1 00:00:05,807 --> 00:00:08,843 SO NOW TO GET THINGS STARTED FOR 2 00:00:08,843 --> 00:00:11,012 THE DAY I WANT TO WELCOME TWO 3 00:00:11,012 --> 00:00:12,447 CO-CHAIRS BOTH OF WHOM YOU HEARD 4 00:00:12,447 --> 00:00:18,787 FROM YESTERDAY, DR. BOB OWENS 5 00:00:18,787 --> 00:00:20,055 AND THIS WILL BE FOLLOWED BY THE 6 00:00:20,055 --> 00:00:22,757 FRAMING OF TODAY'S SESSION WITH 7 00:00:22,757 --> 00:00:25,660 THE PRESENTATION ENTITLED 8 00:00:25,660 --> 00:00:26,995 HETEROGENEITY AND OHS RESPONSE 9 00:00:26,995 --> 00:00:28,663 AND ITS IMPLEMENTATION. 10 00:00:28,663 --> 00:00:29,698 DR. OWENS, WHEN YOU'RE READY FOR 11 00:00:29,698 --> 00:00:31,032 THE SUMMARY, PLEASE TAKE IT 12 00:00:31,032 --> 00:00:31,233 AWAY. 13 00:00:31,233 --> 00:00:32,367 >> THANKS, ALFONSO. 14 00:00:32,367 --> 00:00:33,468 CAN YOU SEE MY SLIDES? 15 00:00:33,468 --> 00:00:34,636 >> LOOKS GOOD. 16 00:00:34,636 --> 00:00:35,870 >> PERFECT. 17 00:00:35,870 --> 00:00:37,839 OKAY. 18 00:00:37,839 --> 00:00:38,573 SO GOOD MORNING OR GOOD 19 00:00:38,573 --> 00:00:39,474 AFTERNOON DEPENDING ON YOUR 20 00:00:39,474 --> 00:00:41,109 LOCATION AROUND THE WORLD. 21 00:00:41,109 --> 00:00:45,647 THANK YOU SO MUCH FOR JOINING US 22 00:00:45,647 --> 00:00:46,448 ON DAY TWO. 23 00:00:46,448 --> 00:00:49,084 MY JOB IS TO TRY TO SUMMARIZE 24 00:00:49,084 --> 00:00:50,485 DAY ONE IN FIVE MINUTES WHICH IS 25 00:00:50,485 --> 00:00:51,853 AS CHALLENGES AS IT SOUNDS. 26 00:00:51,853 --> 00:00:53,355 THANK YOU TO ALL OUR SPEAKERS 27 00:00:53,355 --> 00:00:53,788 YESTERDAY. 28 00:00:53,788 --> 00:00:57,292 I'M HOPING TO VERY BRIEFLY 29 00:00:57,292 --> 00:01:01,429 HIGHLIGHT ONE POINT OR SLIDE 30 00:01:01,429 --> 00:01:02,530 FROM EACH SPEAKER. 31 00:01:02,530 --> 00:01:04,666 I THINK THE THEME WAS 32 00:01:04,666 --> 00:01:05,400 INFORMATION OVERLOAD BUT I WANT 33 00:01:05,400 --> 00:01:09,871 TO START WITH THE TALK YESTERDAY 34 00:01:09,871 --> 00:01:11,172 REALLY FOCUSING ON WHAT WE DON'T 35 00:01:11,172 --> 00:01:12,574 KNOW, WHAT ARE THE GAPS WHEN IT 36 00:01:12,574 --> 00:01:14,576 COMES TO SLEEP APNEA, AND CARE 37 00:01:14,576 --> 00:01:15,243 OF WOMEN. 38 00:01:15,243 --> 00:01:17,846 AND I TOOK THIS SLIDE FROM HER 39 00:01:17,846 --> 00:01:20,348 WORK AS AN ADVOCATE, REALLY 40 00:01:20,348 --> 00:01:21,683 HIGHLIGHTING THAT ONE IN FIVE 41 00:01:21,683 --> 00:01:23,218 WOMEN HAVE SLEEP APNEA, THAT 42 00:01:23,218 --> 00:01:25,720 MOST WOMEN ARE UNDIAGNOSED AND 43 00:01:25,720 --> 00:01:26,688 UNTREATED AND OBVIOUSLY WE NEED 44 00:01:26,688 --> 00:01:29,457 TO DO BETTER WITH THAT. 45 00:01:29,457 --> 00:01:31,860 SO I THINK SHE REALLY CENTERED 46 00:01:31,860 --> 00:01:33,261 WHY WE'RE DOING THIS. 47 00:01:33,261 --> 00:01:35,330 WE TALKED ABOUT HOW OBSTRUCTIVE 48 00:01:35,330 --> 00:01:37,532 SLEEP APNEAS LIKE HYPERTENSION 49 00:01:37,532 --> 00:01:38,633 AND BY THAT, I THINK HE WAS 50 00:01:38,633 --> 00:01:39,968 TALKING ABOUT MANY OF THE 51 00:01:39,968 --> 00:01:41,469 DIFFERENCES IN TERMS OF 52 00:01:41,469 --> 00:01:43,972 DEMOGRAPHICS THAT BOTH OSA AND 53 00:01:43,972 --> 00:01:44,639 HYPERTENSION AFFECT MEN AND 54 00:01:44,639 --> 00:01:46,708 WOMEN DIFFERENTLY, THERE ARE 55 00:01:46,708 --> 00:01:48,143 RACIAL AND ETHNIC DIFFERENCES, 56 00:01:48,143 --> 00:01:49,444 AGE DIFFERENCES, AND THAT WAS A 57 00:01:49,444 --> 00:01:51,313 REALLY INTERESTING PERSPECTIVE. 58 00:01:51,313 --> 00:01:52,514 I THINK THE OTHER THINGS THAT HE 59 00:01:52,514 --> 00:01:54,149 TRIED TO HIGHLIGHT ARE THAT 60 00:01:54,149 --> 00:01:55,583 THERE'S AN INCREDIBLY LARGE 61 00:01:55,583 --> 00:01:57,352 NUMBER OF PATIENTS WITH 62 00:01:57,352 --> 00:01:59,621 OBSTRUCTIVE SLEEP APNEA OR 63 00:01:59,621 --> 00:02:00,288 HYPERTENSION. 64 00:02:00,288 --> 00:02:01,289 FOR MOST PATIENTS WITH 65 00:02:01,289 --> 00:02:03,058 HYPERTENSION, YOU DON'T USE A 66 00:02:03,058 --> 00:02:04,025 LOT OF COMPLEXITY. 67 00:02:04,025 --> 00:02:04,793 YOU SORT OF TREAT THEM BECAUSE 68 00:02:04,793 --> 00:02:07,729 WE HAVE A LOT OF TREATMENT 69 00:02:07,729 --> 00:02:09,264 OPTIONS, YOU DON'T NEED A LOT OF 70 00:02:09,264 --> 00:02:09,898 METRICS OTHER THAN BLOOD 71 00:02:09,898 --> 00:02:11,132 PRESSURE, AND GIVEN THE NUMBERS 72 00:02:11,132 --> 00:02:12,434 OF PATIENTS WITH OBSTRUCTIVE 73 00:02:12,434 --> 00:02:15,270 SLEEP APNEA, ALL OF THIS 74 00:02:15,270 --> 00:02:17,339 COMPLEXITY, DO WE NEED IT ALL OR 75 00:02:17,339 --> 00:02:18,673 NOT, OR WHICH PATIENTS TO WE 76 00:02:18,673 --> 00:02:19,974 REALLY NEED TO UNCOVER THAT 77 00:02:19,974 --> 00:02:21,810 COMPLEXITY. 78 00:02:21,810 --> 00:02:23,712 SO MOVING INTO SESSION ONE, THIS 79 00:02:23,712 --> 00:02:25,213 WAS OUTCOMES ACROSS THE LIFESPAN 80 00:02:25,213 --> 00:02:27,415 AND I THINK DR. ISAIAH REALLY 81 00:02:27,415 --> 00:02:29,150 TALKED ABOUT THE HETEROGENEITY 82 00:02:29,150 --> 00:02:31,986 IN PEDIATRIC OBSTRUCTIVE SLEEP 83 00:02:31,986 --> 00:02:34,856 DISORDERED BREATHING AND AS HE 84 00:02:34,856 --> 00:02:35,824 EMPHASIZED, IT'S SLEEP 85 00:02:35,824 --> 00:02:37,258 DISORDERED BREATHING NOT JUST 86 00:02:37,258 --> 00:02:37,826 OBSTRUCTIVE DISEASE BECAUSE 87 00:02:37,826 --> 00:02:39,327 THERE IS SO MUCH VARIABILITY. 88 00:02:39,327 --> 00:02:40,862 AND I THINK HIS WAS THE FIRST 89 00:02:40,862 --> 00:02:42,764 TALK TO START TO HIGHLIGHT HOW 90 00:02:42,764 --> 00:02:45,033 MUCH DATA WE HAVE, VERY LITTLE 91 00:02:45,033 --> 00:02:47,335 OF WHICH WE USE, AND CAN WE USE 92 00:02:47,335 --> 00:02:48,870 MACHINE LEARNING APPROACHES TO 93 00:02:48,870 --> 00:02:53,775 TRY TO HELP US. 94 00:02:53,775 --> 00:02:54,909 DR. SUSAN REDLINE REALLY GOT 95 00:02:54,909 --> 00:02:56,811 INTO THE COMPLEXITY HERE THAT 96 00:02:56,811 --> 00:02:59,581 WE'RE TRYING TO LINK REALLY EVEN 97 00:02:59,581 --> 00:03:01,416 GENOTYPE WITH ENDOTYPE WITH 98 00:03:01,416 --> 00:03:05,487 PHENOTYPE AND TRY TO PERSONALIZE 99 00:03:05,487 --> 00:03:06,688 TREATMENT OUT COME, BUT THIS 100 00:03:06,688 --> 00:03:10,258 PATHWAY, WE HAVE SOME IDEAS 101 00:03:10,258 --> 00:03:13,094 WHERE WE'RE WORKING OUT SORT OF 102 00:03:13,094 --> 00:03:14,929 HIGHER -- LOWER AROUSAL 103 00:03:14,929 --> 00:03:16,998 THRESHOLD, THESE ENDO PHENOTYPES 104 00:03:16,998 --> 00:03:18,666 BUT WE'RE JUST AT THE INFANCY OF 105 00:03:18,666 --> 00:03:23,705 ALL OF THIS INFORMATION. 106 00:03:23,705 --> 00:03:25,240 DR. NISHA AURORA FROM NYU KIND 107 00:03:25,240 --> 00:03:26,775 OF BUILDING ON THIS, ALL OF OUR 108 00:03:26,775 --> 00:03:28,643 EARLIER SPEAKERS SHOWED HER 109 00:03:28,643 --> 00:03:31,045 RECENT RESULTS IN WHICH THE 110 00:03:31,045 --> 00:03:32,347 FINDINGS WERE DIFFERENT IN MEN 111 00:03:32,347 --> 00:03:33,882 VERSUS WOMEN WHEN YOU LOOKED AT 112 00:03:33,882 --> 00:03:35,183 GLYCEMIC CONTROL. 113 00:03:35,183 --> 00:03:36,084 AND SHE SAID SOMETHING WHICH 114 00:03:36,084 --> 00:03:38,153 REALLY STRUCK WITH ME, STUCK 115 00:03:38,153 --> 00:03:40,221 WITH ME, IS THAT WE MIGHT NEED 116 00:03:40,221 --> 00:03:40,722 DIFFERENT ALGORITHMS OF 117 00:03:40,722 --> 00:03:41,956 DIAGNOSIS AND TREATMENT BASED ON 118 00:03:41,956 --> 00:03:42,290 SEX. 119 00:03:42,290 --> 00:03:43,925 SO IF YOU'RE LOOKING FOR SLEEP 120 00:03:43,925 --> 00:03:45,927 APNEA IN A WOMAN, MAYBE YOU NEED 121 00:03:45,927 --> 00:03:47,762 PSG VERSUS HSAT. 122 00:03:47,762 --> 00:03:49,831 AND SO AGAIN, REALLY 123 00:03:49,831 --> 00:03:51,166 HIGHLIGHTING A RECENT FINDING OF 124 00:03:51,166 --> 00:03:52,934 HOW TREATMENT OF SLEEP APNEA IN 125 00:03:52,934 --> 00:03:54,436 MEN AND WOMEN CAN RESULT IN 126 00:03:54,436 --> 00:04:01,109 DIFFERENT OUTCOMES. 127 00:04:01,109 --> 00:04:04,045 DR. MACEY SPOKE ABOUT SLEEP 128 00:04:04,045 --> 00:04:05,480 APNEA AND ITS EFFECTS ON 129 00:04:05,480 --> 00:04:07,148 COGNITION IN THE BRAIN, WHETHER 130 00:04:07,148 --> 00:04:08,783 OR NOT OSA IS AN ACCELERATED 131 00:04:08,783 --> 00:04:10,218 FORM OF AGING. 132 00:04:10,218 --> 00:04:11,286 I THOUGHT SOME OF THAT 133 00:04:11,286 --> 00:04:11,953 PERSPECTIVE WAS REALLY 134 00:04:11,953 --> 00:04:12,687 INTERESTING BUT ALSO THOUGHT IT 135 00:04:12,687 --> 00:04:13,588 WAS REALLY INTERESTING TO THINK 136 00:04:13,588 --> 00:04:15,790 ABOUT THE MAGNITUDE OF EFFECT OF 137 00:04:15,790 --> 00:04:17,192 OBSTRUCTIVE SLEEP APNEA VERSUS 138 00:04:17,192 --> 00:04:18,393 OTHER THINGS WE THINK ABOUT, 139 00:04:18,393 --> 00:04:21,963 LIKE SLEEP DURATION AND 140 00:04:21,963 --> 00:04:23,064 EXERCISE, AND THIS WILL BE 141 00:04:23,064 --> 00:04:24,165 ANOTHER THEME, IS THAT IT MAY 142 00:04:24,165 --> 00:04:26,568 NOT JUST BE SLEEP APNEA, WHICH 143 00:04:26,568 --> 00:04:27,802 IT SORT OF PAINS ME TO SAY, IT 144 00:04:27,802 --> 00:04:29,103 MAY BE OTHER FACTORS THAT ARE 145 00:04:29,103 --> 00:04:32,807 RELATED TO SLEEP. 146 00:04:32,807 --> 00:04:35,009 SESSION TWO WOS REALLY FO FOCUSD 147 00:04:35,009 --> 00:04:40,248 ON OSA AND MENOPAUSE. 148 00:04:40,248 --> 00:04:42,984 DR. FACCO PRESENTED THE MFMU 149 00:04:42,984 --> 00:04:44,085 SLEEP OVERVIEW TRIAL. 150 00:04:44,085 --> 00:04:45,286 I WAS AMAZED AT THE COMPLEXITY 151 00:04:45,286 --> 00:04:46,921 OF THIS TRIAL AND LIKE THIS 152 00:04:46,921 --> 00:04:48,122 LITTLE GIF HERE, I CANNOT WAIT 153 00:04:48,122 --> 00:04:49,357 FOR THE RESULTS OF THIS TRIAL. 154 00:04:49,357 --> 00:04:51,092 THIS IS AN INCREDIBLY COMPLEX 155 00:04:51,092 --> 00:04:52,861 HARD STUDY TO DO, WHEN DO YOU 156 00:04:52,861 --> 00:04:55,363 START SCREENING PREGNANT WOMEN 157 00:04:55,363 --> 00:04:56,998 FOR SLEEP APNEA, WHEN DO YOU 158 00:04:56,998 --> 00:04:59,501 TREAT THEM, HOW DO YOU GET THEM 159 00:04:59,501 --> 00:05:00,068 ADHERENT WITH THERAPY? 160 00:05:00,068 --> 00:05:01,035 I'M REALLY LOOKING FORWARD TO 161 00:05:01,035 --> 00:05:04,005 THIS TRIAL. 162 00:05:04,005 --> 00:05:05,206 DR. BOURJEILY REALLY IN HER 163 00:05:05,206 --> 00:05:06,407 TALK, TALKED ABOUT MANY OF THE 164 00:05:06,407 --> 00:05:07,709 CHALLENGES OF STUDYING THIS 165 00:05:07,709 --> 00:05:09,611 POPULATION EVEN THOUGH IT IS A 166 00:05:09,611 --> 00:05:11,880 UNIQUE OPPORTUNITY AND OBVIOUSLY 167 00:05:11,880 --> 00:05:13,515 VERY IMPORTANT FROM A PUBLIC 168 00:05:13,515 --> 00:05:17,118 HEALTH POINT OF VIEW. 169 00:05:17,118 --> 00:05:18,419 HER POINT ABOUT NOT FOR GETTING 170 00:05:18,419 --> 00:05:19,621 THE POSTPARTUM PERIOD WHEN 171 00:05:19,621 --> 00:05:21,589 PEOPLE ARE INCREDIBLY SLEEP 172 00:05:21,589 --> 00:05:22,924 DEPRIVED AND HAVE MANY NEW 173 00:05:22,924 --> 00:05:23,892 RESPONSIBILITIES, I THOUGHT WAS 174 00:05:23,892 --> 00:05:28,263 A GREAT REMINDER. 175 00:05:28,263 --> 00:05:31,232 FINALLY DR. JOFFE SPEAKING ABOUT 176 00:05:31,232 --> 00:05:33,535 SLEEP FRAGMENTATION IN 177 00:05:33,535 --> 00:05:34,736 PERIMENOPAUSE PERIOD. 178 00:05:34,736 --> 00:05:36,638 HER SLIDE HERE IF A PATIENT WITH 179 00:05:36,638 --> 00:05:37,705 NIGHT SWEATS COME IN CLINIC, I 180 00:05:37,705 --> 00:05:39,307 THINK WE THINK ABOUT OBSTRUCTIVE 181 00:05:39,307 --> 00:05:39,974 SLEEP APNEA AND WE DON'T THINK 182 00:05:39,974 --> 00:05:41,075 ABOUT ALL THE OTHER CHANGES THAT 183 00:05:41,075 --> 00:05:43,478 ARE HAPPENING, AND I REALLY 184 00:05:43,478 --> 00:05:47,081 ENJOYED HER LINE IN ONE OF HER 185 00:05:47,081 --> 00:05:48,850 CONCLUDING SLIDES, AVOID 186 00:05:48,850 --> 00:05:50,685 REDUCTIONISM, EXPAND 187 00:05:50,685 --> 00:05:51,553 MULTIDIMENSIONAL UNDERSTANDING. 188 00:05:51,553 --> 00:05:52,320 I THOUGHT THAT WAS A GREAT 189 00:05:52,320 --> 00:05:53,755 THOUGHT AND A REMINDER WHEN WE 190 00:05:53,755 --> 00:05:55,290 OFTEN REDUCE EVERYTHING TO 191 00:05:55,290 --> 00:05:58,359 OBSTRUCTIVE SLEEP APNEA. 192 00:05:58,359 --> 00:06:00,061 SESSION THREE FOCUSED ON 193 00:06:00,061 --> 00:06:01,229 HETEROGENEITY OF OSA. 194 00:06:01,229 --> 00:06:02,730 I THINK DR. PACK WON THE SLIDE 195 00:06:02,730 --> 00:06:03,865 OF THE DAY FOR ALL THE DIFFERENT 196 00:06:03,865 --> 00:06:05,600 OUT COME MEASURES AND THEY SEEM 197 00:06:05,600 --> 00:06:07,669 TO BE BREEDING LIKE RABBITS, 198 00:06:07,669 --> 00:06:08,937 AGAIN, A THEME OF COMPLEXITY, 199 00:06:08,937 --> 00:06:10,204 WHAT ARE THE RIGHT MEASUREMENTS, 200 00:06:10,204 --> 00:06:11,839 WHAT ARE THE RIGHT OUTCOMES. 201 00:06:11,839 --> 00:06:12,907 AND HOW ARE WE GOING TO DEAL 202 00:06:12,907 --> 00:06:16,411 WITH ALL THIS INFORMATION. 203 00:06:16,411 --> 00:06:18,947 AND ANKIT GAVE A GREAT SUMMARY 204 00:06:18,947 --> 00:06:19,847 TALK ABOUT MANY DIFFERENT 205 00:06:19,847 --> 00:06:20,448 THINGS. 206 00:06:20,448 --> 00:06:21,349 I THINK MACHINE LEARNING 207 00:06:21,349 --> 00:06:22,750 APPROACHES BUT THIS ERA OF BIG 208 00:06:22,750 --> 00:06:26,054 DATA AND HOW ARE WE GOING TO TRY 209 00:06:26,054 --> 00:06:27,355 TO INCORPORATE ALL OF THIS 210 00:06:27,355 --> 00:06:31,326 INFORMATION YOU SEE JUST A 211 00:06:31,326 --> 00:06:32,694 REPRESENTATIVE SLIDE HERE. 212 00:06:32,694 --> 00:06:35,129 AND DR. GAYANOVA, I THINK IS 213 00:06:35,129 --> 00:06:35,863 STARTING TO LEAD THE WAY. 214 00:06:35,863 --> 00:06:37,732 THIS WAS A GOOD EXAMPLE USING 215 00:06:37,732 --> 00:06:38,833 MACHINE LEARNING APPROACHES. 216 00:06:38,833 --> 00:06:45,506 SO SHE LOOKED AT DR. AURORA'S 217 00:06:45,506 --> 00:06:49,344 HYPNOS TRIAL LOOKING AT GLYCEMIC 218 00:06:49,344 --> 00:06:50,745 PROFILES IN THOSE WITH 219 00:06:50,745 --> 00:06:51,980 OBSTRUCTIVE SLEEP APNEA TREATED 220 00:06:51,980 --> 00:06:53,514 WITH PAP AND THE MAIN PARENT 221 00:06:53,514 --> 00:06:54,682 STUDY DIDN'T FIND AN OVERALL 222 00:06:54,682 --> 00:06:55,450 DIFFERENCE, BUT THEN WHEN YOU 223 00:06:55,450 --> 00:06:56,484 APPLY SOME OF THESE MACHINE 224 00:06:56,484 --> 00:06:57,752 LEARNING APPROACHES, YOU START 225 00:06:57,752 --> 00:07:00,054 TO GET AT SOME OF THE 226 00:07:00,054 --> 00:07:00,822 HETEROGENEITY AND VARIABILITY. 227 00:07:00,822 --> 00:07:02,890 BUT AS A CAUTIONARY NOTE, 228 00:07:02,890 --> 00:07:04,225 DR. WELLMAN LOOKED AT SOME 229 00:07:04,225 --> 00:07:07,729 RECENT DATA WHERE PULSE OXIMETRY 230 00:07:07,729 --> 00:07:09,998 IN WHITE SKINNED VERSUS 231 00:07:09,998 --> 00:07:11,733 DARK-SKINNED PEOPLE MAY ACTUALLY 232 00:07:11,733 --> 00:07:12,967 BE DIFFERENT, SO WE DON'T WANT 233 00:07:12,967 --> 00:07:15,036 MACHINE LEARNING TO PERPETUATE 234 00:07:15,036 --> 00:07:16,671 BIASES OR GOING BACK TO THE 235 00:07:16,671 --> 00:07:18,840 80s SORT OF GARBAGE IN-GARBAGE 236 00:07:18,840 --> 00:07:19,207 OUT. 237 00:07:19,207 --> 00:07:21,943 SO MY TAKEAWAY FROM DAY ONE, 238 00:07:21,943 --> 00:07:22,944 FROM ALL OF THE TALKS, IS THAT 239 00:07:22,944 --> 00:07:24,879 THERE'S A TREMENDOUS AMOUNT OF 240 00:07:24,879 --> 00:07:26,314 HETEROGENEITY, CERTAINLY 241 00:07:26,314 --> 00:07:27,849 INCLUDING GENDER, AND THERE'S 242 00:07:27,849 --> 00:07:29,250 UNIQUE BIOLOGY ACROSS THE 243 00:07:29,250 --> 00:07:30,785 LIFESPAN IN WOMEN THAT PRESENTS 244 00:07:30,785 --> 00:07:32,220 BOTH CHALLENGES AND 245 00:07:32,220 --> 00:07:33,621 OPPORTUNITIES TO REALLY IMPROVE 246 00:07:33,621 --> 00:07:35,723 THE HEALTH OF OUR PATIENTS. 247 00:07:35,723 --> 00:07:37,458 THE OVERWHELMING AMOUNTS OF 248 00:07:37,458 --> 00:07:38,660 INFORMATION THAT WE'RE 249 00:07:38,660 --> 00:07:41,629 COLLECTING REFLECTS REALLY THE 250 00:07:41,629 --> 00:07:43,031 PROTEOME NATURE OF SLEEP, IT'S 251 00:07:43,031 --> 00:07:44,232 NOT JUST SLEEP DISORDER 252 00:07:44,232 --> 00:07:44,999 BREATHING, IT'S HOW MUCH YOU 253 00:07:44,999 --> 00:07:46,134 SLEEP, WHEN YOU SLEEP, THINGS 254 00:07:46,134 --> 00:07:47,402 LIKE THAT, AND THEN MACHINE 255 00:07:47,402 --> 00:07:50,705 LEARNING APPROACHES OFFER 256 00:07:50,705 --> 00:07:52,607 AMAZING POTENTIAL BUT DO HAVE 257 00:07:52,607 --> 00:07:53,207 RISKS. 258 00:07:53,207 --> 00:07:56,711 IT TOOK US QUITE A WHILE TO GET 259 00:07:56,711 --> 00:07:58,279 TO WEARABLES BUT IT SEEMS THE 260 00:07:58,279 --> 00:07:58,846 AMOUNT OF INFORMATION WE'RE 261 00:07:58,846 --> 00:08:00,214 ABOUT TO BE COLLECTING IS JUST 262 00:08:00,214 --> 00:08:01,549 GOING TO INCREASE EXPONENTIALLY. 263 00:08:01,549 --> 00:08:02,950 SO THANK YOU AGAIN TO ALL OF OUR 264 00:08:02,950 --> 00:08:04,552 SPEAKERS. 265 00:08:04,552 --> 00:08:06,054 AND I CAN'T WAIT TO SEE WHAT DAY 266 00:08:06,054 --> 00:08:06,354 TWO BRINGS. 267 00:08:06,354 --> 00:08:16,698 THANK YOU VERY MUCH. 268 00:08:19,233 --> 00:08:21,002 >> SO TAKING OFF ON THE DAY ONE, 269 00:08:21,002 --> 00:08:23,971 I THINK WE DISCUSSED A LOT ABOUT 270 00:08:23,971 --> 00:08:26,307 THE HETEROGENEITY IN TERMS OF 271 00:08:26,307 --> 00:08:28,910 CHARACTERIZING OSA, IN TERMS OF 272 00:08:28,910 --> 00:08:30,545 THE MANIFESTATION OF OSA, THE 273 00:08:30,545 --> 00:08:35,850 DISEASE PROCESS AND SO ON. 274 00:08:35,850 --> 00:08:37,351 AND ONE QUESTION I THINK KEPT 275 00:08:37,351 --> 00:08:38,219 COMING ACROSS THROUGH ALL THE 276 00:08:38,219 --> 00:08:41,956 DISCUSSIONS WAS OKAY, NOW WE 277 00:08:41,956 --> 00:08:43,925 HAVE -- WHAT ABOUT THE 278 00:08:43,925 --> 00:08:45,560 TREATMENT, HOW DO WE TACKLE 279 00:08:45,560 --> 00:08:46,461 HETEROGENEITY IN TREATMENT AND 280 00:08:46,461 --> 00:08:47,328 WHAT ARE THE CHALLENGES THERE 281 00:08:47,328 --> 00:08:48,196 AND WHAT ARE THE OPPORTUNITIES 282 00:08:48,196 --> 00:08:48,863 THERE. 283 00:08:48,863 --> 00:08:51,365 SO ONE OF THE FIRST THINGS I 284 00:08:51,365 --> 00:08:52,800 FEEL THAT IS NEEDED WHEN WE TALK 285 00:08:52,800 --> 00:08:53,935 ABOUT TREATMENT IS WHAT IS THE 286 00:08:53,935 --> 00:08:56,504 DEFINITION OF A RESPONDER VERSUS 287 00:08:56,504 --> 00:08:56,838 NON-RESPONDER. 288 00:08:56,838 --> 00:08:58,372 SO WHEN YOU'RE LOOKING AT 289 00:08:58,372 --> 00:09:01,943 TREATMENT, YOU KNOW, DIFFERENT 290 00:09:01,943 --> 00:09:03,177 TYPES OF TREATMENT AND TREATMENT 291 00:09:03,177 --> 00:09:04,612 RESPONSE, WHAT IS THE DEFINITION 292 00:09:04,612 --> 00:09:06,681 OF A RESPONDER AND WHO DO WE 293 00:09:06,681 --> 00:09:08,783 CONSIDER AS A RESPONDER, DO WE 294 00:09:08,783 --> 00:09:09,851 STICK TO WHAT THE DEFINITIONS 295 00:09:09,851 --> 00:09:11,819 HAVE BEEN SO FAR OR ARE WE NOW 296 00:09:11,819 --> 00:09:14,989 GOING TO ATTEMPT TO INCORPORATE 297 00:09:14,989 --> 00:09:15,890 HETEROGENEITY INTO TERMS OF THE 298 00:09:15,890 --> 00:09:19,160 DEFINITION. 299 00:09:19,160 --> 00:09:21,796 SO IS IT A ONE SIZE FITS ALL 300 00:09:21,796 --> 00:09:22,463 DEFINITION FOR WHAT WE SORT OF 301 00:09:22,463 --> 00:09:23,331 TERM AS RESPONDER? 302 00:09:23,331 --> 00:09:24,966 IS IT GOING TO BE ONLY BASED ON, 303 00:09:24,966 --> 00:09:26,701 YOU KNOW, SORT OF THE 304 00:09:26,701 --> 00:09:27,468 CHARACTERISTICS, THE SYMPTOMS, 305 00:09:27,468 --> 00:09:29,570 OR ARE WE GOING TO LOOK AT A 306 00:09:29,570 --> 00:09:31,072 MORE HOLISTIC APPROACH AND IF WE 307 00:09:31,072 --> 00:09:33,941 DO THAT, HOW DO THE STATISTICS 308 00:09:33,941 --> 00:09:36,010 PLAY OUT AND HOW CAN WE SORT OF 309 00:09:36,010 --> 00:09:38,412 TACKLE THAT. 310 00:09:38,412 --> 00:09:40,281 THE DEFINITION OF A RESPONDER 311 00:09:40,281 --> 00:09:42,016 AND NON-RESPONDER IS ESPECIALLY 312 00:09:42,016 --> 00:09:44,218 CRUCIAL WHEN YOU'RE CONSIDERING 313 00:09:44,218 --> 00:09:44,852 PERSONALIZING TREATMENT AND THE 314 00:09:44,852 --> 00:09:46,721 DIFFERENT TREATMENT MODALITIES. 315 00:09:46,721 --> 00:09:50,024 SO AS WE PROGRESS TODAY, I'M 316 00:09:50,024 --> 00:09:50,925 HOPING THAT CERTAIN DISCUSSIONS 317 00:09:50,925 --> 00:09:54,262 AND QUESTIONS COME ABOUT THAT 318 00:09:54,262 --> 00:09:56,264 CAN HELP US REFINE THIS, WHO IS 319 00:09:56,264 --> 00:09:59,967 A RESPONDER VERSUS 320 00:09:59,967 --> 00:10:00,601 NON-RESPONDER. 321 00:10:00,601 --> 00:10:01,769 IN TERMS OF AGAIN TARGETING 322 00:10:01,769 --> 00:10:03,137 THESE THERAPIES AND TARGETING 323 00:10:03,137 --> 00:10:06,574 THE SPECIFIC POPULATIONS, ARE WE 324 00:10:06,574 --> 00:10:07,742 GOING TO TARGET SYMPTOMS, ARE WE 325 00:10:07,742 --> 00:10:08,743 GOING TO TARGET CHARACTERISTICS 326 00:10:08,743 --> 00:10:10,378 OR ARE WE GOING TO TARGET BOTH 327 00:10:10,378 --> 00:10:13,181 OF THEM OR A COMBINATION OF THEM 328 00:10:13,181 --> 00:10:13,848 AND SO ON. 329 00:10:13,848 --> 00:10:15,283 SO SOME OF THE OTHER SESSIONS 330 00:10:15,283 --> 00:10:18,119 THROUGHOUT THE DAY ARE GOING TO 331 00:10:18,119 --> 00:10:20,521 TACKLE IF THERE ARE COMBINATION 332 00:10:20,521 --> 00:10:21,389 THERAPIES, COMBINATION OF 333 00:10:21,389 --> 00:10:22,156 DIFFERENT DRUGS AND SO ON THAT 334 00:10:22,156 --> 00:10:25,026 COULD BE USED TO TACKLE SYMPTOMS 335 00:10:25,026 --> 00:10:26,227 OR THE PHYSIOLOGICAL 336 00:10:26,227 --> 00:10:28,396 CHARACTERISTICS WHICH THEN SORT 337 00:10:28,396 --> 00:10:30,031 OF HELP SYMPTOMS AND SO ON. 338 00:10:30,031 --> 00:10:33,367 AND AGAIN, FOR THIS SCENARIO, IT 339 00:10:33,367 --> 00:10:34,635 IS KEY TO KNOW WHAT IS THE 340 00:10:34,635 --> 00:10:36,370 RESPONSE TO SORT OF TREATMENT 341 00:10:36,370 --> 00:10:36,704 DEFINITION. 342 00:10:36,704 --> 00:10:39,106 SO EVEN THOUGH YOU HAVE THESE 343 00:10:39,106 --> 00:10:40,875 COMBINATION THERAPIES THAT ARE 344 00:10:40,875 --> 00:10:43,177 GOING TO ATTEND TO SORT OF 345 00:10:43,177 --> 00:10:47,448 MODIFY SOME OF THE PHENOTYPES, 346 00:10:47,448 --> 00:10:48,850 THE ENDO TYPES, IS THE 347 00:10:48,850 --> 00:10:49,851 DEFINITION STILL GOING TO BE 348 00:10:49,851 --> 00:10:51,252 THAT A RESPONDER IS SOMEONE WHO 349 00:10:51,252 --> 00:10:52,453 RESPONDS TO TREATMENT IN TERMS 350 00:10:52,453 --> 00:10:54,422 OF AHI OR ARE WE GOING TO CHANGE 351 00:10:54,422 --> 00:10:55,957 THAT DEFINITION. 352 00:10:55,957 --> 00:10:56,724 SO THAT'S SOMETHING TO KEEP IN 353 00:10:56,724 --> 00:10:57,925 MIND AS YOU HEAR ABOUT THESE 354 00:10:57,925 --> 00:11:00,661 DIFFERENT TALKS, AND BRING TO 355 00:11:00,661 --> 00:11:01,863 DISCUSSION, TO REALLY 356 00:11:01,863 --> 00:11:03,731 EMPHASIZING THE HETEROGENEITY 357 00:11:03,731 --> 00:11:06,367 NOW OF SHIFTING FROM 358 00:11:06,367 --> 00:11:07,568 CHARACTERISTICS OF OSA AND THE 359 00:11:07,568 --> 00:11:10,738 OUTCOMES TO ACTUALLY NOW 360 00:11:10,738 --> 00:11:12,473 TREATMENT. 361 00:11:12,473 --> 00:11:13,774 AGAIN THE COMBINATION THERAPY, 362 00:11:13,774 --> 00:11:15,309 ARE THEY GOING TO TARGET THE 363 00:11:15,309 --> 00:11:16,077 COMBINATION OF CHARACTERISTICS 364 00:11:16,077 --> 00:11:17,511 OR ARE WE GOING TO TACKLE ONE OF 365 00:11:17,511 --> 00:11:21,115 THEM AT A TIME, AND IF THEY ARE 366 00:11:21,115 --> 00:11:22,984 TO BE COMBINED, HOW DO WE 367 00:11:22,984 --> 00:11:23,751 PROCEED TO DO THAT. 368 00:11:23,751 --> 00:11:24,719 WE'LL THEN SORT OF GO FORWARD 369 00:11:24,719 --> 00:11:29,557 AND TALK ABOUT HETEROGENEOUS 370 00:11:29,557 --> 00:11:31,826 EFFECTS, IN PERSONS WITH 371 00:11:31,826 --> 00:11:32,927 INTELLECTUAL AND DEVELOPMENTAL 372 00:11:32,927 --> 00:11:33,594 DISABILITIES, WHAT ARE THE 373 00:11:33,594 --> 00:11:35,897 CHALLENGES WHEN IT COMES TO OSA 374 00:11:35,897 --> 00:11:36,964 CHARACTERIZATION AS WELL AS 375 00:11:36,964 --> 00:11:38,299 TREATMENT. 376 00:11:38,299 --> 00:11:39,767 WHAT ARE THE SPECIFIC OUTCOMES 377 00:11:39,767 --> 00:11:40,701 THAT SHOULD BE TARGETED? 378 00:11:40,701 --> 00:11:41,669 ARE THEY GOING TO BE THE SAME, 379 00:11:41,669 --> 00:11:42,870 ARE THEY GOING TO BE DIFFERENT, 380 00:11:42,870 --> 00:11:44,739 WHAT SHOULD BE PRIORITIZED FOR 381 00:11:44,739 --> 00:11:46,274 THIS POPULATION. 382 00:11:46,274 --> 00:11:49,010 WHAT IS THE ROLE OF LONG TERM 383 00:11:49,010 --> 00:11:50,444 MONITORING IN THESE POPULATIONS 384 00:11:50,444 --> 00:11:53,714 AND IS THAT SOMETHING WE CAN 385 00:11:53,714 --> 00:11:57,885 STOSORT OF USE TO NOT ONLY 386 00:11:57,885 --> 00:12:00,154 ELUCIDATE HETEROGENEITY BUT ALSO 387 00:12:00,154 --> 00:12:01,222 TACKLE SOME OF THE OUTCOMES OF 388 00:12:01,222 --> 00:12:02,256 THE QUESTIONS WE HAD BEFORE. 389 00:12:02,256 --> 00:12:04,425 THE HETEROGENEITY WITHIN THE 390 00:12:04,425 --> 00:12:05,626 COMORBIDITIES IN THESE 391 00:12:05,626 --> 00:12:06,427 POPULATIONS IS A CHALLENGE BUT 392 00:12:06,427 --> 00:12:08,162 COULD ALSO BE AN OPPORTUNITY AND 393 00:12:08,162 --> 00:12:10,131 COULD BE USED TO SORT OF ANSWER 394 00:12:10,131 --> 00:12:11,232 SOME OF THE LONG-STANDING 395 00:12:11,232 --> 00:12:14,502 QUESTIONS WE HAVE ABOUT OSA, SO 396 00:12:14,502 --> 00:12:15,703 AS WE GO THROUGH THE OTHER 397 00:12:15,703 --> 00:12:17,772 SESSION, YOU WILL HEAR ABOUT 398 00:12:17,772 --> 00:12:18,539 DOWN SYNDROME AND SOME OF THE 399 00:12:18,539 --> 00:12:21,175 OTHER VULNERABLE POPULATIONS AND 400 00:12:21,175 --> 00:12:23,477 THE CHALLENGES THAT THAT 401 00:12:23,477 --> 00:12:24,245 POPULATION PRESENTS AND HOW IT 402 00:12:24,245 --> 00:12:26,914 COULD BE SORT OF USED TO 403 00:12:26,914 --> 00:12:28,282 CHARACTERIZE THE HETEROGENEITY 404 00:12:28,282 --> 00:12:33,554 IN OSA. 405 00:12:33,554 --> 00:12:36,157 IN TERMS OF THE EMERGING 406 00:12:36,157 --> 00:12:37,625 THERAPIES COMING ABOUT ON SCENE, 407 00:12:37,625 --> 00:12:39,427 CPAP IS NOT THE ONLY THERAPY 408 00:12:39,427 --> 00:12:40,394 ALTHOUGH IT'S BY FAR THE ONE 409 00:12:40,394 --> 00:12:42,830 THAT'S SORT OF USED WIDELY, WHAT 410 00:12:42,830 --> 00:12:46,434 IS ITS UTILITY IN VULNERABLE 411 00:12:46,434 --> 00:12:47,435 POPULATIONS AND HOW DO WE SORT 412 00:12:47,435 --> 00:12:48,736 OF TARGET OR LOOK AT THESE 413 00:12:48,736 --> 00:12:50,705 EMERGING THERAPIES WITHIN THE 414 00:12:50,705 --> 00:12:53,341 CONTEXT OF VULNERABLE 415 00:12:53,341 --> 00:12:54,308 POPULATIONS, AND HOW DO THE 416 00:12:54,308 --> 00:12:55,609 CHARACTERISTICS THAT WE SORT OF 417 00:12:55,609 --> 00:12:58,479 DESCRIBE FROM DAY ONE, THE 418 00:12:58,479 --> 00:13:02,516 DIFFERENT HETEROYES NAT HETEROGD 419 00:13:02,516 --> 00:13:03,884 HETEROGENEOUS EFFECTS WE SAW ON 420 00:13:03,884 --> 00:13:05,453 DAY ONE, HOW DO THEY PLAY IN 421 00:13:05,453 --> 00:13:06,721 THIS WHOLE POPULATION. 422 00:13:06,721 --> 00:13:07,989 SO HOPEFULLY SOME OF THE TALKS 423 00:13:07,989 --> 00:13:08,856 YOU WILL HEAR THROUGHOUT THE DAY 424 00:13:08,856 --> 00:13:09,824 WILL SHED LIGHT ON THAT AND 425 00:13:09,824 --> 00:13:10,891 DURING THE DISCUSSION I URGE YOU 426 00:13:10,891 --> 00:13:12,059 TO SHORT OF BRING THESE 427 00:13:12,059 --> 00:13:13,794 QUESTIONS TO THE FOREFRONT. 428 00:13:13,794 --> 00:13:15,830 ONE OF THE FACTORS THAT WE 429 00:13:15,830 --> 00:13:18,265 SHOULD BE CONCENTRATING IN 430 00:13:18,265 --> 00:13:19,367 EMERGING THERAPIES, IS IT AGAIN 431 00:13:19,367 --> 00:13:21,435 GOING TO BE A SEQUENTIAL TRIAL, 432 00:13:21,435 --> 00:13:23,004 ONE AFTER THE OTHER OR ARE WE 433 00:13:23,004 --> 00:13:25,106 GOING TO TRY SOME COMBINATION AT 434 00:13:25,106 --> 00:13:26,674 FIRST AND HAVE STRATEGIES THAT 435 00:13:26,674 --> 00:13:28,709 WILL MOVE PERSONS TO ANOTHER 436 00:13:28,709 --> 00:13:29,744 TREATMENT SHOULD THAT TREATMENT 437 00:13:29,744 --> 00:13:30,611 FAIL. 438 00:13:30,611 --> 00:13:32,713 AND FINALLY, WHEN WE ARE TALKING 439 00:13:32,713 --> 00:13:34,548 ABOUT THE HETEROGENEITY, YOU 440 00:13:34,548 --> 00:13:36,017 TALK ABOUT -- WE TALK ABOUT 441 00:13:36,017 --> 00:13:37,418 CHARACTERISTICS AND OTHER THINGS 442 00:13:37,418 --> 00:13:39,687 ON DAY ONE, WE ARE TALKING ABOUT 443 00:13:39,687 --> 00:13:40,388 TREATMENT TODAY. 444 00:13:40,388 --> 00:13:43,624 AT THE END, EVERYONE HAS A 445 00:13:43,624 --> 00:13:44,492 QUESTION ALL THE TIME, HOW ARE 446 00:13:44,492 --> 00:13:45,726 WE GOING TO IMPLEMENT THIS, HOW 447 00:13:45,726 --> 00:13:47,461 ARE WE GOING TO BRING TO THE 448 00:13:47,461 --> 00:13:48,329 CLINIC. 449 00:13:48,329 --> 00:13:50,297 SO FROM DR. OWENS' SLIDE ON DAY 450 00:13:50,297 --> 00:13:51,832 ONE, THE CHARGE WE HAD IN FRONT 451 00:13:51,832 --> 00:13:56,203 OF US BY THE NHLBI AND THE NCDSR 452 00:13:56,203 --> 00:13:57,338 IS HOW ARE WE GOING TO BRING 453 00:13:57,338 --> 00:13:58,739 THIS TO THE CLINIC, WHAT ARE THE 454 00:13:58,739 --> 00:14:00,141 CHALLENGES THAT REMAIN AND HOW 455 00:14:00,141 --> 00:14:01,375 DO WE SORT OF TACKLE THEM. 456 00:14:01,375 --> 00:14:02,676 SO AS YOU HEAR ABOUT THESE 457 00:14:02,676 --> 00:14:04,078 TALKS, I WOULD URGE YOU TO BRING 458 00:14:04,078 --> 00:14:07,815 TO DISCUSSION SOME OF THESE KEY 459 00:14:07,815 --> 00:14:08,582 QUESTIONS THAT COULD BE 460 00:14:08,582 --> 00:14:09,016 ADDRESSED. 461 00:14:09,016 --> 00:14:12,520 SO THERE'S SEVERAL LEVELS OF 462 00:14:12,520 --> 00:14:13,487 IMPLEMENTATION. 463 00:14:13,487 --> 00:14:15,122 ULTIMATELY WE WANT THE SCIENCE 464 00:14:15,122 --> 00:14:16,357 TO BENEFIT ALL RELEVANT 465 00:14:16,357 --> 00:14:17,224 STAKEHOLDERS SO WHAT ARE THE 466 00:14:17,224 --> 00:14:18,259 CHALLENGES THAT ARE PRESENTED 467 00:14:18,259 --> 00:14:18,993 OVER THERE. 468 00:14:18,993 --> 00:14:21,028 WE'LL BE GOING FROM DIAGNOSIS TO 469 00:14:21,028 --> 00:14:22,363 TREATMENT MANAGEMENT AND THEN 470 00:14:22,363 --> 00:14:22,630 FOLLOW-UP. 471 00:14:22,630 --> 00:14:24,865 WHAT ARE THE CHALLENGES FOR 472 00:14:24,865 --> 00:14:25,733 IMPLEMENTATION ACROSS THE 473 00:14:25,733 --> 00:14:29,136 SPECTRUM FOR THESE THREE SORT OF 474 00:14:29,136 --> 00:14:30,104 DOMAINS, AND THEN THE BIG 475 00:14:30,104 --> 00:14:31,872 QUESTION IS ARE WE READY TO 476 00:14:31,872 --> 00:14:32,440 PERSONALIZE CLINICAL TRIALS. 477 00:14:32,440 --> 00:14:33,974 SO WE ARE TALKING ABOUT 478 00:14:33,974 --> 00:14:36,043 HETEROGENEITY SO MUCH, IN TERMS 479 00:14:36,043 --> 00:14:36,944 OF CHARACTERISTICS, IN TERMS OF 480 00:14:36,944 --> 00:14:39,213 THE TREATMENT, ARE WE READY TO 481 00:14:39,213 --> 00:14:40,948 EMBED THAT HETEROGENEITY INTO 482 00:14:40,948 --> 00:14:42,416 THE DESIGN OF OUR CLINICAL 483 00:14:42,416 --> 00:14:42,850 TRIALS. 484 00:14:42,850 --> 00:14:47,955 OR COULD THEY BE USED TO E ENRIH 485 00:14:47,955 --> 00:14:49,156 THE RECRUITMENT THAT COULD 486 00:14:49,156 --> 00:14:50,091 HAPPEN IN CLINICAL TRIALS. 487 00:14:50,091 --> 00:14:51,192 WHAT ARE THE GUIDELINES AND 488 00:14:51,192 --> 00:14:52,093 STANDARDS FOR IMPLEMENTATION? 489 00:14:52,093 --> 00:14:53,494 THIS IS SOMETHING THAT 490 00:14:53,494 --> 00:14:54,095 IMPLEMENTATION SCIENCE IS SORT 491 00:14:54,095 --> 00:14:55,596 OF A FIELD IN ITSELF, AND HOW 492 00:14:55,596 --> 00:14:58,232 CAN WE LEARN FROM THAT AND USE 493 00:14:58,232 --> 00:15:02,069 TO OUR ADVANTAGE FOR SLEEP APNEA 494 00:15:02,069 --> 00:15:03,370 PATIENTS AND ALL THE RELEVANT 495 00:15:03,370 --> 00:15:04,004 STAKEHOLDERS. 496 00:15:04,004 --> 00:15:07,141 SO LASTLY I WOULD WANT TO SORT 497 00:15:07,141 --> 00:15:08,409 OF EMPHASIZE THE ROUND TABLE 498 00:15:08,409 --> 00:15:09,043 DISCUSSIONS THAT WILL HAPPEN 499 00:15:09,043 --> 00:15:12,012 TOWARD THE END OF THE DAY WHERE 500 00:15:12,012 --> 00:15:13,180 SOME OF THESE QUESTION FROM DAY 501 00:15:13,180 --> 00:15:13,981 ONE AND THE QUESTIONS THAT MAY 502 00:15:13,981 --> 00:15:16,050 BE RAISED TODAY FROM DAY TWO 503 00:15:16,050 --> 00:15:19,120 ALONG WITH THIS VIEW THAT -- HOW 504 00:15:19,120 --> 00:15:20,121 CAN WE BRING ALL OF THESE THINGS 505 00:15:20,121 --> 00:15:22,289 TO THE CLINIC, ONE OF THE 506 00:15:22,289 --> 00:15:23,290 QUESTIONS THAT STILL REMAIN, 507 00:15:23,290 --> 00:15:24,258 WHAT ARE THE RESEARCH THAT NEEDS 508 00:15:24,258 --> 00:15:25,893 TO HAPPEN, I WOULD URGE EVERYONE 509 00:15:25,893 --> 00:15:27,094 TO SORT OF BRING THESE QUESTIONS 510 00:15:27,094 --> 00:15:30,064 TO THE ROUNDTABLE DISCUSSIONS 511 00:15:30,064 --> 00:15:32,133 AND TRY AND SORT OF GAIN SOME 512 00:15:32,133 --> 00:15:33,234 CONSENSUS, OR AT LEAST KNOW WHAT 513 00:15:33,234 --> 00:15:34,435 THE FUTURE STEPS OR THE NEXT 514 00:15:34,435 --> 00:15:39,240 STEPS ARE IN THAT DIRECTION. 515 00:15:39,240 --> 00:15:40,441 SO WITH THAT, I'LL STOP OVER 516 00:15:40,441 --> 00:15:42,309 HERE AND THEN I THINK IT'S TIME 517 00:15:42,309 --> 00:15:43,310 FOR OUR FIRST SESSION OF THE 518 00:15:43,310 --> 00:15:53,387 DAY. 519 00:15:54,421 --> 00:15:55,489 >> THANK YOU SO MUCH FOR 520 00:15:55,489 --> 00:15:56,957 WRAPPING THAT UP AND CERTAINLY 521 00:15:56,957 --> 00:15:58,159 SUMMARIZING THE CONVERSATIONS ON 522 00:15:58,159 --> 00:15:58,726 DAY ONE. 523 00:15:58,726 --> 00:16:01,896 AND THEN ANKIT FOR FRAMING DAY 524 00:16:01,896 --> 00:16:02,062 TWO. 525 00:16:02,062 --> 00:16:05,065 SO NEXT UP, WE WILL INTRODUCE OR 526 00:16:05,065 --> 00:16:08,636 RE-INTRODUCE ONE OF OUR 527 00:16:08,636 --> 00:16:12,273 CO-CLAIRES, DR. ESRA TASALI, 528 00:16:12,273 --> 00:16:13,274 PROFESSOR AT THE UNIVERSITY OF 529 00:16:13,274 --> 00:16:14,608 CHICAGO WHO WORKS IN SLEEP AND 530 00:16:14,608 --> 00:16:16,777 ENERGY METABOLISM, LOOKING AT 531 00:16:16,777 --> 00:16:18,179 OSA IN METABOLIC OUTCOMES. 532 00:16:18,179 --> 00:16:21,248 ALSO, AGAIN, ESRA IS A CHAIR OF 533 00:16:21,248 --> 00:16:22,983 THE -- OR THE CURRENT CHAIR OF 534 00:16:22,983 --> 00:16:25,753 THE NIH SLEEP DISORDERS RESEARCH 535 00:16:25,753 --> 00:16:27,288 ADVISORY BOARD, SO ESRA, ARE YOU 536 00:16:27,288 --> 00:16:29,056 READY TO TAKE IT AWAY? 537 00:16:29,056 --> 00:16:30,357 >> YES, YES. 538 00:16:30,357 --> 00:16:31,525 LET ME SEE. 539 00:16:31,525 --> 00:16:36,030 I NEED TO SHARE MY SLIDES, 540 00:16:36,030 --> 00:16:36,297 MARISHKA. 541 00:16:36,297 --> 00:16:44,505 I DID THIS BEFORE, BUT HOLD ON. 542 00:16:44,505 --> 00:16:54,882 I APOLOGIZE, EVERYONE. 543 00:17:18,639 --> 00:17:28,616 > 544 00:18:33,314 --> 00:18:34,581 >> SO WE HEARD EXCELLENT TALKS 545 00:18:34,581 --> 00:18:36,116 YESTERDAY AND MY TASK TODAY IS 546 00:18:36,116 --> 00:18:39,620 TO ADDRESS THIS CHALLENGING 547 00:18:39,620 --> 00:18:40,354 QUESTION. 548 00:18:40,354 --> 00:18:42,222 SO CAN WE IDENTIFY RESPONDERS 549 00:18:42,222 --> 00:18:43,657 VERSUS NON-RESPONDERS? 550 00:18:43,657 --> 00:18:46,060 AND AT THE END OF MY TALK, I MAY 551 00:18:46,060 --> 00:18:47,494 LEAVE YOU WITH MORE QUESTIONS 552 00:18:47,494 --> 00:18:50,998 THAN ANSWERS, BUT I HOPE I WOULD 553 00:18:50,998 --> 00:18:54,034 LIKE THAT THIS WILL HELP FOR THE 554 00:18:54,034 --> 00:18:54,735 DISCUSSIONS LATER. 555 00:18:54,735 --> 00:18:58,739 SO I THINK FIRST WE NEED TO 556 00:18:58,739 --> 00:18:59,940 UNDERSTAND THAT AS HAS BEEN 557 00:18:59,940 --> 00:19:01,275 MENTIONED, THAT THE TREATMENT 558 00:19:01,275 --> 00:19:03,444 RESPONSE IS MULTILEVEL AND 559 00:19:03,444 --> 00:19:06,513 MULTIFACTORIAL IN NATURE. 560 00:19:06,513 --> 00:19:10,217 SO I DID THESE, FOR SIMPLICITY, 561 00:19:10,217 --> 00:19:11,752 THESE THREE LEVELS: WHO TO 562 00:19:11,752 --> 00:19:13,954 STUDY, HOW DO WE TREAT, AND WHAT 563 00:19:13,954 --> 00:19:16,290 END POINTS ARE WE LOOKING AT. 564 00:19:16,290 --> 00:19:20,861 SO WHAT IS OUR STUDY POPULATION 565 00:19:20,861 --> 00:19:22,596 FOR SIMPLICITY, WE NEED TO 566 00:19:22,596 --> 00:19:24,465 UNDERSTAND THAT THERE IS A 567 00:19:24,465 --> 00:19:27,735 TARGET POPULATION, WE WOULD LIKE 568 00:19:27,735 --> 00:19:29,269 THE INFORMATION TO GET 569 00:19:29,269 --> 00:19:30,804 INFORMATION ABOUT IDEALLY, THEN 570 00:19:30,804 --> 00:19:34,408 THERE'S THE ACTUAL POPULATION, 571 00:19:34,408 --> 00:19:36,143 PEOPLE WHOM OUR SAMPLE WILL BE 572 00:19:36,143 --> 00:19:38,879 DRAWN BASED ON OUR ELIGIBILITY 573 00:19:38,879 --> 00:19:40,414 CRITERIA, AND THEN THERE IS THE 574 00:19:40,414 --> 00:19:41,982 SAMPLE WHICH IS A SUBSET OF THE 575 00:19:41,982 --> 00:19:42,516 ACTUAL POPULATION. 576 00:19:42,516 --> 00:19:44,051 SO WE NEED TO CONSIDER THESE 577 00:19:44,051 --> 00:19:45,786 FACTORS WHEN EXAMINING THE 578 00:19:45,786 --> 00:19:50,124 HETEROYES NA 579 00:19:50,124 --> 00:19:50,924 HETEROGENEITY. 580 00:19:50,924 --> 00:19:52,559 SO AS MENTIONED EARLIER, THERE 581 00:19:52,559 --> 00:19:55,295 ARE DEMOGRAPHIC FACTORS AND 582 00:19:55,295 --> 00:19:55,796 PHENOTYPES AND CO-MORBID 583 00:19:55,796 --> 00:19:56,730 CONDITIONS AND DURATION OF 584 00:19:56,730 --> 00:19:58,432 EXPOSURE WHICH ALSO WAS 585 00:19:58,432 --> 00:19:59,333 MENTIONED AND DISTINCT 586 00:19:59,333 --> 00:20:02,035 PHENOTYPES THAT CAN INFLUENCE 587 00:20:02,035 --> 00:20:03,270 THE TREATMENT RESPONSE. 588 00:20:03,270 --> 00:20:06,240 SO HOW DO H WE APPLY TREATMENT S 589 00:20:06,240 --> 00:20:07,241 ALSO IMPORTANT, WHETHER IT'S 590 00:20:07,241 --> 00:20:08,642 SINGLE OR COMBINED TREATMENTS, 591 00:20:08,642 --> 00:20:10,077 THE DELIVERY METHODS FOR 592 00:20:10,077 --> 00:20:12,479 TREATMENTS, TREATMENT DURATION, 593 00:20:12,479 --> 00:20:13,447 TREATMENT ADHERENCE AND 594 00:20:13,447 --> 00:20:14,882 MONITORING AND ACCESS TO 595 00:20:14,882 --> 00:20:15,349 TREATMENT. 596 00:20:15,349 --> 00:20:17,951 AND IN TERMS OF END POINTS, 597 00:20:17,951 --> 00:20:20,554 SHOULD WE BE FOCUSING ON SLEEP 598 00:20:20,554 --> 00:20:22,022 APNEA METRICS, OR SHOULD WE BE 599 00:20:22,022 --> 00:20:24,391 FOCUSING ON DAY TIME SLEEPINESS 600 00:20:24,391 --> 00:20:26,260 OR OTHER ESTIMATES VERSUS 601 00:20:26,260 --> 00:20:29,430 BIOLOGICAL END POINTS. 602 00:20:29,430 --> 00:20:30,864 AND WHAT ARE THE CLINICAL 603 00:20:30,864 --> 00:20:31,732 MEANINGFULNESS AND REA VERSE 604 00:20:31,732 --> 00:20:36,303 AREANDREVERSIBILITY OF THESE OUS 605 00:20:36,303 --> 00:20:37,638 AND WHAT ARE THE CUTOFFS AND 606 00:20:37,638 --> 00:20:39,706 METRICS WE'RE USING TO DEFINE AN 607 00:20:39,706 --> 00:20:40,908 OUTCOME TO STRATIFY OUR 608 00:20:40,908 --> 00:20:42,643 RESPONDERS AND NON-RESPONDERS. 609 00:20:42,643 --> 00:20:43,744 BEFORE MOVING ON AS I WAS 610 00:20:43,744 --> 00:20:45,612 RESEARCHING THIS TOPIC, I CAME 611 00:20:45,612 --> 00:20:48,115 ACROSS THIS STATISTICAL 612 00:20:48,115 --> 00:20:48,882 METHODOLOGICAL PAPER AND MOST OF 613 00:20:48,882 --> 00:20:51,952 YOU MIGHT BE FAMILIAR WITH THIS, 614 00:20:51,952 --> 00:20:54,688 A RESPONDER AS WE DEFINE, AS WE 615 00:20:54,688 --> 00:20:57,191 HEARD, IS AN INDIVIDUAL FOR WHOM 616 00:20:57,191 --> 00:20:58,525 AN INTERVENTION IS BENEFICIAL. 