:48:06,089 --> 00:48:09,092 VARIETY OF OUTCOMES, WHICH ARE 1079 00:48:09,092 --> 00:48:12,195 THE MOST PATIENT CENTRIC AND 1080 00:48:12,195 --> 00:48:15,632 SHOULD WE BE CONCERNED ABOUT? 1081 00:48:15,632 --> 00:48:19,336 AND THE OTHER THING THINKING OF 1082 00:48:19,336 --> 00:48:20,470 SLEEP APNEA IS HOW DETAILED DO 1083 00:48:20,470 --> 00:48:26,309 WE NEED TO BE IN OUR 1084 00:48:26,309 --> 00:48:26,643 UNDERSTANDING. 1085 00:48:26,643 --> 00:48:36,653 IF YOU WHEN 1086 00:48:40,123 --> 00:48:43,660 WE THINK OF ENDOTYPES AND 1087 00:48:43,660 --> 00:48:47,564 PHENOTYPES HOW MANY CLUSTSERS 1088 00:48:47,564 --> 00:48:53,303 AND FOR ENDOTYPES DO WE NEED A 1089 00:48:53,303 --> 00:48:57,640 CERTAIN PHENOTYPE AND THIS 1090 00:48:57,640 --> 00:49:00,343 HETEROGENEITY MAY NOT BE AS 1091 00:49:00,343 --> 00:49:04,514 IMPORTANT AND IF CPAPs WORK DO 1092 00:49:04,514 --> 00:49:06,216 WE NEED THIS LEVEL OF DETAIL? 1093 00:49:06,216 --> 00:49:10,020 AS WE HEAR THE TALKS TODAY AND 1094 00:49:10,020 --> 00:49:11,554 TOMORROW I WANT TO FRAME THE 1095 00:49:11,554 --> 00:49:13,556 DISCUSSION BY SAYING WHAT KIND 1096 00:49:13,556 --> 00:49:21,798 OF MORE -- MEASUREMENTS ARE 1097 00:49:21,798 --> 00:49:24,868 NEEDED FOR PERSONALIZED OSA 1098 00:49:24,868 --> 00:49:29,572 THERAPY AND CLINICAL OUTCOMES 1099 00:49:29,572 --> 00:49:31,741 AND SESSION 3 WE'LL DIVE IN THE 1100 00:49:31,741 --> 00:49:32,275 HETEROGENEITY. 1101 00:49:32,275 --> 00:49:34,911 IF WE AGREE ON SOME OF THESE 1102 00:49:34,911 --> 00:49:41,551 METRICS, HOW WILL WE GET THESE 1103 00:49:41,551 --> 00:49:43,920 INTO THE CLINIC AND MOVE THEM 1104 00:49:43,920 --> 00:49:44,521 FORWARD? 1105 00:49:44,521 --> 00:49:45,822 WE HAVE AN EXECUTIVE SUMMARY 1106 00:49:45,822 --> 00:49:46,823 COMING FROM THE WORKSHOP TODAY 1107 00:49:46,823 --> 00:49:48,458 AND TOMORROW BUT WANT TO 1108 00:49:48,458 --> 00:49:50,093 ENCOURAGE DISCUSSION AND 1109 00:49:50,093 --> 00:49:50,527 COLLABORATIONS. 1110 00:49:50,527 --> 00:49:55,331 SO I'LL END WITH A PICTURE OF 1111 00:49:55,331 --> 00:49:56,266 BIOLUMINESCENCE HERE WHERE WE 1112 00:49:56,266 --> 00:49:58,401 LIVE AND WORK AND THANK YOU VERY 1113 00:49:58,401 --> 00:50:02,372 MUCH. 1114 00:50:02,372 --> 00:50:05,175 >> NEW FOR THE FANTASTIC 1115 00:50:05,175 --> 00:50:06,409 OVERVIEW AND FRAMEWORK AND TO 1116 00:50:06,409 --> 00:50:07,977 THE FIRST TWO PRESENTERS. 1117 00:50:07,977 --> 00:50:11,548 IF YOU HAVE QUESTIONS RELATED TO 1118 00:50:11,548 --> 00:50:15,718 THE INITIAL TALKS HOLD THEM TO 1119 00:50:15,718 --> 00:50:17,520 THE PANEL DISCUSSION OR 1120 00:50:17,520 --> 00:50:18,188 TOMORROW'S ROUNDTABLE DISCUSSION 1121 00:50:18,188 --> 00:50:21,458 AND WE'LL SWITCH TO AN EMOJI FOR 1122 00:50:21,458 --> 00:50:22,459 THE AND WE'LL EXPERIMENT A 1123 00:50:22,459 --> 00:50:23,259 LITTLE BIT. 1124 00:50:23,259 --> 00:50:24,928 WHEN YOU SEE THAT, PLEASE WORK 1125 00:50:24,928 --> 00:50:27,230 TO WRAP UP. 1126 00:50:27,230 --> 00:50:32,302 WITH THIS, DR. OWENS, I'LL 1127 00:50:32,302 --> 00:50:33,303 CONVENIENTLY PASS THE MIKE TO 1128 00:50:33,303 --> 00:50:35,271 YOU AS THE NEXT MODERATOR. 1129 00:50:35,271 --> 00:50:38,374 >> THANK YOU, ALFONSO. 1130 00:50:38,374 --> 00:50:41,211 SO, TODAY WE'LL START WITH 1131 00:50:41,211 --> 00:50:44,781 SESSION 1, OUTCOMES ACROSS THE 1132 00:50:44,781 --> 00:50:53,323 LIFE SPAN, CLINICAL RELEVANCE. 1133 00:50:53,323 --> 00:50:57,994 WE'VE ENCOURAGED TIME FOR 1134 00:50:57,994 --> 00:51:03,733 QUESTIONS AND WILL HAVE SPEAKERS 1135 00:51:03,733 --> 00:51:05,068 WITH 15 MINUTES AND I'D LIKE TO 1136 00:51:05,068 --> 00:51:07,904 DIVE IN TO STAY ON TIME. 1137 00:51:07,904 --> 00:51:13,143 OUR FIRST SPEAKER IS DR. AMAL 1138 00:51:13,143 --> 00:51:15,512 ISAIAH PROFESSOR OF PEDIATRICS, 1139 00:51:15,512 --> 00:51:18,014 DIAGNOSTIC AND RADIOLOGY AND 1140 00:51:18,014 --> 00:51:19,649 NUCLEAR MEDICINE AND DIRECTOR OF 1141 00:51:19,649 --> 00:51:22,285 OAT YO LARYNGOLOGY AT THE 1142 00:51:22,285 --> 00:51:23,353 MARYLAND SCHOOL OF MEDICINE AND 1143 00:51:23,353 --> 00:51:25,221 HIS PRESENTATION IS PREDICTIVE 1144 00:51:25,221 --> 00:51:27,023 MODELS FOR OSA TREATMENT 1145 00:51:27,023 --> 00:51:27,557 OUTCOMES. 1146 00:51:27,557 --> 00:51:28,224 DR. ISAIAH, THANK YOU VERY MUCH 1147 00:51:28,224 --> 00:51:38,601 FOR PRESENTING TODAY. 1148 00:52:01,658 --> 00:52:01,858 1149 00:52:01,858 --> 00:52:04,127 >> I'M AN ONCOLOGIST AT THE 1150 00:52:04,127 --> 00:52:05,228 UNIVERSITY OF MARYLAND 1151 00:52:05,228 --> 00:52:07,931 INTERESTED IN PEDIATRIC SLEEP 1152 00:52:07,931 --> 00:52:12,635 MEDICINE RELATING TO OUTCOMES OF 1153 00:52:12,635 --> 00:52:13,269 PEDIATRIC OBSTRUCTIVE SLEEP 1154 00:52:13,269 --> 00:52:16,406 APNEA AND THE ROLE THE PEDIATRIC 1155 00:52:16,406 --> 00:52:18,908 UPPER AIRWAY PLAYS A ROLE IN IT. 1156 00:52:18,908 --> 00:52:23,346 TODAY I'M GOING TO SPEAK ABOUT 1157 00:52:23,346 --> 00:52:24,013 PREDICTIVE MODELLING FOR 1158 00:52:24,013 --> 00:52:24,547 OBSTRUCTIVE SLEEP APNEA 1159 00:52:24,547 --> 00:52:26,015 TREATMENT OUTCOMES. 1160 00:52:26,015 --> 00:52:29,552 I REALLY THOUGHT PEDIATRICS AT 1161 00:52:29,552 --> 00:52:31,554 THE CORE OF HETEROGENEITY 1162 00:52:31,554 --> 00:52:32,855 BECAUSE WE STILL FOLLOW VERY 1163 00:52:32,855 --> 00:52:36,593 MUCH A ONE SIZE FITS ALL 1164 00:52:36,593 --> 00:52:41,564 APPROACH AND THIS TOPIC IS RIPE 1165 00:52:41,564 --> 00:52:43,499 FOR DISCUSSION. 1166 00:52:43,499 --> 00:52:47,403 IN TERMS OF DISCLOSURES I DO 1167 00:52:47,403 --> 00:52:50,873 ROYALTIES FROM THE SCHOOL AT THE 1168 00:52:50,873 --> 00:52:52,542 UNIVERSITY OF MARYLAND AND OUR 1169 00:52:52,542 --> 00:52:55,878 WORK IS FUNDED BY THE NHLBI. 1170 00:52:55,878 --> 00:52:57,046 THE FIRST OBJECTIVE IS TO 1171 00:52:57,046 --> 00:52:58,047 UNDERSTAND THE SCOPE OF THE 1172 00:52:58,047 --> 00:53:02,018 PROBLEM ESPECIALLY THE 1173 00:53:02,018 --> 00:53:09,092 HETEROGENEITY RELATED TO SOCIAL 1174 00:53:09,092 --> 00:53:10,727 ECONOMIC STARTS AND SOME OF THE 1175 00:53:10,727 --> 00:53:13,997 SOLUTIONS THAT WE CAN PROPO HES 1176 00:53:13,997 --> 00:53:17,567 TO NOT JUST UNDERSTAND BUT TREAT 1177 00:53:17,567 --> 00:53:23,172 PEDIATRIC OSA BETTER. 1178 00:53:23,172 --> 00:53:31,547 AND IT'S ACRONYMS MAKE IT HARD 1179 00:53:31,547 --> 00:53:34,017 FOR ME TO COMMUNICATE THESE TO 1180 00:53:34,017 --> 00:53:35,285 OUR PATIENTS AND SOMETIMES MY 1181 00:53:35,285 --> 00:53:41,557 COLLEAGUES WHO MAY NOT BE IN THE 1182 00:53:41,557 --> 00:53:47,430 FIELD. 1183 00:53:47,430 --> 00:53:49,999 SLEEP DISORDER TREATMENT HAVE 1184 00:53:49,999 --> 00:53:56,706 SOME WHO CANNOT GET DIAGNOSIS OF 1185 00:53:56,706 --> 00:53:59,475 OBSTRUCTIVE SLEEP APNEA. 1186 00:53:59,475 --> 00:54:00,977 OBSTRUCTIVE SLEEP DISORDER 1187 00:54:00,977 --> 00:54:03,279 BREATHING IS ATTRIBUTABLE TO THE 1188 00:54:03,279 --> 00:54:05,548 BURDEN ARRIVING FROM THE UPPER 1189 00:54:05,548 --> 00:54:06,783 AIRWAY SPECIFICALLY. 1190 00:54:06,783 --> 00:54:08,084 WHEN I SAY OBSTRUCTIVE SLEEP 1191 00:54:08,084 --> 00:54:17,994 APNEA IT'S FIRMLY GROUNDED IN 1192 00:54:17,994 --> 00:54:19,662 THE PROBLEMS IN THE POPULATION 1193 00:54:19,662 --> 00:54:22,699 AND NOT TOUCH ON THE PHENOTYPES 1194 00:54:22,699 --> 00:54:24,267 TEE FIND IN LITERATURE SUCH AS 1195 00:54:24,267 --> 00:54:28,071 THE UPPER AIRWAY SYNDROME AND 1196 00:54:28,071 --> 00:54:28,771 SNORING BECAUSE IT COULD BE 1197 00:54:28,771 --> 00:54:30,006 BEYOND THE SCOPE OF OUR 1198 00:54:30,006 --> 00:54:33,776 DISCUSSION HERE. 1199 00:54:33,776 --> 00:54:37,113 WHAT HAVE WE DONE SO FAR? 1200 00:54:37,113 --> 00:54:41,684 THIS ONE SLIDE SUMMARIZES WHAT 1201 00:54:41,684 --> 00:54:45,988 WE FIND IN DISRUPTIVE SLEEP 1202 00:54:45,988 --> 00:54:47,557 APNEA. 1203 00:54:47,557 --> 00:54:49,859 ABOUT 5% PEOPLE PRESENTED 1204 00:54:49,859 --> 00:54:55,998 SNORING AS A PRIMARY SYMPTOM AND 1205 00:54:55,998 --> 00:54:59,235 UNDER GO DIAGNOSIS BY THE 1206 00:54:59,235 --> 00:55:02,004 SOMNOGRAPHY AND TO THE RIGHT IS 1207 00:55:02,004 --> 00:55:04,307 A BUNCH OF MIXED ANALYSIS 1208 00:55:04,307 --> 00:55:09,312 REPRESENTATION OF STUDIES FROM 1209 00:55:09,312 --> 00:55:14,617 ACROSS THE WORLD SHOWS THE 1210 00:55:14,617 --> 00:55:15,651 INCREASING PREVALENCE OF OBESITY 1211 00:55:15,651 --> 00:55:17,253 AND THE MOST IMPORTANT THING IS 1212 00:55:17,253 --> 00:55:19,389 WE ONLY HAVE ONE TREATMENT FOR 1213 00:55:19,389 --> 00:55:22,525 MOST OF THEM PRESENTING TO MY 1214 00:55:22,525 --> 00:55:22,759 CLINIC. 1215 00:55:22,759 --> 00:55:27,029 WE OFFERED TO REMOVE THE TONSILS 1216 00:55:27,029 --> 00:55:29,999 AND ADENOIDS AND MOST THE TIME 1217 00:55:29,999 --> 00:55:34,003 THEY HAVE RESEARCHED THE TOPIC 1218 00:55:34,003 --> 00:55:35,171 OR SPOKE TO SOMEBODY ELSE WHO 1219 00:55:35,171 --> 00:55:40,610 SAID LOOK IT'S TIME TO GET YOUR 1220 00:55:40,610 --> 00:55:48,418 CHILD'S TONSILS AND ADENOIDS 1221 00:55:48,418 --> 00:55:54,190 AND 10% HAVE BLEEDING AS A 1222 00:55:54,190 --> 00:55:56,392 COMPLICATION AND MANY OF THEM 1223 00:55:56,392 --> 00:55:57,994 DID NOT GET BETTER AFTER SURGERY 1224 00:55:57,994 --> 00:56:00,863 AND TO MAKE MATTERS WORSE, SOME 1225 00:56:00,863 --> 00:56:06,602 DO DIETS AS A COMPLICATION OF 1226 00:56:06,602 --> 00:56:09,338 THE SURGERY. 1227 00:56:09,338 --> 00:56:15,111 I WANTED TO EXEMPLAIFY THE 1228 00:56:15,111 --> 00:56:17,980 PROBLEM IT'S PROBLEMATIC BECAUSE 1229 00:56:17,980 --> 00:56:22,251 OVER THE YEARS WE'VE CHOSE 1230 00:56:22,251 --> 00:56:23,052 GENERATING SYSTEMS AND WE WE 1231 00:56:23,052 --> 00:56:27,323 HEARD A HINT ABOUT IT EARLIER. 1232 00:56:27,323 --> 00:56:30,827 WE SWITCHED FROM THE RESPIRATORY 1233 00:56:30,827 --> 00:56:33,830 DISTURBANCE INDEX TO THE APNEA 1234 00:56:33,830 --> 00:56:35,231 METRIC AND THERE'S A BUNCH OF 1235 00:56:35,231 --> 00:56:36,499 METRICS PEOPLE CONSTANTLY PUT 1236 00:56:36,499 --> 00:56:37,033 OUT. 1237 00:56:37,033 --> 00:56:38,501 NONE OF THEM REALLY MAKE A 1238 00:56:38,501 --> 00:56:39,235 DIFFERENCE TO OUR POPULATION 1239 00:56:39,235 --> 00:56:41,437 BECAUSE MANY OF THEM ARE UNABLE 1240 00:56:41,437 --> 00:56:43,105 TO GET SLEEP STUDY. 1241 00:56:43,105 --> 00:56:45,842 YESTERDAY IN MY CLINIC I ORDERED 1242 00:56:45,842 --> 00:56:48,344 IT FOR SOME OF THEM AND I WAS 1243 00:56:48,344 --> 00:56:50,213 TOLD LOOK, IT'S OKAY THAT WE 1244 00:56:50,213 --> 00:56:54,650 WAIT FOR SIX MONTHS TO GET ONE. 1245 00:56:54,650 --> 00:56:56,986 THIS IS FUNDAMENTALLY 1246 00:56:56,986 --> 00:56:59,055 PROBLEMATIC BECAUSE THESE ARE 1247 00:56:59,055 --> 00:57:00,490 KIDS AT RISK FOR SLEEP APNEA AND 1248 00:57:00,490 --> 00:57:01,824 I COULD GET THEM IN THE 1249 00:57:01,824 --> 00:57:02,992 TREATMENT PIPELINE EARLIER BUT 1250 00:57:02,992 --> 00:57:13,536 BECAUSE WE HAVE TO RELY ON POLY 1251 00:57:16,038 --> 00:57:17,573 SONOGRAPHY AND MANY ARE MINORITY 1252 00:57:17,573 --> 00:57:20,343 POPULATIONS THAT DO NOT GET 1253 00:57:20,343 --> 00:57:22,445 ACCESS TO TREATMENT RIGHT AWAY. 1254 00:57:22,445 --> 00:57:24,046 DESPITE US DESCRIBING THE SCOPE 1255 00:57:24,046 --> 00:57:25,982 OF THE PROBLEM NONE OF US CAN 1256 00:57:25,982 --> 00:57:28,584 SEEM TO AGREE ON TREATMENT 1257 00:57:28,584 --> 00:57:28,918 GUIDELINE. 1258 00:57:28,918 --> 00:57:32,755 WE HAVE THE AMERICAN ACADEMY ON 1259 00:57:32,755 --> 00:57:34,223 SLEEP GUIDELINES ON THE 1260 00:57:34,223 --> 00:57:37,393 SOMNOGRAPHY AND THE AMERICAN 1261 00:57:37,393 --> 00:57:41,264 ACADEMY OF OTOLARYNGOLOGY AND 1262 00:57:41,264 --> 00:57:41,964 HEAD AND NECK SOCIETY AND 1263 00:57:41,964 --> 00:57:43,566 EVERYBODY SEEMS TO HAVE I 1264 00:57:43,566 --> 00:57:45,034 DIFFERENT SET OF CRITERIA BUT 1265 00:57:45,034 --> 00:57:47,570 THERE'S NO CONVERGENCE AND HAVE 1266 00:57:47,570 --> 00:57:49,639 TECHNOLOGY THAT UNFORTUNATELY 1267 00:57:49,639 --> 00:57:51,774 DOESN'T APPEAL IN MODERN SENSE 1268 00:57:51,774 --> 00:57:55,611 BECAUSE IT COSTS A LOT OF MONEY 1269 00:57:55,611 --> 00:58:01,984 AND FUNDAMENTALLY KNACK -- 1270 00:58:01,984 --> 00:58:03,452 INACCESSIBLE FOR A LARGE NUMBER 1271 00:58:03,452 --> 00:58:13,963 AND DOES IT PREDICT MORBIDITY? 1272 00:58:21,938 --> 00:58:24,807 AND IS THERE A BETTER WAY TO 1273 00:58:24,807 --> 00:58:26,008 COLLECTION THIS AND COVER THE 1274 00:58:26,008 --> 00:58:26,842 POPULATION BETTER WITH IT? 1275 00:58:26,842 --> 00:58:29,545 SO WHEN I LOOK FOR SEX 1276 00:58:29,545 --> 00:58:32,081 DIFFERENCES, I WAS UNABLE TO 1277 00:58:32,081 --> 00:58:34,417 FIND MUCH ON IT WHICH HOPEFULLY 1278 00:58:34,417 --> 00:58:37,687 SUPPORTS THE COST OF THIS 1279 00:58:37,687 --> 00:58:37,987 WORKSHOP. 1280 00:58:37,987 --> 00:58:40,089 FIRST -- THE CAUSE OF THE 1281 00:58:40,089 --> 00:58:40,423 WORKSHOP. 1282 00:58:40,423 --> 00:58:41,991 FIRST IN THE SCHOOL AGE GROUP 1283 00:58:41,991 --> 00:58:44,293 THESE ARE X-RAYS FROM CHILDREN 1284 00:58:44,293 --> 00:58:48,898 FROM SCHOOL AGE KIDS AS WELL AS 1285 00:58:48,898 --> 00:58:49,999 ADOLESCENT KIDS THE FUNDAMENTAL 1286 00:58:49,999 --> 00:58:51,200 DIFFERENCE WE SEE FROM THE 1287 00:58:51,200 --> 00:58:54,670 LATERAL VIEW OF THE HEAD AND 1288 00:58:54,670 --> 00:59:05,381 NECK THERE'S ANGULATION AND IT 1289 00:59:08,284 --> 00:59:09,051 INCREASES THE COLLAPSIBILITY IN 1290 00:59:09,051 --> 00:59:11,287 BOYS COMPARED TO GIRLS. 1291 00:59:11,287 --> 00:59:12,622 I'M USING SEX ASSIGNED AT BIRTH 1292 00:59:12,622 --> 00:59:15,057 AS THE THE SURROGATE MEASURE FOR 1293 00:59:15,057 --> 00:59:16,892 THE DIFFERENCES AND TRANSITION 1294 00:59:16,892 --> 00:59:18,394 TO ADULTS GENDER STARTS PLAYING 1295 00:59:18,394 --> 00:59:28,871 A SIGNIFICANT ROLE AS WELL. 1296 00:59:29,639 --> 00:59:32,575 WE KNOW THERE'S QUITE A BIT OF 1297 00:59:32,575 --> 00:59:39,248 CONFOUNDING FROM SOCIO ECONOMIC 1298 00:59:39,248 --> 00:59:45,454 STATS AND AT THE SAME TIME IT 1299 00:59:45,454 --> 00:59:55,965 CONTRIBUTES BRAIN DEVELOPMENT 1300 00:59:57,299 --> 00:59:57,933 SOCIO ECONOMICS CAN PLAY A ROLE 1301 00:59:57,933 --> 00:59:58,934 AND CONTRIBUTE TO BRAIN OUTCOMES 1302 00:59:58,934 --> 00:59:59,502 AS WELL. 1303 00:59:59,502 --> 01:00:01,937 A LOT OF STUDIES IN THE PAST 1304 01:00:01,937 --> 01:00:03,172 HAVE SHOWN THERE'S QUITE A BIT 1305 01:00:03,172 --> 01:00:06,809 OF HETEROGENEITY THAT RESULTS 1306 01:00:06,809 --> 01:00:13,382 FROM RISK PROFILES THAT RESULT 1307 01:00:13,382 --> 01:00:21,257 FROM WHERE KIDS LIVE OR SOCIO 1308 01:00:21,257 --> 01:00:23,125 ECONOMIC STARTS. 1309 01:00:23,125 --> 01:00:25,161 I ENCOUNTERED THIS ON A DAY TO 1310 01:00:25,161 --> 01:00:26,629 DAY BASIS. 1311 01:00:26,629 --> 01:00:33,803 THERE'S SLEEP MED SIS PHYSICIANS 1312 01:00:33,803 --> 01:00:35,004 THAT CALL THE PRESENCE OF SLEEP 1313 01:00:35,004 --> 01:00:38,274 APNEA SOMETIMES USING 1.5 AND 1314 01:00:38,274 --> 01:00:41,477 FOR SEVERITY I'M NOT SURE THEY 1315 01:00:41,477 --> 01:00:43,446 CONTRIBUTE TO OUR TREAT OUTCOMES 1316 01:00:43,446 --> 01:00:49,185 AND WHEN WE PROPOSE THE OHI FOR 1317 01:00:49,185 --> 01:00:55,458 5 AND FOR 10 SOMETIMES WE DON'T 1318 01:00:55,458 --> 01:00:57,927 PROP 1319 01:00:57,927 --> 01:01:01,931 PROPOSE AND SOME PATIENTS COME 1320 01:01:01,931 --> 01:01:03,733 FROM SOCIO ECONOMIC ADVANTAGE 1321 01:01:03,733 --> 01:01:05,501 COMPARED TO DISADVANTAGE AND 1322 01:01:05,501 --> 01:01:08,170 LIKELY NOT HAVE AN OUTCOMES 1323 01:01:08,170 --> 01:01:11,140 BASED ISSUE COMPARED TO CHILDREN 1324 01:01:11,140 --> 01:01:14,844 FROM THE LOWER SES AND THESE 1325 01:01:14,844 --> 01:01:16,512 THRESHOLDS OCCASIONALLY LEAD TO 1326 01:01:16,512 --> 01:01:16,779 PROBLEMS. 1327 01:01:16,779 --> 01:01:19,248 SURGERY IT NOT WITHOUT RISK. 1328 01:01:19,248 --> 01:01:21,884 MANY COME BACK FROM BLEEDING AND 1329 01:01:21,884 --> 01:01:25,921 END UP NEEDING A LONG HOSPITAL 1330 01:01:25,921 --> 01:01:27,356 STAY TO GET OUT. 1331 01:01:27,356 --> 01:01:29,492 HERE'S KEY QUESTIONS. 1332 01:01:29,492 --> 01:01:35,364 CAN WE PREDICT MORBIDITY BETTER 1333 01:01:35,364 --> 01:01:36,198 RELATED TO SLEEP APNEA AND 1334 01:01:36,198 --> 01:01:38,167 SCREEN BETTER AND IS THERE A 1335 01:01:38,167 --> 01:01:41,437 ROLE FOR A.I. 1336 01:01:41,437 --> 01:01:45,841 AND THE FIRST DIFFERENCES IN 1337 01:01:45,841 --> 01:01:49,912 OUTCOMES IS THE COMPLICATION OF 1338 01:01:49,912 --> 01:01:50,146 OBESITY. 1339 01:01:50,146 --> 01:01:58,154 IT MAKES IT WORSE IN REMOVAL OF 1340 01:01:58,154 --> 01:02:01,290 ADENOIDS AND WE KNOW THE 1341 01:02:01,290 --> 01:02:05,494 PRESENCE OF OBESITY DOES LEAD TO 1342 01:02:05,494 --> 01:02:08,297 INFERIOR TREATMENT OUTCOME USING 1343 01:02:08,297 --> 01:02:11,200 THE MEASURE. 1344 01:02:11,200 --> 01:02:12,568 AND THIS THIS CONTRIBUTE TO REAL 1345 01:02:12,568 --> 01:02:17,940 WORLD ENVIRONMENTS AND 90% OF 1346 01:02:17,940 --> 01:02:19,909 WOMEN PRESENTING WITH SLEEP 1347 01:02:19,909 --> 01:02:21,911 DISORDER TREATMENT UNDER GO 1348 01:02:21,911 --> 01:02:28,651 TREATMENT WITH TONSILLECTOMY AND 1349 01:02:28,651 --> 01:02:30,486 ADENECTOMY A STUDY AND THERE'S 1350 01:02:30,486 --> 01:02:33,489 QUESTIONS THAT COULD ARISE IN 1351 01:02:33,489 --> 01:02:35,024 DIFFERENT DIRECTIONS. 1352 01:02:35,024 --> 01:02:36,992 SO HERE WE SHOW THE BURDEN OF 1353 01:02:36,992 --> 01:02:37,927 SYMPTOMS. 1354 01:02:37,927 --> 01:02:43,299 ON THE Y IS THE EHI. 1355 01:02:43,299 --> 01:02:45,434 --SORRY, PARENT REPORTED 1356 01:02:45,434 --> 01:02:45,701 BEHAVIOR. 1357 01:02:45,701 --> 01:02:47,002 THIS SHOWS WHAT THE PARENTS ARE 1358 01:02:47,002 --> 01:02:49,004 REPORTING APPEARS TO SUGGEST 1359 01:02:49,004 --> 01:02:50,439 WHAT THE CHILDREN ARE 1360 01:02:50,439 --> 01:02:53,209 EXPERIENCING IN TERMS OF ADVERSE 1361 01:02:53,209 --> 01:02:53,909 BEHAVIORAL OUTCOMES. 1362 01:02:53,909 --> 01:02:57,379 BUT WHEN WE SUBSTITUTE THE 1363 01:02:57,379 --> 01:02:59,481 SYMPTOM PROFILE WITH AHI THERE'S 1364 01:02:59,481 --> 01:03:01,650 WEAK RELATIONSHIP BETWEEN THE 1365 01:03:01,650 --> 01:03:01,817 TWO. 1366 01:03:01,817 --> 01:03:04,153 AND THEN THIS SPILLS OVER TO 1367 01:03:04,153 --> 01:03:05,921 TREATMENT OUTCOMES ASKING 1368 01:03:05,921 --> 01:03:08,290 PARENTS THEY APPEAR TO BELIEVE 1369 01:03:08,290 --> 01:03:11,093 HIGHER SYMPTOM BURDEN PRIOR TO 1370 01:03:11,093 --> 01:03:13,495 THE TREATMENT OFFERED AND IT 1371 01:03:13,495 --> 01:03:16,398 APPEARS AS IF THAT CARRIES OVER 1372 01:03:16,398 --> 01:03:17,933 TREATMENT OUTCOMES OPPOSED TO 1373 01:03:17,933 --> 01:03:22,137 FOLLOWING AHI AND THIS 1374 01:03:22,137 --> 01:03:25,708 CONTRIBUTE TO WHAT WE HAVE AAS A 1375 01:03:25,708 --> 01:03:36,385 CONUNDRUM FOR PEDIATRIC OSA AND 1376 01:03:39,955 --> 01:03:42,658 WE MAY REFER THEM BUT PART IS 1377 01:03:42,658 --> 01:03:46,195 WHAT WE SEE AS THE CONTRIBUTIONS 1378 01:03:46,195 --> 01:03:51,634 TO THE SYSTEM PRESENTATION AND 1379 01:03:51,634 --> 01:03:52,902 AHI FROM RACE AND PATIENT WHICH 1380 01:03:52,902 --> 01:03:56,839 ARE NOT ACCOUNTED FOR IN OUR 1381 01:03:56,839 --> 01:03:57,740 RISK STRATIFICATION METRICS. 1382 01:03:57,740 --> 01:04:01,877 AND I WANT TO PUT IN A PLUG FOR 1383 01:04:01,877 --> 01:04:02,878 TECHNOLOGY BECAUSE ARTIFICIAL 1384 01:04:02,878 --> 01:04:05,514 INTELLIGENCE MADE ITS WAY TO 1385 01:04:05,514 --> 01:04:06,448 MAINSTREAM RISK STRATIFICATION. 1386 01:04:06,448 --> 01:04:08,851 THIS IS A PAPER FROM LAST YEAR 1387 01:04:08,851 --> 01:04:11,487 WHICH TALKED ABOUT WHAT'S CALLED 1388 01:04:11,487 --> 01:04:12,521 OXYNET. 1389 01:04:12,521 --> 01:04:14,156 IT'S A DEEP LEARNING BASED 1390 01:04:14,156 --> 01:04:14,890 ALGORITHM. 1391 01:04:14,890 --> 01:04:17,893 WHAT THAT MEANS IS THERE'S 1392 01:04:17,893 --> 01:04:20,996 FUNDAMENTALLY A NEURAL NET-BASED 1393 01:04:20,996 --> 01:04:22,197 ALGORITHM THAT COULD CLASSIFY 1394 01:04:22,197 --> 01:04:25,935 PATIENTS OR PREDICT THE PRESENCE 1395 01:04:25,935 --> 01:04:29,438 OF SLEEP APNEA SEVERITY BASED ON 1396 01:04:29,438 --> 01:04:29,905 OX METRIC 1397 01:04:29,905 --> 01:04:30,539 FEATURES. 1398 01:04:30,539 --> 01:04:32,341 THE REASON I FEEL IT'S 1399 01:04:32,341 --> 01:04:33,509 SIGNIFICANT FOR REAL WORLD 1400 01:04:33,509 --> 01:04:34,710 PRACTICE IS MANY CANNOT AFFORD 1401 01:04:34,710 --> 01:04:39,214 TO GET IN THE CLINIC TO GET A 1402 01:04:39,214 --> 01:04:39,648 SOMNOGRAPHY DONE. 1403 01:04:39,648 --> 01:04:43,385 IN FACT THEY COULD BENEFIT 1404 01:04:43,385 --> 01:04:45,821 SIGNIFICANTLY FROM EARLY 1405 01:04:45,821 --> 01:04:49,325 DIAGNOSIS EVEN FROM A MISSED 1406 01:04:49,325 --> 01:04:49,658 DIAGNOSIS. 1407 01:04:49,658 --> 01:04:52,795 THE COUNTER ARGUMENT WE HAVE IS 1408 01:04:52,795 --> 01:04:58,434 THAT IN RETURN FOR THE INCREASED 1409 01:04:58,434 --> 01:04:59,034 RELIABILITY OF THE DIAGNOSIS 1410 01:04:59,034 --> 01:05:05,407 WE'RE SACRIFICING THE OUTCOMES 1411 01:05:05,407 --> 01:05:08,811 BECAUSE MANY OF MY PATIENTS IN 1412 01:05:08,811 --> 01:05:11,413 BALTIMORE CAN IN THE GET INTO A 1413 01:05:11,413 --> 01:05:16,719 TREATMENT FOR MONTHS. 1414 01:05:16,719 --> 01:05:19,755 THE QUALITY OF LIFE REFLECTS ON 1415 01:05:19,755 --> 01:05:20,489 THEIR PERFORMANCE AS WELL. 1416 01:05:20,489 --> 01:05:26,061 AND THIS IS THE ARCHITECTURE AS 1417 01:05:26,061 --> 01:05:30,165 WE START WITH THE PREDICTIVE 1418 01:05:30,165 --> 01:05:30,899 MODELS AND IT'S IMPORTANT TO 1419 01:05:30,899 --> 01:05:35,304 LOOK AT THE FEATURES WE HAVE, 1420 01:05:35,304 --> 01:05:37,840 PATIENT DEMOGRAPHICS AND SOCIO 1421 01:05:37,840 --> 01:05:41,410 ECONOMIC CHARACTERISTICS AND 1422 01:05:41,410 --> 01:05:44,980 THEIR INDIVIDUAL HABITS GO TO AN 1423 01:05:44,980 --> 01:05:46,348 ALGORITHM RANKING THEM TO 1424 01:05:46,348 --> 01:05:47,082 IMPORTANCE AND TRAIN THEM USING 1425 01:05:47,082 --> 01:05:49,551 THE DATA WE HAVE AND USE THE 1426 01:05:49,551 --> 01:05:51,887 STANDARDIZED DATA SETS WE HAVE. 1427 01:05:51,887 --> 01:05:53,422 WE SPENT A LOT OF TIME AND 1428 01:05:53,422 --> 01:05:56,392 EFFORT IN COLLECTING THE DATA 1429 01:05:56,392 --> 01:05:58,794 SUCH AS THE CHAT DATA SET WHICH 1430 01:05:58,794 --> 01:06:00,529 HAS BEEN INCREDIBLY USEFUL AS A 1431 01:06:00,529 --> 01:06:03,032 GROUP TO COME UP WITH BETTER 1432 01:06:03,032 --> 01:06:05,401 WAYS TO PREDICT OSA AS WELL AS 1433 01:06:05,401 --> 01:06:08,837 TO PREDICT OUTCOMES RELATED TO 1434 01:06:08,837 --> 01:06:09,838 IT. 1435 01:06:09,838 --> 01:06:12,808 IN CONCLUSION, WE FEEL THAT 1436 01:06:12,808 --> 01:06:16,545 PEDIATRIC OSA IS ASSOCIATED WITH 1437 01:06:16,545 --> 01:06:17,179 SIGNIFICANT HETEROGENEITY AND 1438 01:06:17,179 --> 01:06:18,647 CONTINUE TO FOLLOW THE ONE SIZE 1439 01:06:18,647 --> 01:06:20,949 FITS ALL APPROACH. 1440 01:06:20,949 --> 01:06:23,752 WE FEEL THERE'S A SIGNIFICANT 1441 01:06:23,752 --> 01:06:25,821 ROLE FOR MACHINE LEARNING AND 1442 01:06:25,821 --> 01:06:28,223 UNTAPPED ESPECIALLY IN CHILDREN 1443 01:06:28,223 --> 01:06:33,662 AND HOPING IF INCORPORATED 1444 01:06:33,662 --> 01:06:38,801 CORRECTLY CAN BRING DOWN THE 1445 01:06:38,801 --> 01:06:41,270 COST OF HEALTH CARE FOR CERTAIN 1446 01:06:41,270 --> 01:06:41,570 COMMUNITIES. 1447 01:06:41,570 --> 01:06:42,971 >> THANK YOU FOR THE GREAT TALK. 1448 01:06:42,971 --> 01:06:44,673 I LOOK FORWARD TO SOME QUESTIONS 1449 01:06:44,673 --> 01:06:48,911 AT THE END OF THIS SESSION. 1450 01:06:48,911 --> 01:06:51,180 WE'RE GOING TO MOVE TO OUR NEXT 1451 01:06:51,180 --> 01:06:51,413 SPEAKER. 1452 01:06:51,413 --> 01:06:54,483 THE NEXT SPEAKER IS DR. SUINGSAN 1453 01:06:54,483 --> 01:06:55,484 RED INFORMATION LINE. 1454 01:06:55,484 --> 01:06:57,820 THE PROFESSOR OF SLEEP MEDICINE 1455 01:06:57,820 --> 01:07:02,891 AT HARVARD MEDICAL SCHOOL, 1456 01:07:02,891 --> 01:07:05,360 PROFESSOR OF EPIDEMIOLOGY AT THE 1457 01:07:05,360 --> 01:07:15,204 KHAN SCHOOL OF PUBLIC HEALTH AND 1458 01:07:15,204 --> 01:07:18,474 AT BRIGHAM AND WOMEN'S HOSPITAL 1459 01:07:18,474 --> 01:07:20,109 AND HER PRESENTATION IS 1460 01:07:20,109 --> 01:07:22,878 SEX-GENDER DIFFERENCES IN OSA 1461 01:07:22,878 --> 01:07:24,980 PRESENTATION POLY SOMNOGRAPHY 1462 01:07:24,980 --> 01:07:26,515 AND MECHANISMS IN HEALTH 1463 01:07:26,515 --> 01:07:28,984 DISPARITIESES AND LIFE COURSE 1464 01:07:28,984 --> 01:07:29,284 PERSPECTIVE. 1465 01:07:29,284 --> 01:07:31,487 >> THANK YOU ALL FOR A FANTASTIC 1466 01:07:31,487 --> 01:07:32,454 AND CRITICALLY IMPORTANT 1467 01:07:32,454 --> 01:07:35,858 SYMPOSIUM AND THE OPPORTUNITY TO 1468 01:07:35,858 --> 01:07:36,091 SPEAK. 1469 01:07:36,091 --> 01:07:39,962 I'LL KICK OFF A NUMBER OF THE 1470 01:07:39,962 --> 01:07:41,997 THEMES THE PRIOR SPEAKERS 1471 01:07:41,997 --> 01:07:44,700 MENTIONED AND PARTICULARLY 1472 01:07:44,700 --> 01:07:49,338 EMPHASIZING SOME OF THE 1473 01:07:49,338 --> 01:07:59,882 HETEROGENEITY IN HOW SLEEP APNEA 1474 01:08:01,517 --> 01:08:05,087 PRESENTS AND LOOK AT THIS FROM 1475 01:08:05,087 --> 01:08:08,357 THE HEALTH DISPARITIES AND LIFE 1476 01:08:08,357 --> 01:08:08,790 COURSE PERSPECTIVE. 1477 01:08:08,790 --> 01:08:10,025 HERE'S MY DISCLOSURES. 1478 01:08:10,025 --> 01:08:17,399 THE MOST IMPORTANT GOES TO 1479 01:08:17,399 --> 01:08:20,702 DR. MALLAMPALLI'S STATEMENT OF 1480 01:08:20,702 --> 01:08:21,737 DIFFERENTIATING SEX AND GENDER 1481 01:08:21,737 --> 01:08:23,071 AND THE LITERATURE MAKES IT 1482 01:08:23,071 --> 01:08:24,640 DIFFICULT TO MAKE THE 1483 01:08:24,640 --> 01:08:24,940 DISTINCTION. 1484 01:08:24,940 --> 01:08:26,608 I'LL GOING TO GENERALLY REFER TO 1485 01:08:26,608 --> 01:08:32,548 SEX NOTING ONE RESEARCH NEED IS 1486 01:08:32,548 --> 01:08:35,284 THE ABILITY TO GENERATE DATA TO 1487 01:08:35,284 --> 01:08:37,920 DISTINGUISH BETWEEN THE 1488 01:08:37,920 --> 01:08:38,487 CONCEPTS. 1489 01:08:38,487 --> 01:08:41,123 WE HEARD EARLIER THERE ARE SEX 1490 01:08:41,123 --> 01:08:41,857 DIFFERENCES IN HOW SLEEP APNEA 1491 01:08:41,857 --> 01:08:44,660 PRESENTS IN MEN AND WOMEN. 1492 01:08:44,660 --> 01:08:46,528 AND I WANT POINT OUT WE KNEW 1493 01:08:46,528 --> 01:08:48,664 THIS FROM RESEARCH MORE THAN 20 1494 01:08:48,664 --> 01:08:52,301 YEARS AGO THAT MEN TEND TO MORE 1495 01:08:52,301 --> 01:08:55,837 LIKELY WITH ANY GIVEN L OFIV 1496 01:08:55,837 --> 01:08:58,774 SLEEP APNEA REPORTNE SNE AND 1497 01:08:58,774 --> 01:09:01,677 SNORTING, GASPING AND SLEEPINESS 1498 01:09:01,677 --> 01:09:05,013 AND WOMEN REPORT UNRESTED SLEEP, 1499 01:09:05,013 --> 01:09:06,848 FATIGUE, INSOMNIA AND DEPRESSION 1500 01:09:06,848 --> 01:09:07,115 SYMPTOMS. 1501 01:09:07,115 --> 01:09:12,454 IN FACT A FEW YEARS AGO, A LARGE 1502 01:09:12,454 --> 01:09:15,157 REPORT FROM A SLEEP CLINIC 1503 01:09:15,157 --> 01:09:16,558 REEM IN CLINICAL LI 1504 01:09:16,558 --> 01:09:17,559 PRACTICE NDS ARE SIMILAR. 1505 01:09:17,559 --> 01:09:21,029 WHAT YOU SEE ON THE RIGHT-HAND 1506 01:09:21,029 --> 01:09:23,198 SIDE IS IN FACT WOMEN RELATIVE 1507 01:09:23,198 --> 01:09:24,099 TO MEN PRESENTING WITH SLEEP 1508 01:09:24,099 --> 01:09:27,302 APNEA ARE MORE LIKELY TO HAVE 1509 01:09:27,302 --> 01:09:29,104 INSOMNIA, MEMORY PROBLEMS, 1510 01:09:29,104 --> 01:09:31,773 FATIGUE AND LESS LIKELY TO 1511 01:09:31,773 --> 01:09:33,842 WITNESS APNEAS. 1512 01:09:33,842 --> 01:09:37,246 WHAT THAT IMPLIES IS THAT OUR 1513 01:09:37,246 --> 01:09:39,581 CURRENT FOCUS ON SLEEPINESS AS A 1514 01:09:39,581 --> 01:09:42,484 SYMPTOM RATHER THAN INSOMNIA AND 1515 01:09:42,484 --> 01:09:45,854 THE USE OF REPORTED APNEAS MAY 1516 01:09:45,854 --> 01:09:49,524 CONTRIBUTE TO UNDER DIAGNOSIS IN 1517 01:09:49,524 --> 01:09:50,659 WOMEN. 1518 01:09:50,659 --> 01:09:52,461 THERE'S BEEN AN INCREASING 1519 01:09:52,461 --> 01:09:55,864 INTEREST IN THE OVERLAP OF 1520 01:09:55,864 --> 01:09:57,799 INSOMNIA OR SLEEP APNEA AND WE 1521 01:09:57,799 --> 01:09:59,001 MAY BE MISSING THAT ESPECIALLY 1522 01:09:59,001 --> 01:10:09,177 IN WOMEN. 1523 01:10:19,721 --> 01:10:30,132 THERE'S DIFFERENCES IN POLY 1524 01:10:33,502 --> 01:10:36,305 SOMNOGRAPHIES SHOW MALES ARE 1525 01:10:36,305 --> 01:10:39,641 DEEPER INSATURATION AND IN 1526 01:10:39,641 --> 01:10:42,244 PARTICULAR BLACK FEMALES HAVE 1527 01:10:42,244 --> 01:10:44,780 SHORTER EVENTS WITH LESS 1528 01:10:44,780 --> 01:10:47,049 DESATURATION AND WOMEN TEND TO 1529 01:10:47,049 --> 01:10:49,418 HAVE LESS COLLAPSIBILITY SO THE 1530 01:10:49,418 --> 01:10:52,120 SLEEP APNEA IS MORE SUBTLE AND 1531 01:10:52,120 --> 01:11:01,530 NOT AS A FLAGRANT APNEA BY HY 1532 01:11:01,530 --> 01:11:04,299 HYPONEA AND AGAIN WHAT I WANT TO 1533 01:11:04,299 --> 01:11:07,035 POINT OUT HERE IS THE CAUSE OF 1534 01:11:07,035 --> 01:11:09,304 THIS REM DOMINANCE. 1535 01:11:09,304 --> 01:11:10,305 WE MAY UNDERSTAND ESTIMATE SLEEP 1536 01:11:10,305 --> 01:11:12,974 APNEA IF WE DON'T HAVE ADEQUATE 1537 01:11:12,974 --> 01:11:17,913 ASSESSMENT OF REM OR USE A HOME 1538 01:11:17,913 --> 01:11:18,747 SLEEP APNEA TEST THAT DIDN'T 1539 01:11:18,747 --> 01:11:23,085 REPORT OUT THE REM VERSUS 1540 01:11:23,085 --> 01:11:26,588 NON-REM APNEA AND WHEN WE YOU 1541 01:11:26,588 --> 01:11:33,428 THE 4% DE SATURATION CRITERIA, 1542 01:11:33,428 --> 01:11:38,433 WE WILL HAVE WIDER DISPARITIES 1543 01:11:38,433 --> 01:11:41,103 BETWEEN MEN AND WOMEN AND THE 1544 01:11:41,103 --> 01:11:42,604 BIGGEST DISPARITY IS WHEN WE 1545 01:11:42,604 --> 01:11:44,239 LOOK THE THE ENTIRE PERIOD OF 1546 01:11:44,239 --> 01:11:48,276 THE NIGHT AND USED A 4% DESAT 1547 01:11:48,276 --> 01:11:51,646 WHERE THE RATIO OF THE HI IN MEN 1548 01:11:51,646 --> 01:11:56,284 AND WOMEN WAS CLOSE TO 2.AND IT 1549 01:11:56,284 --> 01:11:57,819 NARROWS USING THE 3% BUT STILL 1550 01:11:57,819 --> 01:12:02,023 SIGNIFICANT UNLESS WE LOOK AT 1551 01:12:02,023 --> 01:12:02,924 REM OR THE RATIO WILLIAMS CLOSE 1552 01:12:02,924 --> 01:12:09,798 TO 1. 1553 01:12:09,798 --> 01:12:13,235 MEASURING THE SUBTLE DIFFERENCES 1554 01:12:13,235 --> 01:12:15,504 MAY UNDERESTIMATE DIFFERENCES IN 1555 01:12:15,504 --> 01:12:18,240 WOMEN AND HERE'S A LARGE COHORT 1556 01:12:18,240 --> 01:12:21,009 OF MEN AND WOMEN WITH STUDIES IN 1557 01:12:21,009 --> 01:12:23,111 THE NEW MOM TO BE STUDY. 1558 01:12:23,111 --> 01:12:26,448 IT DID REPORT A MODEST 1559 01:12:26,448 --> 01:12:27,416 ASSOCIATION BETWEEN SLEEP APNEA 1560 01:12:27,416 --> 01:12:30,719 AS MEASURED BY THE AHI AND RISK 1561 01:12:30,719 --> 01:12:33,422 OF DEVELOPING PREECLAMPSIA. 1562 01:12:33,422 --> 01:12:41,163 HOWEVER, WHEN YOU GO BEYOND THE 1563 01:12:41,163 --> 01:12:43,932 HYPONEAS AND TAKE THE FLOW 1564 01:12:43,932 --> 01:12:46,601 SYSTEM UNOBSTRUCTED AND ABLE TO 1565 01:12:46,601 --> 01:12:48,837 QUANTIFY THE SCOOPING OR AIR 1566 01:12:48,837 --> 01:12:50,672 FLOW OBSTRUCTION AND USE THAT AS 1567 01:12:50,672 --> 01:12:56,178 A QUANTITATIVE VARIABLE, WE HAVE 1568 01:12:56,178 --> 01:13:04,052 A MUCH STRONGER OF PREECLAMPSIA 1569 01:13:04,052 --> 01:13:10,559 A 1570 01:13:10,559 --> 01:13:13,061 AND THE ASSOCIATION PERSISTS. 1571 01:13:13,061 --> 01:13:17,232 MANY ON THE CALL HAVE BEEN 1572 01:13:17,232 --> 01:13:19,701 INVOLVED DEVELOPING TOOLS TO 1573 01:13:19,701 --> 01:13:21,937 REALLY CHARACTERIZE THE 1574 01:13:21,937 --> 01:13:24,306 ENDOTYPES OR MECHANISTIC TRAITS. 1575 01:13:24,306 --> 01:13:26,241 YOU HEARD A LITTLE BIT OF THAT 1576 01:13:26,241 --> 01:13:31,613 INCLUDING LOW AROUSAL THRESHOLD, 1577 01:13:31,613 --> 01:13:33,415 UNSTABLE CONTROL AND LOOP GAIN 1578 01:13:33,415 --> 01:13:35,784 AND AIRWAY MUSCLE COMPENSATION 1579 01:13:35,784 --> 01:13:41,223 AND THE ROLE OF ANATOMY. 1580 01:13:41,223 --> 01:13:44,726 HIGH AND THERE'S BEEN LITTLE 1581 01:13:44,726 --> 01:13:48,730 VARIATION HOW THE FACTORS VARY 1582 01:13:48,730 --> 01:13:52,334 BY SEX BUT KNOW THERE'S ANATOMIC 1583 01:13:52,334 --> 01:13:55,103 DIFFERENCES AND MEN HAVE MORE 1584 01:13:55,103 --> 01:14:01,376 FAT IN THEIR AIRWAY AND A LONGER 1585 01:14:01,376 --> 01:14:05,213 MORE COLLAPSABLE AIRWAY. 1586 01:14:05,213 --> 01:14:08,483 DR. PUNJABI REFERRED TO THIS 1587 01:14:08,483 --> 01:14:12,954 STUDY WHERE WE USED THE 1588 01:14:12,954 --> 01:14:20,262 TECHNIQUES DEVELOPED TO APPLY E 1589 01:14:20,262 --> 01:14:24,633 THE COHORTS THAT DID POLY 1590 01:14:24,633 --> 01:14:26,468 SOMNOGRAPHY AT HOME AND THEY 1591 01:14:26,468 --> 01:14:28,770 HAVE INCREASED COLLAPSIBILITY 1592 01:14:28,770 --> 01:14:31,306 AND LOOP GAIN AND DEFICITS IN 1593 01:14:31,306 --> 01:14:32,908 DIFFERENTIAL COMPENSATION THAT 1594 01:14:32,908 --> 01:14:36,645 ACCOUNT FOR THEIR ELEVATED AHI. 1595 01:14:36,645 --> 01:14:38,046 IN CONTRAST, WOMEN HAVE 1596 01:14:38,046 --> 01:14:40,549 DECREASES IN THEIR AROUSAL 1597 01:14:40,549 --> 01:14:42,551 THRESHOLD MORE LIKELY TO WAKE UP 1598 01:14:42,551 --> 01:14:48,323 WITH A RESPIRATORY DISTURBANCE. 1599 01:14:48,323 --> 01:14:53,695 THEY HAVE INCREASE IN UTILITY L 1600 01:14:53,695 --> 01:14:55,096 AND LESS COLLAPSIBILITY. 1601 01:14:55,096 --> 01:15:02,971 IF YOU ACCOUNT FOR THE ENDOTYPES 1602 01:15:02,971 --> 01:15:08,977 ONE-THIRD OF THE DIFFERENCES IN 1603 01:15:08,977 --> 01:15:10,845 REM. 1604 01:15:10,845 --> 01:15:12,080 IN ADDITION THERE'S INTEREST IN 1605 01:15:12,080 --> 01:15:17,185 THE SLEEP APNEA RESPONSE 1606 01:15:17,185 --> 01:15:21,189 METRICS. 1607 01:15:21,189 --> 01:15:25,193 ONE AND THERE'S A DELTA LATER 1608 01:15:25,193 --> 01:15:28,997 RATE WITH APNEA AND HYPOPNEA AND 1609 01:15:28,997 --> 01:15:32,968 NOW I ADDED THE HEART RATE 1610 01:15:32,968 --> 01:15:33,234 RESPONSE. 1611 01:15:33,234 --> 01:15:36,137 THOUGH MEN HAVE DEEPER 1612 01:15:36,137 --> 01:15:37,105 DESATURATIONS THEY TEND TO HAVE 1613 01:15:37,105 --> 01:15:40,241 LESS OF A HEART RATE RESPONSE AS 1614 01:15:40,241 --> 01:15:42,110 YOU COULD SEE IN THIS PARTICULAR 1615 01:15:42,110 --> 01:15:42,344 FIGURE. 1616 01:15:42,344 --> 01:15:46,848 IN CONTRAST, IN THIS BLACK 1617 01:15:46,848 --> 01:15:51,119 FEMALE DESPITE SMALL DESACH AND 1618 01:15:51,119 --> 01:15:53,722 SHORTER VENT DURATIONS YOU HAVE 1619 01:15:53,722 --> 01:15:54,723 THIS MARK LEERT RATE RESPONSE. 1620 01:15:54,723 --> 01:15:58,727 THE EXTREMES ARE DIFFERENCES 1621 01:15:58,727 --> 01:15:59,361 SEEN BETWEEN BLACK FEMALES AND 1622 01:15:59,361 --> 01:16:09,537 WHITE MEN. 1623 01:16:10,372 --> 01:16:12,374 OTHER DATA PREDICTS 1624 01:16:12,374 --> 01:16:13,174 CARDIOVASCULAR MORBIDITY AND 1625 01:16:13,174 --> 01:16:14,976 MORTALITY. 1626 01:16:14,976 --> 01:16:17,612 THE IMPLICATIONS ARE THAT WOMEN 1627 01:16:17,612 --> 01:16:21,449 MAY HAVE LESS HYPOXIC BURDEN BUT 1628 01:16:21,449 --> 01:16:23,685 A GREATER CARDIOVASCULAR 1629 01:16:23,685 --> 01:16:24,519 AUTONOMIC SYSTEM RESPONSE AND 1630 01:16:24,519 --> 01:16:28,289 THE DELTA HEART RATE MAY BE A 1631 01:16:28,289 --> 01:16:31,559 PHENOTYPE THAT'S PARTICULARLY 1632 01:16:31,559 --> 01:16:35,196 APPROPRIATE TO GET AT SEX AND 1633 01:16:35,196 --> 01:16:37,065 GENDER AND RACE-RELATED 1634 01:16:37,065 --> 01:16:41,970 PHENOTYPES THAT PREDICT DISEASE. 1635 01:16:41,970 --> 01:16:43,371 MOREOVER THIS AROUSAL PHENOTYPE 1636 01:16:43,371 --> 01:16:46,841 OR LOW AROUSAL THRESHOLD, HIGH 1637 01:16:46,841 --> 01:16:53,214 AROUSABILITY MAY BE A MARKER OF 1638 01:16:53,214 --> 01:16:59,854 INSOMNIA AND PREDICT POOR CPAP 1639 01:16:59,854 --> 01:17:08,697 RESPONSES AND THOUGH THE 1640 01:17:08,697 --> 01:17:09,864 ENDOTYPES CAN BE CONSIDERED AS 1641 01:17:09,864 --> 01:17:12,133 WELL AS THE SEVERITY MARKERS, 1642 01:17:12,133 --> 01:17:13,435 THESE ARE ACTUALLY RELATED. 1643 01:17:13,435 --> 01:17:16,538 ON THE TOP ROWS ARE THE REND 1644 01:17:16,538 --> 01:17:21,676 TYPES AND BOTTOM ARE OUR 1645 01:17:21,676 --> 01:17:25,180 SEVERITY MARKERS PEOPLE WITH A 1646 01:17:25,180 --> 01:17:27,248 HIGHER LOOP GAIN HAVE A HIGHER 1647 01:17:27,248 --> 01:17:29,317 RESPONSE AND THOSE WITH A HIGHER 1648 01:17:29,317 --> 01:17:31,186 COLLAPSIBILITY HAVE A HIGHER 1649 01:17:31,186 --> 01:17:33,188 HYPOXIC BURDEN AND THOSE WITH A 1650 01:17:33,188 --> 01:17:35,457 LOWER AROUSAL THRESHOLD WILL 1651 01:17:35,457 --> 01:17:38,226 HAVE A HEART RESPONSE TO ANY 1652 01:17:38,226 --> 01:17:39,327 GIVEN DESATURATION. 1653 01:17:39,327 --> 01:17:42,397 YOU CAN TRY TO CREATE A CAUSAL L 1654 01:17:42,397 --> 01:17:44,733 CHAIN OF RELATING THE 1655 01:17:44,733 --> 01:17:49,104 MECHTRAITS OR ENDOTYPES 1656 01:17:49,104 --> 01:17:51,206 WITH CARDIOVASCULAR AND 1657 01:17:51,206 --> 01:17:51,473 DIABETES. 1658 01:17:51,473 --> 01:17:56,478 AND IN THIS SCHEMA WE SUGGEST 1659 01:17:56,478 --> 01:17:58,179 THESE ENDOTYPES LIKE LOOP GAIN 1660 01:17:58,179 --> 01:18:00,715 AND NEURAL MUSCULAR COMPENSATION 1661 01:18:00,715 --> 01:18:05,253 WILL INFLUENCE AIRWAY PATENSY 1662 01:18:05,253 --> 01:18:07,756 BUT IN SPECIFIC MANNERS IN 1663 01:18:07,756 --> 01:18:11,126 PRESENTING APNEA OR SHORT OR 1664 01:18:11,126 --> 01:18:13,728 LONG EVENT WITH OR WITHOUT 1665 01:18:13,728 --> 01:18:16,164 AROUSAL AND WITH OR WITHOUT 1666 01:18:16,164 --> 01:18:17,398 DESATURATION WILL INFLUENCE THE 1667 01:18:17,398 --> 01:18:21,069 SEVERITY MARKERS OF HYPOXIC 1668 01:18:21,069 --> 01:18:29,511 BURDEN, UTILITORY BURDEN AND 1669 01:18:29,511 --> 01:18:30,879 NEED TO BE CONTRIBUTED IN THE 1670 01:18:30,879 --> 01:18:33,314 CAUSAL LINK TO END OCCURAN 1671 01:18:33,314 --> 01:18:43,458 DAMAGE. 1672 01:18:44,492 --> 01:18:48,696 BE THERE'S AN AVERAGE HYPOPNEA 1673 01:18:48,696 --> 01:18:51,032 DURATION AND AVAILABLE IN MOST 1674 01:18:51,032 --> 01:18:52,934 HOPE SLEEP TESTS AND IS A POOR 1675 01:18:52,934 --> 01:18:56,104 MAN'S MARKER OF YOUR AROUSAL 1676 01:18:56,104 --> 01:18:57,939 THRESHOLD AND ALSO TRAIT LINE. 1677 01:18:57,939 --> 01:19:04,612 IT HAS A HIGH HERITABILITY OF 1678 01:19:04,612 --> 01:19:08,583 60% AND SEVERAL POSITIVE GWAS 1679 01:19:08,583 --> 01:19:09,851 FINDINGS FOR IT. 1680 01:19:09,851 --> 01:19:13,087 EVENTS ARE SHORTER IN WOMEN AND 1681 01:19:13,087 --> 01:19:14,255 SHORTEST UP AFRICAN AMERICAN 1682 01:19:14,255 --> 01:19:20,161 WOMEN AND AS YOU CAN SEE ON THE 1683 01:19:20,161 --> 01:19:21,262 RIGHT-HAND SIDE PEOPLE WITH THE 1684 01:19:21,262 --> 01:19:22,664 SHORTEST EVENTS IN THE QUARTILE 1685 01:19:22,664 --> 01:19:29,070 ARE MORE LIKELY TO HAVE AN 1686 01:19:29,070 --> 01:19:39,614 11-YEAR INCREASED MORTALITY AND 1687 01:19:40,515 --> 01:19:41,883 DISASSOCIATION BETWEEN THE AHI 1688 01:19:41,883 --> 01:19:47,422 AND MORTALITY MISTAKE -- MOSTLY 1689 01:19:47,422 --> 01:19:49,457 IN MEN AND CAN PREDICT MORTALITY 1690 01:19:49,457 --> 01:19:52,994 IN MEN AND WOMEN. 1691 01:19:52,994 --> 01:19:56,497 AND IN HISPANIC COMMUNITY HEALTH 1692 01:19:56,497 --> 01:20:04,539 STUDY WE CAN IDENTIFY COMPOSITES 1693 01:20:04,539 --> 01:20:07,442 THAT AND ENDOTYPES AND CREATE 1694 01:20:07,442 --> 01:20:08,476 METABOLOMIC RISK SCORE AND 1695 01:20:08,476 --> 01:20:11,980 THERE'S A RISK SCORE THAT MAPS 1696 01:20:11,980 --> 01:20:13,181 TO THE SHORT EVENT PHENOTYPE. 1697 01:20:13,181 --> 01:20:20,955 AND IN THE END TYPES IN THE I 1698 01:20:20,955 --> 01:20:24,559 AR PREDICTS DIABETES IN THE 1699 01:20:24,559 --> 01:20:34,769 POPULATION. 1700 01:20:50,018 --> 01:20:54,355 HERE YOU CAN SEE CLEARLY AGES HO 1701 01:20:54,355 --> 01:20:58,293 40-49 MEN HAVE A FOURFOLD HIGHER 1702 01:20:58,293 --> 01:21:00,762 OF SLEEP APNEA AT AHI GREATER 1703 01:21:00,762 --> 01:21:04,966 THAN FIVE AND NARROWS AFTER 1704 01:21:04,966 --> 01:21:09,604 MENOPAUSE IN WOMEN IT GOES UP 1705 01:21:09,604 --> 01:21:14,642 FROM 4% TO 7% PREVALENCE AND THE 1706 01:21:14,642 --> 01:21:16,878 DIFFERENCES ARE MUCH MUCH 1707 01:21:16,878 --> 01:21:23,484 NARROWER. 1708 01:21:23,484 --> 01:21:25,787 AND MOST STUDIES EXAMINE SLEEP 1709 01:21:25,787 --> 01:21:26,854 APNEA AT ONE POINT. 1710 01:21:26,854 --> 01:21:30,425 MOST COHORT STUDIES SLEEP APNEA 1711 01:21:30,425 --> 01:21:32,827 ARE ABOUT AGE 60BO THEN LOOK 1712 01:21:32,827 --> 01:21:35,496 FOR THE DEVELOPMENT OF 1713 01:21:35,496 --> 01:21:37,198 CARDIOVASCULAR DISEASE AFTER 1714 01:21:37,198 --> 01:21:39,567 THAT INITIAL SLEEP STUDY. 1715 01:21:39,567 --> 01:21:41,002 USUALLY YOU HAVE FIVE OR EIGHT 1716 01:21:41,002 --> 01:21:43,604 YEARS OF FOLLOW UP. 1717 01:21:43,604 --> 01:21:46,107 IN FACT IN THE SLEEP STUDY WE 1718 01:21:46,107 --> 01:21:48,009 INITIALLY REPORTED NO FINDINGS 1719 01:21:48,009 --> 01:21:50,511 BETWEEN THE BASELINE SLEEP STUDY 1720 01:21:50,511 --> 01:21:57,885 AND OUTCOMES LIKEIK MORTALITY A 1721 01:21:57,885 --> 01:22:05,393 HEART DISEASE. 1722 01:22:05,393 --> 01:22:07,528 WOMEN ARE AT INCREASED RISK AS 1723 01:22:07,528 --> 01:22:08,730 THEY AGE WITH DEVELOPING 1724 01:22:08,730 --> 01:22:09,464 CARDIOVASCULAR IF YOU FOLLOW 1725 01:22:09,464 --> 01:22:19,774 THEM LONG ENOUGH. 1726 01:22:21,109 --> 01:22:26,514 AND AFTER 13 YEARS OF FOLLOW 1727 01:22:26,514 --> 01:22:32,186 UPWOMEN WERE 26% HIGHER THAN 1728 01:22:32,186 --> 01:22:33,321 THOSE WITHOUT SLEEP APNEA AND WE 1729 01:22:33,321 --> 01:22:43,731 DID NOT SEE IN THE MEN. 1730 01:22:46,701 --> 01:22:52,440 THEY HAD MARKERS OF SUB ELEVATED 1731 01:22:52,440 --> 01:22:59,313 CARDIOVASCULAR DISEASE AND 1732 01:22:59,313 --> 01:23:00,648 PROBABLY WERE EXPERIENCING 1733 01:23:00,648 --> 01:23:01,949 ADVERSE EXPOSURES CONTRIBUTING 1734 01:23:01,949 --> 01:23:03,684 TO HEART DISEASE THAT NEEDED TO 1735 01:23:03,684 --> 01:23:08,022 BE MEASURED OVER LONGER PERIOD 1736 01:23:08,022 --> 01:23:11,359 OF TIME AND THAT CONCEPTUAL 1737 01:23:11,359 --> 01:23:14,295 MODEL IS SHOWNE WHERE SLEEP EP 1738 01:23:14,295 --> 01:23:15,730 APNEA INCRTER IN LIFE 1739 01:23:15,730 --> 01:23:17,165 COURSE IN WOMEN THAN MEN AND 1740 01:23:17,165 --> 01:23:19,200 ONLY STUDY THEM FOR A FEW YEARS 1741 01:23:19,200 --> 01:23:24,639 TO LOOK AT RISK OF CLINICAL 1742 01:23:24,639 --> 01:23:29,777 OUTCOMES WE MAY UNDERESTIMATE 1743 01:23:29,777 --> 01:23:35,316 THEIR EFFECTS WITHOUT GATHERING 1744 01:23:35,316 --> 01:23:37,518 DATA COMPARED TO MEN WITH A 1745 01:23:37,518 --> 01:23:38,453 LONGER PERIOD OF TIME WHEN 1746 01:23:38,453 --> 01:23:40,021 STUDIED THEM. 1747 01:23:40,021 --> 01:23:43,891 I WANTED TO BRIEFLY MENTION WE 1748 01:23:43,891 --> 01:23:46,494 HAVE TO ASK OURSELVES WHY ARE 1749 01:23:46,494 --> 01:23:48,463 MEN AND WOMEN DIFFERENT? 1750 01:23:48,463 --> 01:23:52,467 OTHERS TALKED ABOUT HORMONAL 1751 01:23:52,467 --> 01:23:53,167 DIFFERENCES AND THERE'S CLEARLY 1752 01:23:53,167 --> 01:23:59,006 A LOT OF BIOLOGICAL DIFFERENCES 1753 01:23:59,006 --> 01:24:01,342 AND CAN'T UNDERESTIMATE OUR 1754 01:24:01,342 --> 01:24:04,512 SOCIAL ENVIRONMENT AN THERE'S A 1755 01:24:04,512 --> 01:24:08,483 COMBINED MODEL THAT EMPHASIZES 1756 01:24:08,483 --> 01:24:11,152 THE INFLUENCES OF INSTITUTIONS, 1757 01:24:11,152 --> 01:24:14,021 NEIGHBORHOODS, HOUSING, 1758 01:24:14,021 --> 01:24:16,757 INDIVIDUAL AND INTERPERSONAL 1759 01:24:16,757 --> 01:24:24,465 FACTORS THAT MAY ACUTE LIFE TIME 1760 01:24:24,465 --> 01:24:25,867 PHYSIOLOGICAL STRESSES AND 1761 01:24:25,867 --> 01:24:28,469 THOUGH THE MODEL HAS BEEN USED 1762 01:24:28,469 --> 01:24:38,946 FOR SLEEP APNEA WE HAVE NOT 1763 01:24:41,849 --> 01:24:52,226 ATTRIBUTED IS TO THIS AND 1764 01:24:52,527 --> 01:24:53,461 CORRELATING TO INFLAMMATION AND 1765 01:24:53,461 --> 01:24:56,464 LEADING TO ADVERSE OUTCOMES. 1766 01:24:56,464 --> 01:24:58,666 TO CONCLUDE THE AREAS I'D LIKE 1767 01:24:58,666 --> 01:25:02,370 TO EMPHASIZE IS THAT I THINK 1768 01:25:02,370 --> 01:25:04,672 THERE'S THIS OPPORTUNITY TO 1769 01:25:04,672 --> 01:25:07,542 INVESTIGATE THE SHORT EVENT, LOW 1770 01:25:07,542 --> 01:25:08,910 AROUSAL PHENOTYPE AND ITS IMPACT 1771 01:25:08,910 --> 01:25:12,413 ON DOWN STREAM PATHWAYS THAT MAY 1772 01:25:12,413 --> 01:25:16,484 ALLOW US TO ALSO INTERROGATE 1773 01:25:16,484 --> 01:25:18,686 MECHANISTIC PATHWAYS AND 1774 01:25:18,686 --> 01:25:20,188 LEVERAGE THESE SIMPLIFIED 1775 01:25:20,188 --> 01:25:23,057 ENDOTYPES AND SEVERITY METRICS 1776 01:25:23,057 --> 01:25:24,458 POTENTIALLY COMBINING THOSE WITH 1777 01:25:24,458 --> 01:25:29,497 OTHER DATA FOR EXAMPLE FROM 1778 01:25:29,497 --> 01:25:30,965 OMICS. 1779 01:25:30,965 --> 01:25:33,367 SECONDLY, VERY UNDER STUDIED IS 1780 01:25:33,367 --> 01:25:36,470 UP STREAM RISK FACTORS THAT MAY 1781 01:25:36,470 --> 01:25:38,172 INFLUENCE STRESS AND 1782 01:25:38,172 --> 01:25:41,742 INFLAMMATION AND CONTRIBUTE TO 1783 01:25:41,742 --> 01:25:42,877 HETEROGENEITY BY SEX AND RACE 1784 01:25:42,877 --> 01:25:43,244 AND GENDER. 1785 01:25:43,244 --> 01:25:48,482 AND FINALLY THE NEED TO APPLY 1786 01:25:48,482 --> 01:25:51,052 IMPROVED PHENOTYPE AND USING A 1787 01:25:51,052 --> 01:25:52,920 GENDER SPECIFIC LENS AND THAT'S 1788 01:25:52,920 --> 01:25:54,822 SHOWN WITH THE GOAL WHEN A 1789 01:25:54,822 --> 01:25:59,160 PATIENT COMES INTO CLINIC WE'LL 1790 01:25:59,160 --> 01:26:04,432 BE ABLE TO IDENTIFY THE FEMALE 1791 01:26:04,432 --> 01:26:06,667 SPECIFIC PS REM 1792 01:26:06,667 --> 01:26:08,436 DOMINANT, HYPOPNEA CENTRIC AND 1793 01:26:08,436 --> 01:26:12,173 THE LIFE COURSE EFFECT FOCUS AND 1794 01:26:12,173 --> 01:26:14,542 WITH CONSIDERATION OF GENDER 1795 01:26:14,542 --> 01:26:18,946 SPECIFIC SOCIAL SUPPORTED 1796 01:26:18,946 --> 01:26:24,252 BEHAVIORS VERSUS AN AIRWAY 1797 01:26:24,252 --> 01:26:25,987 THANK YOU VERY MUCH.. 1798 01:26:25,987 --> 01:26:28,022 .NK YOU, SUSAN. 1799 01:26:28,022 --> 01:26:30,658 FASCINATING TO THINK NOT ALL 1800 01:26:30,658 --> 01:26:33,127 APNEA AND HYPOPNEAS ARE THE 1801 01:26:33,127 --> 01:26:33,461 SAME. 1802 01:26:33,461 --> 01:26:35,596 WE'LL AGAIN HAVE OUR QUESTIONS 1803 01:26:35,596 --> 01:26:36,497 AT THE END OF THE SESSION. 1804 01:26:36,497 --> 01:26:38,866 I'D LIKE TO INTRODUCE OUR NEXT 1805 01:26:38,866 --> 01:26:41,369 SPEAKER, DR. NICHA AURORA. 1806 01:26:41,369 --> 01:26:43,237 SHE'S THE ASSOCIATE PROFESSOR OF 1807 01:26:43,237 --> 01:26:45,473 MEDICINE AT THE RUTGERS ROBERT 1808 01:26:45,473 --> 01:26:47,074 WOOD JOHNSON MEDICAL SCHOOL. 1809 01:26:47,074 --> 01:26:48,576 HER PREPARATION IS TITLED OSA 1810 01:26:48,576 --> 01:26:54,548 AND MID LIFE NOT JUST FOR MEN 1811 01:26:54,548 --> 01:26:56,851 ANYMORE. 1812 01:26:56,851 --> 01:27:01,088 DR. NISHA AURORA, THANK YOU. 1813 01:27:01,088 --> 01:27:03,157 >> TO CLARIFY I'M ACTUALLY AT 1814 01:27:03,157 --> 01:27:03,324 NYU. 1815 01:27:03,324 --> 01:27:10,965 I MOVED ACROSS THE RIVER. 1816 01:27:10,965 --> 01:27:12,266 I'M IN THE MORE EXPENSIVE AREA 1817 01:27:12,266 --> 01:27:13,968 BUT I'M EXCITED TO BE HERE AND 1818 01:27:13,968 --> 01:27:17,004 BE A PART OF THE WORKSHOP AND 1819 01:27:17,004 --> 01:27:18,673 SIMILAR TO WHAT YOU'LL HEAR MY 1820 01:27:18,673 --> 01:27:20,875 BE A REPEAT BUT IT'S GOOD TO 1821 01:27:20,875 --> 01:27:22,476 REPEAT THINGS AND DRIVE THEM 1822 01:27:22,476 --> 01:27:24,278 HOME AND GET TO TALK ABOUT MY 1823 01:27:24,278 --> 01:27:26,580 FAVORITE GROUP OF PEOPLE WHICH 1824 01:27:26,580 --> 01:27:28,549 IS MIDDLE AGE WOMEN AND MEN. 1825 01:27:28,549 --> 01:27:29,817 I'LL GET STARTED. 1826 01:27:29,817 --> 01:27:31,719 I HAVE NO CONFLICTS OF INTEREST. 1827 01:27:31,719 --> 01:27:33,154 AND AGAIN THE OBJECTIVES FROM 1828 01:27:33,154 --> 01:27:35,890 WHAT I UNDERSTAND IS TO HELP US 1829 01:27:35,890 --> 01:27:36,857 IDENTIFY GAPS IN OPPORTUNITIES 1830 01:27:36,857 --> 01:27:38,926 THAT WILL ALLOW US TO ADVANCE 1831 01:27:38,926 --> 01:27:41,562 OUR UNDERSTANDING OF THE SEX 1832 01:27:41,562 --> 01:27:45,199 DIFFERENCE SCIENCE IN OSA AND 1833 01:27:45,199 --> 01:27:47,668 ALSO TO TARGET OUTCOME 1834 01:27:47,668 --> 01:27:48,436 IMPROVEMENT IN PATIENT 1835 01:27:48,436 --> 01:27:48,736 EXPERIENCE. 1836 01:27:48,736 --> 01:27:49,603 SO WE'LL KEEP THAT IN MIND AS WE 1837 01:27:49,603 --> 01:27:53,908 MOVE FORWARD. 1838 01:27:53,908 --> 01:27:55,376 SO, YOU'RE ALL FAMILIAR WITH THE 1839 01:27:55,376 --> 01:27:58,979 STATISTICS THAT CAME OUT IN 1993 1840 01:27:58,979 --> 01:28:00,181 INITIALLY THE INITIAL OSA 1841 01:28:00,181 --> 01:28:02,216 PREVALENCE ESTIMATES BEING 24% 1842 01:28:02,216 --> 01:28:04,952 IN MEN, 9% IN WOMEN. 1843 01:28:04,952 --> 01:28:05,786 THIS IS STRAIGHT FROM THE SLEEP 1844 01:28:05,786 --> 01:28:13,794 STUDY ITSELF. 1845 01:28:13,794 --> 01:28:15,830 WHEN YOU LOOKED AT THE GAP IT 1846 01:28:15,830 --> 01:28:18,432 SEEMED LARGE, THREE TO FIVE 1847 01:28:18,432 --> 01:28:23,003 VERSUS ONE IN THE GENERAL 1848 01:28:23,003 --> 01:28:24,171 POPULATION AND EIGHT TO TEN TO 1849 01:28:24,171 --> 01:28:26,240 ONE IN THE CLINICS. 1850 01:28:26,240 --> 01:28:28,275 SINCE THEN THERE'S BEEN A NUMBER 1851 01:28:28,275 --> 01:28:30,144 OF COHORT STUDIES SHOWING THE 1852 01:28:30,144 --> 01:28:32,279 PREVALENCE OF OSA IS HIGHER IN 1853 01:28:32,279 --> 01:28:34,715 WOMEN THAN WE PREVIOUSLY 1854 01:28:34,715 --> 01:28:34,982 THOUGHT. 1855 01:28:34,982 --> 01:28:37,017 AND THE GAP IS ACTUALLY NARROWER 1856 01:28:37,017 --> 01:28:38,586 THAN WE PREVIOUSLY THOUGHT. 1857 01:28:38,586 --> 01:28:43,224 AND YOU CAN SEE THE VARIOUS 1858 01:28:43,224 --> 01:28:44,125 PREVALENCE ESTIMATES ACROSS 1859 01:28:44,125 --> 01:28:46,260 DIFFERENT TYPES OF COHORTS AND 1860 01:28:46,260 --> 01:28:47,995 SOME OF THE VARIATION IN THIS IS 1861 01:28:47,995 --> 01:28:51,799 BECAUSE AGAIN THE WAY AHI 1862 01:28:51,799 --> 01:28:54,435 DEFINED AND DIRECT OBSERVATION 1863 01:28:54,435 --> 01:28:56,003 VERSUS STATISTICAL MODELLING. 1864 01:28:56,003 --> 01:28:58,472 AND OF COURSE AS HAS BEEN 1865 01:28:58,472 --> 01:29:00,241 DISCUSSED AND MENTIONED AND 1866 01:29:00,241 --> 01:29:02,943 WORTH REPEATING, WE'VE COME A 1867 01:29:02,943 --> 01:29:04,578 LONG WAY HOWEVER, THE FACT OF 1868 01:29:04,578 --> 01:29:07,748 THE MATTER IS THAT OSA CONTINUES 1869 01:29:07,748 --> 01:29:09,617 TO BE UNDERESTIMATED IN GENERAL 1870 01:29:09,617 --> 01:29:10,317 AND PARTICULARLY IN WOMEN. 1871 01:29:10,317 --> 01:29:12,920 AND SOME OF THAT HAS TO DO WITH 1872 01:29:12,920 --> 01:29:14,655 OUR CASE IDENTIFICATION. 1873 01:29:14,655 --> 01:29:16,891 YOU JUST SAW THESE SLIDES. 1874 01:29:16,891 --> 01:29:18,492 THIS LIST OF SYMPTOMS ON 1875 01:29:18,492 --> 01:29:22,463 DR. REDLINE'S SLIDE ABOUT HOW 1876 01:29:22,463 --> 01:29:25,633 MEN PRESENT AND IT'S DIFFERENT 1877 01:29:25,633 --> 01:29:28,903 FOR WOMEN AND THE ISSUE HAS BEEN 1878 01:29:28,903 --> 01:29:30,738 BECAUSE MEN WERE PRIMARILY THE 1879 01:29:30,738 --> 01:29:40,581 GENDER OR SEX THAT WERE STUDIED, 1880 01:29:40,581 --> 01:29:42,116 OUR SCREENING TOOLS HAVE 1881 01:29:42,116 --> 01:29:46,587 FOCUSSED ON THE SYMPTOMS OF MEN 1882 01:29:46,587 --> 01:29:51,091 AND THE SLEEPINESS SCALE HAS 1883 01:29:51,091 --> 01:29:53,661 WIDESPREAD USE FOR DETERMINING 1884 01:29:53,661 --> 01:29:56,163 PROPENSITY OF SLEEPINESS AND 1885 01:29:56,163 --> 01:30:01,335 ALSO HAS BEEN BY DEFAULTBYLT US 1886 01:30:01,335 --> 01:30:04,071 FOR OSA SCREENING IN PRIMARY 1887 01:30:04,071 --> 01:30:05,806 CARE CLINIC. 1888 01:30:05,806 --> 01:30:08,209 THE BOTTOM LINE IS WOMEN ARE 1889 01:30:08,209 --> 01:30:11,679 LESS LIKELY TO PRESENT WITH 1890 01:30:11,679 --> 01:30:12,680 SLEEPINESS AND HAVE OTHER 1891 01:30:12,680 --> 01:30:13,380 ATYPICAL SYMPTOMS. 1892 01:30:13,380 --> 01:30:16,750 THE EFFORT IS MORE LIKELY TO 1893 01:30:16,750 --> 01:30:19,386 DETECT SLEEPINESS IN MEN THAN 1894 01:30:19,386 --> 01:30:21,956 WOMEN AND STRONGLY CORRELATES 1895 01:30:21,956 --> 01:30:23,257 WITH ALL LEVELS OF OSA SEVERITY 1896 01:30:23,257 --> 01:30:25,626 IN MEN VERSUS WOMEN WHERE IT 1897 01:30:25,626 --> 01:30:28,662 ONLY CORRELATES WITH MODERATE TO 1898 01:30:28,662 --> 01:30:30,764 SEVERE OSA. 1899 01:30:30,764 --> 01:30:33,667 WHAT I THOUGHT WAS FASCINATING 1900 01:30:33,667 --> 01:30:37,238 IS THE STUDY THAT CAME OUT IN 1901 01:30:37,238 --> 01:30:40,741 2008 DEMONSTRATED ON MSLT, WOMEN 1902 01:30:40,741 --> 01:30:42,643 WERE SLEEPY OBJECTIVE BUT IT 1903 01:30:42,643 --> 01:30:45,446 JUST WAS NOT CAPTURED ON THE 1904 01:30:45,446 --> 01:30:46,747 SLEEPINESS SCALE. 1905 01:30:46,747 --> 01:30:48,449 THIS WAS PARTICULARLY TRUE IN 1906 01:30:48,449 --> 01:30:53,487 POST MENOPAUSAL WOMEN. 1907 01:30:53,487 --> 01:30:58,726 SO THERE ARE SEVEN SCREEN TOOLS 1908 01:30:58,726 --> 01:31:00,060 WE SHOULD CONSIDER. 1909 01:31:00,060 --> 01:31:02,830 THERE'S STOP BACK AND BERLIN 1910 01:31:02,830 --> 01:31:04,732 THAT ARE SPECIFIC FOR SLEEP 1911 01:31:04,732 --> 01:31:07,468 APNEA AND THE OTHERS WERE 1912 01:31:07,468 --> 01:31:10,437 CONSIDERED IN PREDICTING SLEEP 1913 01:31:10,437 --> 01:31:13,807 APNEA DID WELL IN PREDICTING 1914 01:31:13,807 --> 01:31:16,677 SLEEP APNEA WITH HIGHER 1915 01:31:16,677 --> 01:31:19,613 SENSITIVITY IN WOMEN AND IT WAS 1916 01:31:19,613 --> 01:31:23,183 AN INSOMNIA SCALE AND IN OUR 1917 01:31:23,183 --> 01:31:24,084 CURRENT SLEEP APNEA TRIALS 1918 01:31:24,084 --> 01:31:28,055 LOOKING AT MEN VERSUS WOMEN WE 1919 01:31:28,055 --> 01:31:30,758 ARE USING THE INSOMNIA SCALE AND 1920 01:31:30,758 --> 01:31:31,559 FATIGUE SEVERITY SCALE TO 1921 01:31:31,559 --> 01:31:32,126 UNDERSTAND THE SYMPTOMS IN 1922 01:31:32,126 --> 01:31:42,236 WOMEN. 1923 01:31:44,939 --> 01:31:45,773 WE SHOULD CONSIDER SCREENING 1924 01:31:45,773 --> 01:31:47,875 TOOLS MAYBE MODIFYING OUR TOOLS 1925 01:31:47,875 --> 01:31:50,678 A BIT AND NOT USING UNIFIED CUT 1926 01:31:50,678 --> 01:31:52,479 OFF THRESHOLDS THAT MAY HELP 1927 01:31:52,479 --> 01:32:01,922 IMPROVE ACCURACY IN GENERAL. 1928 01:32:01,922 --> 01:32:05,426 WE NEED TO PAY ATTENTION TO THE 1929 01:32:05,426 --> 01:32:07,494 SYMPTOM IN SLEEPINESS IN WOMEN 1930 01:32:07,494 --> 01:32:09,997 MORE AND MORE. 1931 01:32:09,997 --> 01:32:11,999 THIS PHENOTYPE HAS LONG BEEN 1932 01:32:11,999 --> 01:32:13,701 ASSOCIATED WITH MALE SEX AND 1933 01:32:13,701 --> 01:32:15,869 RELATED TO HEALTH RELATED 1934 01:32:15,869 --> 01:32:17,271 QUALITY OF LIFE, CARDIOVASCULAR 1935 01:32:17,271 --> 01:32:18,639 OUTCOMES, INFLAMMATION BUT IN 1936 01:32:18,639 --> 01:32:21,775 FACT THERE'S EMERGING DATA THAT 1937 01:32:21,775 --> 01:32:24,044 SHOWS EXCESSIVE DAYTIME 1938 01:32:24,044 --> 01:32:25,446 SLEEPINESS MAY BE ASSOCIATED 1939 01:32:25,446 --> 01:32:27,648 WITH WORSE MORBIDITY AND 1940 01:32:27,648 --> 01:32:28,082 MORTALITY IN WOMEN. 1941 01:32:28,082 --> 01:32:29,817 AND THIS WAS A STUDY THAT CAME 1942 01:32:29,817 --> 01:32:33,253 OUT LAST YEAR FROM THE MAYO 1943 01:32:33,253 --> 01:32:37,024 CLINIC, SOME OF MY GREAT 1944 01:32:37,024 --> 01:32:40,761 COLLEAGUES THAT BASICALLY SHOWED 1945 01:32:40,761 --> 01:32:43,764 IN ALMOST 15,000 PEOPLE WITH 1946 01:32:43,764 --> 01:32:49,970 OSA, THE HAZARDS RATIO, SIX 1947 01:32:49,970 --> 01:32:52,773 YEARS OUT FOR-TYPE II DIABETES 1948 01:32:52,773 --> 01:32:55,342 WAS EQUAL IN MEN AND WOMEN AND 1949 01:32:55,342 --> 01:32:59,613 ALL CAUSE MORTALITY WAS ONLY 1950 01:32:59,613 --> 01:33:02,416 ELEVATED IN WOMEN ON THE 1951 01:33:02,416 --> 01:33:03,484 SLEEPINESS SCALE AND S 1952 01:33:03,484 --> 01:33:05,853 THOUGHT PROTHO THINK ABOUT 1953 01:33:05,853 --> 01:33:14,228 AND HOW TO CAPTUREAP SLEEPINESS 1954 01:33:14,228 --> 01:33:19,867 PERT AND THIS CAN HAVE A BIGGER 1955 01:33:19,867 --> 01:33:23,203 IMPACT IN WOMEN. 1956 01:33:23,203 --> 01:33:27,274 WE'VE TALKED ABOUT PSG FINDINGS 1957 01:33:27,274 --> 01:33:37,785 AT THE LOW AHI AND OXYGEN AND 1958 01:33:39,720 --> 01:33:41,455 LESS NEUROMUSCULAR AND SEE MORE 1959 01:33:41,455 --> 01:33:41,955 POSITIONAL OSA. 1960 01:33:41,955 --> 01:33:43,490 THIS IS WHERE I THINK THE 1961 01:33:43,490 --> 01:33:44,091 OPPORTUNITY IS. 1962 01:33:44,091 --> 01:33:49,763 THAT IS TO REALLY SIT BACK AND 1963 01:33:49,763 --> 01:34:00,307 THINK AND WHAT ARE WE MISSING IN 1964 01:34:02,943 --> 01:34:03,811 THE HST? 1965 01:34:03,811 --> 01:34:07,347 I THINK THE ISSUE IS WE'RE NOT 1966 01:34:07,347 --> 01:34:10,350 CHARACTERIZING OBSTRUCTIVE 1967 01:34:10,350 --> 01:34:12,953 EVENTS WITH SLEEP ARCHITECTURE 1968 01:34:12,953 --> 01:34:14,388 AND THAT'S A PROBLEM IN WOMEN 1969 01:34:14,388 --> 01:34:15,723 WHERE WE SEE DIFFERENT 1970 01:34:15,723 --> 01:34:16,490 PRESENTATIONS. 1971 01:34:16,490 --> 01:34:23,864 WE HAVE TO THINK ABOUT DO WE 1972 01:34:23,864 --> 01:34:26,300 NEED TO GET GENDER SPECIFIC 1973 01:34:26,300 --> 01:34:28,435 ABOUT THE DIAGNOSIS FROM ONSET 1974 01:34:28,435 --> 01:34:31,338 OR DO MODIFIED PSG IN WOMEN THAT 1975 01:34:31,338 --> 01:34:34,374 INCLUDES AN EEG AND OTHER 1976 01:34:34,374 --> 01:34:35,342 PARAMETERS THAT MIGHT CAPTURE 1977 01:34:35,342 --> 01:34:45,552 SLEEP APNEA IN THEM BETTER. 1978 01:34:45,552 --> 01:34:46,887 MEN AND WOMEN ARE VERY DIFFERENT 1979 01:34:46,887 --> 01:34:48,021 AND WANT TO TURN OUR ATTENTION 1980 01:34:48,021 --> 01:34:50,724 TO A LITTLE BIT OF WHAT'S GOING 1981 01:34:50,724 --> 01:34:50,891 ON. 1982 01:34:50,891 --> 01:34:52,092 I KNOW YOU ALL KNOW THIS BUT 1983 01:34:52,092 --> 01:34:54,728 IT'S GOOD TO SIT BACK AND REVIEW 1984 01:34:54,728 --> 01:34:55,629 IT. 1985 01:34:55,629 --> 01:34:57,564 SO THERE'S BASIC ANATOMICAL 1986 01:34:57,564 --> 01:34:58,899 DIFFERENCES BETWEEN MEN AND 1987 01:34:58,899 --> 01:34:59,099 WOMEN. 1988 01:34:59,099 --> 01:35:03,771 WOMEN TEND TO HAVE A MORE STABLE 1989 01:35:03,771 --> 01:35:05,405 AIRWAY DURING SLEEP WHEREAS MEN 1990 01:35:05,405 --> 01:35:09,309 HAVE LONGER MORE COLLAPSABLE 1991 01:35:09,309 --> 01:35:10,511 AIRWAYS AND HAVE VERY DIFFERENT 1992 01:35:10,511 --> 01:35:14,081 FAT DISTRIBUTION. 1993 01:35:14,081 --> 01:35:17,284 WE ALSO KNOW MEN AND WOMEN ARE 1994 01:35:17,284 --> 01:35:19,720 VERY DIFFERENT IN TERMS OF THEIR 1995 01:35:19,720 --> 01:35:19,987 HORMONES. 1996 01:35:19,987 --> 01:35:22,823 IT'S NOT JUST ABOUT THE SPECIFIC 1997 01:35:22,823 --> 01:35:28,529 HORMONES, ESTROGEN AND 1998 01:35:28,529 --> 01:35:31,064 PROGESTERONE AND TESTOSTERONE 1999 01:35:31,064 --> 01:35:33,433 BUT THE VARIABILITY IN THE LIFE 2000 01:35:33,433 --> 01:35:33,700 SPAN. 2001 01:35:33,700 --> 01:35:34,902 I LIFE THIS COMPARISON BECAUSE 2002 01:35:34,902 --> 01:35:36,370 IT DRIVES IT HOME. 2003 01:35:36,370 --> 01:35:40,240 AT THE TOP YOU SEE WOMEN HAVE 2004 01:35:40,240 --> 01:35:42,843 VARIABILITY MONTH TO MONTH 2005 01:35:42,843 --> 01:35:44,778 PRE-MENOPAUSAL AND VARY DURING 2006 01:35:44,778 --> 01:35:47,114 PREGNANCY AND UP AND DOWN DURING 2007 01:35:47,114 --> 01:35:51,185 PERIMENOPAUSE AND SETTLE OUT IN 2008 01:35:51,185 --> 01:35:51,451 MENOPAUSE. 2009 01:35:51,451 --> 01:35:53,253 MEN ON THE OTHER HAND GO UP AT 2010 01:35:53,253 --> 01:35:54,555 AGE 16 AND STAY THERE. 2011 01:35:54,555 --> 01:36:02,262 IT'S VERY SIMPLE AND 2012 01:36:02,262 --> 01:36:02,629 STRAIGHTFORWARD. 2013 01:36:02,629 --> 01:36:03,497 WHAT'S BECAUSE OF THE VARIATION 2014 01:36:03,497 --> 01:36:06,500 AND THE UP AND DOWN IN WOMEN'S 2015 01:36:06,500 --> 01:36:08,802 HORMONES THAT'S IN SOME WAYS LED 2016 01:36:08,802 --> 01:36:10,871 TO US BEING LEFT OUT OF STUDIES. 2017 01:36:10,871 --> 01:36:13,640 IT'S TOO HARD TO STUDY TOO MUCH 2018 01:36:13,640 --> 01:36:16,543 OF A CHALLENGE BUT IN FACT I 2019 01:36:16,543 --> 01:36:18,478 THINK IT'S EXTREMELY INTERESTING 2020 01:36:18,478 --> 01:36:19,746 AND EXACTLY WHAT WE SHOULD BE 2021 01:36:19,746 --> 01:36:20,380 STUDYING. 2022 01:36:20,380 --> 01:36:23,750 WE SHOULD BE LOOKING AT THE 2023 01:36:23,750 --> 01:36:25,085 HORMONAL VARIATION AND 2024 01:36:25,085 --> 01:36:26,153 HETEROGENEITY OF HORMONES ACROSS 2025 01:36:26,153 --> 01:36:27,087 THE LIFE SPAN. 2026 01:36:27,087 --> 01:36:30,123 I THINK THAT WILL ADD A LOT TO 2027 01:36:30,123 --> 01:36:31,024 OUR UNDERSTANDING OF NOT JUST 2028 01:36:31,024 --> 01:36:33,227 SLEEP APNEA BUT THE OUTCOMES 2029 01:36:33,227 --> 01:36:42,836 ETCETERA. 2030 01:36:42,836 --> 01:36:44,571 THERE'S ESSENTIALLY THREE TO 2031 01:36:44,571 --> 01:36:46,173 FOUR STATES WITH HORMONAL 2032 01:36:46,173 --> 01:36:48,508 VARIATION ACROSS THE LIFE SPAN. 2033 01:36:48,508 --> 01:36:51,712 BEING MENOPAUSAL IS THE STATE 2034 01:36:51,712 --> 01:36:53,780 WITH THE LEAST RISK FOR SLEEP 2035 01:36:53,780 --> 01:36:56,516 APNEA AND POST MENOPAUSE IS THE 2036 01:36:56,516 --> 01:36:57,618 STATE OF MOST RISK FOR SLEEP 2037 01:36:57,618 --> 01:36:57,818 APNEA. 2038 01:36:57,818 --> 01:37:01,054 THIS IS RELATED TO THE FACT THAT 2039 01:37:01,054 --> 01:37:05,959 ESTROGEN AND PROGESTERONES ABATE 2040 01:37:05,959 --> 01:37:07,794 DURING MENOPAUSE. 2041 01:37:07,794 --> 01:37:09,429 THEY'RE IMPORTANT IN OTHER 2042 01:37:09,429 --> 01:37:13,901 EFFECT AGAINST OSA FROM THEIR 2043 01:37:13,901 --> 01:37:18,038 EFFECTS ON UPPER AIRWAY DILATOR 2044 01:37:18,038 --> 01:37:19,706 MUSCLES AND ANOTHER THING TO 2045 01:37:19,706 --> 01:37:22,542 THINK ABOUT IS ESTROGEN IS A 2046 01:37:22,542 --> 01:37:28,916 MAJOR ANTI-OXIDANT DEFENSE 2047 01:37:28,916 --> 01:37:31,618 SYSTEM AND OBSTRUCTIVE SLEEP 2048 01:37:31,618 --> 01:37:33,720 APNEA PRODUCES AN OXIDATIVE 2049 01:37:33,720 --> 01:37:35,689 STRESS ENVIRONMENT. 2050 01:37:35,689 --> 01:37:39,226 THE MEETING OF THESE TWO 2051 01:37:39,226 --> 01:37:42,129 CONDITIONS AND YOU HAVE MORE 2052 01:37:42,129 --> 01:37:43,697 HEIGHTENED OXIDATIVE STRESS IS 2053 01:37:43,697 --> 01:37:46,133 IMPORTANT AND NEEDS TO BE 2054 01:37:46,133 --> 01:37:46,566 THOUGHT ABOUT. 2055 01:37:46,566 --> 01:37:50,637 SO JUST TO SUMMARIZE THAT PART 2056 01:37:50,637 --> 01:37:57,010 WE KNOW MENOPAUSE IMPOSES A 2057 01:37:57,010 --> 01:37:58,312 SIGNIFICANT RISK FOR OBSTRUCTIVE 2058 01:37:58,312 --> 01:37:58,612 SLEEP APNEA. 2059 01:37:58,612 --> 01:38:03,917 THERE'S ALSO A REDUCTION IN WHAT 2060 01:38:03,917 --> 01:38:07,387 IS KNOWN AS LONG-TERM 2061 01:38:07,387 --> 01:38:09,056 FACILITATION OF UPPER AIRWAYS 2062 01:38:09,056 --> 01:38:10,157 AFTER MENOPAUSE. 2063 01:38:10,157 --> 01:38:12,926 WE CAN'T SEEM TO RECRUIT AS WELL 2064 01:38:12,926 --> 01:38:14,528 AND THE MUSCLES DON'T FUNCTION 2065 01:38:14,528 --> 01:38:15,696 AS WELL WHEN THERE'S A STRESS 2066 01:38:15,696 --> 01:38:18,498 AND THE UPPER AIRWAYS ARE 2067 01:38:18,498 --> 01:38:18,799 COLLAPSING. 2068 01:38:18,799 --> 01:38:20,300 IT DOESN'T HAVE THE SAME ABILITY 2069 01:38:20,300 --> 01:38:21,101 AS BEFORE. 2070 01:38:21,101 --> 01:38:24,137 I THINK ANOTHER AREA WE REALLY 2071 01:38:24,137 --> 01:38:34,247 NEED TO THINK ABOUT IS HOW TO 2072 01:38:34,247 --> 01:38:35,782 DISTINGUISH AGING AND BMI 2073 01:38:35,782 --> 01:38:36,783 EFFECTS AND WILL HELP UNDERSTAND 2074 01:38:36,783 --> 01:38:39,920 THE SEX DIFFERENCES THAT COME TO 2075 01:38:39,920 --> 01:38:42,422 BE. 2076 01:38:42,422 --> 01:38:45,258 LET'S MOVE ON TO WHAT WE SEE IN 2077 01:38:45,258 --> 01:38:47,995 TERMS OF CARDIO METABOLIC 2078 01:38:47,995 --> 01:38:54,201 OUTCOMES AND OSA AND GENDER AND 2079 01:38:54,201 --> 01:38:54,835 SEX ISSUES. 2080 01:38:54,835 --> 01:38:59,406 I WANT YOU ALL TO SEE THERE'S A 2081 01:38:59,406 --> 01:39:00,540 LOT OF WORK ONGOING AND 2082 01:39:00,540 --> 01:39:03,744 INCREASING OVER THE LAST TWO 2083 01:39:03,744 --> 01:39:06,747 DECADES THAT SHOWS THERE ARE 2084 01:39:06,747 --> 01:39:08,548 IMPORTANT SEX DIFFERENCES IN 2085 01:39:08,548 --> 01:39:10,884 TERMS OF OSA AND OUTCOMES 2086 01:39:10,884 --> 01:39:13,553 WHETHER IT'S ENDOTHELIAL 2087 01:39:13,553 --> 01:39:16,723 DYSFUNCTION, SUBCLINICAL 2088 01:39:16,723 --> 01:39:18,091 ATHEROSCLEROSIS OR DISEASE 2089 01:39:18,091 --> 01:39:21,395 SPECIFIC DIFFERENCES, CORONARY, 2090 01:39:21,395 --> 01:39:22,562 ARTERY, CALCIUM SCORES, THERE'S 2091 01:39:22,562 --> 01:39:24,297 A LOT OF DIFFERENCES AND WE 2092 01:39:24,297 --> 01:39:26,066 REALLY NEED TO FOCUS ON THESE. 2093 01:39:26,066 --> 01:39:29,836 THESE ARE SECONDARY EVENTS AS 2094 01:39:29,836 --> 01:39:31,138 WAS LAST YEAR. 2095 01:39:31,138 --> 01:39:34,307 HEART FAILURE ESPECIALLY 2096 01:39:34,307 --> 01:39:35,675 PRESERVES, EJECTION FRACTION 2097 01:39:35,675 --> 01:39:37,711 LATER FAILURE ARE IMPORTANT 2098 01:39:37,711 --> 01:39:39,546 DIFFERENCES ASSOCIATED WITH OSA 2099 01:39:39,546 --> 01:39:41,615 AND WE NEED TO THINK ABOUT AND 2100 01:39:41,615 --> 01:39:43,683 STRATIFY BY SEX. 2101 01:39:43,683 --> 01:39:45,752 IT TURNS OUT WOMEN PROBABLY HAVE 2102 01:39:45,752 --> 01:39:51,291 WORSE ENDOTHELIAL FUNCTION, ON 2103 01:39:51,291 --> 01:39:53,894 SUBCLINICAL ATHEROSCLEROSIS 2104 01:39:53,894 --> 01:39:59,032 TOWARDS CARDIOVASCULAR OR 2105 01:39:59,032 --> 01:40:00,200 METABOLIC DISEASE WITH OSA. 2106 01:40:00,200 --> 01:40:06,206 THERE WAS A NICE STUDY THAT 2107 01:40:06,206 --> 01:40:07,841 LOOKED AT DIFFERENT DISORDERS 2108 01:40:07,841 --> 01:40:09,976 AND OSA AND FOUND A LOT OF SEX 2109 01:40:09,976 --> 01:40:11,678 AND GENDER SPECIFIC DIFFERENCES 2110 01:40:11,678 --> 01:40:15,649 BETWEEN MEN AND WOMEN WITH OSA 2111 01:40:15,649 --> 01:40:19,586 WITH WOMEN HAVING MORE 2112 01:40:19,586 --> 01:40:20,187 HYPERTENSION, ISCHEMIC HEART 2113 01:40:20,187 --> 01:40:22,923 DISEASE AND DEPRESSION AND SEEMS 2114 01:40:22,923 --> 01:40:25,926 TO BE A HIGHER HEALTH CARE 2115 01:40:25,926 --> 01:40:28,395 UTILIZATION IN WOMEN WITH OSA. 2116 01:40:28,395 --> 01:40:30,063 I THINK A LOT OF IS ATTRIBUTED 2117 01:40:30,063 --> 01:40:31,665 TO THE FACT THEY HAVE ATYPICAL 2118 01:40:31,665 --> 01:40:31,932 SYMPTOMS. 2119 01:40:31,932 --> 01:40:34,267 IN MY OWN CLINIC THEY GO TO 2120 01:40:34,267 --> 01:40:39,639 SEVERAL DIFFERENT DOCTORS BEFORE 2121 01:40:39,639 --> 01:40:43,143 THEY END UP GETTING DIAGNOSED. 2122 01:40:43,143 --> 01:40:43,844 THESE ARE IMPORTANT THINGS TO 2123 01:40:43,844 --> 01:40:46,480 THINK ABOUT. 2124 01:40:46,480 --> 01:40:49,049 WHERE WE ARE REALLY LACKING IS 2125 01:40:49,049 --> 01:40:49,349 THERAPY. 2126 01:40:49,349 --> 01:40:52,219 THIS IS AN AREA I THINK A BIG 2127 01:40:52,219 --> 01:40:53,887 OPPORTUNITY FOR US TO REALLY 2128 01:40:53,887 --> 01:40:55,222 PROGRESS THE FIELD. 2129 01:40:55,222 --> 01:40:57,491 WHAT WE DO KNOW IS THAT 2130 01:40:57,491 --> 01:41:00,994 TREATMENT IS DELAYED IN WOMEN 2131 01:41:00,994 --> 01:41:05,165 COMPARED TO MEN AND MAY HAVE TO 2132 01:41:05,165 --> 01:41:07,033 DO WITH THE FACT THE DIAGNOSIS 2133 01:41:07,033 --> 01:41:08,468 IS DELAYED. 2134 01:41:08,468 --> 01:41:10,470 THERE'S PRESSURE REQUIREMENTS 2135 01:41:10,470 --> 01:41:11,605 THAT ARE LOWER. 2136 01:41:11,605 --> 01:41:13,240 AND ORAL APPLIANCES TEND TO BE 2137 01:41:13,240 --> 01:41:16,276 MORE EFFECTIVE IN WOMEN BUT 2138 01:41:16,276 --> 01:41:19,579 THESE ARE SMALL STUDIES, S 2139 01:41:19,579 --> 01:41:20,914 POPULATIONS, MODEST SAMPLE 2140 01:41:20,914 --> 01:41:21,214 SIZES. 2141 01:41:21,214 --> 01:41:22,682 AND THE THINGS I THINK WE NEED 2142 01:41:22,682 --> 01:41:28,221 TO CONSIDER GOING FORWARD, ONE 2143 01:41:28,221 --> 01:41:30,590 IS DOES THE DURATION NEED TO BE 2144 01:41:30,590 --> 01:41:35,262 LONGER AND NOT JUST USE THE 2145 01:41:35,262 --> 01:41:38,331 MEDICARE CUT-OFF CRITERIA TO SEE 2146 01:41:38,331 --> 01:41:40,000 THE REM WE'RE SEEING MORE IN 2147 01:41:40,000 --> 01:41:42,636 WOMEN AND WHAT ABOUT HRT? 2148 01:41:42,636 --> 01:41:45,205 IT'S BECOMING MORE AND MORE 2149 01:41:45,205 --> 01:41:47,073 COMMONLY USED THESE DAYS. 2150 01:41:47,073 --> 01:41:48,875 IT SEEMS TO BE A TREND AND I'M 2151 01:41:48,875 --> 01:41:52,445 SEEING A LOT OF THAT IN MY 2152 01:41:52,445 --> 01:41:55,081 CLINICS AS WELL. 2153 01:41:55,081 --> 01:42:01,054 AND COMISA AND THINK OF 2154 01:42:01,054 --> 01:42:01,721 CO-TREATMENT OF THE INSOMNIA 2155 01:42:01,721 --> 01:42:04,958 TREATMENT IN WOMEN WITH COMISA 2156 01:42:04,958 --> 01:42:07,627 AND WITH WEIGHT MANAGEMENT 2157 01:42:07,627 --> 01:42:12,666 THERE'S SEX DIFFERENCES. 2158 01:42:12,666 --> 01:42:17,604 GLP1 AND WE SAW THE STUDY WITH 2159 01:42:17,604 --> 01:42:19,639 HOW SLEEP APNEA IMPROVES AND 2160 01:42:19,639 --> 01:42:21,374 THERE'S SEX DIFFERENCES EVEN 2161 01:42:21,374 --> 01:42:24,844 WITH GLP1 RECEPTOR AGONIST WITH 2162 01:42:24,844 --> 01:42:28,081 WOMEN TYPICALLY LOSING MORE THAN 2163 01:42:28,081 --> 01:42:28,448 THE MEN. 2164 01:42:28,448 --> 01:42:31,651 WHAT WAS NEW TO ME WAS THE FACT 2165 01:42:31,651 --> 01:42:34,020 THAT THAT WEIGHT LOSS ACTUALLY 2166 01:42:34,020 --> 01:42:36,523 DROPS OFF IN WOMEN IN THEIR 2167 01:42:36,523 --> 01:42:37,324 LATER MOST MENOPAUSAL YEARS 2168 01:42:37,324 --> 01:42:40,327 AFTER THE AGE OF ABOUT 65 THE 2169 01:42:40,327 --> 01:42:41,361 WEIGHT LOSS REALLY SLOWS DOWN. 2170 01:42:41,361 --> 01:42:44,965 YOU MAY NOT SEE THE SAME EFFECT 2171 01:42:44,965 --> 01:42:47,534 IN WOMEN AGE 65 AND BEYOND. 2172 01:42:47,534 --> 01:42:50,203 >> WE HAVE PROBABLY ONE TO TWO 2173 01:42:50,203 --> 01:42:50,804 MINUTES, PLEASE. 2174 01:42:50,804 --> 01:42:52,372 >> GOT IT. 2175 01:42:52,372 --> 01:42:55,041 I'LL RUN THROUGH THIS QUICKLY. 2176 01:42:55,041 --> 01:42:56,443 OUTCOMES WITH PAP THERAPY OR 2177 01:42:56,443 --> 01:42:59,012 TREATMENT, THIS IS A VERY NICE 2178 01:42:59,012 --> 01:43:07,554 STUDY FROM 2012 OVER 1,000 2179 01:43:07,554 --> 01:43:07,754 WOMEN. 2180 01:43:07,754 --> 01:43:12,726 CPAP HELPS FOR BOTH GROUPS. 2181 01:43:12,726 --> 01:43:14,427 THIS IS OUR OWN STUDY 2182 01:43:14,427 --> 01:43:16,796 DR. DRPUNJABI AND I WAB FORTUNAE 2183 01:43:16,796 --> 01:43:20,433 ENOUGH TO DO TO LOOK AT GLYCEMIC 2184 01:43:20,433 --> 01:43:25,472 VARIABILITY IN MEN AND WOMEN 2185 01:43:25,472 --> 01:43:26,640 WITH SLEEP APNEA AND TYPE II 2186 01:43:26,640 --> 01:43:29,042 DIABETES AND THERE WAS ALMOST AN 2187 01:43:29,042 --> 01:43:31,711 EQUAL SPLIT OF MEN AND WOMEN AND 2188 01:43:31,711 --> 01:43:34,381 WE SAW WOMEN SEEMED TO RESPOND 2189 01:43:34,381 --> 01:43:36,683 TO THREE MONTHS OF PAP THERAPY 2190 01:43:36,683 --> 01:43:37,550 IN TERMS OF STANDARD DEVIATION 2191 01:43:37,550 --> 01:43:47,560 AND THE MEN DIDN'T. 2192 01:43:47,560 --> 01:43:49,996 AND GLUCOSE LEVELS IS 2193 01:43:49,996 --> 01:43:50,897 INTERESTING AND SPURRED MY 2194 01:43:50,897 --> 01:43:52,899 INTEREST IN SEX-SPECIFIC 2195 01:43:52,899 --> 01:44:03,443 DIFFERENCES IN OSA AND OUTCOMES. 2196 01:44:04,511 --> 01:44:06,746 THESE ARE THE BIG C PAP RCT 2197 01:44:06,746 --> 01:44:07,914 TRIALS THAT HAVE COME OUT IN THE 2198 01:44:07,914 --> 01:44:08,915 LAST TWO DECADE. 2199 01:44:08,915 --> 01:44:11,584 YOU CAN SEE THE PERCENTAGE OF 2200 01:44:11,584 --> 01:44:15,588 WOMEN IN THIS IS KIND OF 2201 01:44:15,588 --> 01:44:17,390 EMBARRASSING ALMOST. 2202 01:44:17,390 --> 01:44:20,026 THE MOST IS MAYBE A THIRD. 2203 01:44:20,026 --> 01:44:22,095 I SHARED THIS WITH WOMEN FROM MY 2204 01:44:22,095 --> 01:44:24,964 STUDY AND THEY'RE ALWAYS AMAZED. 2205 01:44:24,964 --> 01:44:26,766 THEY GET SO EXCITED ABOUT 2206 01:44:26,766 --> 01:44:29,336 PARTICIPATING IN TRIALS AND 2207 01:44:29,336 --> 01:44:30,136 CHANGING THESE NUMBERS. 2208 01:44:30,136 --> 01:44:32,439 I THINK THAT IS WHERE WE CAN 2209 01:44:32,439 --> 01:44:34,074 TRULY, TRULY MAKE A DIFFERENCE 2210 01:44:34,074 --> 01:44:37,610 AND MOVE THE FIELD FORWARD IS 2211 01:44:37,610 --> 01:44:38,745 GETTING MORE WOMEN EXCITED ABOUT 2212 01:44:38,745 --> 01:44:40,280 PARTICIPATING IN OUR STUDIES. 2213 01:44:40,280 --> 01:44:46,119 SO WITH THAT I'M GOING TO STOP. 2214 01:44:46,119 --> 01:44:50,256 I'LL GIVE IT BACK TO YOU. 2215 01:44:50,256 --> 01:44:54,127 >> YOUR LAST SLIDE IS INCREDIBLY 2216 01:44:54,127 --> 01:44:54,394 IMPACTFUL. 2217 01:44:54,394 --> 01:44:56,129 I LIKE THE NO DATA COLUMN IN 2218 01:44:56,129 --> 01:44:57,831 WOMEN. 2219 01:44:57,831 --> 01:45:01,801 MY APOLOGIES AGAIN FOR YOUR 2220 01:45:01,801 --> 01:45:03,403 AFFILIATION OBVIOUSLY RUTGER'S 2221 01:45:03,403 --> 01:45:06,039 LOSS AND NYU'S GAIN, THANK YOU. 2222 01:45:06,039 --> 01:45:08,208 FOR THOSE ON THE CALL OR IN THE 2223 01:45:08,208 --> 01:45:10,343 WEBCAST IN PREPARATION FOR THE 2224 01:45:10,343 --> 01:45:11,177 QUESTION AND ANSWER SESSION 2225 01:45:11,177 --> 01:45:12,278 WHICH WE WILL HAVE AFTER OUR 2226 01:45:12,278 --> 01:45:14,447 NEXT SPEAKER, IF YOU HAVE A 2227 01:45:14,447 --> 01:45:17,417 QUESTION, YOU CAN PLACE IT INTO 2228 01:45:17,417 --> 01:45:18,852 THE Q&A BOX. 2229 01:45:18,852 --> 01:45:20,420 PLEASE DON'T USE THE CHAT. 2230 01:45:20,420 --> 01:45:21,521 PLEASE PUT THEM IN THE Q&A BOX 2231 01:45:21,521 --> 01:45:22,322 YOU'LL ALSO SEE. 2232 01:45:22,322 --> 01:45:24,023 SO IF YOU'RE STARTING TO THINK 2233 01:45:24,023 --> 01:45:25,892 OF QUESTIONS FOR THE NEXT 2234 01:45:25,892 --> 01:45:27,827 SESSION, YOU CAN START PUTTING 2235 01:45:27,827 --> 01:45:32,165 THOSE IN. 2236 01:45:32,165 --> 01:45:35,568 LET ME INTRODUCE OUR SESSION'S 2237 01:45:35,568 --> 01:45:39,339 LAST SPEAKER DR. PAUL MACEY. 2238 01:45:39,339 --> 01:45:40,907 PROFESSOR AND DIRECTOR THE THE 2239 01:45:40,907 --> 01:45:42,876 UCLA SCHOOL OF NURSING. 2240 01:45:42,876 --> 01:45:45,645 HIS PRESENTATION IS TITLED SEX 2241 01:45:45,645 --> 01:45:46,679 GENDER DIFFERENCES IN COGNITION 2242 01:45:46,679 --> 01:45:48,848 IN MIDDLE AGE AND OLDER ADULTS 2243 01:45:48,848 --> 01:45:49,349 WITH OSAs. 2244 01:45:49,349 --> 01:45:53,086 WE'RE MOVING RIGHT DOWN THE AGE 2245 01:45:53,086 --> 01:45:53,420 SPECTRUM. 2246 01:45:53,420 --> 01:45:55,655 IF YOU'RE ABLE TO SHARE YOUR 2247 01:45:55,655 --> 01:46:05,932 SLIDES, PLEASE. 2248 01:46:20,647 --> 01:46:23,516 ING 2249 01:46:25,051 --> 01:46:28,054 >> IT'S BEEN GREAT HEARING THE 2250 01:46:28,054 --> 01:46:29,456 TALKS TODAY. 2251 01:46:29,456 --> 01:46:33,092 SO, THIS IS A FEW MINUTES TO 2252 01:46:33,092 --> 01:46:39,032 THINK ABOUT COGNITION AND HOW 2253 01:46:39,032 --> 01:46:49,576 THAT VARIES AND REALLY WHAT DO 2254 01:47:00,086 --> 01:47:02,856 WE THINK OF IN COGNITION? 2255 01:47:02,856 --> 01:47:07,927 WE CAN SAY MEMORY, ATTENTION, 2256 01:47:07,927 --> 01:47:09,796 EXECUTIVE FUNCTION, PROCESSING 2257 01:47:09,796 --> 01:47:11,564 FIELD. 2258 01:47:11,564 --> 01:47:17,837 THE FIELD OF COGNITION IS E 2259 01:47:17,837 --> 01:47:18,371 ENORM 2260 01:47:18,371 --> 01:47:18,638 ENORMOUS. 2261 01:47:18,638 --> 01:47:19,572 I FIND IT INTERESTING TALKING TO 2262 01:47:19,572 --> 01:47:21,007 PATIENTS WHO COME AND JOIN OUR 2263 01:47:21,007 --> 01:47:22,475 STUDIES AND THE THINGS THEY TALK 2264 01:47:22,475 --> 01:47:23,576 ABOUT A LOT IS RELATED TO 2265 01:47:23,576 --> 01:47:29,549 COGNITION. 2266 01:47:29,549 --> 01:47:35,321 92% OF WOMEN TALK ABOUT 2267 01:47:35,321 --> 01:47:41,728 DIFFICULTIES AT WORK. 2268 01:47:41,728 --> 01:47:43,630 IT INCLUDES THINKING AND BEING 2269 01:47:43,630 --> 01:47:45,331 ON TOP OF THINGS SO COGNITION IS 2270 01:47:45,331 --> 01:47:45,932 AN IMPORTANT OUTCOME TO MANY 2271 01:47:45,932 --> 01:47:52,939 PATIENTS. 2272 01:47:52,939 --> 01:47:54,574 I'LL GO INTO SOME DETAILS BUT 2273 01:47:54,574 --> 01:47:57,744 THERE'S MANY STUDIES THAT LOOK 2274 01:47:57,744 --> 01:48:01,047 AT COGNITION. 2275 01:48:01,047 --> 01:48:08,388 THERE'S NOT A LOT OF CONSISTENT 2276 01:48:08,388 --> 01:48:18,565 MEASURES. 2277 01:48:23,503 --> 01:48:25,438 AND THERE'S IMIN MEN THERE'S 2278 01:48:25,438 --> 01:48:29,042 MORE DECLINE IN EXECUTIVE 2279 01:48:29,042 --> 01:48:31,844 FUNCTION AND VERBAL MEMORY AND 2280 01:48:31,844 --> 01:48:35,348 WOMEN MAY EXPERIENCE MORE BLOW 2281 01:48:35,348 --> 01:48:37,216 NOUNCED EFFECTS ATTENTION AND 2282 01:48:37,216 --> 01:48:40,853 VERBAL MEMORY AND CERTAINLY WITH 2283 01:48:40,853 --> 01:48:45,692 AGE THIS IS COMPOUND WITH SLEEP 2284 01:48:45,692 --> 01:48:48,795 APNEA AND SEX BUT WE HAVE 2285 01:48:48,795 --> 01:48:50,063 STUDIES SHOWING HIGHER SEVERITY 2286 01:48:50,063 --> 01:48:53,132 IN SLEEP APNEA ASSOCIATED WITH 2287 01:48:53,132 --> 01:48:55,568 WORSE PERFORMANCE EVEN WITH THE 2288 01:48:55,568 --> 01:48:58,304 AHI WHICH IS NOT AN AGREE 2289 01:48:58,304 --> 01:48:59,572 MEASURE AS WE'VE HEARD. 2290 01:48:59,572 --> 01:49:05,678 IN TERMS OF INTERACTIONS, OVER 2291 01:49:05,678 --> 01:49:07,547 TIME MEN MAY SHOW GREATER AGE 2292 01:49:07,547 --> 01:49:13,886 RELATED AFFECTS WITH THE SLEEP 2293 01:49:13,886 --> 01:49:15,421 APNEA AND WOMEN SHOWING MORE 2294 01:49:15,421 --> 01:49:16,422 GENERAL PATTERNS. 2295 01:49:16,422 --> 01:49:17,023 THERE'S A LOT OF VARIABILITY 2296 01:49:17,023 --> 01:49:23,563 HERE. 2297 01:49:23,563 --> 01:49:33,940 IS THIS IS AN EXAMPLE. 2298 01:49:34,540 --> 01:49:36,609 THERE'S HUNDREDS OF STUDIES 2299 01:49:36,609 --> 01:49:38,811 WHERE SOMEONE GOES AND DOES A 2300 01:49:38,811 --> 01:49:39,012 TEST. 2301 01:49:39,012 --> 01:49:41,981 THIS IS SOMETHING WE DO A SHORT 2302 01:49:41,981 --> 01:49:42,515 MEMORY TEST. 2303 01:49:42,515 --> 01:49:47,387 IT'S NOT REALLY DESIGN FOR 2304 01:49:47,387 --> 01:49:49,255 GENERAL COGNITIVE PERFORMANCE 2305 01:49:49,255 --> 01:49:51,057 BUT IT IS USED BECAUSE IT ONLY 2306 01:49:51,057 --> 01:49:54,127 TAKES A FEW MINUTES OPPOSED TO 2307 01:49:54,127 --> 01:49:55,561 SEVERAL HOURS AS A COGNITIVE 2308 01:49:55,561 --> 01:49:55,762 TEST. 2309 01:49:55,762 --> 01:49:57,764 THERE'S A COUPLE OF AREAS THAT 2310 01:49:57,764 --> 01:50:01,000 SHOW UP AS DELAYED RECALL AND 2311 01:50:01,000 --> 01:50:03,569 ATTENTION AS IMPACTED AND THEN 2312 01:50:03,569 --> 01:50:06,072 WE SEE WHEN WE SEPARATE OUT WE 2313 01:50:06,072 --> 01:50:07,473 SHOULD BE SEPARATING OUT WOMEN 2314 01:50:07,473 --> 01:50:12,745 FROM MEN AND WOMEN HAVE A LOWER 2315 01:50:12,745 --> 01:50:13,880 DELAYED RECALL. 2316 01:50:13,880 --> 01:50:14,580 AND IT'S LIKE LOWER. 2317 01:50:14,580 --> 01:50:16,449 IT'S NOT HUGE AND THERE'S MANY 2318 01:50:16,449 --> 01:50:21,421 STUDIES THAT WILL SHOW SOME 2319 01:50:21,421 --> 01:50:23,356 EFFECTS AND -- I DID PULL OUT 2320 01:50:23,356 --> 01:50:28,494 THIS RECENT ONE THAT LOOKED AT A 2321 01:50:28,494 --> 01:50:31,397 LARGE NUMBER AND TO LOOK AT 2322 01:50:31,397 --> 01:50:34,467 WELL, WHEN WE LOOK AT THE LIVE 2323 01:50:34,467 --> 01:50:42,241 SCAN WHAT CAN WE SEE? 2324 01:50:42,241 --> 01:50:46,479 THIS IS LOOKING AT 250,000 2325 01:50:46,479 --> 01:50:51,350 PEOPLE AND WHAT THEY FIND IN 2326 01:50:51,350 --> 01:50:53,319 FEMALES ARE SAYING THERE'S HIGH 2327 01:50:53,319 --> 01:50:59,559 RISK OF PRELIMIDEALING WITH NOV 2328 01:50:59,559 --> 01:51:00,526 SITUATIONS, SHORT MEMORY AND IF 2329 01:51:00,526 --> 01:51:04,464 YOU LOOK AT THE EFFECT SIZES AND 2330 01:51:04,464 --> 01:51:09,569 THE SIGNIFICANCE YOU SEE THOUGH 2331 01:51:09,569 --> 01:51:10,837 THERE'S SIGNIFICANCE 2332 01:51:10,837 --> 01:51:13,873 STATISTICALLY IT'S ONLY THIS ONE 2333 01:51:13,873 --> 01:51:17,577 THAT STAND OUT CONTROLLING FOR 2334 01:51:17,577 --> 01:51:19,746 FACTORS AND WITH MALES NOT A 2335 01:51:19,746 --> 01:51:21,247 STRONG ASSOCIATION BETWEEN SLEEP 2336 01:51:21,247 --> 01:51:23,549 APNEA AND IMPAIRMENT. 2337 01:51:23,549 --> 01:51:28,488 IT'S A LITTLE BIT SURPRISING BUT 2338 01:51:28,488 --> 01:51:32,325 IT MAY BE BECAUSE OF THE BIG 2339 01:51:32,325 --> 01:51:41,534 HETEROGENEITY AND THE COGNITION. 2340 01:51:41,534 --> 01:51:44,871 WHY MIGHT BE THE SEX DIFFERENCES 2341 01:51:44,871 --> 01:51:45,104 WE SEE? 2342 01:51:45,104 --> 01:51:48,975 THE AUTOMATIC THING I HEAR ARE 2343 01:51:48,975 --> 01:51:50,243 HORMONAL DIFFERENCES AND WE 2344 01:51:50,243 --> 01:51:58,484 HEARD ABOUT THE PATHOPHYSIOLOGY 2345 01:51:58,484 --> 01:52:02,522 AND I LOOK AT THE BRAIN AND THE 2346 01:52:02,522 --> 01:52:03,589 DIFFERENT DISEASE 2347 01:52:03,589 --> 01:52:06,058 CHARACTERISTICS BETWEEN MEN AND 2348 01:52:06,058 --> 01:52:13,766 WOMEN WOULD IT RELATE TO 2349 01:52:13,766 --> 01:52:14,100 COGNITION. 2350 01:52:14,100 --> 01:52:20,807 THIS IS MY AREA AND WE REPRESENT 2351 01:52:20,807 --> 01:52:22,475 IN GRAY AREAS THAT SHOW A 2352 01:52:22,475 --> 01:52:23,176 DIFFERENCE. 2353 01:52:23,176 --> 01:52:28,114 WHAT I'VE PUT IS TWO PANELS. 2354 01:52:28,114 --> 01:52:31,551 SO THIS IS THREE ANGLES AND THE 2355 01:52:31,551 --> 01:52:35,588 GRAY AREAS ARE A SIGN WHERE THE 2356 01:52:35,588 --> 01:52:40,326 BRAIN IS REDUCING LIKE GETTING 2357 01:52:40,326 --> 01:52:43,830 SLIGHT THINNER AND SMALLER AND 2358 01:52:43,830 --> 01:52:46,766 ON SHOWING THE ABLE AND THE 2359 01:52:46,766 --> 01:52:49,402 AFFECT OF SLEEP APNEA. 