617 00:20:58,525 --> 00:21:00,060 HOWEVER, THERE'S A COMMON NOTION 618 00:21:00,060 --> 00:21:01,028 THAT INDIVIDUALS WHO BENEFIT 619 00:21:01,028 --> 00:21:04,431 FROM TREATMENT AS RESPONDERS ARE 620 00:21:04,431 --> 00:21:06,533 THOSE WHO HAVE GREATER ROOM FOR 621 00:21:06,533 --> 00:21:08,268 IMPROVEMENT, BUT STATISTICIANS 622 00:21:08,268 --> 00:21:10,237 GIVE US A CAUTION FOR 623 00:21:10,237 --> 00:21:12,606 PARTICULARLY POSTDOC SECONDARY 624 00:21:12,606 --> 00:21:13,707 ANALYSES, BECAUSE DIVIDING 625 00:21:13,707 --> 00:21:15,676 GROUPS BY THE OUTCOMES BEING 626 00:21:15,676 --> 00:21:19,379 TESTED WHEN THERE'S NO OVERALL 627 00:21:19,379 --> 00:21:21,782 EFFECT CAN LEAD TO SERIOUS 628 00:21:21,782 --> 00:21:22,649 MISINTERPRETATION OF THE DATA, 629 00:21:22,649 --> 00:21:24,418 BECAUSE YOU WOULD EXPECT THAT 630 00:21:24,418 --> 00:21:26,386 INDIVIDUALS WITH LOW LEVELS OF A 631 00:21:26,386 --> 00:21:29,256 PARTICULAR OUTCOME AT BASELINE 632 00:21:29,256 --> 00:21:30,557 WOULD IMPROVE, AND, THEREFORE, 633 00:21:30,557 --> 00:21:32,526 THERE NEEDS TO BE A 634 00:21:32,526 --> 00:21:34,495 CONSIDERATION FOR A CONTROL 635 00:21:34,495 --> 00:21:35,896 GROUP, CONTROL POPULATION FOR 636 00:21:35,896 --> 00:21:38,765 RIGOROUS RESEARCH. 637 00:21:38,765 --> 00:21:39,399 IN THIS 638 00:21:39,399 --> 00:21:39,867 TREATMENT RESPONSE. 639 00:21:39,867 --> 00:21:43,003 WHEN WE LOOK AT THE LITERATURE, 640 00:21:43,003 --> 00:21:44,872 ONE APPROACH TO PREDICT 641 00:21:44,872 --> 00:21:47,941 TREATMENT RESPONSE IS TO DO 642 00:21:47,941 --> 00:21:49,142 CLUSTER ANALYSES, IN OTHER 643 00:21:49,142 --> 00:21:51,545 WORDS, LOOKING AT BASELINE 644 00:21:51,545 --> 00:21:52,479 PHENOTYPIC CHARACTERISTICS, AND 645 00:21:52,479 --> 00:21:59,319 AS YOU CAN SEE HERE, A JARRED 646 00:21:59,319 --> 00:22:00,721 RESPONSE HAS BEEN USED IN 647 00:22:00,721 --> 00:22:02,589 MULTIPLE META-ANALYSES AND 648 00:22:02,589 --> 00:22:03,490 SYSTEMIC ANALYSES IN THIS 649 00:22:03,490 --> 00:22:06,994 RECENTLY PUBLISHED LARGE 650 00:22:06,994 --> 00:22:08,929 PROSPECTIVE COHORT, EUROPEAN 651 00:22:08,929 --> 00:22:13,033 COHORT, EVEN THOUGH AHI RESPONSE 652 00:22:13,033 --> 00:22:14,101 REMAINS STABLE, THERE WAS 653 00:22:14,101 --> 00:22:15,636 VARIABLE RESPONSE TO SLEEPINESS 654 00:22:15,636 --> 00:22:18,138 BASED ON BASELINE CLUSTERS. 655 00:22:18,138 --> 00:22:20,474 HOW ABOUT METABOLIC OUTCOMES? 656 00:22:20,474 --> 00:22:23,310 WE KNOW THAT EXCESS WEIGHT, 657 00:22:23,310 --> 00:22:25,812 SLEEP APNEA AND IMPAIRMENTS IN 658 00:22:25,812 --> 00:22:29,316 GLUCOSE METABOLISM ARE HIGHLY 659 00:22:29,316 --> 00:22:29,650 INTERRELATED. 660 00:22:29,650 --> 00:22:32,719 WE KNOW THAT OBESITY HAS SEVERAL 661 00:22:32,719 --> 00:22:35,889 COMORBIDITIES AND SLEEP APNEA 662 00:22:35,889 --> 00:22:38,191 AND PREDIABETES, DIABETES CAN 663 00:22:38,191 --> 00:22:39,426 COEXIST, AND WE ALSO KNOW EXCESS 664 00:22:39,426 --> 00:22:40,827 WEIGHT ITSELF CAN LEAD TO 665 00:22:40,827 --> 00:22:42,262 INSULIN RESISTANCE AND DIABETES 666 00:22:42,262 --> 00:22:43,830 THROUGH VARIOUS MECHANISMS, 667 00:22:43,830 --> 00:22:44,998 THROUGH INFLAMMATION, THROUGH 668 00:22:44,998 --> 00:22:47,167 DEFECTS IN FAT METABOLISM, AND 669 00:22:47,167 --> 00:22:50,571 THROUGH DOWNSTREAM EFFECTS IN 670 00:22:50,571 --> 00:22:52,406 MITOCHONDRIAL METABOLISM LEAD 671 00:22:52,406 --> 00:22:55,275 BELEADINGTO IMPAIRED GLUCOSE ANT 672 00:22:55,275 --> 00:22:55,776 UTILIZATION. 673 00:22:55,776 --> 00:22:58,011 WE ALSO KNOW THAT TO MAINTAIN 674 00:22:58,011 --> 00:22:59,079 NORMAL GLUCOSE TOLERANCE, 675 00:22:59,079 --> 00:23:00,614 INDIVIDUALS HAVE TO UPREGULATE 676 00:23:00,614 --> 00:23:03,517 THEIR INSULIN SECRETION RELATIVE 677 00:23:03,517 --> 00:23:06,653 TO THE DEGREE OF INSULIN 678 00:23:06,653 --> 00:23:07,254 RESISTANCE. 679 00:23:07,254 --> 00:23:07,854 BUT ON THE OTHER HAND, EVEN 680 00:23:07,854 --> 00:23:10,457 THOUGH THERE IS THIS DEPENDENCY 681 00:23:10,457 --> 00:23:12,659 ON EXCESS WEIGHT, THERE HAS BEEN 682 00:23:12,659 --> 00:23:16,063 FOR THE PAST TWO DECADE STRONG 683 00:23:16,063 --> 00:23:18,031 LITERATURE SUGGESTING THAT 684 00:23:18,031 --> 00:23:20,300 THROUGH POTENTIAL BIOLOGICAL 685 00:23:20,300 --> 00:23:24,805 PATHWAYS, SLEEP AP FE APNEA MAYE 686 00:23:24,805 --> 00:23:25,772 INDEPENDENTLY LINKED TO 687 00:23:25,772 --> 00:23:28,308 IMPAIRMENTS IN GLUCOSE 688 00:23:28,308 --> 00:23:29,509 METABOLISM AND SYNTHETIC 689 00:23:29,509 --> 00:23:32,112 ACTIVATION HAS BEEN ONE OF THEM, 690 00:23:32,112 --> 00:23:34,881 ALTERED LIPID METABOLISMS HAVE 691 00:23:34,881 --> 00:23:36,416 ALSO BEEN STUDIED, INFLAMMATION 692 00:23:36,416 --> 00:23:37,184 AND OTHERS. 693 00:23:37,184 --> 00:23:42,089 SO ONE OTHER WAY TO LOOK AT THIS 694 00:23:42,089 --> 00:23:43,190 HETEROGENEITY IN TREATMENT 695 00:23:43,190 --> 00:23:45,492 RESPONSE IS POTENTIALLY TO STUDY 696 00:23:45,492 --> 00:23:50,030 YOUNG LEAN INDIVIDUALS AND WE 697 00:23:50,030 --> 00:23:50,731 DID THAT. 698 00:23:50,731 --> 00:23:52,366 THESE WERE YOUNG LEAN MEN WITH 699 00:23:52,366 --> 00:23:56,837 NO CARDIOBOLG DISEASE, AND CARDD 700 00:23:56,837 --> 00:23:58,905 CONTROLS WERE MATCHED FOR AGE, 701 00:23:58,905 --> 00:23:59,906 BMI AND DIABETES RISK. 702 00:23:59,906 --> 00:24:01,742 AND WHAT WE SAW WAS THAT THESE 703 00:24:01,742 --> 00:24:02,509 OTHERWISE HEALTHY INDIVIDUALS 704 00:24:02,509 --> 00:24:04,478 WITH NO CARDIOMETABOLIC DISEASE 705 00:24:04,478 --> 00:24:07,981 HAVE TO SECRETE 37% HIGHER 706 00:24:07,981 --> 00:24:11,818 INSULIN SECRETION TO MAINTAIN A 707 00:24:11,818 --> 00:24:13,120 SIMILAR LEVEL OF GLUCOSE 708 00:24:13,120 --> 00:24:15,989 TOLERANCE AND THEY BEHAVED AS IF 709 00:24:15,989 --> 00:24:19,126 THEY WERE OBESE NORMAL GLUCOSE 710 00:24:19,126 --> 00:24:20,227 TOLERANCE SUBJECTS WHEN WE 711 00:24:20,227 --> 00:24:23,296 CONSIDER THE TRAJECTORY, GLUCOSE 712 00:24:23,296 --> 00:24:24,731 TRAJECTORY INTO DEVELOPMENT OF 713 00:24:24,731 --> 00:24:26,600 TYPE 2 DIABETES. 714 00:24:26,600 --> 00:24:28,769 ANOTHER INTERESTING POPULATION 715 00:24:28,769 --> 00:24:29,770 AND A DISTINCT POPULATION THAT 716 00:24:29,770 --> 00:24:32,606 WE HAVE AN OPPORTUNITY TO STUDY 717 00:24:32,606 --> 00:24:35,442 ARE WOMEN WITH POLYCYSTIC 718 00:24:35,442 --> 00:24:36,543 OVARIAN SYNDROME. 719 00:24:36,543 --> 00:24:38,812 THESE ARE PERIMENOPAUSAL WOMEN 720 00:24:38,812 --> 00:24:42,516 WHO ARE HAVING HIGH TESTOSTERONE 721 00:24:42,516 --> 00:24:44,951 LEVELS, THEIR CHARACTERIZED BY 722 00:24:44,951 --> 00:24:47,788 OBESITY AND INSULIN RESISTANCE, 723 00:24:47,788 --> 00:24:50,323 AND SLEEP APNEA IS HIGHLY 724 00:24:50,323 --> 00:24:51,725 PREVALENT IN THIS POPULATION AND 725 00:24:51,725 --> 00:24:53,260 THE RISK OF SEVERITY OF SLEEP 726 00:24:53,260 --> 00:24:54,795 APNEA IS HIGHLY CORRELATED WITH 727 00:24:54,795 --> 00:24:55,328 METABOLIC IMPAIRMENTS. 728 00:24:55,328 --> 00:24:57,197 SO THEY HAVE AN EARLY ONSET 729 00:24:57,197 --> 00:24:58,899 DIABETES AND CARDIOVASCULAR 730 00:24:58,899 --> 00:24:59,332 RISK. 731 00:24:59,332 --> 00:25:00,834 WE STUDIED THIS POPULATION SOME 732 00:25:00,834 --> 00:25:03,236 YEARS AGO, AND TO MY KNOWLEDGE, 733 00:25:03,236 --> 00:25:04,771 THERE HAS NOT BEEN INTERVENTION 734 00:25:04,771 --> 00:25:07,708 STUDIES IN THIS POPULATION. 735 00:25:07,708 --> 00:25:09,776 ANOTHER POPULATION WE COULD 736 00:25:09,776 --> 00:25:13,080 LEARN FROM IS TYPE 1 DIABETES. 737 00:25:13,080 --> 00:25:16,349 WE NOW KNOW THAT SLEEP APNEA IS 738 00:25:16,349 --> 00:25:17,651 NOT JUST ABOUT TYPE 2 DIABETES 739 00:25:17,651 --> 00:25:21,254 BUT IT'S ALSO INCREASED IN 740 00:25:21,254 --> 00:25:22,589 PREVALENCE IN TYPE WITH AND IN 741 00:25:22,589 --> 00:25:24,124 THIS PARTICULAR STUDY, WE DID 742 00:25:24,124 --> 00:25:25,892 NOT ASSESS SLEEP APNEA BUT WE 743 00:25:25,892 --> 00:25:29,696 SAW WITH LARGE INTERAND 744 00:25:29,696 --> 00:25:30,697 INTRA-INDIVIDUAL VARIABILITY IN 745 00:25:30,697 --> 00:25:33,500 SLEEP AND GLYCEMIC 746 00:25:33,500 --> 00:25:35,602 CHARACTERISTICS IN REAL LIFE 747 00:25:35,602 --> 00:25:36,803 SETTINGS IN THESE PATIENTS. 748 00:25:36,803 --> 00:25:38,538 AND OBJECTIVELY MEASURED SLEEP 749 00:25:38,538 --> 00:25:41,508 QUALITY WAS ASSOCIATED WITH 750 00:25:41,508 --> 00:25:43,009 OVERNIGHT GLYCEMIC VARIABILITY 751 00:25:43,009 --> 00:25:46,546 AND YOU CAN APPRECIATE NIGHT 752 00:25:46,546 --> 00:25:48,515 WITH POOR SLEEP QUALITY SHOWED 753 00:25:48,515 --> 00:25:50,150 HIGHER GLYCEMIC VARIABILITY EVEN 754 00:25:50,150 --> 00:25:54,321 AT AN INDIVIDUAL PATIENT LEVEL. 755 00:25:54,321 --> 00:25:56,056 WE ALSO KNOW THAT INCREASED 756 00:25:56,056 --> 00:25:58,024 SYMPATHETIC ACTIVITY CAN WORSEN 757 00:25:58,024 --> 00:25:59,526 GLUCOSE CONTROL AND WE KNOW THAT 758 00:25:59,526 --> 00:26:02,162 SLEEP APNEA INCREASES 759 00:26:02,162 --> 00:26:04,798 SYMPATHETIC ACTIVITY, BOTH 760 00:26:04,798 --> 00:26:06,099 COMPARED TO LEAN AND OBESE 761 00:26:06,099 --> 00:26:07,667 CONTROL, BUT INTERESTINGLY, 762 00:26:07,667 --> 00:26:17,711 ALSO, WHEN WE DO CPAP WI WITH 763 00:26:17,711 --> 00:26:18,345 WITHDRAWRL, IMMEDIATELY AFTER 764 00:26:18,345 --> 00:26:20,347 THAT THERE IS INCREASED 765 00:26:20,347 --> 00:26:21,314 SYMPATHETIC ACTIVITY. 766 00:26:21,314 --> 00:26:23,083 INDEED SOME OF THE STUDIES 767 00:26:23,083 --> 00:26:24,251 RANDOMIZED CONTROL TRIALS HAVE 768 00:26:24,251 --> 00:26:25,619 SHOWN THAT EVEN AS LITTLE AS ONE 769 00:26:25,619 --> 00:26:27,654 NIGHT OF C PACK WITHDRAWAL CAN 770 00:26:27,654 --> 00:26:29,856 INCREASE NOCTURNAL GLUCOSE 771 00:26:29,856 --> 00:26:31,491 LEVEL, INCREASED FREE FATTY 772 00:26:31,491 --> 00:26:32,259 ACIDS AND CORTISOL. 773 00:26:32,259 --> 00:26:34,995 SO TO ADDRESS THIS QUESTION 774 00:26:34,995 --> 00:26:37,097 ABOUT CPAP USE TO IMPROVE 775 00:26:37,097 --> 00:26:38,899 METABOLIC OUTCOMES, WE FIRST 776 00:26:38,899 --> 00:26:42,869 CONDUCTED A PROOF OF CONCEPT 777 00:26:42,869 --> 00:26:44,838 STUDY, A RANDOMIZED CONTROL 778 00:26:44,838 --> 00:26:48,008 STUDY LED BY DR. PAMIDI AND WE 779 00:26:48,008 --> 00:26:49,976 STUDIED PREDIABETIC PATIENTS 780 00:26:49,976 --> 00:26:51,611 UNDER TWO CONDITIONS, IN AN 781 00:26:51,611 --> 00:26:52,946 UNTREATED CONDITION AND TREATED 782 00:26:52,946 --> 00:26:58,418 CONDITION, FOR TWO WEEKS, CPAP 783 00:26:58,418 --> 00:27:01,488 TREATMENT WAS ADMINISTERED AT 784 00:27:01,488 --> 00:27:04,257 NIGHT UNDER FULL SUPERVISION IN 785 00:27:04,257 --> 00:27:05,192 THE LABORATORY AND SUBJECTS WERE 786 00:27:05,192 --> 00:27:08,695 ALLOWED TO CONTINUE THEIR DAILY 787 00:27:08,695 --> 00:27:09,563 ACTIVITY DURING THE DAY. 788 00:27:09,563 --> 00:27:12,532 WHEN WE DID THIS, WE WERE ABLE 789 00:27:12,532 --> 00:27:14,601 TO, IF I MAY SAY THAT, TURN OFF 790 00:27:14,601 --> 00:27:18,872 THE DISEASE STATE AND NORMALIZE 791 00:27:18,872 --> 00:27:20,740 OSA SEVERITY INDICES IN THIS 792 00:27:20,740 --> 00:27:22,442 PARTICULAR STUDY, THE 793 00:27:22,442 --> 00:27:23,376 TRADITIONAL INDICES AT LEAST, 794 00:27:23,376 --> 00:27:25,412 AND WHAT WE SAW WAS IMPROVEMENT 795 00:27:25,412 --> 00:27:29,616 IN GLUCOSE LEVELS, INSULIN 796 00:27:29,616 --> 00:27:30,884 SENSITIVITY, AND SYMPATHETIC 797 00:27:30,884 --> 00:27:32,752 ACTIVITY AS MEASURED BY 798 00:27:32,752 --> 00:27:35,822 NOREPINEPHRINE LEVELS. 799 00:27:35,822 --> 00:27:37,657 IN A FOLLOW-UP APPLICATION WE 800 00:27:37,657 --> 00:27:39,860 ALSO SHOWED THAT CPAP TREATMENT 801 00:27:39,860 --> 00:27:42,696 REDUCES NOT ONLY NIGHTTIME 802 00:27:42,696 --> 00:27:44,464 RESTING HEART RATE LEVELS BUT 803 00:27:44,464 --> 00:27:45,565 ALSO DURING THE DAY TIME OVER 804 00:27:45,565 --> 00:27:47,067 THE COURSE OF TWO-WEEK 805 00:27:47,067 --> 00:27:50,036 TREATMENT, RESTING HEART RATE 806 00:27:50,036 --> 00:27:52,105 IMPROVED AFTER CPAP TREATMENT. 807 00:27:52,105 --> 00:27:56,376 AND WE KNOW THAT EVEN ONE BEAT 808 00:27:56,376 --> 00:27:57,477 OF INCREASE IN RESTING HEART 809 00:27:57,477 --> 00:27:59,980 RATE CAN INCREASE MORTALITY AND 810 00:27:59,980 --> 00:28:01,748 MORBIDITY, SO THERE IS A 811 00:28:01,748 --> 00:28:04,484 CARRYOVER EFFECT OF NIGHTTIME 812 00:28:04,484 --> 00:28:06,019 TREATMENT TO THE DAY TIME IN 813 00:28:06,019 --> 00:28:11,458 REAL LIFE SETTINGS. 814 00:28:11,458 --> 00:28:12,459 SIMILARLY, A RECENT PUBLICATION 815 00:28:12,459 --> 00:28:22,435 BY DR. REDLINE'S GROUP AND 816 00:28:22,435 --> 00:28:23,436 AZARBARZIN'S WORK HAS SHOWN THAT 817 00:28:23,436 --> 00:28:25,272 A GREATER PRE-TREATMENT DELTA HR 818 00:28:25,272 --> 00:28:26,339 METRIC IS ASSOCIATED WITH 819 00:28:26,339 --> 00:28:28,541 GREATER CPAP RELATED PROTECTION 820 00:28:28,541 --> 00:28:29,643 AGAINST ADVERSE CARDIOVASCULAR 821 00:28:29,643 --> 00:28:30,310 OUTCOMES. 822 00:28:30,310 --> 00:28:37,284 THIS IS DATA POST HOC A ANALYSIS 823 00:28:37,284 --> 00:28:38,485 FROM THE TRIAL. 824 00:28:38,485 --> 00:28:39,819 WE KNOW IT IS HIGHLY VARIABLE IN 825 00:28:39,819 --> 00:28:41,554 REAL LIFE, DEPENDING ON WHAT 826 00:28:41,554 --> 00:28:43,757 POPULATION YOU STUDY, THERE IS 827 00:28:43,757 --> 00:28:50,196 LESS RESPONSE IN TYPE 2 DIAB 828 00:28:50,196 --> 00:28:52,265 2 DIABETICS, THERE IS CONSENSUS 829 00:28:52,265 --> 00:28:53,466 ON IMPROVEMENT IN INSULIN 830 00:28:53,466 --> 00:28:54,467 RESISTANCE IN PERSONS WITHOUT 831 00:28:54,467 --> 00:28:59,706 DIABETES, BUT ALSO RECENT TRIALS 832 00:28:59,706 --> 00:29:01,574 LIKE SAVE STUDY, WHERE WE 833 00:29:01,574 --> 00:29:03,743 INCLUDE PATIENTS WITH CO-MORBID 834 00:29:03,743 --> 00:29:07,480 CARDIOVASCULAR DISEASE, FOUND NO 835 00:29:07,480 --> 00:29:09,115 OVERALL EFFECT ON PREDIABETES OR 836 00:29:09,115 --> 00:29:11,184 DIABETES OUTCOMES AS MEASURED BY 837 00:29:11,184 --> 00:29:15,322 PLASMA GLUCOSE OR A1C, BUT THERE 838 00:29:15,322 --> 00:29:16,456 WAS SOME SIGNAL INTERESTINGLY 839 00:29:16,456 --> 00:29:18,658 FOR A PROTECTIVE ROLE OF CPAP IN 840 00:29:18,658 --> 00:29:19,426 WOMEN WITH DIABETES. 841 00:29:19,426 --> 00:29:23,363 AND THEN WE HEARD ABOUT THE 842 00:29:23,363 --> 00:29:25,765 HYPNOS TRIAL, ALSO OVERALL NO 843 00:29:25,765 --> 00:29:28,368 EFFECT BUT CPAP MAY IMPROVE 844 00:29:28,368 --> 00:29:29,135 GLYCEMIC VARIABILITY IN WOMEN. 845 00:29:29,135 --> 00:29:31,338 SO WHY IN THE REAL WORLD THERE 846 00:29:31,338 --> 00:29:35,075 IS A LOW OR NO CPAP ADHERENCE, 847 00:29:35,075 --> 00:29:39,879 THIS LARGE FRENCH STUDY LOOKED 848 00:29:39,879 --> 00:29:43,616 AT ALMOST 500,000 PATIENTS FROM 849 00:29:43,616 --> 00:29:45,352 THE DATABASE, AND FOUND THAT 850 00:29:45,352 --> 00:29:47,887 CPAP TERMINATION RATE WAS ABOUT 851 00:29:47,887 --> 00:29:50,390 48% AT THREE YEARS. 852 00:29:50,390 --> 00:29:55,128 BUT THE DEFINITION OF CPAP 853 00:29:55,128 --> 00:29:55,929 TERMINATION, I WOULD LIKE TO 854 00:29:55,929 --> 00:30:00,266 POINT OUT, WAS BASED ON CPAP 855 00:30:00,266 --> 00:30:01,668 REVERSEMENTS AND TRIGGERED BY 856 00:30:01,668 --> 00:30:03,236 THE RESPIRATORY PHYSICIAN OR 857 00:30:03,236 --> 00:30:04,971 SLEEP SPECIALIST USING A CPAP 858 00:30:04,971 --> 00:30:07,507 USAGE OF LESS THAN FOUR HOURS 859 00:30:07,507 --> 00:30:09,909 PER NIGHT OR VERY LOW USAGE OR 860 00:30:09,909 --> 00:30:10,777 NO PERCEIVED BENEFIT. 861 00:30:10,777 --> 00:30:12,412 SO I THINK I WOULD LIKE TO AT 862 00:30:12,412 --> 00:30:16,249 LEAST PROPOSE A MISSING LINK 863 00:30:16,249 --> 00:30:18,418 HERE, AND THIS IS HOW WE DEFINE 864 00:30:18,418 --> 00:30:19,753 CPAP TREATMENT ADHERENCE. 865 00:30:19,753 --> 00:30:22,022 WHAT IS THE OPTIMAL NIGHT LEIDOS 866 00:30:22,022 --> 00:30:23,356 FOR AN INDIVIDUAL PATIENT, AND 867 00:30:23,356 --> 00:30:26,326 WHAT IS THE GOAL FOR CPAP 868 00:30:26,326 --> 00:30:26,760 SUCCESS? 869 00:30:26,760 --> 00:30:29,696 I'M GOING TO GIVE YOU A COMMON 870 00:30:29,696 --> 00:30:30,130 CLINICAL SCENARIO. 871 00:30:30,130 --> 00:30:31,297 A PATIENT COMES IN AND SAYS HOW 872 00:30:31,297 --> 00:30:32,866 MUCH DO I NEED TO USE THE CPAP 873 00:30:32,866 --> 00:30:35,935 MACHINE TO GET BETTER, DOCTOR? 874 00:30:35,935 --> 00:30:37,937 AND THE PROVIDER SAYS, THE MORE 875 00:30:37,937 --> 00:30:39,773 YOU USE THE BETTER. 876 00:30:39,773 --> 00:30:41,875 ACTUALLY IF YOU DON'T USE IT, AT 877 00:30:41,875 --> 00:30:43,076 LEAST FOUR HOURS PER NIGHT, THEY 878 00:30:43,076 --> 00:30:46,146 WILL TAKE YOUR MACHINE AWAY. 879 00:30:46,146 --> 00:30:47,547 THIS ADVICE IS BASED OND 880 00:30:47,547 --> 00:30:49,849 MEDICARE CRITERIA, CPAP WEAR 881 00:30:49,849 --> 00:30:53,553 TIME GREATER THAN FOUR HOURS PER 882 00:30:53,553 --> 00:30:55,188 NIGHT, IS CONSIDERED AS 883 00:30:55,188 --> 00:30:57,390 ADHERENT, AND THE PATIENT COMES 884 00:30:57,390 --> 00:30:59,159 BACK AND SAYS, YOU KEEP TELLING 885 00:30:59,159 --> 00:31:00,260 ME I SHOULD USE THIS MACHINE 886 00:31:00,260 --> 00:31:02,529 MORE, DOCTOR, BUT I WEAR MY MASK 887 00:31:02,529 --> 00:31:03,663 ALL NIGHT EVERY NIGHT. 888 00:31:03,663 --> 00:31:07,067 THIS IS JUST HOW I SLEEP, YOU 889 00:31:07,067 --> 00:31:10,537 KNOW? 890 00:31:10,537 --> 00:31:12,205 PATIENTS' HABITUAL SLEEP 891 00:31:12,205 --> 00:31:13,039 PATTERNS CAN BE VARIABLE FROM 892 00:31:13,039 --> 00:31:14,274 NIGHT TO NIGHT AND THIS IS 893 00:31:14,274 --> 00:31:14,941 HIGHLY LIKELY HERE. 894 00:31:14,941 --> 00:31:16,676 SO THIS PATIENT WAS NOT GIVEN A 895 00:31:16,676 --> 00:31:18,912 CLEAR CPAP SUCCESS GOAL, AND 896 00:31:18,912 --> 00:31:20,547 THIS PATIENT'S CPAP TREATMENT IS 897 00:31:20,547 --> 00:31:22,182 NOT TAILORED OR PERSONALIZED TO 898 00:31:22,182 --> 00:31:25,552 THEIR NIGHTLY SLEEP PATTERNS. 899 00:31:25,552 --> 00:31:27,120 AND WE KNOW FROM LARGE 900 00:31:27,120 --> 00:31:28,288 LITERATURE THAT SLEEP PATTERNS 901 00:31:28,288 --> 00:31:34,661 ARE HIGHLY VARIABLE NOT ONLY 902 00:31:34,661 --> 00:31:35,662 NIGHT TO NIGHT BUT ALSO PERSON 903 00:31:35,662 --> 00:31:35,995 TO PERSON. 904 00:31:35,995 --> 00:31:38,531 THIS IS LARGE POPULATION DATA 905 00:31:38,531 --> 00:31:41,367 WITH VARIABLES OF OVER 120,000 906 00:31:41,367 --> 00:31:42,535 INDIVIDUALS WITH UP TO TWO YEARS 907 00:31:42,535 --> 00:31:43,103 OBJECTIVE SLEEP MONITORING. 908 00:31:43,103 --> 00:31:45,071 AS YOU CAN SEE THOUGH EVEN MEAN 909 00:31:45,071 --> 00:31:46,172 SLEEP DURATIONS ARE SIMILAR IN 910 00:31:46,172 --> 00:31:50,477 DIFFERENT PERSONS, THEIR SLEEP 911 00:31:50,477 --> 00:31:52,545 PATTERNS ARE HIGHLY VARIABLE. 912 00:31:52,545 --> 00:31:56,149 THIS IS CLINICAL KAYDAY DATA ONL 913 00:31:56,149 --> 00:32:02,489 THAT IS ONGOING ON NIGHT TO 914 00:32:02,489 --> 00:32:04,457 NIGHT VARIABILITY IN TIME IN BED 915 00:32:04,457 --> 00:32:07,293 OVER FIVE TO SIX MONTH PERIOD IN 916 00:32:07,293 --> 00:32:07,927 DIFFERENT SLEEP APNEA PATIENTS 917 00:32:07,927 --> 00:32:10,563 AND YOU CAN APPRECIATE THE 918 00:32:10,563 --> 00:32:11,564 VARIABILITY IN SLEEP PATTERNS. 919 00:32:11,564 --> 00:32:13,199 SO WE WOULD LIKE TO PROPOSE AND 920 00:32:13,199 --> 00:32:15,635 WE DEVELOPED A NEW CPAP 921 00:32:15,635 --> 00:32:17,804 ADHERENCE METRIC WHICH I CALL 922 00:32:17,804 --> 00:32:19,873 PERCENT CPAP ADHERENCE, AND THIS 923 00:32:19,873 --> 00:32:22,509 IS GOING BACK TO PUNJABI'S TALK, 924 00:32:22,509 --> 00:32:24,611 A NEW SORT OF SIMPLICITY, A NEW 925 00:32:24,611 --> 00:32:26,546 SIMPLE DIGITAL TOOL TOWARDS 926 00:32:26,546 --> 00:32:29,716 POTENTIALLY PERSONALIZED OSA 927 00:32:29,716 --> 00:32:29,916 CARE. 928 00:32:29,916 --> 00:32:31,918 THIS WAS, I WOULD LIKE TO POINT 929 00:32:31,918 --> 00:32:33,353 OUT, A USER CENTERED DESIGN 930 00:32:33,353 --> 00:32:34,854 MEANING THAT PATIENTS THEMSELVES 931 00:32:34,854 --> 00:32:38,358 HELPED US DEVELOP THIS TOOL, 932 00:32:38,358 --> 00:32:40,994 THIS IS AND APP AND WE ALSO HAVE 933 00:32:40,994 --> 00:32:42,762 A DASHBOARD, BUT IMPORTANTLY IT 934 00:32:42,762 --> 00:32:43,630 PROVIDES PATIENTS TO HAVE A 935 00:32:43,630 --> 00:32:49,002 CLEAR GOAL, 100% ADHERENCE, AND 936 00:32:49,002 --> 00:32:51,771 IT INTEGRATES THROUGH VARIABLES 937 00:32:51,771 --> 00:32:53,039 THE TIME IN BED INFORMATION AND 938 00:32:53,039 --> 00:32:55,575 THE THERAPY IS -- THERAPY 939 00:32:55,575 --> 00:32:56,643 SUCCESS THAT THE PATIENTS ARE 940 00:32:56,643 --> 00:32:58,211 LOOKING AT EVERY MORNING ON 941 00:32:58,211 --> 00:33:01,347 THEIR APP IS TAILORED NIGHT BY 942 00:33:01,347 --> 00:33:02,916 NIGHT AND FOLLOWS THEIR NIGHTLY 943 00:33:02,916 --> 00:33:03,583 SLEEP PATTERNS. 944 00:33:03,583 --> 00:33:06,186 IN THIS PARTICULAR CASE, FOR 945 00:33:06,186 --> 00:33:08,388 EXAMPLE, ACTUAL CPAP SUCCESS WAS 946 00:33:08,388 --> 00:33:10,256 ONLY 51% BECAUSE THE PATIENT 947 00:33:10,256 --> 00:33:11,991 SPENT TIME IN BED FOR EIGHT 948 00:33:11,991 --> 00:33:14,294 HOURS, AND THESE ARE FROM LAST 949 00:33:14,294 --> 00:33:16,496 WEEK, I BELIEVE, FROM A PATIENT 950 00:33:16,496 --> 00:33:18,798 WHO'S IN OUR TRIAL. 951 00:33:18,798 --> 00:33:20,567 AS YOU CAN SEE THE PATIENT IS 952 00:33:20,567 --> 00:33:25,939 100% ADHERENT TO CPAP DESPITE 953 00:33:25,939 --> 00:33:27,273 VARIABLE MASK ON DURATION, WHICH 954 00:33:27,273 --> 00:33:29,542 CURRENTLY WE ARE BASING ALL OUR 955 00:33:29,542 --> 00:33:32,612 ADHERENCE TREATMENT CRITERIA, 956 00:33:32,612 --> 00:33:34,347 ONE NIGHT THE TIME IN BED WAS 957 00:33:34,347 --> 00:33:35,515 FIVE HOURS 35 MINUTES AND THE 958 00:33:35,515 --> 00:33:37,250 OTHER NIGHT THE TIME IN BED WAS 959 00:33:37,250 --> 00:33:38,785 7 HOURS AND 46 MINUTES. 960 00:33:38,785 --> 00:33:41,221 SO THIS MISSING LINK, I THINK 961 00:33:41,221 --> 00:33:43,289 THAT OUR CURRENT DEFINITION OF 962 00:33:43,289 --> 00:33:45,158 FOUR HOUR CPAP MASK WEAR IS IN 963 00:33:45,158 --> 00:33:48,661 MY OPINION ARBITRARY AND COULD 964 00:33:48,661 --> 00:33:49,762 BE HIGHLY MISLEADING AND COULD 965 00:33:49,762 --> 00:33:52,365 BE A FACTOR IN EXPLAINING 966 00:33:52,365 --> 00:33:54,467 VARIABILITY IN TREATMENT 967 00:33:54,467 --> 00:33:55,768 RESPONSE. 968 00:33:55,768 --> 00:33:56,869 FOR EXAMPLE, WE CAN LOOK AT 969 00:33:56,869 --> 00:34:00,940 THESE TWO PATIENTS AND BECAUSE 970 00:34:00,940 --> 00:34:04,777 THIS PATIENT DID NOT USE THEIR 971 00:34:04,777 --> 00:34:08,147 MACHINE FOUR HOURS OR MORE, THEY 972 00:34:08,147 --> 00:34:11,451 COULD BE CONSIDERED AS NOT 973 00:34:11,451 --> 00:34:12,585 ADHERENT PER CERTAIN CRITERIA 974 00:34:12,585 --> 00:34:15,922 BUT THEY ARE USING IT 93% OF 975 00:34:15,922 --> 00:34:17,457 TIME THEY SPEND IN BED AND VICE 976 00:34:17,457 --> 00:34:17,790 VERSA. 977 00:34:17,790 --> 00:34:21,861 SO I THINK THAT THERE IS ALSO AN 978 00:34:21,861 --> 00:34:24,597 IMPORTANT IMPLICATION ON HEALTH 979 00:34:24,597 --> 00:34:25,798 EQUITY BECAUSE PEOPLE'S SLEEP 980 00:34:25,798 --> 00:34:27,867 TIMES MAY VARY, ESPECIALLY GIVEN 981 00:34:27,867 --> 00:34:29,969 THE KNOWN RACIAL/ETHNIC AND 982 00:34:29,969 --> 00:34:30,970 SOCIOECONOMIC DIFFERENCES IN 983 00:34:30,970 --> 00:34:34,574 SLEEP PATTERNS. 984 00:34:34,574 --> 00:34:39,178 AND IN SUPPORT OF THIS IDEA OR 985 00:34:39,178 --> 00:34:41,514 NOTION, OR METRIC, THERE HAS 986 00:34:41,514 --> 00:34:44,751 BEEN A VERY LARGE DATA PUBLISHED 987 00:34:44,751 --> 00:34:47,487 SHOWING A DOSE-RESPONSE 988 00:34:47,487 --> 00:34:49,689 RELATIONSHIP BETWEEN CPAP USAGE 989 00:34:49,689 --> 00:34:50,790 AND HEALTHCARE UTILIZATION IN 990 00:34:50,790 --> 00:34:53,192 THIS CASE HOSPITALIZATION AND 991 00:34:53,192 --> 00:34:54,727 EMERGENCY ROOM VISIT. 992 00:34:54,727 --> 00:34:56,696 WITH BENEFITS SEEN EVEN WHEN 993 00:34:56,696 --> 00:34:58,898 USAGE WAS AS LOW AS ONE TO TWO 994 00:34:58,898 --> 00:35:02,335 HOURS PER NIGHT. 995 00:35:02,335 --> 00:35:03,870 SO HOW ABOUT, AGAIN, GOING BACK 996 00:35:03,870 --> 00:35:07,273 TO SIMPLICITY APPROACH, WE HAVE 997 00:35:07,273 --> 00:35:08,708 ALL THESE DETAILED METRICS BUT 998 00:35:08,708 --> 00:35:12,745 HOW ABOUT SIMPLY RESTORING SLEEP 999 00:35:12,745 --> 00:35:15,381 QUALITY, WHAT HAPPENS TO SLOW 1000 00:35:15,381 --> 00:35:16,949 WAVE SLEEP, FOR EXAMPLE, ONE CAN 1001 00:35:16,949 --> 00:35:22,288 ALSO TALK ABOUT RM ABOUT REM SLT 1002 00:35:22,288 --> 00:35:24,157 I'M TAKING THE SLOW WAVE SLEEP 1003 00:35:24,157 --> 00:35:25,792 AS AN EXAMPLE HERE. 1004 00:35:25,792 --> 00:35:34,100 WE KNOW MANY OF US THAT PATIENTS 1005 00:35:34,100 --> 00:35:35,668 MAY NOT GET SLOW WAVE SLEEP AND 1006 00:35:35,668 --> 00:35:37,170 THEY RECOVER THEIR SLOW WAVE 1007 00:35:37,170 --> 00:35:38,838 SLEEP WITH CPAP THERAPY OR SLOW 1008 00:35:38,838 --> 00:35:40,473 WAVE ACTIVITY LEVELS AND SOME 1009 00:35:40,473 --> 00:35:42,141 PATIENTS MAY EVEN HAVE SLOW WAVE 1010 00:35:42,141 --> 00:35:43,443 ACTIVITY AT BASELINE AND EVEN 1011 00:35:43,443 --> 00:35:47,814 OUR FELLOWS KNOW THAT SLEEP 1012 00:35:47,814 --> 00:35:49,916 APNEA DURING SLOW WAVE, IF 1013 00:35:49,916 --> 00:35:53,853 ANYTHING, IS CURED AT THAT TIME. 1014 00:35:53,853 --> 00:35:55,922 SO WE ALSO KNOW THAT SLOW WAVE 1015 00:35:55,922 --> 00:35:58,124 SLEEP PLAYS AN IMPORTANT ROLE IN 1016 00:35:58,124 --> 00:36:02,295 GLUCOSE HOMEOSTASIS AND FUTURE 1017 00:36:02,295 --> 00:36:02,829 DIABETES RISK. 1018 00:36:02,829 --> 00:36:07,133 THIS IS LARGE PO POPULATION BASD 1019 00:36:07,133 --> 00:36:08,334 DATA THAT WAS PUBLISHED TO 1020 00:36:08,334 --> 00:36:09,969 SUGGEST THAT SLOW WAVE SLEEP 1021 00:36:09,969 --> 00:36:11,270 PREDICTS NEXT DAY GLUCOSE 1022 00:36:11,270 --> 00:36:13,373 REGULATION, AND OUR EXPERIMENTAL 1023 00:36:13,373 --> 00:36:16,642 DATA, AND DR. PUNJABI'S GROUP 1024 00:36:16,642 --> 00:36:18,878 PUBLISHED SIMILAR RESULTS THAT 1025 00:36:18,878 --> 00:36:19,946 IF YOU WERE TO SUPPRESS SLOW 1026 00:36:19,946 --> 00:36:25,518 WAVE SLEEP USING GLUCOSE 1027 00:36:25,518 --> 00:36:28,388 STIMULIIZATION, THAT WOULD 1028 00:36:28,388 --> 00:36:30,790 IMPAIR GLUCOSE ME TAB LIIZATION. 1029 00:36:30,790 --> 00:36:32,658 SUPPRESSION OF SLOW WAVE SLEEP 1030 00:36:32,658 --> 00:36:34,427 AND HYPOXEMIA COULD EXPLAIN 1031 00:36:34,427 --> 00:36:39,098 IMPAIRMENTS IN FREE FATTY ACID 1032 00:36:39,098 --> 00:36:39,899 METABOLISM IN SLEEP APNEA AND AS 1033 00:36:39,899 --> 00:36:43,069 YOU CAN SEE THAT IF SLOW WAVE 1034 00:36:43,069 --> 00:36:47,340 SLEEP IS PRESERVED, THERE IS 1035 00:36:47,340 --> 00:36:48,775 BETTER SUPPRESSION OF FREE FATTY 1036 00:36:48,775 --> 00:36:52,145 ACID METABOLISM SO LESS 1037 00:36:52,145 --> 00:36:53,813 DOWNSTREAM EFFECTS ON INSULIN 1038 00:36:53,813 --> 00:36:56,416 RESISTANCE IN THIS CASE. 1039 00:36:56,416 --> 00:36:59,385 AND WE ALSO HAVE VERY RECENT 1040 00:36:59,385 --> 00:37:01,587 DATA PUBLISHED IN HYPERTENSION 1041 00:37:01,587 --> 00:37:03,423 OF ABOUT 7,000 PATIENTS WITH 1042 00:37:03,423 --> 00:37:07,093 SLEEP APNEA HAS BEEN STUDIED, 1043 00:37:07,093 --> 00:37:09,228 AND WHAT THIS STUDY HAVE SHOWED 1044 00:37:09,228 --> 00:37:10,763 THAT DECREASED SLOW WAVE SLEEP 1045 00:37:10,763 --> 00:37:12,565 IS ASSOCIATED WITH A DOSE 1046 00:37:12,565 --> 00:37:15,368 DEPENDENT INCREASE IN ODDS OF 1047 00:37:15,368 --> 00:37:17,870 PREVALENT HYPERTENSION IN SLEEP 1048 00:37:17,870 --> 00:37:19,105 APNEA. 1049 00:37:19,105 --> 00:37:20,440 SO THOSE PATIENTS WHO PRESERVE 1050 00:37:20,440 --> 00:37:21,741 THEIR SLOW WAVE SLEEP AT 1051 00:37:21,741 --> 00:37:25,478 BASELINE HAD LESS LIKELIHOOD OF 1052 00:37:25,478 --> 00:37:27,880 BEING HYPERTENSIVE LATER. 1053 00:37:27,880 --> 00:37:29,081 SO WHETHER PRESERVATION OF SLOW 1054 00:37:29,081 --> 00:37:30,783 WAVE SLEEP AT BASELINE OR 1055 00:37:30,783 --> 00:37:32,285 RECOVERY FROM SLOW WAVE SLEEP 1056 00:37:32,285 --> 00:37:35,421 AFTER TREATMENT MAY EXPLAIN THE 1057 00:37:35,421 --> 00:37:36,889 VARIABILITY IN RESPONSE TO 1058 00:37:36,889 --> 00:37:38,157 TREATMENT IS ANOTHER RESEARCH 1059 00:37:38,157 --> 00:37:39,759 QUESTION. 1060 00:37:39,759 --> 00:37:45,131 AGAIN, WE HAVE MO MORE PROSPECTE 1061 00:37:45,131 --> 00:37:47,200 DATA FOR THE PROTECTIVE ROLE OF 1062 00:37:47,200 --> 00:37:50,703 SLOW WAVE SLEEP IN DIABETES AND 1063 00:37:50,703 --> 00:37:52,038 HYPERTENSION. 1064 00:37:52,038 --> 00:37:56,776 THIS IS OUR DATA FROM THE COHORT 1065 00:37:56,776 --> 00:37:58,311 FROM OUTCOMES OF SLEEP DISORDERS 1066 00:37:58,311 --> 00:37:59,712 IN OLDER MEN, BOTH SHOWING THAT 1067 00:37:59,712 --> 00:38:01,113 IF SLOW WAVE SLEEP IS PRESERVED, 1068 00:38:01,113 --> 00:38:02,682 THERE COULD BE LESS LIKELIHOOD 1069 00:38:02,682 --> 00:38:06,853 OF DIABETES OR HYPERTENSION. 1070 00:38:06,853 --> 00:38:08,921 AND I WOULD LIKE TO ALSO -- THIS 1071 00:38:08,921 --> 00:38:10,590 HAS BEEN MENTIONED SEVERAL 1072 00:38:10,590 --> 00:38:12,425 TIMES, IS IT ALL ABOUT SLEEP 1073 00:38:12,425 --> 00:38:14,961 APNEA, IS IT ALL ABOUT RESTORING 1074 00:38:14,961 --> 00:38:19,165 SLEEP QUALITY WITH OUR THERAPIES 1075 00:38:19,165 --> 00:38:21,434 IN SLEEP APNEA, I THINK I WOULD 1076 00:38:21,434 --> 00:38:23,169 ARGUE THAT INCORPORATING OTHER 1077 00:38:23,169 --> 00:38:24,537 SLEEP INTERVENTIONS IS A BETTER 1078 00:38:24,537 --> 00:38:27,707 WAY TO PERSONALIZE BEYOND OSA 1079 00:38:27,707 --> 00:38:28,341 TREATMENT BECAUSE WE KNOW THAT 1080 00:38:28,341 --> 00:38:30,343 THERE ARE FACTORS SUCH AS SLEEP 1081 00:38:30,343 --> 00:38:31,944 DURATION, SLEEP REGULARITY, 1082 00:38:31,944 --> 00:38:35,581 SLEEP TIMING AND CIRCADIAN 1083 00:38:35,581 --> 00:38:39,185 FACTORS THAT ARE ALL EQUALLY 1084 00:38:39,185 --> 00:38:39,952 IMPORTANT. 1085 00:38:39,952 --> 00:38:42,955 WITH THAT, WE HAVE PUBLISHED A 1086 00:38:42,955 --> 00:38:46,893 RANDOMIZED CONTROL TRIAL, 1087 00:38:46,893 --> 00:38:50,029 RESULTS FROM LOOKING AT THE 1088 00:38:50,029 --> 00:38:55,434 EFFECTS OF SLEEP EXTENSION ON 1089 00:38:55,434 --> 00:38:56,636 OBJECTIVELY ASSESSED ENERGY 1090 00:38:56,636 --> 00:38:58,371 INTAKE AMONG ADULTS WITH 1091 00:38:58,371 --> 00:38:59,171 OVERWEIGHT IN REAL LIFE 1092 00:38:59,171 --> 00:39:00,473 SETTINGS, AND WHAT WE WERE ABLE 1093 00:39:00,473 --> 00:39:02,575 TO SHOW THAT IF YOU CAN OPTIMIZE 1094 00:39:02,575 --> 00:39:05,211 SLEEP DURATION AND AS YOU CAN 1095 00:39:05,211 --> 00:39:06,546 PLEESHT THERE'S INDIVIDUAL 1096 00:39:06,546 --> 00:39:07,813 VARIABILITY, THEN WOULD YOU 1097 00:39:07,813 --> 00:39:10,449 DECREASE CLORK INTALK BY ABOUT 1098 00:39:10,449 --> 00:39:11,784 270 CAN I LOW CALORIES PER DAY, 1099 00:39:11,784 --> 00:39:14,754 AND THIS IS HIGHLY CLINICALLY 1100 00:39:14,754 --> 00:39:16,355 MEANINGFUL BECAUSE AS LITTLE AS 1101 00:39:16,355 --> 00:39:18,057 100 CAN I LOW CALORIES PER DAY 1102 00:39:18,057 --> 00:39:19,292 CAN INCREASE THE RISK FOR WEIGHT 1103 00:39:19,292 --> 00:39:19,792 GAIN. 1104 00:39:19,792 --> 00:39:22,361 WHAT I'M VERY EXCITED ABOUT, 1105 00:39:22,361 --> 00:39:23,462 THAT THIS STUDY WAS WELL 1106 00:39:23,462 --> 00:39:25,298 RECEIVED BY PEOPLE AROUND THE 1107 00:39:25,298 --> 00:39:26,866 GLOBE AND THE LAST SOCIAL MEDIA 1108 00:39:26,866 --> 00:39:28,134 POST FROM THIS STUDY THAT WAS 1109 00:39:28,134 --> 00:39:31,370 PUB LIRKED TWO YEARS AGO WAS 1110 00:39:31,370 --> 00:39:33,639 JUST LAST MONTH ON OCTOBER 21ST. 1111 00:39:33,639 --> 00:39:39,045 GIVEN THE SUCCESS AND INTEREST 1112 00:39:39,045 --> 00:39:42,214 IN THESE INTERESTING FINDINGS, 1113 00:39:42,214 --> 00:39:47,019 WE ARE NOW CONDUCTING A 1114 00:39:47,019 --> 00:39:48,287 RANDOMIZED CONTROLLED TRIAL TO 1115 00:39:48,287 --> 00:39:50,523 REALLY INCORPORATE OPTIMAL SLEEP 1116 00:39:50,523 --> 00:39:51,924 DURATION TO WEIGHT LOSS 1117 00:39:51,924 --> 00:39:53,659 INTERVENTIONS WITH HEALTHY DIET 1118 00:39:53,659 --> 00:39:55,127 AND PHYSICAL ACTIVITY. 1119 00:39:55,127 --> 00:39:57,063 THIS PARTICULAR STUDY ALSO USES 1120 00:39:57,063 --> 00:39:59,365 PERSONALIZED SLEEP INTERVENTION 1121 00:39:59,365 --> 00:40:01,567 TOOLS AND MHEALTH TECHNOLOGY 1122 00:40:01,567 --> 00:40:06,072 WITH HEALTH COACHING TO PROMOTE 1123 00:40:06,072 --> 00:40:08,474 WASTE LOSS AND IMPROVE CARDIOMED 1124 00:40:08,474 --> 00:40:12,445 METH BOLG HEALTH. 1125 00:40:12,445 --> 00:40:13,112 CARDIOMETABOLIC HEALTH. 1126 00:40:13,112 --> 00:40:14,647 SO KNOWING THE ENERGY BALANCE 1127 00:40:14,647 --> 00:40:18,451 MODEL OF OBESITY, WE KNOW THAT 1128 00:40:18,451 --> 00:40:19,819 IT IS -- COMPLEX BODY WEIGHT IS 1129 00:40:19,819 --> 00:40:21,887 REGULATED BY VARIOUS FACTORS, 1130 00:40:21,887 --> 00:40:24,624 WE'RE GOING TO HEAR MORE ABOUT 1131 00:40:24,624 --> 00:40:25,524 POTENTIALLY WEIGHT LOSS 1132 00:40:25,524 --> 00:40:26,392 TREATMENTS, PHARMACOLOGY 1133 00:40:26,392 --> 00:40:27,093 TREATMENTS FOR SLEEP APNEA IN 1134 00:40:27,093 --> 00:40:32,098 THE LATER TALKS, BUT IF I MAY 1135 00:40:32,098 --> 00:40:33,766 PROPOSE, I WOULD PROPOSE HEALTHY 1136 00:40:33,766 --> 00:40:36,602 SLEEP AS A NEW A APPETITE 1137 00:40:36,602 --> 00:40:37,303 SUPPRESSANT. 1138 00:40:37,303 --> 00:40:38,237 WE KNOW OVER THE PAST TWO 1139 00:40:38,237 --> 00:40:39,705 DECADES THAT SLEEP DEPRIVATION 1140 00:40:39,705 --> 00:40:41,774 INCREASES HUNGER, INCREASES 1141 00:40:41,774 --> 00:40:44,043 APPETITE THROUGH TWO MECHANISMS, 1142 00:40:44,043 --> 00:40:45,277 BOTH HOMEOSTATIC MECHANISMS 1143 00:40:45,277 --> 00:40:49,348 THROUGH HORMONES SUCH AS GR GHRN 1144 00:40:49,348 --> 00:40:51,083 AND ALSO REWARD MECHANISMS WHICH 1145 00:40:51,083 --> 00:40:52,652 HAS BEEN SHOWN TO BE ACTIVATED 1146 00:40:52,652 --> 00:40:54,286 WITH SLEEP DEPRIVATION AND 1147 00:40:54,286 --> 00:40:55,021 IMAGES STUDIES. 1148 00:40:55,021 --> 00:40:56,956 SO WHEN WE LOOK AT MATHEMATICAL 1149 00:40:56,956 --> 00:40:59,291 MODELING OF ENERGY BALANCE 1150 00:40:59,291 --> 00:41:01,560 DYNAMICS, WE KNOW THAT INCREASED 1151 00:41:01,560 --> 00:41:03,429 APPETITE PLAYS A GREATER ROLE 1152 00:41:03,429 --> 00:41:05,164 THAN DECREASED ENERGY 1153 00:41:05,164 --> 00:41:05,898 EXPENDITURE. 1154 00:41:05,898 --> 00:41:09,669 AND WE KNOW THAT DURING WEIGHT 1155 00:41:09,669 --> 00:41:11,704 LOSS, THERE IS A PERSISTENT 1156 00:41:11,704 --> 00:41:13,172 EFFORT NEEDED TO OVERCOME THE 1157 00:41:13,172 --> 00:41:14,507 INCREASE IN APPETITE. 1158 00:41:14,507 --> 00:41:15,908 THIS HAS BEEN IN THIS PARTICULAR 1159 00:41:15,908 --> 00:41:17,476 MODELING QUANTIFIED TO BE ABOUT 1160 00:41:17,476 --> 00:41:27,353 95 CA95 CAN I95 KILL 95KILOCALO. 1161 00:41:27,353 --> 00:41:29,422 >> ESRA, I WANT TO INTERJECT, 1162 00:41:29,422 --> 00:41:30,322 YOU'RE GETTING CLOSE TO TIME. 1163 00:41:30,322 --> 00:41:31,123 >> SURE. 1164 00:41:31,123 --> 00:41:34,493 LAST TWO SLIDES. 1165 00:41:34,493 --> 00:41:36,028 WE KNOW THAT AMERICAN HEART 1166 00:41:36,028 --> 00:41:37,263 ASSOCIATION, ACTUALLY WE WERE 1167 00:41:37,263 --> 00:41:38,798 ALL EXCITED THAT AMERICAN HEART 1168 00:41:38,798 --> 00:41:41,867 ASSOCIATION ADDED SLEEP TO 1169 00:41:41,867 --> 00:41:44,904 CARDIOVASCULAR HEALTH METRICS. 1170 00:41:44,904 --> 00:41:47,373 WE ALSO ARE VERY EXCITED THAT 1171 00:41:47,373 --> 00:41:48,240 AMERICAN DIABETES ASSOCIATION 1172 00:41:48,240 --> 00:41:49,442 ADDED SLEEP ASSESSMENT AS PART 1173 00:41:49,442 --> 00:41:50,643 OF PRECISION MEDICINE. 1174 00:41:50,643 --> 00:41:52,278 I THINK THAT WE HAVE AN 1175 00:41:52,278 --> 00:41:54,580 IMPORTANT RESPONSIBILITY HERE TO 1176 00:41:54,580 --> 00:41:57,216 INFORM THESE COMMUNITIES ON HOW 1177 00:41:57,216 --> 00:42:00,920 THAT WE CAN PERSONALIZE SLEEP 1178 00:42:00,920 --> 00:42:01,487 HEALTH. 1179 00:42:01,487 --> 00:42:03,856 I WILL SKIP THAT AND IN TERMS OF 1180 00:42:03,856 --> 00:42:05,891 RESEARCH GAPS AND OPPORTUNITIES, 1181 00:42:05,891 --> 00:42:08,094 I THINK THAT WE HAVE A GREAT 1182 00:42:08,094 --> 00:42:09,895 OPPORTUNITY FOR 1183 00:42:09,895 --> 00:42:10,362 INTERDISCIPLINARY AND 1184 00:42:10,362 --> 00:42:13,766 COLLABORATIVE APPROACH FOR 1185 00:42:13,766 --> 00:42:14,867 PERSONALIZED OSA CARE. 1186 00:42:14,867 --> 00:42:17,169 WE TALKED ABOUT THE GAP IN 1187 00:42:17,169 --> 00:42:20,673 RESEARCH FOR SEX AND GENDER 1188 00:42:20,673 --> 00:42:25,945 DIFFERENCES, WE WILL HEAR MORE 1189 00:42:25,945 --> 00:42:26,812 ABOUT POPULATIONS OF INTEREST. 1190 00:42:26,812 --> 00:42:28,314 I TALKED ABOUT SLOW WAVE SLEEP 1191 00:42:28,314 --> 00:42:30,349 BUT WE CAN DO MORE RESEARCH ON 1192 00:42:30,349 --> 00:42:30,783 REM SLEEP. 1193 00:42:30,783 --> 00:42:32,084 I THINK WE NEED TO DEFINITELY 1194 00:42:32,084 --> 00:42:34,820 DECIDE ON HOW WE DEFINE OUR 1195 00:42:34,820 --> 00:42:39,725 ADHERENCE TO TREATMENT. 1196 00:42:39,725 --> 00:42:40,526 THERE HAS BEEN DISCUSSION 1197 00:42:40,526 --> 00:42:41,694 YESTERDAY ABOUT THE 1198 00:42:41,694 --> 00:42:43,863 REVERSIBILITY OF AN OU OUTCOME H 1199 00:42:43,863 --> 00:42:45,097 TREATMENT AND WHAT IS THE CLUN 1200 00:42:45,097 --> 00:42:46,098 CAL BENEFIT. 1201 00:42:46,098 --> 00:42:46,966 FINALLY, I WOULD LIKE TO SAY 1202 00:42:46,966 --> 00:42:50,169 THERE CAN BE POTENTIALLY NOBLE 1203 00:42:50,169 --> 00:42:51,937 BIOMARKERS SUCH AS SYMPATHETIC 1204 00:42:51,937 --> 00:42:58,711 ACTIVITY MARKERS, HEART RATE 1205 00:42:58,711 --> 00:43:00,946 SURGES OR POTENTIALLY 1206 00:43:00,946 --> 00:43:01,614 MITOCHONDRIA FUNCTION CHANGES. 1207 00:43:01,614 --> 00:43:02,882 THOSE ARE INVOLVED IN THE KEY 1208 00:43:02,882 --> 00:43:03,149 PATHWAYS. 1209 00:43:03,149 --> 00:43:04,316 WITH THAT, I WOULD LIKE TO SAY 1210 00:43:04,316 --> 00:43:05,985 THANK YOU AND APOLOGIZE FOR THE 1211 00:43:05,985 --> 00:43:06,352 TECHNICALITIES. 1212 00:43:06,352 --> 00:43:07,186 >> IT HAPPENS. 1213 00:43:07,186 --> 00:43:09,054 BUT WE DO HAVE TIME FOR ONE 1214 00:43:09,054 --> 00:43:12,491 QUESTION AND IT LOOKS LIKE 1215 00:43:12,491 --> 00:43:16,362 DR. REDLINE HAS IT IN THE CHAT. 1216 00:43:16,362 --> 00:43:17,730 SUSAN, CAN YOU UNMUTE TO ASK 1217 00:43:17,730 --> 00:43:18,264 YOUR QUESTION? 1218 00:43:18,264 --> 00:43:20,399 >> REALLY GREAT TALK, ESRA, AND 1219 00:43:20,399 --> 00:43:24,770 I ESPECIALLY LIKED YOUR TALK 1220 00:43:24,770 --> 00:43:25,571 ABOUT N3 SLEEP. 1221 00:43:25,571 --> 00:43:28,474 WE KNOW FROM POPULATION STUDIES, 1222 00:43:28,474 --> 00:43:31,477 WOMEN ON AVERAGE HAVE MORE SLEEP 1223 00:43:31,477 --> 00:43:33,479 AND AS THEY AGE, THEY PRESERVE 1224 00:43:33,479 --> 00:43:34,146 THEIR N3 SLEEP. 1225 00:43:34,146 --> 00:43:37,082 SO CAN WE ACTUALLY LEVERAGE WHAT 1226 00:43:37,082 --> 00:43:40,820 WE KNOW NOW TO THINK ABOUT HOW 1227 00:43:40,820 --> 00:43:44,523 DIFFERENCES IN PRESERVATION OF 1228 00:43:44,523 --> 00:43:46,192 SLEEP GIVEN SLEEP APNEA MIGHT 1229 00:43:46,192 --> 00:43:47,193 ACTUALLY HELP US UNDERSTAND SOME 1230 00:43:47,193 --> 00:43:48,394 OF THE SEX DIFFERENCES IN 1231 00:43:48,394 --> 00:43:50,362 VULNERABILITY TO CARDIOMETABOLIC 1232 00:43:50,362 --> 00:43:51,497 DISEASE? 