2360 01:52:49,402 --> 01:52:50,369 BASICALLY I THINK AN IMPORTANT 2361 01:52:50,369 --> 01:52:53,372 MESSAGE IS ONE, WE CAN SEE THE 2362 01:52:53,372 --> 01:52:56,876 BRAIN IS AFFECTED IN SLEEP APNEA 2363 01:52:56,876 --> 01:52:59,111 AND THE SLIDE IT WAS EARLY ON 2364 01:52:59,111 --> 01:53:00,913 BUT MAYBE THE EFFECT IS SIMILAR 2365 01:53:00,913 --> 01:53:01,814 IT AGE. 2366 01:53:01,814 --> 01:53:07,453 THE IDEA THAT AGE MIGHT -- WE'RE 2367 01:53:07,453 --> 01:53:11,557 NOT SEEING A MASSIVE IMPACT IN 2368 01:53:11,557 --> 01:53:15,161 THE BRAIN SOME CHANGE AND SOME 2369 01:53:15,161 --> 01:53:19,565 PEOPLE TALK ABOUT OSA 2370 01:53:19,565 --> 01:53:29,108 EXACERBATING AGING EFFECTS. 2371 01:53:29,108 --> 01:53:33,613 WHEN WE THINK OF COGNITION WE 2372 01:53:33,613 --> 01:53:35,481 THINK OF THE HIPPOCAMPUS AND WE 2373 01:53:35,481 --> 01:53:39,185 DID A HYPOTHESIS GENERATING 2374 01:53:39,185 --> 01:53:41,654 STUDY THAT DID SHOW IN A SMALL 2375 01:53:41,654 --> 01:53:43,389 NUMBER OF PEOPLE THERE WERE 2376 01:53:43,389 --> 01:53:44,891 CHANGES IN THE HIPPOCAMPUS AND 2377 01:53:44,891 --> 01:53:47,827 THIS IS HOW ITS REPRESENTED THE 2378 01:53:47,827 --> 01:53:50,529 COLOR ON THE BACKGROUND 2379 01:53:50,529 --> 01:53:52,732 REPRESENTING AREAS WHERE THERE'S 2380 01:53:52,732 --> 01:53:55,768 A SMALLER HIPPOCAMPUS THAN OTHER 2381 01:53:55,768 --> 01:53:55,968 AREAS. 2382 01:53:55,968 --> 01:54:00,506 AND A COUPLE MORE STUDIES. 2383 01:54:00,506 --> 01:54:01,741 THERE WAS A COLLABORATION 2384 01:54:01,741 --> 01:54:03,576 BETWEEN EUROPEAN AND AUSTRALIAN 2385 01:54:03,576 --> 01:54:07,546 GROUP WHERE THEY LOOKED AT 2386 01:54:07,546 --> 01:54:10,149 POSTMORTEM PEOPLE AND THE 2387 01:54:10,149 --> 01:54:13,452 OUTLINES ARE OF THE HIPPOCAMPUS 2388 01:54:13,452 --> 01:54:20,760 AND THIS UPSIDE-DOWN HOOK SHAPE 2389 01:54:20,760 --> 01:54:22,428 SHOWED PEOPLE WITH SLEEP APNEA 2390 01:54:22,428 --> 01:54:25,665 HAD A SMALLER HIPPOCAMPUS AND A 2391 01:54:25,665 --> 01:54:29,168 FOUND A RECENT STUDY USING A 2392 01:54:29,168 --> 01:54:32,371 EUROPEAN DATA BANK LOOKING AT A 2393 01:54:32,371 --> 01:54:34,373 LARGER NUMBER OF SLEEP APNEA 2394 01:54:34,373 --> 01:54:35,574 PATIENTS OVER 20,000. 2395 01:54:35,574 --> 01:54:38,344 AND WHAT'S INTERESTING IS THEY 2396 01:54:38,344 --> 01:54:40,479 FOUND THIS EFFECT ON THE 2397 01:54:40,479 --> 01:54:45,284 HIPPOCAMPUS AND IT'S A 2398 01:54:45,284 --> 01:54:47,186 STATISTICAL NUMBER BUT IT'S 34 2399 01:54:47,186 --> 01:54:51,557 WHEREAS ALL THE OTHER AREAS WERE 2400 01:54:51,557 --> 01:54:55,962 13, 9, 8, 7. 2401 01:54:55,962 --> 01:54:58,264 IN THE LARGE STUDY IT SHOWED A 2402 01:54:58,264 --> 01:55:01,867 DIFFERENCE IN THE HIPPOCAMPUS. 2403 01:55:01,867 --> 01:55:06,238 IF I COULD DO A FACE SLAP EMOJI 2404 01:55:06,238 --> 01:55:11,577 I WOULD BECAUSE THERE'S NO 2405 01:55:11,577 --> 01:55:15,147 DIFFERENCE HERE IN THESE STUDIES 2406 01:55:15,147 --> 01:55:22,488 AND WE LOOKED AT A LARGER COHORT 2407 01:55:22,488 --> 01:55:27,560 AND LOOKED AT JUST THE 2408 01:55:27,560 --> 01:55:29,161 HIPPOCAMPUS. 2409 01:55:29,161 --> 01:55:30,563 IT WAS UNDER 100 SLEEP APNEA 2410 01:55:30,563 --> 01:55:33,432 SUBJECTS AND COMPARED IT TO 900 2411 01:55:33,432 --> 01:55:33,966 CONTROLS. 2412 01:55:33,966 --> 01:55:35,634 THIS IS THE SHAPE OF THE 2413 01:55:35,634 --> 01:55:37,970 HIPPOCAMPUS AND THE COLORED 2414 01:55:37,970 --> 01:55:40,406 AREAS SHOWED WHERE THERE'S A 2415 01:55:40,406 --> 01:55:42,308 CHANGE IN THE HIPPOCAMPUS. 2416 01:55:42,308 --> 01:55:44,877 WHEN WE FIRST LOOK AT IT 2417 01:55:44,877 --> 01:55:45,845 COMBINED WE SEE THESE 2418 01:55:45,845 --> 01:55:49,048 COROLLARIES ON THE LEFT IS A 2419 01:55:49,048 --> 01:55:49,415 FEW. 2420 01:55:49,415 --> 01:55:53,386 WHEN WE SEPARATE IT OUT AND SAID 2421 01:55:53,386 --> 01:55:57,723 WELL, LET'S JUST LOOK AT THE 2422 01:55:57,723 --> 01:56:00,326 HEALTHY NON ASSIGNED FEMALES 2423 01:56:00,326 --> 01:56:01,994 THAT HAVE THE CONDITION. 2424 01:56:01,994 --> 01:56:03,662 WHAT STANDS OUT IS MORE COLORED 2425 01:56:03,662 --> 01:56:04,463 AREAS. 2426 01:56:04,463 --> 01:56:07,566 THAT MEANS WE SEE -- WE ARE 2427 01:56:07,566 --> 01:56:09,835 SENSITIVE TO THE EFFECT OF SLEEP 2428 01:56:09,835 --> 01:56:10,469 APNEA HAPPENING SPECIFICALLY IN 2429 01:56:10,469 --> 01:56:12,405 THE FEMALES. 2430 01:56:12,405 --> 01:56:20,079 SO THIS WAS VERY STRIKING TO US. 2431 01:56:20,079 --> 01:56:25,751 IT'S LIKE IF YOU LOOK AT THE 2432 01:56:25,751 --> 01:56:27,553 BRAIN YOU DON'T SEE THE FULL 2433 01:56:27,553 --> 01:56:30,056 EFFECT BUT IF YOU ASK THE 2434 01:56:30,056 --> 01:56:31,357 QUESTION WHAT HAPPENS IN WOMEN 2435 01:56:31,357 --> 01:56:34,727 AND MEN YOU DETECT MORE GOING ON 2436 01:56:34,727 --> 01:56:40,499 AND SIMILAR WITH MALES. 2437 01:56:56,248 --> 01:57:00,286 SO, WE FOUND THERE WAS NO 2438 01:57:00,286 --> 01:57:08,227 SIGNIFICANT EFFECT BRAIN 2439 01:57:08,227 --> 01:57:10,529 STRUCTURE AND COGNITIVE 2440 01:57:10,529 --> 01:57:13,365 PERFORMANCE AND THEY'RE SAYING 2441 01:57:13,365 --> 01:57:14,800 MAYBE THERE'S NOT MUCH 2442 01:57:14,800 --> 01:57:15,101 DIFFERENCE. 2443 01:57:15,101 --> 01:57:17,002 ONE THING WE CAN TAKE FROM THIS 2444 01:57:17,002 --> 01:57:23,943 IS WHILE IT'S NICE TO SEE THE 2445 01:57:23,943 --> 01:57:25,044 HIPPOCAMPAL DIFFERENCE IT'S NOT 2446 01:57:25,044 --> 01:57:27,546 THE CAUSE OF COGNITIVE SYMPTOMS. 2447 01:57:27,546 --> 01:57:37,957 SO WHAT ABOUT TREATMENT? 2448 01:57:44,864 --> 01:57:47,566 THIS IS ONE STUDY HIGHLIGHTED IN 2449 01:57:47,566 --> 01:57:54,406 GREEN THE VALUES THAT SHOW A 2450 01:57:54,406 --> 01:57:58,410 SIGNIFICANT IMPACT FOR SIX 2451 01:57:58,410 --> 01:58:00,513 MONTHS OF C PAP TREATMENT IN 2452 01:58:00,513 --> 01:58:01,780 DIFFERENT COGNITIVE AREAS. 2453 01:58:01,780 --> 01:58:06,819 AND WHAT ABOUT OTHER TREATMENTS? 2454 01:58:06,819 --> 01:58:10,523 WELL, WHAT ABOUT HORMONES? 2455 01:58:10,523 --> 01:58:15,227 AGAIN, THIS IS SORT OF THE 2456 01:58:15,227 --> 01:58:15,961 AUTOMATIC RESPONSE, WHAT HAPPENS 2457 01:58:15,961 --> 01:58:18,197 WITH TESTOSTERONE AND IS THERE 2458 01:58:18,197 --> 01:58:20,332 LINK OUTSIDE OF OSA. 2459 01:58:20,332 --> 01:58:25,571 MAYBE IT CAN HELP MEN WITH LOW 2460 01:58:25,571 --> 01:58:25,905 TESTOSTERONE. 2461 01:58:25,905 --> 01:58:32,978 COGNITION IS NOT IMPACTED. 2462 01:58:32,978 --> 01:58:34,547 HRT, THERE MAY BE A DIRECTION 2463 01:58:34,547 --> 01:58:38,083 TOWARDS IMPROVEMENT BUT NOT AN 2464 01:58:38,083 --> 01:58:39,552 IMPACT AND WHAT'S INTERESTING 2465 01:58:39,552 --> 01:58:42,354 AND A THOUGHT EXPERIMENT IS WHAT 2466 01:58:42,354 --> 01:58:46,559 HAPPENS WHEN YOU GIVE HORMONES 2467 01:58:46,559 --> 01:58:51,497 AND TESTOSTERONE FOR FEMALES AT 2468 01:58:51,497 --> 01:58:54,166 BIRTH META-ANALYSIS SHOWS IT 2469 01:58:54,166 --> 01:58:57,703 LEANS TO THE RIGHT AND VISUAL 2470 01:58:57,703 --> 01:58:59,605 SPATIAL IMPROVES SLIGHTLY TO 2471 01:58:59,605 --> 01:59:01,740 MAYBE TESTOSTERONE IS RELATED TO 2472 01:59:01,740 --> 01:59:03,576 THIS SEX SPECIFIC DIFFERENCE BUT 2473 01:59:03,576 --> 01:59:06,078 THEN IF WE LOOK AT ESTROGEN AND 2474 01:59:06,078 --> 01:59:09,548 FEMALE HORMONES GIVEN TO MALE 2475 01:59:09,548 --> 01:59:11,984 ASSIGNED AT BIRTH WE SEE AN 2476 01:59:11,984 --> 01:59:12,284 IMPROVEMENT. 2477 01:59:12,284 --> 01:59:15,554 IT'S NOT LIKE A CORRELATED 2478 01:59:15,554 --> 01:59:16,322 EFFECT. 2479 01:59:16,322 --> 01:59:22,328 SO THE TAKE HOME IS THEY HAVE AN 2480 01:59:22,328 --> 01:59:24,363 IMPACT ON SLEEP APNEA AND IT'S 2481 01:59:24,363 --> 01:59:26,131 NOT ONE DIRECTION SO IT'S NOT A 2482 01:59:26,131 --> 01:59:26,765 SIMPLE ANSWER. 2483 01:59:26,765 --> 01:59:28,100 AGAIN WE LOOK AMOUNT WHAT DO 2484 01:59:28,100 --> 01:59:29,935 PEOPLE TALK ABOUT? 2485 01:59:29,935 --> 01:59:32,938 THERE'S THE COGNITIVE ISSUES AND 2486 01:59:32,938 --> 01:59:37,977 SLEEPINESS AND FOGGINESS AND 2487 01:59:37,977 --> 01:59:38,677 DIFFICULTY AND DISTRESS. 2488 01:59:38,677 --> 01:59:44,984 MANY SHOW COGNITION IS IMPAIRED 2489 01:59:44,984 --> 01:59:50,089 BY STRESS. 2490 01:59:50,089 --> 01:59:55,527 WE ALSO KNOW SLEEP CAN CAUSE 2491 01:59:55,527 --> 01:59:59,398 AFFECT AND IF THAT WAS TRUE THEN 2492 01:59:59,398 --> 02:00:01,567 WHAT WE SEE IN THE SAME 2493 02:00:01,567 --> 02:00:04,270 AUSTRALIAN STUDY WE SEE BIG 2494 02:00:04,270 --> 02:00:06,872 DROPS IN STRESS AND WHEN WE LOOK 2495 02:00:06,872 --> 02:00:09,441 AT THE EFFECT SIZES OF COGNITION 2496 02:00:09,441 --> 02:00:10,909 THEY'RE NOT VERY BIG. 2497 02:00:10,909 --> 02:00:14,713 IN OTHER WORDS, YES, WE IMPROVED 2498 02:00:14,713 --> 02:00:17,816 FROM REDUCED STRESS BUT DON'T 2499 02:00:17,816 --> 02:00:19,785 GET A LOT OF DIFFERENCE IN 2500 02:00:19,785 --> 02:00:21,520 COGNITION SO PROBABLY NOT A 2501 02:00:21,520 --> 02:00:23,322 LARGE IMPACT THERE. 2502 02:00:23,322 --> 02:00:25,024 SO THEN THE LAST PLACE I WANT TO 2503 02:00:25,024 --> 02:00:26,425 GO WITH THIS IS WHAT MIGHT HELP 2504 02:00:26,425 --> 02:00:30,763 AND THIS IS REALLY THINKING 2505 02:00:30,763 --> 02:00:31,563 AHEAD. 2506 02:00:31,563 --> 02:00:33,065 CPAP IS NOT CONSISTENT BY PERSON 2507 02:00:33,065 --> 02:00:37,469 THE IDEA OF STRESS REDUCTION 2508 02:00:37,469 --> 02:00:39,071 AGAIN MIGHT VARY BY PERSON BUT 2509 02:00:39,071 --> 02:00:41,373 NOT A CAUSAL RANK AND HORMONES 2510 02:00:41,373 --> 02:00:43,475 PROBABLY NOT AND IF WE CONSIDER 2511 02:00:43,475 --> 02:00:45,778 THE IDEA OF AN INDIVIDUAL WITHIN 2512 02:00:45,778 --> 02:00:48,147 THEIR ENVIRONMENT AND WE LOOK AT 2513 02:00:48,147 --> 02:00:51,283 WHAT HELPS OUTSIDE OF SLEEP 2514 02:00:51,283 --> 02:00:53,419 APNEA THERE'S A WHOLE LIST. 2515 02:00:53,419 --> 02:00:58,957 AND PHYSICAL ACTIVITY, COGNITIVE 2516 02:00:58,957 --> 02:01:03,629 DECLINE IS TWICE AS MUCH IN 2517 02:01:03,629 --> 02:01:14,173 ACTIVE VERSUS ACTIVE ADULTS AND 2518 02:01:15,474 --> 02:01:17,409 AND TIME OUTDOORS INCREASES 2519 02:01:17,409 --> 02:01:27,920 COGNITION SIMILAR TO EXERCISE. 2520 02:01:31,290 --> 02:01:33,759 GETTING US TO THINK OUST BEYOND 2521 02:01:33,759 --> 02:01:44,103 THE SLEEP COGNITION. 2522 02:01:59,418 --> 02:02:03,355 AND IS IT GOING TO HELP IN OSA. 2523 02:02:03,355 --> 02:02:12,164 FOOD FOR THOUGHT I HOPE. 2524 02:02:12,164 --> 02:02:17,870 >> THANK YOU, DR. MACEY. 2525 02:02:17,870 --> 02:02:19,738 A COUPLE HOUSEKEEPING, AS NOT 2526 02:02:19,738 --> 02:02:21,640 COMMON IN THESE THINGS WE'RE 2527 02:02:21,640 --> 02:02:23,342 RUNNING A LITTLE BIT BEHIND AND 2528 02:02:23,342 --> 02:02:25,677 HAVE QUESTIONS FOR THE PANEL FOR 2529 02:02:25,677 --> 02:02:29,314 THE NEXT EIGHT MINUTES AND HAVE 2530 02:02:29,314 --> 02:02:31,216 A TEN INSTEAD OF 15 MINUTE 2531 02:02:31,216 --> 02:02:31,550 BREAK. 2532 02:02:31,550 --> 02:02:33,652 SOME SPEAKERS HAVE HAD TO LEAVE 2533 02:02:33,652 --> 02:02:35,587 AND SO I THINK I'LL SPEAK FOR 2534 02:02:35,587 --> 02:02:36,989 ALL OF THEM WHEN SAYING IF ANY 2535 02:02:36,989 --> 02:02:39,525 OF OF YOU HAVE QUESTIONS, YOU 2536 02:02:39,525 --> 02:02:42,394 COULD DIRECT THEM TO THE 2537 02:02:42,394 --> 02:02:43,896 SPEAKERS' E-MAIL FOR A QUESTION 2538 02:02:43,896 --> 02:02:44,129 OFFLINE. 2539 02:02:44,129 --> 02:02:48,434 I ALSO WANT TO INTRODUCE FIVE 2540 02:02:48,434 --> 02:02:49,868 DISCUSSANTS WE'VE INVITED FOR 2541 02:02:49,868 --> 02:02:52,204 FIVE DAYS OF THE WORKSHOP I WANT 2542 02:02:52,204 --> 02:02:58,510 TO THANK PATRICK, MIJI, HAMIDI 2543 02:02:58,510 --> 02:03:00,112 AND DIEGO AND OTHERS FOR THEIR 2544 02:03:00,112 --> 02:03:01,613 CONTRIBUTIONS AS WELL. 2545 02:03:01,613 --> 02:03:02,181 THERE'S QUESTIONS IN THE 2546 02:03:02,181 --> 02:03:04,049 QUESTION AND ANSWER. 2547 02:03:04,049 --> 02:03:07,486 I WOULD LIKE TO ASK THE FIRST 2548 02:03:07,486 --> 02:03:08,454 QUESTION WHICH COMES FROM DIEGO 2549 02:03:08,454 --> 02:03:11,557 BUT I THINK FROM A COUPLE PEOPLE 2550 02:03:11,557 --> 02:03:14,760 AND I'LL ASK DR. MACEY AND MAYBE 2551 02:03:14,760 --> 02:03:23,168 DR. ISAIAH BUT I THINK ONE THING 2552 02:03:23,168 --> 02:03:26,538 THAT'S BEEN BROUGHT UP IS THE 2553 02:03:26,538 --> 02:03:27,539 DISRUPTION OF SLEEP APNEA. 2554 02:03:27,539 --> 02:03:30,075 IF YOU'VE HAD IT FROM CHILDHOOD 2555 02:03:30,075 --> 02:03:33,045 WHAT'S THE IMPACT ON COGNITION. 2556 02:03:33,045 --> 02:03:40,285 DR. MACEY CAN YOU CONTROL FOR 2557 02:03:40,285 --> 02:03:41,153 HOW LONG SOMEONE'S HAD SLEEP 2558 02:03:41,153 --> 02:03:41,854 APNEA. 2559 02:03:41,854 --> 02:03:45,691 AS WE THINK OF WOMEN WHO MAYBE 2560 02:03:45,691 --> 02:03:47,926 HAVE LESS SLEEP APNEA UNTIL 2561 02:03:47,926 --> 02:03:51,263 MENOPAUSE IS THAT TIME VARIABLE 2562 02:03:51,263 --> 02:03:52,598 DIFFERENT BETWEEN MEN AND WOMEN 2563 02:03:52,598 --> 02:03:55,534 AND THE LONGER TERM IMPACTS. 2564 02:03:55,534 --> 02:03:58,604 MAYBE DR. MACEY FIRST AND THEN 2565 02:03:58,604 --> 02:04:01,240 DR. ISAIAH, THOUGHTS FROM 2566 02:04:01,240 --> 02:04:01,673 CHILDHOOD AS WELL. 2567 02:04:01,673 --> 02:04:04,409 GOOD MY THOUGHT THAT COMES TO 2568 02:04:04,409 --> 02:04:07,579 MIND IS FIRST ON THE COGNITION 2569 02:04:07,579 --> 02:04:13,886 SIDE THERE'S SO MANY WAYS TO 2570 02:04:13,886 --> 02:04:14,586 MEASURE AND MOOSHGERS AND 2571 02:04:14,586 --> 02:04:16,355 MEASURES THAT WE HEARD IN THE 2572 02:04:16,355 --> 02:04:17,589 FIRST TALKS. 2573 02:04:17,589 --> 02:04:18,824 -- MARKERS AND MEASURES WE HEARD 2574 02:04:18,824 --> 02:04:20,959 IN THE FIRST TALKS. 2575 02:04:20,959 --> 02:04:22,594 IF YOU DON'T SLEEP WELL THERE'S 2576 02:04:22,594 --> 02:04:25,264 AN IMMEDIATE IMPACT, THAT'S 2577 02:04:25,264 --> 02:04:27,533 GOING TO AFFECT YOUR PERFORMANCE 2578 02:04:27,533 --> 02:04:29,434 THE NEXT DAY. 2579 02:04:29,434 --> 02:04:31,303 NOW, THEN THERE'S THE QUESTION 2580 02:04:31,303 --> 02:04:37,209 OF SOMETHING DETERIORATING AND I 2581 02:04:37,209 --> 02:04:38,810 SHOWED PICTURES OF CHANGES IN 2582 02:04:38,810 --> 02:04:40,412 THE BRAIN AND OTHER PEOPLE HAVE 2583 02:04:40,412 --> 02:04:41,647 SHOWN THAT TOO. 2584 02:04:41,647 --> 02:04:45,484 SO THE CONCERN THERE WOULD BE 2585 02:04:45,484 --> 02:04:48,754 MAYBE THERE'S SOMETHING THAT'S 2586 02:04:48,754 --> 02:04:51,557 CAUSING A LOT OF DAMAGE AND 2587 02:04:51,557 --> 02:05:02,200 AFFECTS FUNCTION OVER TIME. 2588 02:05:02,200 --> 02:05:12,678 I WISH I WOULD MORE DEFINITE BUT 2589 02:05:14,913 --> 02:05:17,249 AND EXERCISING OUTDOORS WILL IT 2590 02:05:17,249 --> 02:05:21,286 HAVE A THREE OR FOURFOLD 2591 02:05:21,286 --> 02:05:22,120 IMPROVEMENT IN YOUR COGNITION? 2592 02:05:22,120 --> 02:05:26,325 WHAT WOULD IT DO IF WE MEASURED 2593 02:05:26,325 --> 02:05:27,559 COGNITION AND SLEEP APNEA AND 2594 02:05:27,559 --> 02:05:29,494 WOULD IT MATTER HOW LONG YOU HAD 2595 02:05:29,494 --> 02:05:30,095 SLEEP APNEA. 2596 02:05:30,095 --> 02:05:33,365 TO WHAT DEGREE CAN YOU RECOVER 2597 02:05:33,365 --> 02:05:34,967 BACK AND CERTAINLY ANECDOTALLY 2598 02:05:34,967 --> 02:05:38,670 AND I LOVE THE TALK ABOUT THE 2599 02:05:38,670 --> 02:05:43,108 NFA YOU GAVE WITH THE MALE WHO 2600 02:05:43,108 --> 02:05:47,546 COMES IN AT AGE 60 AND STARTS 2601 02:05:47,546 --> 02:05:50,916 USING C PAP AND FEELS 20 YEARS 2602 02:05:50,916 --> 02:05:54,987 YOUNGER AND SUDDENLY THEY 2603 02:05:54,987 --> 02:05:56,221 REALIZE IT WAS JUST SLEEP APNEA 2604 02:05:56,221 --> 02:05:58,357 AND WOULD NEVER HAVE A NIGHT 2605 02:05:58,357 --> 02:06:00,258 WITHOUT C PAP. 2606 02:06:00,258 --> 02:06:03,028 THAT PERSON SO MUCH HAS BEEN 2607 02:06:03,028 --> 02:06:04,129 RECOVERED IT MAKES US THINK EVEN 2608 02:06:04,129 --> 02:06:06,565 IF THEY HAD 20 YEARS OF SLEEP 2609 02:06:06,565 --> 02:06:10,369 APNEA A LOT COULD COME BACK. 2610 02:06:10,369 --> 02:06:14,506 >> LET ME JUMPING IN THERE. 2611 02:06:14,506 --> 02:06:18,477 IT'S INTERESTING AND IN THE CHAT 2612 02:06:18,477 --> 02:06:20,245 WHAT'S REVERSIBLE OR NOT? 2613 02:06:20,245 --> 02:06:23,548 MANY WERE DISAPPOINTED BY THE 2614 02:06:23,548 --> 02:06:24,783 SAVE TRIALS RESULT BUT IF YOU'RE 2615 02:06:24,783 --> 02:06:27,552 TRYING TO AFFECT PATHWAYS THERE 2616 02:06:27,552 --> 02:06:29,688 FOR 10 YEARS AND HAVE CORONARY 2617 02:06:29,688 --> 02:06:33,759 ARTERY DISEASE CAN YOU REVERSE 2618 02:06:33,759 --> 02:06:35,227 THAT OR NOT? 2619 02:06:35,227 --> 02:06:39,564 AND TWO QUESTIONS LINKED, 2620 02:06:39,564 --> 02:06:41,600 DR. ISAIAH, YOU MENTION THE 2621 02:06:41,600 --> 02:06:43,335 BOTTLENECKS OF TESTING. 2622 02:06:43,335 --> 02:06:46,138 IS THERE AN URGENCY LIKE I NEED 2623 02:06:46,138 --> 02:06:48,707 TO FIX THIS NOW BECAUSE OF BRAIN 2624 02:06:48,707 --> 02:06:50,008 DEVELOPMENT OR FUNCTION AT 2625 02:06:50,008 --> 02:06:51,276 SCHOOL AND BEHAVIORAL THINGS AND 2626 02:06:51,276 --> 02:06:54,046 ALSO THERE'S BEEN A COUPLE 2627 02:06:54,046 --> 02:06:57,482 QUESTIONS ABOUT WHAT'S YOUR TAKE 2628 02:06:57,482 --> 02:06:59,317 ON NON-TRADITIONAL FORMS OF 2629 02:06:59,317 --> 02:06:59,951 TESTING FOR CHILDREN I THINK 2630 02:06:59,951 --> 02:07:03,188 THAT WOULD BE A THEME FOR ALL OF 2631 02:07:03,188 --> 02:07:04,122 US HERE AS WELL. 2632 02:07:04,122 --> 02:07:06,324 >> THANK YOU FOR THOSE 2633 02:07:06,324 --> 02:07:07,225 QUESTIONS. 2634 02:07:07,225 --> 02:07:09,194 THEY'RE VERY INTERESTING ONES 2635 02:07:09,194 --> 02:07:14,933 AND ONES I GRAPPLE WITH EVERY 2636 02:07:14,933 --> 02:07:15,100 DAY. 2637 02:07:15,100 --> 02:07:19,771 I'D LIKE TO CITE DR. REDLINE'S 2638 02:07:19,771 --> 02:07:22,174 WORK AND UNDERSTANDING AS FAR AS 2639 02:07:22,174 --> 02:07:23,875 COGNITION'S CONCERNED BASED ON 2640 02:07:23,875 --> 02:07:25,477 THE RESULT FROM CHAT AND PATS 2641 02:07:25,477 --> 02:07:29,981 WHAT WE KNOW SO FAR IS 2642 02:07:29,981 --> 02:07:34,386 SUPPORTIVE CARE IS A BIG BUCKET 2643 02:07:34,386 --> 02:07:35,887 FROM THE REAL WORLD ENVIRONMENT 2644 02:07:35,887 --> 02:07:45,197 AND KIDS WHO MAY BE PUT ON 2645 02:07:45,197 --> 02:07:55,707 INTRANASAL CORTICOIDS AND THE 2646 02:08:00,345 --> 02:08:02,180 CAVEAT IS OVER SEVEN MONTHS IN 2647 02:08:02,180 --> 02:08:06,985 THE CHAT STUDY THOR -- OR THE 2648 02:08:06,985 --> 02:08:08,954 PAT STUDY, DR. REDLIN CAN TALK 2649 02:08:08,954 --> 02:08:11,556 ABOUT IT MORE BUT WE'VE SEEN 2650 02:08:11,556 --> 02:08:22,100 CHILDREN AND THOSE WHO SNORE HAD 2651 02:08:25,771 --> 02:08:27,539 PERSISTENT PROBLEM BEHAVIORS BUT 2652 02:08:27,539 --> 02:08:29,574 THE COGNITION DOESN'T APPEAR TO 2653 02:08:29,574 --> 02:08:30,242 WORSEN OVER TIME. 2654 02:08:30,242 --> 02:08:33,278 WHILE IT'S REASSURING IN SOME 2655 02:08:33,278 --> 02:08:36,581 WAYS, THERE'S ALSO THE QUESTIONS 2656 02:08:36,581 --> 02:08:38,316 REGARDING OKAY WE'RE DOING THAT 2657 02:08:38,316 --> 02:08:40,652 DURING A PERIOD OF BRAIN 2658 02:08:40,652 --> 02:08:41,286 PLASTICITY. 2659 02:08:41,286 --> 02:08:42,521 KIDS BELOW THE AGE OF 4 THE 2660 02:08:42,521 --> 02:08:45,123 BRAIN IS STILL DEVELOPING AND 2661 02:08:45,123 --> 02:08:47,726 CAN SURVIVE HYPOXIC INSULTS AND 2662 02:08:47,726 --> 02:08:58,236 SAME WITH KIDS IN ADOLESCENCE 2663 02:09:02,207 --> 02:09:04,676 AND IT SETS THE TONE FOR 2664 02:09:04,676 --> 02:09:05,811 NATURALISTIC STUDIES BECAUSE 2665 02:09:05,811 --> 02:09:11,550 PREVIOUSLY THERE WAS A POINT OF 2666 02:09:11,550 --> 02:09:14,286 TIME I REMEMBER IN TRAINING WE'D 2667 02:09:14,286 --> 02:09:17,956 RUSH THESE KIDS TO SURGERY 2668 02:09:17,956 --> 02:09:21,326 SOMETIMES EVEN DO TRACHEOSTOMIES 2669 02:09:21,326 --> 02:09:23,695 WITH KIDS AND NOW WE KNOW IT 2670 02:09:23,695 --> 02:09:29,134 DOESN'T APPEAR TO AT LEAST FROM 2671 02:09:29,134 --> 02:09:34,639 OUR DATA SETS QUALITY OF LIFE IS 2672 02:09:34,639 --> 02:09:38,910 IMPAIRED AND COGNITION IS 2673 02:09:38,910 --> 02:09:40,312 SOMEWHAT WELL PROTECTED. 2674 02:09:40,312 --> 02:09:41,446 MAYBE THERE'S VULNERABLE GROUPS 2675 02:09:41,446 --> 02:09:43,548 THAT NEED TO ACCESS THOSE 2676 02:09:43,548 --> 02:09:44,216 PROTECTIVE FACTORS. 2677 02:09:44,216 --> 02:09:47,552 OVER ALL I THINK WE HAVE 2678 02:09:47,552 --> 02:09:49,287 ADDITIONAL INFORMATION IN RECENT 2679 02:09:49,287 --> 02:09:51,690 TIMES FROM THESE RANDOMIZED 2680 02:09:51,690 --> 02:09:52,824 CONTROL TRIALS AS WELL AS 2681 02:09:52,824 --> 02:09:55,260 OBSERVATIONAL STUDIES TO SAY IT 2682 02:09:55,260 --> 02:09:56,995 MAY NOT BE COGNITION BUT 2683 02:09:56,995 --> 02:09:58,496 DEFINITELY BEHAVIOR AND QUALITY 2684 02:09:58,496 --> 02:10:00,265 OF LIFE AND OTHER SUBJECTIVE 2685 02:10:00,265 --> 02:10:02,634 FACTORS MAY BE THE MOST 2686 02:10:02,634 --> 02:10:03,568 IMPACTED. 2687 02:10:03,568 --> 02:10:05,637 >> THANK YOU. 2688 02:10:05,637 --> 02:10:09,241 I THINK WE HAVE JUST TIME FOR 2689 02:10:09,241 --> 02:10:16,648 ONE MORE QUESTION. 2690 02:10:16,648 --> 02:10:21,920 NAJIM YOU HAVE YOUR HAND UP. 2691 02:10:21,920 --> 02:10:26,558 >> THANK YOU FOR NARESH'S 2692 02:10:26,558 --> 02:10:29,427 COMMENT AS WELL AND IN THINKING 2693 02:10:29,427 --> 02:10:32,364 ABOUT HETEROGENEITY ARE SOME 2694 02:10:32,364 --> 02:10:34,666 OUTCOMES NOT REVERSIBLE WHERE 2695 02:10:34,666 --> 02:10:45,143 YOU GET TO THE INADVERTENT 2696 02:10:47,112 --> 02:10:49,281 HYPOXIA THE OBJECTIVE FUNCTION 2697 02:10:49,281 --> 02:10:51,249 MAY NOT GET MUCH BETTER AND PART 2698 02:10:51,249 --> 02:10:52,317 OF THE HETEROGENEITY TRYING TO 2699 02:10:52,317 --> 02:10:53,885 FIGURE OUT WHICH PATIENTS YOU 2700 02:10:53,885 --> 02:10:57,155 WOULD BE MORE LIKELY TO RESPOND 2701 02:10:57,155 --> 02:11:00,625 FROM AN OUTCOME STANDPOINT BY 2702 02:11:00,625 --> 02:11:01,192 TREATING IT BECAUSE IT'S 2703 02:11:01,192 --> 02:11:05,230 POSSIBLE IT'S TOO LATE AND WITH 2704 02:11:05,230 --> 02:11:08,266 ILB THERE'S CT AND FIBROSIS AND 2705 02:11:08,266 --> 02:11:11,102 IN GIVING THE PERSON STEROIDS 2706 02:11:11,102 --> 02:11:15,206 BUT THEY'LL PROBABLY DO BETTER 2707 02:11:15,206 --> 02:11:15,941 AND WONDERING WHETHER THERE'S 2708 02:11:15,941 --> 02:11:17,442 SOMETHING SIMILAR WITH THESE 2709 02:11:17,442 --> 02:11:18,209 PATIENTS AS WELL. 2710 02:11:18,209 --> 02:11:23,982 I WANTED TO MAKE A POINT WITH A 2711 02:11:23,982 --> 02:11:27,552 QUESTION, IS GUESS. 2712 02:11:27,552 --> 02:11:32,691 >> HOPEFULLY THAT WILL BE PART 2713 02:11:32,691 --> 02:11:34,159 OF IT AS WELL. 2714 02:11:34,159 --> 02:11:35,327 WELL, THANK YOU ALL. 2715 02:11:35,327 --> 02:11:38,363 I DID CONFIRM THE CHAT WILL LIVE 2716 02:11:38,363 --> 02:11:43,234 ON IN ETERNITY. 2717 02:11:43,234 --> 02:11:44,736 I THINK THERE'S ROBUST 2718 02:11:44,736 --> 02:11:46,137 DISCUSSION IT'S OVERWHELMING TO 2719 02:11:46,137 --> 02:11:47,405 HAVE THE CHAT AND Q&A AND TALK 2720 02:11:47,405 --> 02:11:49,274 TO EVERYBODY BUT IF YOU WOULD 2721 02:11:49,274 --> 02:11:50,775 LIKE TO PUT SOME THOUGHTS IN THE 2722 02:11:50,775 --> 02:11:52,143 CHAT IT WILL BE THERE AND AGAIN 2723 02:11:52,143 --> 02:11:53,979 AS WE GO FORWARD TODAY I HOPE 2724 02:11:53,979 --> 02:11:56,815 WE'RE ABLE TO PRESERVE TIME FOR 2725 02:11:56,815 --> 02:11:57,882 GREAT CHAT. 2726 02:11:57,882 --> 02:11:59,951 BUT THANK YOU TO ALL OF OUR 2727 02:11:59,951 --> 02:12:01,286 SPEAKERS IN SESSION ONE AND TAKE 2728 02:12:01,286 --> 02:12:03,588 A SHORT BREAK AND BE BACK IN 2729 02:12:03,588 --> 02:12:05,490 ABOUT EIGHT MINUTES OR SO IF 2730 02:12:05,490 --> 02:12:07,993 WE'RE STICKING SO THE ORIGINAL 2731 02:12:07,993 --> 02:12:09,394 TIME SCHEDULE. 2732 02:12:09,394 --> 02:12:13,164 I'LL LEAVE THAT TO ALFONSO AND 2733 02:12:13,164 --> 02:12:13,431 MARISHKA. 2734 02:12:13,431 --> 02:12:15,734 >> WE'RE STICKING TO THE 2735 02:12:15,734 --> 02:12:16,301 ORIGINAL SCHEDULE SO EIGHT 2736 02:12:16,301 --> 02:12:19,537 MINUTES. 2737 02:12:19,537 --> 02:12:55,211 >> RECONVENE AT 1:50 EAST COAST TIME. THANK YOU. 2738 02:12:55,211 --> 02:13:01,016 I'LL BE MO MODERATING 2739 02:13:01,016 --> 02:13:04,987 SESSION 2 MANIFESTATIONS OF OSA 2740 02:13:04,987 --> 02:13:07,022 IN PREGNANCY AND MENOPAUSE AND 2741 02:13:07,022 --> 02:13:09,425 HAVE THREE SPEAKERS AND EACH 2742 02:13:09,425 --> 02:13:11,494 SPEAKER WILL HAVE UP TO 15 2743 02:13:11,494 --> 02:13:12,862 MINUTES TO PRESENT. 2744 02:13:12,862 --> 02:13:14,196 I'LL PROBABLY INTERJECT WHEN YOU 2745 02:13:14,196 --> 02:13:24,573 HAVE TWO MINUTES LEFT. 2746 02:13:28,377 --> 02:13:34,350 OUR FIRST SPEAKER IS FRANCESCO 2747 02:13:34,350 --> 02:13:37,019 FACCO AT THE UNIVERSITY OF 2748 02:13:37,019 --> 02:13:38,721 PITTSBURGH. 2749 02:13:38,721 --> 02:13:40,823 PER PRESENTATION IS TITLED SLEEP 2750 02:13:40,823 --> 02:13:42,758 APNEA IN PREGNANCY A BRIEF 2751 02:13:42,758 --> 02:13:46,762 REVIEW OF CURRENT KNOWLEDGE AND 2752 02:13:46,762 --> 02:13:48,197 INTRODUCTIONS TO THE NICHD 2753 02:13:48,197 --> 02:13:52,134 MATERNAL FETAL MEDICINE UNIT 2754 02:13:52,134 --> 02:13:53,235 NETWORKS SLEEP TRIAL. 2755 02:13:53,235 --> 02:14:03,679 DR. FACCO OVER TO YOU NOW. 2756 02:14:22,798 --> 02:14:27,102 >> I'M HAPPY TO PRESENT THE 2757 02:14:27,102 --> 02:14:29,572 REGARDING SLEEP APNEA IN 2758 02:14:29,572 --> 02:14:31,106 PREGNANCY AND INTRODUCE THE 2759 02:14:31,106 --> 02:14:37,279 SLEEP TRIAL I'M INVOLVED WITH. 2760 02:14:37,279 --> 02:14:47,690 I HAVE NO CONFLICTS OR 2761 02:14:48,457 --> 02:14:48,691 DISCLOSURES 2762 02:14:48,691 --> 02:14:51,660 IT'S NICE TO REVIEW A CAUSAL 2763 02:14:51,660 --> 02:14:52,995 DIAGRAM WHERE A STUDY IN SLEEP 2764 02:14:52,995 --> 02:14:58,901 APNEA IN PREGNANCY IS IMPORTANT. 2765 02:14:58,901 --> 02:15:01,537 WE KNOW WOMEN CAN COME INTO 2766 02:15:01,537 --> 02:15:03,739 PREGNANCY ALREADY WITH 2767 02:15:03,739 --> 02:15:04,673 PREEXISTING SLEEP ISSUES LIKE 2768 02:15:04,673 --> 02:15:06,242 SLEEP APNEA. 2769 02:15:06,242 --> 02:15:10,145 BUT WE ALSO KNOW THE 2770 02:15:10,145 --> 02:15:12,681 PATHOPHYSIOLOGIC CHANGES OF 2771 02:15:12,681 --> 02:15:13,983 PREGNANCY CAN EXACERBATE THE 2772 02:15:13,983 --> 02:15:16,185 SEASON OR CAUSE A NEW ONSET OF 2773 02:15:16,185 --> 02:15:20,122 SLEEP CONDITIONS ESPECIALLY 2774 02:15:20,122 --> 02:15:22,358 WEIGHT GAIN AS IT PERTAINS TO 2775 02:15:22,358 --> 02:15:27,229 SLEEP APNEA. 2776 02:15:27,229 --> 02:15:34,136 WE'RE ALL FAMILIAR WITH THE 2777 02:15:34,136 --> 02:15:37,439 IMPACT SLEEP APNEA HAS ON REST 2778 02:15:37,439 --> 02:15:41,076 FRAGMENTATION AND RESPIRATORY 2779 02:15:41,076 --> 02:15:42,511 PATTERNS AND THE CHANGES HAVE 2780 02:15:42,511 --> 02:15:47,550 BEEN WELL STUDIED OUTSIDE OF 2781 02:15:47,550 --> 02:15:51,820 PREGNANCY AND SHOWN TO BE 2782 02:15:51,820 --> 02:15:54,790 ASSOCIATED WITH DYSREGULATION OF 2783 02:15:54,790 --> 02:15:56,392 APPETITE AND DERANGEMENTED IN 2784 02:15:56,392 --> 02:15:59,328 THE HPA ACCESS AND INCREASE TO 2785 02:15:59,328 --> 02:16:05,801 SHIFT TO SYMPATHETIC ACTIVITY AT 2786 02:16:05,801 --> 02:16:07,670 NIGHT AND STRESS AND SYSTEMIC 2787 02:16:07,670 --> 02:16:08,537 INFLAMMATION. 2788 02:16:08,537 --> 02:16:12,708 IN PREGNANCY WE KNOW THESE 2789 02:16:12,708 --> 02:16:13,208 PATHWAYS THAT HAVE BEEN 2790 02:16:13,208 --> 02:16:13,876 ASSOCIATED WITH SLEEP APNEA HAVE 2791 02:16:13,876 --> 02:16:15,678 ALSO BEEN LINKED TO ADVERSE 2792 02:16:15,678 --> 02:16:19,315 PREGNANCY OUTCOMES. 2793 02:16:19,315 --> 02:16:25,020 NOTABLY TO GLUCOSE DYSFUNCTION 2794 02:16:25,020 --> 02:16:27,756 AND METABOLIC DYSFUNCTION AND 2795 02:16:27,756 --> 02:16:29,992 GESTATIONAL DIABETES AND 2796 02:16:29,992 --> 02:16:31,026 ABNORMALITIES THAT INCREASE THE 2797 02:16:31,026 --> 02:16:40,169 RISK OF PREECLAMPSIA. 2798 02:16:40,169 --> 02:16:41,870 SOME OF THE MOST COMPLETE DATA 2799 02:16:41,870 --> 02:16:49,011 COMES FROM THE NEW MOM TO BE 2800 02:16:49,011 --> 02:16:50,145 COHORT. 2801 02:16:50,145 --> 02:16:53,082 IT WAS WOMEN FOLLOWED 2802 02:16:53,082 --> 02:16:54,016 PROSPECTIVELY ACROSS PREGNANCY 2803 02:16:54,016 --> 02:16:58,954 AND HAD VISITED IN THE FIRST 2804 02:16:58,954 --> 02:17:01,657 TRIMESTER IN THE EARLY SECOND 2805 02:17:01,657 --> 02:17:03,359 TRIMESTER AND THEN THE LATE 2806 02:17:03,359 --> 02:17:04,860 SECOND AND EARLY THIRD 2807 02:17:04,860 --> 02:17:05,127 TRIMESTER. 2808 02:17:05,127 --> 02:17:07,696 AS PART OF THIS COHORT SLEEP 2809 02:17:07,696 --> 02:17:08,998 DATA WAS COLLECTED. 2810 02:17:08,998 --> 02:17:10,899 A VARIETY OF SLEEP MEASURES WERE 2811 02:17:10,899 --> 02:17:16,105 USED BUT IN PARTICULAR AT VISIT 2812 02:17:16,105 --> 02:17:18,907 ONE AND THREE THERE WAS HOME 2813 02:17:18,907 --> 02:17:22,177 SLEEP TESTING IN WHAT WAS CALLED 2814 02:17:22,177 --> 02:17:25,381 THE SLEEP DISORDER BREATHING 2815 02:17:25,381 --> 02:17:28,183 STUDY OF THIS NEW MOM TO BE 2816 02:17:28,183 --> 02:17:28,417 COHORT. 2817 02:17:28,417 --> 02:17:32,354 IN THIS COHORT WE RECRUITED OVER 2818 02:17:32,354 --> 02:17:35,190 3700 WOMEN AND HAD COMPLETE 2819 02:17:35,190 --> 02:17:37,359 SLEEP TESTING RESULTS IN EITHER 2820 02:17:37,359 --> 02:17:40,529 EARLY OR OR MID PREGNANCY FOR 2821 02:17:40,529 --> 02:17:45,734 ABOUT 3500 WOMEN ADEQUATE DATA 2822 02:17:45,734 --> 02:17:48,270 FOR ONE OR BOTH STUDIES IN ABOUT 2823 02:17:48,270 --> 02:17:52,174 3300 WOMEN WHO PARTICIPATED IN 2824 02:17:52,174 --> 02:17:55,110 THIS SUB STUDY. 2825 02:17:55,110 --> 02:18:01,316 WHAT WE FOUND THE PREVALENCE IN 2826 02:18:01,316 --> 02:18:04,186 SLEEP APNEA AND AHI GREATER TO 5 2827 02:18:04,186 --> 02:18:13,362 IN THE STUDY WAS ABOUT 3% IN 2828 02:18:13,362 --> 02:18:15,564 EARLY PREGNANCY 3.5% AND ABOUT 2829 02:18:15,564 --> 02:18:17,132 8% IN MID PREGNANCY. 2830 02:18:17,132 --> 02:18:20,669 AND THE VAST MAJORITY OF THE 2831 02:18:20,669 --> 02:18:22,871 CASES OF SLEEP APNEA BOTH IN 2832 02:18:22,871 --> 02:18:25,007 EARLY AND IN MID PREGNANCY WERE 2833 02:18:25,007 --> 02:18:31,146 NOTED TO BE MILD. 2834 02:18:31,146 --> 02:18:34,183 WHEN WE LOOKED PARTICULARLY AT 2835 02:18:34,183 --> 02:18:36,752 THE PREVALENCE IN OTHER HIGHER 2836 02:18:36,752 --> 02:18:40,189 RISK SUB GROUPS IN THIS COHORT, 2837 02:18:40,189 --> 02:18:48,630 WE DID FIND SNORERS WITH OBESITY 2838 02:18:48,630 --> 02:18:53,268 HAD A 20% AND THE MAJORITY HAD 2839 02:18:53,268 --> 02:18:54,436 MILD SLEEP APNEA. 2840 02:18:54,436 --> 02:18:56,572 IN THIS STUDY THE PARTICIPANTS 2841 02:18:56,572 --> 02:18:57,840 AND PROVIDERS WERE ALL BLINDED 2842 02:18:57,840 --> 02:19:02,678 TO THE SLEEP APNEA RESULTS 2843 02:19:02,678 --> 02:19:04,980 UNLESS SEVERE SLEEP APNEA OR 2844 02:19:04,980 --> 02:19:07,549 HYPOXEMIA WERE ALERTED AND THERE 2845 02:19:07,549 --> 02:19:09,084 WERE PROTOCOLS IN PLACE FOR 2846 02:19:09,084 --> 02:19:12,721 THOSE SETTINGS. 2847 02:19:12,721 --> 02:19:17,192 THIS ALLOWED US TO LOOK 2848 02:19:17,192 --> 02:19:19,094 CAREFULLY AT HOW SLEEP APNEA IN 2849 02:19:19,094 --> 02:19:20,963 PREGNANCY MAY IMPACT ADVERSE 2850 02:19:20,963 --> 02:19:25,234 PREGNANCY OUTCOMES IN THIS 2851 02:19:25,234 --> 02:19:30,172 COHORT THAT WE HAD GOOD 2852 02:19:30,172 --> 02:19:31,406 OBJECTIVE SLEEP APNEA DATA 2853 02:19:31,406 --> 02:19:34,610 BLINDED TO PARTICIPANTS AN 2854 02:19:34,610 --> 02:19:36,211 PROVIDERS AND IN THIS SLIDE WE 2855 02:19:36,211 --> 02:19:39,515 LOOK AT THE RATE OF PREECLAMPSIA 2856 02:19:39,515 --> 02:19:42,117 IN BLUE AND THOSE WITH OSA IN 2857 02:19:42,117 --> 02:19:42,351 YELLOW. 2858 02:19:42,351 --> 02:19:44,987 YOU CAN SEE THE RATE OF 2859 02:19:44,987 --> 02:19:47,856 PREECLAMPSIA WAS HIGHER IN 2860 02:19:47,856 --> 02:19:50,659 PARTICIPANTS WITH OSA AND WE DID 2861 02:19:50,659 --> 02:19:53,896 ADJUSTED ODDS RATIOS LOOKING AT 2862 02:19:53,896 --> 02:19:56,932 ADJUSTMENTS FOR AGE, BMI, 2863 02:19:56,932 --> 02:19:58,467 PRESENCE OF CHRONIC HYPERTENSION 2864 02:19:58,467 --> 02:20:00,969 AND WEIGHT GAIN BETWEEN VISITS 2865 02:20:00,969 --> 02:20:02,938 AND FOUND ADJUSTED ODDS RATIOS 2866 02:20:02,938 --> 02:20:09,244 FOR EARLY AND MID PREGNANCY OF 2867 02:20:09,244 --> 02:20:12,748 1.94 FOR PREECLAMPSIA AND OSA. 2868 02:20:12,748 --> 02:20:14,183 THE GESTATIONAL DIABETES DATA 2869 02:20:14,183 --> 02:20:15,984 WAS EQUALLY OR MORE COMPELLING 2870 02:20:15,984 --> 02:20:18,353 IF YOU SEE H S THE RATES WERE 2871 02:20:18,353 --> 02:20:20,923 MUCH HIGHER FOR GESTATIONAL G 2872 02:20:20,923 --> 02:20:23,926 DIABETES IN PARTICIPANTS WITH 2873 02:20:23,926 --> 02:20:28,931 OSA IN BOTH EARLY OSA OR MID 2874 02:20:28,931 --> 02:20:32,935 PREGNANCY OSA WITH ADJUSTED ODDS 2875 02:20:32,935 --> 02:20:43,111 RATIO FROM 3. 7 TO 3.4 AND 2876 02:20:43,111 --> 02:20:44,913 WE'RE SEEING ROBUST ASSOCIATIONS 2877 02:20:44,913 --> 02:20:46,515 THAT SEEM TO BE INDEPENDENT OF 2878 02:20:46,515 --> 02:20:47,783 KNOWN IMPORTANT CONFOUNDERS 2879 02:20:47,783 --> 02:20:52,855 DESPITE THE FACT THE MAJORITY OF 2880 02:20:52,855 --> 02:20:53,989 PARTICIPANTS THE PHENOTYPE IS 2881 02:20:53,989 --> 02:20:54,189 MILD. 2882 02:20:54,189 --> 02:20:59,494 VERY FEW PARTICIPANTS HAD 2883 02:20:59,494 --> 02:21:00,362 MODERATE SLEEP APNEA IN THE 2884 02:21:00,362 --> 02:21:01,430 COHORT AND SEEING THE 2885 02:21:01,430 --> 02:21:02,965 ASSOCIATION IN WHAT WOULD 2886 02:21:02,965 --> 02:21:08,937 GENERALLY BE THOUGHT OF AS MILD 2887 02:21:08,937 --> 02:21:11,406 PHENOTYPE OF OSA. 2888 02:21:11,406 --> 02:21:13,308 SO WHAT DO WE KNOW ABOUT 2889 02:21:13,308 --> 02:21:16,111 TREATING OSA WITH THE MOST 2890 02:21:16,111 --> 02:21:19,882 COMMONLY PROSCRIBED TREATMENT 2891 02:21:19,882 --> 02:21:21,116 CPAP IN PREGNANCY. 2892 02:21:21,116 --> 02:21:23,952 THE DATA REMAINS LIMITED. 2893 02:21:23,952 --> 02:21:24,920 THERE'S CASE REPORTS AND CASE 2894 02:21:24,920 --> 02:21:27,489 SERIES THAT HAVE BEEN PUBLISHED 2895 02:21:27,489 --> 02:21:28,924 RETROSPECTIVE AND PROSPECTIVE 2896 02:21:28,924 --> 02:21:30,659 CASE SERIES AND RECENTLY SMALL 2897 02:21:30,659 --> 02:21:34,429 TRIALS HAVE ALSO BEEN PUBLISHED. 2898 02:21:34,429 --> 02:21:40,035 I THINK THIS IS AN EXCITING AREA 2899 02:21:40,035 --> 02:21:42,804 OF RESEARCH I THINK PREGNANCY IS 2900 02:21:42,804 --> 02:21:44,640 AN IDEAL SCENARIO TO BETTER 2901 02:21:44,640 --> 02:21:50,279 UNDERSTAND THE ROLE OF PAP AS 2902 02:21:50,279 --> 02:21:52,047 A PREVENTIVE STRATEGY BECAUSE 2903 02:21:52,047 --> 02:21:55,684 THE PHYSIOLOGY OF A PREGNANT 2904 02:21:55,684 --> 02:21:59,788 PERSON CAN BE INTENSIVE IN EARLY 2905 02:21:59,788 --> 02:22:01,123 PREGNANCY TO DEVELOPING 2906 02:22:01,123 --> 02:22:02,858 HYPERTENSION IN THENHE SPAN 30 2907 02:22:02,858 --> 02:22:04,826 TO 40 WEEKS. 2908 02:22:04,826 --> 02:22:08,497 AND AGAIN CAN BE NORMAL GLYCEMIC 2909 02:22:08,497 --> 02:22:14,536 IN EARLY PREGNANCY AND GET TO 2910 02:22:14,536 --> 02:22:15,938 THE POINT OF REQUIRING INSULIN 2911 02:22:15,938 --> 02:22:19,074 BY THE THIRD TRIMESTER AND HELPS 2912 02:22:19,074 --> 02:22:23,145 UNDERSTAND CPAP AS PRIMARY 2913 02:22:23,145 --> 02:22:24,413 PREVENTION OF CERTAIN CARDIO 2914 02:22:24,413 --> 02:22:25,781 METABOLIC MORBIDITIES. 2915 02:22:25,781 --> 02:22:27,382 ONE OF THE TRIALS RECENTLY 2916 02:22:27,382 --> 02:22:28,750 PUBLISHED I THINK IS IMPORTANT 2917 02:22:28,750 --> 02:22:30,953 TO HIGHLIGHT, THIS IS THE 2918 02:22:30,953 --> 02:22:34,656 LARGEST TRIAL TO DATE THAT IS 2919 02:22:34,656 --> 02:22:35,223 RANDOMIZED OF SLEEP APNEA 2920 02:22:35,223 --> 02:22:36,425 TREATMENT IN PREGNANCY. 2921 02:22:36,425 --> 02:22:40,262 IT COMES OUT OF A RESEARCH GROUP 2922 02:22:40,262 --> 02:22:48,770 IN THAILAND AND CARE FOR OSA IN 2923 02:22:48,770 --> 02:22:50,605 PREGNANCY LESS THAN 16 WEEKS AND 2924 02:22:50,605 --> 02:22:54,343 THE PRIMARY OUTCOME WAS PRENATAL 2925 02:22:54,343 --> 02:22:56,745 BLOOD PRESSURE TREND OF SYSTOLIC 2926 02:22:56,745 --> 02:22:57,946 AND DIASTOLIC MEASUREMENTS 2927 02:22:57,946 --> 02:23:01,450 ACROSS PREGNANCY. 2928 02:23:01,450 --> 02:23:06,421 THEY HAD 153 IN THE CPAP AND 157 2929 02:23:06,421 --> 02:23:10,258 IN THE USUAL CARE GROUP. 2930 02:23:10,258 --> 02:23:13,061 C PAP ADHERENCE HAD AN AVERAGE 2931 02:23:13,061 --> 02:23:15,764 USE AT 2.5 HOURS PER5 NIGHT AND 2932 02:23:15,764 --> 02:23:18,200 THE OVER ALL FINDINGS WHICH I'LL 2933 02:23:18,200 --> 02:23:21,770 SHOW IN MORE DETAIL IN THE NEXT 2934 02:23:21,770 --> 02:23:24,573 SLIDE IS IT REDUCED BLOOD 2935 02:23:24,573 --> 02:23:26,641 PRESSURE WITH LARGE EFFECTS ON 2936 02:23:26,641 --> 02:23:28,777 DIASTOLIC AND MEAN ARTERIAL 2937 02:23:28,777 --> 02:23:32,647 PRESSURE COMPARED TO SYSTEMIC 2938 02:23:32,647 --> 02:23:42,924 BLOOD PRESSURE. 2939 02:23:48,663 --> 02:23:51,767 THEY'RE LOOKING AT PATIENTS 2940 02:23:51,767 --> 02:23:54,202 WITHOUT CPAP THERAPY IN BLUE AND 2941 02:23:54,202 --> 02:23:56,204 THE WITH CPAP AND THE RED DOTS. 2942 02:23:56,204 --> 02:24:00,609 YOU CAN SEE IT APPEARS THE CPAP 2943 02:24:00,609 --> 02:24:03,779 GROUP HAD STATISTICALLY 2944 02:24:03,779 --> 02:24:04,413 SIGNIFICANT REDUCTIONS IN THE 2945 02:24:04,413 --> 02:24:07,783 BLOOD PRESSURE ACROSS PREGNANCY. 2946 02:24:07,783 --> 02:24:09,418 THEIR SAMPLE SIDE WAS LIMITED IN 2947 02:24:09,418 --> 02:24:12,587 TERMS OF LOOKING AT ADVERSE 2948 02:24:12,587 --> 02:24:17,859 PREGNANCY OUTCOMES BUT DID CHART 2949 02:24:17,859 --> 02:24:19,961 ABSTRACTION TO LOOKED AT HIGHER 2950 02:24:19,961 --> 02:24:24,599 TENSIVE DISORDERS AND FOUND 2951 02:24:24,599 --> 02:24:27,002 STATISTICALLY SIGNIFICANT 2952 02:24:27,002 --> 02:24:32,607 DIFFERENCES AND 13.7% RATE IN 2953 02:24:32,607 --> 02:24:38,747 THE CPAP GROUP AND THIS IS AN 2954 02:24:38,747 --> 02:24:40,248 EXCITING FINDING WITH THEIR 2955 02:24:40,248 --> 02:24:40,782 BLOOD PRESSURE TRENDS. 2956 02:24:40,782 --> 02:24:48,590 THERE'S LIMITATIONS TO THIS 2957 02:24:48,590 --> 02:24:53,829 TRIAL. 2958 02:24:53,829 --> 02:24:56,031 AND ENROLLMENT CRITERIA BUT 2959 02:24:56,031 --> 02:24:56,965 THERE WAS COMPELLING DATA TO 2960 02:24:56,965 --> 02:25:02,137 KEEP US MOTIVATED TO CONTINUE 2961 02:25:02,137 --> 02:25:03,071 WITH OUR TRIAL WHEN THIS TRIAL 2962 02:25:03,071 --> 02:25:04,372 WAS PUBLISHED. 2963 02:25:04,372 --> 02:25:09,778 NOW THE INTRODUCTION TO THE MFMU 2964 02:25:09,778 --> 02:25:14,116 MATERNAL FETAL MEDICINE UNIT 2965 02:25:14,116 --> 02:25:14,649 SLEEP TRIAL. 2966 02:25:14,649 --> 02:25:23,425 THE FMFU IS A CONSORTIUM OF 14 2967 02:25:23,425 --> 02:25:27,596 CENTERS THAT PARTICIPATE IN 2968 02:25:27,596 --> 02:25:31,099 JOINT PROTOCOLS IN OBSTETRICS 2969 02:25:31,099 --> 02:25:33,602 AND CONDUCT RANDOMIZED CONTROL 2970 02:25:33,602 --> 02:25:33,802 TRIAL. 2971 02:25:33,802 --> 02:25:35,770 IT'S RAN THROUGH THE NICHD AND 2972 02:25:35,770 --> 02:25:39,808 ONE OF THE TRIALS THAT'S ONGOING 2973 02:25:39,808 --> 02:25:43,345 IS OUR SLEEP TRIAL. 2974 02:25:43,345 --> 02:25:48,416 IT'S A MULTI CENTER RCT OF SLEEP 2975 02:25:48,416 --> 02:25:50,418 APNEA IN PREGNANCY AND WE SCREEN 2976 02:25:50,418 --> 02:25:53,021 INDIVIDUALS WITH BMI GREATER OR 2977 02:25:53,021 --> 02:25:55,690 EQUAL THAN 30 AND ASK THEM TO 2978 02:25:55,690 --> 02:25:57,893 PERFORM AT HOME SLEEP TESTS AND 2979 02:25:57,893 --> 02:26:03,632 WE'RE DEFINING AS AN AHI GREATER 2980 02:26:03,632 --> 02:26:03,899 THAN 5. 2981 02:26:03,899 --> 02:26:07,702 OSA POSITIVE SUBJECTS ARE 2982 02:26:07,702 --> 02:26:09,437 OFFERED RANDOMIZATION INTO OUR 2983 02:26:09,437 --> 02:26:16,278 TRIAL AND RECEIVE AUTO TRITATING 2984 02:26:16,278 --> 02:26:18,380 CPAP OR CONTROL. 2985 02:26:18,380 --> 02:26:21,783 THE PRIMARY HYPOTHESIS OF THE 2986 02:26:21,783 --> 02:26:27,756 TRIAL IS TREATMENT OF OSA WITH 2987 02:26:27,756 --> 02:26:30,659 CPAP IN PREGNANCY WILL RESULT IN 2988 02:26:30,659 --> 02:26:35,063 REDUCTION OF DISORDERS IN 2989 02:26:35,063 --> 02:26:35,330 PREGNANCY. 2990 02:26:35,330 --> 02:26:41,102 WHEN WE LOOK TO SEE OUR INTENDED 2991 02:26:41,102 --> 02:26:43,772 RATES OF PREECLAMPSIA UP OUR 2992 02:26:43,772 --> 02:26:46,374 TREATMENT GROUP AND 2993 02:26:46,374 --> 02:26:48,610 NON-COMPLIANT AND WE'RE OVER 66% 2994 02:26:48,610 --> 02:26:50,478 COMPLETED IN THIS TRIAL AND HOPE 2995 02:26:50,478 --> 02:26:53,548 TO HAVE A COMPLETION OF 2996 02:26:53,548 --> 02:26:59,120 ENROLLMENT BY EITHER THE FALL OF 2997 02:26:59,120 --> 02:27:04,092 2025 OR EARLY SPRING OF 2026. 2998 02:27:04,092 --> 02:27:08,597 SO THE SCREEN PORTION OF THE 2999 02:27:08,597 --> 02:27:10,165 TRIAL IS BASED ON SCREENING 3000 02:27:10,165 --> 02:27:12,267 PARTICIPANTS WITH A BMI GREATER 3001 02:27:12,267 --> 02:27:13,368 OR EQUAL TO 30. 3002 02:27:13,368 --> 02:27:17,005 THE REASON WE FOCUSSED ON THIS 3003 02:27:17,005 --> 02:27:20,275 GROUP OF PREGNANT INDIVIDUALS IS 3004 02:27:20,275 --> 02:27:23,445 FROM THE NEW MOM-TO-BE DATA 3005 02:27:23,445 --> 02:27:26,848 THESE INDIVIDUALS HAD THE 3006 02:27:26,848 --> 02:27:28,250 HIGHEST RATE BY ASSESSMENT, 20% 3007 02:27:28,250 --> 02:27:32,020 OF THE COHORT HAD MILD OR 3008 02:27:32,020 --> 02:27:33,288 MODERATE SLEEP APNEA BY MID 3009 02:27:33,288 --> 02:27:35,357 PREGNANCY IF THEIR BMI WAS 3010 02:27:35,357 --> 02:27:36,658 GREATER OR EQUAL TO 30. 3011 02:27:36,658 --> 02:27:39,160 THIS WAS THOUGHT TO BE THE 3012 02:27:39,160 --> 02:27:40,595 POPULATION MOST AT RISK AND 3013 02:27:40,595 --> 02:27:43,431 HENCE THAT'S HOW WE DECIDED HOW 3014 02:27:43,431 --> 02:27:44,599 TO TARGET THE SCREEN IN THIS 3015 02:27:44,599 --> 02:27:50,205 PARTICULAR STUDY. 3016 02:27:50,205 --> 02:27:52,507 REGARDING OF THE TIMING OFHEF 3017 02:27:52,507 --> 02:27:52,774 PREGNANCY. 3018 02:27:52,774 --> 02:27:53,975 IT'S AN INTERESTING BALANCE 3019 02:27:53,975 --> 02:28:00,482 QUESTION BECAUSE OBVIOUSLY THE 3020 02:28:00,482 --> 02:28:05,620 RATE OF SLEEP APNEA WILL GO TO 3021 02:28:05,620 --> 02:28:08,089 THE GAIN AND AFFECTSFF PROGRESSE 3022 02:28:08,089 --> 02:28:09,991 INTO THE THIRD TRIMESTER. 3023 02:28:09,991 --> 02:28:15,697 IN TERMS OF THE SAMPLE AND 3024 02:28:15,697 --> 02:28:16,998 FINDING SLEEP APNEA SUBJECTS 3025 02:28:16,998 --> 02:28:18,366 LATER IN PREGNANCY IS OPTIMAL 3026 02:28:18,366 --> 02:28:20,468 BUT WE ALSO NEED TO UNDERSTAND 3027 02:28:20,468 --> 02:28:31,479 WE HAVE TIME TO ENGAGE IN HAVE E 3028 02:28:33,948 --> 02:28:34,983 NEED TIME WITH THE PARTICIPANT 3029 02:28:34,983 --> 02:28:37,986 TO GET THINGS ENGAGED IN ORDER 3030 02:28:37,986 --> 02:28:39,821 TO SEE A TREATMENT EFFECT. 3031 02:28:39,821 --> 02:28:41,389 EARLIER IN PREGNANCY OPTIMIZES 3032 02:28:41,389 --> 02:28:43,224 THAT TIMING QUESTION AND TIME OF 3033 02:28:43,224 --> 02:28:44,259 THE PARTICIPANTS. 3034 02:28:44,259 --> 02:28:46,094 WE HAVE TO BALANCE THOSE TWO 3035 02:28:46,094 --> 02:28:48,263 ISSUES WHEN WE THINK ABOUT 3036 02:28:48,263 --> 02:28:50,699 SCREENING AND TREATMENT OF 3037 02:28:50,699 --> 02:28:53,101 PATIENTS IN PREGNANCY AND WE 3038 02:28:53,101 --> 02:28:59,240 CAME TO A CONCLUSION THAT OUR 3039 02:28:59,240 --> 02:29:00,709 INITIATION WINDOW WITH 16 WEEKS 3040 02:29:00,709 --> 02:29:03,645 TO 20 WEEKS AND SIX DAYS 3041 02:29:03,645 --> 02:29:04,179 GESTATION. 3042 02:29:04,179 --> 02:29:07,982 WE DIAGNOSE WITH A HOME SLEEP 3043 02:29:07,982 --> 02:29:12,921 APNEA TEST AND USE THE RESMED 3044 02:29:12,921 --> 02:29:14,656 APNEA LINK IN THE STUDY. 3045 02:29:14,656 --> 02:29:23,064 THEY'RE ALL CENTRALLY REVIEWED 3046 02:29:23,064 --> 02:29:26,768 SLEEP APNEA TESTS AND AFTER 3047 02:29:26,768 --> 02:29:28,269 CENTRAL REVIEW DETERMINE YOUR 3048 02:29:28,269 --> 02:29:32,040 INCLUDED IF YOUR SCORE GREATER 3049 02:29:32,040 --> 02:29:35,543 THAN 5 BUT LESS THAN 30 AND HAVE 3050 02:29:35,543 --> 02:29:37,512 A SEVERE HYPOXIA EXCLUSION AND 3051 02:29:37,512 --> 02:29:40,248 URGENT ALERT PROTOCOL. 3052 02:29:40,248 --> 02:29:43,318 SO WE EXCLUDE PARTICIPANTS FROM 3053 02:29:43,318 --> 02:29:46,354 RANDOMIZATION IF THEY MEET 3054 02:29:46,354 --> 02:29:49,224 CRITERIA OR SEVERE SLEEP APNEA. 3055 02:29:49,224 --> 02:29:51,493 AS WE SAW IN NEW MOMS TO BE 3056 02:29:51,493 --> 02:29:54,796 WE'RE SIMILAR SEEING IT'S A RARE 3057 02:29:54,796 --> 02:29:56,264 SITUATION IN PREGNANCY. 3058 02:29:56,264 --> 02:29:58,099 WE ANTICIPATED IT TO BE LESS 3059 02:29:58,099 --> 02:29:59,200 THAN 1% OF OUR SCREENS AND IN 3060 02:29:59,200 --> 02:30:03,171 FACT IT HAS BEEN. 3061 02:30:03,171 --> 02:30:05,907 >> YOU HAVE ABOUT A MINUTELEFT. 3062 02:30:05,907 --> 02:30:09,444 >> OUR TWO ARMS ARE CPAP VERSUS 3063 02:30:09,444 --> 02:30:13,014 SLEEP HYGIENE CONTROL AND USE 3064 02:30:13,014 --> 02:30:18,787 AUTO TRITATING ACPAP IN THE 3065 02:30:18,787 --> 02:30:25,460 STUDY AND CPAP EDUCATION AND 3066 02:30:25,460 --> 02:30:31,299 FOLLOW-UP IN THE CPAP ARM 3067 02:30:31,299 --> 02:30:32,500 THERE'S COMPLIANCE MONITORING 3068 02:30:32,500 --> 02:30:33,701 AND THE PARTICIPANTS ARE 3069 02:30:33,701 --> 02:30:36,805 ENCOURAGED AND INSTRUCTED HOW TO 3070 02:30:36,805 --> 02:30:38,339 GET THEIR OWN COMPLIANCE DATA 3071 02:30:38,339 --> 02:30:40,175 VISIBLE TO THEM ON THEIR SMART 3072 02:30:40,175 --> 02:30:42,610 DEVICE AND HAVE A COMPLIANCE 3073 02:30:42,610 --> 02:30:43,778 INCENTIVE AS WELL AS WEEKLY 3074 02:30:43,778 --> 02:30:45,380 FOLLOW-UPS WITH THE 3075 02:30:45,380 --> 02:30:46,815 PATS. 3076 02:30:46,815 --> 02:30:49,117 THE PRIMARY OUTCOME ARE 3077 02:30:49,117 --> 02:30:53,288 DISORDERS OF PREGNANCY, 3078 02:30:53,288 --> 02:30:58,092 GESTATIONAL PREECLAMPSIA AND WE 3079 02:30:58,092 --> 02:31:00,128 HAVE OTHER PRE-SPECIFIED 3080 02:31:00,128 --> 02:31:02,030 SECONDARY OUTCOMES VERY 3081 02:31:02,030 --> 02:31:03,531 IMPORTANTLY, VERY WELL 3082 02:31:03,531 --> 02:31:05,934 INTERESTED IN THE GESTATIONAL 3083 02:31:05,934 --> 02:31:08,036 DIABETES DATA AND PRETERM BIRTH 3084 02:31:08,036 --> 02:31:11,005 DATA AND BIRTH WEIGHT. 3085 02:31:11,005 --> 02:31:12,507 THE TRIAL IS REGISTERED FOR 3086 02:31:12,507 --> 02:31:13,741 ANYONE WHO WANTS MORE 3087 02:31:13,741 --> 02:31:15,343 INFORMATION OR WANTS TO FIGURE 3088 02:31:15,343 --> 02:31:17,712 OUT IF THERE'S A SITE NEAR THEM. 3089 02:31:17,712 --> 02:31:19,414 AND THIS IS THE CLINICAL 3090 02:31:19,414 --> 02:31:25,286 TRIALS.gov IDENTIFIER. 3091 02:31:25,286 --> 02:31:28,623 AND I'LL END ON THIS SLIDE. 3092 02:31:28,623 --> 02:31:30,725 IT'S THE HIGH PRIORITY 3093 02:31:30,725 --> 02:31:31,125 QUESTIONS. 3094 02:31:31,125 --> 02:31:35,029 I HOPE THIS TRIAL WILL ANSWER. 3095 02:31:35,029 --> 02:31:39,200 OUR PRIMARY OUTCOME IS AIMED TO 3096 02:31:39,200 --> 02:31:40,134 DETERMINE IF SLEEP APNEA IN 3097 02:31:40,134 --> 02:31:42,604 PREGNANCY IS A PREVENTIV 3098 02:31:42,604 --> 02:31:46,107 STRATEGY FOR ADVERSE PREGNANCY 3099 02:31:46,107 --> 02:31:47,942 OUTCOMES IN OUR HIGHER RISK 3100 02:31:47,942 --> 02:31:50,845 COHORT AND HOPE THE TRIAL CAN 3101 02:31:50,845 --> 02:31:53,848 GATHER DATA TO UNDERSTAND 3102 02:31:53,848 --> 02:31:56,518 BARRIERS TO AND OPTIMAL CARE IN 3103 02:31:56,518 --> 02:31:58,052 ORDER TO OPTIMIZE CPAP 3104 02:31:58,052 --> 02:32:01,823 COMPLIANCE IN PREGNANCY. 3105 02:32:01,823 --> 02:32:03,091 I'LL STOP THERE. 3106 02:32:03,091 --> 02:32:06,394 THANK YOU, AARON. 3107 02:32:06,394 --> 02:32:07,629 >> THANK YOU VERY MUCH. 3108 02:32:07,629 --> 02:32:09,664 >> THIS MFMU TRIAL VERY 3109 02:32:09,664 --> 02:32:10,698 IMPORTANT. 3110 02:32:10,698 --> 02:32:14,235 THE RESULTS ARE POTENTIALLY 3111 02:32:14,235 --> 02:32:15,670 TRANSFORMATIVE FOR SLEEP 3112 02:32:15,670 --> 02:32:18,940 RESEARCH AND ALSO HAS 3113 02:32:18,940 --> 02:32:21,175 IMPLICATIONS FOR SLEEP APNEA 3114 02:32:21,175 --> 02:32:23,845 SCIENCE THAT GO BEYOND 3115 02:32:23,845 --> 02:32:24,112 PREGNANCY. 3116 02:32:24,112 --> 02:32:24,746 WE'LL BE VERY INTERESTED IN 3117 02:32:24,746 --> 02:32:26,180 SEEING HOW THE RESULTS OF THIS 3118 02:32:26,180 --> 02:32:26,447 TURN OUT. 3119 02:32:26,447 --> 02:32:34,122 THANK YOU FOR THE OVERVIEW. 3120 02:32:34,122 --> 02:32:39,193 >> WE'LL GO TO THE NEXT SPEAKER, 3121 02:32:39,193 --> 02:32:40,562 DR. GHADA BOURJEILY A HEALTH 3122 02:32:40,562 --> 02:32:41,930 MEDICINE POLICY AND PRACTICE AND 3123 02:32:41,930 --> 02:32:44,165 DIRECTOR OF WOMEN'S RESEARCH AT 3124 02:32:44,165 --> 02:32:45,767 BROWN UNIVERSITY HEALTH IN THE 3125 02:32:45,767 --> 02:32:49,504 DIVISIONS OF PULMONARY CRITICAL 3126 02:32:49,504 --> 02:32:51,539 CARE AND SLEEP AND EXTRACTIVE 3127 02:32:51,539 --> 02:32:54,976 MEDICINE AT THE WARREN ALFRED 3128 02:32:54,976 --> 02:32:56,644 MEDICAL SCHOOL AND BROWN 3129 02:32:56,644 --> 02:32:57,178 UNIVERSITY. 3130 02:32:57,178 --> 02:33:03,952 HER PRESENTATION IS TITLED 3131 02:33:03,952 --> 02:33:04,552 PREGNA 3132 02:33:04,552 --> 02:33:06,688 PREGNANCY, A UNIQUE PHENOTYPE 3133 02:33:06,688 --> 02:33:07,221 FOR OSA. 3134 02:33:07,221 --> 02:33:10,391 >> CAN YOU SEE MY SLIDES? 3135 02:33:10,391 --> 02:33:11,292 >> YES. 3136 02:33:11,292 --> 02:33:11,759 >> GREAT. 3137 02:33:11,759 --> 02:33:13,294 THANKS FOR THE INTRODUCTION. 3138 02:33:13,294 --> 02:33:14,395 THESE ARE MY DISCLOSURES. 3139 02:33:14,395 --> 02:33:15,463 THEY HAVE NOTHING TO DO WITH 3140 02:33:15,463 --> 02:33:16,130 WHAT I'M GOING TO TALK ABOUT 3141 02:33:16,130 --> 02:33:21,102 TODAY. 3142 02:33:21,102 --> 02:33:25,673 SO WHY IS SLEEP DISORDER 3143 02:33:25,673 --> 02:33:28,076 BREATHING AND OSA IN PREGNANCY 3144 02:33:28,076 --> 02:33:28,543 UNIQUE. 3145 02:33:28,543 --> 02:33:31,012 I'D LIKE TO START BY DATA MOST 3146 02:33:31,012 --> 02:33:33,715 KNOW ABOUT THE PLA TERM 3147 02:33:33,715 --> 02:33:34,949 MORTALITY RATE IN THE U.S. HAS 3148 02:33:34,949 --> 02:33:36,684 GONE UP OVER THE LAST COUPLE OF 3149 02:33:36,684 --> 02:33:38,886 DECADES OR SO AND AS YOU CAN SEE 3150 02:33:38,886 --> 02:33:41,222 AND HEAR IT'S SIGNIFICANTLY 3151 02:33:41,222 --> 02:33:43,758 HIGHER THAN MANY OTHER DEVELOPED 3152 02:33:43,758 --> 02:33:45,193 COUNTRIES IN NORTH AMERICA, 3153 02:33:45,193 --> 02:33:47,161 AUSTRALIA AND EUROPE. 3154 02:33:47,161 --> 02:33:49,263 AND THERE ARE ALSO SOME RACIAL 3155 02:33:49,263 --> 02:33:51,165 AND ETHNIC DISPARITIES IN 3156 02:33:51,165 --> 02:33:54,402 PREGNANCY RELATED DEATHS IN THAT 3157 02:33:54,402 --> 02:33:56,571 BLACK WOMEN AND AMERICAN 3158 02:33:56,571 --> 02:33:58,272 CANADIAN AND ALASKAN NATIVE 3159 02:33:58,272 --> 02:33:59,874 WOMEN ARE AT HIGHER RISK 3160 02:33:59,874 --> 02:34:00,775 COMPARED TO WHITE WOMEN. 3161 02:34:00,775 --> 02:34:03,211 WHEN WE LOOK AT CAUSES FOR 3162 02:34:03,211 --> 02:34:04,912 PREGNANCY RELATED DEATHS, YOU 3163 02:34:04,912 --> 02:34:06,748 CAN SEE THE ONES LABELLED IN RED 3164 02:34:06,748 --> 02:34:09,183 ARE THE ONES THAT HAVE BEEN 3165 02:34:09,183 --> 02:34:12,387 DESCRIBED AS BEING ASSOCIATED 3166 02:34:12,387 --> 02:34:13,688 WITH SLEEP DISORDER BREATHING 3167 02:34:13,688 --> 02:34:14,355 AND OSA. 3168 02:34:14,355 --> 02:34:16,157 SO THE REASON IT'S IMPORTANT IS 3169 02:34:16,157 --> 02:34:17,859 BECAUSE WE NEED TO THINK 3170 02:34:17,859 --> 02:34:20,628 CREATIVELY ABOUT WAYS TO IMPROVE 3171 02:34:20,628 --> 02:34:22,597 MATERNAL HEALTH AND REDUCE 3172 02:34:22,597 --> 02:34:24,966 MATERNAL MORBIDITY AND SLEEP AND 3173 02:34:24,966 --> 02:34:25,566 SLEEP DISORDER BREATHING ARE 3174 02:34:25,566 --> 02:34:32,273 IMPORTANT WAYS TO DO THAT. 3175 02:34:32,273 --> 02:34:35,877 IN THE NEXT 12 MONTHS, BEAR WITH 3176 02:34:35,877 --> 02:34:39,180 ME, WE'LL TRY TO COVER WHERE 3177 02:34:39,180 --> 02:34:43,017 PREGNANCY IS A UNIQUE STANDPOINT 3178 02:34:43,017 --> 02:34:43,584 FROM BIOLOGY, DIAGNOSIS AND 3179 02:34:43,584 --> 02:34:47,555 TREATMENT. 3180 02:34:47,555 --> 02:34:51,192 FROM AN OUTCOME STANDPOINT 3181 02:34:51,192 --> 02:34:53,027 THERE'S UNIQUE FEATURES 3182 02:34:53,027 --> 02:34:54,929 ASSOCIATED WITH OSA IN 3183 02:34:54,929 --> 02:34:55,196 PREGNANCY. 3184 02:34:55,196 --> 02:34:57,198 THE SHORT DURATION AS MENTIONED 3185 02:34:57,198 --> 02:34:59,233 BETWEEN EXPOSURE AND OUTCOME CAN 3186 02:34:59,233 --> 02:35:02,437 ADD TO THE CHALLENGES OF TIMELY 3187 02:35:02,437 --> 02:35:03,971 DIAGNOSIS AND INITIATION OF 3188 02:35:03,971 --> 02:35:05,473 THERAPY BUT IT'S THE PERFECT 3189 02:35:05,473 --> 02:35:09,243 EXAMPLE OF WHY WE SHOULD STUDY 3190 02:35:09,243 --> 02:35:11,479 THAT POPULATION. 3191 02:35:11,479 --> 02:35:12,547 WE HEARD ABOUT CARDIOVASCULAR 3192 02:35:12,547 --> 02:35:14,716 AND METABOLIC OUTCOMES FROM THE 3193 02:35:14,716 --> 02:35:15,883 PREVIOUS TALK AND THE 3194 02:35:15,883 --> 02:35:19,454 OPPORTUNITY TO PREVENT THESE 3195 02:35:19,454 --> 02:35:19,721 OUTCOMES. 3196 02:35:19,721 --> 02:35:20,955 BUT THERE'S ALSO DATA OSA IS 3197 02:35:20,955 --> 02:35:27,195 ASSOCIATED WITH WORSE OUTCOMES 3198 02:35:27,195 --> 02:35:32,166 IN WOMEN THAT HAVE DEVELOPED 3199 02:35:32,166 --> 02:35:33,201 PREECLAMPSIA WITHOUT OSA AND 3200 02:35:33,201 --> 02:35:37,438 FURTHER INTERVENTION TO TREAT 3201 02:35:37,438 --> 02:35:39,173 OSA AND SLEEP DISORDER BREATHING 3202 02:35:39,173 --> 02:35:48,583 AND THIS WAS LED BY A SAMPLE OF 3203 02:35:48,583 --> 02:35:50,918 75,000 WOMEN WITH PREECLAMPSIA 3204 02:35:50,918 --> 02:35:55,289 AND WE DEMONSTRATED THERE WAS A 3205 02:35:55,289 --> 02:35:57,358 HIGHER ASSOCIATION WITH SEVERE 3206 02:35:57,358 --> 02:36:00,928 MATERNAL MORBIDITY, SEVERE 3207 02:36:00,928 --> 02:36:01,863 CARDIOVASCULAR MORBIDITY AND 3208 02:36:01,863 --> 02:36:04,565 HEALTH CARE UTILIZATION IN WOMEN 3209 02:36:04,565 --> 02:36:09,737 THAT HAD PREECLAMPSIA AND OSA 3210 02:36:09,737 --> 02:36:11,806 COMPARED TO THOSE THAT HAD 3211 02:36:11,806 --> 02:36:12,406 PREECLAMPSIA BUT DID NOT HAVE 3212 02:36:12,406 --> 02:36:22,483 OSA. 3213 02:36:24,585 --> 02:36:32,593 AND STIMULI MY IMPACT NEONATAL 3214 02:36:32,593 --> 02:36:34,462 HEALTH OUTCOMES AND GROWTH 3215 02:36:34,462 --> 02:36:37,064 OUTCOMES VARY BY THE DEFINITION 3216 02:36:37,064 --> 02:36:38,833 WHETHER IT'S SUBJECTIVE, 3217 02:36:38,833 --> 02:36:43,337 OBJECTIVE OR DEFINEDED BY ICD 3218 02:36:43,337 --> 02:36:43,671 CODES. 3219 02:36:43,671 --> 02:36:45,173 UNFORTUNATELY WE FOUND THAT 3220 02:36:45,173 --> 02:36:46,841 ROUGH OUTCOMES WERE DEFINED IN 3221 02:36:46,841 --> 02:36:47,942 20 WAYS. 3222 02:36:47,942 --> 02:36:49,010 THAT SUGGESTS THERE'S DEFINITELY 3223 02:36:49,010 --> 02:36:53,381 ROOM FOR IMPROVEMENT AND WE NEED 3224 02:36:53,381 --> 02:36:55,550 TO BETTER UNDERSTAND THIS BUT 3225 02:36:55,550 --> 02:36:57,185 YOU CAN TELL THERE'S 3226 02:36:57,185 --> 02:36:59,253 ASSOCIATIONS WITH SMALL FOR 3227 02:36:59,253 --> 02:37:00,655 GESTATIONAL AGE AS WELL AS LARGE 3228 02:37:00,655 --> 02:37:01,656 FOR GESTATIONAL AGE AND THAT 3229 02:37:01,656 --> 02:37:06,294 DEPENDS ON POPULATIONS STUDIED 3230 02:37:06,294 --> 02:37:07,128 AS WELL AS THE METHODOLOGY USED 3231 02:37:07,128 --> 02:37:08,963 TO DEFINE THE OUTCOMES AS WELL. 3232 02:37:08,963 --> 02:37:14,902 AND A FEW YEARS AGO WE 3233 02:37:14,902 --> 02:37:18,206 DEMONSTRATED AN ASSOCIATION 3234 02:37:18,206 --> 02:37:18,973 BETWEEN SLEEP DISORDER BREATHING 3235 02:37:18,973 --> 02:37:20,074 AND CONGENITAL ABNORMALITIES. 3236 02:37:20,074 --> 02:37:23,177 IN A DATA SET OF ABOUT 1.5 3237 02:37:23,177 --> 02:37:25,780 MILLION LINKED MOM AND BABY 3238 02:37:25,780 --> 02:37:29,784 DATA, WE EXAMINE THE RATES OF 3239 02:37:29,784 --> 02:37:30,585 CONGENITAL ABNORMALITIES AND 3240 02:37:30,585 --> 02:37:34,755 SINCE THEN THE ASSOCIATION HAS 3241 02:37:34,755 --> 02:37:38,759 BEEN DEMONSTRATED IN OTHER 3242 02:37:38,759 --> 02:37:39,126 COHORTS. 3243 02:37:39,126 --> 02:37:40,761 WHEN WE THINK OF OSA IN GENERAL 3244 02:37:40,761 --> 02:37:44,265 WE THINK OF THIS TYPE OF 3245 02:37:44,265 --> 02:37:44,932 PHENOTYPE AND MALE OBESITY BEING 3246 02:37:44,932 --> 02:37:51,172 A RISK FACTOR. 3247 02:37:51,172 --> 02:37:53,941 PREGNANCY KIND OF LOOKS LIKE 3248 02:37:53,941 --> 02:37:55,576 THIS BUT MECHANICALLY PLAY 3249 02:37:55,576 --> 02:37:57,845 POSSIBLY BE DIFFERENT AND THE 3250 02:37:57,845 --> 02:37:59,947 DEVELOPMENT OF THE INCREASE IN 3251 02:37:59,947 --> 02:38:02,483 ABDOMINAL CONTENTS IS DIFFERENT 3252 02:38:02,483 --> 02:38:04,151 AND THE CONCEPTION PRODUCT AND 3253 02:38:04,151 --> 02:38:05,553 VISCERAL FAT FOR INSTANCE ARE 3254 02:38:05,553 --> 02:38:06,020 COMPLETELY DIFFERENT 3255 02:38:06,020 --> 02:38:07,521 CONTRIBUTORS. 3256 02:38:07,521 --> 02:38:09,991 IN ADDITION TO THAT, THREE 3257 02:38:09,991 --> 02:38:11,692 MONTHS LATER, THAT PERSON STILL 3258 02:38:11,692 --> 02:38:17,598 LOOKS THE SAME AND THE PREGNANT 3259 02:38:17,598 --> 02:38:18,499 PERSON LOOKS LIKE THIS. 3260 02:38:18,499 --> 02:38:19,867 THERE'S MULTIPLE FACTORS THAT 3261 02:38:19,867 --> 02:38:21,636 WILL BE INFLUENCED BY THE SHORT 3262 02:38:21,636 --> 02:38:23,671 TIMING OF THIS EXPOSURE. 3263 02:38:23,671 --> 02:38:33,648 SO IN PREGNANCY THESE MECHANICAL 3264 02:38:33,648 --> 02:38:39,186 PROPERTIES AND ANTHROPOMORPHIC 3265 02:38:39,186 --> 02:38:41,055 DECREASES IN THE SUPINE POSITION 3266 02:38:41,055 --> 02:38:42,790 AND PRESSURE IN THE COURSE OF 3267 02:38:42,790 --> 02:38:43,991 PREGNANCY AND LOWER IN THE 3268 02:38:43,991 --> 02:38:54,302 POSTPARTUM PERIOD. 3269 02:39:01,042 --> 02:39:03,010 THERE'S OTHER FACTORS LIKE 3270 02:39:03,010 --> 02:39:07,949 ESOPHAGEAL REFLUX AND WE'LL TALK 3271 02:39:07,949 --> 02:39:10,151 ABOUT HOW BIOLOGY IS DIFFERENT 3272 02:39:10,151 --> 02:39:10,918 IN THE PREGNANT POPULATION AS 3273 02:39:10,918 --> 02:39:11,118 WELL. 3274 02:39:11,118 --> 02:39:16,257 WE HEARD ABOUT SEX HORMONES 3275 02:39:16,257 --> 02:39:18,726 EARLIER WE HEARD ABOUT ESTROGEN 3276 02:39:18,726 --> 02:39:25,766 AND PROGESTERONE IN THE COURSE 3277 02:39:25,766 --> 02:39:32,473 OF PREGNANCY AND LEVELS INCREASE 3278 02:39:32,473 --> 02:39:34,375 UP PREGNANCY AND HAVE RECEPTORS 3279 02:39:34,375 --> 02:39:35,876 IN THE UPPER AIRWAY AND 3280 02:39:35,876 --> 02:39:39,447 IMPLICATED WITH FLUID REGULATION 3281 02:39:39,447 --> 02:39:46,687 AND HAVE I A DIRECT EFFECT LIKE 3282 02:39:46,687 --> 02:39:47,955 SMOOTH MUSCLE DILATION AND 3283 02:39:47,955 --> 02:39:49,523 LEADING TO NASAL CONGESTION AND 3284 02:39:49,523 --> 02:39:53,160 SYSTEMIC EFFECTS AND INCREASED 3285 02:39:53,160 --> 02:39:59,934 IN THE VASCULAR VOLUME THAT MAY 3286 02:39:59,934 --> 02:40:02,470 IMPACT THOSE AND HEARD 3287 02:40:02,470 --> 02:40:05,473 PROGESTERONE IS A STIMULANT AND 3288 02:40:05,473 --> 02:40:08,509 HEARD OF THE PRE-MENOPAUSAL BE 3289 02:40:08,509 --> 02:40:09,910 PROTECTIVE AND POST-MENOPAUSAL 3290 02:40:09,910 --> 02:40:15,182 PERIOD IS ELEVATED RISK THIS IS 3291 02:40:15,182 --> 02:40:20,154 THE NORMAL HORMONAL LEVELS AND 3292 02:40:20,154 --> 02:40:23,691 IS THE AFFECT DIFFERENT AND DO 3293 02:40:23,691 --> 02:40:28,095 THEY NOW HAVE A MORE 3294 02:40:28,095 --> 02:40:28,729 PREDISPOSING OF SLEEP DISORDER 3295 02:40:28,729 --> 02:40:31,532 BREATHING IN ADDITION TO THE 3296 02:40:31,532 --> 02:40:35,970 PROTECTION AGAINST THE 3297 02:40:35,970 --> 02:40:38,639 DISORDERED BREATHING. 3298 02:40:38,639 --> 02:40:40,141 WE DEMONSTRATED PROGESTERONE 3299 02:40:40,141 --> 02:40:41,876 LEVELS ARE LOWER WITH OSA 3300 02:40:41,876 --> 02:40:43,844 COMPARED TO THOSE WITHOUT OSA 3301 02:40:43,844 --> 02:40:49,383 AND HEARD ABOUT THE EFFECTIVE OF 3302 02:40:49,383 --> 02:40:52,053 ESTRADIOL ON OXIDATIVE STRESS. 3303 02:40:52,053 --> 02:40:59,593 THIS IS AN EXAMPLE. 3304 02:40:59,593 --> 02:41:02,196 ESTRADIOL SEEMS TO PROTECT 3305 02:41:02,196 --> 02:41:07,968 AGAINST CARDIORESPIRATORY 3306 02:41:07,968 --> 02:41:11,972 DYSFUNCTION AND THOSE THAT HAVE 3307 02:41:11,972 --> 02:41:14,909 REPLACEMENT HAD LOWER DIASTOLIC 3308 02:41:14,909 --> 02:41:19,013 AND SYSTOLIC NUMBERS AND 3309 02:41:19,013 --> 02:41:21,182 SIMILARLY OXIDATIVE STRESS 3310 02:41:21,182 --> 02:41:23,951 APPEARS TO IMPROVE UP A RESPONSE 3311 02:41:23,951 --> 02:41:27,188 TO ESTRADIOL REPLACEMENT AFTER 3312 02:41:27,188 --> 02:41:30,991 MULTIPLE ORGAN SYSTEMS. 3313 02:41:30,991 --> 02:41:39,700 AND THERE'S OTHER STUDIES SHOW 3314 02:41:39,700 --> 02:41:44,371 IT EXPRESSES INFLAMMATORY 3315 02:41:44,371 --> 02:41:45,206 MARKERS SUBJECTING UNIQUE 3316 02:41:45,206 --> 02:41:45,773 MECHANISTIC PATHWAYS IN THE 3317 02:41:45,773 --> 02:41:55,282 POPULATION. 3318 02:41:55,282 --> 02:41:59,753 IN ADDITION THERE'S FLOUINFLUEN 3319 02:41:59,753 --> 02:42:00,654 THE HEALTH OF THE MOTHER AND 3320 02:42:00,654 --> 02:42:02,022 CHILD AND PLACENTA. 3321 02:42:02,022 --> 02:42:06,594 A DECADE AGO WE HAD SHOWN THAT 3322 02:42:06,594 --> 02:42:08,896 PLACENTA SECRETED IN MARKERS IN 3323 02:42:08,896 --> 02:42:15,169 WITH OSA WERE ALTERED IN A 3324 02:42:15,169 --> 02:42:25,713 SIMILAR FASHION TO AND LOOKED AT 3325 02:42:28,215 --> 02:42:31,318 TISSUE AND DEMONSTRATED HYPOXIA 3326 02:42:31,318 --> 02:42:33,187 IN WOMEN WITH OBSTRUCTIVE SLEEP 3327 02:42:33,187 --> 02:42:37,424 APNEA COMPARED TO THOSE WITHOUT 3328 02:42:37,424 --> 02:42:43,531 AND INCREASED MARKER OF A TYPE 3329 02:42:43,531 --> 02:42:44,899 OF HYPOXIA IN WOMEN COMPARED TO 3330 02:42:44,899 --> 02:42:45,166 CONTROLS. 3331 02:42:45,166 --> 02:42:55,676 A COUPLE YEARS AGO THIS STUDY 3332 02:43:07,788 --> 02:43:14,595 AND WHEN THEY LOOKED AT SPECIFIC 3333 02:43:14,595 --> 02:43:23,938 PATHWAY GENES STOOD OUT FOR 3334 02:43:23,938 --> 02:43:31,078 REOXYGENATION AND NOW WHAT ABOUT 3335 02:43:31,078 --> 02:43:34,615 DIAGNOSIS AND HOW WE CALL 3336 02:43:34,615 --> 02:43:42,823 PATHOLOGY IN THE PREGNANT 3337 02:43:42,823 --> 02:43:43,123 POPULATION? 3338 02:43:43,123 --> 02:43:45,192 WE LOOKED AT FLOW IN PREGNANT 3339 02:43:45,192 --> 02:43:47,895 WOMEN AND MATCHED FOR BMI AND 3340 02:43:47,895 --> 02:43:49,563 AHI AND NOT PREGNANT AND 3341 02:43:49,563 --> 02:43:51,932 DEMONSTRATED AND YOU CAN SEE 3342 02:43:51,932 --> 02:43:55,302 PREGNANT WOMEN ARE IN THE TOP 3343 02:43:55,302 --> 02:43:58,038 SCREAM IN RED. 3344 02:43:58,038 --> 02:43:59,707 WE DEMONSTRATED AIR FLOW 3345 02:43:59,707 --> 02:44:01,542 LIMITATION WAS SIGNIFICANTLY 3346 02:44:01,542 --> 02:44:02,643 MORE COMMON IN PREGNANT COMPARED 3347 02:44:02,643 --> 02:44:13,020 TO NON-PREGNANT WOMEN. 3348 02:44:20,728 --> 02:44:26,467 AND WHEN COMPARED WE WERE ABLE 3349 02:44:26,467 --> 02:44:32,973 TO SEE TO THE ONES THAT LATER 3350 02:44:32,973 --> 02:44:33,841 DEVELOPED GESTATIONAL 3351 02:44:33,841 --> 02:44:35,175 HYPERTENSION HAD HIGHER AMOUNTS 3352 02:44:35,175 --> 02:44:36,677 THAN THOSE THAT DIDN'T DEVELOP 3353 02:44:36,677 --> 02:44:38,679 IT AND WE LOOKED AT PULSE 3354 02:44:38,679 --> 02:44:43,917 TRANSIT TIME AND THAT'S A 3355 02:44:43,917 --> 02:44:45,552 MEASURE OF HOW LONG IT TAKES FOR 3356 02:44:45,552 --> 02:44:50,924 BLOOD TO TRAVEL FROM THE 3357 02:44:50,924 --> 02:44:52,760 CONTRACTION OF THE LEFT 3358 02:44:52,760 --> 02:44:53,294 VENTRICLE. 3359 02:44:53,294 --> 02:44:55,095 THE CONSTANT WE DEFINED AND THIS 3360 02:44:55,095 --> 02:44:56,363 WAS THE MEASURE FOR PULSE 3361 02:44:56,363 --> 02:44:57,931 TRANSIT TIME AND THIS MEASURE 3362 02:44:57,931 --> 02:45:00,534 HAD BEEN USED IN THE PEDIATRIC 3363 02:45:00,534 --> 02:45:04,638 POPULATION AND THIS IS A NICE 3364 02:45:04,638 --> 02:45:06,874 REPRESENTATION OF HOW WHEN 3365 02:45:06,874 --> 02:45:07,808 ESOPHAGEAL PRESSURE GOES DOWN 3366 02:45:07,808 --> 02:45:09,209 THERE'S A DROP IN PULSE TRANSIT 3367 02:45:09,209 --> 02:45:11,145 TIME THAT HAPPENS REPEATEDLY. 3368 02:45:11,145 --> 02:45:13,080 SO WE DECIDED TO LOOK AT THAT IN 3369 02:45:13,080 --> 02:45:14,415 THE PREGNANT POPULATION AND SEE 3370 02:45:14,415 --> 02:45:17,885 HOW IT COMPARES TO LOOKING AT 3371 02:45:17,885 --> 02:45:19,820 APNEA, HYPOPNEA MEASURES. 3372 02:45:19,820 --> 02:45:22,089 WE DEMONSTRATED PULSE TRANSIT 3373 02:45:22,089 --> 02:45:26,226 TIME DROPS WERE MORE COMMON IN 3374 02:45:26,226 --> 02:45:30,331 WOMEN WHO SNORE AND HAD A 3375 02:45:30,331 --> 02:45:35,903 HYPOPNEA LESS THAN 5 AND WOMEN 3376 02:45:35,903 --> 02:45:42,676 THAT SNORED WITH A SCORE HIRE 3377 02:45:42,676 --> 02:45:46,413 -- HIGHER THAN 5. 3378 02:45:46,413 --> 02:45:49,316 WHEN WE CATEGORIZED IN THE PULSE 3379 02:45:49,316 --> 02:45:51,785 TRANSIT TIME EVEN IN THE HIGHEST 3380 02:45:51,785 --> 02:45:53,721 CATEGORY WHERE MORE THAN 30 3381 02:45:53,721 --> 02:45:56,090 EVENTS DROPS WERE OCCURRING, THE 3382 02:45:56,090 --> 02:46:06,600 VAST MAJORITY HAD AN H OF AHI 3383 02:46:07,568 --> 02:46:10,003 LESS THAN 5 AND NOT DETECTED BY 3384 02:46:10,003 --> 02:46:11,972 OUR CONVENTION AND EXTRAPOLATING 3385 02:46:11,972 --> 02:46:15,142 FOR THE NON-PREGNANT DEFINITION 3386 02:46:15,142 --> 02:46:15,909 POPULATION. 3387 02:46:15,909 --> 02:46:17,978 WE TOOK THIS FURTHER AND LOOKED 3388 02:46:17,978 --> 02:46:21,048 AT AHI BELOW THE CUT OFF AND HOW 3389 02:46:21,048 --> 02:46:23,917 IT HEIGHT BE ASSOCIATED WITH 3390 02:46:23,917 --> 02:46:26,787 SOME MENTAL HEALTH SYSTEMS. 3391 02:46:26,787 --> 02:46:29,523 WE DEMONSTRATED THAT INCREASING 3392 02:46:29,523 --> 02:46:33,160 LEVELS OF AHI BELOW THE 5 SCORE 3393 02:46:33,160 --> 02:46:35,896 WAS ASSOCIATED WITH HIGHER 3394 02:46:35,896 --> 02:46:36,463 DEPRESSION SCORES IN LATER 3395 02:46:36,463 --> 02:46:42,603 PREGNANCY. 3396 02:46:42,603 --> 02:46:45,706 AND THIS JUST GOT ACCEPTED DAYS 3397 02:46:45,706 --> 02:46:48,675 AGO AND DEMONSTRATED IN WOMEN 3398 02:46:48,675 --> 02:46:54,748 NEGATIVE 4 OSA IN EARLY AND LATE 3399 02:46:54,748 --> 02:46:57,017 PREGNANCY, IF THEY HAD OBESITY 3400 02:46:57,017 --> 02:47:00,821 AND SNORED MORE THAN 60% HAD A 3401 02:47:00,821 --> 02:47:02,489 NOCTURNAL DIPPING A PHYSIOLOGIC 3402 02:47:02,489 --> 02:47:05,058 MEASURE WHEN LACKING CAN BE 3403 02:47:05,058 --> 02:47:07,861 ASSOCIATED WITH BOTH ADVERSE 3404 02:47:07,861 --> 02:47:13,033 PREGNANCY OUTCOMES AND HERE 3405 02:47:13,033 --> 02:47:15,402 IRRESPECTIVE OF WHAT THE AHI CUT 3406 02:47:15,402 --> 02:47:18,872 OFF WAS THE LACK OF NOCTURNAL 3407 02:47:18,872 --> 02:47:23,911 DIPPING WAS PREVALENT IN THIS 3408 02:47:23,911 --> 02:47:24,845 POPULATION THAT HAD REGULAR 3409 02:47:24,845 --> 02:47:26,914 SCORING AND BY DEFINING 3410 02:47:26,914 --> 02:47:29,216 PATHOLOGY THE SAME WAY WE DEFINE 3411 02:47:29,216 --> 02:47:30,851 IT IN THE NON-PREGNANT 3412 02:47:30,851 --> 02:47:31,785 POPULATION, IT MEANS THAT WE'RE 3413 02:47:31,785 --> 02:47:34,555 ONLY IDENTIFYING THE TIP OF THE 3414 02:47:34,555 --> 02:47:36,857 ICEBERG IN TERMS OF PATHOLOGY 3415 02:47:36,857 --> 02:47:39,159 AND MAY BE LEAVING MANY WOMEN 3416 02:47:39,159 --> 02:47:42,396 UNTREATED. 3417 02:47:42,396 --> 02:47:42,830 >> ONE MINUTE LEFT. 3418 02:47:42,830 --> 02:47:45,165 >> SO SPEAKING OF TREATMENT, WE 3419 02:47:45,165 --> 02:47:48,135 KNOW THAT YOUNG WOMEN HAVE THE 3420 02:47:48,135 --> 02:47:50,838 LOWEST ADHERENCE OF CPAP AMONG 3421 02:47:50,838 --> 02:47:54,107 OTHER AGE GROUPS AND GENDERS. 3422 02:47:54,107 --> 02:47:57,077 AND CPAP ADHERENCE IS PRETTY BAD 3423 02:47:57,077 --> 02:47:59,246 IN THE STUDIES THAT HAVE BEEN 3424 02:47:59,246 --> 02:48:00,514 PUBLISHED TO DATE AND THEY GO 3425 02:48:00,514 --> 02:48:02,649 FROM LESS THAN 30 MINUTES TO 3426 02:48:02,649 --> 02:48:04,451 ABOUT THREE AND A HALF HOURS PER 3427 02:48:04,451 --> 02:48:05,018 NIGHT AND THERE ARE RACIAL 3428 02:48:05,018 --> 02:48:07,054 DISPARITIES THAT EXIST. 3429 02:48:07,054 --> 02:48:11,058 SO WE HAVE RECENTLY COMPLETED A 3430 02:48:11,058 --> 02:48:12,593 QUALITATIVE ASSESSMENT OF 3431 02:48:12,593 --> 02:48:15,863 PREGNANT AND NON PREGNANT WOMEN 3432 02:48:15,863 --> 02:48:17,130 INITIATED ON CPAP WITHIN A SHORT 3433 02:48:17,130 --> 02:48:19,800 PERIOD OF TIME AND WERE ABLE TO 3434 02:48:19,800 --> 02:48:21,835 IDENTIFY FACTORS THAT WERE NOT 3435 02:48:21,835 --> 02:48:23,670 SPECIFIC TO PREGNANCY. 3436 02:48:23,670 --> 02:48:25,772 SOME THAT WERE PREGNANCY 3437 02:48:25,772 --> 02:48:29,977 SPECIFIC AND SOME EXACERBATED BY 3438 02:48:29,977 --> 02:48:30,410 PREGNANCY. 3439 02:48:30,410 --> 02:48:31,678 IN SUMMARY, SEX AND GENDER HAVE 3440 02:48:31,678 --> 02:48:36,116 SPECIFIC IMPLICATIONS FOR SLEEP 3441 02:48:36,116 --> 02:48:38,519 DISORDER BREATHING IN PREGNANCY 3442 02:48:38,519 --> 02:48:43,357 AND IT IMPACTS BREATHING IN 3443 02:48:43,357 --> 02:48:46,927 UNIQUE WAYS AND VICE VERSA AND 3444 02:48:46,927 --> 02:48:47,995 WE NEED TO THINK OF SLEEP 3445 02:48:47,995 --> 02:48:49,663 DISORDER BREATHING AS A UNIQUE 3446 02:48:49,663 --> 02:48:53,600 OPPORTUNITY TO PREVENT AND 3447 02:48:53,600 --> 02:48:56,603 IMPROVE MATERNAL HEALTH OUTCOME 3448 02:48:56,603 --> 02:49:03,477 AND FOCUS ON MATERNAL AND 3449 02:49:03,477 --> 02:49:10,017 NEONATAL HEALTH AND CONSIDER 3450 02:49:10,017 --> 02:49:10,817 IMPLEMENTATION STRATEGY FOR 3451 02:49:10,817 --> 02:49:14,087 TREATMENTS THAT CONSIDER BOTH 3452 02:49:14,087 --> 02:49:15,122 THE PHYSIOLOGY OF PREGNANCY AND 3453 02:49:15,122 --> 02:49:17,758 ALSO THE UNIQUE NEEDS OF THIS 3454 02:49:17,758 --> 02:49:19,293 PERINATAL POPULATION AND AT SOME 3455 02:49:19,293 --> 02:49:23,964 POINT WE DO NEED TO ADVOCATE FOR 3456 02:49:23,964 --> 02:49:25,432 SLEEP DISORDER BREATHING FOR 3457 02:49:25,432 --> 02:49:30,270 WOMEN NOT AIMING AT IMPROVING 3458 02:49:30,270 --> 02:49:32,372 PREGNANCY OUTCOMES THERE'S WOMEN 3459 02:49:32,372 --> 02:49:39,346 DENIED COVERAGE FOR TREATMENT AT 3460 02:49:39,346 --> 02:49:43,150 SLEEP APNEA IN PREGNANCY AND 3461 02:49:43,150 --> 02:49:49,990 THOUGH MATERNAL MORTALITY IS 3462 02:49:49,990 --> 02:49:52,192 IMPROVING WE NEED TO DO BETTER 3463 02:49:52,192 --> 02:49:57,831 AT IDENTIFYING RISK FACTORS. 3464 02:49:57,831 --> 02:49:59,566 >> THANK YOU FOR THE 3465 02:49:59,566 --> 02:50:01,902 PRESENTATION A LOT OF IMPORTANT 3466 02:50:01,902 --> 02:50:05,706 DATA RELATED TO RISK FACTORS AND 3467 02:50:05,706 --> 02:50:09,376 UNIQUE PHENOTYPES AND SEVERAL 3468 02:50:09,376 --> 02:50:14,615 MECHANISMS THAT ARE LINKING 3469 02:50:14,615 --> 02:50:15,882 SLEEP APNEA WITH CARDIOVASCULAR 3470 02:50:15,882 --> 02:50:25,192 OUTC 3471 02:50:25,192 --> 02:50:25,759 OUTCOME THANK YOU. 3472 02:50:25,759 --> 02:50:26,860 WE'LL MOVE ON TO THE FINAL 3473 02:50:26,860 --> 02:50:27,260 SPEAKER. 3474 02:50:27,260 --> 02:50:30,364 SORRY, I FORGOT TO PUT ON MY 3475 02:50:30,364 --> 02:50:33,700 VIDEO IF IT'S WORKING. 3476 02:50:33,700 --> 02:50:39,106 WE8 WELL, THE LAST SPEAKER IS 3477 02:50:39,106 --> 02:50:44,378 DR. HADINE JOFFE IN THE FIELD OF 3478 02:50:44,378 --> 02:50:46,747 WOMEN'S HEALTH AND EXECUTIVE 3479 02:50:46,747 --> 02:50:49,616 DIRECTOR OF THE MARY OREGON 3480 02:50:49,616 --> 02:50:51,885 CONNOR CENTER AND FOUNDER OF THE 3481 02:50:51,885 --> 02:50:53,987 WOMEN'S HORMONES AT AGING 3482 02:50:53,987 --> 02:50:55,889 PROGRAM IN THE DEPARTMENT OF 3483 02:50:55,889 --> 02:50:56,757 PSYCHIATRY AT BRIGHAM AND 3484 02:50:56,757 --> 02:50:58,392 WOMEN'S HOSPITAL AT HARVARD 3485 02:50:58,392 --> 02:50:59,359 MEDICAL SCHOOL. 3486 02:50:59,359 --> 02:51:03,864 AND TODAY SHE'LL BE TELLING US 3487 02:51:03,864 --> 02:51:09,102 ABOUT SLEEP AND PARTICULAR 3488 02:51:09,102 --> 02:51:12,239 PHENOTYPES LIKE SLEEP 3489 02:51:12,239 --> 02:51:14,775 FRAGMENTATION REFLECTING 3490 02:51:14,775 --> 02:51:19,880 IMPORTANCE IN MENOPAUSE. 3491 02:51:19,880 --> 02:51:30,323 >> HERE'S MY DISCLOSURES. 3492 02:51:34,728 --> 02:51:37,831 YOU'VE HEARD A LITTLE BIT ABOUT 3493 02:51:37,831 --> 02:51:38,498 MENOPAUSE. 3494 02:51:38,498 --> 02:51:41,368 AND THAT PERSON HAS 12 MONTHS OF 3495 02:51:41,368 --> 02:51:43,870 AMENORRHEA AND THE AVERAGE AGE 3496 02:51:43,870 --> 02:51:50,477 IS 51, 52, LEADING UP TO THAT IS 3497 02:51:50,477 --> 02:51:52,412 THE PERIMENOPAUSE LASTING UP TO 3498 02:51:52,412 --> 02:51:55,882 FOUR YEARS AND YOU SEE IN THE 3499 02:51:55,882 --> 02:51:57,117 TOP RIGHT IN MENOPAUSE THERE'S A 3500 02:51:57,117 --> 02:51:59,286 TREMENDOUS RANGE IN CHAOTIC 3501 02:51:59,286 --> 02:52:03,356 VARIABILITY IN ESTRADIOL AND 3502 02:52:03,356 --> 02:52:06,727 DECLINE I PROGESTERONE RELATED 3503 02:52:06,727 --> 02:52:10,063 TO OVULATION AND THE TIME OF 3504 02:52:10,063 --> 02:52:11,498 SIGNIFICANT HOT FLASHES BRIDGES 3505 02:52:11,498 --> 02:52:15,669 THIS FINAL MENSTRUAL PERIOD. 3506 02:52:15,669 --> 02:52:17,938 SO WHEN WE THINK ABOUT SLEEP IN 3507 02:52:17,938 --> 02:52:20,273 MID LIFE AND MENOPAUSE THERE'S 3508 02:52:20,273 --> 02:52:22,609 MANY CAUSES IDENTIFIED AT 3509 02:52:22,609 --> 02:52:22,909 LENGTH. 3510 02:52:22,909 --> 02:52:26,179 AND I'LL BE TALKING MOSTLY ABOUT 3511 02:52:26,179 --> 02:52:31,918 HOT FLASHES BECAUSE THAT'S THE 3512 02:52:31,918 --> 02:52:34,521 MOST COMMON AND A A BIT 3513 02:52:34,521 --> 02:52:38,024 ABOUT OSA AND THEY CAN MULTI 3514 02:52:38,024 --> 02:52:39,126 PRESENT. 3515 02:52:39,126 --> 02:52:43,830 AND A STUDY SHOWED SLEEP 3516 02:52:43,830 --> 02:52:45,132 MAINTENANCE IS THE MOST COMMON 3517 02:52:45,132 --> 02:52:45,365 SYMPTOM. 3518 02:52:45,365 --> 02:52:48,268 WAKED UP REPEATEDLY OCCURS IN 3519 02:52:48,268 --> 02:52:50,771 42% OF THE POPULATION SO NOT 3520 02:52:50,771 --> 02:52:53,273 ONLY ARE SLEEP PROBLEMS COMMON 3521 02:52:53,273 --> 02:52:55,876 IN THIS MID LIFE POPULATION BUT 3522 02:52:55,876 --> 02:52:57,210 ALSO IT'S PRIMARILY 3523 02:52:57,210 --> 02:52:59,279 CHARACTERIZED BY SLEEP 3524 02:52:59,279 --> 02:53:09,122 INTERRUPTION AND SLEEP 3525 02:53:09,122 --> 02:53:11,424 MAINTENANCE CONCERNS AND THEY 3526 02:53:11,424 --> 02:53:14,194 PRESENT WITH SLEEP INTERRUPTION 3527 02:53:14,194 --> 02:53:15,862 ABOUT 20% AND A LOT IS RELATED 3528 02:53:15,862 --> 02:53:19,833 TO HOT FLASHES AND WE DO KNOW 3529 02:53:19,833 --> 02:53:20,433 SLEEP APNEA AND OTHER FACTORS 3530 02:53:20,433 --> 02:53:23,703 CONTRIBUTE. 3531 02:53:23,703 --> 02:53:25,505 SO YOU HAVE HEARD ABOUT OSA 3532 02:53:25,505 --> 02:53:30,043 RELATED TO MENOPAUSE. 3533 02:53:30,043 --> 02:53:33,113 I'M BRIEFLY GOING TO MENTION IT 3534 02:53:33,113 --> 02:53:35,916 TO SAY WE DO SEE AHI RISES 3535 02:53:35,916 --> 02:53:45,826 FLAUNL ANNUALLY BY 4% PER YEAR 3536 02:53:45,826 --> 02:53:48,028 AND WHETHER THE AHI THRESHOLD 3537 02:53:48,028 --> 02:53:53,600 WAS 5 OR 15 THERE WAS A DOUBLING 3538 02:53:53,600 --> 02:53:59,439 AND TRIPLING OF RISK AS WOMEN 3539 02:53:59,439 --> 02:54:04,244 BECOME POST MENOPAUSAL AND WE DO 3540 02:54:04,244 --> 02:54:05,779 PRESENTATIONS DIFFERENT AS YOU 3541 02:54:05,779 --> 02:54:09,115 HEARD EARLIER AND KNOW AGE AND 3542 02:54:09,115 --> 02:54:11,852 BMI AND NECK CIRCUMFERENCE DON'T 3543 02:54:11,852 --> 02:54:14,187 EXPLAINING THIS EMERGENCE AND 3544 02:54:14,187 --> 02:54:15,722 THERE'S DATA SHOWING 3545 02:54:15,722 --> 02:54:17,591 PROGESTERONE AND ESTRADIOL 3546 02:54:17,591 --> 02:54:21,328 EFFECTS MAY BE CONTRIBUTING. 3547 02:54:21,328 --> 02:54:24,497 AT AN IMPORTANT TIME WHEN WOMEN 3548 02:54:24,497 --> 02:54:27,834 ARE UNDER DIAGNOSED AND 3549 02:54:27,834 --> 02:54:30,370 UNRECOGNIZED FOR HAVING SLEEP 3550 02:54:30,370 --> 02:54:31,538 APNEA. 3551 02:54:31,538 --> 02:54:35,242 I'LL NOW SHIFT TO NIGHT SWEATS, 3552 02:54:35,242 --> 02:54:36,977 NIGHTTIME NOT FLASHES WHICH 3553 02:54:36,977 --> 02:54:39,112 COMMONLY OCCUR AS THE CAUSE OF 3554 02:54:39,112 --> 02:54:40,914 SLEEP DISRUPTION AND KNOW SO 3555 02:54:40,914 --> 02:54:43,516 LITTLE ABOUT SLEEP APNEA AND 3556 02:54:43,516 --> 02:54:51,124 MENOPAUSE AND THE CO-OCCURRENCE. 3557 02:54:51,124 --> 02:54:53,994 WHAT ARE HOT FLOORS? 3558 02:54:53,994 --> 02:54:54,628 THERE'S PERCEPTIONS YOU SEE IN 3559 02:54:54,628 --> 02:54:56,663 THE FIGURE ON THE TOP RIGHT 3560 02:54:56,663 --> 02:55:01,568 PERCEPTION OF HEAT, SWEATING 3561 02:55:01,568 --> 02:55:03,803 SENSATION IN THE THORAX, UPPER 3562 02:55:03,803 --> 02:55:06,072 CHEST AND HEAD. 3563 02:55:06,072 --> 02:55:10,210 YOU SEE INCREASE IN CORE BODY 3564 02:55:10,210 --> 02:55:13,914 TEMPERATURE THAT DISSIPATES AND 3565 02:55:13,914 --> 02:55:15,282 UNDERSTAND THE NEUROPEPTIDE 3566 02:55:15,282 --> 02:55:18,285 BIOLOGY THAT UNDER LIES IT IN 3567 02:55:18,285 --> 02:55:19,819 THE BRAIN. 3568 02:55:19,819 --> 02:55:22,923 THEY'RE EXTREMELY COMMON ABOUT 3569 02:55:22,923 --> 02:55:24,758 80% AND THE DURATION IS SEVEN, 3570 02:55:24,758 --> 02:55:25,692 EIGHT, NINE YEARS. 3571 02:55:25,692 --> 02:55:30,764 AT THE AGE OF 60 WHEN WE START 3572 02:55:30,764 --> 02:55:31,831 LOOKING AT SLEEP APNEA OFTEN A 3573 02:55:31,831 --> 02:55:33,099 THIRD OF WOMEN WILL STILL HAVE 3574 02:55:33,099 --> 02:55:35,535 VASO MOTOR SYMPTOMS WHICH IS THE 3575 02:55:35,535 --> 02:55:37,737 MEDICAL TERM FOR HOT FLASHES AND 3576 02:55:37,737 --> 02:55:40,340 NIGHTTIME HOT FLASHES OR NIGHT 3577 02:55:40,340 --> 02:55:40,740 SWEATS. 3578 02:55:40,740 --> 02:55:42,409 WE KNOW THEY PERSIST DAY AND 3579 02:55:42,409 --> 02:55:45,078 NIGHT AND WHETHER PEOPLE ARE 3580 02:55:45,078 --> 02:55:46,913 AWAKE OR ASLEEP. 3581 02:55:46,913 --> 02:55:50,350 AND WE ALSO KNOW THEY'RE THE 3582 02:55:50,350 --> 02:55:51,117 SECOND MOST COMMON CONCERN 3583 02:55:51,117 --> 02:55:53,053 AFTER -- SORRY, THE SLEEP 3584 02:55:53,053 --> 02:55:54,654 PROBLEM IS THE SECOND MOST 3585 02:55:54,654 --> 02:55:56,323 COMMON CONCERN THAT LEADS WOMEN 3586 02:55:56,323 --> 02:55:57,691 TO SEEK TREATMENT AFTER HOT 3587 02:55:57,691 --> 02:55:59,826 FLASHES AT THE STAGE OF LIFE. 3588 02:55:59,826 --> 02:56:02,329 WHEN YOU LOOK FOR A HOT FLASH 3589 02:56:02,329 --> 02:56:06,800 POPULATION ABOUT TWO-THIRDS WILL 3590 02:56:06,800 --> 02:56:08,168 HAVE SIGNIFICANT SLEEP PROBLEMS. 3591 02:56:08,168 --> 02:56:10,570 SOME STUDIES WE'VE DONE USING 3592 02:56:10,570 --> 02:56:11,805 EXPERIMENTAL PARADIGM 3593 02:56:11,805 --> 02:56:13,540 DEMONSTRATED THE IMPACT OF HOT 3594 02:56:13,540 --> 02:56:14,975 FLASHES ON SLEEP DISTURBANCE. 3595 02:56:14,975 --> 02:56:23,817 THIS FROM A STUDY WHERE WE 3596 02:56:23,817 --> 02:56:27,620 INDUCE THIS IN HEALTHY 3597 02:56:27,620 --> 02:56:28,989 VOLUNTEERS AND WE KNOW WHETHER 3598 02:56:28,989 --> 02:56:31,391 DONE IN WOMEN OR WOMEN OR FOR 3599 02:56:31,391 --> 02:56:35,161 FIBROIDS OR ENDOMETRIOSIS OR 3600 02:56:35,161 --> 02:56:35,829 PROSTATE CANCER TWO-THIRDS 3601 02:56:35,829 --> 02:56:37,797 PEOPLE FLASH AND ONE-THIRD DON'T 3602 02:56:37,797 --> 02:56:39,799 AND ABLE TO TAKE ADVANTAGE OF 3603 02:56:39,799 --> 02:56:43,136 THE FLASH FREQUENCY AND IDENTIFY 3604 02:56:43,136 --> 02:56:47,240 NIGHTTIME AND DAYTIME HOT 3605 02:56:47,240 --> 02:56:50,877 FLASHES AND OBJECTIVE WITH SKIN 3606 02:56:50,877 --> 02:56:51,811 CONDUCTANT MEASUREMENT. 3607 02:56:51,811 --> 02:56:56,349 WE LOOK AT NORMAL HEALTHY 3608 02:56:56,349 --> 02:56:57,851 VOLUNTEERS AND LOOK AT CHANGES 3609 02:56:57,851 --> 02:57:00,353 BEFORE AND AFTER THE EMERGENCE 3610 02:57:00,353 --> 02:57:02,255 OF HOT FLASHES BEFORE IN THE 3611 02:57:02,255 --> 02:57:07,560 STUDY OF CONSTANT ESTRADIOL 3612 02:57:07,560 --> 02:57:07,861 SUPPRESSION. 3613 02:57:07,861 --> 02:57:09,095 THIS IS TO CHARACTERIZE WHAT 3614 02:57:09,095 --> 02:57:10,697 WE'RE TALKING ABOUT. 3615 02:57:10,697 --> 02:57:12,465 AND THE FINDINGS FROM THE STUDY 3616 02:57:12,465 --> 02:57:14,868 SHOWED THE FREQUENT HOT FLASHERS 3617 02:57:14,868 --> 02:57:19,272 IN THE DEEP PINK HAD AN 3618 02:57:19,272 --> 02:57:25,645 EMERGENCE OF NUMBER AWAKINGS IN 3619 02:57:25,645 --> 02:57:27,847 POLY SOMNOGRAPHY AND SEE THE 3620 02:57:27,847 --> 02:57:30,050 TRAJECTORY TOWARDS MORE 3621 02:57:30,050 --> 02:57:31,851 WAKEFULNESS AND EVENTS AND 3622 02:57:31,851 --> 02:57:34,454 GREATER ACCUMULATION OF WASO 3623 02:57:34,454 --> 02:57:39,793 WITH NOCTURNAL FREQUENCY. 3624 02:57:39,793 --> 02:57:44,964 WE ALSO SAW A SHIFT TO MORE 3625 02:57:44,964 --> 02:57:49,202 LIGHT SLEEP AND MORE TIME IN 3626 02:57:49,202 --> 02:57:51,671 WAK 3627 02:57:51,671 --> 02:57:54,474 WAKE. 3628 02:57:54,474 --> 02:57:57,110 VASO MOTOR PROBLEMS AFFECT 3629 02:57:57,110 --> 02:57:57,310 SLEEP. 3630 02:57:57,310 --> 02:57:59,646 WE SEE THE LIGHTER SLEEP AND 3631 02:57:59,646 --> 02:58:01,448 ALSO MORE SLEEP-STAGE 3632 02:58:01,448 --> 02:58:02,749 TRANSITION. 3633 02:58:02,749 --> 02:58:12,792 MORE FRAGMENTED SLEEP PATTERN. 