1233 00:43:51,497 --> 00:43:53,866 >> THIS IS AN EXCELLENT 1234 00:43:53,866 --> 00:43:54,433 QUESTION, SUSAN. 1235 00:43:54,433 --> 00:44:00,139 I THINK THAT CERTAINLY WE NEED 1236 00:44:00,139 --> 00:44:05,077 DO MORE QUANTITATIVE STUDIES 1237 00:44:05,077 --> 00:44:08,347 ACROSS THE COURSE OF HOW WOMEN 1238 00:44:08,347 --> 00:44:10,549 AGE, AND PRE AND POST MENOPAUSE, 1239 00:44:10,549 --> 00:44:12,284 SLOW WAVE SLEEP LEVELS AS YOU 1240 00:44:12,284 --> 00:44:16,789 KNOW, YOU KNOW, ARE CHANGING, 1241 00:44:16,789 --> 00:44:18,757 BUT THOSE POTENTIALLY WHO ARE 1242 00:44:18,757 --> 00:44:19,758 PRESERVING THEIR SLOW WAVE MAY 1243 00:44:19,758 --> 00:44:21,827 BE AT LOWER RISK AS THESE 1244 00:44:21,827 --> 00:44:22,394 POPULATION STUDIES SUGGEST. 1245 00:44:22,394 --> 00:44:25,998 SO I THINK THAT WE COULD CONDUCT 1246 00:44:25,998 --> 00:44:30,069 MORE MECHANISTIC STUDIES OR A 1247 00:44:30,069 --> 00:44:31,804 MORE -- BETTER DESIGN RANDOMIZED 1248 00:44:31,804 --> 00:44:35,307 CONTROL TRIALS REALLY POWER 1249 00:44:35,307 --> 00:44:36,609 TODAY LOOK AT THOSE SEX AND 1250 00:44:36,609 --> 00:44:40,646 GENDER DIFFERENCES. 1251 00:44:40,646 --> 00:44:43,315 >> AND ALSO SIMILARLY TO 1252 00:44:43,315 --> 00:44:44,016 UNDERSTAND PHYSIOLOGICALLY WHAT 1253 00:44:44,016 --> 00:44:45,551 ARE THE CHANGES IN SLOW WAVE 1254 00:44:45,551 --> 00:44:47,853 SLEEP, IS IT JUST A MEDIATOR OF 1255 00:44:47,853 --> 00:44:49,054 BETTER SLEEP CONTINUITY OR IS 1256 00:44:49,054 --> 00:44:50,723 THERE DIFFERENCES IN, YOU KNOW, 1257 00:44:50,723 --> 00:44:52,258 THE AUTONOMIC RESPONSES AT 1258 00:44:52,258 --> 00:44:55,127 NIGHT, ET CETERA. 1259 00:44:55,127 --> 00:44:56,295 >> EXACTLY. 1260 00:44:56,295 --> 00:44:57,963 I HAVEN'T SHOWN -- OUR PAPER IS 1261 00:44:57,963 --> 00:45:01,367 UNDER REVIEW WITH DR. BERSARD, 1262 00:45:01,367 --> 00:45:03,769 BUT WHEN WE DO EXPERIMENTALLY 1263 00:45:03,769 --> 00:45:06,005 RECOVER SLOW WAVE SLEEP, AND GET 1264 00:45:06,005 --> 00:45:10,576 IT BACK TO THE SUBJECTS WHAT IS 1265 00:45:10,576 --> 00:45:15,047 TAKEN AWAY, AMAZINGLY THEIR IS 1266 00:45:15,047 --> 00:45:24,823 LINDINSULIN SECRETORY RESPONSE - 1267 00:45:24,823 --> 00:45:25,624 APPROPRIATELY IF SLOW WAVE IS 1268 00:45:25,624 --> 00:45:26,425 THERE. 1269 00:45:26,425 --> 00:45:28,193 SO THESE FINDINGS HOPEFULLY WILL 1270 00:45:28,193 --> 00:45:29,528 BE PUBLISHED AND I THINK THERE 1271 00:45:29,528 --> 00:45:30,596 IS A LOT OF RESEARCH TO BE DONE 1272 00:45:30,596 --> 00:45:31,397 THERE. 1273 00:45:31,397 --> 00:45:34,366 >> THANK YOU. 1274 00:45:34,366 --> 00:45:35,401 >> WELL, THANK YOU, AND AS WE 1275 00:45:35,401 --> 00:45:41,240 QUEUE UP THE NEXT SESSION, AS 1276 00:45:41,240 --> 00:45:42,041 EVERYONE ON THE CALL IN THE 1277 00:45:42,041 --> 00:45:43,342 WORKSHOP ARE THINKING ABOUT THE 1278 00:45:43,342 --> 00:45:44,143 DISCUSSIONS AT THE END OF THE 1279 00:45:44,143 --> 00:45:45,644 DAY, THINKING ABOUT HOW SOME OF 1280 00:45:45,644 --> 00:45:46,979 THESE -- YOU KNOW, WITH THE 1281 00:45:46,979 --> 00:45:48,013 RESEARCH, IT'S GREAT AND WE'VE 1282 00:45:48,013 --> 00:45:49,949 HEARD KIND OF 360 DEGREES OF ALL 1283 00:45:49,949 --> 00:45:52,184 THE THINGS THAT ARE HAPPENING. 1284 00:45:52,184 --> 00:45:54,954 BUT TO THINK ABOUT HOW SOME OF 1285 00:45:54,954 --> 00:45:58,123 THESE PARTICULAR MEASURES COULD 1286 00:45:58,123 --> 00:45:59,858 BE MORE SPECIFIC AND MORE 1287 00:45:59,858 --> 00:46:00,759 SENSITIVE PARTICULARLY AND HOW 1288 00:46:00,759 --> 00:46:02,628 THESE NEW METRICS ARE IN SOME 1289 00:46:02,628 --> 00:46:03,629 WAYS CORRELATED WITH EACH OTHER, 1290 00:46:03,629 --> 00:46:04,830 AND HOW THEY COULD POTENTIALLY 1291 00:46:04,830 --> 00:46:07,366 BE MOVED TO THE CLINIC, AND SO 1292 00:46:07,366 --> 00:46:08,801 WE CAN CERTAINLY HAVE A FURTHER 1293 00:46:08,801 --> 00:46:09,768 DISCUSSION AT THE END OF THE 1294 00:46:09,768 --> 00:46:11,870 DAY, BUT WE WILL TURN IT OVER 1295 00:46:11,870 --> 00:46:15,607 NOW TO AARON LAPOSKY. 1296 00:46:15,607 --> 00:46:16,141 AARON, THANK YOU. 1297 00:46:16,141 --> 00:46:20,846 >> THANK YOU. 1298 00:46:20,846 --> 00:46:22,848 UNFORTUNATELY I CAN'T ACTIVATE 1299 00:46:22,848 --> 00:46:24,383 MY CAMERA BECAUSE IT SAYS MY 1300 00:46:24,383 --> 00:46:26,285 COMPUTER WON'T IDENTIFY IT SO I 1301 00:46:26,285 --> 00:46:27,386 APOLOGIZE FOR THAT, BUT I WILL 1302 00:46:27,386 --> 00:46:29,688 BE MODERATING THIS NEXT SESSION, 1303 00:46:29,688 --> 00:46:31,323 AGAIN, I'M A PROGRAM DIRECTOR IN 1304 00:46:31,323 --> 00:46:33,092 THE NATIONAL CENTER ON SLEEP 1305 00:46:33,092 --> 00:46:35,094 DISORDERS RESEARCH, AND I 1306 00:46:35,094 --> 00:46:44,536 OVERSEE A PORTFOLIO FOCUSED ON 1307 00:46:44,536 --> 00:46:46,171 CHRONOBIOLOGY AND ALSO 1308 00:46:46,171 --> 00:46:46,805 VENTILATORY CONTROL SCIENCE. 1309 00:46:46,805 --> 00:46:48,140 SO I'M HAPPY TO INTRODUCE THIS 1310 00:46:48,140 --> 00:46:49,541 SESSION WHICH IS LISTED IN THE 1311 00:46:49,541 --> 00:46:50,909 PROGRAM AS A HOT TOPIC AND IT'S 1312 00:46:50,909 --> 00:46:51,910 CONTINUING THE DISCUSSION ON 1313 00:46:51,910 --> 00:46:53,746 VARIOUS APPROACHES FOR TREATING 1314 00:46:53,746 --> 00:46:54,980 SLEEP DISORDERED BREATHING AND 1315 00:46:54,980 --> 00:46:57,716 POTENTIAL WAYS TO BE ABLE TO 1316 00:46:57,716 --> 00:47:00,886 PERSONALIZE THESE TREATMENTS FOR 1317 00:47:00,886 --> 00:47:02,087 PARTICULAR INDIVIDUALS, MAYBE 1318 00:47:02,087 --> 00:47:03,555 BASED ON THE PATHOBIOLOGY THAT 1319 00:47:03,555 --> 00:47:05,958 THEY HAVE FOR SLEEP DISORDERED 1320 00:47:05,958 --> 00:47:07,826 BREATHING. 1321 00:47:07,826 --> 00:47:12,698 SO THE SPEAKER IS DR. KLAR 1322 00:47:12,698 --> 00:47:15,667 YAGGI, PROFESSOR OF MEDICINE AND 1323 00:47:15,667 --> 00:47:17,302 DIRECTOR OF THE YALE PROGRAM IN 1324 00:47:17,302 --> 00:47:18,737 SLEEP MEDICINE AT THE YALE 1325 00:47:18,737 --> 00:47:20,172 UNIVERSITY SCHOOL OF MEDICINE. 1326 00:47:20,172 --> 00:47:22,241 THE TITLE OF HIS PRESENTATION 1327 00:47:22,241 --> 00:47:25,544 WILL FOCUS ON TREATING 1328 00:47:25,544 --> 00:47:27,446 OBSTRUCTIVE SLEEP APNEA WITH 1329 00:47:27,446 --> 00:47:28,747 PHARMACOTHERAPIES. 1330 00:47:28,747 --> 00:47:31,050 SO I'M HAPPY TO TURN THIS OVER 1331 00:47:31,050 --> 00:47:34,586 TO DR. KLAR. 1332 00:47:34,586 --> 00:47:35,788 DR. YAGGI, SORRY. 1333 00:47:35,788 --> 00:47:36,055 DR. YAGGI. 1334 00:47:36,055 --> 00:47:36,855 >> THAT'S JUST FINE. 1335 00:47:36,855 --> 00:47:44,763 THANK YOU VERY MUCH FOR THE 1336 00:47:44,763 --> 00:47:48,867 INVITATION AND PUTTING THIS 1337 00:47:48,867 --> 00:47:50,235 AMAZING WORKSHOP TOGETHER. 1338 00:47:50,235 --> 00:47:52,538 I MUST SAY YESTERDAY I LEFT SO 1339 00:47:52,538 --> 00:47:53,439 ENERGIZED THINKING ABOUT ALL THE 1340 00:47:53,439 --> 00:47:56,708 TOOLS THAT WE CAN LEVERAGE FROM 1341 00:47:56,708 --> 00:47:59,678 A.I. TO DR. PACK'S DISCUSSION OF 1342 00:47:59,678 --> 00:48:03,549 METABOLOMICS AND PRO AND PROTEO. 1343 00:48:03,549 --> 00:48:05,984 TODAY I WAS ASKED TO SPEAK ON 1344 00:48:05,984 --> 00:48:09,054 THE TOPIC OF ENDO PHENOTYPES AND 1345 00:48:09,054 --> 00:48:11,757 PARTICULARLY WITH RESPECT TO 1346 00:48:11,757 --> 00:48:13,192 PHARMACOTHERAPIES, AND FULL 1347 00:48:13,192 --> 00:48:15,394 DISCLOSURE, MY WORK HAS -- AND 1348 00:48:15,394 --> 00:48:17,062 THAT OF SOME OF MY MENTEES, HAS 1349 00:48:17,062 --> 00:48:22,534 REALLY FOCUSED ON BEING END US 1350 00:48:22,534 --> 00:48:24,303 USERS OF THESE TOOLS, AND I 1351 00:48:24,303 --> 00:48:25,838 TRULY BELIEVE THAT WE OWE A DEBT 1352 00:48:25,838 --> 00:48:28,207 OF GRATITUDE TO REALLY SOME OF 1353 00:48:28,207 --> 00:48:30,676 THE REALLY SMART PHYSIOLOGISTS 1354 00:48:30,676 --> 00:48:34,847 WHO HAVE BROUGHT SOME OF THESE 1355 00:48:34,847 --> 00:48:35,981 TOOLS TO THE RESEARCH COMMUNITY 1356 00:48:35,981 --> 00:48:39,151 SO WE CAN ASSESS THEIR CLINICAL 1357 00:48:39,151 --> 00:48:43,422 UTILITY AND VALIDITY, SUCH AS 1358 00:48:43,422 --> 00:48:46,925 ANDREW WELLMAN, SCOTT SANDS, 1359 00:48:46,925 --> 00:48:48,460 BRAD EDWARDS, AND CERTAINLY THE 1360 00:48:48,460 --> 00:48:51,563 WORK THAT'S GOING ON AT PENN 1361 00:48:51,563 --> 00:48:53,966 WITH SYMPTOM PHENOTYPES AND WITH 1362 00:48:53,966 --> 00:48:55,734 SWABS IMAGING, I THINK ALL ARE 1363 00:48:55,734 --> 00:48:57,102 GOING TO BE CRUCIAL IN 1364 00:48:57,102 --> 00:48:58,003 UNDERSTANDING THERAPEUTIC 1365 00:48:58,003 --> 00:48:59,271 POTENTIALS OF PHARMACOTHERAPIES. 1366 00:48:59,271 --> 00:49:02,374 I'M GOING TO SPEAK BRIEFLY ABOUT 1367 00:49:02,374 --> 00:49:03,709 A STUDY THAT WE HAVE JUST 1368 00:49:03,709 --> 00:49:07,513 STARTED THAT IS DOING JUST THAT, 1369 00:49:07,513 --> 00:49:09,982 LOOKING AT LEVERAGING IMAGING 1370 00:49:09,982 --> 00:49:12,151 AND SOME OF THESE PHYSIOLOGIC 1371 00:49:12,151 --> 00:49:13,685 TRAITS IN THE CONTEXT OF A 1372 00:49:13,685 --> 00:49:16,588 MECHANISTIC CLINICAL TRIAL FOR 1373 00:49:16,588 --> 00:49:18,123 OBSTRUCTIVE SLEEP APNEA CALLED 1374 00:49:18,123 --> 00:49:19,324 THE ADIPOSE STUDY. 1375 00:49:19,324 --> 00:49:22,628 I'M ALSO GOING TO MENTION SOME 1376 00:49:22,628 --> 00:49:24,630 WORK OF SEVERAL MENTEES THAT ARE 1377 00:49:24,630 --> 00:49:26,598 RELATED TO THIS TOPIC. 1378 00:49:26,598 --> 00:49:28,233 SO WE'RE GOING TO TALK BRIEFLY 1379 00:49:28,233 --> 00:49:31,236 TO GET EVERYONE ON THE SAME PAGE 1380 00:49:31,236 --> 00:49:33,872 ABOUT ENDOPHENOTYPES AND THEIR 1381 00:49:33,872 --> 00:49:34,306 CLINICAL POTENTIAL. 1382 00:49:34,306 --> 00:49:37,543 WE'RE GOING TO FOCUS FIRST ON 1383 00:49:37,543 --> 00:49:38,510 METABOLIC MODULATION AND ITS 1384 00:49:38,510 --> 00:49:40,379 IMPACT ON ANATOMY, MOVE TO 1385 00:49:40,379 --> 00:49:43,615 TALKING ABOUT NOR ADRENERGIC AND 1386 00:49:43,615 --> 00:49:47,419 ANTIMUSCARINICS AND THEIR IMPACT 1387 00:49:47,419 --> 00:49:57,429 ON GENERAL GENEOGLOSSIS AND UPE 1388 00:49:57,429 --> 00:49:58,497 MUSCLES E WE'RE GOING TO TALK 1389 00:49:58,497 --> 00:50:00,265 ABOUT SOME OF THE LITERATURE ON 1390 00:50:00,265 --> 00:50:03,602 HYPNOTICS AND AROUSAL THRESHOLD, 1391 00:50:03,602 --> 00:50:04,770 CARBONIC AN HIGH DRAIS 1392 00:50:04,770 --> 00:50:06,205 INHIBITORS AND VENTILATORY AND 1393 00:50:06,205 --> 00:50:07,973 STABILITY AND THEN FINISH OFF BY 1394 00:50:07,973 --> 00:50:08,774 TALKING ABOUT FUTURE 1395 00:50:08,774 --> 00:50:09,107 OPPORTUNITIES. 1396 00:50:09,107 --> 00:50:10,342 SO FOR MANY YEARS CERTAINLY WHEN 1397 00:50:10,342 --> 00:50:12,978 I STARTED OUT IN THE FIELD THE 1398 00:50:12,978 --> 00:50:13,745 PATHOGENESIS OF SLEEP APNEA WAS 1399 00:50:13,745 --> 00:50:17,449 THOUGHT REALLY TO ENTIRELY BE AN 1400 00:50:17,449 --> 00:50:19,051 ANATOMIC AND MECHANICAL ISSUE, 1401 00:50:19,051 --> 00:50:20,352 REALLY RELATED TO A BALANCE OF 1402 00:50:20,352 --> 00:50:21,353 FORCES AT PLAY. 1403 00:50:21,353 --> 00:50:22,754 ON THE SIDE OF THOSE FORCES THAT 1404 00:50:22,754 --> 00:50:24,823 ARE PROMOTING PATENCY ARE THE 1405 00:50:24,823 --> 00:50:26,525 PHARYNGEAL DILATOR MUSCLES, WE 1406 00:50:26,525 --> 00:50:30,395 KNOW GENIOGLOSSUS IS A MAJOR 1407 00:50:30,395 --> 00:50:32,030 PLAYER HERE AND PROMOTING AIRWAY 1408 00:50:32,030 --> 00:50:33,365 COLLAPSE IS THE NEGATIVE 1409 00:50:33,365 --> 00:50:35,801 PRESSURE OF INSPIRATION, AND 1410 00:50:35,801 --> 00:50:39,738 EXTRA LUMINAL POSITIVE PRESSURE 1411 00:50:39,738 --> 00:50:41,506 IMPOSED BY FAT OR ADIPOSE TISSUE 1412 00:50:41,506 --> 00:50:42,741 DEPOSITION IN SOME OF THESE 1413 00:50:42,741 --> 00:50:44,042 AIRWAY STRUCTURES OR HAVING A 1414 00:50:44,042 --> 00:50:45,143 SMALL MANDIBULAR SIZE. 1415 00:50:45,143 --> 00:50:47,446 THIS GAVE RISE TO THIS CONCEPT 1416 00:50:47,446 --> 00:50:50,849 OF CRITICAL CLOSING PRESSURE, 1417 00:50:50,849 --> 00:50:53,485 PCRIT AND THE HIGHLY COLLAPSABLE 1418 00:50:53,485 --> 00:50:55,187 UPPER AIRWAYS HAVE A POSITIVE 1419 00:50:55,187 --> 00:50:56,855 PCRIT AND MORE STABLE AIRWAYS, 1420 00:50:56,855 --> 00:50:58,490 IT TAKES MUCH MORE NEGATIVE 1421 00:50:58,490 --> 00:50:59,591 PRESSURE TO COLLAPSE THAT 1422 00:50:59,591 --> 00:51:02,461 AIRWAY. 1423 00:51:02,461 --> 00:51:03,562 REALLY OVER THE LAST 10 YEARS, I 1424 00:51:03,562 --> 00:51:06,164 THINK OUR UNDERSTANDING OF OSA 1425 00:51:06,164 --> 00:51:07,199 PATHOGENESIS HAS GROWN BY LEAPS 1426 00:51:07,199 --> 00:51:09,835 AND BOUNDS. 1427 00:51:09,835 --> 00:51:14,006 IN ADDITION TO THIS ANATOMICAL 1428 00:51:14,006 --> 00:51:15,440 PREDISPOSITION, WE NOW KNOW 1429 00:51:15,440 --> 00:51:18,744 THERE ARE A SERIES OF NON-AN 1430 00:51:18,744 --> 00:51:19,845 NON-ANATOMICAL TRAITS THAT ALSO 1431 00:51:19,845 --> 00:51:21,580 PREDISPOSE TO THE DEVELOPMENT OF 1432 00:51:21,580 --> 00:51:22,781 SLEEP APNEA. 1433 00:51:22,781 --> 00:51:24,816 YOU'VE HEARD ABOUT THESE ALREADY 1434 00:51:24,816 --> 00:51:28,887 THROUGHOUT THE CONFERENCE. 1435 00:51:28,887 --> 00:51:30,255 VENTILATORY CONTROL STABILITY, 1436 00:51:30,255 --> 00:51:33,058 LOOP GAIN, MUSCLE RESPONSIVENESS 1437 00:51:33,058 --> 00:51:35,260 OF THE UPPER AIRWAY, AND AROUSAL 1438 00:51:35,260 --> 00:51:35,560 THRESHOLD. 1439 00:51:35,560 --> 00:51:37,963 AND IT TURNS OUT THAT A MAJORITY 1440 00:51:37,963 --> 00:51:39,965 OF THESE PATIENTS MAY HAVE SLEEP 1441 00:51:39,965 --> 00:51:41,833 APNEA, RELATED TO THESE 1442 00:51:41,833 --> 00:51:45,137 NON-ANATOMICAL CAUSES RATHER 1443 00:51:45,137 --> 00:51:46,872 THAN JUST PURE ANATOMICAL 1444 00:51:46,872 --> 00:51:47,539 ISSUES. 1445 00:51:47,539 --> 00:51:50,542 AS WAS THE FOCUS OF THIS 1446 00:51:50,542 --> 00:51:52,911 WORKSHOP, NOT ALL PATIENTS GET 1447 00:51:52,911 --> 00:52:00,719 SLEEP APNEA FOR THE SAME REASON. 1448 00:52:00,719 --> 00:52:02,120 I THINK ONE OF THE APPEALS OF 1449 00:52:02,120 --> 00:52:04,723 THESE TRAITS IS THAT THEY'RE 1450 00:52:04,723 --> 00:52:07,793 ACTUALLY MEASURING PHYSIOLOGY 1451 00:52:07,793 --> 00:52:09,428 THAT IS OCCURRING DURING SLEEP 1452 00:52:09,428 --> 00:52:11,663 IN CONTRAST TO SOME OTHER 1453 00:52:11,663 --> 00:52:13,632 BIOMARKERS THAT ARE USED, AND 1454 00:52:13,632 --> 00:52:19,204 THEY LEVERAGE POLYSOMNOGRAPHY, 1455 00:52:19,204 --> 00:52:21,239 THE CURRENT WAY WE DIAGNOSE, 1456 00:52:21,239 --> 00:52:23,041 TREAT AND ASSESS OBSTRUCTIVE 1457 00:52:23,041 --> 00:52:23,342 SLEEP APNEA. 1458 00:52:23,342 --> 00:52:26,311 I THINK ANOTHER GREAT POTENTIAL 1459 00:52:26,311 --> 00:52:28,480 IS THAT THIS ACTUALLY MIGHT 1460 00:52:28,480 --> 00:52:34,286 REPRESENT A SCALABLE TECHNOLOGY. 1461 00:52:34,286 --> 00:52:37,589 WE'RE NOW DERIVING SOME OF THESE 1462 00:52:37,589 --> 00:52:42,627 TYPICAL TRAITS FROM STANDARD 1463 00:52:42,627 --> 00:52:43,729 POLYSONOGRAPHY, NOT JUST 1464 00:52:43,729 --> 00:52:44,863 ADVANCED PHYSIOLOGIC 1465 00:52:44,863 --> 00:52:45,330 LABORATORIES. 1466 00:52:45,330 --> 00:52:46,531 AND THE PROMISE OF THIS THERAPY 1467 00:52:46,531 --> 00:52:47,299 POTENTIALLY IS THAT TARGETING 1468 00:52:47,299 --> 00:52:50,068 THESE TRAITS MAY ALLOW US TO 1469 00:52:50,068 --> 00:52:53,772 REALLY MOVE INTO A MORE 1470 00:52:53,772 --> 00:52:55,440 PRECISION-BASED APPROACH TO 1471 00:52:55,440 --> 00:52:56,641 TREATING SLEEP APNEA. 1472 00:52:56,641 --> 00:53:01,046 INSTEAD OF A CPAP FOR ALL, THEN 1473 00:53:01,046 --> 00:53:02,147 SALVAGE THERAPY REALLY TARGETING 1474 00:53:02,147 --> 00:53:03,482 THESE TRAITS WITH VARIOUS 1475 00:53:03,482 --> 00:53:05,317 THERAPIES. 1476 00:53:05,317 --> 00:53:06,218 SO PERHAPS IT'S THE PATIENTS 1477 00:53:06,218 --> 00:53:08,653 WITH A SMALL COLLAPSIBLE AIRWAY 1478 00:53:08,653 --> 00:53:09,755 WHERE WEIGHT LOSS POSITIONAL 1479 00:53:09,755 --> 00:53:11,289 THERAPY OR APPLIANCE OR SURGERY 1480 00:53:11,289 --> 00:53:12,624 ARE BETTER APPROACHES. 1481 00:53:12,624 --> 00:53:14,726 THEN WE HAVE SOME PHARMACOLOGIC 1482 00:53:14,726 --> 00:53:18,864 THERAPIES THAT MAY ALLOW US TO 1483 00:53:18,864 --> 00:53:21,933 TARGET THEIR OVERLY SENSITIVE 1484 00:53:21,933 --> 00:53:24,403 INSULA TRI CONTROL SYSTEMS, 1485 00:53:24,403 --> 00:53:26,905 PHARMACOLOGIC AND NEW UPPER 1486 00:53:26,905 --> 00:53:27,539 AIRWAY NEUROSTIMULATION DEVICES 1487 00:53:27,539 --> 00:53:30,776 THAT MAY BE MORE HELPFUL AMONG 1488 00:53:30,776 --> 00:53:33,278 PATIENTS WITH POOR PHARYNGEAL 1489 00:53:33,278 --> 00:53:37,549 MUSCLE TONE AND SEDATIVE 1490 00:53:37,549 --> 00:53:40,285 HYPNOTICS OF COURSE TO TARGET 1491 00:53:40,285 --> 00:53:41,219 AROUSAL THRECIAL HOLD. 1492 00:53:41,219 --> 00:53:43,522 SO NOW WE'RE GOING TO MOVE INTO 1493 00:53:43,522 --> 00:53:45,257 STARTING TO TALK ABOUT THIS 1494 00:53:45,257 --> 00:53:46,091 ANATOMY AND METABOLIC 1495 00:53:46,091 --> 00:53:46,391 MODULATION. 1496 00:53:46,391 --> 00:53:48,827 HOT OFF THE PRESS LITERALLY 1497 00:53:48,827 --> 00:53:51,129 TODAY FROM THE LANCET IN THE 1498 00:53:51,129 --> 00:53:53,932 UNITED STATES, 75% OF PEOPLE IN 1499 00:53:53,932 --> 00:53:55,567 THIS COUNTRY ARE EITHER 1500 00:53:55,567 --> 00:53:57,102 OVERWEIGHT OR OBESE, WHICH IS 1501 00:53:57,102 --> 00:53:58,336 JUST MIND BLOWING. 1502 00:53:58,336 --> 00:54:02,741 AND IN FACT NOW, HALF OF U.S. 1503 00:54:02,741 --> 00:54:03,942 ADULTS WITH WOMEN ACTUALLY 1504 00:54:03,942 --> 00:54:05,343 LEADING THE WAY, MORE SO THAN 1505 00:54:05,343 --> 00:54:09,014 MEN, ARE ACTUALLY OBESE. 1506 00:54:09,014 --> 00:54:10,615 SO AN ENORMOUS PUBLIC HEALTH 1507 00:54:10,615 --> 00:54:20,759 BURDEN. 1508 00:54:21,426 --> 00:54:24,196 I THINK ONE OF THE THERAPEUTIC 1509 00:54:24,196 --> 00:54:24,896 PHARMACOLOGIC THERAPIES THAT 1510 00:54:24,896 --> 00:54:26,465 WE'RE ALL FAMILIAR WITH NOW ARE 1511 00:54:26,465 --> 00:54:28,467 THE GLP1 RECEPTOR AGONIST AND 1512 00:54:28,467 --> 00:54:29,935 THE STORY OF THESE THERAPIES IS 1513 00:54:29,935 --> 00:54:31,670 ACTUALLY QUITE REMARKABLE. 1514 00:54:31,670 --> 00:54:35,807 SO IN THE 1960s, IF WE 1515 00:54:35,807 --> 00:54:37,742 ADMINISTERED ORAL GLUCOSE, THAT 1516 00:54:37,742 --> 00:54:40,278 ELICITS A MUCH STRONGER INSULIN 1517 00:54:40,278 --> 00:54:43,849 RESPONSE AND GIVING THE EXACT 1518 00:54:43,849 --> 00:54:47,586 SAME AMOUNT OF GLUCOSE 1519 00:54:47,586 --> 00:54:49,054 INTRAVENOUSLY. 1520 00:54:49,054 --> 00:54:52,491 THIS PHENOMENON IS KNOWN AS THE 1521 00:54:52,491 --> 00:54:54,493 INCRETIN EFFECT. 1522 00:54:54,493 --> 00:54:56,394 IT REALLY HINTED THAT THERE WERE 1523 00:54:56,394 --> 00:54:57,929 SUBSTANCES PERHAPS HORMONES 1524 00:54:57,929 --> 00:55:01,233 BEING SECRETED BY INTRASITES IN 1525 00:55:01,233 --> 00:55:03,502 THE GUT THAT WERE ENHANCING 1526 00:55:03,502 --> 00:55:03,902 INSULIN SECRETION. 1527 00:55:03,902 --> 00:55:06,505 IN A NUMBER OF SCIENCES AROUND 1528 00:55:06,505 --> 00:55:08,740 THE 1960s AND 70s STUDYING 1529 00:55:08,740 --> 00:55:10,775 THE HELA MONSTER WHICH IS AN 1530 00:55:10,775 --> 00:55:12,477 ANIMAL THAT IS ADAPTED THAT CAN 1531 00:55:12,477 --> 00:55:13,645 ACTUALLY GO FOR MONTHS WITHOUT 1532 00:55:13,645 --> 00:55:14,813 EATING WHICH IS ACTUALLY VERY 1533 00:55:14,813 --> 00:55:16,781 HELPFUL WHEN YOU ARE LIVING IN A 1534 00:55:16,781 --> 00:55:22,320 DESERT HABITAT WHERE FOOD IS 1535 00:55:22,320 --> 00:55:23,889 SCARCE, IDENTIFIED A PEPTIDE IN 1536 00:55:23,889 --> 00:55:27,425 THE SALIVA OF THESE ANIMALS THAT 1537 00:55:27,425 --> 00:55:29,528 ACTUALLY ENDED UP SHARING VERY 1538 00:55:29,528 --> 00:55:30,395 SIMILAR STRUCTURAL AND 1539 00:55:30,395 --> 00:55:34,232 FUNCTIONAL SIMILARITY TO 1540 00:55:34,232 --> 00:55:35,834 GLUCAGON-TYPE PEPTIDE WHICH IS 1541 00:55:35,834 --> 00:55:37,569 SECRETED BY THE GUT AND WHICH WE 1542 00:55:37,569 --> 00:55:40,105 NOW KNOW STIMULATES INSULIN 1543 00:55:40,105 --> 00:55:42,807 SECRETION IN THE PANCREAS, SLOWS 1544 00:55:42,807 --> 00:55:44,175 GASTRIC EMPTYING AND REDUCES 1545 00:55:44,175 --> 00:55:44,709 APPETITE. 1546 00:55:44,709 --> 00:55:46,044 THESE MEDICATIONS HAVE REALLY 1547 00:55:46,044 --> 00:55:48,179 USHERED IN A NEW PARADIGM FOR 1548 00:55:48,179 --> 00:55:51,316 TREATING BOTH TYPE 2 DIABETES 1549 00:55:51,316 --> 00:55:51,983 AND OBESITY. 1550 00:55:51,983 --> 00:55:53,852 FOR THOSE INTERESTED 1551 00:55:53,852 --> 00:55:55,487 IRONICICALLY JUST THIS WEEK IN 1552 00:55:55,487 --> 00:55:56,955 THE "NEW YORK TIMES" MAGAZINE, I 1553 00:55:56,955 --> 00:56:00,692 THINK COMING OUT, IN FACT, THIS 1554 00:56:00,692 --> 00:56:03,194 WEEKEND, IS THE STORY OF THE 1555 00:56:03,194 --> 00:56:04,629 DEVELOPMENT OF THESE DRUGS AND 1556 00:56:04,629 --> 00:56:05,797 WHAT WE CAN LEARN FROM THE VENOM 1557 00:56:05,797 --> 00:56:06,431 OF ANIMALS. 1558 00:56:06,431 --> 00:56:07,966 I WAS VERY SURPRISED TO LEARN 1559 00:56:07,966 --> 00:56:09,134 THAT A VERY SIMILAR APPROACH WAS 1560 00:56:09,134 --> 00:56:12,604 USED TO DISCOVER ACE INHIBITORS. 1561 00:56:12,604 --> 00:56:14,005 BUT FOR YOUR READING PLEASURE IF 1562 00:56:14,005 --> 00:56:14,973 YOU HAVE A CHANCE TO LOOK AT 1563 00:56:14,973 --> 00:56:20,211 THIS. 1564 00:56:20,211 --> 00:56:26,351 SO WE KNOW SEMAGLUTIDE, PURELY A 1565 00:56:26,351 --> 00:56:28,086 GLP-1 AGONIST, AND AS WE'LL TALK 1566 00:56:28,086 --> 00:56:29,521 ABOUT ALSO THERE SEEMS TO BE A 1567 00:56:29,521 --> 00:56:30,889 GREATER MEAN PERCENTAGE OF 1568 00:56:30,889 --> 00:56:32,190 WEIGHT REDUCTION ASSOCIATED WITH 1569 00:56:32,190 --> 00:56:34,059 THESE MEDICATIONS AMONG WOMEN 1570 00:56:34,059 --> 00:56:35,894 COMPARED TO MEN, AND IN FACT 1571 00:56:35,894 --> 00:56:40,465 WITH RESPECT TO SEMAGLUTIDE, 1572 00:56:40,465 --> 00:56:41,967 FEMALE SEX WAS ASSOCIATED WITH A 1573 00:56:41,967 --> 00:56:44,803 HIGHER LIKELIHOOD OF LOSING 10% 1574 00:56:44,803 --> 00:56:47,305 OR GREATER BUT WE'VE NOW MOVED 1575 00:56:47,305 --> 00:56:49,174 INTO BOTH DOUBLE AND TRIPLE 1576 00:56:49,174 --> 00:56:51,009 HORMONE RECEPTOR AGONISTS. 1577 00:56:51,009 --> 00:56:57,082 WITH TIRZEPATIDE, WE'RE NOW 1578 00:56:57,082 --> 00:56:58,617 ACHIEVING A GREATER BODY WEIGHT 1579 00:56:58,617 --> 00:57:00,485 REDUCTION UP TO 15%, AGAIN 1580 00:57:00,485 --> 00:57:01,853 FEMALE SEX IS ASSOCIATED WITH A 1581 00:57:01,853 --> 00:57:03,388 GREATER REDUCTION IN BODY 1582 00:57:03,388 --> 00:57:09,060 WEIGHT, AND RETATRUTIDE WHICH IS 1583 00:57:09,060 --> 00:57:12,397 A TRIPLE HORMONE RECEPTOR 1584 00:57:12,397 --> 00:57:15,800 RESULTED IN WOMEN WITH NEARLY A 1585 00:57:15,800 --> 00:57:17,002 29% WEIGHT REDUCTION, WHICH NOW 1586 00:57:17,002 --> 00:57:18,069 WE'RE HITTING I THINK THE LOWER 1587 00:57:18,069 --> 00:57:20,338 RANGE OF EFFICACY OF BARIATRIC 1588 00:57:20,338 --> 00:57:22,107 SURGERY, WHICH IS QUITE 1589 00:57:22,107 --> 00:57:25,810 IMPRESSIVE. 1590 00:57:25,810 --> 00:57:27,312 ALTHOUGH WOMEN APPEAR TO HAVE A 1591 00:57:27,312 --> 00:57:28,079 SLIGHTLY GREATER WEIGHT LOSS 1592 00:57:28,079 --> 00:57:31,249 EFFECT WITH THESE MEDICATIONS, 1593 00:57:31,249 --> 00:57:32,550 WE DO KNOW FROM SOME OTHER 1594 00:57:32,550 --> 00:57:34,953 POOLED STUDIES THAT WEIGHT LOSS 1595 00:57:34,953 --> 00:57:39,224 ACTUALLY MAY BE MORE IMPACTFUL 1596 00:57:39,224 --> 00:57:39,858 IN IMPROVING SLEEP APNEA AMONG 1597 00:57:39,858 --> 00:57:43,228 MEN COMPARED TO WOMEN, THOUGH 1598 00:57:43,228 --> 00:57:46,731 THIS LIKELY VARIES A LITTLE BIT 1599 00:57:46,731 --> 00:57:49,567 WITH MENOPAUSAL STATUS. 1600 00:57:49,567 --> 00:57:52,771 WE KNOW THAT SEX DIFFERENCES 1601 00:57:52,771 --> 00:57:54,205 EXIST IN THE RESPONSE TO WEIGHT 1602 00:57:54,205 --> 00:57:59,144 LOSS INTERVENTIONS, AND CLEARLY 1603 00:57:59,144 --> 00:58:01,279 THIS IS A DOMAIN WHERE MORE DATA 1604 00:58:01,279 --> 00:58:02,614 IS NEEDED, PARTICULARLY AROUND 1605 00:58:02,614 --> 00:58:04,749 THE IMPACT OF THESE MEDICATIONS 1606 00:58:04,749 --> 00:58:08,453 ON SYMPTOMS OF SLEEP DISORDERED 1607 00:58:08,453 --> 00:58:09,854 BREATHING AND HOW MENOPAUSAL 1608 00:58:09,854 --> 00:58:10,989 STATUS MAY INFLUENCE THE 1609 00:58:10,989 --> 00:58:12,724 EFFICACY OF THESE. 1610 00:58:12,724 --> 00:58:16,494 BUT IT IS IN THIS CONTEXT THAT 1611 00:58:16,494 --> 00:58:19,764 WE JUST OVER THE SUMMER NOW HAD 1612 00:58:19,764 --> 00:58:23,601 THE SURMOUNT OSA STUDY, WHICH 1613 00:58:23,601 --> 00:58:28,273 WAS A TRIAL EVALUATING 1614 00:58:28,273 --> 00:58:34,112 TIRZEPATITDE, THIS DUAL AGONIST, 1615 00:58:34,112 --> 00:58:35,213 ON OBSTRUCTIVE SLEEP APNEA. 1616 00:58:35,213 --> 00:58:37,415 AND WHAT WAS OBSERVED WAS THAT 1617 00:58:37,415 --> 00:58:39,050 AT 52 WEEKS, A DOSE OF BETWEEN 1618 00:58:39,050 --> 00:58:44,789 10 AND 15 MILLIGRAMS OF 1619 00:58:44,789 --> 00:58:46,658 TIRZEPATITDE RESULTED IN A 16 TO 1620 00:58:46,658 --> 00:58:48,026 70% WEIGHT REDUCTION WHICH 1621 00:58:48,026 --> 00:58:50,428 TRANSLATE NEIGHBORHOOD A 20 TO 1622 00:58:50,428 --> 00:58:57,435 24% REDUCTION IN ACTIVE 1623 00:58:57,435 --> 00:58:57,702 HYPOPNEA. 1624 00:58:57,702 --> 00:58:59,270 THERE WERE ADDITIONAL BENEFIT 1625 00:58:59,270 --> 00:59:01,072 AND A VARIETY OF SECONDARY END 1626 00:59:01,072 --> 00:59:08,780 POINT INCLUDING CRP AND HYPOXIC 1627 00:59:08,780 --> 00:59:10,181 BURDEN AND BLOOD PRESSURE, BOTH 1628 00:59:10,181 --> 00:59:11,516 SYSTOLIC AND DIASTOLIC. 1629 00:59:11,516 --> 00:59:15,086 AND ALTHOUGH THIS MAY NOT BE A 1630 00:59:15,086 --> 00:59:16,287 THERAPY THAT CAN CURE PATIENTS 1631 00:59:16,287 --> 00:59:21,159 WITH RESPECT TO THEIR SLEEP 1632 00:59:21,159 --> 00:59:22,360 APNEA, I THINK THIS LEVEL OF 1633 00:59:22,360 --> 00:59:24,662 WEIGHT LOSS COULD BE AN 1634 00:59:24,662 --> 00:59:25,296 IMPORTANT ADJUNCTIVE TREATMENT 1635 00:59:25,296 --> 00:59:26,698 AND PERHAPS EXPAND SOME OF THE 1636 00:59:26,698 --> 00:59:28,233 POPULATIONS THAT MAY BENEFIT 1637 00:59:28,233 --> 00:59:30,068 FROM EITHER ORAL APPLIANCE 1638 00:59:30,068 --> 00:59:33,638 THERAPY OR HYPOGLOSSAL NERVE 1639 00:59:33,638 --> 00:59:34,105 STIMULATION. 1640 00:59:34,105 --> 00:59:35,507 I'M GOING TO SHIFT GEARS FOR 1641 00:59:35,507 --> 00:59:38,343 JUST A MOMENT AND TALK ABOUT A 1642 00:59:38,343 --> 00:59:39,944 DIFFERENT METABOLIC MODULATOR, 1643 00:59:39,944 --> 00:59:44,649 ANOTHER BLO BLOCKBUSTER DRUG IN 1644 00:59:44,649 --> 00:59:46,151 METABOLISM AND ENDOCRINOLOGY 1645 00:59:46,151 --> 00:59:51,289 WHICH ARE THE SGLT 2I 1646 00:59:51,289 --> 00:59:53,158 INHIBITORS. 1647 00:59:53,158 --> 00:59:55,026 SGLT 2I IS A RECEPTOR BASED IN 1648 00:59:55,026 --> 00:59:59,264 THE PROXIMAL TUBULE THAT IS 1649 00:59:59,264 --> 01:00:00,665 RESPONSIBLE FOR ABOUT 90% OF THE 1650 01:00:00,665 --> 01:00:02,934 GLUCOSE THAT IS FILTERED THROUGH 1651 01:00:02,934 --> 01:00:07,071 THE GL GLOMERULUS, AND THESE 1652 01:00:07,071 --> 01:00:08,406 INHIBITORS BLOCK THIS AND THUS 1653 01:00:08,406 --> 01:00:11,309 WE HAVE GLUCOSE UREA AND WE PEE 1654 01:00:11,309 --> 01:00:12,844 OUT ALL OF THIS GLUCOSE, AND 1655 01:00:12,844 --> 01:00:14,579 WITH THAT GLUCOSE EXCRETION, 1656 01:00:14,579 --> 01:00:16,815 THERE IS A MODEST WEIGHT LOSS OF 1657 01:00:16,815 --> 01:00:20,318 ABOUT A 300-CALORIE A DAY LOSS 1658 01:00:20,318 --> 01:00:22,654 ASSOCIATED WITH THIS GLUCOSE 1659 01:00:22,654 --> 01:00:25,590 EXCRETION. 1660 01:00:25,590 --> 01:00:28,693 THOUGH THESE DRUGS WERE 1661 01:00:28,693 --> 01:00:30,929 INITIALLY BROUGHT TO MARKET FOR 1662 01:00:30,929 --> 01:00:33,731 THE TREATMENT OF DIABETES, WE 1663 01:00:33,731 --> 01:00:35,233 HAVE SINCE LEARNED SIMILAR TO 1664 01:00:35,233 --> 01:00:37,068 THE GLP1s THAT WE'VE RECENTLY 1665 01:00:37,068 --> 01:00:39,938 LEARNED, THEY HAVE REALLY 1666 01:00:39,938 --> 01:00:41,906 IMPRESSIVE EFFECTS ON MAJOR 1667 01:00:41,906 --> 01:00:43,808 ADVERSE CARDIOVASCULAR EVENTS, 1668 01:00:43,808 --> 01:00:44,909 ON CARDIOVASCULAR DEATH, ON 1669 01:00:44,909 --> 01:00:49,080 HEART FAILURE AND EVEN KIDNEY 1670 01:00:49,080 --> 01:00:52,217 END POINTS. 1671 01:00:52,217 --> 01:00:53,218 I HAD THE OPPORTUNITY TO WORK 1672 01:00:53,218 --> 01:00:55,720 WITH FOLKS AND GO BACK AND LOOK 1673 01:00:55,720 --> 01:00:58,523 AT SOME OF THE CARDIOVASCULAR 1674 01:00:58,523 --> 01:01:00,491 TRIALS FOR THESE SGLT TWOs, 1675 01:01:00,491 --> 01:01:02,994 AND WE WENT BACK AND WE OBSERVED 1676 01:01:02,994 --> 01:01:04,929 QUITE CONSISTENTLY IN TWO 1677 01:01:04,929 --> 01:01:09,834 SEPARATE TRIALS USING TWO 1678 01:01:09,834 --> 01:01:15,139 SEPARATE DRUGS THAT THESE ALSO 1679 01:01:15,139 --> 01:01:20,144 HALF THE INCIDENCE FOR SLEEP 1680 01:01:20,144 --> 01:01:21,913 APNEA, AS AN ADVERSE OUT COME IN 1681 01:01:21,913 --> 01:01:23,514 THESE TRIALS. 1682 01:01:23,514 --> 01:01:25,717 AND WE HAVE NOW STARTED A TRIAL 1683 01:01:25,717 --> 01:01:28,353 TRYING TO FIGURE OUT HOW THESE 1684 01:01:28,353 --> 01:01:31,456 DRUGS MIGHT ACTUALLY IMPACT AND 1685 01:01:31,456 --> 01:01:33,124 SERVE AS A POTENTIAL TREATMENT 1686 01:01:33,124 --> 01:01:34,525 FOR SLEEP APNEA. 1687 01:01:34,525 --> 01:01:36,561 AND IN DOING THESE KINDS OF 1688 01:01:36,561 --> 01:01:38,529 MECHANISTIC TRIALS, WE CAN NOW 1689 01:01:38,529 --> 01:01:41,933 LEVERAGE SOME OF THE TOOLS, SO 1690 01:01:41,933 --> 01:01:45,036 IMAGING STUDIES, RICK SCHWAB IS 1691 01:01:45,036 --> 01:01:46,371 WORKING WITH US ON THIS TRIAL TO 1692 01:01:46,371 --> 01:01:49,674 LOOK AT USING MRI AND DYNAMIC 1693 01:01:49,674 --> 01:01:51,576 IMAGING TO LOOK AT HOW THESE 1694 01:01:51,576 --> 01:01:54,746 DRUGS MAY IMPACT ANATOMY, WEIGHT 1695 01:01:54,746 --> 01:01:56,581 LOSS IN THE UPPER AIRWAY, AND WE 1696 01:01:56,581 --> 01:01:59,817 ARE MEASURING THESE NON-ANATOMIC 1697 01:01:59,817 --> 01:02:01,052 PHYSIOLOGIC TRAITS TO SEE HOW 1698 01:02:01,052 --> 01:02:03,121 THESE DRUGS MAY IMPROVE AND 1699 01:02:03,121 --> 01:02:05,590 SERVE AS A TREATMENT OF 1700 01:02:05,590 --> 01:02:07,892 OBSTRUCTIVE SLEEP APNEA. 1701 01:02:07,892 --> 01:02:10,728 I'M GOING TO MOVE NEXT NOW TO 1702 01:02:10,728 --> 01:02:16,367 TALK ABOUT NOR ADRENERGIC AND 1703 01:02:16,367 --> 01:02:17,468 ANTIMUSCARINICS ON UPPER AIRWAY 1704 01:02:17,468 --> 01:02:17,902 MUSCLES. 1705 01:02:17,902 --> 01:02:19,671 WE NOW KNOW THAT THE SLEEP 1706 01:02:19,671 --> 01:02:23,541 RELATED WITHDRAWAL OF NOR 1707 01:02:23,541 --> 01:02:24,676 ADRENERGIC DRIVE IS A 1708 01:02:24,676 --> 01:02:31,215 SIGNIFICANT CAUSE OF 1709 01:02:31,215 --> 01:02:32,283 GENIOGLOSSUS HYPOTONIA, 1710 01:02:32,283 --> 01:02:33,484 PARTICULARLY DURING NON-REM 1711 01:02:33,484 --> 01:02:35,887 SLEEP, AND CORRESPONDINGLY, 1712 01:02:35,887 --> 01:02:37,422 ACTIVE MUSCARINIC INHIBITION 1713 01:02:37,422 --> 01:02:41,960 APPEARS TO REALLY MEDIATE THE 1714 01:02:41,960 --> 01:02:43,628 PHARYNGEAL HYPOTONIA, 1715 01:02:43,628 --> 01:02:49,834 PARTICULARLY DURING REM SLEEP. 1716 01:02:49,834 --> 01:02:51,235 AND WE SORT OF LEVERAGED THIS 1717 01:02:51,235 --> 01:02:55,173 INFORMATION AND NOW A NUMBER OF 1718 01:02:55,173 --> 01:02:56,708 RANDOMIZED CONTROL TRIALS 1719 01:02:56,708 --> 01:02:59,410 LOOKING AT COMBINATIONS OF NOR 1720 01:02:59,410 --> 01:03:02,080 ADRENERGIC AND ANTIMUSCARINIC 1721 01:03:02,080 --> 01:03:03,915 AGENTS, WHETHER THEY WOULD BE 1722 01:03:03,915 --> 01:03:06,317 HELPFUL IN TREATING OBSTRUCTIVE 1723 01:03:06,317 --> 01:03:08,453 SLEEP APNEA AND LO AND BEHOLD, 1724 01:03:08,453 --> 01:03:09,887 IN META-ANALYSIS OF THESE 1725 01:03:09,887 --> 01:03:10,989 TRIALS, THEY ARE. 1726 01:03:10,989 --> 01:03:13,124 AND THE EFFICACY HAS VARIED FROM 1727 01:03:13,124 --> 01:03:16,494 ONE STUDY TO ANOTHER, THE WORK 1728 01:03:16,494 --> 01:03:19,263 BY THE HARVARD GROUP, ONE OF THE 1729 01:03:19,263 --> 01:03:22,834 INITIAL STUDIES PUBLISHED, A 1730 01:03:22,834 --> 01:03:25,103 REALLY IMPRESSIVE 23-POINT 1731 01:03:25,103 --> 01:03:31,976 REDUCTION IN THE APNEA HIGH INDN 1732 01:03:31,976 --> 01:03:35,146 AVERAGE THERE'S ABOUT A 9 TO 10 1733 01:03:35,146 --> 01:03:37,982 UNIT REDUCTION, BUT ONE OF THE 1734 01:03:37,982 --> 01:03:39,917 THINGS THAT MAY EXPLAIN SOME OF 1735 01:03:39,917 --> 01:03:41,119 THE VARIABILITY, AND THIS WAS 1736 01:03:41,119 --> 01:03:42,653 ALSO IN THE META-ANALYSIS, IS 1737 01:03:42,653 --> 01:03:46,791 THAT MEN APPEAR TO RESPOND TO A 1738 01:03:46,791 --> 01:03:47,725 GREATER LEVEL THAN WOMEN. 1739 01:03:47,725 --> 01:03:49,660 AND WHAT WE SEE IN THIS FIGURE 1740 01:03:49,660 --> 01:03:52,163 IS THAT STUDYS THAT HAVE A 1741 01:03:52,163 --> 01:03:53,898 HIGHER PROPORTION OF MEN 1742 01:03:53,898 --> 01:03:58,169 RESULTED IN A SIGNIFICANTLY 1743 01:03:58,169 --> 01:04:02,106 LOWER DECREASE IN THE 1744 01:04:02,106 --> 01:04:02,640 APNEA/HYPOPNEA INDEX. 1745 01:04:02,640 --> 01:04:03,975 THIS IS ONE OF THE FIRST STUDIES 1746 01:04:03,975 --> 01:04:10,782 TO LOOK USING THE COMBINATION OF 1747 01:04:10,782 --> 01:04:15,119 ATOMOXETINE AND OXYBUTYNIN, AND 1748 01:04:15,119 --> 01:04:17,355 IT WAS REALLY THE COMBINATION OF 1749 01:04:17,355 --> 01:04:18,256 THESE TWO MEDICATIONS THAT LED 1750 01:04:18,256 --> 01:04:19,524 TO A SIGNIFICANT DECREASE AND 1751 01:04:19,524 --> 01:04:21,626 THEY MEASURED SOME OF THESE 1752 01:04:21,626 --> 01:04:22,927 TRAITS, IT WAS THROUGH THESE 1753 01:04:22,927 --> 01:04:23,795 PHYSIOLOGIC TRAITS AND IT WAS 1754 01:04:23,795 --> 01:04:27,532 THROUGH IMPROVEMENT IN 1755 01:04:27,532 --> 01:04:28,599 GENIOGLOSSUS ACTIVITY THAT THESE 1756 01:04:28,599 --> 01:04:29,333 WERE MEDIATED. 1757 01:04:29,333 --> 01:04:32,403 I'M GOING TO SHIFT NOW TO 1758 01:04:32,403 --> 01:04:34,372 HYPNOTICS, AND SOME OF THE DATA 1759 01:04:34,372 --> 01:04:37,075 ON THEIR IMPACT ON AROUSAL 1760 01:04:37,075 --> 01:04:37,975 THRESHOLD. 1761 01:04:37,975 --> 01:04:39,377 AND WHAT WE KNOW, AND AGAIN, 1762 01:04:39,377 --> 01:04:42,313 THESE ARE BASED ON NOW 1763 01:04:42,313 --> 01:04:43,414 META-ANALYSIS, THERE HAVE BEEN 1764 01:04:43,414 --> 01:04:45,149 SO MANY TRIALS NOW LOOKING AT 1765 01:04:45,149 --> 01:04:47,452 THE IMPACT OF HYPNOTICS ON 1766 01:04:47,452 --> 01:04:49,053 AROUSAL THRESHOLDS, AND THESE 1767 01:04:49,053 --> 01:04:53,591 DRUGS ARE CAPABLE OF RAISING THE 1768 01:04:53,591 --> 01:04:55,760 AROUSAL THRESHOLD, MAKING IT 1769 01:04:55,760 --> 01:04:57,795 HARDER TO WAKE UP DURING SLEEP. 1770 01:04:57,795 --> 01:04:58,663 BUT UNLIKE SOME OF THE OTHER 1771 01:04:58,663 --> 01:05:01,732 TRAITS SUCH AS THE GENIOGLOSSUS 1772 01:05:01,732 --> 01:05:05,636 AND SOME OF THE ANATOMIC, A 1773 01:05:05,636 --> 01:05:06,838 MODIFYING THE AROUSAL THRESHOLD 1774 01:05:06,838 --> 01:05:09,207 DIDN'T REALLY RESULT IN AN 1775 01:05:09,207 --> 01:05:13,478 OVERALL CLINICALLY SIGNIFICANT 1776 01:05:13,478 --> 01:05:13,778 IMPROVEMENT. 1777 01:05:13,778 --> 01:05:14,812 VERY, VERY MODEST. 1778 01:05:14,812 --> 01:05:18,049 WHAT WAS TO ME ACTUALLY QUITE 1779 01:05:18,049 --> 01:05:20,418 SURPRISING AND A LITTLE BITTEN 1780 01:05:20,418 --> 01:05:24,388 COURAGING WAS THE FACT THAT 1781 01:05:24,388 --> 01:05:26,124 THESE DRUGS ALSO DID NOT APPEAR 1782 01:05:26,124 --> 01:05:30,361 TO SIGNIFICANTLY IMPAIR 1783 01:05:30,361 --> 01:05:31,362 GENIOGLOSSUS FUNCTION. 1784 01:05:31,362 --> 01:05:33,698 LOOKING AT STUDIES THAT INCLUDED 1785 01:05:33,698 --> 01:05:44,342 TA MAT TTEMAZEPAM. 1786 01:05:49,313 --> 01:05:51,415 SO THESE HYPNOTICS DO NOT 1787 01:05:51,415 --> 01:05:53,951 SIGNIFICANTLY DECREASE 1788 01:05:53,951 --> 01:05:54,986 GENIOGLOSSUS ACTIVITY. 1789 01:05:54,986 --> 01:05:56,220 THOUGH THESE ARE NOT NECESSARILY 1790 01:05:56,220 --> 01:05:58,823 TREATMENTS TO IMPROVE THE 1791 01:05:58,823 --> 01:06:00,691 OVERALL APNEA HYPOPNEA INDEX, 1792 01:06:00,691 --> 01:06:02,660 OUR GROUP, I THINK, HAS BEEN 1793 01:06:02,660 --> 01:06:05,696 VERY INTERESTED IN HOW THESE 1794 01:06:05,696 --> 01:06:09,267 DRUGS MAY HELP IN TERMS OF 1795 01:06:09,267 --> 01:06:09,934 PROGNOSIS. 1796 01:06:09,934 --> 01:06:13,137 THIS IS WORK, THE LEAD AUTHOR IN 1797 01:06:13,137 --> 01:06:17,208 THE STUDY WAS ANDRE ZINSHA. 1798 01:06:17,208 --> 01:06:18,943 WHEN WE WENT BACK AND LOOKED AT 1799 01:06:18,943 --> 01:06:23,781 THE DATA FROM THE RIKADZA STUDY, 1800 01:06:23,781 --> 01:06:24,982 WE WERE STUNNED TO SEE THAT 1801 01:06:24,982 --> 01:06:26,717 THOSE PATIENTS WHO HAD LOW 1802 01:06:26,717 --> 01:06:28,419 AROUSAL THRESHOLD HAD NEARLY -- 1803 01:06:28,419 --> 01:06:29,987 ALMOST A TWO-HOUR DIFFERENCE IN 1804 01:06:29,987 --> 01:06:31,422 THEIR ABILITY TO WEAR AND ADHERE 1805 01:06:31,422 --> 01:06:33,057 TO CPAP THERAPY. 1806 01:06:33,057 --> 01:06:38,396 SO KNOWLEDGE OF THIS ENDO DINO 1807 01:06:38,396 --> 01:06:39,797 TYPIC PHYSIOLOGIC TRAIT MAY BE 1808 01:06:39,797 --> 01:06:42,633 HELPFUL IN EXPLAINING CPAP 1809 01:06:42,633 --> 01:06:47,004 ADHERENCE AND CHOOSING THIS 1810 01:06:47,004 --> 01:06:49,640 THERAPY FOR INDIVIDUALS. 1811 01:06:49,640 --> 01:06:51,576 AND PERHAPS STUDIES THAT TARGET 1812 01:06:51,576 --> 01:06:53,911 THIS MAY MAKE IT EASIER FOR 1813 01:06:53,911 --> 01:06:57,048 PATIENTS TO ADHERE. 1814 01:06:57,048 --> 01:07:00,518 THIS IS WORK BY KRISTINE W. ON 1815 01:07:00,518 --> 01:07:01,786 FROM OUR GROUP AND I THINK HAS 1816 01:07:01,786 --> 01:07:04,889 BEEN MENTIONED BEFORE, WHO USING 1817 01:07:04,889 --> 01:07:09,460 THE MESA COHORT DEMONSTRATED IN 1818 01:07:09,460 --> 01:07:10,895 ADDITION TO LOWER LOOP GAIN, 1819 01:07:10,895 --> 01:07:12,997 LESS AIRWAY COLLAPSABILITY, 1820 01:07:12,997 --> 01:07:14,065 WOMEN CONSISTENTLY APPEAR TO 1821 01:07:14,065 --> 01:07:18,836 HAVE THIS LOWER' ROW SAL 1822 01:07:18,836 --> 01:07:19,337 THRESHOLD TRAIT. 1823 01:07:19,337 --> 01:07:21,472 IN FACT, THESE ENDOTYPES EXPLAIN 1824 01:07:21,472 --> 01:07:23,407 30% OF THE DIFFERENCES IN THEIR 1825 01:07:23,407 --> 01:07:24,809 NON-REM AHI. 1826 01:07:24,809 --> 01:07:26,577 THERE'S JUST A LOT OF INTEREST 1827 01:07:26,577 --> 01:07:29,180 ABOUT WHETHER THIS MAY EXPLAIN 1828 01:07:29,180 --> 01:07:30,481 WHY WOMEN MAY BE MORE LIKELY, I 1829 01:07:30,481 --> 01:07:31,916 THINK AS SUSAN BROUGHT UP 1830 01:07:31,916 --> 01:07:36,587 YESTERDAY, TO HAVE COMISA, AND 1831 01:07:36,587 --> 01:07:38,756 PERHAPS EXPLAIN SOME OF THE 1832 01:07:38,756 --> 01:07:40,958 LOWER ADHERENCE RATES TO CPAP 1833 01:07:40,958 --> 01:07:42,927 THERAPY. 1834 01:07:42,927 --> 01:07:44,562 WHICH IS INCREDIBLY IMPORTANT 1835 01:07:44,562 --> 01:07:49,233 GIVEN THEIR HIGH CARDIOVASCULAR 1836 01:07:49,233 --> 01:07:50,968 RISK FROM OBSTRUCTIVE SLEEP 1837 01:07:50,968 --> 01:07:51,302 APNEA. 