3634 02:58:12,792 --> 02:58:13,860 THEY'RE MOSTLY ASSOCIATED WITH 3635 02:58:13,860 --> 02:58:17,630 WAKE EPISODES IN EEX BUT NOT 3636 02:58:17,630 --> 02:58:18,631 EXCLUSIVELY SO PEOPLE DO FLASH 3637 02:58:18,631 --> 02:58:19,799 WHEN THEY DON'T WAKE. 3638 02:58:19,799 --> 02:58:21,101 THEY DON'T WAKE FOR ALL OF THEM 3639 02:58:21,101 --> 02:58:22,735 AND IF YOU ASK THEM THEY DON'T 3640 02:58:22,735 --> 02:58:23,903 REMEMBER ALL THE HOT FLASH 3641 02:58:23,903 --> 02:58:27,807 EPISODES THEY HAD. 3642 02:58:27,807 --> 02:58:29,476 BUT IMPORTANTLY AND 3643 02:58:29,476 --> 02:58:30,977 INTERESTINGLY IN INDIVIDUALS 3644 02:58:30,977 --> 02:58:38,084 HAVING NOCTURNAL HOT FLASHES 3645 02:58:38,084 --> 02:58:39,319 WASSOO ACCUMULATION ONLYNL 3646 02:58:39,319 --> 02:58:42,622 ACCOUNTS FOR 20% OF THE NUA 3647 02:58:42,622 --> 02:58:46,593 SO YOU SEE A LOT IN THE ABSENCE 3648 02:58:46,593 --> 02:58:49,028 OF THE HOT FLASH EVENT. 3649 02:58:49,028 --> 02:58:50,797 THERE'S A GREAT DEAL OF SLEEP 3650 02:58:50,797 --> 02:58:53,766 FRAGMENTATION BETWEEN THE MOTOR 3651 02:58:53,766 --> 02:58:55,668 SYSTEM EVENTS THAT'S QUITE 3652 02:58:55,668 --> 02:58:57,170 DISRUPTIVE OF SLEEP QUALITY AND 3653 02:58:57,170 --> 02:59:04,911 SEE LENGTHENING OF TOTAL SLEEP 3654 02:59:04,911 --> 02:59:05,712 TIME. 3655 02:59:05,712 --> 02:59:07,680 THE CONCEPT IS IT'S NOT JUST 3656 02:59:07,680 --> 02:59:18,191 SMOOTH SAILING WITH SLEEP IN 3657 02:59:20,193 --> 02:59:23,096 BETWEEN THE SLEEP EVENTS. 3658 02:59:23,096 --> 02:59:25,665 I'VE LOOKED AT SLEEP CONTINUITY 3659 02:59:25,665 --> 02:59:27,634 AND I'M TALKING IN THE ABSENCE 3660 02:59:27,634 --> 02:59:31,671 OF APNEA AND SHIFTING OUR MENTAL 3661 02:59:31,671 --> 02:59:35,642 HEALTH MESSAGE TO FOCUS ON SLEEP 3662 02:59:35,642 --> 02:59:36,743 INTERRUPTION AS HAVING 3663 02:59:36,743 --> 02:59:38,044 POTENTIALLY IMPORTANT ADVERSE 3664 02:59:38,044 --> 02:59:40,246 HEALTH OUTCOMES AND I'M GOING TO 3665 02:59:40,246 --> 02:59:41,514 SHOW YOU SOME OF THOSE DATA. 3666 02:59:41,514 --> 02:59:44,951 WE KNOW OF COURSE FROM A WEALTH 3667 02:59:44,951 --> 02:59:46,819 OF ROBUST DATA THAT SHORT TOTAL 3668 02:59:46,819 --> 02:59:49,389 SLEEP TIME IS ASSOCIATED WITH 3669 02:59:49,389 --> 02:59:50,924 MULTIPLE ADVERSE NEUROCOGNITIVE 3670 02:59:50,924 --> 02:59:52,859 AND METABOLIC OUTCOMES BUT 3671 02:59:52,859 --> 02:59:55,628 THAT'S NOT THE PATTERN OF SLEEP 3672 02:59:55,628 --> 02:59:57,197 DISTURBANCE RELATED TO HOT 3673 02:59:57,197 --> 02:59:57,931 FLASHES. 3674 02:59:57,931 --> 02:59:59,499 SO WE'VE ASKED THE QUESTION IN 3675 02:59:59,499 --> 03:00:02,335 THE SETTING OF A PRESERVED TOTAL 3676 03:00:02,335 --> 03:00:08,942 SLEEP TIME, WHAT DO WE SEE IN 3677 03:00:08,942 --> 03:00:10,577 THE AFFECTS OF SLEEP 3678 03:00:10,577 --> 03:00:10,910 FRAGMENTATION. 3679 03:00:10,910 --> 03:00:13,580 A STUDY I'VE CONDUCT AND WANT TO 3680 03:00:13,580 --> 03:00:15,615 CITE MY TREMENDOUS COLLABORATORS 3681 03:00:15,615 --> 03:00:19,419 ON THIS AMONGST MANY OTHERS, WE 3682 03:00:19,419 --> 03:00:22,155 HAVE LOOKED AT THIS 3683 03:00:22,155 --> 03:00:24,924 EXPERIMENTALLY AND THE DESIGN IS 3684 03:00:24,924 --> 03:00:27,660 AN IN PATIENT EXPERIMENTAL 3685 03:00:27,660 --> 03:00:32,932 DESIGN IN THE HIGHEST AND LOWEST 3686 03:00:32,932 --> 03:00:33,833 ESTRADIOL STATE USING MENOPAUSE 3687 03:00:33,833 --> 03:00:35,168 UNDER STRICT REGULATION AND ABLE 3688 03:00:35,168 --> 03:00:41,608 TO HAVE BLOCKS TO LOOK AT HIGH 3689 03:00:41,608 --> 03:00:44,077 ESTRADIOL, UNINTERRUPTED SLEEP 3690 03:00:44,077 --> 03:00:45,845 CONTEXT AND THEN FRAGMENT THEIR 3691 03:00:45,845 --> 03:00:47,313 SLEEP AND I'LL DESCRIBE AND DO 3692 03:00:47,313 --> 03:00:51,251 THAT EXPERIMENTALLY AND REPEAT 3693 03:00:51,251 --> 03:00:54,254 THE SAME SLEEP BLOCK TWO AND 3694 03:00:54,254 --> 03:00:56,923 THREE NIGHTS OF UNINTERRUPTED 3695 03:00:56,923 --> 03:01:00,260 AND FRAGMENTED SLEEP IN THE LOW 3696 03:01:00,260 --> 03:01:02,862 ESTRADIOL SLEEP IN CONTROLLED 3697 03:01:02,862 --> 03:01:04,130 NEW PATIENT CONDITIONS. 3698 03:01:04,130 --> 03:01:08,935 TO CAPTURE THE WAY WE DO THIS IS 3699 03:01:08,935 --> 03:01:13,740 WE PUT THE ACOUSTIC STIMULUS 3700 03:01:13,740 --> 03:01:15,642 DISPLAYED TO THE PARTICIPANT 3701 03:01:15,642 --> 03:01:18,544 THROUGH A SPEAKER IN THEIR HEAD 3702 03:01:18,544 --> 03:01:20,947 AND THE ALARM WAKES THEM EVERY 3703 03:01:20,947 --> 03:01:23,349 15 MINUTES AND HAVE TO STAY 3704 03:01:23,349 --> 03:01:24,717 AWAKE TWO MINUTES AND THEY HAVE 3705 03:01:24,717 --> 03:01:26,953 TO PUNCH THE MARKER INDICATING 3706 03:01:26,953 --> 03:01:27,987 THEY'RE AWAKE. 3707 03:01:27,987 --> 03:01:31,824 WE GIVE THEM AN HOUR OF 3708 03:01:31,824 --> 03:01:35,628 ADDITIONAL WAKEFULNESS MIMICKING 3709 03:01:35,628 --> 03:01:40,767 THE EXTREMES OF SLEEP 3710 03:01:40,767 --> 03:01:41,367 FRAGMENTATION RELATED TO HOT 3711 03:01:41,367 --> 03:01:41,768 FLASHES. 3712 03:01:41,768 --> 03:01:44,704 WE GET THEM TO GET TO A FULL 3713 03:01:44,704 --> 03:01:46,406 EIGHT HOURS BY GIVING THEM AN 3714 03:01:46,406 --> 03:01:47,173 EXTRA HOUR IN BED. 3715 03:01:47,173 --> 03:01:50,176 WE'RE ABLE TO VALIDATE AND 3716 03:01:50,176 --> 03:01:55,248 DOCUMENT THAT WE INDUCED THE 3717 03:01:55,248 --> 03:01:58,751 WAKEFULNESS AND THAT'S THE 3718 03:01:58,751 --> 03:01:59,285 PARADIGM. 3719 03:01:59,285 --> 03:02:01,020 WE USED IT IN A VARIETY OF WAYS 3720 03:02:01,020 --> 03:02:03,489 TO LOOK AT THE OUTCOME HERE. 3721 03:02:03,489 --> 03:02:05,792 I'M GOING TO SHOW YOU PERCEIVED 3722 03:02:05,792 --> 03:02:09,295 SS AND OBJECTIVE 3723 03:02:09,295 --> 03:02:09,562 ALERTNESS. 3724 03:02:09,562 --> 03:02:11,597 THIS ON A SELF-REPORTED SLEEP 3725 03:02:11,597 --> 03:02:14,834 MEASURE WE WERE ABLE TO SHOW THE 3726 03:02:14,834 --> 03:02:20,540 EMERGENCE OF SLEEP FRAGMENTATION 3727 03:02:20,540 --> 03:02:24,811 DID LEAD TO A WORSE PERCEIVED 3728 03:02:24,811 --> 03:02:25,912 SLEEPINESS AND ESTRADIOL 3729 03:02:25,912 --> 03:02:27,413 SUPPRESSION DID NOT HAVE EFFECT. 3730 03:02:27,413 --> 03:02:30,483 AND WHEN WE LOOKED AT RATE OF 3731 03:02:30,483 --> 03:02:38,925 RESPONSIVITY AND ALERTNESS WE 3732 03:02:38,925 --> 03:02:42,495 FOUND BOTH LET TO DIMINISHED 3733 03:02:42,495 --> 03:02:44,597 ALERTNESS AND ABLE TO IDENTIFY 3734 03:02:44,597 --> 03:02:47,467 WHILE ESTRADIOL TRANSITIONS 3735 03:02:47,467 --> 03:02:50,103 OCCUR ACROSS THE MENOPAUSE 3736 03:02:50,103 --> 03:02:52,572 TRANSITION WE CAN SEE THE 3737 03:02:52,572 --> 03:02:53,573 MODIFIABLE EFFECT DOES HAVE 3738 03:02:53,573 --> 03:02:57,610 THESE ADVERSE EFFECTS ON HEALTH 3739 03:02:57,610 --> 03:03:00,847 AND ACUTE CHANGES IN WELL BEING. 3740 03:03:00,847 --> 03:03:02,815 SIMILARLY WE'VE BEEN ABLE TO 3741 03:03:02,815 --> 03:03:04,450 SHOW ADVERSE EFFECTS ON 3742 03:03:04,450 --> 03:03:06,519 EFFECTIVE STATE, UNDERLYING 3743 03:03:06,519 --> 03:03:06,719 MOOD. 3744 03:03:06,719 --> 03:03:10,990 THESE ARE NON-DEPRESSED 3745 03:03:10,990 --> 03:03:19,499 INDIVIDUALS S IN NEGATIVE AND 3746 03:03:19,499 --> 03:03:25,104 POSITIVE AFFECT AND THE SLEEP 3747 03:03:25,104 --> 03:03:26,572 FRAGMENTATION HAD AN AFFECT AND 3748 03:03:26,572 --> 03:03:28,708 RETURN TO BASELINE AFTER 3749 03:03:28,708 --> 03:03:33,146 REPEATED FRAGMENTATION AND SLEEP 3750 03:03:33,146 --> 03:03:35,214 DISRUPTION IS A MODIFIABLE 3751 03:03:35,214 --> 03:03:37,150 TARGET TO SHIFT AFFECT. 3752 03:03:37,150 --> 03:03:39,585 SLEEPING TO CARDIO METABOLIC 3753 03:03:39,585 --> 03:03:41,587 DISEASE, WE KNOW WEIGHT GAIN AND 3754 03:03:41,587 --> 03:03:44,390 PARTICULARLY BODY FAT GAIN IS 3755 03:03:44,390 --> 03:03:47,627 COMMON ACROSS THE MENOPAUSE 3756 03:03:47,627 --> 03:03:54,033 TRANSITION IN 50% OF INDIVIDUALS 3757 03:03:54,033 --> 03:04:00,006 AND ESTRADIOL SUPPRESSION AND AS 3758 03:04:00,006 --> 03:04:04,076 NOTED YEARS AGO IN A STUDY 3759 03:04:04,076 --> 03:04:11,551 LOOKING AT VISCERAL ADIPOSITY 3760 03:04:11,551 --> 03:04:12,185 ACCUMULATION AND BEFORE THE 3761 03:04:12,185 --> 03:04:14,420 FINAL PERIOD WHEN LOOKING AT THE 3762 03:04:14,420 --> 03:04:16,856 BOTTOM FIGURE YOU STILL SEE A 3763 03:04:16,856 --> 03:04:18,057 LOT OF ESTRADIOL BEING PRODUCED. 3764 03:04:18,057 --> 03:04:22,328 THAT'S WHEN YOU SEE THE 3765 03:04:22,328 --> 03:04:26,833 EMERGENCE OF VISCERAL FAT 3766 03:04:26,833 --> 03:04:27,400 ADIPOSITY. 3767 03:04:27,400 --> 03:04:28,668 RAISING THE QUESTION MAYBE IT'S 3768 03:04:28,668 --> 03:04:31,571 NOT ALL ABOUT THE ESTRADIOL 3769 03:04:31,571 --> 03:04:32,839 WITHDRAWAL MAYBE IT'S RELATED TO 3770 03:04:32,839 --> 03:04:34,073 OTHER FACTORS IN MENOPAUSE. 3771 03:04:34,073 --> 03:04:36,209 HERE WE EXTRAPOLATED FROM THE 3772 03:04:36,209 --> 03:04:38,110 QUESTION FROM TOTAL SLEEP TIME 3773 03:04:38,110 --> 03:04:41,547 IF THAT IS RELATED TO BODY FAT 3774 03:04:41,547 --> 03:04:44,684 GAIN AND MIGHT THE SLEEP 3775 03:04:44,684 --> 03:04:46,319 FRAGMENTATION COMMON IN THIS MID 3776 03:04:46,319 --> 03:04:47,186 LIFE STAGE CONTRIBUTE TO BODY 3777 03:04:47,186 --> 03:04:50,223 FAT GAIN. 3778 03:04:50,223 --> 03:04:51,524 >> YOU HAVE ABOUT ONE MINUTE 3779 03:04:51,524 --> 03:04:51,724 LEFT. 3780 03:04:51,724 --> 03:04:57,263 >> THANK YOU. 3781 03:04:57,263 --> 03:05:00,600 SO FIRST I'LL SHOW YOU AND WE 3782 03:05:00,600 --> 03:05:04,871 DID SEE THE CHANGES THAT SLEEP 3783 03:05:04,871 --> 03:05:07,106 FRAGMENTATION CONTRIBUTED TO 3784 03:05:07,106 --> 03:05:08,474 RESPIRATORY QUOTIENT IN THE 3785 03:05:08,474 --> 03:05:11,377 DIRECTION OF BODY FAT GAIN. 3786 03:05:11,377 --> 03:05:14,647 WE ALSO LOOKED AT MULTIPLE 3787 03:05:14,647 --> 03:05:18,718 CARDIO METABOLIC HEALTH OUTCOME 3788 03:05:18,718 --> 03:05:21,654 AND WHEN WE LOOK AT THE 16 3789 03:05:21,654 --> 03:05:23,422 OUTCOMES, SLEEP FRAGMENTATION 3790 03:05:23,422 --> 03:05:24,857 CONTRIBUTED TO ADVERSE CHANGES 3791 03:05:24,857 --> 03:05:28,661 OF 46% OF THOSE 16. 3792 03:05:28,661 --> 03:05:32,231 ESTRADIOL SUPPRESSION TO 66 AND 3793 03:05:32,231 --> 03:05:33,599 IF YOU COMBINE THEM COMBINED 3794 03:05:33,599 --> 03:05:37,270 WITH MENOPAUSE 100% OF THE 3795 03:05:37,270 --> 03:05:39,505 CARDIO METABOLIC INDICATORS WERE 3796 03:05:39,505 --> 03:05:39,972 ADVERSELY AFFECTED. 3797 03:05:39,972 --> 03:05:41,674 I WON'T HAVE TIME TO GET IN THE 3798 03:05:41,674 --> 03:05:43,342 NATURE OF THE ABNORMALITIES BUT 3799 03:05:43,342 --> 03:05:49,916 TO GIVE YOU SOME EXAMPLES WE SEE 3800 03:05:49,916 --> 03:06:00,459 LESS SATIATY AND MY MESSAGE IS 3801 03:06:03,062 --> 03:06:05,164 FIX YOUR WASO IS WHAT I TELL MY 3802 03:06:05,164 --> 03:06:07,533 PATIENTS WHO DON'T TAKE THEIR 3803 03:06:07,533 --> 03:06:08,668 SLEEP FRAGMENTATION SERIOUSLY 3804 03:06:08,668 --> 03:06:10,770 AND HYPOXIA ITSELF HAS 3805 03:06:10,770 --> 03:06:11,170 TREMENDOUS RISK. 3806 03:06:11,170 --> 03:06:14,140 THE WASO ITSELF APPEARED TO HAVE 3807 03:06:14,140 --> 03:06:19,045 IMPORTANT HEALTH RISK. 3808 03:06:19,045 --> 03:06:25,318 I'LL END BY SAYING THERE'S SO IN 3809 03:06:25,318 --> 03:06:29,655 QUESTIONS AND THE TWO MOST SIG 3810 03:06:29,655 --> 03:06:31,724 QUANTITY ARE FLASHES AND OSA AND 3811 03:06:31,724 --> 03:06:34,860 WE KNOW SO LITTLE ABOUT 3812 03:06:34,860 --> 03:06:36,495 COMORBIDITY AND DOWN STREAM 3813 03:06:36,495 --> 03:06:39,532 EFFECTS ON HEALTH, WELLNESS AND 3814 03:06:39,532 --> 03:06:42,234 FUNCTION AND THE INFLEXION POINT 3815 03:06:42,234 --> 03:06:44,537 FOR HEALTH OUTCOMES AS WITH AGE 3816 03:06:44,537 --> 03:06:46,272 WE KNOW SO LITTLE ABOUT THE 3817 03:06:46,272 --> 03:06:48,407 SUSTAIN AFFECTS ON HEALTH. 3818 03:06:48,407 --> 03:06:53,746 WE ALSO NEED LOTS MORE 3819 03:06:53,746 --> 03:06:56,716 STRATEGIES FOR INTERVENTIONS FOR 3820 03:06:56,716 --> 03:06:59,085 TARGETING THE CORE CONDITIONS IN 3821 03:06:59,085 --> 03:07:01,787 MID LIFE AND MENOPAUSE AND 3822 03:07:01,787 --> 03:07:02,622 PHARMACOLOGIC AND DEVICE IN THE 3823 03:07:02,622 --> 03:07:03,155 POPULATIONS HAVE NOT BEEN 3824 03:07:03,155 --> 03:07:08,828 STUDIED. 3825 03:07:08,828 --> 03:07:11,397 AND WE SHOULD THINK SPECIFICALLY 3826 03:07:11,397 --> 03:07:13,032 ABOUT WHAT PEOPLE THINK ABOUT 3827 03:07:13,032 --> 03:07:19,005 WHICH IS PRECIPITATING THE 3828 03:07:19,005 --> 03:07:22,408 WEIGHT GAIN AND THE WASO AND 3829 03:07:22,408 --> 03:07:23,542 PEOPLE CANNOT FALL BACK SLEEP 3830 03:07:23,542 --> 03:07:27,546 AND THIS IS A CONCERN FOR 3831 03:07:27,546 --> 03:07:29,215 DISPROPORTIONATE POPULATIONS AND 3832 03:07:29,215 --> 03:07:31,584 THANK YOU VERY MUCH AND I'LL 3833 03:07:31,584 --> 03:07:33,419 TURN IT BACK TO YOU. 3834 03:07:33,419 --> 03:07:34,020 >> THANK YOU. 3835 03:07:34,020 --> 03:07:35,588 I'D LIKE TO THANK EACH OF YOU 3836 03:07:35,588 --> 03:07:37,923 FOR YOUR PRESENTATIONS. 3837 03:07:37,923 --> 03:07:46,365 THESE ARE EXCELLENT AND COVERED 3838 03:07:46,365 --> 03:07:50,069 A LOT OF INFORMATION ABOUT THE 3839 03:07:50,069 --> 03:07:51,137 LIFE STAGES AND TRANSITIONS 3840 03:07:51,137 --> 03:07:56,008 WOMEN EXPERIENCE THROUGHOUT 3841 03:07:56,008 --> 03:08:02,481 THEIR LIFE TIME. 3842 03:08:02,481 --> 03:08:06,152 DR. FACCO TOLD US ABOUT A STUDY 3843 03:08:06,152 --> 03:08:07,186 ESTABLISHING SLEEP APNEA AS A 3844 03:08:07,186 --> 03:08:08,120 RISK FOR MATERNAL CARDIOVASCULAR 3845 03:08:08,120 --> 03:08:10,489 DISEASE AND HOW THE FINDINGS 3846 03:08:10,489 --> 03:08:16,696 THEN LED TO WHAT'S A NOW A PHASE 3847 03:08:16,696 --> 03:08:19,598 III CLINICAL TRIAL TO FIND OUT 3848 03:08:19,598 --> 03:08:20,833 IF REDUCING SLEEP APNEA CAN 3849 03:08:20,833 --> 03:08:27,139 IMPROVE OUTCOMES. 3850 03:08:27,139 --> 03:08:28,507 DR. GHADA BOURJEILY TOLD US 3851 03:08:28,507 --> 03:08:31,610 ABOUT UNIQUE PHENOTYPES THAT 3852 03:08:31,610 --> 03:08:34,046 OCCUR DURING GESTATION LIKE AIR 3853 03:08:34,046 --> 03:08:35,548 FLOW LIMITATION AND IMPORTANT 3854 03:08:35,548 --> 03:08:36,482 RISK FACTORS AND ALSO TALKED 3855 03:08:36,482 --> 03:08:38,851 ABOUT SOME MECHANISMS THAT COULD 3856 03:08:38,851 --> 03:08:43,055 BE MEDIATING THE AFFECTS OF 3857 03:08:43,055 --> 03:08:44,690 APNEA ON PREGNANCY HEALTH AND 3858 03:08:44,690 --> 03:08:47,460 ALSO HOW SLEEP MAY BE IMPORTANT 3859 03:08:47,460 --> 03:08:51,831 FOR THE PLA TERM FETAL INTERFACE 3860 03:08:51,831 --> 03:08:54,600 AND HOW WOMEN SLEEP DURING 3861 03:08:54,600 --> 03:08:55,835 PREGNANCY COULD BE AFFECTING 3862 03:08:55,835 --> 03:08:59,004 FETAL HEALTH AND DEVELOPMENT AND 3863 03:08:59,004 --> 03:09:00,606 DR. JOFFE TALKED ABOUT THE 3864 03:09:00,606 --> 03:09:02,608 IMPORTANT INTERFACE BETWEEN 3865 03:09:02,608 --> 03:09:05,845 SLEEP AND MENOPAUSE AND HOW SOME 3866 03:09:05,845 --> 03:09:08,547 OF THESE INTERACTIONS MAY BE 3867 03:09:08,547 --> 03:09:11,484 SIGNIFICANTLY CONTRIBUTING TO 3868 03:09:11,484 --> 03:09:14,854 INCREASED CARDIOVASCULAR RISK IN 3869 03:09:14,854 --> 03:09:16,388 WOMEN DURING MENOPAUSE. 3870 03:09:16,388 --> 03:09:20,826 SO, AT THIS POINT WE CAN TAKE 3871 03:09:20,826 --> 03:09:23,529 MAYBE FIVE OR SO MINUTES AND RUN 3872 03:09:23,529 --> 03:09:25,831 INTO THE BREAK A LITTLE BIT TO 3873 03:09:25,831 --> 03:09:27,466 GO OVER QUESTIONS THAT WERE 3874 03:09:27,466 --> 03:09:27,700 OPPOSED. 3875 03:09:27,700 --> 03:09:31,570 I'LL TRY TO JUMP BETWEEN THE 3876 03:09:31,570 --> 03:09:41,647 CLASS AND Q&A. 3877 03:09:41,647 --> 03:09:43,048 A QUESTION SAYS DR. JOFFE, 3878 03:09:43,048 --> 03:09:43,916 EXCELLENT TALK. 3879 03:09:43,916 --> 03:09:51,524 I THINK WE ALL AGREE ON THAT. 3880 03:09:51,524 --> 03:09:56,729 WHICH INTERVENTION DID YOU 3881 03:09:56,729 --> 03:09:59,365 RECOMMEND TO REDUCE WAKE ONSET 3882 03:09:59,365 --> 03:10:01,333 AND ARE THERE STUDY IN THE AREA? 3883 03:10:01,333 --> 03:10:07,540 >> I'LL FOCUS ON THE HOT 3884 03:10:07,540 --> 03:10:08,741 FLASH/WASO PROBLEM. 3885 03:10:08,741 --> 03:10:19,251 WE HAVE DONE AN NIH SUPPORTED 3886 03:10:20,186 --> 03:10:22,822 MULTIPLE CENTER TRIAL CALLED MS 3887 03:10:22,822 --> 03:10:25,624 FLASH AND TOOK INDIVIDUALS WITH 3888 03:10:25,624 --> 03:10:27,059 HOT FLASHES AND RANDOMIZED THEM 3889 03:10:27,059 --> 03:10:31,497 WITH NINE TREATMENTS OVER 3890 03:10:31,497 --> 03:10:33,666 MULTIPLE TRIALS. 3891 03:10:33,666 --> 03:10:35,100 TWO-THIRDS HAVE MOSTLY A WASO 3892 03:10:35,100 --> 03:10:36,669 AFFECT AND LOOKING AT THE 3893 03:10:36,669 --> 03:10:38,137 INTERVENTIONS THAT WORKED, THE 3894 03:10:38,137 --> 03:10:40,940 INTERVENTIONS THAT WORKED FOR 3895 03:10:40,940 --> 03:10:46,745 WASO WERE CBTI OF COURSE HELPED 3896 03:10:46,745 --> 03:10:51,483 REDUCE THE WASO, EXERCISE WHICH 3897 03:10:51,483 --> 03:10:53,652 DIDN'T HELP THE HOT FLASHES BUT 3898 03:10:53,652 --> 03:10:54,820 HELP THE SLEEP DISRUPTION AND 3899 03:10:54,820 --> 03:10:57,556 WASO ACCUMULATION, ESTROGEN DID 3900 03:10:57,556 --> 03:11:02,061 HELP IN THAT POPULATION, WE ALSO 3901 03:11:02,061 --> 03:11:06,999 STUDIED THE SEROTONIN-BASED 3902 03:11:06,999 --> 03:11:07,633 ANTIDEPRESSANTS USED TO TREAT 3903 03:11:07,633 --> 03:11:14,773 HOT FLASHES AND LAD BENEFIT. 3904 03:11:14,773 --> 03:11:18,577 WE SAW BEHAVIORAL LIFESTYLE AND 3905 03:11:18,577 --> 03:11:20,880 PHARMACOLOGIC INTERVENTION AND 3906 03:11:20,880 --> 03:11:28,320 AMONG THOSE CBTI HAD THE MOST 3907 03:11:28,320 --> 03:11:34,360 IMPACT AND SEROTONIN AND 3908 03:11:34,360 --> 03:11:44,670 EXERCISE AS WELL. 3909 03:11:46,705 --> 03:11:50,109 >> IN THE NEW MOMS TO BE STUDY 3910 03:11:50,109 --> 03:11:55,214 AND THE AHI WAS -- IF I'M GOING 3911 03:11:55,214 --> 03:11:57,082 TO SAY THIS CORRECTLY THE AHI 3912 03:11:57,082 --> 03:12:00,352 WAS ASSOCIATED WITH INCREASED 3913 03:12:00,352 --> 03:12:01,186 CARDIOVASCULAR AND GESTATIONAL 3914 03:12:01,186 --> 03:12:04,890 DIABETES LIST BUT THE AIR FLOW 3915 03:12:04,890 --> 03:12:06,558 LIMITATION WAS ONLY ASSOCIATED 3916 03:12:06,558 --> 03:12:09,495 WITH PREECLAMPSIA OR THE 3917 03:12:09,495 --> 03:12:11,463 HYPERTENSION RISK BUT NOT THE 3918 03:12:11,463 --> 03:12:13,032 DIABETES INDICATING PERHAPS 3919 03:12:13,032 --> 03:12:14,900 THESE DIFFERENT PHENOTYPES POSE 3920 03:12:14,900 --> 03:12:20,272 DIFFERENT RISKS FOR OUTCOMES OR 3921 03:12:20,272 --> 03:12:22,608 MIGHT BE OCCURRING THROUGH MAYBE 3922 03:12:22,608 --> 03:12:24,176 DIFFERENT MECHANISMS. 3923 03:12:24,176 --> 03:12:26,845 DO YOU HAVE A COMMENT WHY THAT'S 3924 03:12:26,845 --> 03:12:34,486 IMPORTANT TO BETTER UNDERSTAND? 3925 03:12:34,486 --> 03:12:36,255 >> I THINK REFERRING TO A PAPER 3926 03:12:36,255 --> 03:12:38,824 FROM THE NEW MOM TO BE COHORT 3927 03:12:38,824 --> 03:12:43,529 LOOKING AT AIR FLOW LIMITATIONS 3928 03:12:43,529 --> 03:12:46,899 AND FOUND AS YOU SAID IT DID NOT 3929 03:12:46,899 --> 03:12:49,234 CONFIRM THE ASSOCIATION WITH 3930 03:12:49,234 --> 03:12:58,811 GESTATIONAL DIABETES BUT DID 3931 03:12:58,811 --> 03:12:59,478 FIND THE ASSOCIATION WITH HYPER 3932 03:12:59,478 --> 03:13:00,612 TENSIVE DISORDER. 3933 03:13:00,612 --> 03:13:03,782 THERE'S NO ASSOCIATION WITH 3934 03:13:03,782 --> 03:13:04,616 GESTATIONAL DIABETES SEEMED TO 3935 03:13:04,616 --> 03:13:15,094 NOT BE ASSOCIATED WITH THAT. 3936 03:13:22,668 --> 03:13:27,473 AND FOR EXAMPLE THE REGULATING 3937 03:13:27,473 --> 03:13:31,777 HORMONE AND ITS ROLE IN 3938 03:13:31,777 --> 03:13:33,846 GESTATIONAL DIABETES PERHAPS 3939 03:13:33,846 --> 03:13:36,181 MORE SO THAN ENDOTHELIAL 3940 03:13:36,181 --> 03:13:37,983 DYSFUNCTION AND PREECLAMPSIA AND 3941 03:13:37,983 --> 03:13:40,085 THERE WAS THOUGHT PROVOKING DATA 3942 03:13:40,085 --> 03:13:42,388 FROM THE NEW MOM TO BE COHORT 3943 03:13:42,388 --> 03:13:44,223 AND I'M GLAD YOU POINTED IT OUT. 3944 03:13:44,223 --> 03:13:46,458 >> AS A RELATED QUESTION IT 3945 03:13:46,458 --> 03:13:50,863 SOUND LIKE SOME OF THE SLEEP 3946 03:13:50,863 --> 03:13:58,904 APNEA PHENOTYPES AND ANYONE CAN 3947 03:13:58,904 --> 03:14:01,407 ADDRESS THIS, IT SEEMS THE SLEEP 3948 03:14:01,407 --> 03:14:04,209 APNEA PHENOTYPES DON'T MEET THE 3949 03:14:04,209 --> 03:14:06,211 TYPICAL SEVERITY LEVEL WE 3950 03:14:06,211 --> 03:14:13,018 NORMALLY SEE IN THE NON 3951 03:14:13,018 --> 03:14:15,521 PREGNANT PEOPLE OR THE SUBTLE 3952 03:14:15,521 --> 03:14:17,990 AIR FLOW EVENTS SEEM TO POSE A 3953 03:14:17,990 --> 03:14:19,024 CARDIOVASCULAR RISK. 3954 03:14:19,024 --> 03:14:21,860 WHY DO YOU THINK IN PREGNANCY 3955 03:14:21,860 --> 03:14:24,530 EVEN SMALL -- I'M NOT SURE THIS 3956 03:14:24,530 --> 03:14:30,035 IS THE RIGHT WAY TO SAY IT BUT 3957 03:14:30,035 --> 03:14:32,838 LOW LEVELS HAVE HIGH IMPACT? 3958 03:14:32,838 --> 03:14:37,142 DO PREGNANT WOMEN HAVE INCREASED 3959 03:14:37,142 --> 03:14:39,511 SUSCEPTIBILITY TO THESE 3960 03:14:39,511 --> 03:14:39,778 EXPOSURES? 3961 03:14:39,778 --> 03:14:43,549 OR DO WE NOT HAVE THE 3962 03:14:43,549 --> 03:14:50,389 INFORMATION ON THAT YET? 3963 03:14:50,389 --> 03:14:52,257 >> I DON'T KNOW OF SOME OF THE 3964 03:14:52,257 --> 03:14:54,860 THINGS THAT MAKE PREGNANCY 3965 03:14:54,860 --> 03:14:57,663 UNIQUE LIKE WITH BIOLOGY AND THE 3966 03:14:57,663 --> 03:14:59,598 HORMONES IF THIS IS ACCELERATING 3967 03:14:59,598 --> 03:15:01,967 SOME OF THE MECHANISMS. 3968 03:15:01,967 --> 03:15:02,868 YOU'RE RIGHT. 3969 03:15:02,868 --> 03:15:06,672 WE SEE SIX MONTHS AFTER AN 3970 03:15:06,672 --> 03:15:08,774 EXPOSURE VERSUS WHEN YOU HAVE 3971 03:15:08,774 --> 03:15:11,110 SLEEP APNEA OUTSIDE THE PREGNANT 3972 03:15:11,110 --> 03:15:11,977 POPULATION THE EXPOSURE IS YEARS 3973 03:15:11,977 --> 03:15:16,515 AND YEARS BEFORE YOU SEE THE 3974 03:15:16,515 --> 03:15:17,049 OUTCOMES. 3975 03:15:17,049 --> 03:15:18,083 SO THERE IS SOMETHING ABOUT 3976 03:15:18,083 --> 03:15:20,853 PREGNANCY AND I DON'T KNOW IS IT 3977 03:15:20,853 --> 03:15:26,892 HORMONAL OR HOW IT IMPACTS 3978 03:15:26,892 --> 03:15:28,527 INFLAMMATORY PATHWAYS THAT MAKES 3979 03:15:28,527 --> 03:15:32,030 THEM HAPPEN QUICKER OR MAYBE THE 3980 03:15:32,030 --> 03:15:33,966 PLACENTA IS MODULATING SOME 3981 03:15:33,966 --> 03:15:36,768 EFFECTS AND MAKING THEM HAPPEN. 3982 03:15:36,768 --> 03:15:39,905 I DON'T FLOW. 3983 03:15:39,905 --> 03:15:40,806 -- I DON'T KNOW. 3984 03:15:40,806 --> 03:15:45,611 >> YOU'RE RIGHT. 3985 03:15:45,611 --> 03:15:49,248 WE DON'T KNOW AND COULD THERE BE 3986 03:15:49,248 --> 03:15:55,521 PLACENTAL LEVEL EFFECTS THAT 3987 03:15:55,521 --> 03:15:58,257 CONTRIBUTE TO SIGNALS FOR 3988 03:15:58,257 --> 03:16:01,260 ENDOTHELIAL DYSFUNCTION WE DON'T 3989 03:16:01,260 --> 03:16:05,998 SEE IN A NON PREGNANT POPULATION 3990 03:16:05,998 --> 03:16:06,732 AND INTERESTING AND FURTHER 3991 03:16:06,732 --> 03:16:10,202 RESEARCH IN COHORTS IN NEW MOM 3992 03:16:10,202 --> 03:16:13,105 OR OTHER COHORTS THAT HAVE BEEN 3993 03:16:13,105 --> 03:16:14,907 SPOKEN ABOUT COULD HELP ANSWER 3994 03:16:14,907 --> 03:16:15,107 THAT. 3995 03:16:15,107 --> 03:16:25,350 >> THANK YOU. 3996 03:16:32,057 --> 03:16:34,459 >> LET'S GO TO OUR PANELISTS 3997 03:16:34,459 --> 03:16:34,826 WITH QUESTIONS. 3998 03:16:34,826 --> 03:16:38,864 >> CAN I ASK A QUESTION? 3999 03:16:38,864 --> 03:16:43,535 >> GO AHEAD. 4000 03:16:43,535 --> 03:16:46,104 >> EXCELLENT TALKS. 4001 03:16:46,104 --> 03:16:47,506 I COMMEND YOUR WORK. 4002 03:16:47,506 --> 03:16:49,841 WE ALL KNOW HOW DIFFICULT IT IS 4003 03:16:49,841 --> 03:16:51,877 TO RECRUIT AND GET THEM AND 4004 03:16:51,877 --> 03:16:54,179 KEEPING THEM ON TREATMENT. 4005 03:16:54,179 --> 03:16:55,914 EXCELLENT WORK. 4006 03:16:55,914 --> 03:17:00,919 MY QUESTION/COMMENT IS ABOUT THE 4007 03:17:00,919 --> 03:17:02,888 BALANCE WHEN I WE SCREEN AND 4008 03:17:02,888 --> 03:17:06,024 TREAT THESE WOMEN AND ALL 4009 03:17:06,024 --> 03:17:07,859 UNDERSTAND THE PRAGMATIC 4010 03:17:07,859 --> 03:17:09,228 IMPLICATIONS OF THE LONGEST 4011 03:17:09,228 --> 03:17:11,530 DURATION AND BENEFIT. 4012 03:17:11,530 --> 03:17:16,401 I DON'T THINK REALLY KNOW IF THE 4013 03:17:16,401 --> 03:17:22,207 TREATMENT CORRELATES WITH 4014 03:17:22,207 --> 03:17:22,908 OUTCOMES. 4015 03:17:22,908 --> 03:17:24,743 CLINICALLY WE SEE PROBLEMS IN 4016 03:17:24,743 --> 03:17:28,347 THE THIRD TRIMESTER WHEN WOMEN 4017 03:17:28,347 --> 03:17:30,082 PRESENT WITH THE GREATEST AMOUNT 4018 03:17:30,082 --> 03:17:31,316 OF SYMPTOMS AND THEN COME TO US 4019 03:17:31,316 --> 03:17:33,218 AND ARE RUSHING TO GET THEM 4020 03:17:33,218 --> 03:17:35,487 TESTED AND STARTED ON TREATMENT. 4021 03:17:35,487 --> 03:17:37,456 OF COURSE THERE'S A WHOLE 4022 03:17:37,456 --> 03:17:38,056 IMPLEMENTATION PIECE BUT I'M 4023 03:17:38,056 --> 03:17:41,159 ALSO WONDERING WHAT YOU THINK 4024 03:17:41,159 --> 03:17:43,195 ABOUT THE GAP OR THE FURTHER 4025 03:17:43,195 --> 03:17:46,164 NEED TO STUDY THE TIMING OF 4026 03:17:46,164 --> 03:17:47,299 DIAGNOSIS OR THE DOSE OR 4027 03:17:47,299 --> 03:17:51,370 DURATION AS YOU WERE TALKING 4028 03:17:51,370 --> 03:17:52,738 EARLIER TODAY IN RELATION TO NOT 4029 03:17:52,738 --> 03:17:56,842 ONLY THE MATERNAL OUTCOMES OF 4030 03:17:56,842 --> 03:17:57,943 BLOOD PRESSURE, GLUCOSE AND 4031 03:17:57,943 --> 03:18:01,013 CHILD HEALTH OUTCOMES AT THE 4032 03:18:01,013 --> 03:18:04,983 PLACENTAL LEVEL AND SOME MAY 4033 03:18:04,983 --> 03:18:06,451 HAVE HAD SLEEP APNEA 4034 03:18:06,451 --> 03:18:08,053 PRE-PREGNANCY AND DON'T KNOW THE 4035 03:18:08,053 --> 03:18:12,691 SLEEP COURSE WAS IT DE NOVO IN 4036 03:18:12,691 --> 03:18:14,092 PREGNANCY AND WAS THAT A 4037 03:18:14,092 --> 03:18:15,527 PHENOTYPE AND TALK ABOUT 4038 03:18:15,527 --> 03:18:16,862 POSTPARTUM AND MENOPAUSE. 4039 03:18:16,862 --> 03:18:27,606 TO SAY THAT TEASING OUT OF 4040 03:18:27,606 --> 03:18:28,340 TIMING OF DIAGNOSIS AND THE 4041 03:18:28,340 --> 03:18:34,246 DURINGATION -- DURATION OF 4042 03:18:34,246 --> 03:18:34,513 OUTCOMES. 4043 03:18:34,513 --> 03:18:45,023 >> YES TO EVERYTHING YOU SAID. 4044 03:18:54,299 --> 03:18:56,768 WHEN YOU PICK A TRIAL AND THE 4045 03:18:56,768 --> 03:18:57,803 THIRD TRIMESTER EVALUATION 4046 03:18:57,803 --> 03:19:00,906 TREATMENT COULD HAVE BENEFIT IN 4047 03:19:00,906 --> 03:19:07,546 TERMS OF PATIENTS ALREADY WITH 4048 03:19:07,546 --> 03:19:10,816 PREECLAMPSIA AND ARE THERE 4049 03:19:10,816 --> 03:19:11,483 BENEFITS TO BLOOD PRESSURE 4050 03:19:11,483 --> 03:19:14,886 CONTROL AND LATENCY AND HAVING 4051 03:19:14,886 --> 03:19:18,390 LONGER LATENCY AND NOT HAVING TO 4052 03:19:18,390 --> 03:19:19,424 DELIVER EARLIER. 4053 03:19:19,424 --> 03:19:21,326 THERE'S SOME DATA THAT'S BEEN 4054 03:19:21,326 --> 03:19:22,994 PRESENTED AND PUBLISHED IN THE 4055 03:19:22,994 --> 03:19:23,328 PAST. 4056 03:19:23,328 --> 03:19:26,565 I THINK IT'S AN EXCELLENT 4057 03:19:26,565 --> 03:19:26,898 QUESTION. 4058 03:19:26,898 --> 03:19:30,502 LOGISTICALLY IT'S A CHALLENGE 4059 03:19:30,502 --> 03:19:31,536 BECAUSE BETWEEN SCREENING, 4060 03:19:31,536 --> 03:19:33,605 GETTING TREATMENT AND WE HAVE AN 4061 03:19:33,605 --> 03:19:36,375 IDEALIZED SETTING IN A RESEARCH 4062 03:19:36,375 --> 03:19:38,377 TRIAL WHERE WE HAVE LIKE NURSES 4063 03:19:38,377 --> 03:19:40,612 AND RESEARCH STAFF LIKE ON THE 4064 03:19:40,612 --> 03:19:43,148 READY IMMEDIATELY TO GET 4065 03:19:43,148 --> 03:19:44,783 SOMEBODY ON THE CPAP MACHINE. 4066 03:19:44,783 --> 03:19:50,021 IN THE REAL WORLD IT'S A MORE 4067 03:19:50,021 --> 03:19:53,525 COMPLICATED THING. 4068 03:19:53,525 --> 03:19:58,263 IT WOULD BE AMPLIFIED MORE IN 4069 03:19:58,263 --> 03:19:59,831 REAL WORLD TO GET PEOPLE TREATED 4070 03:19:59,831 --> 03:20:00,165 AND COMPLIANT. 4071 03:20:00,165 --> 03:20:02,667 BUT YOU'RE RIGHT I DON'T THINK 4072 03:20:02,667 --> 03:20:04,169 WE KNOW THERE'S THERE COULDN'T 4073 03:20:04,169 --> 03:20:06,104 BE BENEFIT EVEN IN SHORTER 4074 03:20:06,104 --> 03:20:07,539 DURATIONS OF THERAPY IF YOU CAN 4075 03:20:07,539 --> 03:20:09,708 GET PATIENTS COMBLIENT. 4076 03:20:09,708 --> 03:20:10,275 -- COMPLIANT. 4077 03:20:10,275 --> 03:20:11,143 >> I WANT TO ADD SOMETHING TO 4078 03:20:11,143 --> 03:20:21,253 THIS. 4079 03:20:21,987 --> 03:20:23,522 THE BEST TIME TO INTERVENE IS 4080 03:20:23,522 --> 03:20:24,856 BEFORE PREGNANCY HAPPENS AND A 4081 03:20:24,856 --> 03:20:27,993 LOT OF WORK NEEDS TO BE DONE IN 4082 03:20:27,993 --> 03:20:29,428 PRIMARY CARE LEVEL AND SCREENING 4083 03:20:29,428 --> 03:20:31,096 YOUNG WOMEN AND IDENTIFYING 4084 03:20:31,096 --> 03:20:32,898 DISEASE AND TREATING THEM 4085 03:20:32,898 --> 03:20:42,874 BECAUSE IF WE THINK WHEN THE 4086 03:20:42,874 --> 03:20:53,418 PREGNANCY OUTCOMESS ARE BEING 4087 03:20:53,919 --> 03:20:54,586 DEVELOPED AND BIOLOGY HAPPENS 4088 03:20:54,586 --> 03:20:57,289 THAT IMPACTS HOW OUTCOMES ARE 4089 03:20:57,289 --> 03:20:58,290 GOING TO HAPPEN. 4090 03:20:58,290 --> 03:21:00,325 A COUPLE YEARS AGO WE LOOKED AT 4091 03:21:00,325 --> 03:21:05,263 INSULIN RESISTANCE WITH WOMEN 4092 03:21:05,263 --> 03:21:07,299 DIAGNOSED WITH OSA AT 11 WEEKS 4093 03:21:07,299 --> 03:21:08,133 OF GESTATION. 4094 03:21:08,133 --> 03:21:11,903 THE ASSUMPTION IS AT 11 WEEKS IT 4095 03:21:11,903 --> 03:21:14,940 PROBABLY PREDATED PREGNANCY 4096 03:21:14,940 --> 03:21:17,442 PROBABLY NOT DIAGNOSED AND 4097 03:21:17,442 --> 03:21:21,112 LOOKED AT INSULIN RESISTANCE AND 4098 03:21:21,112 --> 03:21:24,950 IT WAS HIGHER SO THEIR 4099 03:21:24,950 --> 03:21:26,084 PREDISPOSITION TO DEVELOPING 4100 03:21:26,084 --> 03:21:27,953 THESE ADVERSE METABOLIC OUTCOMES 4101 03:21:27,953 --> 03:21:31,556 ARE PROBABLY ALREADY THERE EARLY 4102 03:21:31,556 --> 03:21:31,923 ON. 4103 03:21:31,923 --> 03:21:35,227 IN TERMS IS IT EVER TOO LATE TO 4104 03:21:35,227 --> 03:21:38,730 DIAGNOSIS SOMEONE WITH 4105 03:21:38,730 --> 03:21:41,233 PREGNANCY, THE BULK OF PEOPLE I 4106 03:21:41,233 --> 03:21:43,101 SEE ARE IN LATER PREGNANCY BUT I 4107 03:21:43,101 --> 03:21:45,904 STILL MAKE AN EFFORT TO MAKE A 4108 03:21:45,904 --> 03:21:47,506 DIAGNOSIS BECAUSE OF THE 4109 03:21:47,506 --> 03:21:48,840 IMPLICATIONS TO LABOR AND 4110 03:21:48,840 --> 03:21:51,710 DELIVERY AND MEDICATION TO USE 4111 03:21:51,710 --> 03:21:54,980 AND THE TYPE OF ANESTHESIA AND 4112 03:21:54,980 --> 03:21:55,280 MONITORING. 4113 03:21:55,280 --> 03:21:59,184 THERE'S A REASON TO MAKE THE 4114 03:21:59,184 --> 03:22:00,719 DIAGNOSIS EVEN IF YOU CAN'T 4115 03:22:00,719 --> 03:22:02,754 START CPAP TREATMENT OR GET THEM 4116 03:22:02,754 --> 03:22:06,424 ACCLIMATED TO TREATMENT, 4117 03:22:06,424 --> 03:22:07,526 ETCETERA, DURING THE COURSE OF 4118 03:22:07,526 --> 03:22:07,792 PREGNANCY. 4119 03:22:07,792 --> 03:22:11,062 >> THANK YOU. 4120 03:22:11,062 --> 03:22:11,363 >> THANKS. 4121 03:22:11,363 --> 03:22:13,765 WE'LL TAKE TIME FOR ONE MORE 4122 03:22:13,765 --> 03:22:14,799 COMMENT JUST TO MAKE SURE 4123 03:22:14,799 --> 03:22:18,436 EVERYBODY HAS A BREAK BUT THERE 4124 03:22:18,436 --> 03:22:23,208 WERE A COUPLE QUESTIONS RELATED 4125 03:22:23,208 --> 03:22:26,878 TO SLEEP AND HOT FLASHES OR 4126 03:22:26,878 --> 03:22:29,047 CARDIOVASCULAR INSTABILITY AND 4127 03:22:29,047 --> 03:22:30,215 THIS IS ONE OF THEM. 4128 03:22:30,215 --> 03:22:31,349 CAN YOU COMMENT ON WHAT WE 4129 03:22:31,349 --> 03:22:35,520 CURRENTLY KNOW ABOUT THE 4130 03:22:35,520 --> 03:22:38,924 INTERACTION BETWEEN HOT FLASHES 4131 03:22:38,924 --> 03:22:41,693 AND SLEEP DISORDER BREATHING 4132 03:22:41,693 --> 03:22:45,530 EVENTS SUCH AS THEIR 4133 03:22:45,530 --> 03:22:46,164 BI-DIRECTIONALITY? 4134 03:22:46,164 --> 03:22:48,333 >> THIS IS AN AREA WE NEED 4135 03:22:48,333 --> 03:22:50,769 TREMENDOUS INVESTMENT IN BECAUSE 4136 03:22:50,769 --> 03:22:54,439 THEY'RE BOTH VERY COMMON KWNZ 4137 03:22:54,439 --> 03:22:55,040 CONDITIONS. 4138 03:22:55,040 --> 03:22:55,540 WE DON'T KNOW. 4139 03:22:55,540 --> 03:22:59,511 WE DON'T HAVE THE DATA. 4140 03:22:59,511 --> 03:23:03,248 WE TYPICALLY EXCLUDED PEOPLE 4141 03:23:03,248 --> 03:23:04,783 WITH SLEEP DISORDER BREATHING 4142 03:23:04,783 --> 03:23:07,085 FROM HOT FLASHES AND THEY'RE NOT 4143 03:23:07,085 --> 03:23:12,524 ALL CAPTURED AND QUANTIFIED 4144 03:23:12,524 --> 03:23:15,727 MEANINGFULLY AND THEY BOTH HAVE 4145 03:23:15,727 --> 03:23:18,229 CARDIO METABOLIC CONSEQUENCES 4146 03:23:18,229 --> 03:23:19,764 AND IT'S AN AREA OF REAL 4147 03:23:19,764 --> 03:23:21,566 PRIORITY FOR FURTHER KNOWLEDGE. 4148 03:23:21,566 --> 03:23:24,936 AND WE ALSO KNOW THAT HORMONE 4149 03:23:24,936 --> 03:23:26,905 THERAPY DOESN'T REALLY TREAT THE 4150 03:23:26,905 --> 03:23:27,539 OSA. 4151 03:23:27,539 --> 03:23:31,409 IT CAN TREAT THE HOT FLASHES AND 4152 03:23:31,409 --> 03:23:33,311 NOT OSA. 4153 03:23:33,311 --> 03:23:35,614 WE DON'T HAVE STRATEGIES ALWAYS 4154 03:23:35,614 --> 03:23:39,184 TO TREAT THEM IN A COMBINED WAY. 4155 03:23:39,184 --> 03:23:40,518 SO WE NEED TO INVEST MORE IN 4156 03:23:40,518 --> 03:23:44,956 THAT. 4157 03:23:44,956 --> 03:23:45,457 >> THANK YOU. 4158 03:23:45,457 --> 03:23:48,259 WE'LL BREAK RIGHT NOW TO MAKE 4159 03:23:48,259 --> 03:23:53,498 SURE EVERYONE HAS TIME TO TAKE A 4160 03:23:53,498 --> 03:23:56,935 BREAK THESE TALKS REALLY REVEAL 4161 03:23:56,935 --> 03:24:01,439 IMPORTANT ASPECTS ABOUT SLEEP 4162 03:24:01,439 --> 03:24:03,508 AND PREGNANCY AND IN MENOPAUSE 4163 03:24:03,508 --> 03:24:05,777 AND ADDRESS A PUBLIC HEALTH VIEW 4164 03:24:05,777 --> 03:24:07,512 THAT SLEEP PROBLEMS THAT OCCUR 4165 03:24:07,512 --> 03:24:09,648 DURING THESE TIMES OF LIFE 4166 03:24:09,648 --> 03:24:10,815 DURING PREGNANCY AND MENOPAUSE 4167 03:24:10,815 --> 03:24:14,953 ARE NOT JUST NORMAL 4168 03:24:14,953 --> 03:24:17,756 MANIFESTATIONS IT'S NOT JUST OF 4169 03:24:17,756 --> 03:24:18,690 COURSE SOMEONE PREGNANT DOESN'T 4170 03:24:18,690 --> 03:24:23,161 SLEEP WELL BECAUSE OF CHANGES. 4171 03:24:23,161 --> 03:24:23,928 THEY'RE CONSEQUENTIAL. 4172 03:24:23,928 --> 03:24:25,930 HAVING POOR SLEEP DURING 4173 03:24:25,930 --> 03:24:26,931 PREGNANCY OR MENOPAUSE IS NOT 4174 03:24:26,931 --> 03:24:33,304 OKAY. 4175 03:24:33,304 --> 03:24:35,206 THERE NEEDS TO BE MORE 4176 03:24:35,206 --> 03:24:36,374 RECOGNITION THEY SHOULD BE 4177 03:24:36,374 --> 03:24:37,108 ADDRESSED AND ABOUT THE 4178 03:24:37,108 --> 03:24:38,943 IMPORTANCE OF IMPROVING SLEEP 4179 03:24:38,943 --> 03:24:43,181 AND MITIGATING THE SLEEP 4180 03:24:43,181 --> 03:24:44,949 DEFICIENCY DURING THESE STAGES. 4181 03:24:44,949 --> 03:24:50,622 I THINK THAT'S IMPORTANT FOR 4182 03:24:50,622 --> 03:24:51,523 PUBLIC HEALTH MESSAGING. 4183 03:24:51,523 --> 03:24:58,063 WITH THAT WE'LL TAKE A BREAK 4184 03:24:58,063 --> 03:25:03,439 CONVENE AT 3:10 FOR SESSION 3. THANK YOU TO SPEAKERS. WE APPRECIATE IT. 4185 03:25:03,439 --> 03:25:07,009 >> I'LL BE MODERATE BEING THE 4186 03:25:07,009 --> 03:25:13,315 NEXT SESSION ON VIZIO 4187 03:25:13,315 --> 03:25:14,016 PHYSIOLOGIC AND USING MACHINE 4188 03:25:14,016 --> 03:25:16,251 LEARNING AND ARTIFICIAL 4189 03:25:16,251 --> 03:25:16,919 INTELLIGENCE APPROACHES TO 4190 03:25:16,919 --> 03:25:19,788 PROVIDE A COMPREHENSIVE PICTURE 4191 03:25:19,788 --> 03:25:20,789 OF THE UNDERSTANDING OF THE 4192 03:25:20,789 --> 03:25:21,957 HETEROGENEITY AND WHAT IT MEANS 4193 03:25:21,957 --> 03:25:22,825 FOR LONG-TERM HEALTH 4194 03:25:22,825 --> 03:25:23,892 CONSEQUENCES. 4195 03:25:23,892 --> 03:25:25,694 WE HAVE FOUR TALKS. 4196 03:25:25,694 --> 03:25:27,963 THE FIRST THREE ARE SCHEDULED 4197 03:25:27,963 --> 03:25:31,233 FOR 13 TO 15 MINUTES AND I'LL BE 4198 03:25:31,233 --> 03:25:41,777 PROVIDING PEOPLE WITH A HEADS UP 4199 03:25:43,178 --> 03:25:45,380 TO KEEP US ADHERING TO THE 4200 03:25:45,380 --> 03:25:47,916 SCHEDULE AND THE FOURTH TALK 4201 03:25:47,916 --> 03:25:52,287 WILL BE 30 MINUTES AND FOLLOWING 4202 03:25:52,287 --> 03:25:58,761 THE LAST TALK AT 4:30 BE 30 4203 03:25:58,761 --> 03:26:04,266 MINUTES FOR GENERAL QUESTION AND 4204 03:26:04,266 --> 03:26:12,808 ANSWER. 4205 03:26:12,808 --> 03:26:16,278 AND FOR SPEAKERS STILL ON HAVE 4206 03:26:16,278 --> 03:26:18,147 QUESTIONS AND FOR COMMENTS 4207 03:26:18,147 --> 03:26:19,982 ARRIVING FROM THE TALKS WHICH 4208 03:26:19,982 --> 03:26:24,419 SHOULD BE PROVOCATIVE BECAUSE 4209 03:26:24,419 --> 03:26:26,789 THEY'RE COVERING AN AREA QUITE 4210 03:26:26,789 --> 03:26:27,756 CURRENT, ARTIFICIAL INTELLIGENCE 4211 03:26:27,756 --> 03:26:28,157 ANALYSIS OF OSA. 4212 03:26:28,157 --> 03:26:30,859 LET ME START TO INTRODUCE IT THE 4213 03:26:30,859 --> 03:26:31,126 SPEAKERS. 4214 03:26:31,126 --> 03:26:33,595 THE FIRST SPEAKER IS 4215 03:26:33,595 --> 03:26:35,164 DR. ALLANPACK PROBABLY KNOWN TO 4216 03:26:35,164 --> 03:26:39,134 EVERYBODY ON THE CALL. 4217 03:26:39,134 --> 03:26:42,271 THE ASSISTANT DEAN MUCH THE 4218 03:26:42,271 --> 03:26:44,807 PROGRAM AND VRCH OF TREATMENT 4219 03:26:44,807 --> 03:26:46,708 TRAINING IN THE DEPARTMENT OF 4220 03:26:46,708 --> 03:26:49,678 MEDICINE AT THE UNIVERSITY OF 4221 03:26:49,678 --> 03:26:52,281 PENNSYLVANIA MEDICAL SCHOOL IN 4222 03:26:52,281 --> 03:26:52,748 PHILADELPHIA. 4223 03:26:52,748 --> 03:26:55,217 HIS PRESENTATION IS ENTITLED 4224 03:26:55,217 --> 03:26:56,852 DIFFERENT DIMENSIONS OF 4225 03:26:56,852 --> 03:26:58,987 HETEROGENEITY OF OSA. 4226 03:26:58,987 --> 03:27:02,691 THANKS FOR JOINING US ALLAN. 4227 03:27:02,691 --> 03:27:04,393 LOOKING FORWARD TO HEARING YOUR 4228 03:27:04,393 --> 03:27:14,503 TALK. 4229 03:27:29,685 --> 03:27:30,352 SAID HE WANTS TO RUN THE SLIDES. 4230 03:27:30,352 --> 03:27:40,462 OKAY. 4231 03:27:58,146 --> 03:27:59,114 >> MAYBE WE CAN GIVE HIM A 4232 03:27:59,114 --> 03:27:59,481 COUPLE MINUTES. 4233 03:27:59,481 --> 03:28:09,625 >> OKAY. 4234 03:29:00,876 --> 03:29:05,314 >> THE NEXT SPEAKER IS ANDREW 4235 03:29:05,314 --> 03:29:08,183 WELLMAN AND HIS TALK IS RACIAL 4236 03:29:08,183 --> 03:29:11,353 DIFFERENCES IN OXYGEN-BASED 4237 03:29:11,353 --> 03:29:12,821 ENDOTYPES IN OSA. 4238 03:29:12,821 --> 03:29:23,198 TAKE IT AWAY, PLEASE. 4239 03:29:29,071 --> 03:29:39,481 >> SOME OF YOU MAY HYPOXIC 4240 03:29:47,122 --> 03:29:49,591 BURDEN IS THE MEASUREMENT UNDER 4241 03:29:49,591 --> 03:29:52,461 THE CURB WHEN THE SATURATION 4242 03:29:52,461 --> 03:29:53,362 DROPS DURING A SLEEP APNEA 4243 03:29:53,362 --> 03:29:54,796 EVENT. 4244 03:29:54,796 --> 03:29:56,832 I'M NOT GOING TO TALK TOO MUCH 4245 03:29:56,832 --> 03:29:58,633 ABOUT THIS OTHER THAN TO SAY 4246 03:29:58,633 --> 03:30:02,004 SOME STUDIES ONE FROM OUR LAB 4247 03:30:02,004 --> 03:30:03,538 AND ANOTHER ONE INDEPENDENT OF 4248 03:30:03,538 --> 03:30:09,978 US SUGGESTED IF YOU HAD A HIGH 4249 03:30:09,978 --> 03:30:18,220 HYPOXIC BURDEN YOU HAD LESS 4250 03:30:18,220 --> 03:30:28,563 CHANCE OF SURVIVAL. 4251 03:30:34,603 --> 03:30:36,204 AND SHOW YOU A PAPER THAT SHOWED 4252 03:30:36,204 --> 03:30:39,274 DIFFERENCES IN OXYGEN 4253 03:30:39,274 --> 03:30:39,975 MEASUREMENTS. 4254 03:30:39,975 --> 03:30:43,245 HOW WILL THAT AFFECT -- HOW IS 4255 03:30:43,245 --> 03:30:45,847 DIFFERENT SKIN TONES GOING TO 4256 03:30:45,847 --> 03:30:47,315 AFFECT THE HYPOXIC BURDEN 4257 03:30:47,315 --> 03:30:48,817 MEASUREMENT WE THINK IS AN 4258 03:30:48,817 --> 03:30:52,287 IMPORTANT PREDICTOR OF 4259 03:30:52,287 --> 03:30:53,722 CARDIOVASCULAR OUTCOMES IN SLEEP 4260 03:30:53,722 --> 03:30:53,922 APNEA. 4261 03:30:53,922 --> 03:30:56,792 REAL QUICK, I WANTED TO TALK 4262 03:30:56,792 --> 03:31:07,369 ABOUT THE PHYSICS OF PULSE OX 4263 03:31:08,870 --> 03:31:12,808 OXIMETRY. 4264 03:31:12,808 --> 03:31:16,812 YOU SEEN RED LIGHT THROUGH THE 4265 03:31:16,812 --> 03:31:20,982 PULSIFIED TISSUE AND EACH TIME 4266 03:31:20,982 --> 03:31:31,493 THERE'S A HEARTBEAT THAT YOU 4267 03:31:35,964 --> 03:31:38,166 MEASURE THE RED LIGHT THAT AND 4268 03:31:38,166 --> 03:31:41,970 THE AMPLITUDE OF THE INFRARED 4269 03:31:41,970 --> 03:31:52,514 LIGHT AND LOOK AT THE RATIO AND 4270 03:32:03,058 --> 03:32:05,727 BASED ON THE RATIO YOU GET THE 4271 03:32:05,727 --> 03:32:06,094 READING. 4272 03:32:06,094 --> 03:32:10,365 THE REASON THE RED LIGHTS -- THE 4273 03:32:10,365 --> 03:32:11,800 INFRARED AND RED LIGHT 4274 03:32:11,800 --> 03:32:16,805 TRANSMISSION THROUGH THE FINGER 4275 03:32:16,805 --> 03:32:18,940 CHANGE IS BECAUSE WHENEVER 4276 03:32:18,940 --> 03:32:25,147 HEMOGLOBIN IS OXYGENATED IT 4277 03:32:25,147 --> 03:32:28,016 CHAN 4278 03:32:28,016 --> 03:32:28,483 CHANGES TRANSMISSION. 4279 03:32:28,483 --> 03:32:33,522 WATCH THE ANIMATION AND YOU'LL 4280 03:32:33,522 --> 03:32:35,991 SEE THREE DIFFERENT OXYGEN 4281 03:32:35,991 --> 03:32:36,791 SATURATION LEVELS. 4282 03:32:36,791 --> 03:32:39,027 AGAIN BY GIVING THE RATIO OF THE 4283 03:32:39,027 --> 03:32:42,597 RED TO THE INFRARED LIGHT. 4284 03:32:42,597 --> 03:32:44,533 IF THE RED LIGHT IS LOW YOU GET 4285 03:32:44,533 --> 03:32:51,139 A HIGH READING AND IF THE 4286 03:32:51,139 --> 03:32:52,807 AMPLITUDE IS HIGH COMPARED TO 4287 03:32:52,807 --> 03:33:00,148 THE BLUE SFLAL YOU GET 4288 03:33:00,148 --> 03:33:10,292 READING. 4289 03:33:15,096 --> 03:33:17,499 WE WORK WITH PAUL AND HAS 4290 03:33:17,499 --> 03:33:18,333 EXPERIENCE IN THE TRIALS AND HIS 4291 03:33:18,333 --> 03:33:24,773 PAPER WAS NEVER PUBLISHED. 4292 03:33:24,773 --> 03:33:32,914 HE SHINED THE RED LIGHT AND THE 4293 03:33:32,914 --> 03:33:43,391 WAVE LENGTH AND YOU GET THE 4294 03:33:51,032 --> 03:33:54,736 COUNTS AND THAT'S HOW INTENSE 4295 03:33:54,736 --> 03:33:58,540 AND THROUGH AN EAR LOBE IT 4296 03:33:58,540 --> 03:34:00,775 REDUCES THE TRANSMISSION BUT 4297 03:34:00,775 --> 03:34:02,277 LOOK WHAT HAPPENS WHEN YOU SHINE 4298 03:34:02,277 --> 03:34:04,246 IT THROUGH PEOPLE WITH DARK 4299 03:34:04,246 --> 03:34:04,679 EARS. 4300 03:34:04,679 --> 03:34:08,550 NOT THE RED LIGHT DOES NOT PASS 4301 03:34:08,550 --> 03:34:10,452 THROUGH THE BLACK EARS NEARLY AS 4302 03:34:10,452 --> 03:34:11,620 WELL AS THE RED EARS. 4303 03:34:11,620 --> 03:34:17,425 IF YOU LOOK AT THE INFRARED 4304 03:34:17,425 --> 03:34:19,761 LIGHT WITH WHITE EAR AND BLACK 4305 03:34:19,761 --> 03:34:28,236 EAR AND NOT MUCH ATTENUATION IN 4306 03:34:28,236 --> 03:34:34,476 INFRARED. 4307 03:34:34,476 --> 03:34:36,778 NOTICE IF THE RED LIGHT IS SMALL 4308 03:34:36,778 --> 03:34:41,516 COMPARED TO THE BLUE LIGHT YOU'D 4309 03:34:41,516 --> 03:34:45,287 GET A LARGE SPO2 VALUE. 4310 03:34:45,287 --> 03:34:50,358 I'VE NEVER HEARD ANYONE EXPLAIN 4311 03:34:50,358 --> 03:34:51,860 WHY. 4312 03:34:51,860 --> 03:34:57,299 TO ME SOME SOMEBODY CLAIMS THEY 4313 03:34:57,299 --> 03:35:01,936 SOLVED THE RACIAL BIAS IN 4314 03:35:01,936 --> 03:35:09,344 OXIMETRY THEY NEED TO EXPLAIN 4315 03:35:09,344 --> 03:35:19,587 HOW THEY FIX THIS WE'D LIKE TO 4316 03:35:19,587 --> 03:35:21,523 GET FUNDING. 4317 03:35:21,523 --> 03:35:23,558 I DON'T KNOW IF YOU JUST TURN UP 4318 03:35:23,558 --> 03:35:26,461 THE RED LIGHT INTENSITY WILL IT 4319 03:35:26,461 --> 03:35:28,763 FIX THIS, FIX THE SENSOR? 4320 03:35:28,763 --> 03:35:32,500 I DON'T KNOW OUT IT SEEMS IT'S A 4321 03:35:32,500 --> 03:35:36,771 PROBLEM THAT SHOULD BE DISCUSSED 4322 03:35:36,771 --> 03:35:39,941 THE INABILITY OF THE RED LIGHT 4323 03:35:39,941 --> 03:35:43,278 TO PASS THROUGH DARK TISSUES. 4324 03:35:43,278 --> 03:35:44,746 THIS IS THE NEW ENGLAND JOURNAL 4325 03:35:44,746 --> 03:35:48,383 OF MEDICINE PAPER AND I'LL SAY 4326 03:35:48,383 --> 03:35:51,086 BRIEFLY, IN WHITE PATIENTS THE 4327 03:35:51,086 --> 03:35:53,154 OXYGEN SATURATION WAS 4328 03:35:53,154 --> 03:35:55,990 CONSISTENTLY HIGHER BUT THREE TO 4329 03:35:55,990 --> 03:35:59,094 FOUR PERCENTAGE POINTS THAN 4330 03:35:59,094 --> 03:36:03,298 SELF-IDENTIFIED BLACK PATIENTS. 4331 03:36:03,298 --> 03:36:06,034 SO HERE YOU'D GET A MEASUREMENT 4332 03:36:06,034 --> 03:36:12,741 OF 91% IN THE WHITE PATIENTS AND 4333 03:36:12,741 --> 03:36:16,211 87 OR SO PERCENT IN THE BLACK 4334 03:36:16,211 --> 03:36:26,388 PATIENTS. 4335 03:36:37,699 --> 03:36:40,135 THERE WERE MANY ETHNIC GROUPS 4336 03:36:40,135 --> 03:36:44,973 AND ASIAN AND BLACK AND WHITE 4337 03:36:44,973 --> 03:36:47,108 AND HISPANIC PATIENT AND 4338 03:36:47,108 --> 03:36:50,779 COMPARED PEOPLE WITH THE SAME 4339 03:36:50,779 --> 03:36:56,718 AHI, BLACK AND WHITE PATIENT. 4340 03:36:56,718 --> 03:37:03,391 LOOK AT THIS DIFFERENCE THE TOP 4341 03:37:03,391 --> 03:37:09,164 IS AIR FLOW AND SATURATION AND 4342 03:37:09,164 --> 03:37:19,741 THE DELTA HEART RATE NOTICE THIS 4343 03:37:19,741 --> 03:37:22,210 PERSON WITH LOTS OF APNEAS 4344 03:37:22,210 --> 03:37:26,047 THERE'S NO DESATURATION AND 4345 03:37:26,047 --> 03:37:26,314 HYPOPNEA. 4346 03:37:26,314 --> 03:37:35,423 THIS IS CRAZY TO ME. 4347 03:37:35,423 --> 03:37:40,728 ALL THESE EVENTS WILL GET 4348 03:37:40,728 --> 03:37:44,732 SCORED. 4349 03:37:44,732 --> 03:37:45,767 SURELY THERE'S BETTER LUNG 4350 03:37:45,767 --> 03:37:46,367 RESERVE AND MAYBE THAT'S THE 4351 03:37:46,367 --> 03:37:56,478 ISSUE. 4352 03:38:00,148 --> 03:38:02,951 THESE EVENTS AND THIS PERSON IS 4353 03:38:02,951 --> 03:38:04,185 REAL. 4354 03:38:04,185 --> 03:38:06,087 LOOK AT HOW MUCH HEART RATE 4355 03:38:06,087 --> 03:38:09,524 SURGE YOU GET IN RESPONSE TO THE 4356 03:38:09,524 --> 03:38:10,191 APNEAS. 4357 03:38:10,191 --> 03:38:11,392 THEY'RE NOT AS MUCH AS THE 4358 03:38:11,392 --> 03:38:12,227 PATIENT OVER HERE. 4359 03:38:12,227 --> 03:38:14,529 THIS PERSON ON THE LEFT I THINK 4360 03:38:14,529 --> 03:38:15,997 IS DESATURATING AND YOU'RE JUST 4361 03:38:15,997 --> 03:38:21,603 NOT PICKING UP ON IT. 4362 03:38:21,603 --> 03:38:32,146 MAYBE THAT'S WHY AND I CAN'T SEE 4363 03:38:59,307 --> 03:39:00,842 ANYONE BUT WHEN I SAW THIS IT 4364 03:39:00,842 --> 03:39:02,510 KNOCKED ME OUT OF MY SEAT. 4365 03:39:02,510 --> 03:39:04,612 FOR 20 YEARS I'VE WITHIN LOOKING 4366 03:39:04,612 --> 03:39:05,914 AT READING SLEEP STUDIES AND 4367 03:39:05,914 --> 03:39:08,550 TRIED TO GO BACK AND THINK ABOUT 4368 03:39:08,550 --> 03:39:13,922 HOW MANY OF MY PATIENTS WITH 4369 03:39:13,922 --> 03:39:17,058 DARK SKIN TONE MAYBE HAD LOTS OF 4370 03:39:17,058 --> 03:39:19,294 SNORING AND AHI WASN'T VERY 4371 03:39:19,294 --> 03:39:19,494 HIGH. 4372 03:39:19,494 --> 03:39:20,562 MAYBE THEY ARE WERE TIRED AND WE 4373 03:39:20,562 --> 03:39:23,831 JUST WROTE IT OFF. 4374 03:39:23,831 --> 03:39:25,967 I DON'T KNOW WHAT TO DO ABOUT 4375 03:39:25,967 --> 03:39:26,534 THIS. 4376 03:39:26,534 --> 03:39:27,001 I CAN KEEP 4377 03:39:27,001 --> 03:39:30,104 P GOING. 4378 03:39:30,104 --> 03:39:32,240 WE JUST WENT THROUGH ALL THESE 4379 03:39:32,240 --> 03:39:32,774 STUDIES. 4380 03:39:32,774 --> 03:39:36,144 PEOPLE WITH -- THIS IS 4381 03:39:36,144 --> 03:39:37,312 CONTINUOUS CYCLING HYPOPNEA ON 4382 03:39:37,312 --> 03:39:39,414 THE LEFT. 4383 03:39:39,414 --> 03:39:41,649 IT'S NOT LIKE IT'S A LITTLE 4384 03:39:41,649 --> 03:39:46,988 HYPOPNEA HERE AND THERE THAT 4385 03:39:46,988 --> 03:39:48,456 GETS MISSED. 4386 03:39:48,456 --> 03:39:58,900 AND BIG HEART RATE SURGES. 4387 03:39:59,500 --> 03:40:01,336 TO ME THAT ALONE -- WE HAVE TO 4388 03:40:01,336 --> 03:40:03,771 LOOK AT THIS HOW MANY OF 4389 03:40:03,771 --> 03:40:06,074 THESE PATIENTS ARE BEING MISSED 4390 03:40:06,074 --> 03:40:08,276 OR SYMPTOMS ARE BEING CHOPPED UP 4391 03:40:08,276 --> 03:40:17,151 TO LAZINESS OR SOME OTHER REASOA 4392 03:40:17,151 --> 03:40:27,595 ON 3% TO 4% DESATURATION. 4393 03:40:33,568 --> 03:40:35,103 HOW MANY ARE BEING MISSED? 4394 03:40:35,103 --> 03:40:38,439 WE SCORED ON A 50% REDUCTION IN 4395 03:40:38,439 --> 03:40:42,677 AIR FLOW AND SAW HOW MANY OF 4396 03:40:42,677 --> 03:40:45,713 THOSE -- LET'S CALL THOSE FLOW 4397 03:40:45,713 --> 03:40:47,749 EVENTS. 4398 03:40:47,749 --> 03:40:49,751 HOW MANY OF THOSE SLOW EVENTS, 4399 03:40:49,751 --> 03:40:54,856 HOW MANY NEVER PRODUCED THE 4400 03:40:54,856 --> 03:40:56,658 REQUIRED 3%? 4401 03:40:56,658 --> 03:40:59,293 15% IN BLACK MEN AND LOOK, 30% 4402 03:40:59,293 --> 03:41:02,797 IN PLAQUE WOMEN. 4403 03:41:02,797 --> 03:41:04,165 -- BLAWOMEN. 4404 03:41:04,165 --> 03:41:10,738 SO 30% OF HYPOPNEAS ARE BEING 4405 03:41:10,738 --> 03:41:11,305 MISSED IN OUR BLACK FEMALE 4406 03:41:11,305 --> 03:41:21,482 PATIENTS. 4407 03:41:26,554 --> 03:41:28,990 AND OF THE MISSED HYPOPNEAS I 4408 03:41:28,990 --> 03:41:30,725 THINK ARE REAL PAUSE WHEN WE 4409 03:41:30,725 --> 03:41:33,561 MEASURE THE AHI BASED ONLY ON 4410 03:41:33,561 --> 03:41:38,399 AIR FLOW IN BLACK INDIVIDUALS, 4411 03:41:38,399 --> 03:41:41,169 IT PRODUCED AN INCREASED HAZARD 4412 03:41:41,169 --> 03:41:42,503 RATIO FOR CARDIOVASCULAR EVENTS 4413 03:41:42,503 --> 03:41:47,775 BUT IF YOU REQUIRED THE AIR FLOW 4414 03:41:47,775 --> 03:41:51,312 EVENTS ALSO HAVE DSAP YOU LOSE 4415 03:41:51,312 --> 03:41:52,146 THE PREDICTABILITY. 4416 03:41:52,146 --> 03:41:56,317 SO THE FLOW EVENTS ARE REAL IN 4417 03:41:56,317 --> 03:41:57,418 MY MIND. 4418 03:41:57,418 --> 03:42:03,091 SO BASED ON THIS NDING, THERE 4419 03:42:03,091 --> 03:42:06,160 WAS AN EXPERIMENT WHERE WEEN HA 4420 03:42:06,160 --> 03:42:07,562 PATIENTS DO A 20 SECOND BREATH 4421 03:42:07,562 --> 03:42:11,132 HOLD AT FRC AND I JUST WANTED TO 4422 03:42:11,132 --> 03:42:13,534 SEE HOW MANY OF THESE 20-SECOND 4423 03:42:13,534 --> 03:42:15,536 BREATH HOLDS DURING WAKEFULNESS 4424 03:42:15,536 --> 03:42:18,973 WE COULD COACH PEOPLE TO DO THIS 4425 03:42:18,973 --> 03:42:20,374 AND SEE HOW MANY TIMES THEY ARE 4426 03:42:20,374 --> 03:42:23,244 DESATURATED TO 3%. 4427 03:42:23,244 --> 03:42:24,946 AND SO THE DARK SKIN INDIVIDUALS 4428 03:42:24,946 --> 03:42:28,549 ON THE RIGHT AND INDIVIDUALS 4429 03:42:28,549 --> 03:42:30,651 WITH LIGHT INDIVIDUALS ON THE 4430 03:42:30,651 --> 03:42:31,319 LEFT -- 4431 03:42:31,319 --> 03:42:32,620 >> SORRY TO INTERRUPT THERE'S 4432 03:42:32,620 --> 03:42:33,087 ABOUT TWO 4433 03:42:33,087 --> 03:42:34,622 UTES LEFT. 4434 03:42:34,622 --> 03:42:34,889 THANKS. 4435 03:42:34,889 --> 03:42:35,957 THANK YOU. 4436 03:42:35,957 --> 03:42:39,961 >> THE WHITE PATIENTS 4437 03:42:39,961 --> 03:42:43,798 DESATURATED LIKE 3.5% BUT THE 4438 03:42:43,798 --> 03:42:47,101 BLACK PATIENTS DESATURATED ONLY 4439 03:42:47,101 --> 03:42:51,305 ABOUT 2%. 4440 03:42:51,305 --> 03:42:55,610 THESE ARE MATCHED FOR SEX AND 4441 03:42:55,610 --> 03:42:55,777 BMI. 4442 03:42:55,777 --> 03:42:59,947 AND BY THE WAY, THERE WAS ONLY A 4443 03:42:59,947 --> 03:43:01,549 .2% DIFFERENCE IN THE BASELINE 4444 03:43:01,549 --> 03:43:03,451 OXYGEN SATURATION BETWEEN THE 4445 03:43:03,451 --> 03:43:05,219 GROUPS. 4446 03:43:05,219 --> 03:43:07,955 MEANING THE RACIAL BIAS IS WORSE 4447 03:43:07,955 --> 03:43:09,457 FOR DETECTING THESE TRANSIENT 4448 03:43:09,457 --> 03:43:14,896 OXYGEN DROPS. 4449 03:43:14,896 --> 03:43:20,368 THERE'S REALLYEA NOT MUCH RACIA 4450 03:43:20,368 --> 03:43:21,402 BIAS IN THE VALUES LIKE THE 4451 03:43:21,402 --> 03:43:29,377 PAPER. 4452 03:43:29,377 --> 03:43:32,847 SOMETHING NEEDS TO BE 4453 03:43:32,847 --> 03:43:33,181 INVESTIGATED. 4454 03:43:33,181 --> 03:43:34,415 BY THE WAY, THE BLACK 4455 03:43:34,415 --> 03:43:37,185 INDIVIDUALS IN THE COHORT WERE 4456 03:43:37,185 --> 03:43:39,854 NOT DESATURATING BECAUSE SOMEHOW 4457 03:43:39,854 --> 03:43:42,723 THEY HAD BETTER LUNGS. 4458 03:43:42,723 --> 03:43:49,497 IN FACT WE MEASURED THE EXPIRED 4459 03:43:49,497 --> 03:43:58,105 WE HAD THEM EXHALE TO RESIDUAL 4460 03:43:58,105 --> 03:43:59,106 VOLUME AND THE OXYGEN DROPPED 4461 03:43:59,106 --> 03:44:05,046 MORE THAN THE WHITE PATIENTS BUT 4462 03:44:05,046 --> 03:44:09,350 WASN'T EVEN PICKED UP THAT MEANS 4463 03:44:09,350 --> 03:44:18,926 FOR THE SAME AIRWAY OBSTRUCTION 4464 03:44:18,926 --> 03:44:21,095 THEY HAVE A LARGER DROP AND AND 4465 03:44:21,095 --> 03:44:23,865 SMALLER DETECTED DROP AT THE 4466 03:44:23,865 --> 03:44:24,732 FINGER TRIP. 4467 03:44:24,732 --> 03:44:31,873 -- FINGERTIP. 4468 03:44:31,873 --> 03:44:42,416 IS WE WERE MISSING SLEEP APNEA 4469 03:45:01,202 --> 03:45:05,940 IN THE PATIENTS. 4470 03:45:05,940 --> 03:45:07,108 I'LL STOP THERE BECAUSE I RAN 4471 03:45:07,108 --> 03:45:08,676 OUT OF TIME. 4472 03:45:08,676 --> 03:45:11,145 >> WE DON'T HAVE DR. PACK YET 4473 03:45:11,145 --> 03:45:13,547 AND WE'LL MOVE ON TO 4474 03:45:13,547 --> 03:45:14,582 DR. GAYNANOVA AN ASSOCIATE 4475 03:45:14,582 --> 03:45:16,984 PROFESSOR OF BIO STATISTICS AT 4476 03:45:16,984 --> 03:45:22,390 THE UNIVERSITY OF MICHIGAN ANN 4477 03:45:22,390 --> 03:45:24,625 ARBOR AND HER PRESENTATION IS 4478 03:45:24,625 --> 03:45:26,327 MACHINE LEARNING FOR GLYCEMIC 4479 03:45:26,327 --> 03:45:28,362 MEASURES AND APPLICATIONS FOR 4480 03:45:28,362 --> 03:45:28,562 OSA. 4481 03:45:28,562 --> 03:45:29,330 ARE YOU READY? 4482 03:45:29,330 --> 03:45:30,598 >> YES. 4483 03:45:30,598 --> 03:45:31,699 >> THANK YOU FOR STEPPING IN 4484 03:45:31,699 --> 03:45:32,033 SHORT NOTICE. 4485 03:45:32,033 --> 03:45:42,276 >> THANK YOU. 4486 03:46:09,870 --> 03:46:14,875 THERE WAS TALKS TODAY DURING 4487 03:46:14,875 --> 03:46:16,744 PARALLELS WITH HYPERTENSION AND 4488 03:46:16,744 --> 03:46:19,246 PREVALENCE WITH RSA AND 4489 03:46:19,246 --> 03:46:19,780 GESTATIONAL DIABETES. 4490 03:46:19,780 --> 03:46:21,682 WHAT I WOULD LIKE TO POINT OUT 4491 03:46:21,682 --> 03:46:25,119 IS WE KEEP DOING THIS RANDOMIZED 4492 03:46:25,119 --> 03:46:25,853 CLINICAL TRIALS WHERE WE 4493 03:46:25,853 --> 03:46:27,855 PRESCRIBE THERAPY TO PATIENTS 4494 03:46:27,855 --> 03:46:29,390 WITH DIABETES AND WE KEEP 4495 03:46:29,390 --> 03:46:31,359 REACHING INCONCLUSIVE EFFECTS 4496 03:46:31,359 --> 03:46:32,994 REGARDING THE EFFECTS OF THE 4497 03:46:32,994 --> 03:46:36,664 TREATMENT ON GLUCOSE METABOLISM. 4498 03:46:36,664 --> 03:46:43,604 I THINK WITHIN HYPERTENSION THE 4499 03:46:43,604 --> 03:46:51,278 CONCLUSION IS MUCH BETTER. 4500 03:46:51,278 --> 03:46:55,116 AND SOMETIMES WE MEASURE THESE 4501 03:46:55,116 --> 03:46:58,352 THINGS SO WE MEASURED GLUCOSE 4502 03:46:58,352 --> 03:47:00,321 USING A1C WHICH IS A CRUDE 4503 03:47:00,321 --> 03:47:02,156 SUMMARY BECAUSE IT'S CAPTURING 4504 03:47:02,156 --> 03:47:03,791 THE AVERAGE GLUCOSE OVER THE 4505 03:47:03,791 --> 03:47:06,093 PRECEDING TWO TO THREE MONTHS. 4506 03:47:06,093 --> 03:47:06,927 WHEN WE MEASURE BLOOD PRESSURE 4507 03:47:06,927 --> 03:47:10,564 WE USUALLY DO ONE TIME BLOOD 4508 03:47:10,564 --> 03:47:11,732 PRESSURE READING. 4509 03:47:11,732 --> 03:47:13,134 WHEN WE DO THE USUAL ASSESSMENT 4510 03:47:13,134 --> 03:47:16,570 WE DON'T REALLY CAPTURE THE 4511 03:47:16,570 --> 03:47:18,239 TEMPORAL VARIABILITY IN THE 4512 03:47:18,239 --> 03:47:19,173 MEASUREMENTS AND WE MAY BE 4513 03:47:19,173 --> 03:47:20,074 REACHING A LIMITED UNDERSTANDING 4514 03:47:20,074 --> 03:47:23,844 OF THE IMPACT OF THE SLEEP APNEA 4515 03:47:23,844 --> 03:47:25,980 IN THE MEASURES. 4516 03:47:25,980 --> 03:47:29,116 IN THE TALK I'LL FOCUS PRIMARILY 4517 03:47:29,116 --> 03:47:32,520 ON GLUCOSE AND I'LL GIVE YOU A 4518 03:47:32,520 --> 03:47:34,855 HINT ON HOW THE BLOOD PRESSURE 4519 03:47:34,855 --> 03:47:38,225 CONDITION CAN CONNECT THESE DAYS 4520 03:47:38,225 --> 03:47:41,195 WE HAVE VARIABLE DEVICES ONE 4521 03:47:41,195 --> 03:47:44,198 WILL THE PROMISE OF RICH 4522 03:47:44,198 --> 03:47:45,032 TEMPORAL DATA. 4523 03:47:45,032 --> 03:47:51,405 THERE'S ADVANCEMENTS IN GLUCOSE 4524 03:47:51,405 --> 03:47:57,344 MONITORING AND ADVANCEMENT IN 4525 03:47:57,344 --> 03:48:07,888 BLB AND IF WE USE ADVANTAGE OF 4526 03:48:23,170 --> 03:48:24,271 THE TEMPORAL CHARACTERISTICS OF 4527 03:48:24,271 --> 03:48:27,108 THE DATA WE CAN LOOK AT THE 4528 03:48:27,108 --> 03:48:30,010 HETEROGENEITY IN FEATURES ACROSS 4529 03:48:30,010 --> 03:48:31,245 PATIENT AND THE RESPONSE TO 4530 03:48:31,245 --> 03:48:32,813 TREATMENT. 4531 03:48:32,813 --> 03:48:34,915 SPECIFICALLY I'LL FOCUS ON 4532 03:48:34,915 --> 03:48:37,485 CONTINUOUS GLUCOSE MONITORS THE 4533 03:48:37,485 --> 03:48:39,253 AREA OF MY EXPERTISE. 4534 03:48:39,253 --> 03:48:41,255 SMALL WEARABLE DEVICES. 4535 03:48:41,255 --> 03:48:44,959 THEY HAVE A LITTLE NEEDLE ON 4536 03:48:44,959 --> 03:48:46,760 THEM AND MEASURE INTERSTITIAL 4537 03:48:46,760 --> 03:48:48,929 GLUCOSE EVERY FIVE MINUTES. 4538 03:48:48,929 --> 03:48:51,565 ONE MONITOR TYPICALLY LASTS 10 4539 03:48:51,565 --> 03:48:55,069 DAYS OR 14 DAYS FOR THE FREE 4540 03:48:55,069 --> 03:48:57,338 STYLE LIBRE AND THE STANDARD OF 4541 03:48:57,338 --> 03:48:59,807 CARE FOR PEOPLE WITH TYPE I 4542 03:48:59,807 --> 03:49:01,475 DIABETES AND RECOMMENDED FOR 4543 03:49:01,475 --> 03:49:06,447 THOSE ON INSULIN CONTROL AND 4544 03:49:06,447 --> 03:49:08,816 INCREASINGLY USED IN CLINICAL 4545 03:49:08,816 --> 03:49:13,053 PRACTICE AND RESEARCH STUDIES. 4546 03:49:13,053 --> 03:49:15,823 IF WE TAKE A MEAN OF THE PROFILE 4547 03:49:15,823 --> 03:49:17,258 HERE'S AN EXAMPLE OF DATA FROM 4548 03:49:17,258 --> 03:49:18,726 TWO DIFFERENT SUBJECTS, 24 4549 03:49:18,726 --> 03:49:22,830 HOURS. 4550 03:49:22,830 --> 03:49:31,739 AND WHAT WE SEE IS THE QUESTION 4551 03:49:31,739 --> 03:49:33,807 IS CAN WE DO BETTER AND GO 4552 03:49:33,807 --> 03:49:35,042 BEYOND THE MEAN? 4553 03:49:35,042 --> 03:49:37,711 THIS IS WHERE THE LITERATURE 4554 03:49:37,711 --> 03:49:38,546 WITHIN DIABETES COMMUNITY IN 4555 03:49:38,546 --> 03:49:41,015 PARTICULAR HAS SEEN AN EXPLOSION 4556 03:49:41,015 --> 03:49:43,651 ON DIFFERENT METRICS OF GLYCEMIC 4557 03:49:43,651 --> 03:49:45,052 CONTROL PROPOSED. 4558 03:49:45,052 --> 03:49:50,191 ONE OF THE EARLIER PAPER THAT 4559 03:49:50,191 --> 03:49:51,325 SUMMARIZES A LOT OF THE METRICS 4560 03:49:51,325 --> 03:49:53,694 BUT THERE'S DIFFERENT PAPERS OUT 4561 03:49:53,694 --> 03:49:56,830 THERE AND DEVELOP A PACKAGE THAT 4562 03:49:56,830 --> 03:49:59,733 CAN CALCULATE OVER 60 METRICS OF 4563 03:49:59,733 --> 03:50:00,968 GLYCEMIC CONTROL AND THIS 4564 03:50:00,968 --> 03:50:03,737 CREATES A LOT OF CONFUSION FOR 4565 03:50:03,737 --> 03:50:05,773 RESEARCHERS AND CLINICIANS ALIKE 4566 03:50:05,773 --> 03:50:07,208 TO WHICH METRICS WE SHOULD USE. 4567 03:50:07,208 --> 03:50:09,610 THERE'S BEEN A CONSENSUS THAT'S 4568 03:50:09,610 --> 03:50:11,979 BEEN REACHED IN TERMS OF THE 4569 03:50:11,979 --> 03:50:13,814 MEASURES USED FOR CLINICAL 4570 03:50:13,814 --> 03:50:17,651 TRIALS TO MEASURE GLYCEMIC 4571 03:50:17,651 --> 03:50:20,087 CONTROL AND I WILL ARGUE IT'S 4572 03:50:20,087 --> 03:50:21,255 BEEN REACHED BASED ON 4573 03:50:21,255 --> 03:50:22,856 CONSIDERATIONS FOR PATIENTS WITH 4574 03:50:22,856 --> 03:50:25,326 TYPE 1 DIABETES. 4575 03:50:25,326 --> 03:50:27,261 A LOT OF TIMES WHEN WE SEE 4576 03:50:27,261 --> 03:50:30,831 COMORBIDITIES AND SLEEP APNEA 4577 03:50:30,831 --> 03:50:31,966 IT'S IN TYPE 2 DIABETES PATIENTS 4578 03:50:31,966 --> 03:50:34,368 SO IT'S NOT CLEAR THE METRICS 4579 03:50:34,368 --> 03:50:36,804 ARE THE SAME AND THERE WAS 4580 03:50:36,804 --> 03:50:39,406 INTERPRETABILITY AND SIMPLICITY 4581 03:50:39,406 --> 03:50:42,610 WHERE MAY NOT ALLOW US TO 4582 03:50:42,610 --> 03:50:43,244 CAPTURE SIGNALS. 4583 03:50:43,244 --> 03:50:51,252 TO SUMMARIZE HERE'S AN EXAMPLE 4584 03:50:51,252 --> 03:50:55,623 OF WHERE A PERSON WITH DIABETES 4585 03:50:55,623 --> 03:51:00,928 AND TYPICALLY THE TAR GUEST IS 4586 03:51:00,928 --> 03:51:06,400 TO BE WITHIN THE RANGE TYPICALLY 4587 03:51:06,400 --> 03:51:07,935 WE TAKE THE TEMPORAL PROFILE AND 4588 03:51:07,935 --> 03:51:10,771 CREATE SUMMARIES. 4589 03:51:10,771 --> 03:51:13,674 SUCH AS THE MEAN, PERCENTAGE OF 4590 03:51:13,674 --> 03:51:15,009 TIME AND STANDARD DEVIATIONS AND 4591 03:51:15,009 --> 03:51:15,409 SO FORTH. 4592 03:51:15,409 --> 03:51:19,947 IF WE TRIED TO USE THEM ALL WE 4593 03:51:19,947 --> 03:51:23,550 CAN'T FIND ANY ASSOCIATIONS ALSO 4594 03:51:23,550 --> 03:51:25,853 WHEN WE USE MEASURES BASED ON 4595 03:51:25,853 --> 03:51:27,254 THRESHOLDS, TIME AND RANGE, THEN 4596 03:51:27,254 --> 03:51:29,323 WE HAVE A DEPENDENCE ON THE 4597 03:51:29,323 --> 03:51:29,823 THRESHOLD CHOICE. 4598 03:51:29,823 --> 03:51:33,294 AGAIN THE THRESHOLDS WERE 4599 03:51:33,294 --> 03:51:34,261 DESIGNED FOR PEOPLE WITH TYPE 1 4600 03:51:34,261 --> 03:51:35,696 DIABETES IN MIND. 4601 03:51:35,696 --> 03:51:37,264 IT'S NOT CLEAR THE SAME 4602 03:51:37,264 --> 03:51:38,832 THRESHOLD SHOULD BE USED IF 4603 03:51:38,832 --> 03:51:40,901 WE'RE INTERESTED IN SETTING 4604 03:51:40,901 --> 03:51:51,445 GLUCOSE WITHIN THE OSA CONTEXT. 4605 03:51:56,283 --> 03:52:06,660 AND DR. NISHA RAW--AURORA 4606 03:52:07,695 --> 03:52:08,829 MENTION THE TRIAL AND THESE WERE 4607 03:52:08,829 --> 03:52:09,163 MEASURED RAT THE 4608 03:52:15,336 --> 03:52:17,638 AT THE BASELINE AND THREE MONTHS 4609 03:52:17,638 --> 03:52:19,306 LATER AND NO DIFFERENCE WAS 4610 03:52:19,306 --> 03:52:25,746 FOUND WHEN LOOKING AT THE 4611 03:52:25,746 --> 03:52:33,220 STANDARD DEVIATION. 4612 03:52:33,220 --> 03:52:35,489 WITH LOOK AT HOW THE POP THERAPY 4613 03:52:35,489 --> 03:52:42,029 IS GOING TO AFFECT TGLUCOSE AND 4614 03:52:42,029 --> 03:52:45,099 WE KEEP FINDING NOTHING. 4615 03:52:45,099 --> 03:52:47,434 IT COULD BE THERE'S NO SIGNAL OR 4616 03:52:47,434 --> 03:52:51,705 NEED TO ADJUST FOR THE 4617 03:52:51,705 --> 03:52:53,207 HETEROGENEITY OF SIGNAL BUT 4618 03:52:53,207 --> 03:52:54,475 COULD BE WE NEED MORE 4619 03:52:54,475 --> 03:52:55,709 INFORMATION FROM THE DATA. 4620 03:52:55,709 --> 03:53:01,081 THE IDEA I WANT TO ADVERTISE IS 4621 03:53:01,081 --> 03:53:02,049 USING THE DATA. 4622 03:53:02,049 --> 03:53:04,785 THE BASIC IDEA IS HERE'S AN 4623 03:53:04,785 --> 03:53:07,187 EXAMPLE OF THE PROFILE FOR ONE 4624 03:53:07,187 --> 03:53:07,421 PERSON. 4625 03:53:07,421 --> 03:53:09,323 THIS IS ROUGHLY SEVEN DAYS OF 4626 03:53:09,323 --> 03:53:10,591 MEASUREMENT AND RATHER THAN 4627 03:53:10,591 --> 03:53:12,526 CREATING THE SUMMARY SUCH AS THE 4628 03:53:12,526 --> 03:53:14,795 MEAN OR STANDARD DEVIATION OR 4629 03:53:14,795 --> 03:53:17,664 TIME SPENT WITHIN THE THRESHOLD 4630 03:53:17,664 --> 03:53:18,699 WE'RE GOING TO REPRESENT ALL 4631 03:53:18,699 --> 03:53:21,368 THIS GLUCOSE MEASUREMENT AS A 4632 03:53:21,368 --> 03:53:22,569 MEASUREMENT OVER HERE. 4633 03:53:22,569 --> 03:53:27,107 THE IDEA IS KNOWN AS 4634 03:53:27,107 --> 03:53:28,142 GLUCODENSITY AND FIRST PROPOSED 4635 03:53:28,142 --> 03:53:32,846 AND THE ADVANTAGE OF THE 4636 03:53:32,846 --> 03:53:34,415 APPROACH IT IT GOES TO THE 4637 03:53:34,415 --> 03:53:36,283 SPECIFIC CHOICES OF THE 4638 03:53:36,283 --> 03:53:36,550 THRESHOLD. 4639 03:53:36,550 --> 03:53:43,690 I'M SHOWINGOL170 AND 180 SO IT 4640 03:53:43,690 --> 03:53:48,662 CAPTURES THE THRESHOLD. 4641 03:53:48,662 --> 03:53:51,198 AND CAPTURES A COEFFICIENT OF 4642 03:53:51,198 --> 03:53:51,465 VARIATION. 4643 03:53:51,465 --> 03:53:54,301 THE IDEA IS TO USE THE DENSITY 4644 03:53:54,301 --> 03:53:57,104 AS A PRESENTATION AS AN OUTCOME 4645 03:53:57,104 --> 03:53:58,705 OF CHOICE AND THAT WOULD PROVIDE 4646 03:53:58,705 --> 03:54:01,074 US MORE POWER TO DETECT 4647 03:54:01,074 --> 03:54:02,976 ASSOCIATIONS WHILE ADJUSTING FOR 4648 03:54:02,976 --> 03:54:05,412 THE COVARIATES THAT COULD BE 4649 03:54:05,412 --> 03:54:06,280 IMPORTANT. 4650 03:54:06,280 --> 03:54:08,949 SO SPECIFICALLY WE APPLIED THIS 4651 03:54:08,949 --> 03:54:10,417 TO THE BASELINE DATA FROM 4652 03:54:10,417 --> 03:54:10,684 STUDIES. 4653 03:54:10,684 --> 03:54:15,689 I WANT TO EMPHASIZE IT'S NOT AN 4654 03:54:15,689 --> 03:54:22,629 EFFECTIVE POP THERAPY AND 4655 03:54:22,629 --> 03:54:25,299 GLUCOSE DISTRIBUTION AND LOOKING 4656 03:54:25,299 --> 03:54:27,301 AT A RAY OF 30 PLUS BASELINE 4657 03:54:27,301 --> 03:54:29,269 COMMUNITIES SUCH AS SEX, AGE, 4658 03:54:29,269 --> 03:54:35,108 RACE, MEDICATIONS, ETCETERA 4659 03:54:35,108 --> 03:54:36,477 INCLUDING THE MEASURES OF 4660 03:54:36,477 --> 03:54:39,279 SEVERITY. 4661 03:54:39,279 --> 03:54:41,315 IT'S A COMBINATION OF THINGS 4662 03:54:41,315 --> 03:54:42,683 LIKE AVERAGE AND STANDARD 4663 03:54:42,683 --> 03:54:49,556 DEVIATION AND SO FORTH. 4664 03:54:49,556 --> 03:54:50,991 AND USE THE MACHINE LEARNING 4665 03:54:50,991 --> 03:54:52,659 METHODS TO TRY TO SEE OUT OF ALL 4666 03:54:52,659 --> 03:54:56,296 OF THE COVARIATES CAN WE FIGURE 4667 03:54:56,296 --> 03:54:58,799 OUT WHICH ONES MAY HAVE A 4668 03:54:58,799 --> 03:55:00,467 BASELINE EFFECT AT THE GLUCOSE 4669 03:55:00,467 --> 03:55:02,336 VALUES WITH THE IDEA IF WE SEE 4670 03:55:02,336 --> 03:55:04,471 THE BASELINE DIFFERENCES 4671 03:55:04,471 --> 03:55:06,807 DEPENDING ON SAY SEVERITY OF OUR 4672 03:55:06,807 --> 03:55:09,243 RSA WE HAVE SOME HOPE IT WILL 4673 03:55:09,243 --> 03:55:12,079 MAKE AN IMPROVEMENT. 4674 03:55:12,079 --> 03:55:14,515 THIS IS THE FINDING WE HAVE. 4675 03:55:14,515 --> 03:55:16,550 SO BASICALLY WHAT I'M SHOWING 4676 03:55:16,550 --> 03:55:20,954 YOU IN THE THREE PANELS OF 4677 03:55:20,954 --> 03:55:22,823 COVARIATES WE FOUND TO BE 4678 03:55:22,823 --> 03:55:26,894 IMPORTANT WHEN WE DID THIS 4679 03:55:26,894 --> 03:55:28,662 BASELINE ANALYSIS. 4680 03:55:28,662 --> 03:55:32,966 THE FIRST IS THE BASELINE A1C 4681 03:55:32,966 --> 03:55:34,601 MEASUREMENTS A SELF-FULFILLING 4682 03:55:34,601 --> 03:55:38,805 PROPHECY AND LOOKED AT THE 4683 03:55:38,805 --> 03:55:41,508 MEASUREMENTS OF HEMOGLOBIN A1C 4684 03:55:41,508 --> 03:55:44,411 AND LOOKED AT THE BASELINE AND 4685 03:55:44,411 --> 03:55:51,285 HOPE THE TWO WILL BE RELATED. 4686 03:55:51,285 --> 03:55:53,086 WHAT WE SAW IS THE DISTRIBUTION 4687 03:55:53,086 --> 03:55:57,157 THE GLUCOSE GOING FROM THE 4688 03:55:57,157 --> 03:56:00,193 LOWER RANGE IN BLUE TO THE HIGH 4689 03:56:00,193 --> 03:56:07,334 RANGE OF A1C IN PU 4690 03:56:07,334 --> 03:56:17,844 THE TWO DENSITIES HAVE PEAKS 4691 03:56:34,061 --> 03:56:36,430 AROUND THE SAME AREA WHICH MEANS 4692 03:56:36,430 --> 03:56:37,564 THE DIFFERENCE WAS NOT IN THE 4693 03:56:37,564 --> 03:56:39,166 AVERAGE GLUCOSE LUT THE B 4694 03:56:39,166 --> 03:56:43,604 DIFFERENCE WAS IN TERMSEN OF 4695 03:56:43,604 --> 03:56:43,904 VARIABILITY. 4696 03:56:43,904 --> 03:56:47,140 THE SUBJECTS TAKING IT AT 4697 03:56:47,140 --> 03:56:50,744 BASELINE WERE PRESENT WITH 4698 03:56:50,744 --> 03:56:54,648 HIGHER VARIETY IN GLUCOSE 4699 03:56:54,648 --> 03:56:57,384 VOLUMES THAT THOSE THAT DIDN'T. 4700 03:56:57,384 --> 03:56:59,252 IT WAS SHOWING THE DIFFERENCES 4701 03:56:59,252 --> 03:57:09,463 AT BASELINE. 4702 03:57:24,811 --> 03:57:27,781 AND LOOK BEING AT OXYGEN 4703 03:57:27,781 --> 03:57:29,316 SATURATION CAN LEAD TO THE 4704 03:57:29,316 --> 03:57:30,751 HIGHER GLUCOSEUES AT 4705 03:57:30,751 --> 03:57:33,053 BASELINE COMPARED TO 4706 03:57:33,053 --> 03:57:33,353 VARIABILITY. 4707 03:57:33,353 --> 03:57:35,355 WE'RE CURRENTLY DOING 4708 03:57:35,355 --> 03:57:36,123 METHODOLOGICAL WORK TO ADJUST 4709 03:57:36,123 --> 03:57:40,360 THE FRAMEWORK WHERE REPEATED 4710 03:57:40,360 --> 03:57:41,995 MEASUREMENTS TO LOOK AT THE 4711 03:57:41,995 --> 03:57:43,664 AFFECT OF THERAPY AND REEXAMINE 4712 03:57:43,664 --> 03:57:48,001 THE DATA USING THE FRAMEWORK. 4713 03:57:48,001 --> 03:57:51,104 I WANT IT MENTION WHEN WE GO TO 4714 03:57:51,104 --> 03:57:56,043 THE BLOOD PRESSURE WE HAVE 4715 03:57:56,043 --> 03:58:02,349 BASICALLY THE SAME ISSUES AND WE 4716 03:58:02,349 --> 03:58:06,753 CAN CAPTURE THE DIPPING BUT A 4717 03:58:06,753 --> 03:58:10,657 LOT OF TIMES WE USE THE SUMMARY 4718 03:58:10,657 --> 03:58:10,957 OVERNIGHT. 4719 03:58:10,957 --> 03:58:12,492 AGAIN, WE HAVE A GREAT 4720 03:58:12,492 --> 03:58:16,730 OPPORTUNITY TO USE MORE ADVANCED 4721 03:58:16,730 --> 03:58:20,267 METHODS HERE SO WE CAN HAVE 4722 03:58:20,267 --> 03:58:22,669 BETTER DIFFERENTIATION ACROSS 4723 03:58:22,669 --> 03:58:24,604 SUBJECTS AND HAVE PROGRESS BUT 4724 03:58:24,604 --> 03:58:27,340 I'LL SKIP IT BECAUSE OF TIME. 4725 03:58:27,340 --> 03:58:29,710 THE KEY TAKEAWAYS AND 4726 03:58:29,710 --> 03:58:38,251 OPPORTUNITIES I SEE HERE IS WE 4727 03:58:38,251 --> 03:58:47,060 HAVE AND WE HAVE MEASURES FOR 4728 03:58:47,060 --> 03:58:52,666 GLYCEMIC MEASURES BUT IF WE USE 4729 03:58:52,666 --> 03:58:54,801 ADVANCED MACHINE LEARNING METHOD 4730 03:58:54,801 --> 03:58:57,771 AND THE FRAMEWORK CAN OFFER US 4731 03:58:57,771 --> 03:59:00,607 ADDITIONAL INSIGHTS BEYOND 4732 03:59:00,607 --> 03:59:01,241 CONVENTIONAL SUMMARIES. 4733 03:59:01,241 --> 03:59:03,477 I THINK BY BETTER ACCOUNTING FOR 4734 03:59:03,477 --> 03:59:06,413 THE DATA CHARACTERISTICS WE CAN 4735 03:59:06,413 --> 03:59:10,083 DEVELOP MORE PERSONALIZED 4736 03:59:10,083 --> 03:59:12,119 PHENOTYPES FOR BLOOD GLUCOSE 4737 03:59:12,119 --> 03:59:17,224 METABOLISM AND BLOOD PRESSURE 4738 03:59:17,224 --> 03:59:27,634 AND FINALLY GET DATA ON 4739 03:59:28,735 --> 03:59:37,711 COMORBIDITIES OF HYPERTENSION 4740 03:59:37,711 --> 03:59:39,713 AND WE CAN ADDRESS THE QUESTIONS 4741 03:59:39,713 --> 03:59:43,650 AND I'M THANKFUL FOR MY 4742 03:59:43,650 --> 03:59:46,453 COLLABORATORS WHO INTRODUCED ME 4743 03:59:46,453 --> 03:59:49,422 TO THE QUESTIONS AND STUDY AND I 4744 03:59:49,422 --> 03:59:50,657 WANT TO ACKNOWLEDGE NIH SUPPORT. 4745 03:59:50,657 --> 03:59:53,693 I KNOW I FINISHED EARLY I THINK 4746 03:59:53,693 --> 03:59:55,162 WE HAVE TIME FOR QUESTIONS. 4747 03:59:55,162 --> 03:59:57,397 >> RIGHT ON TIME, ACTUALLY. 4748 03:59:57,397 --> 03:59:59,633 THANKS SO MUCH. 4749 03:59:59,633 --> 04:00:00,901 THANK YOU SO MUCH FOR THE 4750 04:00:00,901 --> 04:00:01,234 PRESENTATION. 4751 04:00:01,234 --> 04:00:02,836 I'M SURE THERE'LL BE QUESTIONS 4752 04:00:02,836 --> 04:00:06,006 ABOUT IT AT THE END. 4753 04:00:06,006 --> 04:00:08,208 ALFONSO WE DO NOT HAVE DR. PACK 4754 04:00:08,208 --> 04:00:09,609 YET WITH US FROM WHAT WE CAN 4755 04:00:09,609 --> 04:00:10,577 SEE. 4756 04:00:10,577 --> 04:00:12,546 >> I SEE DR. CK ONLINE. 4757 04:00:12,546 --> 04:00:14,648 I DON'T KNOW IF YOU'RE READY? 4758 04:00:14,648 --> 04:00:16,583 >> I'M READY TO GO. 4759 04:00:16,583 --> 04:00:25,325 >> THANK YOU. 4760 04:00:25,325 --> 04:00:27,594 HE'LL TELL US ABOUT DIFFERENT 4761 04:00:27,594 --> 04:00:34,401 DIMENSIONS IN HETEROGENEITY. 4762 04:00:34,401 --> 04:00:38,405 >> I'LL TALK ABOUT DIFFERENT 4763 04:00:38,405 --> 04:00:39,272 DIMENSIONS IN HETEROGENEITY. 4764 04:00:39,272 --> 04:00:44,444 THE WAY TO THINK OF PERSONALIZED 4765 04:00:44,444 --> 04:00:49,749 SLEEP APNEA IS MRULT -- 4766 04:00:49,749 --> 04:00:52,219 MULTIPLE SOURCES TO THE RISK 4767 04:00:52,219 --> 04:00:53,620 VARIANTS AND DIFFERENT SYMPTOM 4768 04:00:53,620 --> 04:00:56,189 SUB TYPES AND DIFFERENT 4769 04:00:56,189 --> 04:01:01,361 PHYSIOLOGICAL CHARACTERISTICS D 4770 04:01:01,361 --> 04:01:02,963 SATURATION AND DIFFERENT 4771 04:01:02,963 --> 04:01:04,931 MOLECULAR RESPONSES SO WE'RE 4772 04:01:04,931 --> 04:01:05,532 DEALING WITH A SITUATION WITH 4773 04:01:05,532 --> 04:01:09,135 DIFFERENT DIMENSIONS. 4774 04:01:09,135 --> 04:01:11,404 AND THIS IS A SLIDE WE SHOWED 4775 04:01:11,404 --> 04:01:13,707 EARLIER AND THE REASONS FOR 4776 04:01:13,707 --> 04:01:15,775 THESE PATIENTS WITH APPARENTLY 4777 04:01:15,775 --> 04:01:16,910 THE SAME DISORDER ACT 4778 04:01:16,910 --> 04:01:18,578 DIFFERENTLY BECAUSE OF A 4779 04:01:18,578 --> 04:01:22,315 DIFFERENT ENVIRONMENT AND THE 4780 04:01:22,315 --> 04:01:24,517 ENVIRONMENT EFFECTS EPIGENETIC 4781 04:01:24,517 --> 04:01:27,487 MARKS AND DIFFERENT GENETICS AND 4782 04:01:27,487 --> 04:01:29,823 DIFFERENT MICROBIOME AND LEADS 4783 04:01:29,823 --> 04:01:32,125 PEOPLE TO BE VERY DIFFERENT 4784 04:01:32,125 --> 04:01:33,860 THOUGH THEY'RE THE SAME 4785 04:01:33,860 --> 04:01:34,127 DISORDER. 4786 04:01:34,127 --> 04:01:36,396 AS A RESULT OF THE BIOLOGICAL 4787 04:01:36,396 --> 04:01:38,164 DIFFERENCES YOU GET DIFFERENT 4788 04:01:38,164 --> 04:01:41,134 PHENOTYPES AND CHARACTERISTICS. 4789 04:01:41,134 --> 04:01:44,037 SOME ARE SLEEPY, SOME ARE NOT, 4790 04:01:44,037 --> 04:01:47,307 COMORBIDITIES, DIFFERENT PLEK 4791 04:01:47,307 --> 04:01:50,477 PROFILES AND TRANSCRIPTOMICS AND 4792 04:01:50,477 --> 04:01:55,849 DIFFERENCES IN PHENOTYPING BOTH 4793 04:01:55,849 --> 04:02:06,326 PHYSIOLOGY AND ALSO IMAGING. 4794 04:02:10,363 --> 04:02:12,265 THIS IS TRUE IN OSA AND VARIES 4795 04:02:12,265 --> 04:02:15,168 BROADLY IN ALL DISORDERS. 4796 04:02:15,168 --> 04:02:18,939 ALL PATIENTS ARE NOT IDENTICAL. 4797 04:02:18,939 --> 04:02:20,140 AND THE QUESTION IS HOW ARE WE 4798 04:02:20,140 --> 04:02:22,976 GOING TO APPROACH THAT? 4799 04:02:22,976 --> 04:02:25,011 THE IDEA IS WE'RE TALKING ABOUT 4800 04:02:25,011 --> 04:02:26,146 DIFFERENCES AND DIFFERENT 4801 04:02:26,146 --> 04:02:28,281 DOMAINS YOU'LL USE MULTIPLE 4802 04:02:28,281 --> 04:02:30,517 APPROACHES TO EVALUATE THE 4803 04:02:30,517 --> 04:02:31,017 DIFFERENCES. 4804 04:02:31,017 --> 04:02:34,521 YOU'LL LOOK FOR PHYSIOLOGICAL 4805 04:02:34,521 --> 04:02:36,356 AND CLINICAL DIFFERENCES AN 4806 04:02:36,356 --> 04:02:39,826 BIOMARKERS AND OMIC DIFFERENCES 4807 04:02:39,826 --> 04:02:42,529 AND GENETIC, EPIGENETIC 4808 04:02:42,529 --> 04:02:46,566 DIFFERENCES AND USED UNBIASED 4809 04:02:46,566 --> 04:02:48,768 DISCOVERY APPROACHES AND LET THE 4810 04:02:48,768 --> 04:02:50,136 DATA SPEAK FOR ITSELF. 4811 04:02:50,136 --> 04:02:56,142 THERE'S A HUGE AMOUNT OF 4812 04:02:56,142 --> 04:03:02,148 INFRASTRUCTURE TO SUPPORT THE 4813 04:03:02,148 --> 04:03:02,515 APPROACH. 4814 04:03:02,515 --> 04:03:04,951 PROGRAMS LIKE TOP MED AND NHLBI 4815 04:03:04,951 --> 04:03:07,520 AND THE U.K. BIO BANK AND SO ON. 4816 04:03:07,520 --> 04:03:09,622 THERE'S A LOT OF PROGRAMS OUT 4817 04:03:09,622 --> 04:03:10,423 THERE AND A LOT OF DATA 4818 04:03:10,423 --> 04:03:14,160 AVAILABLE FOR US TO APPROACH 4819 04:03:14,160 --> 04:03:14,527 THIS. 4820 04:03:14,527 --> 04:03:17,297 SO THESE RESOURCES HAVE BEEN 4821 04:03:17,297 --> 04:03:20,133 BUILT NOT JUST FOR SLEEP APNEA 4822 04:03:20,133 --> 04:03:25,705 BUT MORE BROADLY FOR HOW YOU 4823 04:03:25,705 --> 04:03:27,807 APPROACH PERSONALIZED MEDICINE. 4824 04:03:27,807 --> 04:03:29,442 THERE'S A VERSION OF 4825 04:03:29,442 --> 04:03:30,844 PERSONALIZED MEDICINE I LIKE 4826 04:03:30,844 --> 04:03:32,345 CALLED THE FOUR P MEDICINE. 4827 04:03:32,345 --> 04:03:36,883 IT WAS A CONCEPT PROPOSED AND 4828 04:03:36,883 --> 04:03:38,518 THE FOUR Ps ARE PREDICTIVE. 4829 04:03:38,518 --> 04:03:41,287 WE'RE GOING TO USE DATA TO 4830 04:03:41,287 --> 04:03:43,456 PREDICT WHO WILL GET DISEASE AND 4831 04:03:43,456 --> 04:03:47,494 IF WE CAN DO THAT WE CAN MOVE 4832 04:03:47,494 --> 04:03:49,062 MEDICINE FROM TREATING PEOPLE TO 4833 04:03:49,062 --> 04:03:50,130 PREVENTION. 4834 04:03:50,130 --> 04:03:51,731 IF THEY GET DISORDERS WE'LL 4835 04:03:51,731 --> 04:03:55,168 PERSONALIZED AND THE FOURTH P IS 4836 04:03:55,168 --> 04:03:55,468 PARTICIPATE. 4837 04:03:55,468 --> 04:03:57,003 THAT'S GETTING PATIENTS ENGAGED 4838 04:03:57,003 --> 04:03:58,471 IN THEIR OWN CARE. 4839 04:03:58,471 --> 04:04:00,340 THERE'S VERSIONS OF PERSONALIZED 4840 04:04:00,340 --> 04:04:02,042 MEDICINE AND THIS IS ONE I THINK 4841 04:04:02,042 --> 04:04:03,309 IS RELEVANT. 4842 04:04:03,309 --> 04:04:05,178 WE HAVE WRITTEN ABOUT THAT FOR A 4843 04:04:05,178 --> 04:04:09,916 WHILE ON THE FOUR P APPROACH. 4844 04:04:09,916 --> 04:04:10,550 PREVENTION AND PERSONALIZED AND 4845 04:04:10,550 --> 04:04:17,757 PARTICIPATING. 4846 04:04:17,757 --> 04:04:19,959 WE HAVE DIFFERENT PHYSIOLOGICAL 4847 04:04:19,959 --> 04:04:24,130 RISK FACTORS AND THE OBESITY 4848 04:04:24,130 --> 04:04:26,032 PATHWAY AND THE NON OBESITY 4849 04:04:26,032 --> 04:04:27,667 PATHWAY AND DIFFERENCES IN 4850 04:04:27,667 --> 04:04:27,934 NEURAL. 4851 04:04:27,934 --> 04:04:30,537 SO PEOPLE ARE GOING TO GET THE 4852 04:04:30,537 --> 04:04:41,081 DISORDER FOR DIFFERENT REASONS. 4853 04:04:42,382 --> 04:04:46,486 WE HEARD ABOUT ENDOTYPES AND 4854 04:04:46,486 --> 04:04:48,088 PROBABLY HEAR MORE AND AIRWAY 4855 04:04:48,088 --> 04:04:50,523 AND LOOP GAIN AND AROUSAL AND 4856 04:04:50,523 --> 04:04:54,461 UPPER AIRWAY MUSCLE 4857 04:04:54,461 --> 04:04:55,161 RESPONSIVENESS AND THE QUESTION 4858 04:04:55,161 --> 04:04:58,164 IS CAN THEY ARE BE DETERMINED BY 4859 04:04:58,164 --> 04:05:00,066 THE SIMPLE MODEL OF CONTROL? 4860 04:05:00,066 --> 04:05:01,367 I THY OF O BELIEVE 4861 04:05:01,367 --> 04:05:04,404 THERE'S A REAL NEED FOR 4862 04:05:04,404 --> 04:05:05,405 VALIDATION STUDIES BECAUSE TO 4863 04:05:05,405 --> 04:05:10,343 BUILD A MODEL YOU HAVE TO MAKE A 4864 04:05:10,343 --> 04:05:11,578 LOT OF ASSUMPTIONS AND THE 4865 04:05:11,578 --> 04:05:15,448 QUESTION DO THEY DEGRADE WHAT 4866 04:05:15,448 --> 04:05:18,084 YOU CAN DO AND WE'RE LOOKING FOR 4867 04:05:18,084 --> 04:05:19,686 VALIDATION STUDIES. 4868 04:05:19,686 --> 04:05:21,354 AS I'VE INDICATED THERE'S 4869 04:05:21,354 --> 04:05:21,955 MULTIPLE PATHWAYS. 4870 04:05:21,955 --> 04:05:24,824 THE FACT IS MANY OF THESE 4871 04:05:24,824 --> 04:05:30,497 PATHWAYS ARE GOING TO BE 4872 04:05:30,497 --> 04:05:32,332 GENETICALLY DETERMINED. 4873 04:05:32,332 --> 04:05:33,967 THERE'S DETERMINATES LIKE 4874 04:05:33,967 --> 04:05:35,835 OBESITY AND A NUMBER OF GRANTS 4875 04:05:35,835 --> 04:05:38,705 TO DETERMINE CRANIOFACIAL 4876 04:05:38,705 --> 04:05:41,975 STRUCTURE AND A NUMBER FOR 4877 04:05:41,975 --> 04:05:43,810 NEURAL CONTROL AND SOFT TISSUE 4878 04:05:43,810 --> 04:05:48,148 PLAYS A ROLE. 4879 04:05:48,148 --> 04:05:58,691 SO THERE'LL BE GENEITY AND HERT 4880 04:06:00,160 --> 04:06:02,629 GEN EIGHT AND THERE WAS A GWAS 4881 04:06:02,629 --> 04:06:04,797 STUDY AND THE SO-CALLED 4882 04:06:04,797 --> 04:06:05,598 MANHATTAN PLOT. 4883 04:06:05,598 --> 04:06:06,366 THE PEAKS REPRESENT WHERE 4884 04:06:06,366 --> 04:06:08,501 THERE'S AN ASSOCIATION BASICALLY 4885 04:06:08,501 --> 04:06:13,740 OF VARIANT IN THE REGION AND 4886 04:06:13,740 --> 04:06:20,880 THIS IS A LARGE STUDY DONE WHERE 4887 04:06:20,880 --> 04:06:25,418 THEY ACCUMULATED VETS AND GAVE 4888 04:06:25,418 --> 04:06:28,521 BLOOD AND 90% WERE MALE AND THEN 4889 04:06:28,521 --> 04:06:32,091 YOU RUN THESE ANALYSES BASED ON 4890 04:06:32,091 --> 04:06:35,929 DIAGNOSES COMING FROM THE E.H.R. 4891 04:06:35,929 --> 04:06:44,404 THIS IS FTO AND WE LOOK AT THE 4892 04:06:44,404 --> 04:06:47,106 UPSIDE-DOWN AT THE BOTTOM AND 4893 04:06:47,106 --> 04:06:48,074 ADJUSTED FOR BMI. 4894 04:06:48,074 --> 04:06:57,183 WHAT YOU CAN SEE IS THE O PLOT 4895 04:06:57,183 --> 04:07:06,426 COMPLETELY DISAPPEARS YOU HAVE 4896 04:07:06,426 --> 04:07:08,795 POLYMORPHISMS ASSOCIATED WITH 4897 04:07:08,795 --> 04:07:10,096 OSA AND SOME ARE OBESITY PATHWAY 4898 04:07:10,096 --> 04:07:14,100 AND THERE'S A NUMBER IN THE 4899 04:07:14,100 --> 04:07:23,810 NON-OBESITY PATHWAY. 4900 04:07:23,810 --> 04:07:26,646 AND WE LOOKED AT CASES TO 4901 04:07:26,646 --> 04:07:29,048 ANALYZE DATA AND WOMEN AND MEN 4902 04:07:29,048 --> 04:07:30,583 AND FOUND THE GENETIC RISK 4903 04:07:30,583 --> 04:07:32,085 FACTORS WERE DIFFERENT IN WOMEN 4904 04:07:32,085 --> 04:07:33,953 THAN THEY WERE IN MEN. 4905 04:07:33,953 --> 04:07:36,055 YOU HAVE TO TAKE THAT CAREFULLY 4906 04:07:36,055 --> 04:07:39,025 BECAUSE THE SAMPLE SIZE ARE VERY 4907 04:07:39,025 --> 04:07:42,128 DIFFERENT BUT IT'S CONCEIVABLE 4908 04:07:42,128 --> 04:07:43,029 THE GENETIC INFRASTRUCTURE THAT 4909 04:07:43,029 --> 04:07:43,730 DRIVES THIS IS DIFFERENT FOR MEN 4910 04:07:43,730 --> 04:07:51,604 AND WOMEN. 4911 04:07:51,604 --> 04:07:55,708 THIS WILL ALLOW US TO DEVELOP A 4912 04:07:55,708 --> 04:07:58,444 POLY GENIC RISK SCORES AND IF 4913 04:07:58,444 --> 04:08:01,447 YOU CALCULATE THESE THINGS YOU 4914 04:08:01,447 --> 04:08:02,749 CAN CALCULATE AND LOOK AT ALL 4915 04:08:02,749 --> 04:08:06,452 THE STEPS AND SO ON. 4916 04:08:06,452 --> 04:08:13,092 AND ALSO YOU NEED TO BRING IN 4917 04:08:13,092 --> 04:08:15,728 RARE VARIANTS IN THE POLY GENIC 4918 04:08:15,728 --> 04:08:17,330 RISK STORES AND I CAN PREDICT 4919 04:08:17,330 --> 04:08:19,666 WHO WILL DEVELOP OSA AND THAT 4920 04:08:19,666 --> 04:08:22,368 WILL CHANGE THE WAY I APPROACH 4921 04:08:22,368 --> 04:08:24,504 THE WHOLE THINK AND THINK OF A 4922 04:08:24,504 --> 04:08:24,804 PREVENTION. 