1838 01:07:51,302 --> 01:07:53,804 THIS IS JUST TO REMIND US THAT 1839 01:07:53,804 --> 01:07:58,309 THE APPLE STUDY, WHICH WAS ONE 1840 01:07:58,309 --> 01:08:01,078 OF THE FIRST RANDOMIZED 1841 01:08:01,078 --> 01:08:03,514 CONTROLLED TRIALS IN OUR FIELD 1842 01:08:03,514 --> 01:08:05,283 LOOKING AT C PAM THERAPY WHICH 1843 01:08:05,283 --> 01:08:07,018 FOCUSED ON NEUROCOGNITION, AND I 1844 01:08:07,018 --> 01:08:08,319 THINK WE HAD A ROBUST DISCUSSION 1845 01:08:08,319 --> 01:08:11,822 OF THE IMPACT OF CPAP ON COG NI 1846 01:08:11,822 --> 01:08:13,691 REALLY SHOWED VERY MILD AND 1847 01:08:13,691 --> 01:08:15,059 TRANSIENT IMPROVEMENTS 1848 01:08:15,059 --> 01:08:16,260 PARTICULARLY IN EXECUTIVE 1849 01:08:16,260 --> 01:08:17,395 FUNCTION, WHICH WAS SORT OF 1850 01:08:17,395 --> 01:08:18,262 SURPRISING TO MANY OF US. 1851 01:08:18,262 --> 01:08:19,530 MORE RECENTLY, WE'VE GONE BACK 1852 01:08:19,530 --> 01:08:22,166 AND LOOKED AT THE APPLES DATA, 1853 01:08:22,166 --> 01:08:24,669 AND AS OBSERVED THAT THIS 1854 01:08:24,669 --> 01:08:27,204 EXECUTIVE FUNCTION IS COMPLETELY 1855 01:08:27,204 --> 01:08:28,539 MODIFIED BY THE AROUSAL 1856 01:08:28,539 --> 01:08:31,042 THRESHOLD. 1857 01:08:31,042 --> 01:08:32,243 SO THE PATIENTS WHO REALLY 1858 01:08:32,243 --> 01:08:35,279 BENEFIT FROM CPAP THERAPY WITH 1859 01:08:35,279 --> 01:08:37,682 RESPECT TO THIS MEASURE OF 1860 01:08:37,682 --> 01:08:40,351 COGNITION, EXECUTIVE FUNCTION 1861 01:08:40,351 --> 01:08:41,886 AND WE VALIDATED THIS IN TWO 1862 01:08:41,886 --> 01:08:43,654 SEPARATE MEASURES OF EXECUTIVE 1863 01:08:43,654 --> 01:08:45,756 FUNCTION, ARE THE ONES THAT HAVE 1864 01:08:45,756 --> 01:08:47,258 HIGHER AROUSAL THRESHOLD, THE 1865 01:08:47,258 --> 01:08:49,126 PATIENTS WITH LOWER AROUSAL 1866 01:08:49,126 --> 01:08:54,365 THRESHOLD DON'T SEEM TO BENEFIT. 1867 01:08:54,365 --> 01:09:02,773 SO WE WERE HEARING THOSE HEAR HE 1868 01:09:02,773 --> 01:09:03,741 PATIENTS TOGETHER AND THIS MAY 1869 01:09:03,741 --> 01:09:05,710 SHED SOME LIGHT ON HOW FUTURE 1870 01:09:05,710 --> 01:09:07,111 TRIALS AND HOW WE TARGET LOOKING 1871 01:09:07,111 --> 01:09:08,746 AT THINGS LIKE COGNITION. 1872 01:09:08,746 --> 01:09:10,715 ESRA'S JUST LAST TALK I THINK 1873 01:09:10,715 --> 01:09:16,387 BROUGHT UP CIRCADIAN BIOLOGY, 1874 01:09:16,387 --> 01:09:18,356 AND THAT'S NOT REALLY A FOCUS OF 1875 01:09:18,356 --> 01:09:19,990 THIS, BUT JUST TO POINT OUT THAT 1876 01:09:19,990 --> 01:09:24,028 A CIRCADIAN BIOLOGY DOES, IN 1877 01:09:24,028 --> 01:09:27,865 FACT, IMPACT SLEEP APNEA 1878 01:09:27,865 --> 01:09:30,768 TREATMENT AND WE CAN OFTEN MOD 1879 01:09:30,768 --> 01:09:33,537 MODIFY THAT WITH MEDICAL AND 1880 01:09:33,537 --> 01:09:35,172 BEHAVIORAL THERAPY. 1881 01:09:35,172 --> 01:09:39,744 MILY IS A KNAUERT IN OUR GROUP 1882 01:09:39,744 --> 01:09:40,845 ELEGANTLY WENT BACK THROUGH THE 1883 01:09:40,845 --> 01:09:41,812 APPLES DATA AND OBSERVED THAT 1884 01:09:41,812 --> 01:09:44,115 THOSE PATIENTS WHO WERE A 1885 01:09:44,115 --> 01:09:45,182 MORNING CHRONOTYPE HAD 1886 01:09:45,182 --> 01:09:46,617 SIGNIFICANTLY HIGHER ADHERENCE 1887 01:09:46,617 --> 01:09:47,918 RATES, SO ANOTHER DOMAIN TO 1888 01:09:47,918 --> 01:09:48,252 EXPLORE. 1889 01:09:48,252 --> 01:09:49,487 I'M GOING TO FINISH UP BY 1890 01:09:49,487 --> 01:09:50,855 TALKING ABOUT SOME OF THE DATA 1891 01:09:50,855 --> 01:09:54,158 ON CARBONIC AN HIGH DRAIS 1892 01:09:54,158 --> 01:09:55,359 INHIBITORS AND VENTILATORY 1893 01:09:55,359 --> 01:09:57,895 INSTABILITY AND WE WERE VERY 1894 01:09:57,895 --> 01:10:03,367 FORTUNATE THAT DR. SCHMICKL FROM 1895 01:10:03,367 --> 01:10:05,770 UCSD DID A VERY NICE AND 1896 01:10:05,770 --> 01:10:07,171 THOROUGH SYSTEMATIC LITERATURE 1897 01:10:07,171 --> 01:10:08,272 REVIEW ON THESE TOPICS. 1898 01:10:08,272 --> 01:10:14,044 SO THESE DRUGS BASICALLY ACIDIFY 1899 01:10:14,044 --> 01:10:15,246 THE BLOOD AND ARE TARGETING THE 1900 01:10:15,246 --> 01:10:18,282 LOOP GAIN, THE VENTILATORY 1901 01:10:18,282 --> 01:10:18,849 CONTROL INSTABILITY. 1902 01:10:18,849 --> 01:10:20,551 HE LOOKED AT POOLED STUDIES THAT 1903 01:10:20,551 --> 01:10:22,386 WERE LOOKING AT BOTH OBSTRUCTIVE 1904 01:10:22,386 --> 01:10:23,988 SLEEP APNEA AS WELL AS CENTRAL 1905 01:10:23,988 --> 01:10:25,489 SLEEP APNEA, AND THESE DRUGS 1906 01:10:25,489 --> 01:10:26,590 WORK. 1907 01:10:26,590 --> 01:10:31,362 THEY OVERALL LOWERED THE APNEA 1908 01:10:31,362 --> 01:10:33,130 HRB HYPOPNEA MIX BY A MEAN 1909 01:10:33,130 --> 01:10:34,432 DIFFERENCE OF 14 EVENTS PER 1910 01:10:34,432 --> 01:10:38,803 HOUR, ABOUT A 37% REDUCTION IN 1911 01:10:38,803 --> 01:10:43,641 SEVERITY. 1912 01:10:43,641 --> 01:10:45,376 WHAT SURPRISED ME, VERY SIMILAR 1913 01:10:45,376 --> 01:10:47,545 EFFICACY FROM BOTH OBSTRUCTIVE 1914 01:10:47,545 --> 01:10:48,212 AND CENTRAL SLEEP APNEA, I THINK 1915 01:10:48,212 --> 01:10:50,714 WE TEND TO USE THESE DRUGS MORE 1916 01:10:50,714 --> 01:10:52,049 CLINICALLY AMONG PATIENTS WITH 1917 01:10:52,049 --> 01:10:53,250 CENTRAL SLEEP APNEA, BUT IT 1918 01:10:53,250 --> 01:10:56,754 POINTS OUT THAT HIGH LOOP GAIN 1919 01:10:56,754 --> 01:10:57,721 OR VENTILATORY CONTROL 1920 01:10:57,721 --> 01:11:00,458 INSTABILITY IS PATHOPHYSIOLOGIC 1921 01:11:00,458 --> 01:11:02,326 AND OBSTRUCTIVE AS WELL AS 1922 01:11:02,326 --> 01:11:04,195 SENTRA SLEEP APNEA, AND THESE 1923 01:11:04,195 --> 01:11:06,230 DRUGS AS EXPECTED IN THEIR 1924 01:11:06,230 --> 01:11:07,231 DIURETIC CAPACITY WERE ALSO 1925 01:11:07,231 --> 01:11:09,600 FOUND TO SIGNIFICANTLY LOWER 1926 01:11:09,600 --> 01:11:14,672 BLOOD PRESSURE. 1927 01:11:14,672 --> 01:11:16,273 SO JUST BY WAY OF TAKE-HOME 1928 01:11:16,273 --> 01:11:17,208 POINTS AND WHAT WE'VE TALKED 1929 01:11:17,208 --> 01:11:19,477 ABOUT TODAY, KNOWLEDGE OF THESE 1930 01:11:19,477 --> 01:11:21,378 PHYSIOLOGIC TRAITS HAVE EXPANDED 1931 01:11:21,378 --> 01:11:29,887 OUR CONCEPT OF OSA PATHOGENESIS, 1932 01:11:29,887 --> 01:11:31,288 GLP-1 AGONISTS ARE COMBINATION 1933 01:11:31,288 --> 01:11:32,690 AGONISTS RESULT IN SIGNIFICANT 1934 01:11:32,690 --> 01:11:34,792 WEIGHT LOSS AND MARKED 1935 01:11:34,792 --> 01:11:37,761 IMPROVEMENT IN THE 1936 01:11:37,761 --> 01:11:39,964 APNEA/HYPOPNEA MIX FROM THE 1937 01:11:39,964 --> 01:11:40,498 SURMOUNT OSA TRIAL. 1938 01:11:40,498 --> 01:11:42,600 THE USE OF CLINICAL IMAGING 1939 01:11:42,600 --> 01:11:44,602 MODALITIES SUCH AS THE WORK FROM 1940 01:11:44,602 --> 01:11:46,203 PENICILLIN AND RICK SCHWAB 1941 01:11:46,203 --> 01:11:49,039 COMBINED WITH MEASURES OF 1942 01:11:49,039 --> 01:11:51,542 ENDOPHENOTYPES REALLY PERMIT 1943 01:11:51,542 --> 01:11:53,377 THESE SORT OF MECHANISTIC 1944 01:11:53,377 --> 01:11:55,479 CLINICAL TRIALS. 1945 01:11:55,479 --> 01:11:56,380 EXAMINING POTENTIALLY NOVEL 1946 01:11:56,380 --> 01:11:57,248 PHARMACOLOGIC TREATMENTS. 1947 01:11:57,248 --> 01:11:59,750 AND WE'RE LEVERAGING BOTH OF 1948 01:11:59,750 --> 01:12:06,957 THESE TOOLS IN ADIPOSA, THIS 1949 01:12:06,957 --> 01:12:08,058 SGL2 TRIAL, THAT WAS DONE AS 1950 01:12:08,058 --> 01:12:09,693 WELL AND SOME OF THE STUDIES 1951 01:12:09,693 --> 01:12:14,465 LOOKING AT GENIOGLOSSUS FUNCTION 1952 01:12:14,465 --> 01:12:17,768 AND 1953 01:12:17,768 --> 01:12:18,435 NEUROADRENERGIC/ANTIMUSCARINICS. 1954 01:12:18,435 --> 01:12:20,804 THIS COMBINATION OF NOR 1955 01:12:20,804 --> 01:12:22,873 ADRENERGIC AND ANTIMUSCARINIC 1956 01:12:22,873 --> 01:12:24,642 HAVE A MORE ROBUST EFFECT AMONG 1957 01:12:24,642 --> 01:12:29,313 MEN WITH RESPECT TO GENIOGLOSSIC 1958 01:12:29,313 --> 01:12:29,647 ACTIVITIES. 1959 01:12:29,647 --> 01:12:32,049 WE TALKED ABOUT HYPNOTICS ARE 1960 01:12:32,049 --> 01:12:34,785 ABLE TO ARROW THE THRESHOLD BUT 1961 01:12:34,785 --> 01:12:36,620 THEIR OVERALL IMPACT ON OSA 1962 01:12:36,620 --> 01:12:39,356 SEVERITY IS NOT THAT LARGE. 1963 01:12:39,356 --> 01:12:40,925 HOWEVER, THIS TOOL MAY ACTUALLY 1964 01:12:40,925 --> 01:12:42,560 END UP BEING MORE HELPFUL FROM 1965 01:12:42,560 --> 01:12:45,496 ITS PROGNOSTIC IMPLICATIONS. 1966 01:12:45,496 --> 01:12:49,533 IT'S ABLE TO PREDICT LOW CPAP 1967 01:12:49,533 --> 01:12:51,702 ADHERENCE, AND TARGETING THIS 1968 01:12:51,702 --> 01:12:53,704 MAY BE A THERAPEUTIC OPTION. 1969 01:12:53,704 --> 01:12:55,306 THERE HAVE BEEN SOME STUDIES 1970 01:12:55,306 --> 01:12:57,074 USING Z DRUGS THAT HAVE SHOWN 1971 01:12:57,074 --> 01:12:58,576 IMPROVED ADHERENCE RATES WITH 1972 01:12:58,576 --> 01:13:03,180 THE COMBINATION OF CPAP INSTEAD 1973 01:13:03,180 --> 01:13:04,148 OF HYPNOTICS. 1974 01:13:04,148 --> 01:13:05,349 THIS MEASURE OF AROUSAL 1975 01:13:05,349 --> 01:13:07,217 THRESHOLD, I THINK AS WE'VE 1976 01:13:07,217 --> 01:13:10,921 DISCUSSED ALREADY, MAY PROVIDE 1977 01:13:10,921 --> 01:13:11,922 REALLY IMPORTANT INSIGHT INTO 1978 01:13:11,922 --> 01:13:13,390 SOME OF THE SEX DIFFERENCES IN 1979 01:13:13,390 --> 01:13:15,059 SLEEP APNEA. 1980 01:13:15,059 --> 01:13:17,695 AND AS WE TALKED ABOUT, THIS 1981 01:13:17,695 --> 01:13:20,197 APPEARS TO MODERATE SOME OF THE 1982 01:13:20,197 --> 01:13:23,334 IMPACT OF CPAP ON EXECUTIVE 1983 01:13:23,334 --> 01:13:23,701 FUNCTION. 1984 01:13:23,701 --> 01:13:30,708 AND FINALLY, WE TALKED ABOUT HOW 1985 01:13:30,708 --> 01:13:33,010 ACETAZOLAMIDE LOWERS AHI BY 37%, 1986 01:13:33,010 --> 01:13:35,579 A SIMILAR IMPACT ON OBSTRUCTIVE 1987 01:13:35,579 --> 01:13:37,681 AND CENTRAL, AND IT APPEARS 1988 01:13:37,681 --> 01:13:39,550 BASED ON THAT META-ANALYSIS, 1989 01:13:39,550 --> 01:13:41,285 GREATER THAN 500 MG DOSE IS 1990 01:13:41,285 --> 01:13:42,486 REQUIRED TO REALLY SEE THESE 1991 01:13:42,486 --> 01:13:44,888 BENEFITS. 1992 01:13:44,888 --> 01:13:51,228 FINALLY, I THINK IN TERMS OF A 1993 01:13:51,228 --> 01:13:52,963 FUTURE OPPORTUNITIES, I THINK 1994 01:13:52,963 --> 01:13:54,298 THERE'S SOME REAL OPPORTUNITY 1995 01:13:54,298 --> 01:13:56,700 PERHAPS WITH THE SURMOUNT OSA 1996 01:13:56,700 --> 01:13:59,003 STUDY TO LOOK AT AND EXPLORE IN 1997 01:13:59,003 --> 01:14:01,405 MORE DETAIL SOME OF THE SEX 1998 01:14:01,405 --> 01:14:03,340 DIFFERENCES IN SLEEP APNEA THAT 1999 01:14:03,340 --> 01:14:06,043 OCCUR WITH GLP-1 FACILITATED 2000 01:14:06,043 --> 01:14:06,343 WEIGHT LOSS. 2001 01:14:06,343 --> 01:14:07,611 I THINK IT'S IMPORTANT FOR US TO 2002 01:14:07,611 --> 01:14:10,547 THINK BOTH ABOUT NOT JUST THE 2003 01:14:10,547 --> 01:14:12,850 OBJECTIVE POLYSONOGRAPHIC 2004 01:14:12,850 --> 01:14:14,918 MEASURES BUT THE SUBJECTIVE 2005 01:14:14,918 --> 01:14:18,088 MEASURES, SLEEPINESS, SYMPTOMS, 2006 01:14:18,088 --> 01:14:19,957 QUALITY OF LIFE, ET CETERA. 2007 01:14:19,957 --> 01:14:24,528 WE TALKED ABOUT -- AND I THINK 2008 01:14:24,528 --> 01:14:27,398 ANOTHER OPPORTUNITY IS USING 2009 01:14:27,398 --> 01:14:30,467 THIS COMBINATION OF IMAGING 2010 01:14:30,467 --> 01:14:31,869 MODALITIES AND THESE COMBINED 2011 01:14:31,869 --> 01:14:34,571 WITH MEASURES OF ENDO PHENOTYPES 2012 01:14:34,571 --> 01:14:36,440 TO REALLY BETTER UNDERSTAND SOME 2013 01:14:36,440 --> 01:14:40,611 OF THE SEX DIFFERENCES IN SLEEP 2014 01:14:40,611 --> 01:14:42,846 APNEA ACROSS VARIOUS LIFESPAN 2015 01:14:42,846 --> 01:14:43,547 STATES. 2016 01:14:43,547 --> 01:14:45,949 THAT INCLUDES PREGNANCY, 2017 01:14:45,949 --> 01:14:47,918 PREMENOPAUSAL STATUS AND 2018 01:14:47,918 --> 01:14:50,554 POST-MENOPAUSAL STATUS. 2019 01:14:50,554 --> 01:14:52,322 LONGER TERM FOLLOW-UP STUDIES IN 2020 01:14:52,322 --> 01:14:53,524 BOTH SEXES ARE NEEDED, 2021 01:14:53,524 --> 01:15:03,801 PARTICULARLY WITH RESPECT TO 2022 01:15:03,801 --> 01:15:09,273 ACETO TAZOLAMIDE, SEX DIFFERENCS 2023 01:15:09,273 --> 01:15:10,674 IN CIRCADIAN BIOLOGY. 2024 01:15:10,674 --> 01:15:11,675 I THINK THERE'S A REAL 2025 01:15:11,675 --> 01:15:12,776 OPPORTUNITY TO THINK ABOUT HOW 2026 01:15:12,776 --> 01:15:14,411 WE MIGHT COMBINE SOME OF THESE 2027 01:15:14,411 --> 01:15:16,480 PHARMACOTHERAPIES TO TARGET 2028 01:15:16,480 --> 01:15:18,015 SPECIFIC ENDOPHENOTYPES. 2029 01:15:18,015 --> 01:15:19,049 PATIENT DON'T USUALLY HAVE ONE 2030 01:15:19,049 --> 01:15:22,820 OF THESE BUT RATHER SOME OF THEM 2031 01:15:22,820 --> 01:15:24,788 TRACK TOGETHER, AND JUST LAST 2032 01:15:24,788 --> 01:15:28,726 PLUG, ON A COMPLETELY UNRELATED 2033 01:15:28,726 --> 01:15:30,594 TOPIC ON CANNABIS, AND AS I WAS 2034 01:15:30,594 --> 01:15:33,964 GOING THROUGH THIS LITERATURE ON 2035 01:15:33,964 --> 01:15:34,832 PHARMACOLOGY, THERE IS ACTUALLY 2036 01:15:34,832 --> 01:15:38,869 A LITERATURE ON LEVERAGING THE 2037 01:15:38,869 --> 01:15:40,604 ENDOCANNABINOID SYSTEM AND 2038 01:15:40,604 --> 01:15:45,109 CANNABIS IN TREATING OBSTRUCTIVE 2039 01:15:45,109 --> 01:15:46,844 SLEEP APNEA. 2040 01:15:46,844 --> 01:15:51,582 THIS IS NASCENT, BUT MORE FROM A 2041 01:15:51,582 --> 01:15:52,983 PUBLIC HEALTH -- I'VE RECENTLY 2042 01:15:52,983 --> 01:15:55,052 LEARNED AGAIN THIS SPEAKS TO 2043 01:15:55,052 --> 01:15:56,153 HETEROGENEITY BUT THAT THE 2044 01:15:56,153 --> 01:15:57,821 LARGEST RISING GROUP OF CANNABIS 2045 01:15:57,821 --> 01:15:59,256 USERS ARE OVER THE AGE OF 65, 2046 01:15:59,256 --> 01:16:01,191 THEY'RE USING IT FOR SLEEP AND 2047 01:16:01,191 --> 01:16:02,726 TO TREAT PAIN AND ALL OF THE 2048 01:16:02,726 --> 01:16:04,161 STUDIES HAVE BEEN DONE FROM THE 2049 01:16:04,161 --> 01:16:04,962 1970s IN YOUNG PEOPLE. 2050 01:16:04,962 --> 01:16:07,464 WE HAVE ZERO DATA AMONG OLDER 2051 01:16:07,464 --> 01:16:09,767 PEOPLE, AND I THINK THAT'S 2052 01:16:09,767 --> 01:16:12,836 REALLY IMPORTANT GIVEN HOW 2053 01:16:12,836 --> 01:16:14,838 LEGALIZATION HAS IMPACTED USE 2054 01:16:14,838 --> 01:16:15,472 ACROSS THIS COUNTRY. 2055 01:16:15,472 --> 01:16:18,776 SO WITH THAT, I'M GOING TO STOP. 2056 01:16:18,776 --> 01:16:20,010 THANK YOU VERY MUCH FOR YOUR 2057 01:16:20,010 --> 01:16:24,281 ATTENTION. 2058 01:16:24,281 --> 01:16:26,483 >> OKAY, DR. YAGGI, THANK YOU. 2059 01:16:26,483 --> 01:16:28,318 THAT WAS REALLY AN EXCEPTIONAL 2060 01:16:28,318 --> 01:16:29,553 OVERVIEW OF DIFFERENT 2061 01:16:29,553 --> 01:16:31,755 PHARMACOLOGICAL APPROACHES, FOR 2062 01:16:31,755 --> 01:16:35,259 TREATING SLEEP APNEA, AND THE 2063 01:16:35,259 --> 01:16:36,126 POTENTIAL FOR PERSONALIZING 2064 01:16:36,126 --> 01:16:39,196 THESE APPROACHES BASED ON THE 2065 01:16:39,196 --> 01:16:40,831 SPECIFIC PATHOBIOLOGY AND 2066 01:16:40,831 --> 01:16:44,434 SPECIFIC PHENOTYPES THAT THE 2067 01:16:44,434 --> 01:16:45,302 INDIVIDUALS MAY EXHIBIT. 2068 01:16:45,302 --> 01:16:47,171 I'D LIKE TO LEAVE TIME FOR ONE 2069 01:16:47,171 --> 01:16:48,705 QUESTION, EVEN THOUGH WE'RE 2070 01:16:48,705 --> 01:16:50,674 MOSTLY OUT OF TIME, BUT THIS IS 2071 01:16:50,674 --> 01:16:52,976 ONE THAT SHOWED UP IN THE CHAT. 2072 01:16:52,976 --> 01:16:58,415 SO IT SAYS DO YOU THINK SEX 2073 01:16:58,415 --> 01:17:00,184 DIFFERENCES IN VISCERAL FAT OR 2074 01:17:00,184 --> 01:17:01,385 OTHER FAT CHARACTERISTICS MAY 2075 01:17:01,385 --> 01:17:03,954 EXPLAIN SEX DIFFERENCE AND 2076 01:17:03,954 --> 01:17:05,756 WEIGHT LOSS IN RESPONSE TO 2077 01:17:05,756 --> 01:17:06,990 GLPs, AND IS IT PLAUSIBLE THAT 2078 01:17:06,990 --> 01:17:09,459 WE WILL SEE A BETTER OSA 2079 01:17:09,459 --> 01:17:10,327 RESPONSE WITH THOSE DRUGS IN 2080 01:17:10,327 --> 01:17:12,196 WOMEN DUE TO DIFFERENCES IN FAT 2081 01:17:12,196 --> 01:17:14,198 IN MEN AND WOMEN? 2082 01:17:14,198 --> 01:17:17,334 >> I THINK THAT'S AN EXCELLENT 2083 01:17:17,334 --> 01:17:18,869 QUESTION, AND WE TOUCHED A 2084 01:17:18,869 --> 01:17:20,070 LITTLE BIT UPON THIS YESTERDAY. 2085 01:17:20,070 --> 01:17:28,212 I THINK AT LEAST IN THE CHAT. 2086 01:17:28,212 --> 01:17:30,380 THERE WAS I THINK A VERY GOOD 2087 01:17:30,380 --> 01:17:32,983 DISCUSSION YESTERDAY ABOUT THE 2088 01:17:32,983 --> 01:17:37,354 IMPACT OF MENOPAUSAL STATUS ON 2089 01:17:37,354 --> 01:17:41,625 FAT DISTRIBUTION IN WOMEN. 2090 01:17:41,625 --> 01:17:44,595 AND THAT MAY AT LEAST IN PART 2091 01:17:44,595 --> 01:17:46,663 EXPLAIN HOW SLEEP APNEA IS 2092 01:17:46,663 --> 01:17:47,931 REALLY -- I THINK IT GOES UP 2093 01:17:47,931 --> 01:17:48,966 FOUR FOLD IF I REMEMBER 2094 01:17:48,966 --> 01:17:50,601 CORRECTLY COMPARING 2095 01:17:50,601 --> 01:17:51,935 PREMENOPAUSAL TO MENOPAUSAL 2096 01:17:51,935 --> 01:17:52,669 WOMEN. 2097 01:17:52,669 --> 01:17:55,305 AND THAT'S CERTAINLY, I THINK, 2098 01:17:55,305 --> 01:17:58,675 LIKELY A CONTRIBUTOR. 2099 01:17:58,675 --> 01:18:00,444 AND SO ALTHOUGH I THINK MANY 2100 01:18:00,444 --> 01:18:02,613 STUDIES HAVE SHOWN A MORE ROBUST 2101 01:18:02,613 --> 01:18:06,250 SLEEP APNEA IMPROVEMENT 2102 01:18:06,250 --> 01:18:07,351 ASSOCIATED WITH WEIGHT LOSS IN 2103 01:18:07,351 --> 01:18:08,518 GENERAL AMONG MEN, I'M NOT SURE 2104 01:18:08,518 --> 01:18:10,153 THEY HAVE BEEN STRATIFYING AND 2105 01:18:10,153 --> 01:18:11,388 LOOKING AT MENOPAUSAL STATUS IN 2106 01:18:11,388 --> 01:18:11,588 THAT. 2107 01:18:11,588 --> 01:18:15,425 AND I THINK IT'S AN EXCELLENT 2108 01:18:15,425 --> 01:18:18,695 HYPOTHESIS TO EXPLORE, AND WITH 2109 01:18:18,695 --> 01:18:22,432 SOME OF THESE TRIALS 2110 01:18:22,432 --> 01:18:23,800 PARTICULARLY WITH THIS DEGREE OF 2111 01:18:23,800 --> 01:18:25,035 WEIGHT LOSS, WE'LL HAVE AN 2112 01:18:25,035 --> 01:18:25,335 OPPORTUNITY. 2113 01:18:25,335 --> 01:18:29,439 AS A SIDE EMAIL JUST THIS WEEK, 2114 01:18:29,439 --> 01:18:30,941 THEY HAVEN'T RELEASED THAT YET 2115 01:18:30,941 --> 01:18:36,747 BUT I THINK THEY'RE UNDER FDA 2116 01:18:36,747 --> 01:18:37,681 RESTRICTIONS AT THE MOMENT BUT 2117 01:18:37,681 --> 01:18:39,483 HE SAID THAT'S ON THEIR RADAR 2118 01:18:39,483 --> 01:18:40,350 AND THEY'RE VERY MUCH INTERESTED 2119 01:18:40,350 --> 01:18:41,551 IN LOOKING AT THESE SEX 2120 01:18:41,551 --> 01:18:42,886 DIFFERENCES AT LEAST IN THE 2121 01:18:42,886 --> 01:18:47,291 SURMOUNT OSA TRIAL. 2122 01:18:47,291 --> 01:18:48,058 >> THANK YOU VERY MUCH. 2123 01:18:48,058 --> 01:18:49,359 IT'S TIME TO MOVE ON TO THE NEXT 2124 01:18:49,359 --> 01:18:49,593 SESSION. 2125 01:18:49,593 --> 01:18:53,297 SO I'D LIKE TO INTRODUCE THE 2126 01:18:53,297 --> 01:18:59,102 MODERATOR FOR SESSION FIVE, 2127 01:18:59,102 --> 01:19:01,505 DR. MEGHAN O'NEILL, SO MEGHAN, 2128 01:19:01,505 --> 01:19:02,673 WE'LL TURN THIS OVER TO YOU NOW. 2129 01:19:02,673 --> 01:19:03,040 >> GREAT. 2130 01:19:03,040 --> 01:19:03,674 THANK YOU SO MUCH. 2131 01:19:03,674 --> 01:19:07,511 ALL RIGHT. 2132 01:19:07,511 --> 01:19:08,812 SO GOOD AFTERNOON, EVERYONE. 2133 01:19:08,812 --> 01:19:11,181 MY NAME IS MEGHAN O'NEILL AND 2134 01:19:11,181 --> 01:19:12,950 I'LL BE MODERATING SESSION FIVE 2135 01:19:12,950 --> 01:19:14,284 TIETD TITHE HE WOULD WHAT CAN WE 2136 01:19:14,284 --> 01:19:18,255 LEARN ABOUT OSA HETEROGENEITY IN 2137 01:19:18,255 --> 01:19:20,657 PERSONS LIVING WITH INTELLECTUAL 2138 01:19:20,657 --> 01:19:21,325 AND DEVELOPMENTAL DISABILITIES? 2139 01:19:21,325 --> 01:19:23,527 I THINK I MIGHT BE THE ONLY NEW 2140 01:19:23,527 --> 01:19:24,628 MODERATOR TODAY SO JUST TO 2141 01:19:24,628 --> 01:19:26,363 INTRODUCE MYSELF QUICKLY, I AM A 2142 01:19:26,363 --> 01:19:29,766 MEDICAL OFFICER AT NICHD OR THE 2143 01:19:29,766 --> 01:19:30,834 EUNICE KENNEDY SHRIVER NATIONAL 2144 01:19:30,834 --> 01:19:32,703 INSTITUTE OF CHILD HEALTH AND 2145 01:19:32,703 --> 01:19:33,770 HUMAN DEVELOPMENT, AND I WORK IN 2146 01:19:33,770 --> 01:19:34,871 THE INTELLECTUAL AND 2147 01:19:34,871 --> 01:19:35,672 DEVELOPMENTAL DISABILITIES 2148 01:19:35,672 --> 01:19:36,840 BRANCH. 2149 01:19:36,840 --> 01:19:38,508 I'M TRAINED AS A PHYSICIAN IN 2150 01:19:38,508 --> 01:19:39,943 CHILD NEUROLOGY AND 2151 01:19:39,943 --> 01:19:40,677 NEURODEVELOPMENTAL DISABILITIES, 2152 01:19:40,677 --> 01:19:42,212 AND I MANAGE A PORTFOLIO OF 2153 01:19:42,212 --> 01:19:44,748 GRANTS RELEVANT TO IDD WITH 2154 01:19:44,748 --> 01:19:47,384 PARTICULAR INTEREST IN DOWN 2155 01:19:47,384 --> 01:19:47,784 SYNDROME. 2156 01:19:47,784 --> 01:19:49,853 IN THAT CAPACITY, I ALSO SERVE 2157 01:19:49,853 --> 01:19:51,054 ON THE INCLUDE PROJECT 2158 01:19:51,054 --> 01:19:52,055 LEADERSHIP TEAM AND I WANTED TO 2159 01:19:52,055 --> 01:19:53,056 TALK BRIEFLY ABOUT INCLUDE 2160 01:19:53,056 --> 01:19:54,591 BECAUSE IT'S RELEVANT TO OUR 2161 01:19:54,591 --> 01:19:56,994 TALKS TODAY. 2162 01:19:56,994 --> 01:19:59,629 THE INCLUDE ACRONYM STANDS FOR 2163 01:19:59,629 --> 01:20:01,131 INVESTIGATION OF CO-OCCURRING 2164 01:20:01,131 --> 01:20:03,333 CONDITIONS ACROSS THE LIFESPAN 2165 01:20:03,333 --> 01:20:05,302 TO UNDERSTAND DOWN SYNDROME. 2166 01:20:05,302 --> 01:20:08,772 WHICH IS A MOUTHFUL, BUT IT DOES 2167 01:20:08,772 --> 01:20:09,906 REPRESENT WELL WHAT OUR PROJECT 2168 01:20:09,906 --> 01:20:10,107 DOES. 2169 01:20:10,107 --> 01:20:12,275 THIS PROJECT WAS LAUNCHED IN 2170 01:20:12,275 --> 01:20:13,844 2018 IN SUPPORT OF A 2171 01:20:13,844 --> 01:20:16,580 CONGRESSIONAL DIRECTIVE FOR AN 2172 01:20:16,580 --> 01:20:18,048 NIH-WIDE INITIATIVE TO FUND MORE 2173 01:20:18,048 --> 01:20:19,483 RESEARCH TO ADDRESS CRITICAL 2174 01:20:19,483 --> 01:20:22,052 HEALTH AND QUALITY OF LIFE NEEDS 2175 01:20:22,052 --> 01:20:24,454 FOR INDIVIDUALS WITH DOWN 2176 01:20:24,454 --> 01:20:24,788 SYNDROME. 2177 01:20:24,788 --> 01:20:26,857 MOST OF YOU ARE AWARE THAT 2178 01:20:26,857 --> 01:20:27,724 OBSTRUCTIVE SLEEP APNEA AND 2179 01:20:27,724 --> 01:20:31,661 OTHER SLEEP DYSFUNCTION ARE ALL 2180 01:20:31,661 --> 01:20:35,932 STROOSTROODZLY COMMON IN PEOPLEH 2181 01:20:35,932 --> 01:20:37,367 DOWN SYNDROME SO MANY OF OUR 2182 01:20:37,367 --> 01:20:38,668 FUNDED INVESTIGATORS OVER THE 2183 01:20:38,668 --> 01:20:39,669 PAST SIX YEARS HAVE RESEARCHED 2184 01:20:39,669 --> 01:20:42,506 SLEEP IN DOWN DOWN SYNDROME ANT 2185 01:20:42,506 --> 01:20:44,708 INCLUDES THE TWO SPEAKERS WE'LL 2186 01:20:44,708 --> 01:20:49,046 BE HEARING FROM IN TODAY'S 2187 01:20:49,046 --> 01:20:49,813 SESSION. 2188 01:20:49,813 --> 01:20:53,784 OUR FIRST SPEAKER IS DR. CHRIS 2189 01:20:53,784 --> 01:20:54,751 CIELO, PROFESSOR OF PEDIATRICS 2190 01:20:54,751 --> 01:20:56,286 IN THE DIVISION OF PULMONARY AND 2191 01:20:56,286 --> 01:20:57,554 SLEEP MEDICINE AT CHILDREN'S 2192 01:20:57,554 --> 01:20:58,622 HOSPITAL OF PHILADELPHIA. 2193 01:20:58,622 --> 01:21:00,357 HIS PRESENTATION IS TITLED 2194 01:21:00,357 --> 01:21:01,792 LESSONS ABOUT OSA HETEROGENEITY 2195 01:21:01,792 --> 01:21:04,861 FROM A DOWN SYNDROME POPULATION. 2196 01:21:04,861 --> 01:21:05,729 AND WE'LL HAVE CHRIS TAKE OVER. 2197 01:21:05,729 --> 01:21:09,900 THANK YOU. 2198 01:21:09,900 --> 01:21:11,201 >> THANKS VERY MUCH, MEGHAN. 2199 01:21:11,201 --> 01:21:16,807 IS EVERYONE SEEING THE SLIDES? 2200 01:21:16,807 --> 01:21:21,011 >> WH YES, WE CAN SEE IT. 2201 01:21:21,011 --> 01:21:22,712 >> I'LL START OFF BY SAYING FOR 2202 01:21:22,712 --> 01:21:24,347 MANY YEARS AND STILL TO SOME 2203 01:21:24,347 --> 01:21:26,083 EXTENT, PEDIATRIC SLEEP APNEA 2204 01:21:26,083 --> 01:21:27,551 COHORTS HAVE BEEN RESTRICTED TO 2205 01:21:27,551 --> 01:21:28,985 EXCLUDE PATIENTS WITH GENETIC 2206 01:21:28,985 --> 01:21:30,387 CONDITIONS AND OTHER 2207 01:21:30,387 --> 01:21:31,922 COMORBIDITIES THAT REALLY 2208 01:21:31,922 --> 01:21:33,156 CREATES I THINK KIND OF THE 2209 01:21:33,156 --> 01:21:35,792 SPIRIT IN THIS WHOLE SESSION AN 2210 01:21:35,792 --> 01:21:36,993 ARTIFICIALLY HOMOGENEOUS COHORT 2211 01:21:36,993 --> 01:21:38,228 THAT'S REALLY NOT REPRESENTATIVE 2212 01:21:38,228 --> 01:21:39,329 OF THE PATIENTS THAT WE SEE IN 2213 01:21:39,329 --> 01:21:40,263 CLINIC AND IN THE REAL WORLD. 2214 01:21:40,263 --> 01:21:41,698 SO FOR THE NEXT FEW MINUTES I'LL 2215 01:21:41,698 --> 01:21:43,300 TALK A LITTLE ABOUT ONE 2216 01:21:43,300 --> 01:21:44,568 CONDITION, DOWN SYNDROME, AND 2217 01:21:44,568 --> 01:21:45,335 DR. O'NEILL ALREADY MENTIONED A 2218 01:21:45,335 --> 01:21:47,204 LITTLE BIT, HOPEFULLY CON VIPS 2219 01:21:47,204 --> 01:21:48,538 YOU THERE'S REAL VALUE IN 2220 01:21:48,538 --> 01:21:49,439 INCLUDES THESE PATIENTS AND 2221 01:21:49,439 --> 01:21:51,074 THOSE WITH SIMILAR CONDITIONS 2222 01:21:51,074 --> 01:21:54,077 ARE WORTH INCLUDING IN KRIN CALL 2223 01:21:54,077 --> 01:21:56,313 TRIALS AND OTHER STUDIES, I 2224 01:21:56,313 --> 01:21:58,949 THINK IT CAN BENEFIT THE 2225 01:21:58,949 --> 01:22:00,050 COMMUNITY OF PATIENTS WHO WE 2226 01:22:00,050 --> 01:22:00,951 SERVE AS WELL AS THE 2227 01:22:00,951 --> 01:22:02,219 INVESTIGATORS AND CLINICIANS. 2228 01:22:02,219 --> 01:22:04,187 JUST WANT TO POINT OUT FUNDING 2229 01:22:04,187 --> 01:22:04,955 AGENCIES LIKE NIH AND OTHERS 2230 01:22:04,955 --> 01:22:07,491 HAVE REALLY PUT REAL RESOURCES 2231 01:22:07,491 --> 01:22:09,126 IN IMPROVING THE HEALTH OF 2232 01:22:09,126 --> 01:22:11,661 PEOPLE WITH DOWN SYNDROME AND 2233 01:22:11,661 --> 01:22:12,662 SLEEP HAS BEEN A SIGNIFICANT 2234 01:22:12,662 --> 01:22:14,297 COMPONENT OF THAT INVESTMENT 2235 01:22:14,297 --> 01:22:15,165 PARTICULARLY THROUGH THE NIH 2236 01:22:15,165 --> 01:22:16,266 INCLUDE PROGRAM THAT SHE JUST 2237 01:22:16,266 --> 01:22:16,800 MENTIONED. 2238 01:22:16,800 --> 01:22:19,369 I'VE BEEN FORTUNATE THAT 2239 01:22:19,369 --> 01:22:20,871 MARISHKA, ALFONSO AND OTHERS 2240 01:22:20,871 --> 01:22:22,539 HAVE BEEN REAL ADVOCATES FOR 2241 01:22:22,539 --> 01:22:25,709 THIS KIND OF WORK TO GET SLEEP 2242 01:22:25,709 --> 01:22:27,144 IN PART OF THAT INITIATIVE. 2243 01:22:27,144 --> 01:22:29,012 I'VE HAD THE OPPORTUNITY TO 2244 01:22:29,012 --> 01:22:30,313 PARTICIPATE IN IN A NUMBER OF 2245 01:22:30,313 --> 01:22:31,314 STUDIES IN THIS AREA. 2246 01:22:31,314 --> 01:22:33,183 YOU CAN SEE FROM THIS LIST SOME 2247 01:22:33,183 --> 01:22:35,352 HAVE BEEN EARLY STAGE PILOT 2248 01:22:35,352 --> 01:22:36,853 STUDY, SINGLE CENTER CLINICAL 2249 01:22:36,853 --> 01:22:38,455 TRIALS LIKE THE ONE I'M DOING AT 2250 01:22:38,455 --> 01:22:42,492 CHOP CURRENTLY, THEN SOME OTHER 2251 01:22:42,492 --> 01:22:45,462 CLINICAL TRIALS, OTHER 2252 01:22:45,462 --> 01:22:47,664 MULTICENTER TRIALS, AND 2253 01:22:47,664 --> 01:22:48,732 U01 PROJECTS THAT HAVE RECENTLY 2254 01:22:48,732 --> 01:22:51,601 BEEN FUNDED THAT ARE GENERATING 2255 01:22:51,601 --> 01:22:52,702 LARGER STANDARDIZED DATA 2256 01:22:52,702 --> 01:22:53,470 COLLECTION NATIONALLY AND I 2257 01:22:53,470 --> 01:22:55,639 THINK GETTING SLEEP AND OTHER 2258 01:22:55,639 --> 01:22:57,607 METRICS INVOLVED WITH THOSE 2259 01:22:57,607 --> 01:22:59,176 COHORTS WILL REALLY BE A 2260 01:22:59,176 --> 01:23:00,243 VALUABLE RESOURCE MOVING FORWARD 2261 01:23:00,243 --> 01:23:02,012 FOR US AND FOR DOWN SYNDROME 2262 01:23:02,012 --> 01:23:02,345 INVESTIGATORS. 2263 01:23:02,345 --> 01:23:03,780 SO I'LL TALK ABOUT SOME OF THE 2264 01:23:03,780 --> 01:23:04,848 HETEROGENEITY IN THIS POPULATION 2265 01:23:04,848 --> 01:23:05,949 RELATED TO THE PRESENTATION OF 2266 01:23:05,949 --> 01:23:08,051 SLEEP APNEA, THE EVALUATION OF 2267 01:23:08,051 --> 01:23:09,920 OSA AND THEN MANAGEMENT OF SLEEP 2268 01:23:09,920 --> 01:23:10,887 APNEA AND AT THE END, I'LL JUST 2269 01:23:10,887 --> 01:23:11,555 TALK ABOUT SOME OF THE 2270 01:23:11,555 --> 01:23:14,090 OPPORTUNITIES AND CHALLENGES FOR 2271 01:23:14,090 --> 01:23:17,594 RESEARCHERS IN THIS AREA. 2272 01:23:17,594 --> 01:23:18,695 SO FOR THOSE WHO AREN'T FAMILIAR 2273 01:23:18,695 --> 01:23:19,930 WITH THIS CONDITION, DOWN 2274 01:23:19,930 --> 01:23:21,898 SYNDROME IS THE MOST COMMON 2275 01:23:21,898 --> 01:23:22,432 CHROMOSOMAL ABNORMALITY. 2276 01:23:22,432 --> 01:23:23,733 THERE'S ABOUT 400,000 PEOPLE 2277 01:23:23,733 --> 01:23:24,734 LIVING IN THE UNITED STATES 2278 01:23:24,734 --> 01:23:26,369 RIGHT NOW WITH DOWN SYNDROME 2279 01:23:26,369 --> 01:23:28,905 MOST OF WHICH HAVE A THIRD COPY 2280 01:23:28,905 --> 01:23:31,074 OF CHROMOSOME 21 BUT MORE RARELY 2281 01:23:31,074 --> 01:23:33,310 IT CAN OCCUR AS A MOSAIC OR 2282 01:23:33,310 --> 01:23:34,945 TRANSLOCATION, AND SOME OF THESE 2283 01:23:34,945 --> 01:23:35,712 CO-OCCURRING CONDITIONS THAT ARE 2284 01:23:35,712 --> 01:23:38,915 PART OF THIS INCLUDE INITIATIVE 2285 01:23:38,915 --> 01:23:40,116 RELATED TO SLEEP APNEA I THINK 2286 01:23:40,116 --> 01:23:42,953 ARE CRITICAL END POINTS OR 2287 01:23:42,953 --> 01:23:46,022 CONSEQUENCES OF SLEEP APNEA. 2288 01:23:46,022 --> 01:23:46,656 INTELLECTUAL DISABILITY IS ONE 2289 01:23:46,656 --> 01:23:48,258 OF THE HALLMARK FEATURES OF DOWN 2290 01:23:48,258 --> 01:23:49,693 SYNDROME AND THERE'S REALLY A 2291 01:23:49,693 --> 01:23:52,529 TREMENDOUS AMOUNT OF VARIABILITY 2292 01:23:52,529 --> 01:23:53,763 IN THAT OUT COME. 2293 01:23:53,763 --> 01:23:55,832 HEART DISEASE IS INCREDIBLY 2294 01:23:55,832 --> 01:23:57,267 COMMON, OVER HALF THE PEOPLE 2295 01:23:57,267 --> 01:23:58,001 WITH DOWN SYNDROME HAVE SOME 2296 01:23:58,001 --> 01:23:59,302 SORT OF CONGENITAL HEART 2297 01:23:59,302 --> 01:23:59,536 DISEASE. 2298 01:23:59,536 --> 01:24:02,939 THERE'S BEEN A LOT OF WORK 2299 01:24:02,939 --> 01:24:04,241 RECENTLY RELATED TO ALZHEIMER'S 2300 01:24:04,241 --> 01:24:06,443 DISEASE AND OBESITY IS 2301 01:24:06,443 --> 01:24:08,645 INCREASINGLY COMMON TOO, SO HOW 2302 01:24:08,645 --> 01:24:10,280 SLA RELATES TO SOME OF THESE 2303 01:24:10,280 --> 01:24:11,514 CO-OCCURRING CONDITIONS REALLY 2304 01:24:11,514 --> 01:24:12,716 IS JUST NOT WELL UNDERSTOOD BUT 2305 01:24:12,716 --> 01:24:14,451 THIS IS A VERY ENRICHED 2306 01:24:14,451 --> 01:24:15,252 POPULATION TO THINK ABOUT SOME 2307 01:24:15,252 --> 01:24:16,019 OF THOSE QUESTIONS. 2308 01:24:16,019 --> 01:24:17,220 THERE'S BEEN TREMENDOUS 2309 01:24:17,220 --> 01:24:18,321 IMPROVEMENT IN PATIENTS WITH 2310 01:24:18,321 --> 01:24:19,956 DODOWN SYNDROME. 2311 01:24:19,956 --> 01:24:21,825 IT'S AMAZING TO THINK THEIR LIFE 2312 01:24:21,825 --> 01:24:23,026 EXPECTANCY WAS ONLY 10 YEARS 2313 01:24:23,026 --> 01:24:27,230 BACK IN 1960 AND NOW CURRENTLY 2314 01:24:27,230 --> 01:24:29,032 MORE THAN 60 YEARS. 2315 01:24:29,032 --> 01:24:30,700 THERE WERE TREMENDOUS HEALTH 2316 01:24:30,700 --> 01:24:31,668 DISPARITIES IN THIS POPULATION 2317 01:24:31,668 --> 01:24:35,705 WITH WHITE PEOPLE WITH DOWN 2318 01:24:35,705 --> 01:24:37,274 SYNDROME WERE LIVING TWICE AS 2319 01:24:37,274 --> 01:24:38,375 LONG AS THOSE THAT WERE BLACK, 2320 01:24:38,375 --> 01:24:39,576 SO THERE'S A LOT OF HEALTH 2321 01:24:39,576 --> 01:24:40,510 DISPARITIES IN THIS POPULATION 2322 01:24:40,510 --> 01:24:41,678 AS WELL. 2323 01:24:41,678 --> 01:24:44,381 AND WHEN THINKING ABOUT SLEEP 2324 01:24:44,381 --> 01:24:45,081 APNEA, DOWN SYNDROME IS REALLY 2325 01:24:45,081 --> 01:24:49,119 SORT OF A PERFECT STORM. 2326 01:24:49,119 --> 01:24:53,490 YOU -- THIS HAS BEEN BROUGHT UP 2327 01:24:53,490 --> 01:24:54,391 SEVERAL TIMES IN OTHER TALKS 2328 01:24:54,391 --> 01:25:00,630 ABOUT SOME OF THESE MORE MORE 2329 01:25:00,630 --> 01:25:05,869 ANATOMIC FEATURES. 2330 01:25:05,869 --> 01:25:06,870 MACROGLOSSIA, NARROW, FLOPPY 2331 01:25:06,870 --> 01:25:08,004 AIRWAYS. 2332 01:25:08,004 --> 01:25:10,907 THESE PATIENTS IS HYPOTONIA AND 2333 01:25:10,907 --> 01:25:11,875 THEN OBESITY IS VERY COMMON AND 2334 01:25:11,875 --> 01:25:13,343 WE'RE SEEING MORE OF IT IN THIS 2335 01:25:13,343 --> 01:25:14,444 GROUP. 2336 01:25:14,444 --> 01:25:16,646 SO IT'S SOME REASONS WHY THERE'S 2337 01:25:16,646 --> 01:25:17,947 JUST A VERY, VERY HIGH 2338 01:25:17,947 --> 01:25:18,615 PREVALENCE OF SLEEP APNEA. 2339 01:25:18,615 --> 01:25:19,949 EVEN WITH ALL THAT, WE REALLY 2340 01:25:19,949 --> 01:25:21,584 DON'T KNOW EXACTLY WHAT THE 2341 01:25:21,584 --> 01:25:23,386 PREVALENCE ACTUALLY IS IN THIS 2342 01:25:23,386 --> 01:25:24,454 POPULATION, SORT OF ACROSS THE 2343 01:25:24,454 --> 01:25:25,422 LIFESPAN. 2344 01:25:25,422 --> 01:25:27,924 WE KNOW THAT IT'S VERY 2345 01:25:27,924 --> 01:25:31,127 PREVALENT, AND WE KNOW 2346 01:25:31,127 --> 01:25:32,562 APPROXIMATELY 50% OR MORE 2347 01:25:32,562 --> 01:25:34,064 CHILDREN WITH DOWN SYNDROME HAVE 2348 01:25:34,064 --> 01:25:35,832 SLEEP APNEA AND INFANTS MAY 2349 01:25:35,832 --> 01:25:37,934 ACTUALLY BE AT THE HIGHEST RISK. 2350 01:25:37,934 --> 01:25:39,703 THIS IS SOME WORK DONE BY KAREN 2351 01:25:39,703 --> 01:25:42,305 WATERS IN SYDNEY WHO LOOKED AT 2352 01:25:42,305 --> 01:25:45,842 152 CHILDREN ACROSS THE 2353 01:25:45,842 --> 01:25:52,282 PEDIATRIC -- SPECTRUM AND WE 2354 01:25:52,282 --> 01:25:53,383 REALLY DON'T SEE THIS IN MOST 2355 01:25:53,383 --> 01:25:54,284 OTHER POPULATIONS. 2356 01:25:54,284 --> 01:25:56,119 IN ADULTS, THE PREVALENCE AGAIN 2357 01:25:56,119 --> 01:25:57,420 NOT REALLY TOTALLY UNDERSTOOD 2358 01:25:57,420 --> 01:25:59,189 BECAUSE WE DON'T HAVE GOOD 2359 01:25:59,189 --> 01:26:00,190 POPULATION-BASED COHORTS BUT 2360 01:26:00,190 --> 01:26:03,059 THERE HAVE BEEN SOME COHORTS 2361 01:26:03,059 --> 01:26:04,160 WHERE 100% OF REFERRALS HAVE 2362 01:26:04,160 --> 01:26:05,929 BEEN FOUND TO HAVE SLEEP APNEA, 2363 01:26:05,929 --> 01:26:07,731 PEOPLE THINK THAT'S LIKELY IN 2364 01:26:07,731 --> 01:26:09,899 THE 78% RANGE AND A VERY HIGH 2365 01:26:09,899 --> 01:26:12,535 PROPORTION OF THOSE PATIENTS 2366 01:26:12,535 --> 01:26:14,304 HAVE SEVERE OSA. 2367 01:26:14,304 --> 01:26:19,376 THERE ARE HIGH RATES OF SLEEP 2368 01:26:19,376 --> 01:26:21,111 RELATED HYPOVENTILATION EVEN 2369 01:26:21,111 --> 01:26:22,312 REGARDLESS OF OSA SEVERITY. 2370 01:26:22,312 --> 01:26:24,714 THERE'S A SIGNIFICANT IMPACT 2371 01:26:24,714 --> 01:26:25,882 FROM SLEEP APNEA ON THESE 2372 01:26:25,882 --> 01:26:27,484 PATIENTS WHO ALREADY HAVE A LOT 2373 01:26:27,484 --> 01:26:30,019 OF CO-OCCURRING COMORBIDITIES. 2374 01:26:30,019 --> 01:26:31,755 THIS IS A FIGURE BY THE 2375 01:26:31,755 --> 01:26:33,022 BARCELONA GROUP WHICH SORT OF 2376 01:26:33,022 --> 01:26:34,758 HAD THIS HYPOTHESIZED 2377 01:26:34,758 --> 01:26:35,759 RELATIONSHIP BETWEEN BEHAVIORAL 2378 01:26:35,759 --> 01:26:37,494 SLEEP DISORDERS AND OBSTRUCTIVE 2379 01:26:37,494 --> 01:26:39,162 SLEEP APNEA KIND OF DISRUPTING 2380 01:26:39,162 --> 01:26:41,030 SLEEP, AND THEN CAUSING SORT OF 2381 01:26:41,030 --> 01:26:42,932 A WORSENING OF SOME OF THESE 2382 01:26:42,932 --> 01:26:43,700 HALLMARK FEATURES. 2383 01:26:43,700 --> 01:26:45,268 I THINK SOME OF THE DISCUSSION 2384 01:26:45,268 --> 01:26:47,203 THAT'S BEEN GOING ON THROUGHOUT 2385 01:26:47,203 --> 01:26:48,938 YESTERDAY AND TODAY'S SESSIONS 2386 01:26:48,938 --> 01:26:50,807 ABOUT SLEEP DISRUPTION, 2387 01:26:50,807 --> 01:26:53,009 INSUFFICIENT SLEEP, AND THEN 2388 01:26:53,009 --> 01:26:55,945 EVEN WHAT DR. YAGGIE WAS JUST 2389 01:26:55,945 --> 01:26:57,046 MENTIONING OR GOING THROUGH SOME 2390 01:26:57,046 --> 01:26:59,048 OTHER DATASETS TO TRY TO LOOK AT 2391 01:26:59,048 --> 01:27:00,116 DISRUPTION OF SLEEP MAY BE 2392 01:27:00,116 --> 01:27:02,585 REALLY RELEVANT HERE AND HAS NOT 2393 01:27:02,585 --> 01:27:03,753 BEEN EXPLORED IN PATIENTS WITH 2394 01:27:03,753 --> 01:27:04,220 DOWN SYNDROME. 2395 01:27:04,220 --> 01:27:06,156 WE KNOW IN KIDS, ESPECIALLY, 2396 01:27:06,156 --> 01:27:08,491 THERE'S A NEGATIVE CORRELATION 2397 01:27:08,491 --> 01:27:11,227 BETWEEN THE APNEA HYPOPNEA INDEX 2398 01:27:11,227 --> 01:27:13,129 AND THE DEVELOPMENTAL QUOTIENT. 2399 01:27:13,129 --> 01:27:15,865 THETHIS WAS A CROSS-SECTIONAL SY 2400 01:27:15,865 --> 01:27:17,934 OF 53 KIDS WHO UNDERWENT 2401 01:27:17,934 --> 01:27:22,338 DEVELOPMENTAL TESTING AND 2402 01:27:22,338 --> 01:27:23,440 POLYSONOGRAPHY, THERE'S A 2403 01:27:23,440 --> 01:27:25,308 CORRELATION BETWEEN THEIR AHI 2404 01:27:25,308 --> 01:27:26,142 AND DEVELOPMENTAL QUOTIENT. 2405 01:27:26,142 --> 01:27:28,511 BUT THE IMPACT OF SLEEP APNEA IN 2406 01:27:28,511 --> 01:27:29,813 INFANTS REALLY ISN'T WELL-KNOWN 2407 01:27:29,813 --> 01:27:32,182 AND WE KNOW THAT THIS GROUP OF 2408 01:27:32,182 --> 01:27:33,316 PATIENTS CAN HAVE SLEEP APNEA 2409 01:27:33,316 --> 01:27:34,317 FROM THE TIME THAT THER VERY 2410 01:27:34,317 --> 01:27:35,218 YOUNG. 2411 01:27:35,218 --> 01:27:36,519 SO CLEARLY A LOT MORE NEED TO BE 2412 01:27:36,519 --> 01:27:38,488 DONE IN THIS AREA. 2413 01:27:38,488 --> 01:27:40,390 SO THE HIGH PREVALENCE AND 2414 01:27:40,390 --> 01:27:41,991 POTENTIALLY SIGNIFICANT IMPACT 2415 01:27:41,991 --> 01:27:43,960 IN PEOPLE WITH DOWN SYNDROME 2416 01:27:43,960 --> 01:27:45,228 POSES SOME CHALLENGES FOR WHEN 2417 01:27:45,228 --> 01:27:47,397 AND THEN HOW TO EVALUATE THIS 2418 01:27:47,397 --> 01:27:50,333 POPULATION OF PEOPLE IN TERMS OF 2419 01:27:50,333 --> 01:27:51,367 SLEEP APNEA AND BECAUSE THERE'S 2420 01:27:51,367 --> 01:27:54,070 SUCH A HIGH RISK AND SCREENING 2421 01:27:54,070 --> 01:27:55,605 QUESTIONS ARE REALLY NOT 2422 01:27:55,605 --> 01:27:57,841 VALIDATED IN YOUNG KIDS, THE 2423 01:27:57,841 --> 01:27:58,575 AMERICAN ACADEMY OF PEDIATRICS 2424 01:27:58,575 --> 01:27:59,809 ACTUALLY HAS RECOMMENDED THAT 2425 01:27:59,809 --> 01:28:02,745 ALL PATIENTS WITH DISUNDERGO 2426 01:28:02,745 --> 01:28:04,314 POLYSO KNOWGRAPHY OR SLEEP APNEA 2427 01:28:04,314 --> 01:28:04,781 EVALUATION. 2428 01:28:04,781 --> 01:28:06,316 THEY JUST CHANGED THIS GUIDELINE 2429 01:28:06,316 --> 01:28:07,851 FROM FOUR TO 3 1/2 YEARS OLD. 2430 01:28:07,851 --> 01:28:09,452 AND THEY SAY THAT FOR CHILDREN 2431 01:28:09,452 --> 01:28:10,820 THAT ARE YOUNGER AND OLDER, THAT 2432 01:28:10,820 --> 01:28:12,589 WE SHOULD JUST USE SYMPTOMS, 2433 01:28:12,589 --> 01:28:13,389 ALTHOUGH UNFORTUNATELY THERE'S 2434 01:28:13,389 --> 01:28:14,724 NOT A LOT OF GOOD EVIDENCE 2435 01:28:14,724 --> 01:28:16,793 SAYING THAT THAT'S BEEN A 2436 01:28:16,793 --> 01:28:19,662 SUCCESSFUL STRATEGY. 2437 01:28:19,662 --> 01:28:22,065 IN THE UK, THEY ACTUALLY JUST 2438 01:28:22,065 --> 01:28:23,299 RECOMMEND OXIMETRY FOR INFANTS 2439 01:28:23,299 --> 01:28:25,802 AND THEN THROUGH AGE 3 TO 5, AND 2440 01:28:25,802 --> 01:28:27,670 YOU CAN SEE THIS WAS A REALLY 2441 01:28:27,670 --> 01:28:32,375 IMPORTANT STUDY DONE BY BRIAN 2442 01:28:32,375 --> 01:28:33,710 SKOTKO AND COLLEAGUES IN BOSTON 2443 01:28:33,710 --> 01:28:34,711 WHERE THEY ACTUALLY TOOK A LOT 2444 01:28:34,711 --> 01:28:36,679 OF TIME TO TRY TO VALIDATE A 2445 01:28:36,679 --> 01:28:37,146 DOWN SYNDROME SPECIFIC 2446 01:28:37,146 --> 01:28:38,448 QUESTIONNAIRE. 2447 01:28:38,448 --> 01:28:40,550 HE'SA REALLY INVESTED DOWN 2448 01:28:40,550 --> 01:28:43,052 SYNDROME RESEARCHER WHO'S REALLY 2449 01:28:43,052 --> 01:28:44,387 PARTNERED WITH A NUMBER OF OTHER 2450 01:28:44,387 --> 01:28:45,755 GROUPS SO THEN THEY ACTUALLY 2451 01:28:45,755 --> 01:28:47,190 WENT BACK AND TRIED TO VALIDATE 2452 01:28:47,190 --> 01:28:48,591 THIS AND THEY CREATED A NUMBER 2453 01:28:48,591 --> 01:28:49,926 OF DIFFERENT MODELS AND 2454 01:28:49,926 --> 01:28:50,927 UNFORTUNATELY THEY WERE REALLY 2455 01:28:50,927 --> 01:28:52,862 TERRIBLE AT PREDICTING THE 2456 01:28:52,862 --> 01:28:54,197 POSITIVE AND -- THE FALSE 2457 01:28:54,197 --> 01:28:55,965 POSITIVE AND TRUE POSITIVE RATE 2458 01:28:55,965 --> 01:28:56,966 FOR SLEEP APNEA IN THIS GROUP. 2459 01:28:56,966 --> 01:28:58,167 SO VERY HARD TO SCREEN THEM. 2460 01:28:58,167 --> 01:28:59,602 SO IT'S JUST SORT OF HARD TO 2461 01:28:59,602 --> 01:29:01,070 KNOW WHEN TO DO THE INITIAL 2462 01:29:01,070 --> 01:29:03,039 EVALUATION AND THEN WHEN TO DO A 2463 01:29:03,039 --> 01:29:04,007 FOLLOW-UP EVALUATION. 2464 01:29:04,007 --> 01:29:06,809 AND WE KNOW THAT IN GROUPS EVEN 2465 01:29:06,809 --> 01:29:08,177 WHO DON'T HAVE SYMPTOMS BOTH IN 2466 01:29:08,177 --> 01:29:10,313 CHILDREN AND IN ADULTS, THAT 2467 01:29:10,313 --> 01:29:11,281 VERY HIGH RATES OF THOSE 2468 01:29:11,281 --> 01:29:16,452 PATIENTS CAN STILL HAVE OSA. 2469 01:29:16,452 --> 01:29:17,687 SO IN ADDITION TO NOT HAVING 2470 01:29:17,687 --> 01:29:18,855 ADEQUATE SCREENING PROCEDURES, 2471 01:29:18,855 --> 01:29:20,290 THERE'S OTHER REASONS WHY 2472 01:29:20,290 --> 01:29:21,491 UNFORTUNATELY MANY PEOPLE WITH 2473 01:29:21,491 --> 01:29:22,825 DOWN SYNDROME AREN'T EVALUATED 2474 01:29:22,825 --> 01:29:24,027 FOR SLEEP APNEA AND A LOT OF 2475 01:29:24,027 --> 01:29:25,595 PLACES JUST REALLY AREN'T 2476 01:29:25,595 --> 01:29:26,095 APPROPRIATE FACILITIES. 2477 01:29:26,095 --> 01:29:28,765 WE SEE THIS ALL THE TIME AT 2478 01:29:28,765 --> 01:29:30,633 CHILDREN'S LOPTS LIKE WHERE I 2479 01:29:30,633 --> 01:29:32,168 WORK WHERE KIDS FOR YEARS HAVE 2480 01:29:32,168 --> 01:29:33,369 BEEN TRYING TO GET SLEEP STUDIES 2481 01:29:33,369 --> 01:29:34,804 AND THEY'RE NOT ABLE TO DO IT 2482 01:29:34,804 --> 01:29:35,772 EITHER BECAUSE FACILITIES WON'T 2483 01:29:35,772 --> 01:29:37,240 ACCEPT THEM, LABS WON'T ACCEPT 2484 01:29:37,240 --> 01:29:39,442 THEM OR THEY ATTEMPT IT AND THEN 2485 01:29:39,442 --> 01:29:39,976 THEY FAIL. 2486 01:29:39,976 --> 01:29:43,947 IT'S REALLY CHALLENGING. 2487 01:29:43,947 --> 01:29:44,914 POLYSONOGRAPHY MAY BE REALLY 2488 01:29:44,914 --> 01:29:45,915 DIFFICULT BECAUSE SOME OF THESE 2489 01:29:45,915 --> 01:29:47,684 KIDS HAVE SENSORY ISSUE, THEY 2490 01:29:47,684 --> 01:29:48,885 MAY HAVE FEAR OF GOING TO THE 2491 01:29:48,885 --> 01:29:50,320 HOSPITAL FOR LOTS OF MEDICAL 2492 01:29:50,320 --> 01:29:51,421 ISSUES THEY MAY HAVE, AND THERE 2493 01:29:51,421 --> 01:29:53,289 WAS A STUDY THAT CAME OUT OF 2494 01:29:53,289 --> 01:29:54,390 CINCINNATI CHILDREN'S WHICH WAS 2495 01:29:54,390 --> 01:29:55,592 REALLY ONE OF THE TOP CHILDREN'S 2496 01:29:55,592 --> 01:29:56,492 HOSPITALS IN THE COUNTRY WHERE 2497 01:29:56,492 --> 01:29:58,394 ONLY ABOUT 60% OF THE KIDS ARE 2498 01:29:58,394 --> 01:29:59,462 EVEN EVALUATED FOR SLEEP APNEA 2499 01:29:59,462 --> 01:30:00,630 AND THEY FOUND THAT DISTANCE 2500 01:30:00,630 --> 01:30:02,999 FROM THE HOSPITAL ACTUALLY 2501 01:30:02,999 --> 01:30:03,833 CORRELATED WITH WHETHER OR NOT 2502 01:30:03,833 --> 01:30:05,635 PATIENTS WERE BEING EVALUATED. 2503 01:30:05,635 --> 01:30:06,869 SO WE JUST REALLY DON'T 2504 01:30:06,869 --> 01:30:09,472 UNDERSTAND THE NATURAL HISTORY 2505 01:30:09,472 --> 01:30:11,240 OF SLEEP APNEA IN THIS 2506 01:30:11,240 --> 01:30:11,808 CONDITION. 2507 01:30:11,808 --> 01:30:13,876 AND THERE REALLY AREN'T DOWN 2508 01:30:13,876 --> 01:30:14,911 SYNDROME SPECIFIC GUIDELINES FOR 2509 01:30:14,911 --> 01:30:15,945 SLEEP APNEA IN OLDER ADULTS IN 2510 01:30:15,945 --> 01:30:17,647 TERMS OF WHETHER THEY SHOULD 2511 01:30:17,647 --> 01:30:19,716 HAVE INLAB POLYSONOGRAPHY, HOW 2512 01:30:19,716 --> 01:30:20,817 LONG THEY SHOULD BE SCREENED, 2513 01:30:20,817 --> 01:30:22,151 WHETHER HOME TESTING WOULD BE 2514 01:30:22,151 --> 01:30:23,152 APPROPRIATE, SO LOTS OF 2515 01:30:23,152 --> 01:30:28,191 IMPORTANT QUESTIONS THERE. 2516 01:30:28,191 --> 01:30:29,492 SO I'D LIKE TO HIGHLIGHT SOME OF 2517 01:30:29,492 --> 01:30:31,060 THE RECENT ANTIONGOING WORK TO 2518 01:30:31,060 --> 01:30:32,495 ADDRESS SOME OF THESE ISSUES 2519 01:30:32,495 --> 01:30:33,896 RELATED TO IMPROVING EVALUATION 2520 01:30:33,896 --> 01:30:35,298 AND MANAGEMENT IN CHURN AND 2521 01:30:35,298 --> 01:30:36,833 ADULTS WITH DOWN SYNDROME. 2522 01:30:36,833 --> 01:30:37,934 THIS IS SOME WORK THAT'S BEEN 2523 01:30:37,934 --> 01:30:39,869 GOING ON AT MY INSTITUTION THAT 2524 01:30:39,869 --> 01:30:41,004 WE'VE BEEN FORTUNATE TO PARTNER 2525 01:30:41,004 --> 01:30:42,672 WITH A LOT OF THESE FAMILIES, 2526 01:30:42,672 --> 01:30:44,207 AND WE KNOW THAT WE FOUND THAT 2527 01:30:44,207 --> 01:30:46,876 HOME SLEEP TESTING MAY BE AN 2528 01:30:46,876 --> 01:30:48,044 ALTERNATIVE IN CHILDREN WITH 2529 01:30:48,044 --> 01:30:50,246 DOWN SYNDROME THAT HAVE TROUBLE 2530 01:30:50,246 --> 01:30:51,447 EITHER ACCESSING SLEEP 2531 01:30:51,447 --> 01:30:52,715 LABORATORIES OR HAVING THE 2532 01:30:52,715 --> 01:30:54,817 TESTING COMPLETED, AND SO WE'VE 2533 01:30:54,817 --> 01:30:57,420 SEEN FOR YEARS THERE'S BEEN WORK 2534 01:30:57,420 --> 01:31:01,624 DONE BY BROCKMANN IN CHILE AND 2535 01:31:01,624 --> 01:31:04,027 THERE'S TESTING POSSIBLE IN KIDS 2536 01:31:04,027 --> 01:31:05,461 AND EVEN INFANTS WITH DOWN 2537 01:31:05,461 --> 01:31:05,862 SYNDROME. 2538 01:31:05,862 --> 01:31:07,897 WE DID THIS PILOT STUDY WHERE WE 2539 01:31:07,897 --> 01:31:10,767 FOUND THAT 43 YOUTH, MOSTLY 2540 01:31:10,767 --> 01:31:12,168 ADOLESCENTS BUT SOME SCHOOL AGED 2541 01:31:12,168 --> 01:31:13,836 KIDS AND SOME YOUNG ADULTS 2542 01:31:13,836 --> 01:31:15,071 ACTUALLY HIGHLY PREFERRED DOING 2543 01:31:15,071 --> 01:31:17,774 HOME SLEEP TESTING COMPARED WITH 2544 01:31:17,774 --> 01:31:19,042 IN-LAB POLYSOME NOGRAPHY. 2545 01:31:19,042 --> 01:31:21,344 WE FOUND HOME TESTS ACTUALLY HAD 2546 01:31:21,344 --> 01:31:25,481 PRETTY GOOD ACCURACY FOR OSA 2547 01:31:25,481 --> 01:31:29,652 COMPARED WITH IN-LAB PSG. 2548 01:31:29,652 --> 01:31:31,587 WE'RE CONTINUING WITH OUR 2549 01:31:31,587 --> 01:31:32,789 CURRENT CLINICAL TRIAL WHICH HAS 2550 01:31:32,789 --> 01:31:34,657 BEEN PRETTY SUCCESSFUL IN 2551 01:31:34,657 --> 01:31:36,659 RECRUITING BOTH KIDS WITH AND 2552 01:31:36,659 --> 01:31:39,062 WITHOUT DOWN SYNDROME TO TRY A 2553 01:31:39,062 --> 01:31:40,697 BETTER STUDY LIST WITH LARGER 2554 01:31:40,697 --> 01:31:42,131 NUMBERS OF PATIENTS. 2555 01:31:42,131 --> 01:31:44,000 THEN LOOKING IN TERMS OF 2556 01:31:44,000 --> 01:31:45,735 RESPONSE TO OSA TREATMENT, THIS 2557 01:31:45,735 --> 01:31:47,170 IS UNFORTUNATELY PRETTY HIGHLY 2558 01:31:47,170 --> 01:31:47,603 VARIABLE. 2559 01:31:47,603 --> 01:31:49,305 I'LL SHOW IN THE NEXT SLIDE A 2560 01:31:49,305 --> 01:31:52,909 NUMBER OF ONGOING STUDIES IN 2561 01:31:52,909 --> 01:31:53,443 THIS AREA. 2562 01:31:53,443 --> 01:31:56,212 SO THIS WAS SOME WORK IN THIS 2563 01:31:56,212 --> 01:31:59,916 TOP FIGURE BY A GROUP, FIRST 2564 01:31:59,916 --> 01:32:05,021 LINE THERAPY FOR CHILDREN WITH 2565 01:32:05,021 --> 01:32:07,590 OBSTRUCTIVE SLEEP APNEA. 2566 01:32:07,590 --> 01:32:09,058 UNFORTUNATELY ALMOST HALF HAD 2567 01:32:09,058 --> 01:32:10,593 RESIDUAL OHI GREATER THAN 2568 01:32:10,593 --> 01:32:12,228 5 WHICH IS CONSIDERED SUGGEST 2569 01:32:12,228 --> 01:32:16,666 CAN'T SLEEP SIGNIFICANT SLEEP A. 2570 01:32:16,666 --> 01:32:19,702 SO THERE'S A HIGHLY VARIABLE 2571 01:32:19,702 --> 01:32:20,703 RESPONSE MORE THAN WE WOULD 2572 01:32:20,703 --> 01:32:22,371 EXPECT TO SEE IN OTHERWISE 2573 01:32:22,371 --> 01:32:23,573 HEALTHY KIDS. 2574 01:32:23,573 --> 01:32:26,642 THIS IS SOME WORK DONE BY MY 2575 01:32:26,642 --> 01:32:28,878 COLLEAGUE LOOKING AT CPAP THAT 2576 01:32:28,878 --> 01:32:30,179 REALLY PERFORMED A LOT OF VERY 2577 01:32:30,179 --> 01:32:32,048 DETAILED SEMI STRUCTURED 2578 01:32:32,048 --> 01:32:35,017 INTERVIEWS AND PARENTS. 2579 01:32:35,017 --> 01:32:36,552 -- REALLY ASSOCIATED WITH 2580 01:32:36,552 --> 01:32:37,553 ADHERENCE, SO HER WORK RIGHT NOW 2581 01:32:37,553 --> 01:32:39,622 IS TRYING TO FOCUS IN SOME 2582 01:32:39,622 --> 01:32:40,857 ONGOING CLINICAL TRIALS OF HOW 2583 01:32:40,857 --> 01:32:42,625 TO USE SOME OF THOSE QUALITATIVE 2584 01:32:42,625 --> 01:32:44,494 FIND TOTION IMPROVE ADHERENCE 2585 01:32:44,494 --> 01:32:47,597 WITH CPAP AND OTHER MEASURES 2586 01:32:47,597 --> 01:32:48,898 LIKE NASAL CANNULA OXYGEN FOR 2587 01:32:48,898 --> 01:32:49,465 THESE FAMILIES. 2588 01:32:49,465 --> 01:32:53,369 THERE'S BEEN A LOT OF WORK DONE 2589 01:32:53,369 --> 01:32:54,303 WITH HYPOGLOSSAL NERVE 2590 01:32:54,303 --> 01:32:55,872 STIMULATION RELATED TO SLEEP 2591 01:32:55,872 --> 01:32:57,273 APNEA IN CHILDREN WITH DOWN 2592 01:32:57,273 --> 01:32:58,641 SYNDROME, ALL WITH PRETTY 2593 01:32:58,641 --> 01:32:59,041 VARIABLE RESULTS. 2594 01:32:59,041 --> 01:33:02,378 SOME KIDS DO VERY WELL BUT IN 2595 01:33:02,378 --> 01:33:04,647 THIS COHORT WHICH IS PUBLISHED 2596 01:33:04,647 --> 01:33:06,983 RECENTLY, THERE'S ABOUT A 50% 2597 01:33:06,983 --> 01:33:08,417 REDUCTION BUT AGAIN HIGHLY 2598 01:33:08,417 --> 01:33:16,058 VARIABLE AND ABOUT 36% HAD AN 2599 01:33:16,058 --> 01:33:17,560 AHI LESS THAN 5 AFTER ONE YEAR. 2600 01:33:17,560 --> 01:33:18,861 SO AGAIN THERE'S LOTS OF 2601 01:33:18,861 --> 01:33:20,630 PATIENTS WHO ARE SORT OF 2602 01:33:20,630 --> 01:33:21,931 UNDERTREATED SO MAY BE SOME 2603 01:33:21,931 --> 01:33:23,065 POSSIBILITIES FOR LEVERAGING 2604 01:33:23,065 --> 01:33:24,100 MULTIPLE DIFFERENT TREATMENTS AS 2605 01:33:24,100 --> 01:33:25,568 HAS BEEN MENTIONED IN OTHER 2606 01:33:25,568 --> 01:33:25,902 TALKS. 2607 01:33:25,902 --> 01:33:31,774 JUST TO COMMENT ON, THERE'S A 2608 01:33:31,774 --> 01:33:32,775 WHOLE BUNCH OF DIFFERENT TRIALS 2609 01:33:32,775 --> 01:33:34,010 HERE THAT ARE ONGOING RIGHT NOW, 2610 01:33:34,010 --> 01:33:35,278 I'M NOT GOING TO GO INTO A LOT 2611 01:33:35,278 --> 01:33:36,746 OF DETAIL HERE, BUT A LOT OF 2612 01:33:36,746 --> 01:33:37,947 THESE HAVE DIFFERENT OUTCOMES 2613 01:33:37,947 --> 01:33:44,020 THAT ARE BEING ECK AM INNED A EI 2614 01:33:44,020 --> 01:33:44,987 THINK HIS COMMENTS ABOUT 2615 01:33:44,987 --> 01:33:46,088 SEQUENTIAL THERAPIES ARE REALLY 2616 01:33:46,088 --> 01:33:47,557 RELEVANT TO THIS POPULATION 2617 01:33:47,557 --> 01:33:48,658 BECAUSE THERE'S JUST SUCH A HIGH 2618 01:33:48,658 --> 01:33:50,726 FAIL RATE, AND THERE COULD BE A 2619 01:33:50,726 --> 01:33:52,495 REALLY IMPORTANT GROUP TO LOOK 2620 01:33:52,495 --> 01:33:54,797 AT OF COMBINATION OF SEQUENTIAL 2621 01:33:54,797 --> 01:33:55,064 THERAPIES. 2622 01:33:55,064 --> 01:33:57,233 THIS IS DR. REDLINE'S TRIAL 2623 01:33:57,233 --> 01:34:00,903 LOOKING AT ME SAL CANNULA 2624 01:34:00,903 --> 01:34:03,639 OXYGEN, THE MOSAIC STUDY IS RUN 2625 01:34:03,639 --> 01:34:05,808 BY DAN COMBS IN ARIZONA AND IS 2626 01:34:05,808 --> 01:34:07,276 LOOKING AT A COMBINATION DRUG 2627 01:34:07,276 --> 01:34:08,511 THERAPY THAT HAS SOME PROMISE IN 2628 01:34:08,511 --> 01:34:09,579 CHILDREN. 2629 01:34:09,579 --> 01:34:12,348 THIS IS THE APAP21 TRIAL LOOKING 2630 01:34:12,348 --> 01:34:14,116 AT A MORE INTENSIVE CPAP 2631 01:34:14,116 --> 01:34:15,117 INTERVENTION. 2632 01:34:15,117 --> 01:34:17,620 AND THEN DERRICK LAM AT OREGON 2633 01:34:17,620 --> 01:34:21,757 LOOKING AT DRUG INDUCED SLEEP 2634 01:34:21,757 --> 01:34:24,260 ENDOSCOPY, I THINK WE'RE GOING 2635 01:34:24,260 --> 01:34:26,662 TO HEAR ABOUT SOME SELF 2636 01:34:26,662 --> 01:34:28,431 SUPPORTED NASOPHARYNGEAL AIRWAY 2637 01:34:28,431 --> 01:34:29,765 THAT INCLUDES SOME PEOPLE WITH 2638 01:34:29,765 --> 01:34:30,399 DOWN SYNDROME AS WELL. 2639 01:34:30,399 --> 01:34:32,068 SO A LOT OF EXCITING WORK GOING 2640 01:34:32,068 --> 01:34:37,673 ON IN THIS AREA. 2641 01:34:37,673 --> 01:34:38,541 I'LL JUST BRIEFLY MENTION TO 2642 01:34:38,541 --> 01:34:40,243 WRAP UP HERE THAT THERE'S A LOT 2643 01:34:40,243 --> 01:34:42,411 GOING ON IN TERMS OF JUST DATA 2644 01:34:42,411 --> 01:34:44,080 COLLECTION IN THIS AREA SO THE 2645 01:34:44,080 --> 01:34:48,117 INCLUDE INITIATIVE HAS FUND THIS 2646 01:34:48,117 --> 01:34:49,018 HAD DATA COORDINATING CENTER 2647 01:34:49,018 --> 01:34:50,152 WHICH INCLUDES A LOT OF 2648 01:34:50,152 --> 01:34:51,120 RESOURCES AND OUTREACH TO 2649 01:34:51,120 --> 01:34:52,655 DIFFERENT STUDY TEAMS, THINKING 2650 01:34:52,655 --> 01:34:54,156 ABOUT DATA COLLECTION AND 2651 01:34:54,156 --> 01:34:55,124 MANAGEMENT AND THEN THEY PROVIDE 2652 01:34:55,124 --> 01:34:56,993 TOOLS FOR DATA ANALYSIS AND 2653 01:34:56,993 --> 01:34:57,894 INTERPRETATION. 2654 01:34:57,894 --> 01:34:59,295 I'VE BEEN IN SOME CALLS WITH 2655 01:34:59,295 --> 01:35:00,096 LEADERSHIP FROM THIS GROUP AND 2656 01:35:00,096 --> 01:35:02,632 THEY'RE REALLY TRYING TO BE 2657 01:35:02,632 --> 01:35:03,599 THOUGHTFUL ABOUT ESPECIALLY SOME 2658 01:35:03,599 --> 01:35:05,835 OF THE MORE IMPORTANT 2659 01:35:05,835 --> 01:35:06,168 COMORBIDITIES. 2660 01:35:06,168 --> 01:35:07,703 YOU CAN SEE SLEEP APNEA IS IN 2661 01:35:07,703 --> 01:35:08,804 RED THERE, THE CONDITION FOR 2662 01:35:08,804 --> 01:35:10,706 WHICH THEY HAVE THE FIFTH MOST 2663 01:35:10,706 --> 01:35:11,073 PARTICIPANTS. 2664 01:35:11,073 --> 01:35:12,808 LIKE THERE'S ABOUT 1300 RIGHT 2665 01:35:12,808 --> 01:35:14,777 NOW, I KNOW THIS COHORT IS 2666 01:35:14,777 --> 01:35:16,679 GROWING, SO I THINK IT'S JUST 2667 01:35:16,679 --> 01:35:18,247 GENERATING AN IMPORTANT DATASET 2668 01:35:18,247 --> 01:35:20,516 THAT WE CAN KIND OF PARTNER WITH 2669 01:35:20,516 --> 01:35:23,653 A LOT OF THESE INVESTIGATORS 2670 01:35:23,653 --> 01:35:24,654 FOCUSED ON DOWN SYNDROME. 2671 01:35:24,654 --> 01:35:26,155 I MENTIONED NE BEGINNING THERE'S 2672 01:35:26,155 --> 01:35:28,491 THIS NEWLY FUNDED U01 PROGRAM 2673 01:35:28,491 --> 01:35:29,825 LOOKING FOR STANDARDIZED 2674 01:35:29,825 --> 01:35:30,760 COLLECTION ACROSS A NUMBER OF 2675 01:35:30,760 --> 01:35:31,928 SITES INCLUDING MY OWN AND I 2676 01:35:31,928 --> 01:35:33,462 THINK AGAIN WE'RE TRYING TO HAVE 2677 01:35:33,462 --> 01:35:34,563 SOME IMPORTANT SLEEP METRICS 2678 01:35:34,563 --> 01:35:35,631 COLLECTED THERE BOTH IN CHILDREN 2679 01:35:35,631 --> 01:35:38,834 AND IN ADULTS SO THAT WE CAN 2680 01:35:38,834 --> 01:35:40,770 HAVE THAT AS WELL AS ALL THE 2681 01:35:40,770 --> 01:35:41,737 OTHER COMORBIDITIES THAT WILL BE 2682 01:35:41,737 --> 01:35:42,838 COLLECTED WHICH I THINK WILL BE 2683 01:35:42,838 --> 01:35:46,042 A GREAT RESOURCE. 2684 01:35:46,042 --> 01:35:47,076 I THINK FINALLY I'LL MENTION 2685 01:35:47,076 --> 01:35:48,244 THAT THERE HAVE BEEN SOME 2686 01:35:48,244 --> 01:35:49,445 CHALLENGES BUT SOME REALLY GREAT 2687 01:35:49,445 --> 01:35:50,346 OPPORTUNITIES IN TERMS OF 2688 01:35:50,346 --> 01:35:51,580 PARTNERING WITH THIS COMMUNITY. 2689 01:35:51,580 --> 01:35:54,116 THESE PATIENTS CAN HAVE REALLY 2690 01:35:54,116 --> 01:35:56,652 VARIABLE INTELLECTUAL DISABILITY 2691 01:35:56,652 --> 01:35:57,954 WHICH MAKES IT PROPOSE SOME 2692 01:35:57,954 --> 01:35:58,254 CHALLENGES. 2693 01:35:58,254 --> 01:36:00,089 THERE CAN BE A LIMITED LOCAL 2694 01:36:00,089 --> 01:36:01,824 POPULATION, THERE'S A LOT OF 2695 01:36:01,824 --> 01:36:03,125 HETEROGENEITY AMONG THE 2696 01:36:03,125 --> 01:36:03,659 CO-OCCURRING CONDITION BUT 2697 01:36:03,659 --> 01:36:06,195 THERE'S A LOT OF I THINK VALUE, 2698 01:36:06,195 --> 01:36:07,697 THESE FAMILIES ARE REALLY 2699 01:36:07,697 --> 01:36:09,231 INVESTED IN THE RESEARCH, 2700 01:36:09,231 --> 01:36:11,133 THERE'S A HIGH INCLUSION AND 2701 01:36:11,133 --> 01:36:12,335 RETENTION RATE AND THERE'S A LOT 2702 01:36:12,335 --> 01:36:13,769 OF RESOURCES AVAILABLE TO THEM 2703 01:36:13,769 --> 01:36:15,404 TO PARTICIPATE IN RESEARCH. 2704 01:36:15,404 --> 01:36:16,672 SO OPPORTUNITIES INCLUDE 2705 01:36:16,672 --> 01:36:18,841 UTILIZING LARGE COHORTS THAT ARE 2706 01:36:18,841 --> 01:36:20,176 GETTING BIGGER AND BIGGER TO 2707 01:36:20,176 --> 01:36:21,844 ASSESS SOME OF TEASE 2708 01:36:21,844 --> 01:36:22,511 RELATIONSHIPS, COLLABORATING 2709 01:36:22,511 --> 01:36:24,747 BETWEEN INVESTIGATORS FOCUSED ON 2710 01:36:24,747 --> 01:36:26,549 DOWN SYNDROME AS WELL AS SLEEP 2711 01:36:26,549 --> 01:36:27,450 INVESTIGATORS LIKE THOSE ON THIS 2712 01:36:27,450 --> 01:36:28,117 CALL. 2713 01:36:28,117 --> 01:36:29,885 AND THEN CHARACTERIZING OSA 2714 01:36:29,885 --> 01:36:31,420 ACROSS THIS HIGH RISK POPULATION 2715 01:36:31,420 --> 01:36:35,257 ACROSS THE LIFESPAN. 2716 01:36:35,257 --> 01:36:40,363 SO THAT WILL BE IT FOR ME. 2717 01:36:40,363 --> 01:36:40,796 >> GREAT. 2718 01:36:40,796 --> 01:36:42,965 THANK YOU SO MUCH, DR. CIELO. 2719 01:36:42,965 --> 01:36:47,036 SO WE JUST HEARD A GREAT 2720 01:36:47,036 --> 01:36:47,937 DISCUSSION ABOUT THE HIGH RISK 2721 01:36:47,937 --> 01:36:49,338 OF OSA AMONG INDIVIDUALS WITH 2722 01:36:49,338 --> 01:36:51,007 DOWN SYNDROME, THE PRESENTATION 2723 01:36:51,007 --> 01:36:52,675 EVALUATION AND MANAGEMENT AND I 2724 01:36:52,675 --> 01:36:54,977 THINK HIGHLIGHTING THE NEED FOR 2725 01:36:54,977 --> 01:36:56,178 MORE -- JUST MORE INFORMATION 2726 01:36:56,178 --> 01:37:00,683 ABOUT THE NATURAL HISTORY OF OSA 2727 01:37:00,683 --> 01:37:02,351 IN DOWN SYNDROME AND THE 2728 01:37:02,351 --> 01:37:03,552 IMPORTANCE OF SEQUENTIAL 2729 01:37:03,552 --> 01:37:05,388 THERAPISTS AND SOME SORT OF 2730 01:37:05,388 --> 01:37:06,188 ALTERNATIVE TREATMENT OPTIONS. 2731 01:37:06,188 --> 01:37:10,393 AGO THOSE LINES, WE'RALONG THOSG 2732 01:37:10,393 --> 01:37:12,194 TO TRANSITION TO HEARING MORE 2733 01:37:12,194 --> 01:37:13,696 ABOUT EMERGING THERAPY FROM 2734 01:37:13,696 --> 01:37:16,165 DR. DAVID ZOPF, ASSOCIATE 2735 01:37:16,165 --> 01:37:18,734 PROFESSOR IN THE DIVISION OF 2736 01:37:18,734 --> 01:37:19,702 OTOLARYNGOLOGY, HEAD AND NECK 2737 01:37:19,702 --> 01:37:23,372 SURGERY AND THE DIRECTOR OF 2738 01:37:23,372 --> 01:37:27,309 INNOVATION AND SECTION CHIEF OF 2739 01:37:27,309 --> 01:37:29,578 PEDIATRIC -- AT THE UNIVERSITY 2740 01:37:29,578 --> 01:37:30,212 OF WISCONSIN SCHOOL OF MEDICINE 2741 01:37:30,212 --> 01:37:30,780 AND PUBLIC HEALTH. 2742 01:37:30,780 --> 01:37:32,648 HIS PRESENTATION IS TITLED 2743 01:37:32,648 --> 01:37:33,883 EMERGING OSA THERAPIES IN 2744 01:37:33,883 --> 01:37:34,550 VULNERABLE POPULATIONS. 2745 01:37:34,550 --> 01:37:34,917 THANK YOU. 2746 01:37:34,917 --> 01:37:35,551 >> HELLO. 2747 01:37:35,551 --> 01:37:36,652 THANK YOU SO MUCH. 2748 01:37:36,652 --> 01:37:38,854 REALLY EXCITED TO HAVE THE 2749 01:37:38,854 --> 01:37:43,592 OPPORTUNITY TO JOIN THIS REALLY 2750 01:37:43,592 --> 01:37:44,827 WONDERFUL DISCUSSION. 2751 01:37:44,827 --> 01:37:46,896 AS WAY OF DISCLOSURES, THESE ARE 2752 01:37:46,896 --> 01:37:48,597 LISTED BELOW, AND I'LL JUST 2753 01:37:48,597 --> 01:37:50,866 HIGHLIGHT THE TREMENDOUS SUPPORT 2754 01:37:50,866 --> 01:37:55,771 AND COLLABORATION WITH 2755 01:37:55,771 --> 01:37:58,040 DR. ALFINI, DR. BROWN AND NHLBI. 2756 01:37:58,040 --> 01:38:00,209 SO WHAT WE'RE GOING TO DO IS 2757 01:38:00,209 --> 01:38:01,944 KIND OF LOOK AT A COUPLE OF 2758 01:38:01,944 --> 01:38:03,679 VULNERABLE POPULATIONS, 2759 01:38:03,679 --> 01:38:05,114 PARTICULARLY DOWN SYNDROME AND 2760 01:38:05,114 --> 01:38:06,649 CEREBRAL PALSY, AND REALLY KIND 2761 01:38:06,649 --> 01:38:08,150 OF HIGHLIGHT THE NEED FOR 2762 01:38:08,150 --> 01:38:09,952 ADDITIONAL TREATMENT OPTIONS 2763 01:38:09,952 --> 01:38:12,822 ACCESSIBLE TO ALL. 2764 01:38:12,822 --> 01:38:14,890 AND THE WAY THAT I'LL KIND OF 2765 01:38:14,890 --> 01:38:16,592 THINK ABOUT THESE TWO IS KIND OF 2766 01:38:16,592 --> 01:38:20,096 AN INDEX NON-SURGICAL INNOVATION 2767 01:38:20,096 --> 01:38:21,730 AND INDEX SURGICAL INNOVATION. 2768 01:38:21,730 --> 01:38:24,500 WE TALKED A LITTLE BIT ABOUT 2769 01:38:24,500 --> 01:38:25,901 DOWN SYNDROME, CEREBRAL PALSY AS 2770 01:38:25,901 --> 01:38:29,438 WE KNOW IS THE MOST COMMON 2771 01:38:29,438 --> 01:38:32,374 NEUROMUSCULAR DISABILITY IN 2772 01:38:32,374 --> 01:38:33,742 CHILDHOOD. 2773 01:38:33,742 --> 01:38:37,613 AND IT'S INTERESTING HOW THERE 2774 01:38:37,613 --> 01:38:39,882 ARE A NUMBER OF ANATOMIC AND I 2775 01:38:39,882 --> 01:38:42,118 THINK PHYSIOLOGIC PARALLELS WITH 2776 01:38:42,118 --> 01:38:46,722 DOWN SYNDROME AND WE'VE HEARD A 2777 01:38:46,722 --> 01:38:48,491 GOOD AMOUNT WITH SOME OF THE 2778 01:38:48,491 --> 01:38:49,558 UNDERLYING PREDISPOSITION 2779 01:38:49,558 --> 01:38:51,694 ANATOMIC CONTRIBUTORS FROM DOWN 2780 01:38:51,694 --> 01:38:52,828 SYNDROME AND WHAT I WAS FINDING 2781 01:38:52,828 --> 01:38:56,866 AS I WAS EVALUATING MORE AND 2782 01:38:56,866 --> 01:38:58,868 MORE PATIENTS WITH CEREBRAL 2783 01:38:58,868 --> 01:39:00,503 PALSY AND DOWN SYNDROME IS 2784 01:39:00,503 --> 01:39:01,804 THERE'S QUITE A BIT OF 2785 01:39:01,804 --> 01:39:03,439 SIMILARITY BETWEEN THE TWO WHERE 2786 01:39:03,439 --> 01:39:05,441 THERE'S A PREDOMINENCE OF KIND 2787 01:39:05,441 --> 01:39:07,643 OF RETRO PALATAL AND RETRO 2788 01:39:07,643 --> 01:39:11,147 LINGUAL COLLAPSE, AND THIS IS 2789 01:39:11,147 --> 01:39:13,616 JUST A NICE SAGITTAL PICTURE 2790 01:39:13,616 --> 01:39:16,252 SHOWING A NUMBER OF THOSE 2791 01:39:16,252 --> 01:39:18,888 ANATOMICAL CONTRIBUTORS BUT 2792 01:39:18,888 --> 01:39:19,855 CEREBRAL PALSY AS WELL. 2793 01:39:19,855 --> 01:39:21,123 I THOUGHT THIS WOULD BE GOOD 2794 01:39:21,123 --> 01:39:23,092 JUST TO KIND OF THINK THROUGH AS 2795 01:39:23,092 --> 01:39:26,695 A PEDIATRIC OTOLARYNGOLOGIST WHO 2796 01:39:26,695 --> 01:39:28,364 PARTICIPATES IN A 2797 01:39:28,364 --> 01:39:29,098 MULTIDISCIPLINARY SLEEP CLINIC, 2798 01:39:29,098 --> 01:39:32,001 HOW DO I THINK ABOUT KIND OF THE 2799 01:39:32,001 --> 01:39:32,935 CURRENT STATE OF TREATMENT 2800 01:39:32,935 --> 01:39:33,536 OPTIONS. 2801 01:39:33,536 --> 01:39:36,338 WITH THESE VULNERABLE PATIENT 2802 01:39:36,338 --> 01:39:37,640 POPULATIONS, IT'S GOING TO BE 2803 01:39:37,640 --> 01:39:40,042 LIKELY A MULTIMODAL 2804 01:39:40,042 --> 01:39:41,277 INDIVIDUALIZED TREATMENT 2805 01:39:41,277 --> 01:39:44,446 APPROACH. 2806 01:39:44,446 --> 01:39:45,748 AND WE KNOW SOME OF THE GOLD 2807 01:39:45,748 --> 01:39:47,550 STANDARD TREATMENTS ARE POSITIVE 2808 01:39:47,550 --> 01:39:49,285 AIRWAY PRESSURE, PERHAPS NASAL 2809 01:39:49,285 --> 01:39:51,086 OXYGEN, DRUG INDUCED SLEEP 2810 01:39:51,086 --> 01:39:54,490 ENDOSCOPY HAS BEEN A REALLY 2811 01:39:54,490 --> 01:40:05,000 VALUABLE TOOL, AND USING DISE 2812 01:40:05,000 --> 01:40:06,168 INDUCED UPPER AIRWAY SURGERY 2813 01:40:06,168 --> 01:40:07,236 MIGHT BE AN OPTION. 2814 01:40:07,236 --> 01:40:08,904 SO OPTIONS IN WHITE ARE REALLY 2815 01:40:08,904 --> 01:40:10,239 NON-SURGICAL APPROACHES AND THE 2816 01:40:10,239 --> 01:40:11,340 OPTIONS IN BLUE ARE SURGICAL 2817 01:40:11,340 --> 01:40:11,640 APPROACHES. 2818 01:40:11,640 --> 01:40:13,642 WE KNOW DENTAL APPLIANCES MAY BE 2819 01:40:13,642 --> 01:40:15,678 HELPFUL FOR MILD THOUGH MAY BE 2820 01:40:15,678 --> 01:40:17,213 LIMITED AS FAR AS VULNERABLE 2821 01:40:17,213 --> 01:40:17,546 POPULATIONS. 2822 01:40:17,546 --> 01:40:19,315 WE TALKED A GOOD AMOUNT THIS 2823 01:40:19,315 --> 01:40:20,916 MORNING ABOUT WEIGHT REDUCTION 2824 01:40:20,916 --> 01:40:23,485 STRATEGIES AND GLP, 2825 01:40:23,485 --> 01:40:25,988 PHARMACEUTICALS, AND THEN 2826 01:40:25,988 --> 01:40:28,724 POTENTIALLY AS THEIR ROLE FOR 2827 01:40:28,724 --> 01:40:30,526 BARIATRIC SURGERY AND MORE 2828 01:40:30,526 --> 01:40:34,563 MORBID OBESITY, 2829 01:40:34,563 --> 01:40:39,268 NASOCORTICOSTEROIDS OR ORAL 2830 01:40:39,268 --> 01:40:42,938 LEUKOTRIENE MODIFIERS. 2831 01:40:42,938 --> 01:40:43,706 TYPICALLY MUCH FURTHER DOWN THE 2832 01:40:43,706 --> 01:40:48,210 LIST FOR ME IS CONSIDERATION OF 2833 01:40:48,210 --> 01:40:50,446 HYPOGLOSSAL STIMULATOR OR 2834 01:40:50,446 --> 01:40:53,949 TRACHEOSTOMY, SO WE KNOW THAT -- 2835 01:40:53,949 --> 01:40:55,884 UNFORTUNATELY ARE NOT AS 2836 01:40:55,884 --> 01:40:59,088 EFFECTIVE IN THE DOWN SYNDROME 2837 01:40:59,088 --> 01:41:00,556 AND CP POPULATION, AND 2838 01:41:00,556 --> 01:41:04,627 PARTICULARLY IN THE CP 2839 01:41:04,627 --> 01:41:06,028 POPULATION, PAP THERAPY CAN BE A 2840 01:41:06,028 --> 01:41:09,265 RISK, RIGHT, WITH ASPIRATION OR 2841 01:41:09,265 --> 01:41:13,102 POTENTIAL ASPHYXIATION RISK. 2842 01:41:13,102 --> 01:41:24,480 ADENOTONS ELTONS LEADENOTONSILLD 2843 01:41:26,715 --> 01:41:27,750 PATIENTS HAVE PERSISTENT OSA. 2844 01:41:27,750 --> 01:41:29,184 IN ADDITION, THESE POPULATIONS 2845 01:41:29,184 --> 01:41:30,686 NOT ONLY ARE THEY MUCH MORE 2846 01:41:30,686 --> 01:41:32,388 LIKELY TO FAIL TREATMENT WITH 2847 01:41:32,388 --> 01:41:33,822 THESE GOLD STANDARD TREATMENTS 2848 01:41:33,822 --> 01:41:36,458 BUT THEY'RE ALSO IN THE SURGICAL 2849 01:41:36,458 --> 01:41:38,093 OPTIONS MUCH HIGHER 2850 01:41:38,093 --> 01:41:39,561 PERIOPERATIVE RISKS, SO 2851 01:41:39,561 --> 01:41:42,865 PARTICULARLY THE CEREBRAL PALSY 2852 01:41:42,865 --> 01:41:43,966 POPULATION, WHEREAS OTHERWISE 2853 01:41:43,966 --> 01:41:49,872 HEALTHY CHILD HAVING 2854 01:41:49,872 --> 01:41:50,673 ADENOTONSILLECTOMY MAY GO HOME 2855 01:41:50,673 --> 01:41:53,175 NA DAY OR THE NEXT DAY, PATIENTS 2856 01:41:53,175 --> 01:41:58,781 WITH CEREBRAL PALSY MAY BE IN 2857 01:41:58,781 --> 01:42:01,150 THE ICU FOR THREE OFF FOUR WEEKS 2858 01:42:01,150 --> 01:42:02,951 AND HAVE PERIODIC COMPLICATIONS 2859 01:42:02,951 --> 01:42:05,287 REQUIRING REINTEGRATION SYNDROME 2860 01:42:05,287 --> 01:42:08,524 TO A LESSER EXTENT BUT ALSO MUCH 2861 01:42:08,524 --> 01:42:10,659 HIGHER PERIOPERATIVE RISK. 2862 01:42:10,659 --> 01:42:13,595 A GOOD NUMBER OF THEY WILL ENDED 2863 01:42:13,595 --> 01:42:17,399 UP GOING FORWARD AND REQUIRING 2864 01:42:17,399 --> 01:42:18,500 TRACHEOSTOMY TO ADDRESS THEIR 2865 01:42:18,500 --> 01:42:20,135 UPPER AIRWAY OBSTRUCTION. 2866 01:42:20,135 --> 01:42:24,239 SO I FOUND MYSELF REALLY KIND OF 2867 01:42:24,239 --> 01:42:24,840 STRUGGLINGERRING FAMILIES THAT 2868 01:42:24,840 --> 01:42:25,941 HAVE KIND OF REACHED THE POINT 2869 01:42:25,941 --> 01:42:29,178 WHERE THE OPTIONS ENDED UP BEING 2870 01:42:29,178 --> 01:42:32,281 TRACHEOSTOMY OR PALLIATIVE 2871 01:42:32,281 --> 01:42:33,382 OBSERVATION WAS REALLY 2872 01:42:33,382 --> 01:42:34,249 DISSATISFYING FOR THE FAMILIES 2873 01:42:34,249 --> 01:42:35,684 AND THE PATIENTS AND CERTAINLY 2874 01:42:35,684 --> 01:42:37,820 THE CAREGIVERS AS WELL, AND SO 2875 01:42:37,820 --> 01:42:40,989 WE REALLY WERE INSPIRED TO 2876 01:42:40,989 --> 01:42:42,224 DEVELOP SOMETHING NOVEL, KIND OF 2877 01:42:42,224 --> 01:42:42,858 IN BETWEEN. 2878 01:42:42,858 --> 01:42:46,128 AND SO I THOUGHT THROUGH THE 2879 01:42:46,128 --> 01:42:47,196 ANATOMIC PATTERN OF COLLAPSE AND 2880 01:42:47,196 --> 01:42:50,799 IT REMINDED ME OF PATIENTS WITH 2881 01:42:50,799 --> 01:42:51,800 ANOTHER POPULATION I CARE FOR 2882 01:42:51,800 --> 01:42:53,102 WHERE THERE IS A SIGNIFICANT 2883 01:42:53,102 --> 01:42:58,674 AMOUNT OF RETRO LINGUAL COLLA 2884 01:42:58,674 --> 01:42:59,441 COLLAPSE, BASAL TIME WAS KIND OF 2885 01:42:59,441 --> 01:43:03,812 THE STAR OF THE SHOW. 2886 01:43:03,812 --> 01:43:05,280 THE GREAT -- HAD LED THE WAY 2887 01:43:05,280 --> 01:43:06,815 WITH TREATING THOSE PATIENTS 2888 01:43:06,815 --> 01:43:12,855 WITH NAY SEWER FAIR JEEL 2889 01:43:12,855 --> 01:43:13,288 AIRWAYS. 2890 01:43:13,288 --> 01:43:15,023 SO THAT WAS KIND OF THE STARTING 2891 01:43:15,023 --> 01:43:15,858 POINT FOR OUR DESIGN AND I 2892 01:43:15,858 --> 01:43:17,826 THOUGHT IF WE COULD BYPASS THE 2893 01:43:17,826 --> 01:43:20,829 RETRO PALATAL AND RETRO LINGUAL 2894 01:43:20,829 --> 01:43:22,097 OBSTRUCTION, PERHAPS WE COULD DO 2895 01:43:22,097 --> 01:43:24,133 A GOOD JOB OF TREATING THIS 2896 01:43:24,133 --> 01:43:24,666 UPPER AIRWAY OBSTRUCTION. 2897 01:43:24,666 --> 01:43:26,135 THERE'S A NUMBER OF DESIGN 2898 01:43:26,135 --> 01:43:27,803 FEATURES TO THE DEVICE WHERE 2899 01:43:27,803 --> 01:43:29,104 IT'S ACTUALLY OPEN CHANNEL SO 2900 01:43:29,104 --> 01:43:32,241 IT'S MORE LIKE A NASOPHARYNGEAL 2901 01:43:32,241 --> 01:43:32,441 STENT. 2902 01:43:32,441 --> 01:43:34,743 THIS IS AN EXAMPLE OF AN ENDO 2903 01:43:34,743 --> 01:43:36,812 SCOPIC EXAM OF A PATIENT WITH 2904 01:43:36,812 --> 01:43:37,146 CHECKPOINT. 2905 01:43:37,146 --> 01:43:38,180 YOU CAN HEAR THE OBSTRUCTION. 2906 01:43:38,180 --> 01:43:39,481 THIS PATIENT IS AWAKE. 2907 01:43:39,481 --> 01:43:43,752 THIS IS NOT A SLEEP ENDOSCOPY. 2908 01:43:43,752 --> 01:43:53,562 THEY'RE AWAKE AND SO THERE'S 2909 01:43:53,562 --> 01:43:54,763 COMPLETE PALATAL OBSTRUCTION AND 2910 01:43:54,763 --> 01:43:56,632 YOU'LL SEE VERY DYNAMIC AND 2911 01:43:56,632 --> 01:43:58,500 SEVERE OBSTRUCTION BEHIND THE 2912 01:43:58,500 --> 01:43:59,435 TONGUE TOO. 2913 01:43:59,435 --> 01:44:01,303 BUT THE PATTERN I WAS SEEING 2914 01:44:01,303 --> 01:44:02,805 WAS, ONCE WE GOT BEYOND THAT 2915 01:44:02,805 --> 01:44:04,206 TONGUE, THE AIRWAY OPENS UP 2916 01:44:04,206 --> 01:44:06,942 REALLY NICELY, SO THERE'S NO 2917 01:44:06,942 --> 01:44:10,078 SUPERGLOTTIC COLLAPSE, THE VOCAL 2918 01:44:10,078 --> 01:44:13,482 CORDS ARE OPENING REALLY NICELY. 2919 01:44:13,482 --> 01:44:14,349 ONE OF THE COMMENTS THAT CAME 2920 01:44:14,349 --> 01:44:16,051 WAS, YOU KNOW, WHO'S GOING TO 2921 01:44:16,051 --> 01:44:17,352 TOLERATE ANYTHING GOING IN THEIR 2922 01:44:17,352 --> 01:44:19,021 NOSE AND INTERESTINGLY, THIS 2923 01:44:19,021 --> 01:44:20,756 DEVELOPMENT STARTED PREPANDEMIC, 2924 01:44:20,756 --> 01:44:23,392 AND SO IT WAS INTERESTING TO SEE 2925 01:44:23,392 --> 01:44:24,993 HOW MOST EVERYBODY HAD TO 2926 01:44:24,993 --> 01:44:25,961 UNDERGO SOMETHING GOING IN THEIR 2927 01:44:25,961 --> 01:44:28,230 NOSE WITH COVID TESTS BUT A LOT 2928 01:44:28,230 --> 01:44:29,331 OF DESIGN OF THE DEVICE HAS BEEN 2929 01:44:29,331 --> 01:44:32,167 FOCUSED ON MAKING IT COMFORTABLE 2930 01:44:32,167 --> 01:44:36,305 TO PLACE AND TOLERABLE. 2931 01:44:36,305 --> 01:44:38,273 THIS IS A VIDEO OF A PATIENT 2932 01:44:38,273 --> 01:44:44,279 WITH SEVERE CEREBRAL PALSY. 2933 01:44:44,279 --> 01:44:45,881 SO THE PARENT PROVIDED VIDEO AND 2934 01:44:45,881 --> 01:44:47,649 YOU CAN HEAR THE REALLY SEVERE 2935 01:44:47,649 --> 01:44:54,423 OBSTRUCTION. 2936 01:44:54,423 --> 01:44:56,692 REALLY KIND OF WORKING FOR EVERY 2937 01:44:56,692 --> 01:44:56,925 BREATH. 2938 01:44:56,925 --> 01:45:00,429 AND THEN MOTHER IS GOING TO 2939 01:45:00,429 --> 01:45:10,739 PLACE THE DEVICE. 2940 01:45:14,943 --> 01:45:17,579 >> IS THAT BETTER? 2941 01:45:17,579 --> 01:45:27,789 YEAH, YEAH! 2942 01:45:30,125 --> 01:45:31,894 >> SO YOU CAN HEAR THE 2943 01:45:31,894 --> 01:45:33,228 OBSTRUCTION HAS PRETTY QUKLY 2944 01:45:33,228 --> 01:45:33,762 QUIETED DOWN. 2945 01:45:33,762 --> 01:45:35,564 SO WE'RE VERY FORTUNATE TO BE 2946 01:45:35,564 --> 01:45:38,634 STARTING THE FOURTH YEAR OF OUR 2947 01:45:38,634 --> 01:45:40,602 R33 PHASE OF THIS RANDOMIZED 2948 01:45:40,602 --> 01:45:41,537 CONTROL CLINICAL TRIAL. 2949 01:45:41,537 --> 01:45:45,507 I REALLY LOVE THE DESIGN OF THE 2950 01:45:45,507 --> 01:45:47,910 TRIAL, AND IT'S RANDOMIZED 2951 01:45:47,910 --> 01:45:49,845 CONTROLLED SO HALF OF PATIENTS 2952 01:45:49,845 --> 01:45:51,013 ARE GOING TO BE WAIT LIST 2953 01:45:51,013 --> 01:45:52,114 CONTROLLED WITH THE IDEA THAT IF 2954 01:45:52,114 --> 01:45:55,918 A PATIENT GETS PRESCRIBED CPAP 2955 01:45:55,918 --> 01:45:57,319 OR GETS BOOKED FOR A SURGERY, 2956 01:45:57,319 --> 01:45:58,420 IT'S NOT GOING TO HAPPEN THAT 2957 01:45:58,420 --> 01:45:59,388 DAY, THERE'S LIKELY GOING TO BE 2958 01:45:59,388 --> 01:46:00,489 KIND OF A WAIT PERIOD. 2959 01:46:00,489 --> 01:46:02,391 AND THEN THE OTHER GROUP IS 2960 01:46:02,391 --> 01:46:06,128 IMMEDIATE TREATMENT. 2961 01:46:06,128 --> 01:46:08,830 WHAT I LOVE ABOUT THIS DESIGN IS 2962 01:46:08,830 --> 01:46:09,631 SIMILAR TO DISCUSSION YESTERDAY 2963 01:46:09,631 --> 01:46:11,199 WHERE THERE IS THAT VIRTUAL 2964 01:46:11,199 --> 01:46:12,968 TWIN, THE PATIENT IN THE WAIT 2965 01:46:12,968 --> 01:46:14,836 LIST GROUP CAN ALMOST SERVE AS 2966 01:46:14,836 --> 01:46:18,607 THEIR ACTUAL TWIN, SO AFTER THE 2967 01:46:18,607 --> 01:46:21,577 8-WEEK PSG, BOTH GROUPS GET AN 2968 01:46:21,577 --> 01:46:23,579 8-WEEK PSG AND LAB PSG AND THE 2969 01:46:23,579 --> 01:46:25,581 WAIT LIST GROUP THEN IS OFFERED 2970 01:46:25,581 --> 01:46:28,383 THE DEVICE SO EVERYBODY GETS TO 2971 01:46:28,383 --> 01:46:29,217 TRIAL THE DEVICE AND THEN 2972 01:46:29,217 --> 01:46:31,887 THERE'S A 16-WEEK PSG. 2973 01:46:31,887 --> 01:46:33,956 INCLUSION CRITERIA ARE FOR 2974 01:46:33,956 --> 01:46:36,224 CONDITIONS WITH PHARYNGEAL 2975 01:46:36,224 --> 01:46:38,293 HYPOTONIA, SO DOWN SYNDROME, 2976 01:46:38,293 --> 01:46:40,963 CEREBRAL PALSY, SEVERE OSA, 2977 01:46:40,963 --> 01:46:42,831 REALLY THE BIG EXCLUSION 2978 01:46:42,831 --> 01:46:44,132 CRITERIA I'LL HIGHLIGHT IS 2979 01:46:44,132 --> 01:46:45,667 DISTAL AIRWAY COLLAPSE, SO THE 2980 01:46:45,667 --> 01:46:47,502 DEVICE CAN'T BE INTUBATING THE 2981 01:46:47,502 --> 01:46:49,237 PATIENT SO IF THERE'S 2982 01:46:49,237 --> 01:46:50,872 OBSTRUCTION AT THE LEVEL OF THE 2983 01:46:50,872 --> 01:46:52,608 VOCAL CORDS OR MORE DISTAL, THAT 2984 01:46:52,608 --> 01:46:56,278 WOULD BE AN EXCLUSION CRITERIA. 2985 01:46:56,278 --> 01:46:57,379 A COUPLE SNAPSHOT PATIENTS FROM 2986 01:46:57,379 --> 01:46:59,448 THE R61 TRIAL, THIS IS A DOWNS 2987 01:46:59,448 --> 01:47:02,250 PATIENT WHO HAD UNDERGROUND 2988 01:47:02,250 --> 01:47:03,785 MULTIPLE DISE DIRECTED 2989 01:47:03,785 --> 01:47:08,290 SURGERIES, WAS NOT A CANDIDATE 2990 01:47:08,290 --> 01:47:11,426 FOR A -- WAS NOT TOLERATING CPAP 2991 01:47:11,426 --> 01:47:13,161 DESPITE NUMEROUS ATTEMPTS WITH 2992 01:47:13,161 --> 01:47:15,364 SLEEP PSYCHOLOGISTS, SO WE WOULD 2993 01:47:15,364 --> 01:47:17,799 KIND OF CATEGORIZE THEM AS A 2994 01:47:17,799 --> 01:47:19,568 POTENTIAL TRACH CANDIDATE WITH 2995 01:47:19,568 --> 01:47:21,203 PERSISTENT REALLY PROFOUND 2996 01:47:21,203 --> 01:47:25,841 OBSTRUCTIVE SLEEP APNEA WITH AN 2997 01:47:25,841 --> 01:47:28,810 AHI OF 69 WE THE DEVICE, THAT 2998 01:47:28,810 --> 01:47:31,213 AHI COMES DOWN TO 17.8. 2999 01:47:31,213 --> 01:47:34,449 IF WE UTILIZE A MEDICARE 3000 01:47:34,449 --> 01:47:37,285 CRITERIA, IT WOULD BE 8.1, AND 3001 01:47:37,285 --> 01:47:40,088 INTERESTINGLY, THE RECOMMEND REP 3002 01:47:40,088 --> 01:47:41,657 WHICH REALLY THERE WAS NOT MUCH 3003 01:47:41,657 --> 01:47:42,958 AT ALL AT BASE LIERNTION WE 3004 01:47:42,958 --> 01:47:45,360 START TO SEE EMERGENCE OF REM 3005 01:47:45,360 --> 01:47:45,927 SLEEP. 3006 01:47:45,927 --> 01:47:47,095 PATIENT TWO, JUST TO LOOK AT, IS 3007 01:47:47,095 --> 01:47:49,598 A PATIENT WITH SEVERE CEREBRAL 3008 01:47:49,598 --> 01:47:50,365 PALSY. 3009 01:47:50,365 --> 01:47:53,268 AND SEVERE UPPER AIRWAY 3010 01:47:53,268 --> 01:47:54,469 OBSTRUCTION EVEN AWAKE, CPAP WAS 3011 01:47:54,469 --> 01:47:57,005 NOT DEEMED TO BE A SAFE OPTION 3012 01:47:57,005 --> 01:47:58,640 BECAUSE OF THE ASPHYXIATION 3013 01:47:58,640 --> 01:48:01,376 ASPIRATION RISK, SO WE WOULD 3014 01:48:01,376 --> 01:48:03,311 AGAIN CONSIDER THIS PATIENT 3015 01:48:03,311 --> 01:48:06,481 POTENTIAL FOR TRACHEOSTOMY TO 3016 01:48:06,481 --> 01:48:07,783 ADDRESS THEIR OBSTRUCTIVE SLEEP 3017 01:48:07,783 --> 01:48:08,717 APNEA. 3018 01:48:08,717 --> 01:48:11,920 THEIR AHI IS 6.7, BUT 3019 01:48:11,920 --> 01:48:14,456 IMPRESSIVELY, THEIR HYPOXIA 3020 01:48:14,456 --> 01:48:16,692 IS -- THE MINIMUM O2 SAT IN THE 3021 01:48:16,692 --> 01:48:17,793 60s AND A GOOD PERCENTAGE OF 3022 01:48:17,793 --> 01:48:21,063 THE NIGHT HYPOXIC, WITH THE 3023 01:48:21,063 --> 01:48:22,664 DEVICE, THAT AHI COMES DOWN TO 3024 01:48:22,664 --> 01:48:27,469 LESS THAN 1, THE O2NATOR 3025 01:48:27,469 --> 01:48:29,071 IMPROVES TO STAYING IN THE 3026 01:48:29,071 --> 01:48:30,505 90s, AND AGAIN, WE SEE REALLY 3027 01:48:30,505 --> 01:48:32,274 NOT MUCH REM SLEEP BUT WE START 3028 01:48:32,274 --> 01:48:35,210 TO SEE SOME RESTORATION OF REM 3029 01:48:35,210 --> 01:48:35,944 SLEEP. 3030 01:48:35,944 --> 01:48:39,047 IMPORTANTLY, NO DEVICE-RELATED 3031 01:48:39,047 --> 01:48:41,850 ADVERSE EVENTS, SERIOUS DEVICE 3032 01:48:41,850 --> 01:48:43,118 ADVERSE EVENTS. 3033 01:48:43,118 --> 01:48:44,653 INTERESTINGLY, YOU KNOW, AS WE 3034 01:48:44,653 --> 01:48:45,987 THINK ABOUT A NON-SURGICAL AND 3035 01:48:45,987 --> 01:48:49,357 SURGICAL APPROACH, IN THE EVENT 3036 01:48:49,357 --> 01:48:51,727 OF A CONCERN FOR SOMETHING LIKE 3037 01:48:51,727 --> 01:48:53,161 A RECALL, A NON-SURGICAL 3038 01:48:53,161 --> 01:48:54,796 APPROACH LIKE THIS, LIKE CPAP, 3039 01:48:54,796 --> 01:48:57,933 IS FAIRLY EASY TO ADDRESS, 3040 01:48:57,933 --> 01:49:01,103 WHEREAS AS WE THINK ABOUT 3041 01:49:01,103 --> 01:49:02,137 SURGICAL INNOVATIONS, SOMETHING 3042 01:49:02,137 --> 01:49:03,405 OF THAT NATURE WOULD BE MUCH 3043 01:49:03,405 --> 01:49:04,906 MORE DIFFICULT TO ADDRESS. 3044 01:49:04,906 --> 01:49:06,775 SO KIND OF THINKING ABOUT 3045 01:49:06,775 --> 01:49:10,812 SURGICAL INNOVATION AND EMERGING 3046 01:49:10,812 --> 01:49:13,515 OPTIONS ON THE SURGICAL 3047 01:49:13,515 --> 01:49:14,282 STANDPOINT, HYPOGLOSSAL NERVE 3048 01:49:14,282 --> 01:49:16,151 STIMULATOR IS AN INTERESTING 3049 01:49:16,151 --> 01:49:16,685 APPROACH TO CONSIDER. 