4923 04:08:24,804 --> 04:08:29,409 THE OTHER QUESTION IS IN THE 4924 04:08:29,409 --> 04:08:32,412 ASSESSMENT OF VARIANTS WITH 4925 04:08:32,412 --> 04:08:34,180 INFORMATION OF THE PATHWAYS TO 4926 04:08:34,180 --> 04:08:35,915 THE DISORDER SOME WILL BE DUE TO 4927 04:08:35,915 --> 04:08:37,884 OBESITY AND SOME CRANIOFACIAL 4928 04:08:37,884 --> 04:08:39,986 AND IF I CAN SHOW THE INDIVIDUAL 4929 04:08:39,986 --> 04:08:42,221 HAS ASSOCIATION WITH THE 4930 04:08:42,221 --> 04:08:43,489 CRANIOFACIAL VARIANCE IT'S 4931 04:08:43,489 --> 04:08:45,458 TELLING ME SOMETHING ON THE 4932 04:08:45,458 --> 04:08:54,334 PATHWAYS TO DISEASE. 4933 04:08:54,334 --> 04:08:58,438 THE NEXT IS SYMPTOMS AND WE 4934 04:08:58,438 --> 04:09:06,079 HEARD OF INSOMNIA SYMPTOMS IN 4935 04:09:06,079 --> 04:09:11,718 FEMALES AND WHEN WE TOOK THE 4936 04:09:11,718 --> 04:09:12,885 QUESTIONNAIRES AND USED AND SAYS 4937 04:09:12,885 --> 04:09:17,423 THERE'S DIFFERENT GROUPS AND 4938 04:09:17,423 --> 04:09:21,694 WERE ABLE TO IDENTIFY THE GROUP 4939 04:09:21,694 --> 04:09:24,097 AND SOME WERE SYMPTOMATIC AND 4940 04:09:24,097 --> 04:09:25,898 SNORED AND SO ON BUT DIDN'T HAVE 4941 04:09:25,898 --> 04:09:30,436 COMPLAINTS RELATED TO SLEEP AND 4942 04:09:30,436 --> 04:09:34,607 WOKE UP REFRESHED AND A GROUP 4943 04:09:34,607 --> 04:09:36,209 THAT WAS VERY SLEEPY AND FELL 4944 04:09:36,209 --> 04:09:38,411 ASLEEP DRIVING AND SO ON. 4945 04:09:38,411 --> 04:09:40,980 YOU CAN SEE THE DIFFERENT SUB 4946 04:09:40,980 --> 04:09:43,116 TYPES AND THE FACT IT IMPROVES 4947 04:09:43,116 --> 04:09:46,753 TREATMENT IS REALLY RELATED TO 4948 04:09:46,753 --> 04:09:54,427 CLUSTER 3 YOU SEE AND YOU SEE 4949 04:09:54,427 --> 04:10:04,704 MINIMAL AFFECTS. 4950 04:10:05,338 --> 04:10:07,173 WE REPLICATED THIS IN STUDIES IN 4951 04:10:07,173 --> 04:10:10,943 AUSTRALIA AND ALL OVER THE WORLD 4952 04:10:10,943 --> 04:10:16,149 AND IN THE U.S. AND WHAT WAS 4953 04:10:16,149 --> 04:10:26,659 INTERESTING IS AND PROMINENT 4954 04:10:37,303 --> 04:10:42,575 GROUPS COME IN AND TRY TO BUILD 4955 04:10:42,575 --> 04:10:44,343 ON THAT. 4956 04:10:44,343 --> 04:10:45,945 WHAT'S INTERESTING IS THE 4957 04:10:45,945 --> 04:10:49,081 SYMPTOMS NOT ONLY WERE RELEVANT 4958 04:10:49,081 --> 04:10:53,553 BUT THE MAJORITY OF EVIDENCE 4959 04:10:53,553 --> 04:10:55,121 WOULD INDICATE THEY'RE 4960 04:10:55,121 --> 04:10:57,723 PREDICTIVE OF OTHER OUTCOME AND 4961 04:10:57,723 --> 04:10:59,292 CARDIOVASCULAR TERMS AND THERE 4962 04:10:59,292 --> 04:11:03,896 WAS A PAPER THAT SHOWED AN 4963 04:11:03,896 --> 04:11:07,066 INCREASED RISK OF CV EVENTS. 4964 04:11:07,066 --> 04:11:09,936 THERE WAS NO INCREASED RISK IN 4965 04:11:09,936 --> 04:11:14,440 THE MODERATE SLEEPY OR MINIMALLY 4966 04:11:14,440 --> 04:11:15,341 SYMPTOMATIC OR INSOMNIA. 4967 04:11:15,341 --> 04:11:24,584 THAT WAS REPLICATED IN OUR STUDY 4968 04:11:24,584 --> 04:11:32,191 AND YOU GOT AN INCREASED RISK OF 4969 04:11:32,191 --> 04:11:38,097 CV DISEASE AND THE FOUR GAVE A 4970 04:11:38,097 --> 04:11:40,967 BETTER DIFFERENTIATION AND A 4971 04:11:40,967 --> 04:11:44,237 NUMBER OF STUDIES HAVE SHOWN 4972 04:11:44,237 --> 04:11:47,173 THAT AND GREATER BENEFIT WITH 4973 04:11:47,173 --> 04:11:49,976 CPAP UNTIL FRENCH COHORT AND 4974 04:11:49,976 --> 04:11:52,311 HIGHER INCIDENTS IN CV EVENTS 4975 04:11:52,311 --> 04:11:56,816 AND SYMPTOMATIC IN THE OTHER 4976 04:11:56,816 --> 04:11:58,451 COHORT. 4977 04:11:58,451 --> 04:12:06,425 IN THE STUDIES HAVE SHOWN THE 4978 04:12:06,425 --> 04:12:07,560 NEW IDEA. 4979 04:12:07,560 --> 04:12:13,799 THERE'S A STRUCTURE TO REALLY 4980 04:12:13,799 --> 04:12:22,241 ASSIGN PEOPLE AND IF YOU LOOKED 4981 04:12:22,241 --> 04:12:26,212 AT PEOPLE WITH OSA AND AN 4982 04:12:26,212 --> 04:12:28,080 ASSOCIATION WITH PEOPLE WITH 4983 04:12:28,080 --> 04:12:30,216 HYPERTENSION AND IF YOU FOLLOWED 4984 04:12:30,216 --> 04:12:32,151 THEM OVER TIME MOST WERE 4985 04:12:32,151 --> 04:12:34,487 UNTREATED YOU FIND HIGHER RATE 4986 04:12:34,487 --> 04:12:36,188 OF INFARCTION IN PEOPLE WITH 4987 04:12:36,188 --> 04:12:37,423 EXCESSIVE SLEEPINESS. 4988 04:12:37,423 --> 04:12:40,960 THERE'S TWO NEGATIVE STUDIES. 4989 04:12:40,960 --> 04:12:46,399 ONE FROM THE FRENCH COHORT WHICH 4990 04:12:46,399 --> 04:12:48,868 SAID THERE WAS NO THE CV RISK 4991 04:12:48,868 --> 04:12:51,671 AND ANOTHER STUDY SHOWING NO 4992 04:12:51,671 --> 04:12:55,841 DIFFERENCE IN CV CASES WITH OR 4993 04:12:55,841 --> 04:12:56,175 WITHOUT EDS. 4994 04:12:56,175 --> 04:13:00,012 AND ONE DIFFERENCE BETWEEN THE 4995 04:13:00,012 --> 04:13:03,382 NEGATIVE AND STUDIED RECORDED 4996 04:13:03,382 --> 04:13:06,352 WAS THERE WAS MORE CPAP USE. 4997 04:13:06,352 --> 04:13:08,888 WHETHER THAT'S THE EXPLANATION 4998 04:13:08,888 --> 04:13:09,388 STATISTICALLY IT'S NOT 4999 04:13:09,388 --> 04:13:11,857 SUFFICIENT BUT NOTE WORTHY IN 5000 04:13:11,857 --> 04:13:15,227 THE STUDIES THAT HAVE POSITIVE 5001 04:13:15,227 --> 04:13:18,431 THERE WAS ACCEPT OR MINIMAL CPAP 5002 04:13:18,431 --> 04:13:20,866 USE. 5003 04:13:20,866 --> 04:13:23,469 WHERE DO WITH GO FROM HERE? 5004 04:13:23,469 --> 04:13:30,476 WITH HAVE TO KNOW AS MENTIONED 5005 04:13:30,476 --> 04:13:38,718 EARLIER AND ARE YOU STILL GOING 5006 04:13:38,718 --> 04:13:47,727 TO BE IN EXCESS AND AND THERE 5007 04:13:47,727 --> 04:13:50,463 ARE QUESTIONS WHETHER SOME ARE 5008 04:13:50,463 --> 04:13:54,433 ASYMPTOMATIC OR NEED TO BE 5009 04:13:54,433 --> 04:13:56,135 TREATED. 5010 04:13:56,135 --> 04:14:04,410 AGAIN, WE HEARD EARLIER AND YOU 5011 04:14:04,410 --> 04:14:08,147 STILL FIND THE SAME BASIC GROUPS 5012 04:14:08,147 --> 04:14:10,449 COME UP. 5013 04:14:10,449 --> 04:14:14,153 THERE'S STILL WOMEN EXCESSIVELY 5014 04:14:14,153 --> 04:14:17,223 SLEEPY AND THE PROPORTIONS VARY 5015 04:14:17,223 --> 04:14:20,059 BETWEEN MEN AND WOMEN BUT THE 5016 04:14:20,059 --> 04:14:20,826 BASIC CONSTRUCT DOESN'T CHANGE 5017 04:14:20,826 --> 04:14:22,428 AND IMPORTANT TO THINK ABOUT 5018 04:14:22,428 --> 04:14:32,705 MOVING FORWARD. 5019 04:14:34,774 --> 04:14:45,251 THERE AND WE LOOK AT PULSE RATE 5020 04:14:47,420 --> 04:14:48,120 AND AMPLITUDE THAT DROPS. 5021 04:14:48,120 --> 04:14:54,193 >> WE HAVE ABOUT A MINUTE LEFT. 5022 04:14:54,193 --> 04:14:56,195 >> THERE'S IMPROVED PROTECTION 5023 04:14:56,195 --> 04:14:56,829 OF CARDIOVASCULAR RISK. 5024 04:14:56,829 --> 04:15:04,437 AND WHAT WE NEED TO DO IS TAKING 5025 04:15:04,437 --> 04:15:05,104 INFORMATION ASSESSING DIFFERENT 5026 04:15:05,104 --> 04:15:09,709 DIM EDGES AND CAN WE INTEGRATE 5027 04:15:09,709 --> 04:15:10,776 THE DIFFERENT TO PROVIDE ONE 5028 04:15:10,776 --> 04:15:21,153 COMPREHENSIVE MEASURE. 5029 04:15:25,791 --> 04:15:31,163 AND DEVELOP AND VALIDATE POLY 5030 04:15:31,163 --> 04:15:33,165 GENETIC RISK SCORES FOR MEN AND 5031 04:15:33,165 --> 04:15:33,632 WOMEN. 5032 04:15:33,632 --> 04:15:36,569 WE SHOULD THINK ABOUT DEVELOPING 5033 04:15:36,569 --> 04:15:39,071 RANDOMIZED TRIALS WITHIN THE 5034 04:15:39,071 --> 04:15:42,341 FRAMEWORK OF THE SUBTYPES. 5035 04:15:42,341 --> 04:15:44,143 LET'S THINK ABOUT INSOMNIA 5036 04:15:44,143 --> 04:15:49,281 BENEFIT AND WE NEED TO MOVE 5037 04:15:49,281 --> 04:15:51,617 WHETHER SYMPTOMS OR PHYSIOLOGY 5038 04:15:51,617 --> 04:15:56,655 ARE THE BEST AND INTEGRATE 5039 04:15:56,655 --> 04:15:59,358 INFORMATION AND FINALLY THIS 5040 04:15:59,358 --> 04:16:01,794 ENTIRE EFFORT IN PERSONALIZED 5041 04:16:01,794 --> 04:16:03,996 SLEEP APNEA IS FACILITATED BY 5042 04:16:03,996 --> 04:16:04,497 RESEARCH CONSORTIUM. 5043 04:16:04,497 --> 04:16:05,698 I THINK THAT'S A VERY IMPORTANT 5044 04:16:05,698 --> 04:16:10,970 THING TO THINK ABOUT. 5045 04:16:10,970 --> 04:16:15,674 SO THANK YOU VERY MUCH. 5046 04:16:15,674 --> 04:16:20,146 >> IT SEGUES TO THE LAST TALK BY 5047 04:16:20,146 --> 04:16:24,550 DR. PAREKH WHO IS AN ASSISTANT 5048 04:16:24,550 --> 04:16:25,684 PROFESSOR IN THE DIVISION OF 5049 04:16:25,684 --> 04:16:26,685 PULMONARY CRITICAL CARE AND 5050 04:16:26,685 --> 04:16:28,788 SLEEP MEDICINE IN THE DEPARTMENT 5051 04:16:28,788 --> 04:16:34,160 OF MEDICINE AT THE ICAHN SCHOOL 5052 04:16:34,160 --> 04:16:39,799 OF MEDICINE AT MOUNT SINAI AND 5053 04:16:39,799 --> 04:16:42,334 HIS A.I. IN SLEEP APNEA AND 5054 04:16:42,334 --> 04:16:44,103 INTEGRATING SKWOERZ AND 5055 04:16:44,103 --> 04:16:46,438 BIOMARKERS AND FINDS AND 5056 04:16:46,438 --> 04:16:55,014 ENDTIEPT -- ENDOTYPES AND 5057 04:16:55,014 --> 04:16:57,950 ELUCIDATE DISEASE HETEROGENEITY 5058 04:16:57,950 --> 04:16:59,652 AND HIS TALK THERE BE TO ABOUT 5059 04:16:59,652 --> 04:17:04,223 4:30 AND THEN WE'LL HAVE MORE 5060 04:17:04,223 --> 04:17:14,733 TIME FOR TALK THAN WE'VE HAD. 5061 04:17:20,306 --> 04:17:23,309 >> THIS SEGUES ABOUT THE CARE 5062 04:17:23,309 --> 04:17:25,911 AND I'LL BE MORE PROVOCATIVE AND 5063 04:17:25,911 --> 04:17:28,247 POINT TO NOT TO WHAT HAS BEEN 5064 04:17:28,247 --> 04:17:32,451 DONE BUT THE WANL -- PATHWAY 5065 04:17:32,451 --> 04:17:34,987 FORWARD AND THINK OF INTEGRATING 5066 04:17:34,987 --> 04:17:39,325 THE DIFFERENT DOMAINS MENTIONED. 5067 04:17:39,325 --> 04:17:41,060 I THINK BY NOW ACROSS ALL THE 5068 04:17:41,060 --> 04:17:43,295 DIFFERENT TALKS I HOPE YOU'RE 5069 04:17:43,295 --> 04:17:46,732 CONVINCED AND IF YOU DIDN'T 5070 04:17:46,732 --> 04:17:52,705 ALREADY KNOW OSA IS A 5071 04:17:52,705 --> 04:17:53,873 HETEROGENEITY OF OUTCOME AND 5072 04:17:53,873 --> 04:17:58,444 THERE'S WE MYRIAD OF PATHWAYS 5073 04:17:58,444 --> 04:18:04,116 AND MECHANISMS TO THE EVENTS ARE 5074 04:18:04,116 --> 04:18:10,222 DIFFERENT AMONG INDIVIDUALS AND 5075 04:18:10,222 --> 04:18:12,057 OUTCOMES AMONG INDIVIDUALS AND 5076 04:18:12,057 --> 04:18:16,028 HOW TO WE CHARACTERIZE OSA AND 5077 04:18:16,028 --> 04:18:17,563 ITS HETEROGENEITY. 5078 04:18:17,563 --> 04:18:20,900 I'LL GIVE A QUICK REVIEW ON THE 5079 04:18:20,900 --> 04:18:24,203 DIFFERENT DOMAINS AND SOME OF 5080 04:18:24,203 --> 04:18:24,803 THE POINTS. 5081 04:18:24,803 --> 04:18:26,372 AND FIRST AND FOREMOST WE HAVE 5082 04:18:26,372 --> 04:18:30,476 BEEN DOING THIS SO MANY YEARS 5083 04:18:30,476 --> 04:18:36,782 USING CONVENTIONAL PO 5084 04:18:36,782 --> 04:18:40,719 POLYSOMNOGRAPHY AND CONTAIN 5085 04:18:40,719 --> 04:18:43,522 VARIABLES PATIENTS ARE USED TO 5086 04:18:43,522 --> 04:18:46,425 STARTING WITH RESPIRATORY 5087 04:18:46,425 --> 04:18:51,430 INDEXES AND VARIATIONS AND 5088 04:18:51,430 --> 04:19:00,039 PALPITATIONS AND MACRO AND MICRO 5089 04:19:00,039 --> 04:19:04,109 ARCHITECTURES AND MANY OTHERS 5090 04:19:04,109 --> 04:19:10,449 AND INFLAMMATION AND LEG 5091 04:19:10,449 --> 04:19:12,584 MOVEMENTS AND SO ON. 5092 04:19:12,584 --> 04:19:14,186 THERE'S ONE WAY TO CHARACTERIZE 5093 04:19:14,186 --> 04:19:15,487 THE HETEROGENEITY WE SEE. 5094 04:19:15,487 --> 04:19:19,058 SOME OF THE NEWER MEASURES AND 5095 04:19:19,058 --> 04:19:21,560 UNDER THE UMBRELLA TERM OF 5096 04:19:21,560 --> 04:19:22,661 PHYSIOLOGICAL BURDENS. 5097 04:19:22,661 --> 04:19:30,369 THESE MEASURES TRY TO USE THE 5098 04:19:30,369 --> 04:19:32,938 POLYSOMNOGRAPHY AND TRY TO 5099 04:19:32,938 --> 04:19:34,106 CHARACTERIZE MORE THAN OTHER 5100 04:19:34,106 --> 04:19:42,047 MEASURES. 5101 04:19:42,047 --> 04:19:43,716 AND ATTEMPTS IN MANY DIFFERENT 5102 04:19:43,716 --> 04:19:46,452 WAYS TO QUANTIFY THE AIR FLOW 5103 04:19:46,452 --> 04:19:51,590 AND VENTILATION CHANGES LOOK 5104 04:19:51,590 --> 04:19:54,193 BEING AT THE HYPOXIC DOMAIN 5105 04:19:54,193 --> 04:19:55,728 LOOKING AT THE OXYGEN SATURATION 5106 04:19:55,728 --> 04:19:56,962 CHANGES OVERNIGHT. 5107 04:19:56,962 --> 04:20:02,434 THE AROUSAL DOMAIN AND THE 5108 04:20:02,434 --> 04:20:04,336 ECONOMIC DOMAIN AND SUPPORTED BY 5109 04:20:04,336 --> 04:20:07,339 THE PULSE RATE CHANGES AND THESE 5110 04:20:07,339 --> 04:20:08,941 ARE SOME THAT HAVE RECENTLY COME 5111 04:20:08,941 --> 04:20:10,976 OUT BUT THERE'S A LOT MORE THAT 5112 04:20:10,976 --> 04:20:12,411 CAN COME UP. 5113 04:20:12,411 --> 04:20:19,218 AND A POINT OF NOTE THOUGH THE 5114 04:20:19,218 --> 04:20:21,787 BURDENS THE TRUE BURDEN IN SLEEP 5115 04:20:21,787 --> 04:20:28,394 APNEA IS ONE SO THERE'S ONE TRUE 5116 04:20:28,394 --> 04:20:29,862 REGULATORY BURDEN BUT ONE KEY 5117 04:20:29,862 --> 04:20:34,266 QUESTION WE SHOULD THINK ABOUT 5118 04:20:34,266 --> 04:20:36,535 IS ARE THESE ALL CORRELATED AND 5119 04:20:36,535 --> 04:20:38,437 DO THEY ARE GIVE THE SAME 5120 04:20:38,437 --> 04:20:38,737 INFORMATION? 5121 04:20:38,737 --> 04:20:42,274 THEN THERE'S ENDOTYPES USED TO 5122 04:20:42,274 --> 04:20:44,176 CHARACTERIZE OSA OR TYPE OF 5123 04:20:44,176 --> 04:20:44,510 OSAs. 5124 04:20:44,510 --> 04:20:50,282 I'LL TRY TO SUMMARIZE THIS 5125 04:20:50,282 --> 04:20:57,056 BRIEFLY BUT AND LOOKING AT THE 5126 04:20:57,056 --> 04:20:59,058 SYSTEM AND AROUSAL THRESHOLD AND 5127 04:20:59,058 --> 04:21:02,194 EASE OF SLEEP DISRUPTION BY 5128 04:21:02,194 --> 04:21:03,862 RESPIRATORY EVENTS AND 5129 04:21:03,862 --> 04:21:04,997 COLLAPSIBILITY BY THE STRUCTURE 5130 04:21:04,997 --> 04:21:13,005 OF THE UPPER AIRWAY. 5131 04:21:13,005 --> 04:21:18,410 AND THESE HAVE BEEN USED TO 5132 04:21:18,410 --> 04:21:22,414 CHARACTERIZE THE HETEROGENEITY. 5133 04:21:22,414 --> 04:21:25,050 AND THERE'S SYMPTOM SUBTYPES 5134 04:21:25,050 --> 04:21:27,252 BETWEEN COHORTS BASED ON SOME OF 5135 04:21:27,252 --> 04:21:29,721 THE QUESTIONNAIRE DATA AND SO 5136 04:21:29,721 --> 04:21:30,456 ON. 5137 04:21:30,456 --> 04:21:35,494 AND CLINICAL TYPES OF OSA AND 5138 04:21:35,494 --> 04:21:37,563 CLASSIFICATION THAT TRIES TO 5139 04:21:37,563 --> 04:21:44,169 INTEGRATE THE END ORGAN IMPACT 5140 04:21:44,169 --> 04:21:50,175 AND E.H.R. BASED. 5141 04:21:50,175 --> 04:21:53,545 THE RESEARCH HAS LOOKED AT 5142 04:21:53,545 --> 04:21:54,379 STATS, LAB, SYMPTOM SUPPORTS AND 5143 04:21:54,379 --> 04:21:56,081 COMORBIDITIES TO CHARACTERIZE 5144 04:21:56,081 --> 04:21:59,051 OSA OR CLUSTERS OR SUBTYPES THAT 5145 04:21:59,051 --> 04:22:03,989 CAN COME OUT FROM THE CLINICAL 5146 04:22:03,989 --> 04:22:05,724 REPORTS. 5147 04:22:05,724 --> 04:22:07,693 THERE'S PLASMA MARKERS AND 5148 04:22:07,693 --> 04:22:10,262 THERE'S BEEN STUDIES WITH 5149 04:22:10,262 --> 04:22:10,963 SEVERAL MARKERS. 5150 04:22:10,963 --> 04:22:13,732 VERY FEW HAVE BEEN REPLICATED 5151 04:22:13,732 --> 04:22:17,636 ACROSS THE DIFFERENT DATA SETS 5152 04:22:17,636 --> 04:22:21,140 BUT NONETHELESS THEY DO EXIST. 5153 04:22:21,140 --> 04:22:23,542 ABAC AND SO ON. 5154 04:22:23,542 --> 04:22:25,110 MARKERS OF SYSTEMIC INFLAMMATION 5155 04:22:25,110 --> 04:22:27,679 HAVE BEEN LOOKED AT AND TRIED TO 5156 04:22:27,679 --> 04:22:30,415 CAPTURE AS OSA AND ITS 5157 04:22:30,415 --> 04:22:31,683 HETEROGENEITY. 5158 04:22:31,683 --> 04:22:35,787 THE POLY GENETIC RISK SCORE. 5159 04:22:35,787 --> 04:22:38,190 IT'S A SPECIFIC SCORE WITH 5160 04:22:38,190 --> 04:22:41,393 SUSCEPTIBILITY TO ONE OF THE 5161 04:22:41,393 --> 04:22:42,995 PAPERS CORONARY ARTERY DISEASE. 5162 04:22:42,995 --> 04:22:52,337 ME TABL ICES -- METABOLOMICS 5163 04:22:52,337 --> 04:22:56,041 AND MOVING TO CHARACTERIZING 5164 04:22:56,041 --> 04:23:00,112 HETEROGENEITY WITH BIOMARKERS. 5165 04:23:00,112 --> 04:23:03,515 THE NEXT WAVE OF TECHNICAL 5166 04:23:03,515 --> 04:23:06,418 ADVANCES IN TERMS OF THE 5167 04:23:06,418 --> 04:23:08,220 WEARABLES THERE'S SMART WATCHES 5168 04:23:08,220 --> 04:23:10,622 AND SOME THAT HAVE RECENTLY HAD 5169 04:23:10,622 --> 04:23:14,226 FDA APPROVAL TO USE SOME 5170 04:23:14,226 --> 04:23:16,828 MODALITY TO DETECT SLEEP APNEA 5171 04:23:16,828 --> 04:23:21,133 OR MEASURES AND PATCHES PEOPLE 5172 04:23:21,133 --> 04:23:22,434 HAVE BEEN USING. 5173 04:23:22,434 --> 04:23:26,305 SOME ARE AND LOOKING SOME 5174 04:23:26,305 --> 04:23:29,741 SURROGATE OF MOVEMENT TO 5175 04:23:29,741 --> 04:23:31,210 DETERMINE SLEEP DISRUPTION AND 5176 04:23:31,210 --> 04:23:32,244 SLEEP APNEA IN GENERAL AND SOME 5177 04:23:32,244 --> 04:23:35,414 ARE TRYING TO USE SOME OF THE 5178 04:23:35,414 --> 04:23:36,949 OPTICAL TECHNIQUES TO PRODUCE 5179 04:23:36,949 --> 04:23:40,485 THE DIFFERENT CHARACTER ICS OF 5180 04:23:40,485 --> 04:23:41,820 OSA. 5181 04:23:41,820 --> 04:23:46,291 THERE'S SENSORS PLACED ON THE 5182 04:23:46,291 --> 04:23:52,097 BED AND MONITORED AND THE 5183 04:23:52,097 --> 04:23:53,265 TECHNOLOGICAL NOVATIONS AND 5184 04:23:53,265 --> 04:23:55,234 KNOWING HOW THEY PRODUCE THESE 5185 04:23:55,234 --> 04:24:00,639 THINGS AND PRESUMABLY THEY USE 5186 04:24:00,639 --> 04:24:04,276 SOME METER OR MOVEMENT-BASED 5187 04:24:04,276 --> 04:24:04,509 METRICS. 5188 04:24:04,509 --> 04:24:10,415 THERE'S CONTACTLESS MONITORS AND 5189 04:24:10,415 --> 04:24:13,118 SIT ON THE NIGHTSTAND AND TRY TO 5190 04:24:13,118 --> 04:24:15,621 RECORD THE CHEST MOVEMENTS AND 5191 04:24:15,621 --> 04:24:17,522 TRY TO DEDUCE SLEEP APNEA 5192 04:24:17,522 --> 04:24:24,663 SEVERITY OR EVENTS AND SO ON. 5193 04:24:24,663 --> 04:24:29,701 WE ALSO LOOK AT THE RESEARCH 5194 04:24:29,701 --> 04:24:33,872 THAT COULD BE USED TO LOOK AT 5195 04:24:33,872 --> 04:24:36,441 THE DYNAMIC MRI. 5196 04:24:36,441 --> 04:24:39,544 AND THERE'S BEEN A TECHNIQUE 5197 04:24:39,544 --> 04:24:40,646 TRYING TO LOOK AT DIFFERENT 5198 04:24:40,646 --> 04:24:44,249 KINDS OF CHARACTERISTICS THAT 5199 04:24:44,249 --> 04:24:49,554 COULD DIFFERENTIATE SOME OF THE 5200 04:24:49,554 --> 04:25:00,098 SUB TYPES AND A FEW IMAGING IS A 5201 04:25:12,544 --> 04:25:13,979 DOMAIN PRESENT. 5202 04:25:13,979 --> 04:25:16,581 WE HAVE BEEN CHARACTERIZING OR 5203 04:25:16,581 --> 04:25:19,284 STUDY THAT CHARACTERIZE OSA AND 5204 04:25:19,284 --> 04:25:25,357 WOULD BE RELATIVELY EASY BUT 5205 04:25:25,357 --> 04:25:26,425 IMPORTANT TO INTRODUCE 5206 04:25:26,425 --> 04:25:32,264 HETEROGENEITY IN THE DOMAINS IN 5207 04:25:32,264 --> 04:25:33,231 OSA. 5208 04:25:33,231 --> 04:25:35,100 IF YOU'RE LOOKING AT THE 5209 04:25:35,100 --> 04:25:40,405 DIFFERENT DOMAINS AND METRICS 5210 04:25:40,405 --> 04:25:44,242 PRESUMABLY WE STACK BLOCKS 5211 04:25:44,242 --> 04:25:45,811 WITHOUT THINKING HOW WE SHOULD 5212 04:25:45,811 --> 04:25:52,117 BE LOOKING AT ALL THESE THINGS 5213 04:25:52,117 --> 04:25:54,119 THEY BENEFIT THE CLINIC AND 5214 04:25:54,119 --> 04:25:54,353 PATIENT. 5215 04:25:54,353 --> 04:25:56,588 HOPEFULLY BY THE END OF THE TALK 5216 04:25:56,588 --> 04:26:01,126 I CAN GIVE YOU SOME SENSE OF 5217 04:26:01,126 --> 04:26:02,761 FRAMEWORK THAT COULD BE USED AND 5218 04:26:02,761 --> 04:26:06,431 GET YOU THINKING ON HOW WE CAN 5219 04:26:06,431 --> 04:26:08,467 THINK IN THE MORE GLOBAL WAY 5220 04:26:08,467 --> 04:26:10,035 ABOUT THIS. 5221 04:26:10,035 --> 04:26:12,337 THE OTHER THING IS CURRENTLY OUR 5222 04:26:12,337 --> 04:26:14,106 REPORTS CONTAIN SO MANY 5223 04:26:14,106 --> 04:26:15,374 DIFFERENT METRICS AND SO MANY 5224 04:26:15,374 --> 04:26:17,709 MEASURES FORME PATIENTS IT'S HA 5225 04:26:17,709 --> 04:26:18,744 TO KNOW WHAT AM I LOOKING AT AND 5226 04:26:18,744 --> 04:26:21,346 WHAT I SHOULD BE LOOKING AT AND 5227 04:26:21,346 --> 04:26:24,616 IS THERE SOMETHING NORMAL OR 5228 04:26:24,616 --> 04:26:26,184 ABNORMAL AND THAT'S PROMPTED 5229 04:26:26,184 --> 04:26:29,020 MANUFACTURERS TO COME UP WITH 5230 04:26:29,020 --> 04:26:32,057 NEW INFO GRAPHICS IT HIGHLIGHT 5231 04:26:32,057 --> 04:26:34,693 TO THE PATIENT WHAT IS IMPORTANT 5232 04:26:34,693 --> 04:26:37,996 AND NOT AND SOME SUBTLETIES. 5233 04:26:37,996 --> 04:26:41,666 THESE ARE LOOKING AT THE 5234 04:26:41,666 --> 04:26:42,334 MEASURES. 5235 04:26:42,334 --> 04:26:47,506 IF YOU THINK OF ADDING NEW 5236 04:26:47,506 --> 04:26:49,508 MEASURES AND DOMAINS THE REPORT 5237 04:26:49,508 --> 04:26:51,109 CAN FURTHER CONFUSE THE PATIENT 5238 04:26:51,109 --> 04:26:51,309 MORE. 5239 04:26:51,309 --> 04:26:55,180 AND WE ALL WANT TO MOVE TOWARDS 5240 04:26:55,180 --> 04:26:58,283 DIGITAL FUTURE WHERE THE FUTURE 5241 04:26:58,283 --> 04:27:00,218 CLINIC LOOKS NORMAL AND THE 5242 04:27:00,218 --> 04:27:02,187 REPORTS THAT GETS GENERATED ARE 5243 04:27:02,187 --> 04:27:03,755 INTERACTIVE FOR THE PATIENTS AND 5244 04:27:03,755 --> 04:27:06,825 A CLEAR PATHWAY HOW TO MOVE TO 5245 04:27:06,825 --> 04:27:09,161 THAT AND WHILE PRESERVING ALL 5246 04:27:09,161 --> 04:27:11,596 THE INFORMING WE WANT TO 5247 04:27:11,596 --> 04:27:13,131 PRESERVE. 5248 04:27:13,131 --> 04:27:18,170 WE HAVE WAYS OF CHARACTERIZING 5249 04:27:18,170 --> 04:27:20,172 OSA AND HAVE HETEROGENEITY AND 5250 04:27:20,172 --> 04:27:22,374 CAN WORK ON THAT MORE AND WE 5251 04:27:22,374 --> 04:27:23,842 HAVE THE DIMENSIONALITY. 5252 04:27:23,842 --> 04:27:25,310 AS WE START ADDING MORE AND MORE 5253 04:27:25,310 --> 04:27:27,345 METRICS AND MORE AND MORE DATA 5254 04:27:27,345 --> 04:27:30,382 COMES OUT, THE DIMENSION STARTS 5255 04:27:30,382 --> 04:27:31,516 TO GROW. 5256 04:27:31,516 --> 04:27:32,484 WE DON'T HAVE COMPLETE DATA IN 5257 04:27:32,484 --> 04:27:33,385 ALL THE CASES. 5258 04:27:33,385 --> 04:27:36,221 FOR EXAMPLE, IF YOU'RE LOOKING 5259 04:27:36,221 --> 04:27:41,092 AT STUDIES DONE IN THE PAST 5260 04:27:41,092 --> 04:27:42,160 PERHAPS THERE'S SOME NOTHING 5261 04:27:42,160 --> 04:27:43,995 PHOTOGRAPHY BUT DON'T HAVE THE 5262 04:27:43,995 --> 04:27:46,364 DATA FOR METABOLOMICS AND OTHER 5263 04:27:46,364 --> 04:27:54,372 THINGS AND SO ON OR IF THEY 5264 04:27:54,372 --> 04:27:56,141 COLLECTED SLEEP INFORMATION VIA 5265 04:27:56,141 --> 04:27:58,176 QUESTIONNAIRE BUT NOT 5266 04:27:58,176 --> 04:27:58,810 SOMNOGRAPHY SO IT'S NOT COMPLETE 5267 04:27:58,810 --> 04:28:00,812 DATA IN ALL CASES. 5268 04:28:00,812 --> 04:28:03,849 WE DON'T HAVE AN INTEGRATIVE 5269 04:28:03,849 --> 04:28:06,117 SCORE AT THE END OF THE DAY IT 5270 04:28:06,117 --> 04:28:08,220 MATTERS IF THERE'S AN INTEGRATED 5271 04:28:08,220 --> 04:28:10,522 SCORE ACROSS DOMAINS OR EVEN IF 5272 04:28:10,522 --> 04:28:13,024 DOMAIN SPECIFIC YOU HAVE A SCORE 5273 04:28:13,024 --> 04:28:15,760 TO TELL THEM WHAT EXACTLY IS THE 5274 04:28:15,760 --> 04:28:18,430 ISSUE AND WHAT SHOULD BE THE 5275 04:28:18,430 --> 04:28:26,238 LIKELY NEXT STEP IN TERMS OF 5276 04:28:26,238 --> 04:28:34,112 SLEEP APNEA MANAGEMENT. 5277 04:28:34,112 --> 04:28:38,216 AND NO MATTER THE METHOD OR 5278 04:28:38,216 --> 04:28:41,720 TECHNIQUE WE USE IT HAS TO BE 5279 04:28:41,720 --> 04:28:44,222 THE RESOURCES WE HAVE IN TERMS 5280 04:28:44,222 --> 04:28:46,358 OF INFRASTRUCTURE AND COMPUTING 5281 04:28:46,358 --> 04:28:51,096 AND SO ON. 5282 04:28:51,096 --> 04:28:53,798 HOW HAVE WE BEEN INTEGRATING 5283 04:28:53,798 --> 04:28:57,469 APPROACH TO OSA? 5284 04:28:57,469 --> 04:28:59,638 TYPICAL APPROACHES ARE YOU FIND 5285 04:28:59,638 --> 04:29:02,807 THE COFOUNDERS AND COVARIATES ON 5286 04:29:02,807 --> 04:29:05,810 THE LITERATURE OR DOMAIN 5287 04:29:05,810 --> 04:29:08,480 KNOWLEDGE OR USE A LINEAR OR 5288 04:29:08,480 --> 04:29:10,048 NON-LINEAR MODEL AND THESE 5289 04:29:10,048 --> 04:29:14,219 LINEAR OR NON-LINEAR MODELS HAVE 5290 04:29:14,219 --> 04:29:18,356 PREDEFINED EQUATIONS AND WE USE 5291 04:29:18,356 --> 04:29:24,062 THAT AND SEE IF THE OUTCOME IS 5292 04:29:24,062 --> 04:29:27,566 DETERMINED BY THE DOMAINS OR IF 5293 04:29:27,566 --> 04:29:28,867 TREATMENT RESPONSE CAN BE 5294 04:29:28,867 --> 04:29:31,803 DETERMINED THAT WAY AND 5295 04:29:31,803 --> 04:29:33,071 CHARACTERISTICS ARE MODEL DRIVEN 5296 04:29:33,071 --> 04:29:38,310 SO NEED TO KNOW THE ASSUMPTIONS 5297 04:29:38,310 --> 04:29:48,853 THAT GOVERN THE MODEL IMPLICIT 5298 04:29:51,056 --> 04:29:52,757 DATA AND WHAT CONFOUNDERS AND 5299 04:29:52,757 --> 04:29:53,692 WHAT MEASURES OR METRICS AND SO 5300 04:29:53,692 --> 04:29:55,694 ON. 5301 04:29:55,694 --> 04:29:57,596 IT HAS REQUIREMENTS. 5302 04:29:57,596 --> 04:29:59,230 YOU HAVE TO HAVE STATISTICAL 5303 04:29:59,230 --> 04:30:00,932 ASSUMPTIONS THAT HAVE TO BE MET 5304 04:30:00,932 --> 04:30:02,901 AT EVERY STEP OF THE WAY. 5305 04:30:02,901 --> 04:30:04,336 IN ADDITION, DIMENSION REDUCTION 5306 04:30:04,336 --> 04:30:07,405 IS ONE OF THE KEY THINGS. 5307 04:30:07,405 --> 04:30:09,240 YOU CANNOT HAVE 10 DIFFERENT 5308 04:30:09,240 --> 04:30:13,144 MEASURES FOR LOOKING AT OXYGEN 5309 04:30:13,144 --> 04:30:14,245 DESATURATION IF THEY'RE ALL 5310 04:30:14,245 --> 04:30:15,447 CORRELATED AND LINEAR AND SO ON 5311 04:30:15,447 --> 04:30:18,483 YOU HAVE TO REDUCE THE DIMENSION 5312 04:30:18,483 --> 04:30:19,818 AND DON'T HAVE STATISTICAL POWER 5313 04:30:19,818 --> 04:30:21,286 TO DO THAT SO YOU HAVE TO REDUCE 5314 04:30:21,286 --> 04:30:31,463 DIMENSION. 5315 04:30:34,432 --> 04:30:39,104 I THINK MULTIMODAL A.I. BEEN THE 5316 04:30:39,104 --> 04:30:43,108 HO HOLY GRAIL AND IT'S HAPPENING 5317 04:30:43,108 --> 04:30:48,446 IN OTHER FIELDS OF MEDICINE. 5318 04:30:48,446 --> 04:30:54,119 AND A LOT OF RESEARCH LOOKED AT 5319 04:30:54,119 --> 04:30:56,888 MULTIMODAL A.I. TO PREDICT SOME 5320 04:30:56,888 --> 04:30:58,356 DISEASE AS WELL AS LOOK AT 5321 04:30:58,356 --> 04:30:58,757 HETEROGENEITY. 5322 04:30:58,757 --> 04:31:00,659 ON THE LEFT WE HAVE THIS COULD 5323 04:31:00,659 --> 04:31:02,560 BE TRUE FOR ANY DISEASE AND IN 5324 04:31:02,560 --> 04:31:04,596 THE CASE OF SLEEP APNEA IT'S 5325 04:31:04,596 --> 04:31:08,133 TRUE YOU HAVE DIFFERENT DATA 5326 04:31:08,133 --> 04:31:08,733 MODALITIES. 5327 04:31:08,733 --> 04:31:11,403 IN SLEEP APNEA WE HAVE MORE DATA 5328 04:31:11,403 --> 04:31:13,805 MODALITIES THAN OTHER DISEASES 5329 04:31:13,805 --> 04:31:15,707 AND BRINGS WITH IT DIFFERENT 5330 04:31:15,707 --> 04:31:16,141 OPPORTUNITIES. 5331 04:31:16,141 --> 04:31:18,376 FOR PRECISION HEALTH WE'RE 5332 04:31:18,376 --> 04:31:24,783 LOOKING AT CLINICAL TRIALS AND 5333 04:31:24,783 --> 04:31:27,819 SURVEILLANCE, DIGITAL TWINS AND 5334 04:31:27,819 --> 04:31:30,255 TOUCH ON COPIES. 5335 04:31:30,255 --> 04:31:32,257 A.I. IS THE UMBRELLA TERM AND 5336 04:31:32,257 --> 04:31:34,359 MACHINE LEARNING FOR DATA IN 5337 04:31:34,359 --> 04:31:36,394 SOME CASES FOR IMAGE BASED DATA 5338 04:31:36,394 --> 04:31:38,863 AND DEEP LEARNING FAVORED FOR 5339 04:31:38,863 --> 04:31:39,431 IMAGE BASED DATA. 5340 04:31:39,431 --> 04:31:43,868 THERE ARE TRANSFORMERS THE NEW 5341 04:31:43,868 --> 04:31:45,170 MACHINE LEARNING MODELS THAT TRY 5342 04:31:45,170 --> 04:31:47,672 IT PAY ATTENTION TO THE CONTEXT 5343 04:31:47,672 --> 04:31:50,241 SURROUNDING THE INPUTS AND USED 5344 04:31:50,241 --> 04:31:53,278 FOR TIME AND IMAGE BASED DATA 5345 04:31:53,278 --> 04:31:55,647 AND ADVANCEMENTS ON NEWER 5346 04:31:55,647 --> 04:32:03,321 NETWORKS AND THE GENERATIVE A.I. 5347 04:32:03,321 --> 04:32:05,957 HAS MORE CAPACITY TO DIGEST THE 5348 04:32:05,957 --> 04:32:06,558 DATA MODALITIES. 5349 04:32:06,558 --> 04:32:12,097 AND I'LL TALK ABOUT THIS AS 5350 04:32:12,097 --> 04:32:13,765 WELL, ONE OF THE EXCITING THINGS 5351 04:32:13,765 --> 04:32:16,000 IS WE DON'T NEED TO HAVE LABEL 5352 04:32:16,000 --> 04:32:19,437 DATA OF THE STEPS OF YOUR MODEL. 5353 04:32:19,437 --> 04:32:20,505 YOU CAN WORK WITH UNLABELLED 5354 04:32:20,505 --> 04:32:26,644 DATA AS WELL. 5355 04:32:26,644 --> 04:32:30,048 AND WE'RE LIVING IN DECADES IN 5356 04:32:30,048 --> 04:32:32,383 THE MAKING BUT RECENT ADVANCES 5357 04:32:32,383 --> 04:32:33,184 USED THE A.I. 5358 04:32:33,184 --> 04:32:36,054 THIS IS A GRAPH LOOKING AT THE 5359 04:32:36,054 --> 04:32:38,323 NUMBER OF PAPERS. 5360 04:32:38,323 --> 04:32:40,024 ESTABLISHED SINCE THE GENERATIVE 5361 04:32:40,024 --> 04:32:48,366 A.I. AND SO ON ANDOU CAN SEE 5362 04:32:48,366 --> 04:32:54,239 THE SHARP INCREASE AND SIMILARLY 5363 04:32:54,239 --> 04:32:57,108 IN TERMS OF THE A.I. MEDICAL 5364 04:32:57,108 --> 04:32:59,878 DEVICES THERE'S BEEN UPSWING IN 5365 04:32:59,878 --> 04:33:04,382 APPROVALS WITH GENERATIVE A.I. 5366 04:33:04,382 --> 04:33:10,221 AROUND THE TIME OF THE PANDEMIC 5367 04:33:10,221 --> 04:33:17,962 EXPONENTIAL USE AND SOME HAD 5368 04:33:17,962 --> 04:33:21,599 A.I. AND SOME HAD HUMAN 5369 04:33:21,599 --> 04:33:21,900 INVOLVEMENT. 5370 04:33:21,900 --> 04:33:24,569 AND THE DIFFERENT DATA 5371 04:33:24,569 --> 04:33:27,005 MODALITIES WERE PHYSIOLOGICAL 5372 04:33:27,005 --> 04:33:29,207 BURDENS AND HR AND BIOMARKERS 5373 04:33:29,207 --> 04:33:31,276 AND VARIABLES, IMAGING AND SO 5374 04:33:31,276 --> 04:33:32,043 ON. 5375 04:33:32,043 --> 04:33:33,044 HOW DO WE COMBINE THESE 5376 04:33:33,044 --> 04:33:36,447 DIFFERENT DOMAINS AT THAT LEAD 5377 04:33:36,447 --> 04:33:41,019 TO THEN USE SOME OF THE 5378 04:33:41,019 --> 04:33:42,153 OPPORTUNITIES DATA PRESENTS US 5379 04:33:42,153 --> 04:33:42,353 WITH? 5380 04:33:42,353 --> 04:33:48,193 THIS IS WHERE THE TOPIC OF THE 5381 04:33:48,193 --> 04:33:50,228 IDEA OF FUSION. 5382 04:33:50,228 --> 04:33:53,731 THERE'S SEVERAL TYPE OF FUSION. 5383 04:33:53,731 --> 04:33:56,434 IT'S IMPORTANT TO DECIDE WHEN TO 5384 04:33:56,434 --> 04:34:07,078 USE THE MODALMODALI 5385 04:34:10,882 --> 04:34:14,152 AND YOU FUSE THEM BY DOING SOME 5386 04:34:14,152 --> 04:34:17,222 TRANSFORMATION AND CREATE ONE 5387 04:34:17,222 --> 04:34:18,056 FINAL MODEL. 5388 04:34:18,056 --> 04:34:26,164 IN THIS CASE YOU HAVE 5389 04:34:26,164 --> 04:34:31,302 PATHOLOGICAL SCANS TO THEN BE 5390 04:34:31,302 --> 04:34:33,271 USED AND HAVE INTERMEDIATE 5391 04:34:33,271 --> 04:34:35,874 FUSION TO USE SEPARATE MODELS 5392 04:34:35,874 --> 04:34:37,442 FOR SEPARATE DATA MODALITIES AND 5393 04:34:37,442 --> 04:34:40,678 FUSE THE OUTPUTS OF THE MODELS 5394 04:34:40,678 --> 04:34:45,016 AND CLEARS ANOTHER LAYER OR IRDE 5395 04:34:45,016 --> 04:34:48,186 FUSE DATA TO LEARN 5396 04:34:48,186 --> 04:34:49,721 CHARACTERISTICS OF THE DATA TO 5397 04:34:49,721 --> 04:34:50,355 THEN PREDICT THE INFORMATION YOU 5398 04:34:50,355 --> 04:34:56,995 WANT. 5399 04:34:56,995 --> 04:34:58,830 FINALLY A LATE FUSION WHERE ATR 5400 04:34:58,830 --> 04:35:01,266 EACH LEVEL YOU CREATE THE MODELS 5401 04:35:01,266 --> 04:35:03,134 AND GET THE OUTPUT AND GET 5402 04:35:03,134 --> 04:35:04,535 PREDICTIVE SCORES AND SO ON AND 5403 04:35:04,535 --> 04:35:06,704 USE THE PREDICTIVE SCORES TO 5404 04:35:06,704 --> 04:35:08,940 FUSE IN ANOTHER A.I. MODEL AND 5405 04:35:08,940 --> 04:35:10,775 THEN YOU GET A FINAL SCO OR A 5406 04:35:10,775 --> 04:35:11,876 DIFFERENT TYPE OF SCORE THAT CAN 5407 04:35:11,876 --> 04:35:13,945 BE USED. 5408 04:35:13,945 --> 04:35:15,246 SO IT'S VERY IMPORTANT AT LEAST 5409 04:35:15,246 --> 04:35:16,648 IN THE KWON TEXT OF FUSION TO 5410 04:35:16,648 --> 04:35:21,886 KNOW WHICH ONE TO USE AND WHEN 5411 04:35:21,886 --> 04:35:27,892 TO USE THE DIFFERENT TYPES OF 5412 04:35:27,892 --> 04:35:29,260 EXECUTION. 5413 04:35:29,260 --> 04:35:34,532 AND YOU LEARN THE UNDERLYING 5414 04:35:34,532 --> 04:35:35,466 PRESENTATION SO IN GENERAL SENSE 5415 04:35:35,466 --> 04:35:37,101 WHEN YOU HEAR THE WORD DOG OR 5416 04:35:37,101 --> 04:35:39,570 SHOWN THE IMAGE OF A DOG IN YOUR 5417 04:35:39,570 --> 04:35:41,205 MIND THE REPRESENTATION IS THE 5418 04:35:41,205 --> 04:35:41,406 SAME. 5419 04:35:41,406 --> 04:35:44,676 SIMILARLY WE NEED TO COME TO A 5420 04:35:44,676 --> 04:35:47,211 POINT WHERE FOR OSA OUR INTERNAL 5421 04:35:47,211 --> 04:35:49,347 REPRESENTATION OR DATA 5422 04:35:49,347 --> 04:35:50,515 REPRESENTATION IS THE SAME WHERE 5423 04:35:50,515 --> 04:35:53,618 THEN HAVING HYPOXIC BURDEN VALUE 5424 04:35:53,618 --> 04:35:55,586 OF SO AND SO DESATURATION 5425 04:35:55,586 --> 04:35:59,123 PROFILE WITH A GIVE SHAPE AND 5426 04:35:59,123 --> 04:36:00,992 THEM HAVING MAYBE SOME OTHER 5427 04:36:00,992 --> 04:36:04,696 POLYSO SOME SOMNOGRAPHY OR MARK 5428 04:36:04,696 --> 04:36:07,966 THE SAME REPRESENTATION OF THE 5429 04:36:07,966 --> 04:36:18,443 DISEASE FOR THE INDIVIDUAL. 5430 04:36:29,887 --> 04:36:31,956 AND AHI HAS DIFFERENT DOMAINS 5431 04:36:31,956 --> 04:36:37,695 AND HYPOXIC AROUSAL AND THERE'S 5432 04:36:37,695 --> 04:36:39,497 AUTONOMIC DEMAIN NOT IN THE AHI 5433 04:36:39,497 --> 04:36:41,632 BUT CORRELATED TO AHI. 5434 04:36:41,632 --> 04:36:44,002 SO OUR FUSION WAS YOU HAVE 5435 04:36:44,002 --> 04:36:45,803 THREES DIFFERENT MODALITIES AND 5436 04:36:45,803 --> 04:36:49,874 HOW CAN YOU COMBINE THEM FOR 5437 04:36:49,874 --> 04:36:55,980 FUSE THEM WITHOUT USING 5438 04:36:55,980 --> 04:36:57,882 CONVENTION STATISTICS AND WE 5439 04:36:57,882 --> 04:36:58,950 DERIVED FEATURES AND TRAINED 5440 04:36:58,950 --> 04:37:02,987 MACHINE LEARNING FOR DIFFERENT 5441 04:37:02,987 --> 04:37:03,254 OUTCOMES. 5442 04:37:03,254 --> 04:37:05,823 NOT ONE MACHINE LEARNING FOR AL 5443 04:37:05,823 --> 04:37:06,457 DIFFERENT OUTCOMES. 5444 04:37:06,457 --> 04:37:11,362 THE IDEA WAS THEN IF AN 5445 04:37:11,362 --> 04:37:12,497 INDIVIDUAL HAS HIGH RISK IN 5446 04:37:12,497 --> 04:37:19,804 SEVERAL LEVELS YOU CAN USE 5447 04:37:19,804 --> 04:37:23,741 SOMETHING ANALOGOUS TO CANCER 5448 04:37:23,741 --> 04:37:33,651 AND IF SOMEONE HAS LIKELIHOOD OF 5449 04:37:33,651 --> 04:37:44,162 OUTCOMES AND COMPARED TO A.I. 5450 04:37:57,742 --> 04:38:04,148 THE MODELS AND YOU CAN SEE THE 5451 04:38:04,148 --> 04:38:05,483 FEATURES THAT COME ABOUT IN 5452 04:38:05,483 --> 04:38:08,086 PREDICTING SOME OF THESE 5453 04:38:08,086 --> 04:38:08,352 OUTCOMES. 5454 04:38:08,352 --> 04:38:13,658 FOR EXAMPLE FOR SLEEPINESS WE 5455 04:38:13,658 --> 04:38:17,662 SAW APNEAS AND HYPOXIC BURDEN 5456 04:38:17,662 --> 04:38:18,930 AND IMPORTANT FEATURES IN 5457 04:38:18,930 --> 04:38:19,764 CHARACTERIZING THE 5458 04:38:19,764 --> 04:38:30,041 CLASSIFICATION. 5459 04:38:31,509 --> 04:38:35,379 AND THIS IS HEALTH STUDY DATA WE 5460 04:38:35,379 --> 04:38:43,020 SAW AN EXPONENTIAL INCREASE MEN 5461 04:38:43,020 --> 04:38:47,091 WE USED THE FUSION MODEL AND 5462 04:38:47,091 --> 04:38:49,360 EXTENDED A.I. CAN ALLOW YOU TO 5463 04:38:49,360 --> 04:38:51,095 SEE WHAT FEATURES ARE IMPORTANT 5464 04:38:51,095 --> 04:38:55,700 AND LEARN THE DIFFERENT ASPECTS 5465 04:38:55,700 --> 04:38:56,901 OF IT. 5466 04:38:56,901 --> 04:38:57,668 YOU CAN MOVE BEYOND THAT AS 5467 04:38:57,668 --> 04:39:05,576 WELL. 5468 04:39:05,576 --> 04:39:06,944 YOU CAN LOOK AT SURVIVAL 5469 04:39:06,944 --> 04:39:09,680 TRAJECTORY AND PROFILES AND 5470 04:39:09,680 --> 04:39:12,717 USING SLEEP DATA YOU WERE ABLE 5471 04:39:12,717 --> 04:39:16,621 TO DERIVE SURVIVAL TRAJECTORY 5472 04:39:16,621 --> 04:39:21,058 AND HERE'S AN EXAMPLE OF A 5473 04:39:21,058 --> 04:39:22,226 PERSON WHO DIED AND THE 5474 04:39:22,226 --> 04:39:24,162 COMBINATION OF DIFFERENT 5475 04:39:24,162 --> 04:39:25,596 DOMAINS. 5476 04:39:25,596 --> 04:39:26,531 ACCURATELY PREDICTED THEY ARE 5477 04:39:26,531 --> 04:39:27,899 WERE AT LOWER TRAJECTORY 5478 04:39:27,899 --> 04:39:31,235 COMPARED TO THE AVERAGE GROUP 5479 04:39:31,235 --> 04:39:36,140 AND THE RA HI WAS HIGHER SO 5480 04:39:36,140 --> 04:39:40,478 ACCORDING TO AHI THEY ARE WERE 5481 04:39:40,478 --> 04:39:43,247 NOT A HIGHER RISK AND THIS CAN 5482 04:39:43,247 --> 04:39:48,786 PROMPT IF THEY'RE USING THIS TO 5483 04:39:48,786 --> 04:39:53,791 INTERVENE. 5484 04:39:53,791 --> 04:39:57,128 DR. REKH TALKED ABOUT SYMPTOM 5485 04:39:57,128 --> 04:39:58,029 SUB TYPES. 5486 04:39:58,029 --> 04:40:00,164 WHAT WE DID LOOKED AT 5487 04:40:00,164 --> 04:40:03,634 CLINICAL NOTES AND ASKED THE 5488 04:40:03,634 --> 04:40:09,040 QUESTION CAN WE DERIVE TYPES AND 5489 04:40:09,040 --> 04:40:12,076 THIS IS IN COLLABORATION AND 5490 04:40:12,076 --> 04:40:13,578 USING PROMPT ENGINEERING AND 5491 04:40:13,578 --> 04:40:16,214 LARGE LANGUAGE MODELS THAT EXIST 5492 04:40:16,214 --> 04:40:21,052 FROM THE OPEN SOURCE 5493 04:40:21,052 --> 04:40:22,019 AVAILABILITY MODELS YOU CAN ASK 5494 04:40:22,019 --> 04:40:25,556 THE QUESTION CAN YOU EXTRACT THE 5495 04:40:25,556 --> 04:40:27,391 RELEVANT SYMPTOMS TO HELP ME 5496 04:40:27,391 --> 04:40:29,660 CLASSIFY THE INDIVIDUAL INTO ONE 5497 04:40:29,660 --> 04:40:32,830 OF THE OSA CLUSTERS AND GIVING A 5498 04:40:32,830 --> 04:40:34,899 PROMPT TO GIVE A REASONING DOES 5499 04:40:34,899 --> 04:40:36,734 EYE GOOD JOB AT EXTRACTING ALL 5500 04:40:36,734 --> 04:40:41,172 THOSE AND GIVING US THE 5501 04:40:41,172 --> 04:40:42,873 REASONING WHY THE SYMPTOM IS 5502 04:40:42,873 --> 04:40:43,341 PRESENT. 5503 04:40:43,341 --> 04:40:44,542 ONCE YOU GET THE RESPONSES YOU 5504 04:40:44,542 --> 04:40:47,511 CAN FUSE THEM AND GET TO THE 5505 04:40:47,511 --> 04:40:50,314 SYMPTOMS EFFECTS AND CLUSTERS. 5506 04:40:50,314 --> 04:40:52,316 THAT'S ONE FUSION OR EARLY 5507 04:40:52,316 --> 04:40:55,653 FUSION. IS AN EXAMPLE OF 5508 04:40:55,653 --> 04:40:59,490 INTERMEDIATE FOR LATE FUSION. 5509 04:40:59,490 --> 04:41:02,126 I SHOWED THE EVENTS AND THE 5510 04:41:02,126 --> 04:41:03,361 SYMPTOM SUBTYPES AND USING 5511 04:41:03,361 --> 04:41:05,463 CLINICAL NODE. 5512 04:41:05,463 --> 04:41:09,433 IF YOU FUSE THEM TO ANOTHER 5513 04:41:09,433 --> 04:41:11,068 MULTIMODEL MODEL TO PREDICT 5514 04:41:11,068 --> 04:41:12,436 OUTCOMES YOU HAVE LATE FUSION. 5515 04:41:12,436 --> 04:41:15,106 THAT'S WHERE ONE OF THE 5516 04:41:15,106 --> 04:41:16,340 POSSIBILITIES IS TO COMBINE 5517 04:41:16,340 --> 04:41:17,441 THIS. 5518 04:41:17,441 --> 04:41:21,445 WORK IS ONGOING ON THAT AND 5519 04:41:21,445 --> 04:41:28,819 WE'RE IN INTERESTING TIME AND IF 5520 04:41:28,819 --> 04:41:33,758 GEN A.I. FOR DISEASE CATERS WELL 5521 04:41:33,758 --> 04:41:35,526 TO THE DATA SLEEP APNEA 5522 04:41:35,526 --> 04:41:35,860 GENERATES. 5523 04:41:35,860 --> 04:41:37,895 I'LL QUICKLY TALK ABOUT THE IDEA 5524 04:41:37,895 --> 04:41:40,498 OF THE DIGITAL TWIN. 5525 04:41:40,498 --> 04:41:41,332 GIVEN RANDOMIZED CONTROL TRIALS 5526 04:41:41,332 --> 04:41:51,876 AND THIS IS SOME OF THE WORK AND 5527 04:41:57,348 --> 04:42:01,886 LOOK AT HOW INTERVENTION WOULD 5528 04:42:01,886 --> 04:42:06,090 HAVE PLAYED OUT AND CREATE A 5529 04:42:06,090 --> 04:42:09,160 DIGITAL TWIN ON THE DATA AND 5530 04:42:09,160 --> 04:42:10,428 SIMULATE IF THEY WERE IN THE 5531 04:42:10,428 --> 04:42:17,201 OTHER ARM NOT WE ONE THEY WERE 5532 04:42:17,201 --> 04:42:17,902 RANDOMIZED TO. 5533 04:42:17,902 --> 04:42:18,903 YOU CAN USE THE SIMULATION 5534 04:42:18,903 --> 04:42:19,737 WHETHER THE INTERVENTION WOULD 5535 04:42:19,737 --> 04:42:30,047 BE HELPFUL OR NOT. 5536 04:42:40,925 --> 04:42:42,126 WITH THE ADVENT OF GEN A.I. A 5537 04:42:42,126 --> 04:42:44,495 VIRTUAL COACH WILL HELP TO NOT 5538 04:42:44,495 --> 04:42:45,096 ONLY UNDERSTAND THE 5539 04:42:45,096 --> 04:42:47,832 HETEROGENEITY BUT USE IT TO ITS 5540 04:42:47,832 --> 04:42:48,099 ADVANTAGE. 5541 04:42:48,099 --> 04:42:50,701 A.I. POWERED HEALTH COACHING IS 5542 04:42:50,701 --> 04:42:52,970 SOMETHING MOST E.H.R. COMPANIES 5543 04:42:52,970 --> 04:42:56,907 ARE PUSHING FOR. 5544 04:42:56,907 --> 04:43:00,077 SO FROM THEIR OWN DATA THEY'RE 5545 04:43:00,077 --> 04:43:04,048 WORK INTEGRATING AT ALL 5546 04:43:04,048 --> 04:43:06,717 POSSIBLE LEVELS AND IT'S 5547 04:43:06,717 --> 04:43:11,422 CRITICAL FOR US TO HIGHLIGHT 5548 04:43:11,422 --> 04:43:12,056 HETEROGENEITY IN THE DISORDER 5549 04:43:12,056 --> 04:43:15,126 WHEN ALL THINGS ARE BEING 5550 04:43:15,126 --> 04:43:16,193 DECIDED ABOUT. 5551 04:43:16,193 --> 04:43:21,265 THERE'S SMARTPHONE APPLICATIONS 5552 04:43:21,265 --> 04:43:27,705 THAT COULD BE USED THIS BE 5553 04:43:27,705 --> 04:43:30,441 INTEGRATED INTO THE CLINIC AND 5554 04:43:30,441 --> 04:43:34,879 COULD BE HELPFUL FOR THE 5555 04:43:34,879 --> 04:43:36,414 PATIENTS TO BE USED. 5556 04:43:36,414 --> 04:43:39,049 THERE ARE CHAT BOTS I THINK WE 5557 04:43:39,049 --> 04:43:45,022 USE IT FOR DIFFERENT THINGS BUT 5558 04:43:45,022 --> 04:43:46,557 IT IS BEING PLANNED TO BE 5559 04:43:46,557 --> 04:43:48,092 BROUGHT IN THE E.H.R. CLINIC AND 5560 04:43:48,092 --> 04:43:50,528 USE THAT AND HETEROGENEITY 5561 04:43:50,528 --> 04:43:52,596 EXISTS NOT ONLY IN THE DISEASE 5562 04:43:52,596 --> 04:43:55,433 BUT HOW A PATIENT SORT OF 5563 04:43:55,433 --> 04:43:56,267 SELF-PERCEIVES SOME SYMPTOMS AND 5564 04:43:56,267 --> 04:43:57,468 SO ON SO IT'S IMPORTANT TO 5565 04:43:57,468 --> 04:44:00,471 HUMIDITY IT SHOULD BE EMBEDDED 5566 04:44:00,471 --> 04:44:01,505 INTO THE -- HIGHLIGHT IT SHOULD 5567 04:44:01,505 --> 04:44:05,276 BE EMBEDDED AND THE CHAT BOTS 5568 04:44:05,276 --> 04:44:07,411 ARE NOT REALLY HETEROGENEOUS SO 5569 04:44:07,411 --> 04:44:08,045 IT'S IMPORTANT TO CONSIDER THAT. 5570 04:44:08,045 --> 04:44:11,449 IT COULD BE USED TO PREPARE 5571 04:44:11,449 --> 04:44:15,719 PATIENTS AHEAD OF CLINIC VISITS 5572 04:44:15,719 --> 04:44:17,254 AND CAN PROVIDE THEM WITH 5573 04:44:17,254 --> 04:44:18,122 CLINICAL TRIAL INFORMATION TO 5574 04:44:18,122 --> 04:44:21,859 ALLOW THEM TO RECRUIT INTO THE 5575 04:44:21,859 --> 04:44:23,727 OTHERS THEY MAY BE ELIGIBLE FOR. 5576 04:44:23,727 --> 04:44:25,262 THE CHALLENGES ARE RELIABILITY 5577 04:44:25,262 --> 04:44:26,797 AND SAFETY. 