3050 01:49:16,685 --> 01:49:19,488 I THINK THAT AS WE THINK ABOUT 3051 01:49:19,488 --> 01:49:23,992 KIND OF THE INHERENT CHALLENGES 3052 01:49:23,992 --> 01:49:25,660 OF IMPLANTS, AGAIN IF A DEVASE 3053 01:49:25,660 --> 01:49:27,896 FAILS AND THERE IS A RECALL, 3054 01:49:27,896 --> 01:49:32,467 IT'S A MUCH MORE SERIOUS AND 3055 01:49:32,467 --> 01:49:33,135 CHALLENGING RISK. 3056 01:49:33,135 --> 01:49:34,136 AGAIN IF THE PATIENT HAS TO GO 3057 01:49:34,136 --> 01:49:35,871 BACK TO THE OPERATING ROOM, WE 3058 01:49:35,871 --> 01:49:37,806 KNOW THEY'RE PERIOPERATIVE HIGH 3059 01:49:37,806 --> 01:49:38,707 RISK PATIENTS. 3060 01:49:38,707 --> 01:49:41,810 THERE DOES SEEM TO BE SOME 3061 01:49:41,810 --> 01:49:45,881 IMPROVEMENT, AS DR. CIELO 3062 01:49:45,881 --> 01:49:48,049 HIGHLIGHT, IN THE -- ABOUT 36% 3063 01:49:48,049 --> 01:49:51,419 HAD TREATMENT TO LESS THAN AHI5, 3064 01:49:51,419 --> 01:49:53,955 BUT IT'S NOT ACROSS THE BOARD 3065 01:49:53,955 --> 01:49:55,023 CERTAINLY AND THINKING ABOUT 3066 01:49:55,023 --> 01:49:58,059 WHAT TREATMENT RESPONSE IS, I 3067 01:49:58,059 --> 01:50:00,595 THINK IS CRITICAL. 3068 01:50:00,595 --> 01:50:02,130 WHEN WE LOOK AT KIND OF LONG 3069 01:50:02,130 --> 01:50:04,633 TERM FOLLOW-UP AND LONG TERM 3070 01:50:04,633 --> 01:50:05,801 POTENTIAL COMPLICATIONS, HART 3071 01:50:05,801 --> 01:50:07,936 NICK'S GROUP, DR. HARTNICK OUT 3072 01:50:07,936 --> 01:50:09,604 OF BOSTON REALLY HAS LED THE WAY 3073 01:50:09,604 --> 01:50:11,773 AND HAS DESCRIBED SOME OF THE 3074 01:50:11,773 --> 01:50:14,276 POTENTIAL CHALLENGES WITH HAVING 3075 01:50:14,276 --> 01:50:17,712 TO REPLACE BATTERIES AND HAVE 3076 01:50:17,712 --> 01:50:18,980 OTHER ISSUES FROM THE SURGICAL 3077 01:50:18,980 --> 01:50:19,281 STANDPOINT. 3078 01:50:19,281 --> 01:50:20,649 THEN I THINK IT'S GOOD TO KIND 3079 01:50:20,649 --> 01:50:22,551 OF CONSIDER COST, SO HOW 3080 01:50:22,551 --> 01:50:25,954 ACCESSIBLE IS THIS TREATMENT 3081 01:50:25,954 --> 01:50:30,525 OPTION, BOTH IN THE STATES AND 3082 01:50:30,525 --> 01:50:31,126 LOW/MIDDLE RESOURCE 3083 01:50:31,126 --> 01:50:31,626 ENVIRONMENTS. 3084 01:50:31,626 --> 01:50:34,996 THE TAKE-HOME POINTS THAT I'LL 3085 01:50:34,996 --> 01:50:36,598 HIGHLIGHT IS CLEARLY IN THESE 3086 01:50:36,598 --> 01:50:37,933 VULNERABLE POPULATIONS, THERE'S 3087 01:50:37,933 --> 01:50:39,901 A DIRE NEED FOR ADDITIONAL 3088 01:50:39,901 --> 01:50:41,002 TREATMENT OPTIONS THAT CAN REACH 3089 01:50:41,002 --> 01:50:43,271 ALL POPULATIONS. 3090 01:50:43,271 --> 01:50:45,106 I THINK IT'S REALLY FASCINATING 3091 01:50:45,106 --> 01:50:46,541 TO THINK ABOUT AS NEW TREATMENT 3092 01:50:46,541 --> 01:50:49,277 OPTIONS EMERGE, HOW THAT MAY 3093 01:50:49,277 --> 01:50:53,315 DRIVE ADDED KNOWLEDGE TO 3094 01:50:53,315 --> 01:50:54,082 INFORMATION. 3095 01:50:54,082 --> 01:50:58,653 I'VE SPOKE WITH DR. COLIN 3096 01:50:58,653 --> 01:50:59,321 SULLIVAN, FASCINATING TO HEAR 3097 01:50:59,321 --> 01:51:01,890 HOW THE DEVELOPMENT OF CPAP 3098 01:51:01,890 --> 01:51:04,192 REALLY KIND OF PRECEDED FULL 3099 01:51:04,192 --> 01:51:05,427 UNDERSTANDING OF SLEEP MEDICINE, 3100 01:51:05,427 --> 01:51:07,162 SO PERHAPS WE'LL LEARN MORE AS 3101 01:51:07,162 --> 01:51:10,966 THESE TREATMENT OPTIONS EMERGE. 3102 01:51:10,966 --> 01:51:12,901 GOOD TO HIGHLIGHT THAT THE 3103 01:51:12,901 --> 01:51:14,402 STANDARD -- THE GOLD STANDARD 3104 01:51:14,402 --> 01:51:15,303 TREATMENT OPTIONS ARE OFTEN NOT 3105 01:51:15,303 --> 01:51:16,504 FEASIBLE FOR THESE VULNERABLE 3106 01:51:16,504 --> 01:51:18,540 PATIENT POPULATIONS, AND SO 3107 01:51:18,540 --> 01:51:22,677 REALLY KIND OF HAVING TO THINK 3108 01:51:22,677 --> 01:51:26,448 MULTIMODAL AND INNOVATIVELY TO 3109 01:51:26,448 --> 01:51:30,252 ADDRESS THEIR SLEEP CHALLENGES, 3110 01:51:30,252 --> 01:51:33,288 AND THEN FUNDING FOR HIGHER RISK 3111 01:51:33,288 --> 01:51:35,123 INNOVATIVE SOLUTIONS LIKE THIS 3112 01:51:35,123 --> 01:51:39,294 REALLY I THINK WILL DRIVE 3113 01:51:39,294 --> 01:51:39,794 EVIDENCE-BASED CLINICAL 3114 01:51:39,794 --> 01:51:41,062 SOLUTIONS. 3115 01:51:41,062 --> 01:51:43,131 THANK YOU AGAIN SO MUCH FOR THE 3116 01:51:43,131 --> 01:51:44,532 OPPORTUNITY TO DISCUSS THESE 3117 01:51:44,532 --> 01:51:50,238 EMERGING OPTIONS. 3118 01:51:50,238 --> 01:51:58,647 >> THANK YOU, DR. ZOPF. 3119 01:51:58,647 --> 01:51:59,948 MY CAMERA WON'T WORK -- OH, 3120 01:51:59,948 --> 01:52:00,515 THERE WE GO. 3121 01:52:00,515 --> 01:52:01,917 SO I'M JUST GOING TO SUMMARIZE 3122 01:52:01,917 --> 01:52:03,418 REALLY QUICKLY WHAT WE JUST 3123 01:52:03,418 --> 01:52:05,754 HEARD AND THEN WE'LL JUMP INTO A 3124 01:52:05,754 --> 01:52:09,324 Q & A UNTIL ABOUT 2:10 OR SO AND 3125 01:52:09,324 --> 01:52:11,059 THEN WEAL TAKE A MORE 3126 01:52:11,059 --> 01:52:14,562 ABBREVIATED BREAK. 3127 01:52:14,562 --> 01:52:16,598 DR. CIELO DISCUSSED THE UNIQUE 3128 01:52:16,598 --> 01:52:18,566 SCREENING AND MANAGEMENT OF OSA 3129 01:52:18,566 --> 01:52:19,701 IN DOWN SYNDROME POINTING OUT 3130 01:52:19,701 --> 01:52:22,404 SEVERAL GAPS IN OUR CURRENT 3131 01:52:22,404 --> 01:52:23,505 KNOWLEDGE AND IN NATURAL HISTORY 3132 01:52:23,505 --> 01:52:27,943 AND TERRITORIMENT OPTIONS 3133 01:52:27,943 --> 01:52:31,246 AND TREATMENT OPTIONS. 3134 01:52:31,246 --> 01:52:33,415 HE ADDRESSED SOME CURRENT 3135 01:52:33,415 --> 01:52:34,849 CLINICAL TRIALS TO ADDRESS OSA 3136 01:52:34,849 --> 01:52:36,151 AND DOWN SYNDROME THAT ARE BEING 3137 01:52:36,151 --> 01:52:39,454 SUPPORTED BY THE NIH. 3138 01:52:39,454 --> 01:52:40,355 DR. ZOPF HIGHLIGHTED THE 3139 01:52:40,355 --> 01:52:41,556 SHORTCOMINGS OF TRADITIONAL 3140 01:52:41,556 --> 01:52:42,857 PEDIATRIC TREATMENT PATHWAYS FOR 3141 01:52:42,857 --> 01:52:48,730 OSA WHEN APLAYED TO CHILDREN APN 3142 01:52:48,730 --> 01:52:50,165 WITH CERTAIN DEVELOPMENTAL 3143 01:52:50,165 --> 01:52:53,001 DISABILITIES INCLUDING CEREBRAL 3144 01:52:53,001 --> 01:52:54,836 PALSY, DOWN SYNDROME AND 3145 01:52:54,836 --> 01:52:55,470 HYPOTONIA IN GENERAL. 3146 01:52:55,470 --> 01:52:57,973 HE DISCUSSED THE IMPORTANCE OF 3147 01:52:57,973 --> 01:52:59,374 MULTIMODAL INDIVIDUALIZED 3148 01:52:59,374 --> 01:53:00,375 TREATMENT PLANS AND REA VEALED 3149 01:53:00,375 --> 01:53:02,010 SOME POTENTIAL INNOVATIVE 3150 01:53:02,010 --> 01:53:04,512 SOLUTIONS INCLUDING SELF 3151 01:53:04,512 --> 01:53:07,015 SUPPORTED AIRWAY DEVICES BUT 3152 01:53:07,015 --> 01:53:08,650 ALSO MENTIONED THE NEED FOR 3153 01:53:08,650 --> 01:53:09,117 ADDITIONAL OPTIONS. 3154 01:53:09,117 --> 01:53:10,618 SO WITH THAT, WE'LL KIND OF 3155 01:53:10,618 --> 01:53:12,153 OPENED IT UP TO QUESTIONS, AND I 3156 01:53:12,153 --> 01:53:18,693 SEE A FEW IN THE CHAT. 3157 01:53:18,693 --> 01:53:20,662 ONE, I THINK DR. CIELO STARTED 3158 01:53:20,662 --> 01:53:22,097 ANSWERING BUT I JUST WILL 3159 01:53:22,097 --> 01:53:23,398 VERBALLY TALK ABOUT IT. 3160 01:53:23,398 --> 01:53:27,302 THIS IS FROM DR. REDLINE. 3161 01:53:27,302 --> 01:53:28,670 ANECDOTALLY I'VE BEEN IMPRESSED 3162 01:53:28,670 --> 01:53:30,038 OVER THE HUGE DIFFERENCES IN OSA 3163 01:53:30,038 --> 01:53:32,107 SEVERITY IN DOWN SYNDROME IN 3164 01:53:32,107 --> 01:53:32,640 N3 VERSUS REM. 3165 01:53:32,640 --> 01:53:35,076 DO YOU THINK STAGE DIFFERENCES 3166 01:53:35,076 --> 01:53:36,011 IN DOWN SYNDROME ARE DIFFERENT 3167 01:53:36,011 --> 01:53:37,312 THAN IN OTHER PEDIATRIC 3168 01:53:37,312 --> 01:53:38,947 POPULATIONS, AND HOW DO WE LEARN 3169 01:53:38,947 --> 01:53:40,949 FROM STAGE-SPECIFIC CHANGES TO 3170 01:53:40,949 --> 01:53:45,653 DESIGN NEW TREATMENTS? 3171 01:53:45,653 --> 01:53:48,490 >> I THINK IT'S AN IMPORTANT 3172 01:53:48,490 --> 01:53:51,092 QUESTION, AND THERE'S A LOT OF 3173 01:53:51,092 --> 01:53:54,162 VARIABILITY, I THINK. 3174 01:53:54,162 --> 01:53:55,563 THERE HAVE BEEN PATIENTS WITH 3175 01:53:55,563 --> 01:53:57,966 DOWN SYNDROME WITH REALLY SEVERE 3176 01:53:57,966 --> 01:53:58,967 OBSTRUCTIVE SLEEP APNEA WHERE 3177 01:53:58,967 --> 01:54:00,502 STILL THERE IS VERY -- THERE ARE 3178 01:54:00,502 --> 01:54:02,203 VERY FEW EVENTS IN N3 SLEEP. 3179 01:54:02,203 --> 01:54:03,838 IT'S NOT TOTALLY UNCOMMON FOR 3180 01:54:03,838 --> 01:54:06,474 THAT TO HAPPEN IN CHILDREN SO 3181 01:54:06,474 --> 01:54:09,411 CERTAINLY SEEN IN OTHER WIRN 3182 01:54:09,411 --> 01:54:10,178 CHILDREN WITH PRETTY SEVERE 3183 01:54:10,178 --> 01:54:10,612 SLEEP APNEA. 3184 01:54:10,612 --> 01:54:11,813 I THINK THERE'S A LOT OF 3185 01:54:11,813 --> 01:54:14,416 VARIABILITY THERE, AS I THINK I 3186 01:54:14,416 --> 01:54:15,517 MADE MENTION IN THE COMMENT. 3187 01:54:15,517 --> 01:54:16,518 THIS IS AN OPPORTUNITY BECAUSE 3188 01:54:16,518 --> 01:54:20,088 WE HAVE A NUMBER OF THERAPEUTIC 3189 01:54:20,088 --> 01:54:22,624 TRIALS GOING ON, THE WORK THAT 3190 01:54:22,624 --> 01:54:25,026 DR. ZOPF IS DOING AND THEN SOME 3191 01:54:25,026 --> 01:54:26,528 OF THE STUFF I MENTIONED. 3192 01:54:26,528 --> 01:54:28,396 I THINK AS WE GENERATE THESE 3193 01:54:28,396 --> 01:54:29,597 LARGER COHORT OF PATIENTS WHO 3194 01:54:29,597 --> 01:54:31,633 ARE UNDERGOING ONE OR MAYBE 3195 01:54:31,633 --> 01:54:34,702 MULTIPLE THERAPIES, FOR EXAMPLE, 3196 01:54:34,702 --> 01:54:36,037 JUST CPAP TO BETTER UNDERSTAND 3197 01:54:36,037 --> 01:54:37,005 WHICH OF THESE PATIENTS ARE 3198 01:54:37,005 --> 01:54:38,740 GOING TO RESPOND BETTER TO 3199 01:54:38,740 --> 01:54:39,474 DIFFERENT THERAPIES. 3200 01:54:39,474 --> 01:54:40,675 BECAUSE AGAIN AS I MENTIONED 3201 01:54:40,675 --> 01:54:41,810 THIS IS A GROUP OF WHERE THERE 3202 01:54:41,810 --> 01:54:43,311 ARE A LOT OF HOWEVER YOU WANT TO 3203 01:54:43,311 --> 01:54:44,546 DEFINE NON-RESPONDERS, THERE ARE 3204 01:54:44,546 --> 01:54:45,914 A LOT OF NON-RESPONDERS. 3205 01:54:45,914 --> 01:54:47,482 AND IT MAY BE THAT ONE THERAPY 3206 01:54:47,482 --> 01:54:49,951 MAY BE BETTER FOR ONE PATIENT 3207 01:54:49,951 --> 01:54:51,286 AND MAYBE THAT THEY NEED 3208 01:54:51,286 --> 01:54:52,153 MULTIPLE THERAPIES. 3209 01:54:52,153 --> 01:54:54,189 AND I THINK THIS IS ONE OF 3210 01:54:54,189 --> 01:54:54,989 PROBABLY MULTIPLE DIFFERENT 3211 01:54:54,989 --> 01:54:57,992 THINGS TO LOOK AT IN TERMS OF 3212 01:54:57,992 --> 01:54:59,360 WHICH THERAPIES ARE GOING TO BE 3213 01:54:59,360 --> 01:55:00,061 MOST HELPFUL. 3214 01:55:00,061 --> 01:55:01,396 JUST BUILDING ON SOME OF THE 3215 01:55:01,396 --> 01:55:04,132 OTHER TALKS THAT WERE MADE ABOUT 3216 01:55:04,132 --> 01:55:05,967 THINGS LIKE AROUSAL INDEX AND 3217 01:55:05,967 --> 01:55:07,802 SOME OF THE SYMPTOMS IN TERMS OF 3218 01:55:07,802 --> 01:55:08,803 WHETHER IF YOU WERE TO THINK 3219 01:55:08,803 --> 01:55:09,904 ABOUT DIFFERENT CLUSTERS, 3220 01:55:09,904 --> 01:55:12,841 BUILDING ON WHAT DR. PACK HAD 3221 01:55:12,841 --> 01:55:14,576 MENTIONED IN THE ADULT 3222 01:55:14,576 --> 01:55:15,810 COMMUNITY, SO CLUSTERS OF 3223 01:55:15,810 --> 01:55:18,913 PEDIATRIC PATIENTS WITH DOWN 3224 01:55:18,913 --> 01:55:20,381 SYNDROME OR OTHERWISE WHO 3225 01:55:20,381 --> 01:55:25,120 PRESENT WITH DAY TIME SYMPTOMS 3226 01:55:25,120 --> 01:55:28,923 IN TERMS OF SLEEPINESS, AGAIN, 3227 01:55:28,923 --> 01:55:30,425 WHICH OF THESE THERAPIES ARE 3228 01:55:30,425 --> 01:55:32,594 GOING TO ADDRESS THOSE DAY TIME 3229 01:55:32,594 --> 01:55:34,329 SYMPTOMS OR THOSE 3230 01:55:34,329 --> 01:55:34,896 NEURODEVELOPMENTAL SYMPTOMS. 3231 01:55:34,896 --> 01:55:36,131 I THINK WE'RE RIGHT NOW GETTING 3232 01:55:36,131 --> 01:55:37,198 INTO A POSITION WHERE WE CAN 3233 01:55:37,198 --> 01:55:38,399 ANSWER SOME OF THOSE QUESTIONS 3234 01:55:38,399 --> 01:55:41,903 AND IT'S REALLY EXCITING. 3235 01:55:41,903 --> 01:55:42,470 >> THANK YOU. 3236 01:55:42,470 --> 01:55:43,605 ALL RIGHT. 3237 01:55:43,605 --> 01:55:45,140 WE HAVE A QUESTION FROM THE 3238 01:55:45,140 --> 01:55:46,474 VIDEOCAST WEBSITE. 3239 01:55:46,474 --> 01:55:48,643 THIS IS FOR DR. ZOPF. 3240 01:55:48,643 --> 01:55:50,478 HOW ARE YOU ACCOUNTING FOR THE 3241 01:55:50,478 --> 01:55:51,146 HIGH DEGREE OF VARIABILITY WITH 3242 01:55:51,146 --> 01:55:55,717 REA INSPECRESPECT TO WHAT'S LABS 3243 01:55:55,717 --> 01:55:57,185 CEREBRAL PALSY IN YOUR STUDIES? 3244 01:55:57,185 --> 01:55:58,486 >> THAT'S A GREAT POINT. 3245 01:55:58,486 --> 01:56:00,955 I THINK THAT, YOU KNOW, THE 3246 01:56:00,955 --> 01:56:04,893 PATIENTS THAT ARE IN THE STUDY 3247 01:56:04,893 --> 01:56:08,963 TEND TO BE MORE FUNCTIONALLY 3248 01:56:08,963 --> 01:56:15,370 IMPACTED, GM, FCS, YOU KNOW, 3249 01:56:15,370 --> 01:56:18,072 4s AND 5s, MORE SEVERELY 3250 01:56:18,072 --> 01:56:20,041 IMPACTED WITH MORE SIGNIFICANT 3251 01:56:20,041 --> 01:56:21,476 PHARYNGEAL HAY POE TONYA, 3252 01:56:21,476 --> 01:56:25,180 TYPICALLY WHEELCHAIR BOUND, SO 3253 01:56:25,180 --> 01:56:29,017 GREAT CONSIDERATION AND THERE IS 3254 01:56:29,017 --> 01:56:30,752 THAT HIGH VARIABILITY. 3255 01:56:30,752 --> 01:56:34,923 I THINK AS WE GET MORE 3256 01:56:34,923 --> 01:56:36,758 EXPERIENCE WITH THIS MO VEL 3257 01:56:36,758 --> 01:56:40,261 APPROACH, WE'LL BEGIN TO KIND OF 3258 01:56:40,261 --> 01:56:42,130 EXPLORE ARE THERE SUBPOPULATIONS 3259 01:56:42,130 --> 01:56:43,631 OF CP WHICH ARE BETTER 3260 01:56:43,631 --> 01:56:45,833 RESPONDERS, ARE THERE PATIENTS 3261 01:56:45,833 --> 01:56:49,437 WITH ADDITIONAL COMORBIDITIES 3262 01:56:49,437 --> 01:56:50,638 THAT THE APPROACH IS MORE 3263 01:56:50,638 --> 01:56:52,740 EFFECTIVE OR LESS EFFECTIVE FOR. 3264 01:56:52,740 --> 01:56:55,677 AND WE KNOW THAT A NUMBER OF 3265 01:56:55,677 --> 01:56:58,513 THESE PATIENT -- THE CEREBRAL 3266 01:56:58,513 --> 01:56:59,614 PALSY PATIENTS IN PARTICULAR CAN 3267 01:56:59,614 --> 01:57:03,218 HAVE SEIZURE DISORDERS, OTHERS 3268 01:57:03,218 --> 01:57:05,954 CAN HAVE OTHER COMORBIDITIES AND 3269 01:57:05,954 --> 01:57:08,456 HOW ARE THOSE SUBPOPULATIONS 3270 01:57:08,456 --> 01:57:10,258 KIND OF MORE OR PERHAPS LESS 3271 01:57:10,258 --> 01:57:11,059 RESPONSIVE. 3272 01:57:11,059 --> 01:57:14,696 MY HOPE IS THAT THE APPROACH 3273 01:57:14,696 --> 01:57:19,267 THAT WE'VE TAKEN A ANATOMICALLY 3274 01:57:19,267 --> 01:57:20,435 WHERE IF YOU THINK ABOUT CPAP, 3275 01:57:20,435 --> 01:57:22,637 IT IS KIND OF LIKE A PNEUMATIC 3276 01:57:22,637 --> 01:57:24,839 STENT, AND THE DEVICE THAT WE 3277 01:57:24,839 --> 01:57:27,308 DEVELOPED IS KIND OF LIKE A SOFT 3278 01:57:27,308 --> 01:57:28,643 SILICONE PHYSICAL STENT BUT I 3279 01:57:28,643 --> 01:57:30,612 THINK VERY MUCH EMLATES WHAT 3280 01:57:30,612 --> 01:57:34,382 CPAP TRIES TO DO AND SO EARLY IN 3281 01:57:34,382 --> 01:57:35,750 THE DEVELOPMENT OF OUR CLINICAL 3282 01:57:35,750 --> 01:57:37,452 TRIAL, WE THOUGHT, BOY, WE COULD 3283 01:57:37,452 --> 01:57:38,453 REALLY NARROW THE POPULATION 3284 01:57:38,453 --> 01:57:41,055 THAT WE LOOK AT AND TRY TO KIND 3285 01:57:41,055 --> 01:57:44,659 OF TEE OURSELF UP FOR A SUCCESS. 3286 01:57:44,659 --> 01:57:48,396 OR WE CAN LOOK AT A MORE 3287 01:57:48,396 --> 01:57:49,530 HETEROGENOUS POPULATION AND SEE 3288 01:57:49,530 --> 01:57:53,101 DOES IT SEEM TO BE MORE 3289 01:57:53,101 --> 01:57:54,135 EFFECTIVE FOR OR LESS EFFECTIVE 3290 01:57:54,135 --> 01:57:55,737 FOR PATIENTS WITH OBESITY, WITH 3291 01:57:55,737 --> 01:57:58,039 SOME OTHER COMORBIDITIES, SO OUR 3292 01:57:58,039 --> 01:58:01,743 HOPE IS THAT IT'S MORE BROADLY 3293 01:58:01,743 --> 01:58:05,613 EFFECTED BECAUSE AFFECTED BECAUH 3294 01:58:05,613 --> 01:58:06,147 THAT IT TAKES. 3295 01:58:06,147 --> 01:58:08,516 >> THANK YOU, DR. ZOPF. 3296 01:58:08,516 --> 01:58:08,850 ALL RIGHT. 3297 01:58:08,850 --> 01:58:11,686 I HAVE ANOTHER QUESTION FOR 3298 01:58:11,686 --> 01:58:12,387 DR. CIELO. 3299 01:58:12,387 --> 01:58:13,755 REALLY EXCELLENT AND IMPACTFUL 3300 01:58:13,755 --> 01:58:14,422 WORK, CHRIS. 3301 01:58:14,422 --> 01:58:16,924 CAN YOU SHARE YOUR THOUGHTS 3302 01:58:16,924 --> 01:58:18,459 ABOUT WHAT INSTITUTIONAL AND 3303 01:58:18,459 --> 01:58:19,861 BROADER SYSTEM-RELATED FACTORS 3304 01:58:19,861 --> 01:58:23,931 WOULD BE NEEDED TO SUCCESSFULLY 3305 01:58:23,931 --> 01:58:26,200 SCALE HSAT FOR CHILDREN WITH 3306 01:58:26,200 --> 01:58:27,435 DOWN SYNDROME VERSUS CHILDREN 3307 01:58:27,435 --> 01:58:29,370 THAT ARE TYPICALLY DEVELOPING 3308 01:58:29,370 --> 01:58:30,538 AND/OR ARE NOT MEDICALLY 3309 01:58:30,538 --> 01:58:31,039 COMPLEX. 3310 01:58:31,039 --> 01:58:39,447 WOULD IT BE MORE EFFECTIVE TO 3311 01:58:39,447 --> 01:58:40,515 SCALE GIVEN SOME OF THE 3312 01:58:40,515 --> 01:58:42,684 CHALLENGES WITH H SAT 3313 01:58:42,684 --> 01:58:43,785 SENSITIVITY SPECIFICITY AND 3314 01:58:43,785 --> 01:58:45,119 SENSORY DIFFERENCES ACROSS 3315 01:58:45,119 --> 01:58:45,420 POPULATIONS? 3316 01:58:45,420 --> 01:58:47,522 >> I THINK THAT IN MY IDEAL 3317 01:58:47,522 --> 01:58:50,325 DREAM WORLD, YOU WOULD HAVE 3318 01:58:50,325 --> 01:58:51,859 CLINICIANS WHO HAVE EXPERTISE IN 3319 01:58:51,859 --> 01:58:55,363 SLEEP MEDICINE THAT UNDERSTAND 3320 01:58:55,363 --> 01:58:57,899 THE LIMITATIONS AND THE BENEFITS 3321 01:58:57,899 --> 01:58:59,334 OF THESE DIFFERENT INSTRUMENTS, 3322 01:58:59,334 --> 01:59:00,535 WHETHER IT'S SOMETHING THAT'S 3323 01:59:00,535 --> 01:59:02,236 VERY SIMPLISTIC USING SOMETHING 3324 01:59:02,236 --> 01:59:04,772 LIKE A PULSE OXIMETER ALL THE 3325 01:59:04,772 --> 01:59:07,742 WAY THROUGH FULL POLYSONOGRAPHY 3326 01:59:07,742 --> 01:59:08,776 AND ALSO KNOWS THE RESOURCES 3327 01:59:08,776 --> 01:59:11,079 THAT ARE AVAILABLE LOCAL LEGAL 3328 01:59:11,079 --> 01:59:12,413 TO THEM AND THAT ALSO IS SEEING 3329 01:59:12,413 --> 01:59:13,614 THE PATIENT IN THE CLINIC AND 3330 01:59:13,614 --> 01:59:15,350 CAN SAY I KNOW WHAT THE 3331 01:59:15,350 --> 01:59:16,451 RESOURCES ARE OF THIS FAMILY AND 3332 01:59:16,451 --> 01:59:19,620 WIWHAT THE POSSIBILITIES ARE AND 3333 01:59:19,620 --> 01:59:20,555 HAVE THAT DISCUSSION TO THE 3334 01:59:20,555 --> 01:59:22,623 FAMILY AND TO BE ABLE TO SAY 3335 01:59:22,623 --> 01:59:24,359 OKAY, BASED ON YOUR NEEDS, MY 3336 01:59:24,359 --> 01:59:25,827 INDEX OF SUSPICION FOR SLEEP 3337 01:59:25,827 --> 01:59:27,528 APNEA AND KNOWING ALL THESE 3338 01:59:27,528 --> 01:59:28,696 DIFFERENT INSTRUMENTS, THIS IS 3339 01:59:28,696 --> 01:59:30,331 THE MODALITY I'M GOING TO 3340 01:59:30,331 --> 01:59:31,632 RECOMMEND TO DO THIS ASSESSMENT 3341 01:59:31,632 --> 01:59:34,268 FOR SLEEP APNEA. 3342 01:59:34,268 --> 01:59:35,837 I THINK THAT'S A PRETTY HIGH BAR 3343 01:59:35,837 --> 01:59:37,772 TO REACH, BUT RIGHT NOW WE'RE 3344 01:59:37,772 --> 01:59:38,973 NOWHERE NEAR THAT BECAUSE WE 3345 01:59:38,973 --> 01:59:42,343 REALLY ARE VERY LIMITED TO WHAT 3346 01:59:42,343 --> 01:59:43,277 INSTRUMENTS WE'RE GOING TO USE 3347 01:59:43,277 --> 01:59:44,379 TO TEST FOR SLEEP APNEA SO WE'RE 3348 01:59:44,379 --> 01:59:45,680 LEFT WITH THIS DISPARITY WHERE 3349 01:59:45,680 --> 01:59:47,315 IF YOU'RE IN AN AREA WITH LOTS 3350 01:59:47,315 --> 01:59:50,051 OF RESOURCES, IN A REALLY 3351 01:59:50,051 --> 01:59:53,421 EXCELLENT SLEEP LAB, YOU CAN 3352 01:59:53,421 --> 01:59:54,822 STUDY MOST PATIENTS WITH DOWN 3353 01:59:54,822 --> 01:59:56,691 SYNDROME OR OTHER SIMILAR 3354 01:59:56,691 --> 01:59:57,358 CONDITIONS LIKE A LOT OF THE 3355 01:59:57,358 --> 01:59:59,127 PATIENTS DR. ZOPF IS TALKING 3356 01:59:59,127 --> 02:00:00,228 ABOUT, ALSO VERY CHALLENGING 3357 02:00:00,228 --> 02:00:01,529 TOO, YOU CAN GET A GOOD RESULT 3358 02:00:01,529 --> 02:00:03,264 AND THEN YOU HAVE THE RESOURCE 3359 02:00:03,264 --> 02:00:04,465 THERE TO TREAT THEM WITH ALL 3360 02:00:04,465 --> 02:00:06,667 THESE AVAILABLE POTENTIAL 3361 02:00:06,667 --> 02:00:07,769 OPTIONS, SURGICAL, NON-SURGICAL, 3362 02:00:07,769 --> 02:00:08,302 CPAP, ET CETERA. 3363 02:00:08,302 --> 02:00:09,737 BUT NOT EVERYONE HAS THOSE 3364 02:00:09,737 --> 02:00:10,838 OPTIONS AVAILABLE TO THEM. 3365 02:00:10,838 --> 02:00:13,808 AND SO I THINK THINKING MORE 3366 02:00:13,808 --> 02:00:16,210 BROADLY LIKE WE NEED TO INVEST 3367 02:00:16,210 --> 02:00:18,146 IN ALL THE STUFF THAT'S BEEN 3368 02:00:18,146 --> 02:00:18,413 DISCUSSED. 3369 02:00:18,413 --> 02:00:19,614 YESTERDAY AND TO SOME EXTENT 3370 02:00:19,614 --> 02:00:21,449 TODAY, DEALING WITH SOME OF THE 3371 02:00:21,449 --> 02:00:23,017 ARTIFICIAL INTELLIGENCE MODELS, 3372 02:00:23,017 --> 02:00:25,953 BIG DATA ANALYSIS, AND THEN 3373 02:00:25,953 --> 02:00:27,822 LOOKING -- PARTNERING WITH 3374 02:00:27,822 --> 02:00:29,123 ENGINEERS, DATA SCIENTIST AND 3375 02:00:29,123 --> 02:00:30,358 OTHERS TO TRY TO UNDERSTAND 3376 02:00:30,358 --> 02:00:31,426 THESE DIFFERENT MODALITIES AND 3377 02:00:31,426 --> 02:00:33,127 KNOW HOW THEY WORK IN DIFFERENT 3378 02:00:33,127 --> 02:00:34,529 POPULATIONS LIKE THOSE WITH DOWN 3379 02:00:34,529 --> 02:00:34,796 SYNDROME. 3380 02:00:34,796 --> 02:00:36,597 I THINK WE HAVE AN OPPORTUNITY 3381 02:00:36,597 --> 02:00:37,565 IN DOWN SYNDROME BECAUSE THERE'S 3382 02:00:37,565 --> 02:00:38,433 REAL FUNDING AVAILABLE TO DO 3383 02:00:38,433 --> 02:00:40,168 SOME OF THESE STUDIES AND THESE 3384 02:00:40,168 --> 02:00:41,436 BIG COHORTS THAT ARE AVAILABLE. 3385 02:00:41,436 --> 02:00:44,105 I THINK SOME OF THE POPULATIONS 3386 02:00:44,105 --> 02:00:44,972 THAT DR. ZOPF IS DEALING WITH, 3387 02:00:44,972 --> 02:00:46,307 IT EVEN MORE CHALLENGING BECAUSE 3388 02:00:46,307 --> 02:00:47,842 SOME OF THESE ARE EVEN MORE RARE 3389 02:00:47,842 --> 02:00:49,677 DISEASES, THERE'S MORE 3390 02:00:49,677 --> 02:00:51,412 HETEROGENEITY AND MAY BE HARDER 3391 02:00:51,412 --> 02:00:52,613 TO DO THOSE KIND OF STUDIES. 3392 02:00:52,613 --> 02:00:53,748 SO I THINK THAT'S SORT OF WHERE 3393 02:00:53,748 --> 02:00:56,751 I WOULD LOVE PEDIATRIC FIELD TO 3394 02:00:56,751 --> 02:00:59,387 GO, AND I'M JUST DISCLOSURE, I'M 3395 02:00:59,387 --> 02:01:01,122 PART OF THE AMERICAN ACADEMY OF 3396 02:01:01,122 --> 02:01:02,156 SLEEP MEDICINE TASK FORCE THAT'S 3397 02:01:02,156 --> 02:01:03,124 LOOKING AT THE EVIDENCE IN HOME 3398 02:01:03,124 --> 02:01:04,258 SLEEP TESTING IN CHILDREN AND 3399 02:01:04,258 --> 02:01:05,393 IT'S REALLY TOUGH BECAUSE IT'S 3400 02:01:05,393 --> 02:01:06,494 ALL OVER THE PLACE AND A LOT OF 3401 02:01:06,494 --> 02:01:08,362 THESE STUDIES WERE VERY SMALL 3402 02:01:08,362 --> 02:01:10,198 STUDIES, THEY WERE DONE 3403 02:01:10,198 --> 02:01:11,199 CLINICALLY OUTSIDE THE UNITED 3404 02:01:11,199 --> 02:01:12,266 STATES LIKE DURING COVID OR 3405 02:01:12,266 --> 02:01:14,135 OTHER SITUATIONS, SO PUTTING 3406 02:01:14,135 --> 02:01:16,103 TOGETHER THOSE DATA, IT'S VERY 3407 02:01:16,103 --> 02:01:16,404 CHALLENGING. 3408 02:01:16,404 --> 02:01:18,005 BUT I THINK MORE WORK NEEDS TO 3409 02:01:18,005 --> 02:01:25,746 BE DONE IN THIS AREA. 3410 02:01:25,746 --> 02:01:27,148 >> THANK YOU. 3411 02:01:27,148 --> 02:01:27,815 GREAT INNOVATION. 3412 02:01:27,815 --> 02:01:29,784 HOW IS THE COMPLIANCE OR 3413 02:01:29,784 --> 02:01:30,318 DESENSITIZATION PROCESS? 3414 02:01:30,318 --> 02:01:31,786 DO YOU THINK A SIMILAR STRATEGY 3415 02:01:31,786 --> 02:01:35,389 FOR THE ORAL AIRWAY MIGHT BE 3416 02:01:35,389 --> 02:01:40,094 HELPFUL? 3417 02:01:40,094 --> 02:01:41,062 >> GREAT QUESTION. 3418 02:01:41,062 --> 02:01:42,630 I THINK HAVING THE INDEX 3419 02:01:42,630 --> 02:01:46,734 POPULATION HAVING BE CEREBRAL 3420 02:01:46,734 --> 02:01:50,471 PALSY AND DOWN'S AS WELL, THE 3421 02:01:50,471 --> 02:01:53,708 MORE HIGHLY IMPACTED PATIENT 3422 02:01:53,708 --> 02:01:55,076 LAKE THE PATIENT IN THE VIDEO, I 3423 02:01:55,076 --> 02:01:57,678 WILL SAY THERE IS ALMOST KIND OF 3424 02:01:57,678 --> 02:01:59,881 RELIEF AND YOU COULD SEE THAT 3425 02:01:59,881 --> 02:02:01,716 YOUNG BOY SMILE WHEN HE GOT THE 3426 02:02:01,716 --> 02:02:03,451 DEVICE, SO AS YOU WOULD IMAGINE, 3427 02:02:03,451 --> 02:02:06,521 BEING ABLE TO BREATHE IS A 3428 02:02:06,521 --> 02:02:10,258 BENEFICIAL THING, SO THERE TENDS 3429 02:02:10,258 --> 02:02:11,659 TO BE, IN THAT POPULATION, 3430 02:02:11,659 --> 02:02:15,930 REALLY WARM RECEPTION TO THE 3431 02:02:15,930 --> 02:02:18,065 DEVICE. 3432 02:02:18,065 --> 02:02:19,667 IN THE DOWN'S POPULATION, I 3433 02:02:19,667 --> 02:02:21,002 THINK IT'S HIGHLY DEPENDENT ON 3434 02:02:21,002 --> 02:02:25,573 THE CAREGIVER, AND SO I THINK 3435 02:02:25,573 --> 02:02:27,308 WITH KIND OF ACCLAMATION TO USE 3436 02:02:27,308 --> 02:02:32,813 OF THE DEVICE, WHAT WE FOUND WAS 3437 02:02:32,813 --> 02:02:35,082 TO BE MOST HELPFUL IS CERTAINLY 3438 02:02:35,082 --> 02:02:36,284 IF CAREGIVERS ARE INVESTED AND 3439 02:02:36,284 --> 02:02:37,485 IF THEY CAN INCORPORATE 3440 02:02:37,485 --> 02:02:39,020 PLACEMENT OF THE DEVICE AND A 3441 02:02:39,020 --> 02:02:40,221 BEDTIME ROUTINE, IT SEEMS LIKE 3442 02:02:40,221 --> 02:02:41,656 THAT ROUTINE FOR THE DOWN'S 3443 02:02:41,656 --> 02:02:43,824 POPULATION SEEMS TO BE REALLY 3444 02:02:43,824 --> 02:02:45,793 VALUABLE. 3445 02:02:45,793 --> 02:02:47,361 AND SO COMPLIANCE IS HIGH IF THE 3446 02:02:47,361 --> 02:02:49,096 FAMILY IS ABLE TO KIND OF 3447 02:02:49,096 --> 02:02:52,567 INTEGRATE IT IN A BEDTIME 3448 02:02:52,567 --> 02:02:52,800 ROUTINE. 3449 02:02:52,800 --> 02:02:53,834 INTERESTINGLY, ANOTHER APPROACH 3450 02:02:53,834 --> 02:02:56,070 THAT'S BEEN SUCCESSFUL IS 3451 02:02:56,070 --> 02:02:57,505 PLACING IT AFTER THE CHILD'S 3452 02:02:57,505 --> 02:02:59,140 GONE TO SLEEP, AND IT'S BEEN 3453 02:02:59,140 --> 02:03:01,442 SUPER VALUABLE FOR ME HEARING 3454 02:03:01,442 --> 02:03:04,178 ABOUT SOME OF THE THRESHOLD DATA 3455 02:03:04,178 --> 02:03:06,380 TOO, AND IT MAKES ME WONDER IF A 3456 02:03:06,380 --> 02:03:08,349 TREATMENT APPROACH LIKE THIS, 3457 02:03:08,349 --> 02:03:12,920 YOU KNOW, COULD BENEFIT FROM 3458 02:03:12,920 --> 02:03:13,921 ADJUNCTIVE THERAPIES LIKE BEING 3459 02:03:13,921 --> 02:03:17,858 ABLE TO MODIFY SOME OF THOSE 3460 02:03:17,858 --> 02:03:27,501 AROUSAL THRESHOLDS, AND SO -- 3461 02:03:27,501 --> 02:03:28,803 >> GREAT, THANK YOU. 3462 02:03:28,803 --> 02:03:30,237 I THINK THIS QUESTION COULD BE 3463 02:03:30,237 --> 02:03:34,275 FOR BOTH OF YOU FROM DR. TASALI. 3464 02:03:34,275 --> 02:03:35,276 WHAT ARE YOUR THOUGHTS ON 3465 02:03:35,276 --> 02:03:36,577 NOTICEABLE VERSUS VALUABLE 3466 02:03:36,577 --> 02:03:37,878 CHANGE, AS I TRIED TO ALLUDE TO 3467 02:03:37,878 --> 02:03:39,513 IN MY TALK, FOR DOWN SYNDROME 3468 02:03:39,513 --> 02:03:45,353 PATIENTS AND CAREGIVERS? 3469 02:03:45,353 --> 02:03:47,521 >> IT'S SUCH A FASCINATING 3470 02:03:47,521 --> 02:03:49,190 QUESTION. 3471 02:03:49,190 --> 02:03:51,659 I THINK IT'S SOMETHING THAT I'VE 3472 02:03:51,659 --> 02:03:56,130 SEEN A LOT IN MY DISE DIRECTED 3473 02:03:56,130 --> 02:03:58,332 SURGERIES OR REALLY ANY 3474 02:03:58,332 --> 02:04:00,735 INTERVENTION WHERE SOMETIMES 3475 02:04:00,735 --> 02:04:02,603 FAMILIES WILL COME BACK REALLY 3476 02:04:02,603 --> 02:04:05,139 HAPPY AND CAREGIVERS WILL SAY 3477 02:04:05,139 --> 02:04:07,742 BOY, THINGS SEEM A LOT BETTER, 3478 02:04:07,742 --> 02:04:12,346 AND THEN WE MIGHT GET A POST-OP 3479 02:04:12,346 --> 02:04:14,849 PSG WHICH SHOWS THERE MAY BE 3480 02:04:14,849 --> 02:04:16,183 IMPROVEMENT BUT THERE'S STILL 3481 02:04:16,183 --> 02:04:16,617 SLEEP APNEA. 3482 02:04:16,617 --> 02:04:22,023 I THINK IT KIND OF HARPS ON THE 3483 02:04:22,023 --> 02:04:25,459 QUESTION WHAT IS KIND OF 3484 02:04:25,459 --> 02:04:29,830 TREATMENT SUCCESS AND KIND OF 3485 02:04:29,830 --> 02:04:31,799 WHAT'S THE END POINT IN THESE 3486 02:04:31,799 --> 02:04:32,967 VULNERABLE POPULATIONS? 3487 02:04:32,967 --> 02:04:35,436 IS IT THE SAME AS CHILDREN 3488 02:04:35,436 --> 02:04:36,737 WITHOUT THESE VULNERABLE 3489 02:04:36,737 --> 02:04:39,140 POPULATIONS? 3490 02:04:39,140 --> 02:04:42,877 AND THAT TENDS TO BE KIND OF 3491 02:04:42,877 --> 02:04:45,813 WHERE THERE'S DISCORDANCE, IN MY 3492 02:04:45,813 --> 02:04:48,315 EXPERIENCE, WHERE I'M KIND OF 3493 02:04:48,315 --> 02:04:50,184 STRUGGLING WITH THERE SEEMS TO 3494 02:04:50,184 --> 02:04:52,053 BE IMPROVEMENT IN QUALITY OF 3495 02:04:52,053 --> 02:04:53,688 LIFE, THERE SEEMS TO BE IMPROVED 3496 02:04:53,688 --> 02:04:57,191 KIND OF CAREGIVER AND PATIENT 3497 02:04:57,191 --> 02:04:59,927 CLINICAL RESPONSE, BUT THAT MAY 3498 02:04:59,927 --> 02:05:04,198 NOT ALWAYS PAIR UP CLOSELY WITH 3499 02:05:04,198 --> 02:05:06,300 THE PSG FINDINGS. 3500 02:05:06,300 --> 02:05:09,570 >> I'LL JUST ADD THAT I THINK 3501 02:05:09,570 --> 02:05:10,638 THE DISCUSSION OF RESPONSE 3502 02:05:10,638 --> 02:05:11,772 VERSUS NON-RESPONSE IS SOMETHING 3503 02:05:11,772 --> 02:05:14,008 THAT'S REALLY, REALLY IMPORTANT 3504 02:05:14,008 --> 02:05:16,210 AND JUST I THINK IN PEDIATRICS, 3505 02:05:16,210 --> 02:05:17,344 THERE'S JUST A LOT OF OUTCOMES 3506 02:05:17,344 --> 02:05:19,480 THAT ARE SIMILAR TO TRIALS IN 3507 02:05:19,480 --> 02:05:20,281 ADULTS BUT THERE'S OTHERS THAT 3508 02:05:20,281 --> 02:05:20,715 ARE DIFFERENT. 3509 02:05:20,715 --> 02:05:22,783 SO I MEAN, YOU ALWAYS HAVE A 3510 02:05:22,783 --> 02:05:23,651 PARENT THAT'S PART OF THE 3511 02:05:23,651 --> 02:05:25,820 EQUATION AS WELL AND ESPECIALLY 3512 02:05:25,820 --> 02:05:28,022 LIKE YOUNGER KIDS THAT HAVE 3513 02:05:28,022 --> 02:05:29,023 OBSTRUCTIVE SLEEP APNEA, THE 3514 02:05:29,023 --> 02:05:31,192 PARENT IS OFTEN IMPACTED TOO. 3515 02:05:31,192 --> 02:05:32,460 THEIR SLEEP CAN BE IMPACTED, 3516 02:05:32,460 --> 02:05:35,563 THEIR ABILITY TO DA CARE FOR THR 3517 02:05:35,563 --> 02:05:37,531 CHILD CAN BE IMPACTED. 3518 02:05:37,531 --> 02:05:40,067 SOMETIMES IT'S NOT THE CONDITION 3519 02:05:40,067 --> 02:05:42,236 ITSELF, JUST PAU BECAUSE OF THER 3520 02:05:42,236 --> 02:05:43,237 WORRY ABOUT IT. 3521 02:05:43,237 --> 02:05:44,138 PARENTS ARE UP ALL NIGHT BECAUSE 3522 02:05:44,138 --> 02:05:45,439 THEY'RE WORRIED THAT THEIR CHILD 3523 02:05:45,439 --> 02:05:46,741 CAN'T BREATHE, AND IN SOME 3524 02:05:46,741 --> 02:05:48,109 CASES, THEY HAVE GOOD REASON FOR 3525 02:05:48,109 --> 02:05:49,810 THAT CONCERN. 3526 02:05:49,810 --> 02:05:51,145 AND SO PARENT REPORTED QUALITY 3527 02:05:51,145 --> 02:05:52,580 OF LIFE AND PARENT REPORTED 3528 02:05:52,580 --> 02:05:54,415 OUTCOMES, I THINK ARE AN 3529 02:05:54,415 --> 02:05:55,049 IMPORTANT MEASURE THAT WE NEED 3530 02:05:55,049 --> 02:05:56,383 TO CONSIDER TOO, BECAUSE IT CAN 3531 02:05:56,383 --> 02:05:58,919 REALLY AFFECT THE WHOLE FAMILY 3532 02:05:58,919 --> 02:06:00,121 IN SOME OF THESE CASES. 3533 02:06:00,121 --> 02:06:01,789 BUT IN OTHER CASES, FOR EXAMPLE, 3534 02:06:01,789 --> 02:06:04,358 A CHILD WITH DOWN SYNDROME THAT 3535 02:06:04,358 --> 02:06:06,260 HAS POOR SLEEP, EITHER THEY'RE 3536 02:06:06,260 --> 02:06:07,128 NOT SLEEPING WELL OR HAVE SLEEP 3537 02:06:07,128 --> 02:06:08,529 APNEA OR BOTH, IT AFFECTS THEIR 3538 02:06:08,529 --> 02:06:10,598 DAY TIME ACTIVITY TOO AND THAT 3539 02:06:10,598 --> 02:06:12,366 CAN IMPACT THE REST OF THE 3540 02:06:12,366 --> 02:06:13,667 FAMILY AND THERE CAN JUST BE A 3541 02:06:13,667 --> 02:06:15,136 LOT OF DOWNSTREAM CONSEQUENCES. 3542 02:06:15,136 --> 02:06:17,104 SO WE SHOULD THINK MORE BROADLY 3543 02:06:17,104 --> 02:06:17,872 ABOUT RESPONDERS IN TERMS OF 3544 02:06:17,872 --> 02:06:18,606 THESE THERAPIES. 3545 02:06:18,606 --> 02:06:22,276 SOMETIMES WITH THE AHI, HOW THAT 3546 02:06:22,276 --> 02:06:23,444 GOES DOWN OR CHANGES, BUT I 3547 02:06:23,444 --> 02:06:25,112 THINK ALSO HOW IT'S AFFECTING 3548 02:06:25,112 --> 02:06:27,081 DIET NA MIX AND THE FAMILY OF 3549 02:06:27,081 --> 02:06:28,382 THE CHILD'S WELL-BEING AND JUST 3550 02:06:28,382 --> 02:06:29,483 TO BE MORE BROAD ABOUT THAT. 3551 02:06:29,483 --> 02:06:30,751 AGAIN I'LL JUST KEEP MENTIONING 3552 02:06:30,751 --> 02:06:32,520 THAT SOME OF THESE COHORT 3553 02:06:32,520 --> 02:06:33,854 STUDIES, I THINK WITH A LOT OF 3554 02:06:33,854 --> 02:06:34,922 THOSE DEMOGRAPHIC KIND OF 3555 02:06:34,922 --> 02:06:36,791 FACTORS WILL BE A GREAT RESOURCE 3556 02:06:36,791 --> 02:06:38,659 TO TRY TO LOOK AS WE THINK ABOUT 3557 02:06:38,659 --> 02:06:39,560 CLINICAL TRIALS IN THESE 3558 02:06:39,560 --> 02:06:41,095 POPULATIONS. 3559 02:06:41,095 --> 02:06:43,397 >> OKAY, I THINK WE HAVE TIME 3560 02:06:43,397 --> 02:06:47,668 FOR ONE LAST QUICK QUESTION. 3561 02:06:47,668 --> 02:06:48,335 DR. ZOPF, GREAT TALK. 3562 02:06:48,335 --> 02:06:50,638 DO YOU ANTICIPATE THE DEVASE 3563 02:06:50,638 --> 02:06:51,605 WORKING DIFFERENTLY OR HAVING 3564 02:06:51,605 --> 02:06:52,807 MORE RISK FOR ADVERSE EFFECT 3565 02:06:52,807 --> 02:06:57,611 SUCH AS BLEADING B BLEEDING BASN 3566 02:06:57,611 --> 02:06:59,446 REASONS BEHIND NASAL OBSTRUCTION 3567 02:06:59,446 --> 02:07:02,883 FOR INSTANCE, TISSUE 3568 02:07:02,883 --> 02:07:03,517 HYPERTROPHY -- 3569 02:07:03,517 --> 02:07:04,385 >> GREAT QUESTION. 3570 02:07:04,385 --> 02:07:06,620 WITH DR. CIELO'S COMMENT, ONE OF 3571 02:07:06,620 --> 02:07:08,522 THE QUALITY OF LIFE INDICES THAT 3572 02:07:08,522 --> 02:07:09,523 WE'RE LOOKING AT IN THE STUDY IS 3573 02:07:09,523 --> 02:07:14,228 FAMILY IMPACT, AND I WILL SAY 3574 02:07:14,228 --> 02:07:15,863 PARTICULARLY THE CP POPULATION, 3575 02:07:15,863 --> 02:07:20,467 IT'S ASTOUNDING HEARING 3576 02:07:20,467 --> 02:07:21,902 ANECDOTAL RESPONSES FROM PARENTS 3577 02:07:21,902 --> 02:07:23,470 WHERE THEY WERE GETTING UP KIND 3578 02:07:23,470 --> 02:07:24,638 OF MULTIPLE TIMES PER HOUR TO 3579 02:07:24,638 --> 02:07:28,342 MAKE SURE THEIR CHILD WAS STILL 3580 02:07:28,342 --> 02:07:32,079 BREADTHING AND THEN KIND OF 3581 02:07:32,079 --> 02:07:33,180 HAVING THAT MORE PEACE OF MIND 3582 02:07:33,180 --> 02:07:34,915 BEING ABLE TO SLEEP THROUGH THE 3583 02:07:34,915 --> 02:07:36,784 NIGHT FROM THE CAREGIVER SIDE. 3584 02:07:36,784 --> 02:07:40,387 AS FAR AS CONCERNS FOR BLEEDING 3585 02:07:40,387 --> 02:07:42,022 OR TISSUE OBSTRUCTION, IN 3586 02:07:42,022 --> 02:07:45,226 PLACING THE DEVICE, WE KIND OF 3587 02:07:45,226 --> 02:07:46,627 UTILIZE APPROACH ALMOST SIMILAR 3588 02:07:46,627 --> 02:07:48,829 TO ENDOTRACHEAL TUBE SIZING, SO 3589 02:07:48,829 --> 02:07:53,234 IT'S NOT CUSTOM FOR EACH 3590 02:07:53,234 --> 02:07:54,735 PATIENT, BUT THERE ARE KIND OF 3591 02:07:54,735 --> 02:07:58,472 LIKE HALF COUNCILME CENTIMETER . 3592 02:07:58,472 --> 02:08:01,642 INITIALLY WE'LL DO AN ENDO 3593 02:08:01,642 --> 02:08:02,743 SCOPIC EXAM DURING CLINIC AND 3594 02:08:02,743 --> 02:08:04,378 MAKE SURE THERE'S NOT SOMETHING 3595 02:08:04,378 --> 02:08:08,983 LIKE A POLYP OR JUVENILE ANG JOE 3596 02:08:08,983 --> 02:08:10,284 FIBROMA OR OTHER MASS THAT COULD 3597 02:08:10,284 --> 02:08:10,951 BE CONCERNING. 3598 02:08:10,951 --> 02:08:12,920 IT COULD ALSO GIVE US SOME HINTS 3599 02:08:12,920 --> 02:08:14,154 AS TO WHICH SIDE MIGHT BE BETTER 3600 02:08:14,154 --> 02:08:16,123 TO PLACE THE DEVICE ON. 3601 02:08:16,123 --> 02:08:17,524 PRETTY ASTOUNDINGLY, AND I'LL 3602 02:08:17,524 --> 02:08:20,294 KNOCK ON WOOD, WE'VE NOT HAD 3603 02:08:20,294 --> 02:08:26,000 ISSUES WITH EP EP EPISTAXIS, SE 3604 02:08:26,000 --> 02:08:27,534 DEVICE IS COMPOSED OF MEDICAL 3605 02:08:27,534 --> 02:08:31,805 GRADE SILICONE, IT'S QUITE SOFT, 3606 02:08:31,805 --> 02:08:35,109 AND SO HAVING HYPERVASCULAR 3607 02:08:35,109 --> 02:08:36,610 MUCOSA OR AGAIN WE DO KIND OF 3608 02:08:36,610 --> 02:08:38,479 SCREEN FOR ANY CONCERNING 3609 02:08:38,479 --> 02:08:39,713 ANATOMIC OBSTRUCTION, BUT 3610 02:08:39,713 --> 02:08:41,515 FORTUNATELY IT'S NOT BEEN AN 3611 02:08:41,515 --> 02:08:42,850 ISSUE. 3612 02:08:42,850 --> 02:08:45,252 >> GREAT. 3613 02:08:45,252 --> 02:08:45,686 ALL RIGHT. 3614 02:08:45,686 --> 02:08:49,857 THANK YOU SO MUCH, DR. ZOPF AND 3615 02:08:49,857 --> 02:08:50,124 DR. CIELO. 3616 02:08:50,124 --> 02:08:51,091 WITH THAT, I THINK WE'LL 3617 02:08:51,091 --> 02:08:51,859 CONCLUDE THIS SESSION AND 3618 02:08:51,859 --> 02:08:52,927 EVERYONE WILL HAVE A BREAK. 3619 02:08:52,927 --> 02:08:54,428 I THINK ALFONSO AND EVERYONE, 3620 02:08:54,428 --> 02:08:56,330 THE PLAN IS FOR PEOPLE TO COME 3621 02:08:56,330 --> 02:08:58,999 BACK AT 2:15, IS THAT RIGHT, 3622 02:08:58,999 --> 02:08:59,633 FIVE MINUTES? 3623 02:08:59,633 --> 02:09:01,902 >> FIVE MINUTES IS WHAT WE'VE 3624 02:09:01,902 --> 02:09:02,069 GOT. 3625 02:09:02,069 --> 02:09:02,803 >> ALL RIGHT. 3626 02:09:02,803 --> 02:09:04,238 SO WE'LL RECONVENE THEN. 3627 02:09:04,238 --> 02:09:14,548 THANKS, EVERYBODY. 3628 02:11:30,795 --> 02:11:31,263 >> OKAY. 3629 02:11:31,263 --> 02:11:33,999 SO JUST VERY QUICKLY, MY 3630 02:11:33,999 --> 02:11:34,766 DISCLOSURES, NOTHING RELEVANT TO 3631 02:11:34,766 --> 02:11:37,402 THIS CONVERSATION. 3632 02:11:37,402 --> 02:11:38,603 I WANT TO DO THE FOLLOWING. 3633 02:11:38,603 --> 02:11:40,472 I WANT TO TALK ABOUT THE 3634 02:11:40,472 --> 02:11:42,340 DISTINCTION BETWEEN 3635 02:11:42,340 --> 02:11:43,375 IMPLEMENTATION, IMPLEMENTATION 3636 02:11:43,375 --> 02:11:45,010 RESEARCH, AND IMPLEMENTATION 3637 02:11:45,010 --> 02:11:45,310 SCIENCE. 3638 02:11:45,310 --> 02:11:47,579 THEY ARE ALL CONNECTED BUT THERE 3639 02:11:47,579 --> 02:11:49,247 ARE SOME KEY DIFFERENCES THAT I 3640 02:11:49,247 --> 02:11:50,682 THINK ARE IMPORTANT FOR THE 3641 02:11:50,682 --> 02:11:54,819 FUTURE OF OSA RESEARCH. 3642 02:11:54,819 --> 02:11:57,656 MOST OF WHAT I WILL DO IS PREND 3643 02:11:57,656 --> 02:12:01,726 PRESENT A BRIEF OVERVIEW OF 3644 02:12:01,726 --> 02:12:02,527 IMPLEMENTATION SCIENCE THEORIES 3645 02:12:02,527 --> 02:12:04,462 AND FRAME WORKS BUT DOING THIS 3646 02:12:04,462 --> 02:12:05,730 STANDING ON ONE FOOT. 3647 02:12:05,730 --> 02:12:07,365 I REALLY APOLOGIZE IN ADVANCE IF 3648 02:12:07,365 --> 02:12:09,534 MY TALK COMES ACROSS AT EITHER 3649 02:12:09,534 --> 02:12:11,736 TOO BASIC AND SUPERFICIAL OR I 3650 02:12:11,736 --> 02:12:13,038 RACE THROUGH THEE THINGS. 3651 02:12:13,038 --> 02:12:14,472 THEN FINALLY, I WILL MENTION 3652 02:12:14,472 --> 02:12:18,176 VERY, VERY BRIEFLY A COUPLE OF 3653 02:12:18,176 --> 02:12:19,210 EXAMPLES FROM THE RECENT 3654 02:12:19,210 --> 02:12:22,347 LITERATURE OF IMPLEMENTATION 3655 02:12:22,347 --> 02:12:24,215 OUTCOMES IN STUDIES OF SLEEP 3656 02:12:24,215 --> 02:12:25,750 APNEA AND THEN CLOSE WITH A FEW 3657 02:12:25,750 --> 02:12:26,651 RECOMMENDATIONS. 