5578 04:44:26,797 --> 04:44:27,731 THERE NEEDS TO BE WORKFORCE 5579 04:44:27,731 --> 04:44:29,967 TRAINING AND DATA PRIVACY AND 5580 04:44:29,967 --> 04:44:33,037 SECURITY AND AS I SAID THE DATA 5581 04:44:33,037 --> 04:44:34,238 IT'S TRAINED ON IS NOT ALWAYS 5582 04:44:34,238 --> 04:44:37,241 FREE OF BIAS AND IT'S IMPORTANT 5583 04:44:37,241 --> 04:44:40,778 TO KEEP THAT IN MIND. 5584 04:44:40,778 --> 04:44:43,447 FINALLY I'LL GO THROUGH THE 5585 04:44:43,447 --> 04:44:53,891 SOURCES OF BIG DATA AVAILABLE. 5586 04:44:53,891 --> 04:44:56,160 ONE HAS SEVERAL OTHER KINDS OF 5587 04:44:56,160 --> 04:44:57,261 DATA THAT IS AVAILABLE TO THE 5588 04:44:57,261 --> 04:44:58,195 RESEARCHERS. 5589 04:44:58,195 --> 04:45:00,231 IF YOU LOOK AT THE GRID IN TERMS 5590 04:45:00,231 --> 04:45:06,403 OF THE COHORT METRICS OF THE 5591 04:45:06,403 --> 04:45:08,105 DIFFERENT DATA SETS AVAILABLE 5592 04:45:08,105 --> 04:45:12,576 THERE'S A LOT OF OUTCOMES AND 5593 04:45:12,576 --> 04:45:17,982 DOMAINS FOR RESEARCHERS TO USE 5594 04:45:17,982 --> 04:45:25,289 OVER 10 TERABYTE OF DATA AND 5595 04:45:25,289 --> 04:45:29,159 THERE'S A STUDY THAT HAS SLEEP 5596 04:45:29,159 --> 04:45:30,694 AN RESPIRATORY AND 5597 04:45:30,694 --> 04:45:33,397 OTHER CLINICAL DATA SETS ARE 5598 04:45:33,397 --> 04:45:36,033 GOING TO BE INCLUDED. 5599 04:45:36,033 --> 04:45:38,536 THERE'S TOP MED. 5600 04:45:38,536 --> 04:45:45,109 HAS ABOUT 50K PLUS GENOME DATA 5601 04:45:45,109 --> 04:45:55,653 AND RNA SEQ AND AN A.I. TO USE 5602 04:45:57,187 --> 04:46:07,431 THE DATA TOGETHER. 5603 04:46:07,698 --> 04:46:08,599 THERE'S DATA SETS AND THIS IS 5604 04:46:08,599 --> 04:46:09,967 THE TIP OF THE ICEBERG AND 5605 04:46:09,967 --> 04:46:13,103 SEVERAL HAVE DATA SETS 5606 04:46:13,103 --> 04:46:20,110 AVAILABLE. 5607 04:46:20,110 --> 04:46:25,015 THERE'S 20,000 SLEEP STUDIES AND 5608 04:46:25,015 --> 04:46:27,251 E.H.R. DATA THROUGH THE 5609 04:46:27,251 --> 04:46:28,218 UNIVERSITY MEDICAL CENTER WHICH 5610 04:46:28,218 --> 04:46:33,123 HAS E.H.R., MEDICARE AND CLAIMS 5611 04:46:33,123 --> 04:46:43,567 AND SLEEP STUDIES AND AND 5612 04:46:44,935 --> 04:46:47,671 THERE'S SCREEN AND CLINIC DATA 5613 04:46:47,671 --> 04:46:51,475 WITH 180 SLEEP STUDIES THAT 5614 04:46:51,475 --> 04:46:54,278 COULD BE USED AND A LOT OF DATA 5615 04:46:54,278 --> 04:46:55,946 HOUSED IN INSTITUTIONAL SILOS 5616 04:46:55,946 --> 04:46:57,114 THAT CAN BE USED FOR THE 5617 04:46:57,114 --> 04:46:58,849 ONS ITIED TODAY. 5618 04:46:58,849 --> 04:47:00,618 THAT'S WHERE THE GEN A.I. SIGNS. 5619 04:47:00,618 --> 04:47:02,720 THE KEY STRATEGY FOR THE 5620 04:47:02,720 --> 04:47:09,627 TRANSFORMERS IS ALLOWING THE 5621 04:47:09,627 --> 04:47:12,730 NEURAL NETWORKS AND YOU CAN 5622 04:47:12,730 --> 04:47:18,569 REMODEL IT AND USE IT FOR ANY 5623 04:47:18,569 --> 04:47:22,339 TYPE OF DATA. 5624 04:47:22,339 --> 04:47:24,808 IT COULD LEARN REPRESENTATIONS 5625 04:47:24,808 --> 04:47:25,976 OF POLYSOMNOGRAPHY DATA AND YOU 5626 04:47:25,976 --> 04:47:28,212 HAVE AIR FLOW SIGNAL YOU CAN USE 5627 04:47:28,212 --> 04:47:30,881 THAT TO GENERATE A SATURATION 5628 04:47:30,881 --> 04:47:33,017 SIGNAL PROVIDED THE DATA YOU 5629 04:47:33,017 --> 04:47:36,954 TRAINED ON WAS HETEROGENEOUS AND 5630 04:47:36,954 --> 04:47:41,759 HAD VARIANTS WE WERE LOOKING FOR 5631 04:47:41,759 --> 04:47:44,261 OR GIVE DATA IT CAN PREDICT WHAT 5632 04:47:44,261 --> 04:47:51,001 CAN HAPPEN IF CPAP WAS INITIATED 5633 04:47:51,001 --> 04:47:53,570 AND STUDIES DONE IN THE SLEEP 5634 04:47:53,570 --> 04:47:58,142 LABS BUT NOT USED AT ALL. 5635 04:47:58,142 --> 04:48:03,747 AND NON-COMPLIANCE WITH THERAPY. 5636 04:48:03,747 --> 04:48:07,217 TO GIVE YOU A QUICK EXAMPLE YOU 5637 04:48:07,217 --> 04:48:12,790 CAN GENERATE FLOW FROM THE 5638 04:48:12,790 --> 04:48:16,260 VARIABLES AND YOU COULD USE 5639 04:48:16,260 --> 04:48:17,628 ARCHITECTURE TO DIVIDE FLOW 5640 04:48:17,628 --> 04:48:22,099 BASED ON USING ALL THE DATA 5641 04:48:22,099 --> 04:48:25,202 AVAILABLE TO TRAIN AND LEARN THE 5642 04:48:25,202 --> 04:48:28,939 DEPEND 5643 04:48:28,939 --> 04:48:29,273 DEPENDENCIES. 5644 04:48:29,273 --> 04:48:34,712 THERE'S DIFFERENT BIASES. 5645 04:48:34,712 --> 04:48:40,918 HISTORICAL BIASES AND AND THIS 5646 04:48:40,918 --> 04:48:44,955 IS REPRESENTED BY HETEROGENEOUS 5647 04:48:44,955 --> 04:48:47,858 POPULATIONS AND ARE WE CHOOSING 5648 04:48:47,858 --> 04:48:49,626 METRICS OR OUTCOMES THAT MATTER 5649 04:48:49,626 --> 04:48:52,963 TO EVERYONE OR ONLY LOOKING AT 5650 04:48:52,963 --> 04:48:55,499 THOSE AVAILABLE AND ARRHYTHMIC 5651 04:48:55,499 --> 04:48:59,436 BIAS AND BIAS WS MODALITY. 5652 04:48:59,436 --> 04:49:00,204 MODEL EXPLAINABILITY ARE 5653 04:49:00,204 --> 04:49:01,839 PARAMOUNT TO OVERCOME THE BIAS. 5654 04:49:01,839 --> 04:49:04,274 AND BEFORE I GIVE YOU THE FINAL 5655 04:49:04,274 --> 04:49:07,111 KEY POINTS, I REALLY WANT TO 5656 04:49:07,111 --> 04:49:09,713 STRESS FOR A.I., HETEROGENEITY 5657 04:49:09,713 --> 04:49:10,781 ADDS EFFICIENCY AND ACCURACY. 5658 04:49:10,781 --> 04:49:15,152 IT'S NOT THE CASE IF YOU HAVE 5659 04:49:15,152 --> 04:49:17,054 HETEROGENEOUS DATA A.I. WELL 5660 04:49:17,054 --> 04:49:18,021 FAIL. 5661 04:49:18,021 --> 04:49:20,357 IT WOULD PERFORM IF YOU'RE 5662 04:49:20,357 --> 04:49:21,558 SOPHISTICATED UP USING IT. 5663 04:49:21,558 --> 04:49:25,629 WHAT ARE THE PRIORITY QUESTIONS 5664 04:49:25,629 --> 04:49:28,732 IN MY OPINION? 5665 04:49:28,732 --> 04:49:31,735 USING THE TRANSFORMERS TO USE 5666 04:49:31,735 --> 04:49:34,905 THE GAPS BETWEEN HOME SLEEP 5667 04:49:34,905 --> 04:49:40,844 STUDY AND VARIABLES COULD BE A 5668 04:49:40,844 --> 04:49:42,412 KEY FACTOR. 5669 04:49:42,412 --> 04:49:52,189 WE NEED TO UTILIZE SIMULATION TO 5670 04:49:52,189 --> 04:49:55,092 LOOK THIS AND WITH THAT I'LL 5671 04:49:55,092 --> 04:50:02,132 STOP HERE. 5672 04:50:02,132 --> 04:50:03,967 >> THANK YOU. 5673 04:50:03,967 --> 04:50:08,505 THAT'S A SUMMARY OF ALL THE 5674 04:50:08,505 --> 04:50:09,173 ARTIFICIAL INTELLIGENCE USED IN 5675 04:50:09,173 --> 04:50:11,341 SLEEP AND A TASTE OF WHAT HES 5676 04:50:11,341 --> 04:50:12,176 GOING TO BE AVAILABLE IN THE 5677 04:50:12,176 --> 04:50:14,912 FUTURE AND AN EXCITING PICTURE. 5678 04:50:14,912 --> 04:50:16,747 LET ME SUMMARIZE THE TALKS FROM 5679 04:50:16,747 --> 04:50:17,915 THE SESSION A LITTLE BIT BRIEFLY 5680 04:50:17,915 --> 04:50:21,585 BECAUSE I KNOW WE'RE RUNNING ON. 5681 04:50:21,585 --> 04:50:24,788 DR. WELLMAN SHOWED US EXAMPLES 5682 04:50:24,788 --> 04:50:27,257 OF WHITE/BLACK DIFFERENCES IN 5683 04:50:27,257 --> 04:50:32,563 HYPOXIC BURDEN AS DETECTED AND 5684 04:50:32,563 --> 04:50:34,431 CARDIOVASCULAR RESPONSES IN OSA 5685 04:50:34,431 --> 04:50:36,834 AND COULD HAVE SIGNIFICANT 5686 04:50:36,834 --> 04:50:37,501 LONG-TERM HEALTH CONSEQUENCES 5687 04:50:37,501 --> 04:50:40,871 BECAUSE SUSCEPTIBILITY TO OSA 5688 04:50:40,871 --> 04:50:42,773 AND THE LONG-TERM HEALTH 5689 04:50:42,773 --> 04:50:44,842 CONSEQUENCES FROM OSA DIFFERS 5690 04:50:44,842 --> 04:50:45,509 SIGNIFICANTLY BETWEEN BLACK AND 5691 04:50:45,509 --> 04:50:55,819 WHITE POPULATIONS. 5692 04:51:00,224 --> 04:51:03,694 AND GLUCOSE MONITORING AND SLEEP 5693 04:51:03,694 --> 04:51:07,164 STUDIES INCORPORATING THE DATA 5694 04:51:07,164 --> 04:51:10,868 WITH THE DATA STREAMS FROM 5695 04:51:10,868 --> 04:51:13,103 VARIABLE DEVICES USING THE 5696 04:51:13,103 --> 04:51:14,771 APPROACHES TALKED ABOUT IN 5697 04:51:14,771 --> 04:51:15,772 MACHINE LEARNING AND ARTIFICIAL 5698 04:51:15,772 --> 04:51:17,107 INTELLIGENCE TO INTEGRATE THE 5699 04:51:17,107 --> 04:51:19,376 DATA STREAMS TO A COMPREHENSIVE 5700 04:51:19,376 --> 04:51:20,944 PICTURE OF SLEEP AND ITS 5701 04:51:20,944 --> 04:51:24,848 DISTURBANCES. 5702 04:51:24,848 --> 04:51:28,685 DR. PAREKH DESCRIBED THE 5703 04:51:28,685 --> 04:51:33,090 PHENOTYPIC DIFFERENCES 5704 04:51:33,090 --> 04:51:34,291 CONTRIBUTING TO THE 5705 04:51:34,291 --> 04:51:35,425 HETEROGENEITY OF OBSTRUCTIVE 5706 04:51:35,425 --> 04:51:37,794 SLEEP APNEA AND MULTIPLE 5707 04:51:37,794 --> 04:51:39,796 APPROACHES ARE USED TO DESCRIBE 5708 04:51:39,796 --> 04:51:41,164 THE HETEROGENEITY AND THEY PLAY 5709 04:51:41,164 --> 04:51:43,100 RESULT IN DIFFERENT OUTCOMES AND 5710 04:51:43,100 --> 04:51:48,772 RESPONSE TO TREATMENTS AND EVEN 5711 04:51:48,772 --> 04:51:49,773 METHODS FOR PREVENTION OF SLEEP 5712 04:51:49,773 --> 04:51:54,745 APNEA IN THE DIFFERENT 5713 04:51:54,745 --> 04:51:57,848 POPULATIONS AND FINALLY 5714 04:51:57,848 --> 04:52:02,152 APPROACHES FOR THE SUB TYPES OF 5715 04:52:02,152 --> 04:52:06,523 SLEEP APNEA AND SHOWED 5716 04:52:06,523 --> 04:52:07,090 INCREASINGLY SOPHISTICATED 5717 04:52:07,090 --> 04:52:10,994 MACHINE LEARNING AND BIG DATA 5718 04:52:10,994 --> 04:52:12,262 APPROACHES CAN HAVE 5719 04:52:12,262 --> 04:52:13,096 CHARACTERIZATION AND 5720 04:52:13,096 --> 04:52:14,898 CLASSIFICATION MUCH THE CELL 5721 04:52:14,898 --> 04:52:16,133 TYPES PERHAPS ULTIMATELY 5722 04:52:16,133 --> 04:52:24,841 RESULTING IN MORE EFFECTIVE 5723 04:52:24,841 --> 04:52:28,145 TREATMENTS FOR THESE DIVERSE SUB 5724 04:52:28,145 --> 04:52:31,048 TYPES OF SLEEP APNEA SO A NICE 5725 04:52:31,048 --> 04:52:33,216 WAY OF WRAPPING UP THE DAY'S 5726 04:52:33,216 --> 04:52:33,417 TALKS. 5727 04:52:33,417 --> 04:52:36,653 WE HAVE SOMETHING LIKE 20 5728 04:52:36,653 --> 04:52:47,030 MINUTES OR SO FOR Q&A. 5729 04:52:48,598 --> 04:52:50,400 MAYBE IT'S GOOD TO HAVE FURTHER 5730 04:52:50,400 --> 04:52:51,401 DISCUSSION ON THINGS POSSIBLE 5731 04:52:51,401 --> 04:52:56,640 FOR THE BRIEF MESSAGES IN THE 5732 04:52:56,640 --> 04:52:57,074 CHAT. 5733 04:52:57,074 --> 04:52:59,609 ONE ONE INTERESTING COMMENTS OR 5734 04:52:59,609 --> 04:53:01,511 QUESTIONS WAS TALKING ABOUT 5735 04:53:01,511 --> 04:53:08,852 RACIAL BIAS AND DETECTION OF 5736 04:53:08,852 --> 04:53:11,822 DESATURATION AND THERE WAS 5737 04:53:11,822 --> 04:53:12,856 RACIAL BIAS IN THE FILTRATION 5738 04:53:12,856 --> 04:53:14,658 RATE FOR A LONG TIME. 5739 04:53:14,658 --> 04:53:19,129 THAT'S PRETTY MUCH BEEN SOLVED 5740 04:53:19,129 --> 04:53:22,766 BY INCORPORATING A CORRECTION 5741 04:53:22,766 --> 04:53:23,033 FACTOR. 5742 04:53:23,033 --> 04:53:33,677 ONE QUESTION IS IF THAT BE 5743 04:53:33,677 --> 04:53:37,114 APPROACH OF LOOKING AT 5744 04:53:37,114 --> 04:53:38,815 DESATURATION AND TRANSLATING THE 5745 04:53:38,815 --> 04:53:40,283 DATA IN AFRICAN AMERICAN PEOPLE 5746 04:53:40,283 --> 04:53:44,855 SO THE DESATURATIONS ARE 5747 04:53:44,855 --> 04:53:50,594 DEFECTED AND FOR A LONG TIME 5748 04:53:50,594 --> 04:53:51,628 OPTICAL ENGINEERS PEOPLE 5749 04:53:51,628 --> 04:53:53,497 DESIGNING THESE PULSE OX DEVICES 5750 04:53:53,497 --> 04:53:55,632 WHY CAN'T THEY CHANGE THE DESIGN 5751 04:53:55,632 --> 04:53:59,703 TO BE MORE SENSITIVE IN PEOPLE 5752 04:53:59,703 --> 04:54:02,105 WITH DARK SKIN AND WE DIDN'T 5753 04:54:02,105 --> 04:54:04,741 HEAR ANYTHING ABOUT THAT. 5754 04:54:04,741 --> 04:54:05,742 PERHAPS YOU CAN COULD COMMENT ON 5755 04:54:05,742 --> 04:54:16,053 THOSE TWO ISSUES. 5756 04:54:20,624 --> 04:54:24,027 >> DOES 5757 04:54:24,361 --> 04:54:26,363 >> I REMEMBER WHEN I FIRST 5758 04:54:26,363 --> 04:54:31,134 LEARNED ABOUT PULSE OXIMETRY IN 5759 04:54:31,134 --> 04:54:34,037 MEDICAL SCHOOL AND ASKED ABOUT 5760 04:54:34,037 --> 04:54:36,807 DARK SKIN AND NAIL POLISH, THEY 5761 04:54:36,807 --> 04:54:38,208 TOLD ME IT WAS ALREADY SOLVED 5762 04:54:38,208 --> 04:54:43,113 AND DON'T WORRY ABOUT IT. 5763 04:54:43,113 --> 04:54:47,350 I CAN'T BELIEVE IT SEEMS -- 5764 04:54:47,350 --> 04:54:49,719 SUSAN BROUGHT UP THAT PEOPLE CAN 5765 04:54:49,719 --> 04:54:51,188 CHANGE LIKE THE WAY THEY'RE 5766 04:54:51,188 --> 04:54:54,024 TRYING TO FIX IT NOW IS CHANGE 5767 04:54:54,024 --> 04:55:03,066 THE CALIBRATION CURB SO YOU HAVE 5768 04:55:03,066 --> 04:55:05,902 A CALIBRATION CURB FOR DARK SKIN 5769 04:55:05,902 --> 04:55:07,471 AND DIFFERENT FOR WHITE. 5770 04:55:07,471 --> 04:55:09,906 I HAD NOT HEARD OF THAT AND TO 5771 04:55:09,906 --> 04:55:12,209 ME IT SEEMS LIKE IT WOULD WORK 5772 04:55:12,209 --> 04:55:13,310 AND WOULD LIKE TO KNOW PEOPLE 5773 04:55:13,310 --> 04:55:18,748 DOING THAT AND HOW THEY'RE DOING 5774 04:55:18,748 --> 04:55:27,591 THAT AND THAT'S JUST A DIFFERENT 5775 04:55:27,591 --> 04:55:28,492 CAL OPERATION CURB. 5776 04:55:28,492 --> 04:55:31,294 UNTIL I HEARD ABOUT THAT I 5777 04:55:31,294 --> 04:55:36,833 WASN'T SURE HOW OPTICAL 5778 04:55:36,833 --> 04:55:40,770 ENGINEERS WOULD FIX IT BECAUSE 5779 04:55:40,770 --> 04:55:42,706 THE WAY THE DEVICES CORRECT FOR 5780 04:55:42,706 --> 04:55:44,274 ERRORS AND NOISE IS THEY SMOOTH 5781 04:55:44,274 --> 04:55:48,612 THE SIGNAL. 5782 04:55:48,612 --> 04:55:52,849 THEY SMOOTH IT SO MUCH IF WE 5783 04:55:52,849 --> 04:55:56,419 WERE TO REMOVE SOME OF THE 5784 04:55:56,419 --> 04:56:00,557 SMOOTHING THEY WOULD TURN INTO 5785 04:56:00,557 --> 04:56:04,861 STATS BECAUSE THE SIGNAL IS SO 5786 04:56:04,861 --> 04:56:05,195 OVER FILTERED. 5787 04:56:05,195 --> 04:56:07,964 AND THEY ARE WERE TO DETECT 5788 04:56:07,964 --> 04:56:11,835 STEADY STATE OFFSETS FOR PEOPLE 5789 04:56:11,835 --> 04:56:14,471 ONE PNEUMONIA AND IN THE ICU AND 5790 04:56:14,471 --> 04:56:16,840 IT WAS NOT TO DETECT TRANSIENT 5791 04:56:16,840 --> 04:56:26,950 DROPS. 5792 04:56:33,023 --> 04:56:36,126 WHENEVER THE ERROR IS THE 3% TO 5793 04:56:36,126 --> 04:56:40,063 4% THAT EXISTS BETWEEN WHITES 5794 04:56:40,063 --> 04:56:42,999 AND BLACKS ON OXIMETRY -- WHAT'S 5795 04:56:42,999 --> 04:56:48,238 THAT DO TO THE 3%, 4% HYPOPNEA 5796 04:56:48,238 --> 04:56:52,242 DEFINITION WE HAVE FOR SLEEP AP? 5797 04:56:52,242 --> 04:56:55,111 IF SOMEONE CAN FIX THAT I'D LOVE 5798 04:56:55,111 --> 04:56:57,247 TO GET HOLD OF THAT DEVICE AND 5799 04:56:57,247 --> 04:57:07,424 TEST THAT. 5800 04:57:10,160 --> 04:57:15,365 >> THERE'S RACIAL BIAS IN LUNG 5801 04:57:15,365 --> 04:57:17,834 FUNCTION SO THE EXCESSIVELY 5802 04:57:17,834 --> 04:57:20,470 SLEEPY PHENOTYPES AND THE 5803 04:57:20,470 --> 04:57:23,473 CONCERN IN THE HETEROGENEOUS 5804 04:57:23,473 --> 04:57:26,876 SLEEP PHENOTYPES WE LOOKED AT 5805 04:57:26,876 --> 04:57:28,878 BECAUSE IT'S GOT THE MOST 5806 04:57:28,878 --> 04:57:30,480 SIGNIFICANT LONG-TERM HEALTH 5807 04:57:30,480 --> 04:57:33,583 CONSEQUENCES AND THE QUESTION IS 5808 04:57:33,583 --> 04:57:34,918 WHY? 5809 04:57:34,918 --> 04:57:39,489 WHY IS IT EXCESSIVELY SLEEPY 5810 04:57:39,489 --> 04:57:40,624 REFLECTS SOMETHING ADVERSE IN 5811 04:57:40,624 --> 04:57:41,024 THE CONSEQUENCES? 5812 04:57:41,024 --> 04:57:44,894 ANY THOUGHTS ON THAT? 5813 04:57:44,894 --> 04:57:46,863 >> I DON'T THINK IT'S SLEEPINESS 5814 04:57:46,863 --> 04:57:47,230 PER SE. 5815 04:57:47,230 --> 04:57:49,566 IF YOU LOOK AT PEOPLE WITH SLEEP 5816 04:57:49,566 --> 04:57:52,836 APNEA, WE DON'T HAVE SLEEP APNEA 5817 04:57:52,836 --> 04:57:56,506 THEY'RE EXCESSIVELY SLEEPY AND 5818 04:57:56,506 --> 04:57:59,643 THERE'S NO INCREASED RISK OF 5819 04:57:59,643 --> 04:57:59,909 OUTCOMES. 5820 04:57:59,909 --> 04:58:02,712 I THINK THE WAY TO LOOK AT IT 5821 04:58:02,712 --> 04:58:06,516 THE WAY WE LOOK AT IT IS 5822 04:58:06,516 --> 04:58:09,753 EXCESSIVE SLEEPINESS IS LIKE A 5823 04:58:09,753 --> 04:58:12,022 SYMPTOMATIC BIOMARKER OF WHO'S 5824 04:58:12,022 --> 04:58:13,156 AT INCREASED RISK. 5825 04:58:13,156 --> 04:58:20,830 THERE'S A MOLECULAR RESPONSE AND 5826 04:58:20,830 --> 04:58:22,766 THERE'S A DIFFERENT INFLAMMATORY 5827 04:58:22,766 --> 04:58:24,567 RESPONSE AND WE KNOW THAT FROM 5828 04:58:24,567 --> 04:58:27,237 OTHER DATA THE CLUSTERS AND SOME 5829 04:58:27,237 --> 04:58:28,571 PEOPLE HAVE HIGH INFLAMMATORY 5830 04:58:28,571 --> 04:58:31,141 RESPONSES AND IT'S A HIGH 5831 04:58:31,141 --> 04:58:32,842 INFLAMMATORY RESPONSE TO 5832 04:58:32,842 --> 04:58:34,244 CARDIOVASCULAR RISK AND ALSO 5833 04:58:34,244 --> 04:58:34,878 DRIVES SLEEPINESS THAT'S WHY 5834 04:58:34,878 --> 04:58:36,446 THEY'RE RELATED. 5835 04:58:36,446 --> 04:58:38,682 SO THAT'S THE WAY WE TEND TO 5836 04:58:38,682 --> 04:58:42,018 THINK ABOUT IT. 5837 04:58:42,018 --> 04:58:45,655 IT'S A SYMPTOMATIC BIOMARKER AND 5838 04:58:45,655 --> 04:58:46,856 GETTING TO THE FUNDAMENTAL 5839 04:58:46,856 --> 04:58:48,525 QUESTION WHY IS IT? 5840 04:58:48,525 --> 04:58:53,630 WHY DO SOME WITH THE SAME 5841 04:58:53,630 --> 04:59:04,174 DISEASE HAVE MARGINAL SLEEPINESS 5842 04:59:04,808 --> 04:59:06,743 AND SOME DON'T. 5843 04:59:06,743 --> 04:59:08,378 >> DIEGO, DO YOU WANT TO COMMENT 5844 04:59:08,378 --> 04:59:09,813 ON THAT? 5845 04:59:09,813 --> 04:59:11,815 YOU LOOKED AT THIS EXTENSIVELY 5846 04:59:11,815 --> 04:59:12,248 TOO. 5847 04:59:12,248 --> 04:59:20,857 >> MY HYPOTHESIS IS IN LINE WITH 5848 04:59:20,857 --> 04:59:23,193 WHAT ALLAN SAID AND ANOTHER 5849 04:59:23,193 --> 04:59:27,130 QUESTION I HAVE IN MY MIND IS 5850 04:59:27,130 --> 04:59:29,432 CAN SLEEPINESS OR SYMPTOM 5851 04:59:29,432 --> 04:59:31,134 PRESENTATIONS BE A MARKER OF HOW 5852 04:59:31,134 --> 04:59:32,635 LONG SOMEONE'S HAD THE DISEASE. 5853 04:59:32,635 --> 04:59:34,904 WE HAD DISCUSSION HOW WE CAN 5854 04:59:34,904 --> 04:59:36,840 LEVERAGE THE INFORMATION TO PUT 5855 04:59:36,840 --> 04:59:39,275 THEM INTO THE PATH OF LIKE 5856 04:59:39,275 --> 04:59:40,844 DISEASE PROGRESSION. 5857 04:59:40,844 --> 04:59:44,647 SO WHEN A PATIENT COMES IN TO 5858 04:59:44,647 --> 04:59:52,288 GET THE DIAGNOSIS WE DON'T KNOW 5859 04:59:52,288 --> 04:59:57,961 HOW LONG THEY'VE HAD THE 5860 04:59:57,961 --> 04:59:58,194 DISEASE. 5861 04:59:58,194 --> 05:00:00,830 AND AND WE LOOKED AT HOW THE 5862 05:00:00,830 --> 05:00:02,699 SYMPTOMS TRANSITIONED OVER TIME 5863 05:00:02,699 --> 05:00:05,034 BETWEEN THE BASELINE AND 5864 05:00:05,034 --> 05:00:06,369 FIVE-YEAR VISIT FROM THE HEALTH 5865 05:00:06,369 --> 05:00:08,838 STUDY AND SEE IT TENDS TO BE AN 5866 05:00:08,838 --> 05:00:11,708 ATTENUATION OF THE SYMPTOMS. 5867 05:00:11,708 --> 05:00:15,478 THOSE EXCESSIVELY SLEEPY OR LESS 5868 05:00:15,478 --> 05:00:17,380 SLEEPY BUT IN A SEPARATE 5869 05:00:17,380 --> 05:00:19,149 ANALYSIS WE HAVE PUBLISHED AT 5870 05:00:19,149 --> 05:00:21,451 THIS POINT THOSE THAT MAINTAIN 5871 05:00:21,451 --> 05:00:23,486 SLEEPY OVER TIME THOSE ARE AT 5872 05:00:23,486 --> 05:00:24,554 THE HIGHEST RISK. 5873 05:00:24,554 --> 05:00:26,589 IT SEEMS TO ME IT IS JUST 5874 05:00:26,589 --> 05:00:28,224 TRACKING ALONG WITH SOMETHING 5875 05:00:28,224 --> 05:00:31,127 ELSE AND I THINK -- A LOT OF THE 5876 05:00:31,127 --> 05:00:32,829 WORK ALLAN IS GOING ON TRYING TO 5877 05:00:32,829 --> 05:00:35,265 DESCRIBE THE METABOLIC AND 5878 05:00:35,265 --> 05:00:37,100 MOLECULAR MARKERS OF THE 5879 05:00:37,100 --> 05:00:37,700 SUBTYPES COULD SHED LIGHT ON 5880 05:00:37,700 --> 05:00:39,402 THAT. 5881 05:00:39,402 --> 05:00:42,005 >> I AGREE WITH THAT. 5882 05:00:42,005 --> 05:00:44,707 >> AND DID YOU HEAR THE 5883 05:00:44,707 --> 05:00:46,910 QUESTION, ALLAN? 5884 05:00:46,910 --> 05:00:49,879 >> A COUPLE POINTS IF I COULD. 5885 05:00:49,879 --> 05:00:51,648 CLEARLY THERE WAS AGREEMENT IN 5886 05:00:51,648 --> 05:00:52,916 THIS SESSION ABOUT WHERE WE'RE 5887 05:00:52,916 --> 05:00:55,151 AT AND THE MULTIPLE DIMENSIONS 5888 05:00:55,151 --> 05:00:57,086 AND MULTIPLE TOOLS ARE THERE AND 5889 05:00:57,086 --> 05:01:00,590 I THINK THIS IS APPROACH TO 5890 05:01:00,590 --> 05:01:04,828 PERSONALIZED SLEEP APNEA GETS TO 5891 05:01:04,828 --> 05:01:06,896 THE MAINSTREAM OF PERSONALIZED 5892 05:01:06,896 --> 05:01:11,134 MEDICINE AND WE HAD AN EXCELLENT 5893 05:01:11,134 --> 05:01:12,168 TALK OF TOOLS APPLIED IN THE 5894 05:01:12,168 --> 05:01:14,404 CANCER WORLD AND SO ON. 5895 05:01:14,404 --> 05:01:16,573 IN THE MAINSTREAM OF 5896 05:01:16,573 --> 05:01:17,207 PERSONALIZED MEDICINE I THINK 5897 05:01:17,207 --> 05:01:21,945 THERE'S A LOT TO GET DONE. 5898 05:01:21,945 --> 05:01:24,447 I THINK THE IDEA OF INTEGRATING 5899 05:01:24,447 --> 05:01:26,382 ACROSS THE SYMPTOMS AND 5900 05:01:26,382 --> 05:01:28,218 PHYSIOLOGY AND BIOMARKERS IS 5901 05:01:28,218 --> 05:01:30,053 WHERE WE NEED TO BE. 5902 05:01:30,053 --> 05:01:31,054 HOW DO WE PULL THE INFORMATION 5903 05:01:31,054 --> 05:01:34,224 TOGETHER AND I THINK WHAT YOU 5904 05:01:34,224 --> 05:01:36,693 TALKED ABOUT WAS YOU HAVE 5905 05:01:36,693 --> 05:01:37,861 ANALYTICAL APPROACHES THAT ALLOW 5906 05:01:37,861 --> 05:01:39,262 YOU TO DO THAT. 5907 05:01:39,262 --> 05:01:42,866 THE OTHER THING IS WITHIN THE 5908 05:01:42,866 --> 05:01:46,436 SESSION THERE'S BEEN A THEME OF 5909 05:01:46,436 --> 05:01:48,404 AGENDA DIFFERENCES AND 5910 05:01:48,404 --> 05:01:51,841 PERSONALIZED SLEEP APNEA AND 5911 05:01:51,841 --> 05:01:53,376 THEY CAN COME TOGETHER BECAUSE 5912 05:01:53,376 --> 05:01:55,712 IF WE'RE GOING TO TACKLE THE 5913 05:01:55,712 --> 05:01:57,146 GENDER DIFFERENCES THEY SHOULD 5914 05:01:57,146 --> 05:01:58,848 BE WITHIN THE FRAMEWORK AND 5915 05:01:58,848 --> 05:02:00,283 BIOMARKER AND SYMPTOM AND 5916 05:02:00,283 --> 05:02:01,084 PHYSIOLOGY AND SO ON. 5917 05:02:01,084 --> 05:02:03,853 IT'S THE SAME FRAMEWORK THAT 5918 05:02:03,853 --> 05:02:06,389 WOULD ALLOW US TO COMPLETELY 5919 05:02:06,389 --> 05:02:07,156 CHARACTERIZE THE GENDER 5920 05:02:07,156 --> 05:02:17,700 DIFFERENCES AND UNDERSTAND THAT. 5921 05:02:22,639 --> 05:02:26,142 S THE SAME HEART DATA HAS BEEN 5922 05:02:26,142 --> 05:02:27,810 PRODUCTIVE AND THERE WERE NO 5923 05:02:27,810 --> 05:02:30,113 BIOMARKERS IN THERE AND SO ON 5924 05:02:30,113 --> 05:02:33,850 AND ONE OF THE CHALLENGES IS 5925 05:02:33,850 --> 05:02:43,159 BECAUSE THEY GO UP AND THE 5926 05:02:43,159 --> 05:02:53,469 AVERAGE AGE IS 65. 5927 05:03:12,255 --> 05:03:14,257 HAVING THE RESOURCES WOULD BE 5928 05:03:14,257 --> 05:03:17,060 ENORMOUS TO THE FIELD. 5929 05:03:17,060 --> 05:03:20,630 AND IT WOULDN'T BE COMPREHENSIVE 5930 05:03:20,630 --> 05:03:22,131 BECAUSE LOTS OF PEOPLE ARE 5931 05:03:22,131 --> 05:03:23,166 GETTING STUDIED THE QUESTION IS 5932 05:03:23,166 --> 05:03:24,767 HOW DO YOU CAPTURE THE DATA AND 5933 05:03:24,767 --> 05:03:25,868 DO IT. 5934 05:03:25,868 --> 05:03:32,308 THAT'S ONE OF THE BARRIERS WE 5935 05:03:32,308 --> 05:03:38,281 HAVE I THINK. 5936 05:03:38,281 --> 05:03:39,382 THE STUDY WAS THE GOLD STANDARD 5937 05:03:39,382 --> 05:03:48,825 AND I HAVE CONCERNS ABOUT THAT. 5938 05:03:48,825 --> 05:03:50,860 >> WHAT DO PEOPLE THINK ABOUT 5939 05:03:50,860 --> 05:03:51,060 THAT? 5940 05:03:51,060 --> 05:03:52,261 >> IT'S A VALID CONCERN. 5941 05:03:52,261 --> 05:03:55,398 AND TWO STRATEGIES ONE IS 5942 05:03:55,398 --> 05:03:56,366 COHORTS THAT IS MORE 5943 05:03:56,366 --> 05:04:01,871 HETEROGENEOUS AND SO ON LOOKING 5944 05:04:01,871 --> 05:04:05,408 AT CLINICAL POPULATIONS AND 5945 05:04:05,408 --> 05:04:07,243 PROSPECTIVE VALIDATION AND NOT 5946 05:04:07,243 --> 05:04:10,046 USING ALREADY EXISTING DATA AND 5947 05:04:10,046 --> 05:04:15,451 RUNNING THE ALGORITHM IN THE 5948 05:04:15,451 --> 05:04:25,962 BACKGROUND AND SLEEP DATA WAS 5949 05:04:28,831 --> 05:04:36,906 ONE OF THE FIRST DATA SETS. 5950 05:04:36,906 --> 05:04:39,208 >> THE OTHER THING IS IF WE 5951 05:04:39,208 --> 05:04:40,343 ORGANIZED AND THESE PROGRAMS 5952 05:04:40,343 --> 05:04:47,817 LIKE TOP MED IF YOU DON'T HAVE 5953 05:04:47,817 --> 05:04:48,885 COHORTS, THERE'S NOT AS MUCH AS 5954 05:04:48,885 --> 05:04:51,754 WITH COHORTS AND GIVE YOU 5955 05:04:51,754 --> 05:04:55,825 RESOURCES TO DO THE METABOLOMICS 5956 05:04:55,825 --> 05:04:57,460 AND WHOLE GENOME SEQUENCING AND 5957 05:04:57,460 --> 05:04:59,328 THAT'S THE WHOLE IDEA. 5958 05:04:59,328 --> 05:05:01,130 IF YOU'RE NOT ORGANIZED WITH A 5959 05:05:01,130 --> 05:05:02,365 COHORT COLLECTING SAMPLES YOU 5960 05:05:02,365 --> 05:05:12,909 CAN'T REALLY ACCESS THE TOP MED 5961 05:05:16,112 --> 05:05:17,947 RESOURCE S. 5962 05:05:17,947 --> 05:05:23,186 >> A QUESTION, POST PANDEMIC 5963 05:05:23,186 --> 05:05:26,122 WORLD THERE'S MORE CONTINUOUS 5964 05:05:26,122 --> 05:05:26,789 MONITORING. 5965 05:05:26,789 --> 05:05:29,692 THERE'S BEEN A PROLIFERATION OF 5966 05:05:29,692 --> 05:05:31,127 DEVICES THAT MEASURE 5967 05:05:31,127 --> 05:05:38,468 PHYSIOLOGICAL PARAMETERS. 5968 05:05:38,468 --> 05:05:41,270 ACTIGRAPHY COMES TO MIND AND NOW 5969 05:05:41,270 --> 05:05:42,572 CONTINUOUS GLUCOSE MONITORING. 5970 05:05:42,572 --> 05:05:48,211 IT'S AN UNREGULATED FIELD AND 5971 05:05:48,211 --> 05:05:48,845 WHETHER THEY'RE BELIEVABLE IN 5972 05:05:48,845 --> 05:05:52,281 THE VALIDATIONS AND I KNOW IT'S 5973 05:05:52,281 --> 05:05:56,819 IN THE TRUE FOR ACTIGRAPHY 5974 05:05:56,819 --> 05:06:00,823 BECAUSE PEOPLE HAVE COMPARED IT 5975 05:06:00,823 --> 05:06:03,092 TO STANDARD POLYSOMNOGRAPHY AND 5976 05:06:03,092 --> 05:06:07,130 SOME ARE GOOD AND SO THE NOT SO 5977 05:06:07,130 --> 05:06:08,698 GOOD. 5978 05:06:08,698 --> 05:06:11,167 DO YOU SEE VARIABILITY WITH 5979 05:06:11,167 --> 05:06:13,936 CONTINUOUS GLUCOSE MONITORS. 5980 05:06:13,936 --> 05:06:16,472 >> THE WAY THEY ARE WERE DESIGN 5981 05:06:16,472 --> 05:06:18,107 IS FOR PEOPLE WITH TYPE 1 5982 05:06:18,107 --> 05:06:20,710 DIABETES TO TAKE INSULIN BASED 5983 05:06:20,710 --> 05:06:21,277 ON MEASUREMENT. 5984 05:06:21,277 --> 05:06:23,279 BECAUSE OF THAT THE ACCURACY FOR 5985 05:06:23,279 --> 05:06:24,847 FDA APPROVED DEVICES IS 5986 05:06:24,847 --> 05:06:32,688 REGULATED. 5987 05:06:32,688 --> 05:06:33,689 THAT SAID THEY'RE NOT PERFECT 5988 05:06:33,689 --> 05:06:36,025 AND HAVE A MEASUREMENT ERROR TO 5989 05:06:36,025 --> 05:06:37,493 MY KNOWLEDGE IS NOTE ACCOUNTED 5990 05:06:37,493 --> 05:06:38,895 UP MOST METHODS. 5991 05:06:38,895 --> 05:06:40,830 THEY'RE ALSO ISSUES SUCH AS THE 5992 05:06:40,830 --> 05:06:48,738 MISSING DATA. 5993 05:06:48,738 --> 05:06:51,340 OVER ALL THE MODELS THAT DON'T 5994 05:06:51,340 --> 05:06:55,878 REQUIRE CALIBRATION ARE PRETTY 5995 05:06:55,878 --> 05:06:56,145 ACCURATE. 5996 05:06:56,145 --> 05:06:57,647 THE PROBLEM IS WE'RE SEEING 5997 05:06:57,647 --> 05:07:01,150 INTEREST FROM CONSUMERS WHO 5998 05:07:01,150 --> 05:07:03,986 DON'T HAVE DIABETES HAVING 5999 05:07:03,986 --> 05:07:08,157 INTEREST AND THEY'RE PRODUCING 6000 05:07:08,157 --> 05:07:09,659 CONSUMER-GRADE DEVICES AND I 6001 05:07:09,659 --> 05:07:10,860 HAVE A QUESTION IS IT A 6002 05:07:10,860 --> 05:07:13,162 DIFFERENCE ON THE ACCURACY THEN 6003 05:07:13,162 --> 05:07:16,833 AND IF THERE'S A DIFFERENT IN 6004 05:07:16,833 --> 05:07:18,301 THE ACCURACY HOW DOES IT 6005 05:07:18,301 --> 05:07:21,704 TRANSLATE TO THE PHENOTYPES WE 6006 05:07:21,704 --> 05:07:21,938 MEASURE? 6007 05:07:21,938 --> 05:07:22,538 THE SHORT ORDINANCE IS THE 6008 05:07:22,538 --> 05:07:24,540 GLUCOSE MEASUREMENTS ARE MORE 6009 05:07:24,540 --> 05:07:31,514 COMPARABLE AND ABSOLUTE BUT 6010 05:07:31,514 --> 05:07:32,849 STILL HAVE ERRORS. 6011 05:07:32,849 --> 05:07:34,317 >> 6012 05:07:34,317 --> 05:07:36,352 >> THERE'S RESEARCH GRADE 6013 05:07:36,352 --> 05:07:40,423 DEVICES WHICH ARE EXPENSIVE AND 6014 05:07:40,423 --> 05:07:41,691 CONSUMER GRADE DEVICES LESS 6015 05:07:41,691 --> 05:07:47,597 ACCURATE BUT MORE AMENABLE TO 6016 05:07:47,597 --> 05:07:58,007 PURCHASING BY CONSUMERS. 6017 05:08:02,211 --> 05:08:04,247 >> IT'S BEEN A GREAT DISCUSSION 6018 05:08:04,247 --> 05:08:07,283 AND DEFINING DISEASE WE'RE CLETH 6019 05:08:07,283 --> 05:08:13,456 CLOSER IN BEING -- WE'RE 6020 05:08:13,456 --> 05:08:16,659 GETTING CLOSER TO DEFINING SLEEP 6021 05:08:16,659 --> 05:08:19,428 APNEA AND PROBLEMS IN RACIAL 6022 05:08:19,428 --> 05:08:20,830 BIAS AND OTHER ISSUES WILL COME 6023 05:08:20,830 --> 05:08:23,866 UP TOMORROW ABOUT TREATMENT AND 6024 05:08:23,866 --> 05:08:24,500 COMPLETENESS OF TREATMENT AND 6025 05:08:24,500 --> 05:08:28,704 ALLAN ALLUDED TO THIS IN THE 6026 05:08:28,704 --> 05:08:32,441 FRENCH STUDY MANY PEOPLE WERE ON 6027 05:08:32,441 --> 05:08:32,642 CPAP. 6028 05:08:32,642 --> 05:08:35,044 THERE'S SOME PLASTICITY IN 6029 05:08:35,044 --> 05:08:35,645 REGARD TO TREATMENT. 6030 05:08:35,645 --> 05:08:40,349 THERE WAS WORK LOOKING AT 6031 05:08:40,349 --> 05:08:40,983 IMPROVEMENT IN NEUROCOGNITIVE 6032 05:08:40,983 --> 05:08:47,356 FUNCTION AND IMPROVEMENTS IN MRI 6033 05:08:47,356 --> 05:08:48,824 WITH CPAP ADHERENCE AND IT PLAY 6034 05:08:48,824 --> 05:08:52,194 NOT BE THE ONLY TREATMENT AND 6035 05:08:52,194 --> 05:08:55,131 MAY BE DIFFICULT TO EMPLOY IN 6036 05:08:55,131 --> 05:08:59,669 SELECTED PHENOTYPES AND E 6037 05:08:59,669 --> 05:09:01,137 ENDOTYPES AND WE'LL SEE WHERE IT 6038 05:09:01,137 --> 05:09:02,371 GOES. 6039 05:09:02,371 --> 05:09:04,340 THE ONLY QUESTION IS IN THE 6040 05:09:04,340 --> 05:09:06,342 PRELIMINARY DATA WERE YOU USING 6041 05:09:06,342 --> 05:09:09,345 HIGH RESOLUTION OXIMETRY OR WAS 6042 05:09:09,345 --> 05:09:14,650 IT JUST ONE TYPE? 6043 05:09:14,650 --> 05:09:19,522 >> THIS WAS JUST PRELIMINARY 6044 05:09:19,522 --> 05:09:23,092 WORK WITH THE OXIMETER. 6045 05:09:23,092 --> 05:09:27,630 >> THERE'S PROBABLY A NEED TO 6046 05:09:27,630 --> 05:09:28,864 LOOK AT OTHER OXIMETRY 6047 05:09:28,864 --> 05:09:35,571 STRATEGIES. 6048 05:09:35,571 --> 05:09:41,210 THE WORK NEEDS TO BE REPEATED 6049 05:09:41,210 --> 05:09:48,851 AND THE COMMON OXIMETER AND THIS 6050 05:09:48,851 --> 05:09:51,420 CHANGING OR NEW CALIBRATION 6051 05:09:51,420 --> 05:09:54,190 CURVE THAT SUSAN HAS 6052 05:09:54,190 --> 05:09:56,826 MENTIONED -- I WONDERED WHO IS 6053 05:09:56,826 --> 05:09:57,326 DOING THAT. 6054 05:09:57,326 --> 05:10:00,429 I'D LIKE TO SEE THE RESULTS. 6055 05:10:00,429 --> 05:10:02,832 ALL THESE OXIMETERS WILL HAVE TO 6056 05:10:02,832 --> 05:10:04,567 GO THROUGH A NEW FDA APPROVAL 6057 05:10:04,567 --> 05:10:08,137 PROCESS WHERE YOU HAVE CAREFULLY 6058 05:10:08,137 --> 05:10:08,604 MEASURED SKIN TONE. 6059 05:10:08,604 --> 05:10:14,510 I WANT TO SEE THE RESULT OF THE 6060 05:10:14,510 --> 05:10:23,285 STUDIES THE DIFFERENCE IN THE 6061 05:10:23,285 --> 05:10:28,357 STUDIES OFFSET AND TRANSIENT HOW 6062 05:10:28,357 --> 05:10:32,428 DOES THAT TRANSLATE TO SLEEP 6063 05:10:32,428 --> 05:10:35,331 APNEA AND HOW MANY ARE WE 6064 05:10:35,331 --> 05:10:38,000 MISSING AND WHEN WE DO THE 6065 05:10:38,000 --> 05:10:43,039 STUDIES, MAYBE WE SHOULD NOT 6066 05:10:43,039 --> 05:10:44,106 JUST TEST STEADY STATE BUT TEST 6067 05:10:44,106 --> 05:10:51,347 THE ABILITY TO DETECT TRANSIENT 6068 05:10:51,347 --> 05:10:51,881 DROPS? 6069 05:10:51,881 --> 05:10:53,716 I THINK A LOT OF THE ERROR 6070 05:10:53,716 --> 05:10:55,384 CORRECTION IS THEY JUST SMOOTH 6071 05:10:55,384 --> 05:10:58,988 IT A LOT. 6072 05:10:58,988 --> 05:11:00,322 HUGE TIME CONSTANTS. 6073 05:11:00,322 --> 05:11:05,995 THAT'S WHAT WE DO WITH 6074 05:11:05,995 --> 05:11:06,295 SPIROMETRY. 6075 05:11:06,295 --> 05:11:15,638 YOU OF 6076 05:11:18,407 --> 05:11:20,843 >> TIME FOR ONE MORE QUESTION 6077 05:11:20,843 --> 05:11:23,712 AND FACTORS THAT LEAD TO THE 6078 05:11:23,712 --> 05:11:26,015 HETEROGENEITY OF THE 6079 05:11:26,015 --> 05:11:27,750 PRESENTATION OF OSA. 6080 05:11:27,750 --> 05:11:30,586 WHAT ABOUT COMORBIDITIES. 6081 05:11:30,586 --> 05:11:33,322 WHAT ABOUT PULMONARY DYSFUNCTION 6082 05:11:33,322 --> 05:11:38,227 LIKE COPD AND ASTHMA AND FACTORS 6083 05:11:38,227 --> 05:11:40,329 THEM INTO THE CLINICAL 6084 05:11:40,329 --> 05:11:42,164 MANIFESTATIONS AND THE OUTCOME 6085 05:11:42,164 --> 05:11:46,102 AND CONSEQUENCES OF OSA? 6086 05:11:46,102 --> 05:11:49,238 MAYBE IT'S ANOTHER CHALLENGE FOR 6087 05:11:49,238 --> 05:11:49,872 MACHINE LEARNING AND ARTIFICIAL 6088 05:11:49,872 --> 05:11:52,842 INTELLIGENCE. 6089 05:11:52,842 --> 05:11:55,311 COMMENTS? 6090 05:11:55,311 --> 05:11:57,680 >> WITH COMORBIDITIES AND E.H.R. 6091 05:11:57,680 --> 05:11:58,981 YOU FIND THE SAME THING. 6092 05:11:58,981 --> 05:12:00,516 YOU FIND GROUPS OF THIS AND 6093 05:12:00,516 --> 05:12:01,150 GROUPS OF THAT. 6094 05:12:01,150 --> 05:12:06,055 AS YOU INDICATED IF YOU HAVE A 6095 05:12:06,055 --> 05:12:09,125 COMBINATION OF COPD AND SLEEP 6096 05:12:09,125 --> 05:12:19,602 APNEA AND OVERLAP SYNDROME. 6097 05:12:20,369 --> 05:12:28,844 >> OKAY. 6098 05:12:28,844 --> 05:12:30,980 >> THERE'S A COUPLE VIDEOCAST 6099 05:12:30,980 --> 05:12:32,748 QUESTIONS IN THE Q&A. 6100 05:12:32,748 --> 05:12:36,819 >> I FOUND THAT. 6101 05:12:36,819 --> 05:12:38,988 I SEE ONE ON COPD. 6102 05:12:38,988 --> 05:12:40,723 COMORBIDITIES WAS ONE OF THOSE. 6103 05:12:40,723 --> 05:12:41,891 I DON'T SEE ANYTHING ELSE THERE. 6104 05:12:41,891 --> 05:12:48,831 THANKS ANOTHER ENGINEERING 6105 05:12:48,831 --> 05:12:55,171 QUESTION FOR ANDREW. 6106 05:12:55,171 --> 05:12:58,741 PULSE OXIMETERS BEING INFLUENCED 6107 05:12:58,741 --> 05:12:59,542 BY SKIN COLOR. 6108 05:12:59,542 --> 05:13:01,844 SOME APPARENTLY USE A THIRD 6109 05:13:01,844 --> 05:13:04,613 GREEN COLOR OF LIGHT AND THE 6110 05:13:04,613 --> 05:13:07,783 ALGORITHMS MAY BEHAVE 6111 05:13:07,783 --> 05:13:09,185 DIFFERENTLY WITH RESPECT TO SKIN 6112 05:13:09,185 --> 05:13:10,219 COLOR. 6113 05:13:10,219 --> 05:13:14,323 DO YOU KNOW HOW GREEN LIGHT -- 6114 05:13:14,323 --> 05:13:16,158 >> YEAH. 6115 05:13:16,158 --> 05:13:21,463 I KNOW GREEN LIGHT DOESN'T 6116 05:13:21,463 --> 05:13:26,735 CONSUME THE BATTERY AS MUCH. 6117 05:13:26,735 --> 05:13:30,639 THEY ARE USE IT FOR ACTIGRAPHY. 6118 05:13:30,639 --> 05:13:32,308 THERE'S CERTAIN CHARACTERISTICS. 6119 05:13:32,308 --> 05:13:35,644 I DON'T THINK ADDING A THIRD 6120 05:13:35,644 --> 05:13:36,845 WAVE LENGTH WITH SOLVE THE 6121 05:13:36,845 --> 05:13:45,287 RACIAL BIAS. 6122 05:13:45,287 --> 05:13:48,757 IF SOMEBODY THINKS IT WILL I'D 6123 05:13:48,757 --> 05:13:52,261 LOVE TO HEAR HOW BUT THE GREEN 6124 05:13:52,261 --> 05:13:55,164 LIGHT WON'T WORK. 6125 05:13:55,164 --> 05:13:58,167 PEOPLE HAVE TRIED THAT. 6126 05:13:58,167 --> 05:14:02,304 ANY WAY, I'M NOT AN OPTICAL 6127 05:14:02,304 --> 05:14:05,107 ENGINEER BUT IT'S A THIRD LIGHT 6128 05:14:05,107 --> 05:14:06,041 THEORY WORKS IT DOESN'T MAKE 6129 05:14:06,041 --> 05:14:08,344 SENSE TO ME HOW IT WOULD. 6130 05:14:08,344 --> 05:14:09,511 >> ONE FINAL COMMENT BECAUSE WE 6131 05:14:09,511 --> 05:14:16,819 ARE COMING TO THE TOP OF THE 6132 05:14:16,819 --> 05:14:17,620 HOUR. 6133 05:14:17,620 --> 05:14:20,489 SLEEPINESS THE PHENOTYPE OF OSA 6134 05:14:20,489 --> 05:14:28,631 AND MORE COMPLICATED THAN THAT 6135 05:14:28,631 --> 05:14:31,166 SLEEPINESS HAS SEVERAL SUB TYPE 6136 05:14:31,166 --> 05:14:32,501 WITH DIFFERENT GENETIC 6137 05:14:32,501 --> 05:14:32,835 ASSOCIATIONS. 6138 05:14:32,835 --> 05:14:33,535 FURTHER INCREASING THE 6139 05:14:33,535 --> 05:14:38,974 COMPLEXITY OF THE MANIFESTATION 6140 05:14:38,974 --> 05:14:41,477 OF OSA AND DIFFERENT SUBTYPES OF 6141 05:14:41,477 --> 05:14:44,847 SLEEPINESS AND CONSEQUENCES OF 6142 05:14:44,847 --> 05:14:48,050 THE TYPES OF SLEEPINESS AS WELL. 6143 05:14:48,050 --> 05:14:55,090 >> AND IT MAY BE POSSIBLE BUT 6144 05:14:55,090 --> 05:15:01,196 THE GROUP HAS EXCESSIVE 6145 05:15:01,196 --> 05:15:04,466 SLEEPINESS AND IF IT'S DRIVEN 6146 05:15:04,466 --> 05:15:06,368 GENETICALLY YOU SHOULD BE ABLE 6147 05:15:06,368 --> 05:15:08,937 TO DEVELOP A RISK SCORE. 6148 05:15:08,937 --> 05:15:13,642 THAT SEEMS POSSIBLE. 6149 05:15:13,642 --> 05:15:19,181 >> I AGREE THERE'S MANY CAUSES 6150 05:15:19,181 --> 05:15:20,816 FOR SLEEPINESS. 6151 05:15:20,816 --> 05:15:24,286 ONE I THINK SHORT SLEEP DURATION 6152 05:15:24,286 --> 05:15:26,355 AND CIRCADIAN DISRUPTION AND 6153 05:15:26,355 --> 05:15:29,491 OTHER FACTORS NOT BEING CAPTURED 6154 05:15:29,491 --> 05:15:30,959 AND UNDERSTANDING GENETIC 6155 05:15:30,959 --> 05:15:31,894 MECHANISMS MAY HELP. 6156 05:15:31,894 --> 05:15:35,764 WE LOOK AT THE PHYSIOLOGY. 6157 05:15:35,764 --> 05:15:43,172 WE LOOK AT DIFFERENCES IN EEG 6158 05:15:43,172 --> 05:15:48,844 BIOMARKERS AND THAT'S WORK LED 6159 05:15:48,844 --> 05:15:51,580 WITH ALLAN'S GROUP AND NOT AS 6160 05:15:51,580 --> 05:15:57,186 MUCH AS EXCESSIVELY SLEEPY. 6161 05:15:57,186 --> 05:16:03,726 PERHAPS THERE'S OTHER SIGNALS 6162 05:16:03,726 --> 05:16:07,496 AND THAT WERE BEYOND EXPERT 6163 05:16:07,496 --> 05:16:09,732 DEFINITIONS OF THE DISEASE. 6164 05:16:09,732 --> 05:16:10,632 THERE'S A POTENTIAL OPPORTUNITY 6165 05:16:10,632 --> 05:16:13,068 OF PERHAPS REFINING HOW WE'RE 6166 05:16:13,068 --> 05:16:16,138 DEFINING THESE AND TAKING 6167 05:16:16,138 --> 05:16:21,377 ADVANTAGE OF ALL THE WAYS WE'RE 6168 05:16:21,377 --> 05:16:24,947 MEASURING THE DISEASE AND AFREE 6169 05:16:24,947 --> 05:16:26,982 WHERE WE HAVE APPROACHES TO HAVE 6170 05:16:26,982 --> 05:16:30,452 A MORE REFINED WAY OF WHAT ARE 6171 05:16:30,452 --> 05:16:32,821 YOUR CALLING SLEEP APNEA AND THE 6172 05:16:32,821 --> 05:16:35,023 DISEASE AND THAT CAN HAVE 6173 05:16:35,023 --> 05:16:37,926 SEVERAL IMPLICATIONS HOW WE 6174 05:16:37,926 --> 05:16:39,428 IDENTIFY PATIENTS AND HOW WE'RE 6175 05:16:39,428 --> 05:16:41,597 DEFINING HOW WE'RE RESPONDING TO 6176 05:16:41,597 --> 05:16:42,231 THERAPY. 6177 05:16:42,231 --> 05:16:44,833 WHAT DOES IT NEED TO TREAT TO BE 6178 05:16:44,833 --> 05:16:47,836 TREATED AND TOMORROW HOPEFULLY 6179 05:16:47,836 --> 05:16:48,971 THE DISCUSSION WILL SHED LIGHT 6180 05:16:48,971 --> 05:16:50,839 ON THAT AS WELL. 6181 05:16:50,839 --> 05:16:52,741 >> THANKS SO MUCH TO THE SESSION 6182 05:16:52,741 --> 05:16:55,844 3 SPEAKERS FOR PROVOCATIVE AND 6183 05:16:55,844 --> 05:16:56,845 COMPREHENSIVE TALK AND ALL THE 6184 05:16:56,845 --> 05:17:00,048 SPEAKERS THAT CAME BEFORE YOU AS 6185 05:17:00,048 --> 05:17:01,750 WELL. 6186 05:17:01,750 --> 05:17:04,653 WE'RE AT TIME AT 5:00 A LITTLE 6187 05:17:04,653 --> 05:17:05,254 AFTER ACTUALLY. 6188 05:17:05,254 --> 05:17:07,122 ALFONSO DO YOU WANT TO TAKE CARE 6189 05:17:07,122 --> 05:17:07,523 OF THE LOGISTICS. 6190 05:17:07,523 --> 05:17:11,427 THANKS. 6191 05:17:11,427 --> 05:17:11,927 >> THANK YOU. 6192 05:17:11,927 --> 05:17:12,828 BEFORE EVERYBODY SIGNS OFF THANK 6193 05:17:12,828 --> 05:17:15,297 YOU TO THE PRESENTERS AND FOR 6194 05:17:15,297 --> 05:17:19,134 THE EXCITING DAY ONE OF THE 6195 05:17:19,134 --> 05:17:20,836 WORKSHOP AND SPURRED QUESTIONS 6196 05:17:20,836 --> 05:17:22,371 AND GREAT DISCUSSION BUT THERE'S 6197 05:17:22,371 --> 05:17:23,605 DISCUSSION AND CRITICAL POINTS 6198 05:17:23,605 --> 05:17:26,241 THAT WERE PROBABLY NOT ADDRESSED 6199 05:17:26,241 --> 05:17:28,210 SO PLEASE BRING THOSE TOMORROW 6200 05:17:28,210 --> 05:17:29,144 FOR THE ROUNDTABLE DISCUSSION AT 6201 05:17:29,144 --> 05:17:32,681 THE END OF THE DAY WE'LL HAVE. 6202 05:17:32,681 --> 05:17:34,082 TOMORROW WORKSHOP'S WILL START 6203 05:17:34,082 --> 05:17:38,020 AT 12:00 P.M., HALF AN HOUR 6204 05:17:38,020 --> 05:17:40,489 LATER THAN TODAY AND WE'LL BE IN 6205 05:17:40,489 --> 05:17:42,858 TOUCH TONIGHT MOST LIKELY AND 6206 05:17:42,858 --> 05:17:44,293 HOPE EVERYONE HAS A WONDERFUL 6207 05:17:44,293 --> 05:17:49,932 EVENING AND GOOD NIGHT'S SLEEP. 6208 05:17:49,932 --> 05:18:00,108 >> THANKS.