3658 02:12:26,651 --> 02:12:31,356 SO JUST BY WAY OF BACKGROUND AS 3659 02:12:31,356 --> 02:12:35,627 DR. TASALI MENTIONED, I RUN 3660 02:12:35,627 --> 02:12:36,962 CLINICAL DIRECTORS NETWORK, A 3661 02:12:36,962 --> 02:12:38,730 PRIMARY CARE PRACTICE BASED 3662 02:12:38,730 --> 02:12:39,698 RESEARCH AND A NETWORK OF 3663 02:12:39,698 --> 02:12:41,633 PRACTICE BASED RESEARCH NETWORKS 3664 02:12:41,633 --> 02:12:45,170 THAT FOCUS IN PRIMARY CARE AND 3665 02:12:45,170 --> 02:12:46,304 MEDICALLY UNDERSERVED SETTINGS 3666 02:12:46,304 --> 02:12:48,373 ACROSS THE COUNTRY AND WE ALSO 3667 02:12:48,373 --> 02:12:53,078 WORK WITH SEVERAL OF THE PCORNET 3668 02:12:53,078 --> 02:12:54,612 CLINICAL DATA RESEARCH NETWORKS 3669 02:12:54,612 --> 02:12:56,948 AND THIS WILL BE IMPORTANT WHEN 3670 02:12:56,948 --> 02:12:58,249 I WRAP UP AND TALK ABOUT 3671 02:12:58,249 --> 02:13:00,218 RECOMMENDATIONS FOR FUTURE 3672 02:13:00,218 --> 02:13:01,720 STUDIES, THE NATURE OF WHICH MAY 3673 02:13:01,720 --> 02:13:03,855 BE MORE PRAG PRAGMATIC STUDIES O 3674 02:13:03,855 --> 02:13:04,956 I'LL COME BACK TO WHY THIS IS 3675 02:13:04,956 --> 02:13:05,490 IMPORTANT. 3676 02:13:05,490 --> 02:13:06,958 SO JUST TO BEGIN WITH SOME 3677 02:13:06,958 --> 02:13:07,792 DEFINITIONS, IF WE THINK OF THIS 3678 02:13:07,792 --> 02:13:09,894 AS A CONTINUUM WHERE QUALITY 3679 02:13:09,894 --> 02:13:11,096 IMPROVEMENT IS OFTEN FOCUSED ON 3680 02:13:11,096 --> 02:13:13,431 THE HERE AND NOW IN A LOCAL 3681 02:13:13,431 --> 02:13:16,568 SETTING, IMPLEMENTATION RESEARCH 3682 02:13:16,568 --> 02:13:19,471 IS MORE FOCUSED ON LOOKING AT 3683 02:13:19,471 --> 02:13:20,372 IMPLEMENTATION STRATEGIES ACROSS 3684 02:13:20,372 --> 02:13:25,377 MULTIPLE SETTINGS AND TRYING TO 3685 02:13:25,377 --> 02:13:27,045 UNDERSTAND HOW THEORY, COULD BE 3686 02:13:27,045 --> 02:13:29,447 TEXT, MEDIATORS, MECHANISMS 3687 02:13:29,447 --> 02:13:31,116 ADDRESS A GAP IN IMPLEMENTATION. 3688 02:13:31,116 --> 02:13:32,017 AND IMPLEMENTATION SCIENCE IS 3689 02:13:32,017 --> 02:13:34,619 THE STUDY OF METHODS TO PROMOTE 3690 02:13:34,619 --> 02:13:35,854 THE SYSTEMATIC UPTAKE OF 3691 02:13:35,854 --> 02:13:38,456 RESEARCH FINDINGS AND OTHER 3692 02:13:38,456 --> 02:13:40,592 EVIDENCE-BASED PRACTICES INTO 3693 02:13:40,592 --> 02:13:42,994 ROUTINE CARE, WHICH IF IT WORKS, 3694 02:13:42,994 --> 02:13:46,297 WILL IMPROVE THE QUALITY, 3695 02:13:46,297 --> 02:13:47,232 EFFECTIVENESS AND ACCESS TO 3696 02:13:47,232 --> 02:13:48,500 HEALTH SERVICES. 3697 02:13:48,500 --> 02:13:50,135 AND SO THE KEY DISTINCTION IN 3698 02:13:50,135 --> 02:13:52,771 THIS CONTINUUM IS THAT BOTH 3699 02:13:52,771 --> 02:13:54,672 IMPLEMENTATION RESEARCH AND 3700 02:13:54,672 --> 02:13:59,044 IMPLEMENTATION SCIENCE ARE 3701 02:13:59,044 --> 02:14:01,346 AIMING AND DEVELOPING 3702 02:14:01,346 --> 02:14:02,347 GENERALIZABLE KNOWLEDGE, AND 3703 02:14:02,347 --> 02:14:04,015 THAT I THINK IS AN IMPORTANT 3704 02:14:04,015 --> 02:14:04,315 DISTINCTION. 3705 02:14:04,315 --> 02:14:05,950 NIH ALSO BRINGS INTO THE PICTURE 3706 02:14:05,950 --> 02:14:07,385 DISSEMINATION RESEARCH, WHICH IS 3707 02:14:07,385 --> 02:14:09,254 TO UNDERSTAND THE PROCESSES AND 3708 02:14:09,254 --> 02:14:13,291 FACTORS THAT LEAD TO WIDESPREAD 3709 02:14:13,291 --> 02:14:16,261 AWARENESS AND UNDERSTANDING OF 3710 02:14:16,261 --> 02:14:16,861 EVIDENCE-BASED INTERVENTIONS, 3711 02:14:16,861 --> 02:14:19,564 BUT THAT THAT IS ON A CONTINUUM 3712 02:14:19,564 --> 02:14:20,865 AND IMPLEMENTATION RESEARCH 3713 02:14:20,865 --> 02:14:22,200 TRIES TO UNDERSTAND HOW THOSE 3714 02:14:22,200 --> 02:14:24,602 FINDINGS GET TAKEN UP, 3715 02:14:24,602 --> 02:14:26,271 IMPLEMENTED AND UNDERSTAND THE 3716 02:14:26,271 --> 02:14:28,573 PROCESSES THAT EITHER ACCELERATE 3717 02:14:28,573 --> 02:14:31,643 OR INHIBIT THEIR UPTAKE AND IN 3718 02:14:31,643 --> 02:14:32,844 PARTICULAR ONE OF THE AREAS 3719 02:14:32,844 --> 02:14:35,046 THAT'S VERY CRITICAL IN 3720 02:14:35,046 --> 02:14:36,448 IMPLEMENTATION RESEARCH HAS TO 3721 02:14:36,448 --> 02:14:38,349 DO WITH ADAPTATION AND HOW THE 3722 02:14:38,349 --> 02:14:42,520 SETTING INFLUENCES THE WAY IN 3723 02:14:42,520 --> 02:14:43,721 WHICH AN INTERVENTION OR 3724 02:14:43,721 --> 02:14:45,023 INNOVATION IS ACTUALLY 3725 02:14:45,023 --> 02:14:46,024 IMPLEMENTED. 3726 02:14:46,024 --> 02:14:48,560 SO THIS IS I THINK A GOOD 3727 02:14:48,560 --> 02:14:50,395 SYNOPSIS OF THE DISTINCTION 3728 02:14:50,395 --> 02:14:52,697 BETWEEN DISSEMINATION 3729 02:14:52,697 --> 02:14:54,966 IMPLEMENTATION, IMPLEMENTATION 3730 02:14:54,966 --> 02:14:56,167 INTERVENTION, IMPLEMENTATION 3731 02:14:56,167 --> 02:14:58,470 STRATEGY AND IMPLEMENTATION 3732 02:14:58,470 --> 02:15:00,872 RESEARCH, AND ALL MY SLIDES ARE 3733 02:15:00,872 --> 02:15:02,507 AVAILABLE SO THESE HAVE THE 3734 02:15:02,507 --> 02:15:05,143 REFERENCES AS WELL. 3735 02:15:05,143 --> 02:15:08,546 SO TAKING A STEP BACK, MOST OF 3736 02:15:08,546 --> 02:15:09,881 IMPLEMENTATION RESEARCH CAN 3737 02:15:09,881 --> 02:15:14,719 REALLY TRACE ITS ANCESTRY TO 3738 02:15:14,719 --> 02:15:16,121 RODGERS' THEORY OF THE DIFFUSION 3739 02:15:16,121 --> 02:15:17,989 OF INNOVATIONS WHICH FOCUSES ON 3740 02:15:17,989 --> 02:15:20,391 THE CHARACTERISTICS OF THE 3741 02:15:20,391 --> 02:15:20,925 INNOVATION, ORGANIZATION, 3742 02:15:20,925 --> 02:15:23,027 ENVIRONMENT THAT LEAD TO A 3743 02:15:23,027 --> 02:15:25,763 DECISION TO ADOPT OR NOT TO 3744 02:15:25,763 --> 02:15:28,666 ADOPT, WHICH LEADS TO EFFECTIVE 3745 02:15:28,666 --> 02:15:30,635 IMPLEMENTATION AND OUTCOMES. 3746 02:15:30,635 --> 02:15:31,936 THIS OF COURSE IS VASTLY 3747 02:15:31,936 --> 02:15:34,272 SIMPLIFIED AND MODERN 3748 02:15:34,272 --> 02:15:35,140 IMPLEMENTATION SCIENCE SEEKS TO 3749 02:15:35,140 --> 02:15:37,642 UNDERSTAND EACH OF THE ARROWS 3750 02:15:37,642 --> 02:15:39,611 BETWEEN THESE DIFFERENT KEY 3751 02:15:39,611 --> 02:15:41,412 ELEMENTS OF THE DIFFUSION AND 3752 02:15:41,412 --> 02:15:44,883 INNOVATION PROCESS. 3753 02:15:44,883 --> 02:15:48,186 SO ONE MODEL OR FRAMEWORK I HOPE 3754 02:15:48,186 --> 02:15:49,220 MANY OF YOU ARE FAMILIAR WITH 3755 02:15:49,220 --> 02:15:50,622 AND IF NOT, I WOULD POINT YOU TO 3756 02:15:50,622 --> 02:15:53,158 THE WORK ON RE-AIM, WHICH STANDS 3757 02:15:53,158 --> 02:15:54,826 FOR REACH, EFFECTIVENESS, 3758 02:15:54,826 --> 02:15:56,127 ADOPTION, IMPLEMENTATION, AND 3759 02:15:56,127 --> 02:15:57,529 MAINTENANCE. 3760 02:15:57,529 --> 02:15:58,963 AND THESE ARE A SERIES OF 3761 02:15:58,963 --> 02:16:03,501 VARIABLES THAT CAN BE MEASURED 3762 02:16:03,501 --> 02:16:05,470 IN A CLINICAL TRIAL OR 3763 02:16:05,470 --> 02:16:06,671 OBSERVATIONAL STUDY THAT HELP TO 3764 02:16:06,671 --> 02:16:07,972 UNDERSTAND THE DIFFERENT ASPECTS 3765 02:16:07,972 --> 02:16:08,706 OF IMPLEMENTATION. 3766 02:16:08,706 --> 02:16:10,775 WHAT'S THE FRACTION OF ELIGIBLE 3767 02:16:10,775 --> 02:16:12,510 PATIENTS THAT ARE REACHED, HOW 3768 02:16:12,510 --> 02:16:13,611 EFFECTIVE IS AN INTERVENTION, 3769 02:16:13,611 --> 02:16:18,082 HOW DO I ENHANCE THE LIKELIHOOD 3770 02:16:18,082 --> 02:16:19,317 THAT AN ORGANIZATION WILL MAKE A 3771 02:16:19,317 --> 02:16:21,152 DECISION TO ADOPT AN INNOVATION, 3772 02:16:21,152 --> 02:16:25,156 HOW DO I ENSURE THAT THIS IS 3773 02:16:25,156 --> 02:16:27,458 DELIVERED PROPERLY WITH HIGH 3774 02:16:27,458 --> 02:16:29,627 FIDELITY AND HOW CAN I DETERMINE 3775 02:16:29,627 --> 02:16:30,862 THAT IT'S SUSTAINED OVER TIME. 3776 02:16:30,862 --> 02:16:32,530 SO THESE ARE SOME OF THE KEY 3777 02:16:32,530 --> 02:16:33,698 ELEMENTS OF IMPLEMENTATION 3778 02:16:33,698 --> 02:16:38,303 SCIENCE, AND THERE ARE SOME 3779 02:16:38,303 --> 02:16:39,637 SUBSEQUENT MODIFICATIONS OR 3780 02:16:39,637 --> 02:16:41,172 INNOVATIONS TO RE-AIM, ONE IN 3781 02:16:41,172 --> 02:16:42,173 PARTICULAR CALLED QUEST, WHICH 3782 02:16:42,173 --> 02:16:45,510 KEEPS THE SAME SET OF VARIABLES 3783 02:16:45,510 --> 02:16:47,545 BUT ADDS A SERIES OF QUALITATIVE 3784 02:16:47,545 --> 02:16:50,181 AND ETHNOGRAPHIC AND 3785 02:16:50,181 --> 02:16:54,118 OBSERVATIONAL NON-INTERVENTIONAL 3786 02:16:54,118 --> 02:16:55,253 ASSESSMENTS TO REALLY TRY TO 3787 02:16:55,253 --> 02:16:57,956 UNDERSTAND THE PROCESS OF 3788 02:16:57,956 --> 02:16:59,090 ADOPTION, IMPLEMENTATION, 3789 02:16:59,090 --> 02:16:59,724 SUSTAINABILITY. 3790 02:16:59,724 --> 02:17:02,527 AND MORE RECENTLY, ANOTHER 3791 02:17:02,527 --> 02:17:04,262 INNOVATION IN RE-AIM IS REFERRED 3792 02:17:04,262 --> 02:17:07,232 TO AS PRISSMM, THE PRACTICAL 3793 02:17:07,232 --> 02:17:10,335 ROBUST IMPLEMENTATION AND 3794 02:17:10,335 --> 02:17:11,603 SUSTAINABILITY MODEL, WHICH IN 3795 02:17:11,603 --> 02:17:15,340 ADDITION TO THE SAME RE-AIM 3796 02:17:15,340 --> 02:17:16,107 CHARACTERISTICS, ALSO 3797 02:17:16,107 --> 02:17:17,242 CHARACTERIZES THE ORGANIZATIONAL 3798 02:17:17,242 --> 02:17:18,209 PATIENT PERSPECTIVES, 3799 02:17:18,209 --> 02:17:20,812 CHARACTERISTICS OF THE 3800 02:17:20,812 --> 02:17:21,579 ORGANIZATION, CHARACTERISTICS OF 3801 02:17:21,579 --> 02:17:23,414 PATIENTS, AND TRIES TO MODEL ALL 3802 02:17:23,414 --> 02:17:26,017 OF THESE ELEMENTS, AS WELL AS 3803 02:17:26,017 --> 02:17:29,954 THE INTECIAL INTERNAL AND EXTERL 3804 02:17:29,954 --> 02:17:31,089 ENVIRONMENT TO EXAMINE THEIR 3805 02:17:31,089 --> 02:17:31,422 IMPACT. 3806 02:17:31,422 --> 02:17:32,724 SO AGAIN THESE ARE THE ARROWS 3807 02:17:32,724 --> 02:17:34,926 BETWEEN THE ARROWS THAT LEND 3808 02:17:34,926 --> 02:17:36,361 THEMSELF TO CONCEPTUALIZATION 3809 02:17:36,361 --> 02:17:37,362 AND MEASUREMENT. 3810 02:17:37,362 --> 02:17:38,663 ANOTHER FRAMEWORK THAT YOU MAY 3811 02:17:38,663 --> 02:17:41,299 COME ACROSS OR HAVE SEEN IS 3812 02:17:41,299 --> 02:17:43,401 REFERRED TO AS THE CONSOLIDATED 3813 02:17:43,401 --> 02:17:45,136 FRAMEWORK FOR IMPLEMENTATION 3814 02:17:45,136 --> 02:17:46,571 RESEARCH, OR CFIR. 3815 02:17:46,571 --> 02:17:48,439 AND IT CHARACTERIZES 3816 02:17:48,439 --> 02:17:49,240 IMPLEMENTATION IN TERMS OF THE 3817 02:17:49,240 --> 02:17:50,341 OUTER SETTING. 3818 02:17:50,341 --> 02:17:52,410 THESE ARE NEIGHBORHOOD AND 3819 02:17:52,410 --> 02:17:54,279 COMMUNITY CHARACTERISTICS, THE 3820 02:17:54,279 --> 02:17:55,913 INNER SETTING ASPECTS OF THE 3821 02:17:55,913 --> 02:17:58,016 PRACTICE, ACCESS TO SPECIALISTS, 3822 02:17:58,016 --> 02:18:00,785 THE WORKFORCE, THE WORKFLOW, ET 3823 02:18:00,785 --> 02:18:01,953 CETERA, CHARACTERISTICS OF THE 3824 02:18:01,953 --> 02:18:02,220 PATIENTS. 3825 02:18:02,220 --> 02:18:05,790 IT LOOKS AT MEASURES OF PROCESS, 3826 02:18:05,790 --> 02:18:07,458 AND THEN IT LOOKS AT THE 3827 02:18:07,458 --> 02:18:09,661 ADAPTATION STARTING WITH THE 3828 02:18:09,661 --> 02:18:11,095 INTERVENTION IN ITS PUREST FORM, 3829 02:18:11,095 --> 02:18:14,465 AND THEN TRIES TO UNDERSTAND HOW 3830 02:18:14,465 --> 02:18:19,103 ALL OF THESE FACTORS AFFECT THE 3831 02:18:19,103 --> 02:18:20,104 ADAPTATION SO THAT THE 3832 02:18:20,104 --> 02:18:21,072 INTERVENTION CAN FIT WITHIN THE 3833 02:18:21,072 --> 02:18:22,774 SETTING WITHIN THE RESOURCES. 3834 02:18:22,774 --> 02:18:24,842 AND SO CFIR I THINK IS A VERY 3835 02:18:24,842 --> 02:18:26,144 IMPORTANT OTHER WAY TO LOOK AT 3836 02:18:26,144 --> 02:18:29,347 IT, AND AS I MENTIONED BEFORE, 3837 02:18:29,347 --> 02:18:30,348 PRISM, YOU'LL SEE HAS SOME OF 3838 02:18:30,348 --> 02:18:33,084 THE SAME MEASURES OF INNER AND 3839 02:18:33,084 --> 02:18:34,052 OUTER ORGANIZATIONAL 3840 02:18:34,052 --> 02:18:39,123 CHARACTERISTICS. 3841 02:18:39,123 --> 02:18:41,859 WHEN WE STUDY IMPLEMENTATION, 3842 02:18:41,859 --> 02:18:43,294 THERE ARE SOME KEY MEASURES WE 3843 02:18:43,294 --> 02:18:45,296 OFTEN LOOK AT AND A FEW EXAMPLES 3844 02:18:45,296 --> 02:18:46,264 OF THEM ARE FEASIBILITY, 3845 02:18:46,264 --> 02:18:47,131 FIDELITY, HOW WELL THE 3846 02:18:47,131 --> 02:18:49,033 INTERVENTION IS RE REPLICATED FM 3847 02:18:49,033 --> 02:18:50,335 PATIENT TO PATIENT, FROM 3848 02:18:50,335 --> 02:18:51,235 CLINICIAN TO CLINICIAN AND 3849 02:18:51,235 --> 02:18:53,404 SETTING TO SETTING. 3850 02:18:53,404 --> 02:18:56,607 PENETRATION, ACCEPTABILITY, 3851 02:18:56,607 --> 02:18:57,275 SUSTAINABILITY, UPTAKE, COSTS. 3852 02:18:57,275 --> 02:18:59,477 THESE ARE SOME OF THE 3853 02:18:59,477 --> 02:19:00,778 IMPLEMENTATION SCIENCE OUTCOMES 3854 02:19:00,778 --> 02:19:06,784 THAT ONE CAN BUILD INTO A STUDY, 3855 02:19:06,784 --> 02:19:09,987 AND OFTENTIMES AN IMPLEMENTATION 3856 02:19:09,987 --> 02:19:12,023 SCIENCE STUDY WILL LOOK AT 3857 02:19:12,023 --> 02:19:13,324 MULTIPLE IMPLEMENTATION 3858 02:19:13,324 --> 02:19:13,658 OUTCOMES. 3859 02:19:13,658 --> 02:19:15,693 THIS TRIES TO SCOPE OUT A LITTLE 3860 02:19:15,693 --> 02:19:16,994 BIT FURTHER WAYS IN WHICH WE CAN 3861 02:19:16,994 --> 02:19:19,497 LOOK AT ACCEPTABILITY, ADOPTION, 3862 02:19:19,497 --> 02:19:20,565 APPROPRIATENESS, FEASIBILITY, ET 3863 02:19:20,565 --> 02:19:21,532 CETERA, AND I WANT TO MENTION 3864 02:19:21,532 --> 02:19:24,035 THAT FIDELITY IS A PARTICULARLY 3865 02:19:24,035 --> 02:19:26,537 CHALLENGING QUESTION BECAUSE 3866 02:19:26,537 --> 02:19:28,639 PRIOR TO THE WIDESPREAD 3867 02:19:28,639 --> 02:19:29,974 DIFFUSION OF IMPLEMENTATION 3868 02:19:29,974 --> 02:19:32,143 SCIENCE, WE WOULD CONSIDER A 3869 02:19:32,143 --> 02:19:36,781 STUDY THAT HAD HIGH LEVELS OF 3870 02:19:36,781 --> 02:19:38,216 ADAPTATION, LOW FIDELITY, AND 3871 02:19:38,216 --> 02:19:39,851 HAD POOR INTERNAL VALIDITY. 3872 02:19:39,851 --> 02:19:41,119 I THINK IMPLEMENTATION SCIENCE 3873 02:19:41,119 --> 02:19:45,056 HAS HELPED US TO UNDERSTAND THAT 3874 02:19:45,056 --> 02:19:46,557 ANY IMPLEMENTATION STRATEGY 3875 02:19:46,557 --> 02:19:47,558 REQUIRES SOME ADAPTATION. 3876 02:19:47,558 --> 02:19:49,127 SO IN THINKING ABOUT THIS, THE 3877 02:19:49,127 --> 02:19:50,828 FIDELITY OR THE REPRODUCIBILITY 3878 02:19:50,828 --> 02:19:52,964 OF THE INTERVENTION REALLY WHEN 3879 02:19:52,964 --> 02:19:55,500 YOU THINK ABOUT ITS ADAPTATION 3880 02:19:55,500 --> 02:19:59,237 HAS A LOT MORE TO DO WITH ITS 3881 02:19:59,237 --> 02:19:59,670 GENERALIZABILITY. 3882 02:19:59,670 --> 02:20:01,205 SO HOW WELL CAN THIS 3883 02:20:01,205 --> 02:20:03,408 INTERVENTION STRATEGY WORK IN 3884 02:20:03,408 --> 02:20:04,041 DIFFERENT SETTINGS? 3885 02:20:04,041 --> 02:20:06,411 I THINK ABOUT OUR FEDERALLY 3886 02:20:06,411 --> 02:20:10,114 QUALIFIED HEALTH CENTERS WHERE I 3887 02:20:10,114 --> 02:20:12,383 KNOW OF ONLY ONE PULMONOLOGIST, 3888 02:20:12,383 --> 02:20:13,551 PERHAPS THERE ARE OTHERS BUT I 3889 02:20:13,551 --> 02:20:14,986 ONLY KNOW OF ONE, VERY FEW 3890 02:20:14,986 --> 02:20:16,721 PLACES THAT HAVE SLEEP LABS 3891 02:20:16,721 --> 02:20:18,423 WITHIN THEIR HEALTH CENTERS, 3892 02:20:18,423 --> 02:20:21,826 MANY HAVE ACCESS TO THEM THROUGH 3893 02:20:21,826 --> 02:20:22,493 COMMUNITY REFERRALS, SO ONE HAS 3894 02:20:22,493 --> 02:20:25,062 TO THINK ABOUT HOW DO YOU ADAPT 3895 02:20:25,062 --> 02:20:28,866 THE BEST PRACTICES IN THE 3896 02:20:28,866 --> 02:20:29,801 EVIDENCE-BASED STRATEGY SO THEY 3897 02:20:29,801 --> 02:20:31,569 CAN WORK IN LOW RESOURCE 3898 02:20:31,569 --> 02:20:32,370 SETTINGS. 3899 02:20:32,370 --> 02:20:33,704 SO ONE WAY TO APPROACH THIS THAT 3900 02:20:33,704 --> 02:20:37,875 I THINK HAS INCREASING 3901 02:20:37,875 --> 02:20:39,477 IMPORTANCE AT NHLBI AND 3902 02:20:39,477 --> 02:20:41,746 ELSEWHERE IS THE IDEA OF THESE 3903 02:20:41,746 --> 02:20:42,713 EFFECTIVENESS IMPLEMENTATION 3904 02:20:42,713 --> 02:20:44,682 HYBRID DESIGNS THAT ALLOW US TO 3905 02:20:44,682 --> 02:20:49,353 DESIGN THESE SO-CALLED HYBRID 3906 02:20:49,353 --> 02:20:50,688 STUDIES THAT LOOK AT BOTH 3907 02:20:50,688 --> 02:20:52,023 CLINICAL EFFECTIVENESS AND THE 3908 02:20:52,023 --> 02:20:53,591 EFFECTIVENESS OF DIFFERENT 3909 02:20:53,591 --> 02:20:54,892 IMPLEMENTATION STRATEGIES, AND 3910 02:20:54,892 --> 02:20:56,194 THEIR COMBINED EFFECT ON 3911 02:20:56,194 --> 02:20:57,295 IMPROVED OUTCOMES. 3912 02:20:57,295 --> 02:21:01,432 AND SO THIS IS AN AREA WHERE I 3913 02:21:01,432 --> 02:21:02,467 THINK THERE'S GREAT WORK TO BE 3914 02:21:02,467 --> 02:21:03,468 DONE IN OSA. 3915 02:21:03,468 --> 02:21:05,470 AND THERE ARE THREE TYPES OF 3916 02:21:05,470 --> 02:21:07,605 HYBRID STUDIES, THERE ARE MANY 3917 02:21:07,605 --> 02:21:10,241 SUBTYPES, WE HAVE ENDOTYPES 3918 02:21:10,241 --> 02:21:11,676 WITHIN THIS KIND OF STUDY 3919 02:21:11,676 --> 02:21:13,778 DESIGN, BUT IN A HYBRID TYPE 1, 3920 02:21:13,778 --> 02:21:15,413 THE FOCUS IS ON THE 3921 02:21:15,413 --> 02:21:17,181 EFFECTIVENESS QUESTION, AND WE 3922 02:21:17,181 --> 02:21:19,917 OFTEN THEN COLLECT PRELIMINARY 3923 02:21:19,917 --> 02:21:21,052 INFORMATION ON ITS 3924 02:21:21,052 --> 02:21:22,487 IMPLEMENTATION, A HYBRID TYPE 3925 02:21:22,487 --> 02:21:24,455 3 DOES THE REVERSE. 3926 02:21:24,455 --> 02:21:26,123 IT TAKES AS A GIVEN WE KNOW THAT 3927 02:21:26,123 --> 02:21:27,992 THE INTERVENTION IS CLINICALLY 3928 02:21:27,992 --> 02:21:30,061 EFFECTIVE, BUT WE WANT TO FOCUS 3929 02:21:30,061 --> 02:21:31,796 ON GATHERING THE MOST RIGOROUS 3930 02:21:31,796 --> 02:21:34,298 OUTCOMES ON ITS IMPLEMENTATION. 3931 02:21:34,298 --> 02:21:36,901 IT'S THE HYBRID TYPE 2 THAT 3932 02:21:36,901 --> 02:21:39,437 BALANCE OF 50/50 WHERE WE WOULD 3933 02:21:39,437 --> 02:21:42,106 DESIGN A STUDY THAT WOULD BE 3934 02:21:42,106 --> 02:21:45,276 POWERED TO DETECT THE MINIMALLY 3935 02:21:45,276 --> 02:21:47,578 DETECTABLE CLINICALLY AND 3936 02:21:47,578 --> 02:21:49,447 ORGANIZATIONALLY SIGNIFICANT 3937 02:21:49,447 --> 02:21:50,882 DIFFERENCES FOR AN INTERVENTION 3938 02:21:50,882 --> 02:21:52,416 AND ITS SETTINGS. 3939 02:21:52,416 --> 02:21:54,819 SO THE HYBRID TYPE 2 IS PERHAPS 3940 02:21:54,819 --> 02:21:56,921 THE MOST CHALLENGING BECAUSE IT 3941 02:21:56,921 --> 02:21:58,689 REQUIRES SAMPLE SIZES TO BE 3942 02:21:58,689 --> 02:22:00,992 ADEQUATE AT BOTH THE 3943 02:22:00,992 --> 02:22:02,627 EFFECTIVENESS OUT COME AND THE 3944 02:22:02,627 --> 02:22:08,399 IMPLEMENTATION OUTCOME. 3945 02:22:08,399 --> 02:22:09,800 WHEN WE THINK ABOUT THIS WHOLE 3946 02:22:09,800 --> 02:22:11,135 PROCESS, WE THINK ABOUT WAYS OF 3947 02:22:11,135 --> 02:22:12,103 DESIGNING INTERVENTIONS THAT CAN 3948 02:22:12,103 --> 02:22:12,837 BE DELIVERED IN DIFFERENT 3949 02:22:12,837 --> 02:22:13,137 SETTINGS. 3950 02:22:13,137 --> 02:22:17,174 THIS IS REFERRING TO EMERGING 3951 02:22:17,174 --> 02:22:19,010 CONCEPT OF DESIGNING FOR 3952 02:22:19,010 --> 02:22:19,777 DISSEMINATION AND 3953 02:22:19,777 --> 02:22:20,645 IMPLEMENTATION. 3954 02:22:20,645 --> 02:22:23,915 AND I THINK THIS IS AN AREA 3955 02:22:23,915 --> 02:22:24,782 WHERE THERE'S IMPORTANT WORK TO 3956 02:22:24,782 --> 02:22:26,284 BE DONE THAT ASKS THE QUESTION 3957 02:22:26,284 --> 02:22:29,887 HOW DO WE RETROFIT COMPLEX 3958 02:22:29,887 --> 02:22:33,257 MULTISTEP MULTILEVEL 3959 02:22:33,257 --> 02:22:34,492 IMPLEMENTATION STRATEGIES IN 3960 02:22:34,492 --> 02:22:36,827 BUSY COMPLICATED MEDICAL 3961 02:22:36,827 --> 02:22:38,362 PRACTICES THAT HAVE DIFFERENT 3962 02:22:38,362 --> 02:22:40,097 ACCESS TO DIFFERENT RESOURCES, 3963 02:22:40,097 --> 02:22:42,400 AND SO THE DESIGN PROCESS TAKES 3964 02:22:42,400 --> 02:22:43,968 MANY OF THESE INTO 3965 02:22:43,968 --> 02:22:44,335 CONSIDERATION. 3966 02:22:44,335 --> 02:22:46,170 WE ONLY HAVE TO THINK ABOUT 3967 02:22:46,170 --> 02:22:50,474 COVID VACCINATION AS BEING 3968 02:22:50,474 --> 02:22:52,143 HIGHLY EFFECTIVE BUT NOT, 3969 02:22:52,143 --> 02:22:53,244 PERHAPS, EASY TO DISSEMINATE AND 3970 02:22:53,244 --> 02:22:54,679 IMPLEMENT IN LOW RESOURCE 3971 02:22:54,679 --> 02:22:56,647 SETTINGS BECAUSE OF THE 3972 02:22:56,647 --> 02:22:57,615 REFRIGERATION REQUIREMENTS AND 3973 02:22:57,615 --> 02:22:59,417 OTHER HANDLING REQUIREMENTS. 3974 02:22:59,417 --> 02:23:02,286 SO DESIGNED FOR DISSEMINATION, 3975 02:23:02,286 --> 02:23:03,688 TRIES TO PUT MANY OF THESE 3976 02:23:03,688 --> 02:23:04,789 CHARACTERISTICS AT THE VERY 3977 02:23:04,789 --> 02:23:05,623 BEGINNING. 3978 02:23:05,623 --> 02:23:07,458 AND I'LL JUST LINK THIS TO THE 3979 02:23:07,458 --> 02:23:10,995 BROADER AREA OF COMPARATIVE 3980 02:23:10,995 --> 02:23:12,163 EFFECTIVENESS RESEARCH, WHICH IS 3981 02:23:12,163 --> 02:23:14,065 LOOKING AT DIFFERENT OPTIONS AND 3982 02:23:14,065 --> 02:23:15,833 OSA RESEARCH AS I UNDERSTAND IT 3983 02:23:15,833 --> 02:23:17,468 HAS DONE MANY IMPORTANT STUDIES 3984 02:23:17,468 --> 02:23:20,338 THAT HAVE COMPARED THE 3985 02:23:20,338 --> 02:23:21,339 EFFECTIVENESS OF DIFFERENT 3986 02:23:21,339 --> 02:23:25,476 DIAGNOSTIC AND THERAPEUTIC 3987 02:23:25,476 --> 02:23:28,145 INTERVENTIONS FOR HETEROJEEP HES 3988 02:23:28,145 --> 02:23:29,580 SETS OF PATIENTS. 3989 02:23:29,580 --> 02:23:31,882 PATIENT-CENTERED OUTCOMES BUILDS 3990 02:23:31,882 --> 02:23:33,618 ON COMPARATIVE EFFECTIVENESS 3991 02:23:33,618 --> 02:23:35,152 RESEARCH BUT FOCUSES ON OUTCOMES 3992 02:23:35,152 --> 02:23:35,953 THAT MATTER TO PEOPLE. 3993 02:23:35,953 --> 02:23:37,622 SO SOME OF THE PATIENT-CENTERED 3994 02:23:37,622 --> 02:23:38,990 OUTCOMES THAT I'VE COME ACROSS 3995 02:23:38,990 --> 02:23:40,391 HAVE TO DO WITH SYMPTOMS, DAY 3996 02:23:40,391 --> 02:23:42,893 TIME SLEEPINESS ABILITY, 3997 02:23:42,893 --> 02:23:44,462 FUNCTIONAL STATUS, COGNITIVE 3998 02:23:44,462 --> 02:23:47,031 STATUS. 3999 02:23:47,031 --> 02:23:48,232 THOSE ARE OUTCOMES THAT MATTER 4000 02:23:48,232 --> 02:23:50,067 TO PATIENTS THAT MAY NOT BE 4001 02:23:50,067 --> 02:23:53,237 ACCESSIBLE IN THE SAME RIGOR 4002 02:23:53,237 --> 02:23:54,705 THAT LUNG FUNCTION AND BREATHING 4003 02:23:54,705 --> 02:23:56,007 CAN BE ASSESSED. 4004 02:23:56,007 --> 02:23:59,076 BUT THEY CAN BE PUT TOGETHER, SO 4005 02:23:59,076 --> 02:24:01,445 CER AND PCOR HAVE A LOGICAL 4006 02:24:01,445 --> 02:24:02,780 AFFINITY FOR ONE ANOTHER, AND AS 4007 02:24:02,780 --> 02:24:04,849 I REVIEWED SOME STUDIES IN THIS 4008 02:24:04,849 --> 02:24:11,455 AREA, I SEE THIS AS ALS ALSO AST 4009 02:24:11,455 --> 02:24:16,027 FOR FUTURE WORK. 4010 02:24:16,027 --> 02:24:18,796 THE IDEA OF DESIGN TRIALS TO 4011 02:24:18,796 --> 02:24:20,264 INFORM DECISIONS IN PRACTICE, 4012 02:24:20,264 --> 02:24:23,968 AND PRAGMATIC TROILS GO BACK TOO 4013 02:24:23,968 --> 02:24:26,037 THAT CONCEPT OF ADAPTATION AND 4014 02:24:26,037 --> 02:24:27,571 FLEXIBILITY IN TERMS OF PATIENT 4015 02:24:27,571 --> 02:24:28,839 ELIGIBILITY, THE RECRUITMENT, 4016 02:24:28,839 --> 02:24:30,241 THE SETTING, THE ORGANIZATIONS, 4017 02:24:30,241 --> 02:24:31,776 THE ADHERENCE TO THE 4018 02:24:31,776 --> 02:24:33,277 INTERVENTION, THE ADHERENCE TO 4019 02:24:33,277 --> 02:24:37,515 ITS DELIVERY, THE FOLLOW-UP, AND 4020 02:24:37,515 --> 02:24:38,482 THE DECISION OF PATIENT 4021 02:24:38,482 --> 02:24:39,283 OUTCOMES. 4022 02:24:39,283 --> 02:24:41,719 WITH PRAGMATIC STUDIES, WE CAN 4023 02:24:41,719 --> 02:24:43,020 CHARACTERIZE HOW EXPLANATORY 4024 02:24:43,020 --> 02:24:47,391 VERSUS HOW PRAGMATIC A TRIAL IS 4025 02:24:47,391 --> 02:24:51,062 USING THIS WHEEL WHERE 5 IS THE 4026 02:24:51,062 --> 02:24:53,030 MOST PRAGMATIC AND 1 IS THE MOST 4027 02:24:53,030 --> 02:24:53,731 EXPLANATORY. 4028 02:24:53,731 --> 02:24:55,099 SO A PURE EXPLANATORY TRIAL 4029 02:24:55,099 --> 02:24:56,934 WOULD LOOK LIKE THIS WITH A 4030 02:24:56,934 --> 02:24:58,769 RADIUS OF 1 AND A PURE PRAGMATIC 4031 02:24:58,769 --> 02:25:00,204 TRIAL WOULD LOOK LIKE THIS WITH 4032 02:25:00,204 --> 02:25:02,173 A RADIUS OF 5, BUT IN PRACTICE, 4033 02:25:02,173 --> 02:25:04,308 IN THIS RECENT SUMMARY OF SERIES 4034 02:25:04,308 --> 02:25:06,877 OF PRAGMATIC TRIALS FROM THE NIH 4035 02:25:06,877 --> 02:25:08,412 COLLABORATORY, YOU CAN SEE THAT 4036 02:25:08,412 --> 02:25:10,181 MOST PRAGMATIC TRIALS LOOK MORE 4037 02:25:10,181 --> 02:25:12,817 LIKE AN IRREGULAR POLYGON, BUT 4038 02:25:12,817 --> 02:25:15,986 AS YOU CAN SEE IN THIS 4039 02:25:15,986 --> 02:25:18,089 DEMONSTRATION, 4s AND 5s ARE 4040 02:25:18,089 --> 02:25:19,990 THE MODAL LEVEL OF PRAGMATISM IN 4041 02:25:19,990 --> 02:25:20,324 THESE TRIALS. 4042 02:25:20,324 --> 02:25:22,259 AND SO THE DEGREE TO WHICH WE 4043 02:25:22,259 --> 02:25:25,262 CAN ADHERE TO SOME OF THESE 4044 02:25:25,262 --> 02:25:26,497 RECOMMENDED STRATEGIES WILL MAKE 4045 02:25:26,497 --> 02:25:28,766 THESE MORE LIKELY TO BE ADOPTED 4046 02:25:28,766 --> 02:25:30,201 AND IMPLEMENTED. 4047 02:25:30,201 --> 02:25:33,003 ONE STUDY THAT I DID WORKED WITH 4048 02:25:33,003 --> 02:25:35,339 A GROUP OF OLDER ADULTS HERE IN 4049 02:25:35,339 --> 02:25:38,676 NEW YORK CITY TO IMPLEMENT THE 4050 02:25:38,676 --> 02:25:39,677 DASH DIET AND HOME BLOOD 4051 02:25:39,677 --> 02:25:47,051 PRESSURE MONITORING THROUGH CON 4052 02:25:47,051 --> 02:25:48,352 CONGREGATE MEALS AND WELLNESS 4053 02:25:48,352 --> 02:25:50,421 PROGRAMS AND USING RE-AIM WE 4054 02:25:50,421 --> 02:25:51,655 REPORTED THAT WE REACHED ABOUT 4055 02:25:51,655 --> 02:25:53,858 HALF THE ELIGIBILITY PATIENTS, 4056 02:25:53,858 --> 02:25:57,094 WE LOWERED THE SYSTOLIC BLOOD 4057 02:25:57,094 --> 02:25:59,897 PRESSURE BY 4-MILLILITER OF 4058 02:25:59,897 --> 02:26:01,232 MERCURY, WE INCREASED THE 4059 02:26:01,232 --> 02:26:02,833 MAINTENANCE OF BLOOD PRESSURE 4060 02:26:02,833 --> 02:26:05,069 REDUCTION AT 7-MILLIMETERS OVER 4061 02:26:05,069 --> 02:26:05,970 SIX MONTHS AND THAT'S THE KIND 4062 02:26:05,970 --> 02:26:07,938 OF DROP YOU GET WHEN YOU ADD ONE 4063 02:26:07,938 --> 02:26:08,706 TO TWO MEDICATIONS. 4064 02:26:08,706 --> 02:26:09,807 SO THIS WAS TO ILLUSTRATE THE 4065 02:26:09,807 --> 02:26:11,942 WAY IN WHICH WE WERE ABLE TO 4066 02:26:11,942 --> 02:26:12,710 IMPLEMENT RE-AIM. 4067 02:26:12,710 --> 02:26:19,283 WHAT I WANTED TO DO IS BUZZ 4068 02:26:19,283 --> 02:26:20,885 THROUGH A COUPLE STUDIES I'VE 4069 02:26:20,885 --> 02:26:21,952 SEEN IN THE OSA LITERATURE 4070 02:26:21,952 --> 02:26:23,721 THAT'S REALLY NEW TO ME BUT 4071 02:26:23,721 --> 02:26:25,189 REALLY HIGHLIGHT SEVERAL STUDIES 4072 02:26:25,189 --> 02:26:27,658 WHERE A DIAGNOSIS, THIS STUDY 4073 02:26:27,658 --> 02:26:30,795 EXAMINED -- AND I APOLOGIZE IFI 4074 02:26:30,795 --> 02:26:34,365 GIVE SHORT SHRIFT TO MANY OF THE 4075 02:26:34,365 --> 02:26:35,599 AUTHORS WHO ARE PROBABLY IN THE 4076 02:26:35,599 --> 02:26:37,168 AUDIENCE, BUT LOOKING AT HOME 4077 02:26:37,168 --> 02:26:38,803 MONITORING VERSUS LABORATORY 4078 02:26:38,803 --> 02:26:39,637 MONITORING, CONCLUDING THAT IT 4079 02:26:39,637 --> 02:26:41,539 WAS FEASIBLE AND PREFERRED BY 4080 02:26:41,539 --> 02:26:42,540 PATIENTS. 4081 02:26:42,540 --> 02:26:47,178 SO IT GETS POSITIVE RANKING FOR 4082 02:26:47,178 --> 02:26:49,146 AN IMPLEMENTATION OUTCOME, IT'S 4083 02:26:49,146 --> 02:26:50,948 HYBRID EFFECTIVE IMPLEMENTATION 4084 02:26:50,948 --> 02:26:52,817 STUDY BECAUSE IT FINDS SIMILAR 4085 02:26:52,817 --> 02:26:54,752 EFFECTIVENESS IN DIAGNOSIS AND 4086 02:26:54,752 --> 02:26:56,320 AS A PATIENT-CENTERED OR PATIENT 4087 02:26:56,320 --> 02:27:04,028 PREFERRED OUT COME. 4088 02:27:04,028 --> 02:27:05,963 A SECOND STUDY LOOKED AT HOME 4089 02:27:05,963 --> 02:27:07,131 SLEEP APNEA CONCLUDED IT WAS 4090 02:27:07,131 --> 02:27:09,667 WELL TOLERATED AND PREFERRED IN 4091 02:27:09,667 --> 02:27:11,969 COMPARISON TO IN-LAB SLEEP 4092 02:27:11,969 --> 02:27:12,970 STUDIES BUT AT THE SAME TIME, I 4093 02:27:12,970 --> 02:27:13,938 NOTICED A THIRD STUDY THAT 4094 02:27:13,938 --> 02:27:17,174 SEEMED TO INDICATE THAT THE 4095 02:27:17,174 --> 02:27:18,409 IN-LAB STUDIES WERE MORE LIKELY 4096 02:27:18,409 --> 02:27:23,414 TO BE PREFERRED BY THE PATIENTS 4097 02:27:23,414 --> 02:27:24,782 IN THIS PARTICULAR TRIAL. 4098 02:27:24,782 --> 02:27:25,916 SO I THINK THE THINKING ABOUT 4099 02:27:25,916 --> 02:27:27,251 IMPLEMENTATION STRATEGIES IS THE 4100 02:27:27,251 --> 02:27:30,154 WAY IN WHICH ONE IMPLEMENTS BOTH 4101 02:27:30,154 --> 02:27:33,290 THE TESTING FOR OSA AND THEN 4102 02:27:33,290 --> 02:27:35,159 TURNING TO STUDIES OF TREATMENT, 4103 02:27:35,159 --> 02:27:37,728 THIS STUDY LOOKED AT HOME-BASED 4104 02:27:37,728 --> 02:27:39,263 INITIATION, CONCLUDING THAT IT 4105 02:27:39,263 --> 02:27:42,233 LED TO FASTER THERAPY ACCESS, 4106 02:27:42,233 --> 02:27:44,235 THIS STUDY FOUND THAT PATIENTS 4107 02:27:44,235 --> 02:27:47,104 WERE MORE LIKELY IN A COACHING 4108 02:27:47,104 --> 02:27:49,306 ARM TO A BRIEF TELEPHONE 4109 02:27:49,306 --> 02:27:54,745 COACHING ARM TO INCREASE THEIR 4110 02:27:54,745 --> 02:27:54,979 USAGE. 4111 02:27:54,979 --> 02:27:56,547 THIS STUDY SHOWED A DIGITAL 4112 02:27:56,547 --> 02:27:58,649 PLATFORM WAS VERY PROMISING IN 4113 02:27:58,649 --> 02:27:59,850 TERMS OF PATIENT ADHERENCE AND 4114 02:27:59,850 --> 02:28:00,718 THERAPY EXPERIENCE. 4115 02:28:00,718 --> 02:28:02,553 SO THESE GIVE ME GREAT HOPE THAT 4116 02:28:02,553 --> 02:28:04,054 THERE ARE A NUMBER OF DIFFERENT 4117 02:28:04,054 --> 02:28:05,289 IMPLEMENTATION STRATEGIES FOR 4118 02:28:05,289 --> 02:28:08,425 BOTH DIAGNOSIS AND THERAPEUTICS, 4119 02:28:08,425 --> 02:28:09,526 SO TO CONCLUDE IN THE TIME THAT 4120 02:28:09,526 --> 02:28:11,929 I HAVE ALLOCATED, I'D RECOMMEND 4121 02:28:11,929 --> 02:28:15,065 THAT THE DESIGN, CONDUCT AND 4122 02:28:15,065 --> 02:28:17,001 DISSEMINATION ACTIVITIES IN THE 4123 02:28:17,001 --> 02:28:19,637 FUTURE FOCUS ON PRAGMATIC 4124 02:28:19,637 --> 02:28:20,304 PATIENT-CENTERED HYBRID 4125 02:28:20,304 --> 02:28:22,239 EFFECTIVE AND IMPLEMENTATION 4126 02:28:22,239 --> 02:28:25,309 TRIALS THAT WE EXAMINE 4127 02:28:25,309 --> 02:28:26,510 IMPLEMENTATION STRATEGIES THAT 4128 02:28:26,510 --> 02:28:28,245 ENHANCED ACCESS TO CARE AND 4129 02:28:28,245 --> 02:28:31,615 HEALTH EQUITY AT THE PRACTICE, 4130 02:28:31,615 --> 02:28:33,183 PHYSIOLOGIC PATIENTS AND 4131 02:28:33,183 --> 02:28:34,785 POPULATION LEVELS, WE NEED TO 4132 02:28:34,785 --> 02:28:36,020 INCREASE THE DIVERSITY OF THE 4133 02:28:36,020 --> 02:28:37,821 PRACTICE SETTINGS IN WHICH THESE 4134 02:28:37,821 --> 02:28:39,890 STUDIES ARE CONDUCTED SO WE HAVE 4135 02:28:39,890 --> 02:28:41,325 BETTER EVIDENCE FOR 4136 02:28:41,325 --> 02:28:42,326 DISSEMINATION AND 4137 02:28:42,326 --> 02:28:43,627 IMPLEMENTATION, AND LIKEWISE THE 4138 02:28:43,627 --> 02:28:45,262 BROADER RANGE OF CLINICIANS AND 4139 02:28:45,262 --> 02:28:46,697 PATIENTS IN REAL WORLD SETTINGS 4140 02:28:46,697 --> 02:28:49,733 THAT COULD BENEFIT FROM BETTER 4141 02:28:49,733 --> 02:28:51,035 SCREENING TREATMENT DIAGNOSES 4142 02:28:51,035 --> 02:28:57,474 AND TREATMENT, AND FINALLY AS I 4143 02:28:57,474 --> 02:28:58,876 THINK I'VE HEARD SEVERAL TIMES, 4144 02:28:58,876 --> 02:29:00,311 IT'S GOING TO BE REALLY CRITICAL 4145 02:29:00,311 --> 02:29:01,512 TO DESIGN RECRUITMENT STRATEGIES 4146 02:29:01,512 --> 02:29:03,414 THAT WILL RECRUIT ADEQUATELY 4147 02:29:03,414 --> 02:29:05,416 POWERED SUBGROUPS SO THAT THE 4148 02:29:05,416 --> 02:29:06,250 HETEROGENEITY OF TREATMENT 4149 02:29:06,250 --> 02:29:08,419 EFFECTS CAN BE OBSERVED IN THE 4150 02:29:08,419 --> 02:29:10,120 BROADEST RANGE OF PATIENT 4151 02:29:10,120 --> 02:29:11,522 POPULATIONS, AND IN THE BROADEST 4152 02:29:11,522 --> 02:29:12,556 RANGE OF SETTINGS. 4153 02:29:12,556 --> 02:29:15,326 AND I WOULD URGE US TO BE 4154 02:29:15,326 --> 02:29:18,095 THINKING ABOUT PRINCIPLES OF 4155 02:29:18,095 --> 02:29:20,364 DESIGN FOR DISSEMINATION AT THE 4156 02:29:20,364 --> 02:29:22,433 POINT AT WHICH THESE STUDIES AND 4157 02:29:22,433 --> 02:29:22,967 INNOVATIONS ARE DEVELOPED 4158 02:29:22,967 --> 02:29:24,101 BECAUSE THESE ARE GOING TO BE 4159 02:29:24,101 --> 02:29:25,736 REALLY CRITICAL TO THEIR UPTAKE, 4160 02:29:25,736 --> 02:29:27,705 THEIR EFFECTIVENESS, AND THEIR 4161 02:29:27,705 --> 02:29:30,841 SUSTAINABILITY. 4162 02:29:30,841 --> 02:29:31,775 THANK YOU FOR THE OPPORTUNITY TO 4163 02:29:31,775 --> 02:29:32,876 SHARE SOME THOUGHTS AND 4164 02:29:32,876 --> 02:29:34,044 APPRECIATE ALL THAT I'VE LEARNED 4165 02:29:34,044 --> 02:29:37,948 IN THESE LAST TWO DAYS FROM 4166 02:29:37,948 --> 02:29:42,920 EVERYBODY. 4167 02:29:42,920 --> 02:29:44,955 >> THANK YOU, DR. TOBIN, FOR 4168 02:29:44,955 --> 02:29:46,357 THIS REALLY NICE OVERVIEW ON THE 4169 02:29:46,357 --> 02:29:50,694 KEY ELEMENTS OF IMPLEMENTATION 4170 02:29:50,694 --> 02:29:51,929 SCIENCE AND THEORIES. 4171 02:29:51,929 --> 02:29:55,065 WE DO NOT HAVE TIME FOR 4172 02:29:55,065 --> 02:29:56,500 QUESTIONS. 4173 02:29:56,500 --> 02:29:57,868 WE WILL MOVE ON TO THE NEXT TALK 4174 02:29:57,868 --> 02:29:59,069 BUT WE WILL TAKE QUESTIONS AT 4175 02:29:59,069 --> 02:30:00,070 THE END DURING THE Q & A 4176 02:30:00,070 --> 02:30:02,039 SESSION. 4177 02:30:02,039 --> 02:30:07,644 OUR NEXT SPEAKER IS DR. SARAH 4178 02:30:07,644 --> 02:30:09,346 HONAKER, WHO IS AN ASSISTANT 4179 02:30:09,346 --> 02:30:12,049 PROFESSOR OF PEDIATRICS AT 4180 02:30:12,049 --> 02:30:12,883 INDIANA UNIVERSITY SCHOOL OF 4181 02:30:12,883 --> 02:30:14,051 MEDICINE AND THE DIRECTOR OF 4182 02:30:14,051 --> 02:30:16,253 BEHAVIORAL SLEEP MEDICINE AT 4183 02:30:16,253 --> 02:30:18,856 RILEY CHILDREN'S HOSPITAL. 4184 02:30:18,856 --> 02:30:22,326 HER TALK IS TITLED 4185 02:30:22,326 --> 02:30:23,727 EVIDENCE-BASED PEDIATRIC OSA 4186 02:30:23,727 --> 02:30:24,595 DETECTION AND MANAGEMENT IN 4187 02:30:24,595 --> 02:30:27,531 PRIMARY CARE. 4188 02:30:27,531 --> 02:30:36,740 DR. HONAKER. 4189 02:30:36,740 --> 02:30:38,108 >> HAPPY TO BE HERE AND TALK TO 4190 02:30:38,108 --> 02:30:40,077 YOU TODAY EVIDENCE-BASED 4191 02:30:40,077 --> 02:30:41,011 PEDIATRIC OSA DETECTION AND 4192 02:30:41,011 --> 02:30:42,112 MANAGEMENT IN PRIMARY CARE 4193 02:30:42,112 --> 02:30:46,483 CLINICS. 4194 02:30:46,483 --> 02:30:48,152 SO MY GOAL TODAY IS TO TALK 4195 02:30:48,152 --> 02:30:49,620 ABOUT WHY PRIMARY CARE IS SUCH 4196 02:30:49,620 --> 02:30:50,621 AN IMPORTANT IMPLEMENTATION 4197 02:30:50,621 --> 02:30:52,256 SETTING IN PEDIATRICS, TO TALK 4198 02:30:52,256 --> 02:30:54,291 ABOUT THE CURRENT STATUS OF 4199 02:30:54,291 --> 02:30:55,592 EVIDENCE-BASED DETECTION AND 4200 02:30:55,592 --> 02:30:57,227 MANAGEMENT OF PEDIATRIC OSA IN 4201 02:30:57,227 --> 02:31:01,031 PRIMARY CARE, TO TALK ABOUT SOME 4202 02:31:01,031 --> 02:31:02,366 IMPLEMENTATION APPROACHES THAT 4203 02:31:02,366 --> 02:31:03,400 HAVE BEEN EMPLOYED AND HAVE 4204 02:31:03,400 --> 02:31:05,169 PROMISE AND THEN TO SUMMARIZE 4205 02:31:05,169 --> 02:31:08,539 GAPS AND OPPORTUNITIES. 4206 02:31:08,539 --> 02:31:09,907 THROUGHOUT I'M GOING TO TRY TO 4207 02:31:09,907 --> 02:31:11,341 HIGHLIGHT DIFFERENT SYSTEMS THAT 4208 02:31:11,341 --> 02:31:16,013 I THINK ARE CRITICAL, SO SOME OF 4209 02:31:16,013 --> 02:31:23,654 THE KEY PLAYERS, PROVIDERS, 4210 02:31:23,654 --> 02:31:24,655 FAMILIES, HEALTH SYSTEMS AND 4211 02:31:24,655 --> 02:31:25,556 COMMUNITIES. 4212 02:31:25,556 --> 02:31:26,557 SO PRIMARY CARE HAS UNIQUE 4213 02:31:26,557 --> 02:31:28,092 ACCESS TO FAMILIES. 4214 02:31:28,092 --> 02:31:30,160 SO THERE ARE 28 RECOMMENDED WELL 4215 02:31:30,160 --> 02:31:31,895 CHILD VISITS FROM BIRTH TO 18 4216 02:31:31,895 --> 02:31:33,297 YEARS. 4217 02:31:33,297 --> 02:31:34,531 AND THERE'S GOOD ADHERENCE WITH 4218 02:31:34,531 --> 02:31:35,332 THOSE AS WELL. 4219 02:31:35,332 --> 02:31:42,039 SO FOR IM EXAMP FOR EXAMPLE, INT 4220 02:31:42,039 --> 02:31:43,574 YOUTH HAD AT LEAST ONE WELL 4221 02:31:43,574 --> 02:31:43,907 CHILD CHECK. 4222 02:31:43,907 --> 02:31:46,276 IN ADDITION, THE AAP DOES 4223 02:31:46,276 --> 02:31:47,578 PEDIATRIC OSA GUIDELINES THAT 4224 02:31:47,578 --> 02:31:49,046 HAVE IMPLICATIONS FOR PRIMARY 4225 02:31:49,046 --> 02:31:51,915 CARE DELIVERY. 4226 02:31:51,915 --> 02:31:54,518 AND SPECIFICALLY, THESE ARE 2006 4227 02:31:54,518 --> 02:31:54,852 GUIDELINES. 4228 02:31:54,852 --> 02:31:55,986 SPECIFICALLY THEY NOTE THAT ALL 4229 02:31:55,986 --> 02:31:57,354 CHILDREN AND ADOLESCENTS SHOULD 4230 02:31:57,354 --> 02:32:00,457 BE SCREENED FOR SNORING. 4231 02:32:00,457 --> 02:32:02,893 IF A CHILD OR ADOLESCENT 4232 02:32:02,893 --> 02:32:03,861 SENATORS REGULARLY AND HAS ONE 4233 02:32:03,861 --> 02:32:05,162 OR MORE OF THE COMPLAINTS OR 4234 02:32:05,162 --> 02:32:07,231 FINDINGS SHOWN IN TABLE TWO, 4235 02:32:07,231 --> 02:32:08,432 THEN CLINICIANS SHOULD ORDER A 4236 02:32:08,432 --> 02:32:10,467 SLEEP STUDY OR COULD ALSO REFER 4237 02:32:10,467 --> 02:32:13,003 THE PATIENT TO SLEEP OR ENT FOR 4238 02:32:13,003 --> 02:32:16,173 FURTHER EVALUATION. 4239 02:32:16,173 --> 02:32:17,975 SO THAT'S THE IDEA. 4240 02:32:17,975 --> 02:32:19,943 BUT WHEN WE LOOK AT LITERATURE 4241 02:32:19,943 --> 02:32:22,079 EXAMINING PRACTICES IN PEDIATRIC 4242 02:32:22,079 --> 02:32:24,181 PRIMARY CARE, WE SEE RATES OF 4243 02:32:24,181 --> 02:32:27,451 SCREENING RAGE FROM 2 TO 25% IN 4244 02:32:27,451 --> 02:32:28,652 PEDIATRICS AND KEEP IN MIND THAT 4245 02:32:28,652 --> 02:32:30,154 NUMBER SHOULD BE 100%. 4246 02:32:30,154 --> 02:32:35,292 DIAGNOSIS IS AROUND 1%, AND WE 4247 02:32:35,292 --> 02:32:37,794 SUSPECT THAT SHOULD BE CLOSER TO 4248 02:32:37,794 --> 02:32:38,695 3 TO 5%. 4249 02:32:38,695 --> 02:32:41,598 AND WHEN CHILDREN WITH OSA AND 4250 02:32:41,598 --> 02:32:43,867 SLEEP DISORDER BREATHING ARE I'D 4251 02:32:43,867 --> 02:32:44,768 IDENTIFIED, RATES OF MANAGEMENT 4252 02:32:44,768 --> 02:32:45,035 ARE LOW. 4253 02:32:45,035 --> 02:32:49,006 IN ADDITION, WE SEE SIGNIFICANT 4254 02:32:49,006 --> 02:32:49,773 DISPARITIES BOTH IN THE 4255 02:32:49,773 --> 02:32:51,208 PREVALENCE AND SEVERITY OF 4256 02:32:51,208 --> 02:32:53,510 DISEASE, BUT ALSO IN THE RECEIPT 4257 02:32:53,510 --> 02:32:54,578 OF EVIDENCE-BASED CARE. 4258 02:32:54,578 --> 02:32:56,180 SO CHILDREN FROM MINORITIZED 4259 02:32:56,180 --> 02:32:57,514 RACIAL OR ETHNIC BACKGROUNDS 4260 02:32:57,514 --> 02:33:00,017 HAVE HIGHER RATES OF OSA, SO 4261 02:33:00,017 --> 02:33:02,419 THERE'S FOR EXAMPLE A 2 TO 4262 02:33:02,419 --> 02:33:03,954 4 FOLD INCREASE IN PREVALENCE IN 4263 02:33:03,954 --> 02:33:05,055 BLACK CHILDREN. 4264 02:33:05,055 --> 02:33:07,157 GREATER SEVERITY OF DISEASE, BUT 4265 02:33:07,157 --> 02:33:11,695 THERE THEY'RE ALSO LESS LIKELY O 4266 02:33:11,695 --> 02:33:16,900 RECEIVE A T ABDUL T & A AND HAVA 4267 02:33:16,900 --> 02:33:18,435 LONGER TIME TO OSA DIAGNOSIS. 4268 02:33:18,435 --> 02:33:21,171 CHILDREN FROM LOWER SE SBAC 4269 02:33:21,171 --> 02:33:25,509 GROWBDZ ALSO HAVE HIGHER RATES 4270 02:33:25,509 --> 02:33:27,678 OF OSA, LESS ACCESS TO T & A AND 4271 02:33:27,678 --> 02:33:29,546 LONGER TIME TO OSA DIAGNOSIS. 4272 02:33:29,546 --> 02:33:31,682 WE DON'T KNOW AS MUCH ABOUT SEX 4273 02:33:31,682 --> 02:33:32,983 AND GENDER DISPARITIES 4274 02:33:32,983 --> 02:33:34,218 PARTICULARLY WHEN IT COMES TO 4275 02:33:34,218 --> 02:33:34,885 EVIDENCE-BASED CARE. 4276 02:33:34,885 --> 02:33:36,453 SO UNLIKE IN THE SLIDE THAT WE 4277 02:33:36,453 --> 02:33:38,655 SAW YESTERDAY, LOOKING AT LOW 4278 02:33:38,655 --> 02:33:41,491 RATES OF FEMALE PARTICIPATION IN 4279 02:33:41,491 --> 02:33:46,597 PAP STUDIES, I DO THINK MOST OF 4280 02:33:46,597 --> 02:33:48,365 THE STUDIES INCLUDE FAIRLY 4281 02:33:48,365 --> 02:33:49,766 PROPORTIONAL RATES OF MALES AND 4282 02:33:49,766 --> 02:33:51,568 FEMALES, HOWEVER, THERE ARE 4283 02:33:51,568 --> 02:33:53,036 RELATIVELY FEW THAT EXAMINE 4284 02:33:53,036 --> 02:33:54,271 GENDER AS A POTENTIAL PREDICTOR 4285 02:33:54,271 --> 02:33:56,073 OF DIAGNOSIS OR CARE. 4286 02:33:56,073 --> 02:33:57,574 THERE IS SOME LITERATURE TO 4287 02:33:57,574 --> 02:33:58,675 SUGGEST HIGHER PREVALENCE OF OSA 4288 02:33:58,675 --> 02:34:01,745 IN BOYS, HIGHER AHI, BUT AS 4289 02:34:01,745 --> 02:34:03,013 WE'VE BEEN LEARNING THE LAST TWO 4290 02:34:03,013 --> 02:34:04,214 DAYS, SOME OF THAT CAN BE COULD 4291 02:34:04,214 --> 02:34:10,287 BE FOUNDED FOUND CONFOUNDED BYE 4292 02:34:10,287 --> 02:34:12,155 OF AHI AS A MEASURE AND 4293 02:34:12,155 --> 02:34:13,323 POTENTIAL GENDER DIFFERENCES 4294 02:34:13,323 --> 02:34:13,957 THERE. 4295 02:34:13,957 --> 02:34:14,958 THIS IS ALSO PARTICULARLY THE 4296 02:34:14,958 --> 02:34:16,893 CASE FOR BOYS WHO HAVE OBESITY. 4297 02:34:16,893 --> 02:34:18,061 HOWEVER, WHEN WE LOOK AT 4298 02:34:18,061 --> 02:34:19,129 DELIVERY OF EVIDENCE-BASED CARE, 4299 02:34:19,129 --> 02:34:21,498 SO FAR STUDIES HAVE NOT SHOWN 4300 02:34:21,498 --> 02:34:22,699 GENDER DISPARITIES IN TERMS OF 4301 02:34:22,699 --> 02:34:25,602 WHO GETS REFERRED BY THE PCP, 4302 02:34:25,602 --> 02:34:28,572 LIKELIHOOD OF RECEIVING A T & A 4303 02:34:28,572 --> 02:34:30,274 AND FOLLOW-UP CARE AFTER A T & 4304 02:34:30,274 --> 02:34:35,412 A. 4305 02:34:35,412 --> 02:34:37,614 SO ONE OF THE CHALLENGES WITH 4306 02:34:37,614 --> 02:34:38,582 PEDIATRIC OSA DETECTION AND 4307 02:34:38,582 --> 02:34:39,683 MANAGEMENT IS THERE ARE A LOT OF 4308 02:34:39,683 --> 02:34:41,318 STEPS IN THIS PROCESS, RIGHT? 4309 02:34:41,318 --> 02:34:42,552 SO TO START OFF WITH, SOMEBODY 4310 02:34:42,552 --> 02:34:44,154 HAS TO BE AWARE OF THE SYMPTOMS 4311 02:34:44,154 --> 02:34:45,555 AND RISK FACTORS, SO THE FAMILY 4312 02:34:45,555 --> 02:34:49,159 HAS TO NOTICE THAT THE CHILD 4313 02:34:49,159 --> 02:34:49,426 SENATORS. 4314 02:34:49,426 --> 02:34:51,094 THEY HAVE TO RECOGNIZE THAT AS 4315 02:34:51,094 --> 02:34:52,095 PROBLEMATIC, AND THERE HAVE BEEN 4316 02:34:52,095 --> 02:34:55,365 SEVERAL STUDIES THAT HAVE SHOWN 4317 02:34:55,365 --> 02:34:57,367 THAT A NUMBER OF FAMILIES THINK 4318 02:34:57,367 --> 02:35:02,873 OF SENATORS AS SOMETHING THAT IS 4319 02:35:02,873 --> 02:35:04,508 NORMAL OR CUTE OR SOMETHING 4320 02:35:04,508 --> 02:35:05,709 THAT'S OUTGROWN. 4321 02:35:05,709 --> 02:35:06,710 IN ADDITION FAMILIES HAVE TO BE 4322 02:35:06,710 --> 02:35:08,345 ACTIVATED THEN TO ENGAGE WITH 4323 02:35:08,345 --> 02:35:09,746 THE MEDICAL SYSTEM AROUND THE 4324 02:35:09,746 --> 02:35:10,547 SYMPTOMS THEY'RE SEEING. 4325 02:35:10,547 --> 02:35:11,915 OF COURSE IF WE CAN GET 4326 02:35:11,915 --> 02:35:13,884 UNIVERSAL SCREENING, WE DON'T 4327 02:35:13,884 --> 02:35:14,885 NECESSARILY NEED THOSE THREE 4328 02:35:14,885 --> 02:35:16,553 STEPS, SO THEN WE NEED THE PCP 4329 02:35:16,553 --> 02:35:19,022 TO DO AN EVALUATION AND USE 4330 02:35:19,022 --> 02:35:20,357 EVIDENCE-BASED DEDISITION 4331 02:35:20,357 --> 02:35:21,491 MAKING, APPROPRIATE REFERRAL AND 4332 02:35:21,491 --> 02:35:21,825 CARE. 4333 02:35:21,825 --> 02:35:23,960 THE FAMILY NEEDS TO ADHERE TO 4334 02:35:23,960 --> 02:35:25,195 WHATEVER THAT RECOMMENDATION WAS 4335 02:35:25,195 --> 02:35:26,596 AND THEN THERE'S COORDINATION 4336 02:35:26,596 --> 02:35:28,732 BETWEEN SYSTEMS, BETWEEN PRIMARY 4337 02:35:28,732 --> 02:35:30,701 CARE AND THE LAB AND 4338 02:35:30,701 --> 02:35:31,435 SUBSPECIALISTS. 4339 02:35:31,435 --> 02:35:32,436 SO THERE ARE A LOT OF 4340 02:35:32,436 --> 02:35:35,138 OPPORTUNITIES HERE FOR US TO 4341 02:35:35,138 --> 02:35:38,342 LOSE PATIENTS ON THIS PATHWAY. 4342 02:35:38,342 --> 02:35:39,743 A COUPLE STUDIES HAVE LOOKED AT 4343 02:35:39,743 --> 02:35:40,210 THAT. 4344 02:35:40,210 --> 02:35:41,611 SO ONE STUDY THAT LOOKED AT 4345 02:35:41,611 --> 02:35:51,088 TREATMENT PATHWAYS BY MINNETH 4346 02:35:51,088 --> 02:35:52,856 ALL, DR. WILLIAMSON ON THE CALL 4347 02:35:52,856 --> 02:35:55,459 WAS AN AUTHOR ON THIS PROJECT AS 4348 02:35:55,459 --> 02:35:56,760 WELL, THEY FOUND THAT CHILDREN 4349 02:35:56,760 --> 02:35:59,062 WITH AN OSA DIAGNOSIS THE MOST 4350 02:35:59,062 --> 02:36:01,598 COMMON PATHWAY WAS ACTUALLY NO 4351 02:36:01,598 --> 02:36:03,300 CARE WITH 34.4% OF CHILDREN. 4352 02:36:03,300 --> 02:36:06,770 IN OUR STUDIES WE'VE LACKED AT 4353 02:36:06,770 --> 02:36:09,239 PCP ALERTS FOR CHILDREN AT RISK 4354 02:36:09,239 --> 02:36:10,741 OF OSA AND WE FIND THAT JUST 4355 02:36:10,741 --> 02:36:12,209 OVER HALF OF CHILDREN THAT HAVE 4356 02:36:12,209 --> 02:36:18,014 A POSITIVE SC POSITIVE SCREEN FT 4357 02:36:18,014 --> 02:36:19,349 RECEIVE CARE SO CLEARLY THERE 4358 02:36:19,349 --> 02:36:20,751 ARE MANY MISSED OPPORTUNITIES. 4359 02:36:20,751 --> 02:36:22,052 THAT TAKES ME TO IMPLEMENTATION 4360 02:36:22,052 --> 02:36:22,386 APPROACHES. 4361 02:36:22,386 --> 02:36:24,254 I'M GOING TO FOCUS AT LEAST 4362 02:36:24,254 --> 02:36:25,689 WITHIN THE PRIMARY CARE SETTING, 4363 02:36:25,689 --> 02:36:27,591 I'M GOING TO FOCUS ON CLINICAL 4364 02:36:27,591 --> 02:36:28,792 DECISION SUPPORT SYSTEMS. 4365 02:36:28,792 --> 02:36:30,961 SO THIS WAS AN EFFICACIOUS TOOL 4366 02:36:30,961 --> 02:36:33,397 TO FACILITATE EVIDENCE-BASED 4367 02:36:33,397 --> 02:36:34,798 SCREENING, SURVEILLANCE, 4368 02:36:34,798 --> 02:36:35,799 REFERRAL, TREATMENT AND 4369 02:36:35,799 --> 02:36:36,400 FOLLOW-UP. 4370 02:36:36,400 --> 02:36:37,701 TYPICALLY IT INCLUDES SCREENING 4371 02:36:37,701 --> 02:36:39,803 FOR RISK, PROVIDER ALERTS, 4372 02:36:39,803 --> 02:36:44,908 WORKFLOW FACILITATION, PATIENT 4373 02:36:44,908 --> 02:36:47,210 EDUCATION, AND BY DEFINITION, 4374 02:36:47,210 --> 02:36:49,179 CDSS IS TAILORED, AND IT DOES 4375 02:36:49,179 --> 02:36:50,447 CONSIDER PERSONALIZED RISK. 4376 02:36:50,447 --> 02:36:51,415 SO I THINK THERE'S A LOT OF 4377 02:36:51,415 --> 02:36:54,284 OPPORTUNITY HERE. 4378 02:36:54,284 --> 02:36:55,519 SO FOR EXAMPLE, YOU COULD HAVE 4379 02:36:55,519 --> 02:36:57,120 SEPARATE ALGORITHMS FOR BOYS AND 4380 02:36:57,120 --> 02:36:58,955 GIRLS IF THE SCIENCE INFORMS 4381 02:36:58,955 --> 02:37:03,960 THAT NEED. 4382 02:37:03,960 --> 02:37:06,797 SO TO GIVE YOU AN EXAMPLE, THIS 4383 02:37:06,797 --> 02:37:08,965 IS A SYSTEM WE IMPLEMENTED IN MY 4384 02:37:08,965 --> 02:37:10,133 INSTITUTION SEVERAL YEARS AGO IN 4385 02:37:10,133 --> 02:37:11,368 FIVE PRIMARY CARE CLINICS THAT 4386 02:37:11,368 --> 02:37:13,703 SERVE MOSTLY BLACK AND HISPANIC 4387 02:37:13,703 --> 02:37:14,538 CHILDREN WITH MEDICAID 4388 02:37:14,538 --> 02:37:16,506 INSURANCE. 4389 02:37:16,506 --> 02:37:17,808 SO WE ASKED PARENTS IN THE 4390 02:37:17,808 --> 02:37:19,776 WAITING ROOM ON A TABLET, DOES 4391 02:37:19,776 --> 02:37:20,944 YOUR CHILD USUALLY SENATOR THREE 4392 02:37:20,944 --> 02:37:22,379 OR MOWR NIGHTS PER WEEK, AND WE 4393 02:37:22,379 --> 02:37:24,347 DID THIS WITH ALL PARENTS. 4394 02:37:24,347 --> 02:37:27,651 IF THE PARENT SAID YES, THEN WE 4395 02:37:27,651 --> 02:37:29,820 SENT THE PCP A VERY BASIC PROMPT 4396 02:37:29,820 --> 02:37:32,656 IN THE ELECTRONIC HEALTH RECORD. 4397 02:37:32,656 --> 02:37:33,857 THIS CHILD SENATORS, THIS MIGHT 4398 02:37:33,857 --> 02:37:37,661 BE OSA. 4399 02:37:37,661 --> 02:37:41,731 SNORES, THIS MIGHT BE 4400 02:37:41,731 --> 02:37:42,232 OSA. 4401 02:37:42,232 --> 02:37:44,734 WITH THIS SIMPLE INTERVENTION WE 4402 02:37:44,734 --> 02:37:46,570 FOUND ALMOST TRIPLE THE RATES OF 4403 02:37:46,570 --> 02:37:49,840 BOTH PSG REFERRALS AND 4404 02:37:49,840 --> 02:37:50,707 DOCUMENTATION OF SNORING 4405 02:37:50,707 --> 02:37:52,776 COMPARED TO THE COMPARABLE TIME 4406 02:37:52,776 --> 02:37:53,910 PERIOD PRIOR TO IMPLEMENTATION 4407 02:37:53,910 --> 02:37:54,978 OF THE SYSTEM. 4408 02:37:54,978 --> 02:37:57,481 HOWEVER, WE ALSO SAW THERE WAS 4409 02:37:57,481 --> 02:37:58,582 SIGNIFICANT VARIATION IN 4410 02:37:58,582 --> 02:38:01,318 PROVIDER BEHAVIOR IN REGARDS TO 4411 02:38:01,318 --> 02:38:01,818 REFERRALS. 4412 02:38:01,818 --> 02:38:05,222 YOU CAN SEE ON THE X AXIS, EACH 4413 02:38:05,222 --> 02:38:07,324 I.D. REPRESENTS A PROVIDER WHO 4414 02:38:07,324 --> 02:38:08,525 RECEIVED AT LEAST FIVE PROMPTS 4415 02:38:08,525 --> 02:38:10,994 ABOUT A CHILD HISTORY -- CHILD 4416 02:38:10,994 --> 02:38:15,265 WHO SCREENED -- ABOUT A CHILD 4417 02:38:15,265 --> 02:38:18,001 WHO SNORES. 4418 02:38:18,001 --> 02:38:23,340 HERE YOU SEE THE RATE IN WHICH 4419 02:38:23,340 --> 02:38:24,875 THEY THEN REFERRED THE CHILD OR 4420 02:38:24,875 --> 02:38:25,842 IDENTIFIED OSA IN THAT CHILD. 4421 02:38:25,842 --> 02:38:27,911 SO SOME PROVIDERS FELT A CHILD 4422 02:38:27,911 --> 02:38:33,683 HAD OSA, SOME PROVIDERS ACTED 4423 02:38:33,683 --> 02:38:34,551 ABOUT TWO THIRDS OF THE TIME. 4424 02:38:34,551 --> 02:38:37,621 SO QUITE A BIT OF PRACTICE 4425 02:38:37,621 --> 02:38:37,888 VARIATION. 4426 02:38:37,888 --> 02:38:39,356 SO WE WANTED TO UNDERSTAND A 4427 02:38:39,356 --> 02:38:43,159 LITTLE BIT MORE WHAT FACTORS ARE 4428 02:38:43,159 --> 02:38:44,828 PROMPTING THESE DIFFERENTIAL 4429 02:38:44,828 --> 02:38:45,996 REFERRAL RATES. 4430 02:38:45,996 --> 02:38:47,397 WE LOOKED AT PATIENT DEMOGRAPHIC 4431 02:38:47,397 --> 02:38:50,133 FACTORS INCLUDING SEX, PATIENT 4432 02:38:50,133 --> 02:38:51,902 HEALTH FACTORS AND THEN PROVIDER 4433 02:38:51,902 --> 02:38:54,604 AND CLINIC CHARACTERISTICS. 4434 02:38:54,604 --> 02:38:56,673 AND WE FOUND THAT WHILE AGE WAS 4435 02:38:56,673 --> 02:38:58,441 SOMEWHAT PREDICTIVE, THE MAIN 4436 02:38:58,441 --> 02:38:59,209 PREDICTORS OF WHETHER OR NOT A 4437 02:38:59,209 --> 02:39:02,646 CHILD RECEIVED A REFERRAL WERE 4438 02:39:02,646 --> 02:39:03,413 RELATED TO THE PROVIDER 4439 02:39:03,413 --> 02:39:07,918 CHARACTERISTICS AND NOT, FOR 4440 02:39:07,918 --> 02:39:09,386 EXAMPLE, THE PATIENT RISK 4441 02:39:09,386 --> 02:39:11,922 FACTORS WHICH WOULD BE 4442 02:39:11,922 --> 02:39:12,355 APPROPRIATE. 4443 02:39:12,355 --> 02:39:14,991 SORE JUST ANOTHER EXAMPLE OF 4444 02:39:14,991 --> 02:39:20,430 CDSS, THIS IS MY K23 WORK FUNDED 4445 02:39:20,430 --> 02:39:21,765 BY NHLBI, THANK YOU. 4446 02:39:21,765 --> 02:39:25,035 SO THIS INVOLVED SCREENING IN MY 4447 02:39:25,035 --> 02:39:33,209 CART ANDCHART AND WE ASKED ABOUT 4448 02:39:33,209 --> 02:39:36,046 SNORING. 4449 02:39:36,046 --> 02:39:38,148 WIF THE CHILD SCREENED POSITIVE 4450 02:39:38,148 --> 02:39:40,050 WE THEN PROVIDED A 4451 02:39:40,050 --> 02:39:41,117 NON-INTERRUPTIVE PROVIDER ALERT, 4452 02:39:41,117 --> 02:39:43,353 SO YOU CAN SEE HERE THAT IN THE 4453 02:39:43,353 --> 02:39:44,854 MENU IT SAYS SCREENED POSITIVE 4454 02:39:44,854 --> 02:39:47,157 AND IF THE PROVIDER CLICKS ON 4455 02:39:47,157 --> 02:39:49,693 THAT, THEN A BEST PRACTICE 4456 02:39:49,693 --> 02:39:51,928 ADVISORY ALERT EMERGES THAT 4457 02:39:51,928 --> 02:39:53,263 NOTES THAT THE PATIENT IS AT 4458 02:39:53,263 --> 02:39:57,200 HIGHER RISK FOR OSA AND LISTS 4459 02:39:57,200 --> 02:39:59,869 PATIENT SYMPTOMS AND RISK 4460 02:39:59,869 --> 02:40:01,004 FACTORS, AS WELL AS A VARIETY OF 4461 02:40:01,004 --> 02:40:07,143 ACTIONS THAT CAN BE TAKEN. 4462 02:40:07,143 --> 02:40:09,346 SO I WANT TO TAKE A STEP BACK 4463 02:40:09,346 --> 02:40:10,614 AND TALK ABOUT THE ROLE OF THE 4464 02:40:10,614 --> 02:40:12,048 FAMILY IN PRIMARY CARE 4465 02:40:12,048 --> 02:40:12,682 IMPLEMENTATION AND OSA 4466 02:40:12,682 --> 02:40:13,016 DETECTION. 4467 02:40:13,016 --> 02:40:15,185 SO IN TRADITIONAL CDSS, THE 4468 02:40:15,185 --> 02:40:17,387 PARENT'S INVOLVEMENT INVOLVES 4469 02:40:17,387 --> 02:40:17,921 PROVIDING INFORMATION. 4470 02:40:17,921 --> 02:40:18,989 THAT INFORMATION IS THEN GIVEN 4471 02:40:18,989 --> 02:40:21,191 TO THE PROVIDER WHO MAY OR MAY 4472 02:40:21,191 --> 02:40:22,826 NOT ACT ON THAT INFORMATION 4473 02:40:22,826 --> 02:40:24,694 AND/OR TALK TO THAT FAMILY ABOUT 4474 02:40:24,694 --> 02:40:30,033 THE INFORMATION. 4475 02:40:30,033 --> 02:40:31,134 HOWEVER, THERE IS AN ARGUMENT TO 4476 02:40:31,134 --> 02:40:33,436 BE MADE INVOLVING PROVIDERS AND 4477 02:40:33,436 --> 02:40:36,139 FAMILIES MORE IN THIS PROCESS 4478 02:40:36,139 --> 02:40:39,009 WHEREBY THE FAMILIES PROVIDE 4479 02:40:39,009 --> 02:40:40,076 INFORMATION, BUT IF THERE'S A 4480 02:40:40,076 --> 02:40:41,277 POSITIVE SCREEN, THE FAMILIES 4481 02:40:41,277 --> 02:40:42,212 ARE GIVEN THAT INFORMATION, AND 4482 02:40:42,212 --> 02:40:45,448 THEY HAVE THE OPTION TO BRING 4483 02:40:45,448 --> 02:40:46,783 THAT INFORMATION TO THE 4484 02:40:46,783 --> 02:40:48,318 PROVIDER. 4485 02:40:48,318 --> 02:40:50,053 SO THIS IDEA OF PATIENT 4486 02:40:50,053 --> 02:40:52,656 ACTIVATION KIND OF LIKE A 4487 02:40:52,656 --> 02:40:53,957 PHARMACEUTICAL COMMERCIAL. 4488 02:40:53,957 --> 02:41:02,165 SO WE DEVELOPED WITH STAKEHOLDER 4489 02:41:02,165 --> 02:41:03,366 FEEDBACK A HEALTH COMMUNICATION 4490 02:41:03,366 --> 02:41:05,235 MESSAGE TO ACTIVATE PARENTS 4491 02:41:05,235 --> 02:41:06,903 AROUND OSA, IT SAYS BASED OP 4492 02:41:06,903 --> 02:41:08,772 YOUR ANSWERS YOUR CHILD MAY HAVE 4493 02:41:08,772 --> 02:41:10,774 A SLEEP PROBLEM CALLED SLEEP 4494 02:41:10,774 --> 02:41:12,642 APNEA. 4495 02:41:12,642 --> 02:41:14,077 IF YOU SEE ANY OF THESE 4496 02:41:14,077 --> 02:41:14,944 PROBLEMS, LET YOUR CHILD'S 4497 02:41:14,944 --> 02:41:15,378 DOCTOR KNOW. 4498 02:41:15,378 --> 02:41:16,579 SO WE WANTED TO LOOK AT THE 4499 02:41:16,579 --> 02:41:18,882 IMPACT OF THIS TYPE OF MESSAGING 4500 02:41:18,882 --> 02:41:22,819 WITHIN COMPUTER DECISION SUPP 4501 02:41:22,819 --> 02:41:23,353 SUPPORT. 4502 02:41:23,353 --> 02:41:25,188 SO IF A CHILD SCREENED POSITIVE 4503 02:41:25,188 --> 02:41:27,257 FOR OSA THE PARENT WOULD SEE 4504 02:41:27,257 --> 02:41:29,993 THIS MESSAGE PRIOR TO THE 4505 02:41:29,993 --> 02:41:30,894 CHILD'S APPOINTMENT. 4506 02:41:30,894 --> 02:41:35,965 AND THEN WE ASKED PARENTS BASED 4507 02:41:35,965 --> 02:41:37,400 ON THIS MESSAGE, DO YOU PLAN TO 4508 02:41:37,400 --> 02:41:39,135 TALK TO YOUR CHILD'S DOCTOR 4509 02:41:39,135 --> 02:41:39,969 ABOUT SLEEP APNEA TODAY? 4510 02:41:39,969 --> 02:41:41,137 JUST UNDER HALF SAID YES. 4511 02:41:41,137 --> 02:41:42,672 ABOUT A THIRD WERE UNSURE. 4512 02:41:42,672 --> 02:41:44,641 AND ABOUT 22% SAID THEY'RE NOT 4513 02:41:44,641 --> 02:41:46,009 PLANNING TO TALK TO THEIR 4514 02:41:46,009 --> 02:41:46,576 CHILD'S DOCTOR ABOUT SLEEP 4515 02:41:46,576 --> 02:41:52,816 APNEA. 4516 02:41:52,816 --> 02:41:54,784 SO THERE WAS A DIFFERENT 4517 02:41:54,784 --> 02:41:57,087 RESPONSE, THE MESSAGE RESONATED 4518 02:41:57,087 --> 02:41:58,154 MORE WITH SOME FAMILIES THAN 4519 02:41:58,154 --> 02:41:58,388 OTHERS. 4520 02:41:58,388 --> 02:41:59,389 OF THOSE WHO SAID THEY PLANNED 4521 02:41:59,389 --> 02:42:01,224 TO TALK TO THEIR CHILD'S DOCTOR, 4522 02:42:01,224 --> 02:42:02,859 MORE THAN HALF OF THOSE CHILDREN 4523 02:42:02,859 --> 02:42:03,827 RECEIVED DOCUMENTED OSA 4524 02:42:03,827 --> 02:42:05,161 FOLLOW-UP. 4525 02:42:05,161 --> 02:42:08,765 SO A NASAL STEROID OR PSG 4526 02:42:08,765 --> 02:42:10,200 REFERRAL, WHEREAS THE RATE WAS 4527 02:42:10,200 --> 02:42:12,168 CLOSER TO 20% IN CASES WHERE 4528 02:42:12,168 --> 02:42:16,106 PARENTS WERE NOT ACTIVATED. 4529 02:42:16,106 --> 02:42:17,841 SO I THINK THIS REALLY SPEAKS TO 4530 02:42:17,841 --> 02:42:18,808 THE PROMISE OF PATIENT AND 4531 02:42:18,808 --> 02:42:22,612 FAMILY ACTIVATION AS AN APPROACH 4532 02:42:22,612 --> 02:42:24,180 TO PROMOTE EVIDENCE-BASED 4533 02:42:24,180 --> 02:42:24,614 DETECTION AND CARE. 4534 02:42:24,614 --> 02:42:25,882 THERE ARE ALSO SOME STUDIES THAT 4535 02:42:25,882 --> 02:42:29,285 HAVE LOOKED AT COMMUNITY AND 4536 02:42:29,285 --> 02:42:32,789 OTHER SETTINGS AS A WAY TO 4537 02:42:32,789 --> 02:42:35,158 SCREEN AND BRING PARENTS INTO 4538 02:42:35,158 --> 02:42:40,764 THE PRIMARY CARE SETTING. 4539 02:42:40,764 --> 02:42:44,701 THEY DID A STUDY WHERE THEY 4540 02:42:44,701 --> 02:42:47,203 ADMINISTERED THE PEDIATRIC SLEEP 4541 02:42:47,203 --> 02:42:48,671 QUESTIONNAIRE AT SEVEN HEAD 4542 02:42:48,671 --> 02:42:49,405 START CLINICS AND FAMILIES 4543 02:42:49,405 --> 02:42:50,874 RECEIVE WRITTEN INFORMATION AND 4544 02:42:50,874 --> 02:42:51,775 HELP WITH REFERRALS. 4545 02:42:51,775 --> 02:42:53,676 WE CONDUCTED A STUDY WHERE WE 4546 02:42:53,676 --> 02:42:54,577 HAD PARENTS COMPLETE THE 4547 02:42:54,577 --> 02:42:55,445 PEDIATRIC SLEEP QUESTIONNAIRE. 4548 02:42:55,445 --> 02:42:58,181 WE ALSO HAD TEACHERS COMPLETE 4549 02:42:58,181 --> 02:43:00,116 THE PSQ BASED ON THEIR 4550 02:43:00,116 --> 02:43:01,117 OBSERVATION OF CHILDREN NAPPING. 4551 02:43:01,117 --> 02:43:02,418 WE NOTIFIED FAMILIES OF A 4552 02:43:02,418 --> 02:43:03,520 POSITIVE SCREEN, GAVE THEM A 4553 02:43:03,520 --> 02:43:05,588 LETTER TO TAKE TO THEIR PCP AND 4554 02:43:05,588 --> 02:43:09,859 AN INFORMATIONAL MESS J A, AND F 4555 02:43:09,859 --> 02:43:10,927 THOSE THAT RECEIVED THAT 4556 02:43:10,927 --> 02:43:11,694 INTERVENTION, ALMOST ALL 4557 02:43:11,694 --> 02:43:13,429 CONTACTED THEIR PCP AND ABOUT 4558 02:43:13,429 --> 02:43:15,298 60% RECEIVED APPROPRIATE CARE 4559 02:43:15,298 --> 02:43:17,133 INITIALLY. 4560 02:43:17,133 --> 02:43:18,234 I THINK THERE'S ALSO SOME 4561 02:43:18,234 --> 02:43:19,335 IMPORTANT WORK AROUND CARE 4562 02:43:19,335 --> 02:43:22,505 NAVIGATION, SO THIS IS A STUDY 4563 02:43:22,505 --> 02:43:23,706 THAT'S ONGOING THAT LOOKS AT 4564 02:43:23,706 --> 02:43:26,843 PRIMARY CARE SLEEP NAVIGATION 4565 02:43:26,843 --> 02:43:28,945 FOR CHILDREN WHO HAVE BEEN 4566 02:43:28,945 --> 02:43:30,680 REFERRED TO SPECIAL CARE TO HELP 4567 02:43:30,680 --> 02:43:32,315 THEM SUCCESSFULLY COMPLETE THAT 4568 02:43:32,315 --> 02:43:33,183 PATHWAY AND COORDINATE CARE AND 4569 02:43:33,183 --> 02:43:35,885 THIS IS BEING CONDUCTED BY 4570 02:43:35,885 --> 02:43:36,553 AERIAL WILLIAMSON AND 4571 02:43:36,553 --> 02:43:37,654 COLLEAGUES, SO EAGER TO SEE 4572 02:43:37,654 --> 02:43:43,459 THOSE RESULTS. 4573 02:43:43,459 --> 02:43:46,396 SO IN SUMMARY, I THINK WE HAVE A 4574 02:43:46,396 --> 02:43:48,031 REALLY IMPORTANT GAP REGARDING 4575 02:43:48,031 --> 02:43:49,232 INSUFFICIENT RATES OF 4576 02:43:49,232 --> 02:43:50,200 EVIDENCE-BASED DETECTION AND 4577 02:43:50,200 --> 02:43:51,534 CARE FOR PEDIATRIC OSA. 4578 02:43:51,534 --> 02:43:52,602 SO I THINK ONE OF THE THINGS FOR 4579 02:43:52,602 --> 02:43:55,872 ME THAT THIS WORKSHOP HAS 4580 02:43:55,872 --> 02:43:57,507 ILLUSTRATED IS THERE'S A LOT 4581 02:43:57,507 --> 02:43:59,375 THAT WE DON'T KNOW ABOUT 4582 02:43:59,375 --> 02:44:02,111 EVIDENCE-BASED TREATMENT AND 4583 02:44:02,111 --> 02:44:08,985 ADDRESSING HETEROYES NATE AND HD 4584 02:44:08,985 --> 02:44:09,719 PERSONALIZED TREATMENT. 4585 02:44:09,719 --> 02:44:11,187 WE HAVE A LOT TO LEARN. 4586 02:44:11,187 --> 02:44:13,189 AT THE SAME TIME THERE'S A LOT 4587 02:44:13,189 --> 02:44:14,324 THAT WE ALREADY KNOW AND WE WANT 4588 02:44:14,324 --> 02:44:15,625 TO MAKE SURE THAT'S GETTING TO 4589 02:44:15,625 --> 02:44:16,626 THE PATIENTS WHO NEED IT. 4590 02:44:16,626 --> 02:44:18,328 I THINK SOME GAPS RELATED TO 4591 02:44:18,328 --> 02:44:19,996 THIS, THERE'S NOT ENOUGH DATA ON 4592 02:44:19,996 --> 02:44:21,297 SEX AND GENDER AND HOW THAT 4593 02:44:21,297 --> 02:44:24,200 INFLUENCES DETECTION AND CARE. 4594 02:44:24,200 --> 02:44:24,968 UNIVERSAL SCREENING IS 4595 02:44:24,968 --> 02:44:27,370 RECOMMENDED BUT DOESN'T OCCUR. 4596 02:44:27,370 --> 02:44:29,172 THERE'S UNWARRANTED PRACTICE 4597 02:44:29,172 --> 02:44:30,874 VARIATION AND THERE ARE 4598 02:44:30,874 --> 02:44:32,609 BOTTLENECKS, BARRIERS AND MISSED 4599 02:44:32,609 --> 02:44:33,977 OPPORTUNITIES IN THE CARE 4600 02:44:33,977 --> 02:44:34,210 PATHWAY. 4601 02:44:34,210 --> 02:44:34,944 SO IF WE GO BACK TO THINKING 4602 02:44:34,944 --> 02:44:36,546 ABOUT THIS PATHWAY, I THINK 4603 02:44:36,546 --> 02:44:37,614 THERE'S SOME INTERVENTIONS THAT 4604 02:44:37,614 --> 02:44:40,350 CAN BE HELPFUL AT VARIOUS 4605 02:44:40,350 --> 02:44:41,317 STAGES. 4606 02:44:41,317 --> 02:44:43,419 SO TECHNOLOGY LIKE WEARABLES OR 4607 02:44:43,419 --> 02:44:46,122 BABY CAMERAS COULD MAKE PARENTS 4608 02:44:46,122 --> 02:44:49,292 AWARE OF SYMPTOMS ORIS BEING 4609 02:44:49,292 --> 02:44:49,959 FACTORS. 4610 02:44:49,959 --> 02:44:50,760 HEALTH COMMUNICATION MESSAGING 4611 02:44:50,760 --> 02:44:52,695 CAN HELP FAMILIES RECOGNIZE THAT 4612 02:44:52,695 --> 02:44:54,497 SYMPTOMS ARE A PROBLEM AND 4613 02:44:54,497 --> 02:44:56,065 ACTIVATE THEM TO TALK TO THEIR 4614 02:44:56,065 --> 02:44:57,734 PROVIDER. 4615 02:44:57,734 --> 02:44:59,769 UNIVERSAL SCREENING AT THE PCP 4616 02:44:59,769 --> 02:45:02,839 LEVEL, CLINICAL DECISION 4617 02:45:02,839 --> 02:45:04,574 SUPPORT, ALSO FAMILY ACTIVATION 4618 02:45:04,574 --> 02:45:07,043 AFTER THE REFERRAL, AS WELL AS 4619 02:45:07,043 --> 02:45:09,245 COORDINATION TO HELP FAMILIES 4620 02:45:09,245 --> 02:45:12,448 WHO ARE REFERRED COMPLETE THOSE 4621 02:45:12,448 --> 02:45:15,718 STEPS. 4622 02:45:15,718 --> 02:45:17,153 SO JUST TO SUMMARIZE, I THINK 4623 02:45:17,153 --> 02:45:18,254 SOME NICE OPPORTUNITIES ARE KIND 4624 02:45:18,254 --> 02:45:21,190 OF WEARABLES TO IDENTIFY RISK OR 4625 02:45:21,190 --> 02:45:22,825 TECHNOLOGY, AUTOMATED SCREENING, 4626 02:45:22,825 --> 02:45:24,093 SCALABLE CLINICAL DECISION 4627 02:45:24,093 --> 02:45:25,862 SUPPORT TOOLS POSSIBLY WITH 4628 02:45:25,862 --> 02:45:27,063 GENDER-SPECIFIC ALGORITHMS, 4629 02:45:27,063 --> 02:45:28,932 LEARNING MORE ABOUT PATIENT AK 4630 02:45:28,932 --> 02:45:30,033 VAITION SUPPORTING PATHWAYS TO 4631 02:45:30,033 --> 02:45:31,501 KAI AND YOU CAN SEE SOME OF THE 4632 02:45:31,501 --> 02:45:32,302 DISCIPLINES AND FRAMEWORKS THAT 4633 02:45:32,302 --> 02:45:33,403 I THINK COULD BE HELPFUL IN 4634 02:45:33,403 --> 02:45:34,037 THESE ENDEAVORS. 4635 02:45:34,037 --> 02:45:39,342 YOU THAT. 4636 02:45:39,342 --> 02:45:45,381 >> THANK YOU VERY MUCH FOR THIS 4637 02:45:45,381 --> 02:45:52,055 INTERESTING TALK ON PRIMARY CARE 4638 02:45:52,055 --> 02:45:53,690 AND IMPLEMENTATION OF PEDIATRIC 4639 02:45:53,690 --> 02:45:56,659 OSA AND STRIKING LOW RATES OF 4640 02:45:56,659 --> 02:45:57,327 UNDERDIAGNOSIS AND TREATMENT 4641 02:45:57,327 --> 02:45:58,194 LOOK BEING FORWARD TO DISCUSSION 4642 02:45:58,194 --> 02:45:59,395 LATER ON FOR THE CLINICAL 4643 02:45:59,395 --> 02:46:02,098 APPROACHES YOU DESCRIBED. 4644 02:46:02,098 --> 02:46:06,669 MOVING ON TO OUR THIRD SPEAKER, 4645 02:46:06,669 --> 02:46:14,644 OUR THIRD SPEAKER IS DR. SUZANN 4646 02:46:14,644 --> 02:46:17,814 BERTISCH, CLINICAL DIRECTOR OF 4647 02:46:17,814 --> 02:46:20,316 BEHAVIORAL SLEEP AT BRIGHAM'S 4648 02:46:20,316 --> 02:46:21,951 WOMEN HOSPITAL AND ASSISTANT 4649 02:46:21,951 --> 02:46:23,486 PROFESSOR AT HARVARD MEDICAL 4650 02:46:23,486 --> 02:46:23,820 SCHOOL. 4651 02:46:23,820 --> 02:46:26,222 HER TALK IS ENTITLED 4652 02:46:26,222 --> 02:46:27,924 INCORPORATING DISSEMINATION AND 4653 02:46:27,924 --> 02:46:29,258 IMPLEMENTATION SCIENCE IN SLEEP 4654 02:46:29,258 --> 02:46:29,692 CLINICAL TRIALS. 4655 02:46:29,692 --> 02:46:30,460 THE MICROPHONE IS YOURS. 4656 02:46:30,460 --> 02:46:31,561 >> THANK YOU SO MUCH FOR HAVING 4657 02:46:31,561 --> 02:46:32,261 ME. 4658 02:46:32,261 --> 02:46:33,930 I JUST WANT TO MAKE SURE, IT 4659 02:46:33,930 --> 02:46:35,565 LOOKS LIKE MY SLIDES ARE SHOWING 4660 02:46:35,565 --> 02:46:37,333 A LITTLE BIT FUNKY, SO LET ME 4661 02:46:37,333 --> 02:46:47,543 GET THEM -- 4662 02:46:50,847 --> 02:46:51,714 >> YOU'RE HAVING THE SAME 4663 02:46:51,714 --> 02:46:52,248 PROBLEM I HAD. 4664 02:46:52,248 --> 02:46:53,149 >> HERE WE GO. 4665 02:46:53,149 --> 02:46:53,716 OKAY. 4666 02:46:53,716 --> 02:46:59,822 SORRY. 4667 02:46:59,822 --> 02:47:01,491 THANK YOU SO MUCH FOR HAVING ME. 4668 02:47:01,491 --> 02:47:02,692 I THINK I'M THE LAST SPEAKER OF 4669 02:47:02,692 --> 02:47:03,559 THE CONFERENCE, SO THANK 4670 02:47:03,559 --> 02:47:05,762 EVERYBODY FOR STAYING, STICKING 4671 02:47:05,762 --> 02:47:09,232 AROUND FOR OUR LAST SESSION ON 4672 02:47:09,232 --> 02:47:09,966 IMPLEMENTATION SCIENCE. 4673 02:47:09,966 --> 02:47:11,100 I'M REALLY EXCITED THAT THIS 4674 02:47:11,100 --> 02:47:13,469 SESSION WAS INCLUDED BECAUSE 4675 02:47:13,469 --> 02:47:14,637 IT'S NEAR AND DEAR TO A LOT OF 4676 02:47:14,637 --> 02:47:24,914 THE WORK WE DO. 4677 02:47:28,317 --> 02:47:31,754 I DO RECEIVE CONSULTING FEES 4678 02:47:31,754 --> 02:47:33,489 FROM INDUSTRY BUT I HAVE NO 4679 02:47:33,489 --> 02:47:35,358 ACTUAL CONFLICT OF INTEREST IN 4680 02:47:35,358 --> 02:47:38,461 RELATION TO WHAT I'M SPEAKING ON 4681 02:47:38,461 --> 02:47:38,961 TODAY. 4682 02:47:38,961 --> 02:47:42,698 I KNOW DR. TOBIN GAVE A NICE 4683 02:47:42,698 --> 02:47:44,233 OVERVIEW AND I WILL JUST TOUCH 4684 02:47:44,233 --> 02:47:45,001 ON SOME POINTS BRIEFLY. 4685 02:47:45,001 --> 02:47:46,335 SO AT THE BEGINNING AND 4686 02:47:46,335 --> 02:47:47,403 THROUGHOUT THE TALK AS WELL. 4687 02:47:47,403 --> 02:47:48,304 THEN WE'LL TALK ABOUT SOME OF 4688 02:47:48,304 --> 02:47:49,839 THE APPROACHES AND EXAMPLES 4689 02:47:49,839 --> 02:47:52,408 SPECIFIC TO THE SLEEP LITERATURE 4690 02:47:52,408 --> 02:47:53,876 WITH IMPLEMENTATION SCIENCE HAS 4691 02:47:53,876 --> 02:47:56,045 BEEN LEVERAGED TO IMPROVE THE 4692 02:47:56,045 --> 02:47:57,547 SCIENCE AND I'LL WRAP UP WITH 4693 02:47:57,547 --> 02:48:00,783 SOME KEY POINTS AND THEN WE'LL 4694 02:48:00,783 --> 02:48:02,018 OPEN FOR DISCUSSION AT THE END. 4695 02:48:02,018 --> 02:48:03,653 SO ALREADY TALKED ABOUT TODAY, 4696 02:48:03,653 --> 02:48:05,588 THE REAL GOAL OF IMPLEMENTATION 4697 02:48:05,588 --> 02:48:07,056 SCIENCE IS A METHODOLOGY TO TAKE 4698 02:48:07,056 --> 02:48:09,225 WHAT WE KNOW FROM OUR RESEARCH 4699 02:48:09,225 --> 02:48:10,960 IN OUR CLINICAL RESEARCH FINDING 4700 02:48:10,960 --> 02:48:12,462 AND BRING TO THE BEDSIDE TO THE 4701 02:48:12,462 --> 02:48:13,996 PATIENT TO THE COMMUNITY AND 4702 02:48:13,996 --> 02:48:15,198 REALLY INFORM WHAT WE DO. 4703 02:48:15,198 --> 02:48:18,367 AND I THINK IMPLEMENTATION 4704 02:48:18,367 --> 02:48:19,769 SCIENCE IS THE TOOLBOX THAT 4705 02:48:19,769 --> 02:48:20,937 REALLY GIVES US AN ARRAY OF 4706 02:48:20,937 --> 02:48:22,338 TOOLS TO FIGURE OUT THE HOW AND 4707 02:48:22,338 --> 02:48:23,906 HOW CAN WE ACTUALLY OVERCOME 4708 02:48:23,906 --> 02:48:26,008 THIS GAP OF EFFECTIVE TREATMENTS 4709 02:48:26,008 --> 02:48:26,843 FOR SLEEP APNEA BUT HOW DO WE 4710 02:48:26,843 --> 02:48:27,910 ACTUALLY GET THEM TO THE HANDS 4711 02:48:27,910 --> 02:48:29,979 OF OUR PAITION OR AT THE 4712 02:48:29,979 --> 02:48:31,581 BEDSIDES AND USE THEM MORE 4713 02:48:31,581 --> 02:48:32,215 READILY IN THE CLINIC? 4714 02:48:32,215 --> 02:48:36,486 AS WAS TALKED ABOUT ACTUALLY 4715 02:48:36,486 --> 02:48:39,655 EARLIER, YESTERDAY, SHE HAD THIS 4716 02:48:39,655 --> 02:48:40,123 ON ONE OF HER SLIDES. 4717 02:48:40,123 --> 02:48:41,324 IT'S IMPORTANT TO NOTE THAT 4718 02:48:41,324 --> 02:48:42,391 IMPLEMENTATION SCIENCE IN 4719 02:48:42,391 --> 02:48:45,461 GENERAL CLOSELY ALIGNS TO -- IN 4720 02:48:45,461 --> 02:48:46,329 WHAT WE'VE TALKED ABOUT TODAY, 4721 02:48:46,329 --> 02:48:48,064 PRINCIPLES OF EQUITY, WHICH IS 4722 02:48:48,064 --> 02:48:49,398 DEFINED AS GIVING EVERYONE A 4723 02:48:49,398 --> 02:48:52,101 FAIR AND JUST OPPORTUNITY TO BE 4724 02:48:52,101 --> 02:48:53,636 AS HEALTHY AS POSSIBLE. 4725 02:48:53,636 --> 02:48:55,538 AND THE FIELD OF IMPLEMENTATION 4726 02:48:55,538 --> 02:48:57,140 SCIENCE CAN HELP US ADDRESS 4727 02:48:57,140 --> 02:48:58,674 THESE INEQUITIES BY HELPING US 4728 02:48:58,674 --> 02:49:01,744 STUDY THE FACTORS, PROCESSES AND 4729 02:49:01,744 --> 02:49:03,913 STRATEGIES AT MULTIPLE LEVELS OF 4730 02:49:03,913 --> 02:49:05,915 A SYSTEM OF CARE THAT INFLUENCED 4731 02:49:05,915 --> 02:49:11,787 THE UPPER TAKE, UP TAKE, USE ANY 4732 02:49:11,787 --> 02:49:13,222 SUSTAINABILITY OF OUR 4733 02:49:13,222 --> 02:49:14,857 EVIDENCE-BASED INTERVENTIONS AS 4734 02:49:14,857 --> 02:49:15,525 WELL AS POLICIES IN DIFFERENT 4735 02:49:15,525 --> 02:49:16,626 COMMUNITY AND PRACTICE SETTINGS. 4736 02:49:16,626 --> 02:49:17,927 SO JUST AS AN EXAMPLE I THINK 4737 02:49:17,927 --> 02:49:19,729 ABOUT IN SLEEP RESEARCH, THERE 4738 02:49:19,729 --> 02:49:20,963 ARE SEVERAL DIFFERENT CLINICAL 4739 02:49:20,963 --> 02:49:21,831 PRACTICE GUIDELINES. 4740 02:49:21,831 --> 02:49:23,166 I JUST PULLED ONE OF THE MORE 4741 02:49:23,166 --> 02:49:25,801 RECENT ONES FOR THE AMERICAN 4742 02:49:25,801 --> 02:49:32,441 THORACIC SOCIETY IN WHICH THE 4743 02:49:32,441 --> 02:49:33,910 GUIDELINES RECOMMENDS 4744 02:49:33,910 --> 02:49:36,012 PARTICIPATION IN A COMPREHENSIVE 4745 02:49:36,012 --> 02:49:37,313 LIFESTYLE INTERVENTION PROGRAM 4746 02:49:37,313 --> 02:49:38,814 FOR WEIGHT MANAGEMENT AND 4747 02:49:38,814 --> 02:49:40,216 TREATMENT OF OBSTRUCTIVE SLEEP 4748 02:49:40,216 --> 02:49:40,416 APNEA. 4749 02:49:40,416 --> 02:49:41,450 HOWEVER WHAT THE GUIDELINE 4750 02:49:41,450 --> 02:49:42,652 DOESN'T TELL US IS HOW WE 4751 02:49:42,652 --> 02:49:44,020 ACTUALLY USE THIS IN OUR 4752 02:49:44,020 --> 02:49:44,854 CLINICAL SETTINGS SO THERE'S NO 4753 02:49:44,854 --> 02:49:46,355 ROAD MAP ON HOW TO DISSEMINATE 4754 02:49:46,355 --> 02:49:48,024 AND BROADLY IMPLEMENT THESE 4755 02:49:48,024 --> 02:49:48,524 GUIDELINES. 4756 02:49:48,524 --> 02:49:49,926 THE OTHER ISSUE IS THAT ASSUMING 4757 02:49:49,926 --> 02:49:51,060 THAT ALL OF THESE TREATMENTS 4758 02:49:51,060 --> 02:49:53,029 WILL IMPROVE NOT JUST THE 4759 02:49:53,029 --> 02:49:55,531 QUALITY BUT ALSO COST AND SYSTEM 4760 02:49:55,531 --> 02:49:57,600 OUTCOMES, ONCE THEY'RE 4761 02:49:57,600 --> 02:49:58,467 DISSEMINATED, OVERLOOKS, AGAIN, 4762 02:49:58,467 --> 02:50:00,836 SOME OF THE FACTORS WE'VE HEARD 4763 02:50:00,836 --> 02:50:01,604 ABOUT IN THE OTHER TWO TALKS IN 4764 02:50:01,604 --> 02:50:02,905 THIS SESSION, IS THAT THE 4765 02:50:02,905 --> 02:50:04,674 CONTEXT IN WHICH WE DELIVER 4766 02:50:04,674 --> 02:50:06,342 THESE TREATMENT STRATEGIES ARE 4767 02:50:06,342 --> 02:50:07,276 REALLY IMPORTANT, SO WE'VE 4768 02:50:07,276 --> 02:50:08,811 TALKED A LOT IN THE LAST FEW 4769 02:50:08,811 --> 02:50:11,214 DAYS ABOUT THE SEX AND GENDER 4770 02:50:11,214 --> 02:50:14,917 DIVERSITY OF THE SLEEP APNEA 4771 02:50:14,917 --> 02:50:19,155 POPULATION, BUT THERE'S ALSO 4772 02:50:19,155 --> 02:50:20,323 DIVERSITY OF PROVIDERS IN THE 4773 02:50:20,323 --> 02:50:22,124 SETTINGS OF WHICH WE DELIVER THE 4774 02:50:22,124 --> 02:50:23,125 INTERVENTION AND IT'S UNLAKELY 4775 02:50:23,125 --> 02:50:25,628 THAT THE SAME STRATEGIES CAN BE 4776 02:50:25,628 --> 02:50:26,963 IMPLEMENTED SUCCESSFULLY ACROSS 4777 02:50:26,963 --> 02:50:28,798 THE CONTEXT. 4778 02:50:28,798 --> 02:50:29,966 MENTIONED ALREADY, THIS IS 4779 02:50:29,966 --> 02:50:30,967 REALLY MORE THAN BECAUSE WE KNOW 4780 02:50:30,967 --> 02:50:32,702 SLEEP APNEA IS A VERY DIFFERENT 4781 02:50:32,702 --> 02:50:34,537 DISEASE, WHETHER ENDOTYPE OR 4782 02:50:34,537 --> 02:50:35,738 PHENOTYPE AND EVEN WHAT IT LOOKS 4783 02:50:35,738 --> 02:50:41,010 LIKE IN THE FACES IN OUR CLINIC. 4784 02:50:41,010 --> 02:50:42,645 IN LIGHT OF THIS, IT'S IMPORTANT 4785 02:50:42,645 --> 02:50:43,813 FOR US AS A FIELD TO EVEN START 4786 02:50:43,813 --> 02:50:44,580 ASKING MORE QUESTIONS. 4787 02:50:44,580 --> 02:50:45,481 AGAIN THERE'S BEEN A LOT OF 4788 02:50:45,481 --> 02:50:47,350 QUESTIONS TODAY ABOUT ENDOTYPES 4789 02:50:47,350 --> 02:50:48,784 AND PHENOTYPES AND SEX AND 4790 02:50:48,784 --> 02:50:51,821 GENDER, BUT ALSO OTHER QUESTIONS 4791 02:50:51,821 --> 02:50:53,889 TA WE'LL SORT OF PEPPER IN AND 4792 02:50:53,889 --> 02:50:55,091 TALK ABOUT HOW WE CAN THINK OF 4793 02:50:55,091 --> 02:50:57,159 THIS AND ALSO TO URGE PEOPLE AND 4794 02:50:57,159 --> 02:50:58,961 THINK ABOUT THIS EARLIER ON IN 4795 02:50:58,961 --> 02:51:00,162 THE TRANSLATIONAL SPECTRUM, AND 4796 02:51:00,162 --> 02:51:03,099 HOW DO WE ACTUALLY THINK ABOUT 4797 02:51:03,099 --> 02:51:04,533 CONSIDERING SEX AND GENDER 4798 02:51:04,533 --> 02:51:05,801 DIFFERENCES AND DEVELOPING OUR 4799 02:51:05,801 --> 02:51:07,169 INTERVENTIONS, ALSO HOW DO WE 4800 02:51:07,169 --> 02:51:08,437 MEASURE AND ANALYZE THE EFFECTS 4801 02:51:08,437 --> 02:51:10,873 OF SEX AND GENDER ON SLEEP APNEA 4802 02:51:10,873 --> 02:51:11,907 OUTCOMES AND THEN DOWN THE LINE 4803 02:51:11,907 --> 02:51:15,878 IN THE FUTURE, ON IMPLEMENTATION 4804 02:51:15,878 --> 02:51:16,946 OUTCOMES. 4805 02:51:16,946 --> 02:51:18,547 SO WHAT ARE SOME EXAMPLES OF 4806 02:51:18,547 --> 02:51:21,651 BARRIERS TO IMPLEMENTATION? 4807 02:51:21,651 --> 02:51:24,387 SARAH JUST TALKED A LOT ABOUT 4808 02:51:24,387 --> 02:51:28,224 THIS, THE BARRIERS TO PEDIATRIC 4809 02:51:28,224 --> 02:51:29,225 SLEEP APNEA IN THE PRIMARY CARE 4810 02:51:29,225 --> 02:51:30,960 SETTING BUT ALSO TALK A LITTLE 4811 02:51:30,960 --> 02:51:31,794 ABOUT WHY WE SHOULD CONSIDER THE 4812 02:51:31,794 --> 02:51:33,796 SEX AN AND GENDER DIFFERENCES. 4813 02:51:33,796 --> 02:51:35,998 SO EVEN IF WE HAVE A TREATMENT 4814 02:51:35,998 --> 02:51:38,234 THAT'S 100% EFFICACIOUS, YOU CAN 4815 02:51:38,234 --> 02:51:39,535 ALMOST THINK ABOUT SOMETHING -- 4816 02:51:39,535 --> 02:51:40,970 CPAP IS ACTUALLY NEARLY 4817 02:51:40,970 --> 02:51:44,807 EFFICACIOUS RIGHT IN THE IDEAL 4818 02:51:44,807 --> 02:51:46,642 SETTINGS, BUT WHERE IT DROPS -- 4819 02:51:46,642 --> 02:51:48,611 WHERE THE VOLTAGE DROPS, THE 4820 02:51:48,611 --> 02:51:54,850 EFFECTS OF CPAP ARE DONE BECAUSE 4821 02:51:54,850 --> 02:51:56,285 WE HAVE LIMITATIONS ON THE 4822 02:51:56,285 --> 02:51:56,886 INDIVIDUAL PATIENT LEVEL ABOUT 4823 02:51:56,886 --> 02:51:58,321 PEOPLE DON'T ADOPT IT, IT'S NOT 4824 02:51:58,321 --> 02:52:04,327 ACCEPTABLE TO SOME PATIENTS, 4825 02:52:04,327 --> 02:52:05,861 THEN OTHER THINGS THAT 4826 02:52:05,861 --> 02:52:08,731 INTERFERE, EVEN IF THINGS ARE 4827 02:52:08,731 --> 02:52:10,266 ARE 100% EFFECTIVE, THE IMPACT 4828 02:52:10,266 --> 02:52:11,901 ALSO DEPENDS ON THE FIDELITY OF 4829 02:52:11,901 --> 02:52:12,668 THE INTERVENTION AS WELL AS THE 4830 02:52:12,668 --> 02:52:14,170 FEASIBILITY AND APPROPRIATENESS, 4831 02:52:14,170 --> 02:52:16,605 AND THAT SOME OF THE QUESTIONS 4832 02:52:16,605 --> 02:52:18,341 YOU THINK ABOUT, IS IT 4833 02:52:18,341 --> 02:52:20,476 APPROPRIATE FOR EVERYBODY, HOW 4834 02:52:20,476 --> 02:52:21,977 THIS ACTUALLY MAY VARY BY SOME 4835 02:52:21,977 --> 02:52:23,713 OF THE BOTH BIOLOGICAL AS WELL 4836 02:52:23,713 --> 02:52:26,015 AS SOCIAL FEATURES AS WELL. 4837 02:52:26,015 --> 02:52:27,416 EVEN IF AN INTERVENTION IS 100% 4838 02:52:27,416 --> 02:52:28,351 EFFECTIVE, SO IT BEEN SHOWN TO 4839 02:52:28,351 --> 02:52:30,386 BE EFFECTIVE IN THE REAL WORLD, 4840 02:52:30,386 --> 02:52:32,355 ITS IMPACT IS ALSO DIMINISHED BY 4841 02:52:32,355 --> 02:52:34,423 WE CAN THINK ABOUT MORE SYSTEM 4842 02:52:34,423 --> 02:52:34,957 FACTORS. 4843 02:52:34,957 --> 02:52:36,292 OUR SYSTEM IS GOING TO ADOPT 4844 02:52:36,292 --> 02:52:38,894 THESE PRACTICES, CAN WE TRAIN 4845 02:52:38,894 --> 02:52:43,165 PRACTITIONERS TO DELIVER THESE 4846 02:52:43,165 --> 02:52:44,300 INTERVENTIONS AND THEN CAN THEY 4847 02:52:44,300 --> 02:52:45,368 ACTUALLY DELIVER IT WITH 4848 02:52:45,368 --> 02:52:49,638 FIDELITY AS WELL. 4849 02:52:49,638 --> 02:52:53,008 ARE WE GIVING PATIENTS ACCESS TO 4850 02:52:53,008 --> 02:52:54,210 TREATMENT, IF WE THINK ABOUT 4851 02:52:54,210 --> 02:52:55,411 PATIENTS ACCESS TO TREATMENT AT 4852 02:52:55,411 --> 02:52:57,713 A POPULATION LEVEL, CAN THESE 4853 02:52:57,713 --> 02:52:58,948 INTERVENTIONS BE SUSTAINED OVER 4854 02:52:58,948 --> 02:52:59,148 TIME. 4855 02:52:59,148 --> 02:53:00,116 SO THESE ARE ALL THINGS THAT 4856 02:53:00,116 --> 02:53:01,350 AGAIN THE FIELD OF 4857 02:53:01,350 --> 02:53:02,418 IMPLEMENTATION SCIENCE SOMETIMES 4858 02:53:02,418 --> 02:53:05,488 REFER TO AS THE VOLTAGE DROP, 4859 02:53:05,488 --> 02:53:06,789 THAT AS WE TAKE SOMETHING FROM 4860 02:53:06,789 --> 02:53:08,124 THE CONTROLLED CLINICAL TRIAL 4861 02:53:08,124 --> 02:53:10,292 SETTINGS, THEY HAVE LESS 4862 02:53:10,292 --> 02:53:10,926 EFFECTIVENESS IN THE REAL WORLD 4863 02:53:10,926 --> 02:53:12,695 DUE TO A VARIETY OF FACTORS 4864 02:53:12,695 --> 02:53:14,130 INCLUDING PATIENT HETEROGENEITY. 4865 02:53:14,130 --> 02:53:16,932 SO THIS IS THE SLIDE THAT 4866 02:53:16,932 --> 02:53:19,034 DR. REDLINE SHOWED IN ONE TALK 4867 02:53:19,034 --> 02:53:21,237 IN THINKING ABOUT HOW SEX AND 4868 02:53:21,237 --> 02:53:25,341 GENDER PERMEATE EACH LEVEL OF 4869 02:53:25,341 --> 02:53:26,809 SLEEP APNEA THINKING ABOUT BOTH 4870 02:53:26,809 --> 02:53:30,479 SOCIETAL, INS TAWTIONAL, IN 4871 02:53:30,479 --> 02:53:31,547 ADDITION HOUSES AND INDIVIDUAL 4872 02:53:31,547 --> 02:53:33,048 DIFFERENCES BUT IT'S ALSO 4873 02:53:33,048 --> 02:53:33,649 IMPORTANT TO THINK ABOUT HOW 4874 02:53:33,649 --> 02:53:36,786 THESE FACTORS ALSO IMPACT OUR 4875 02:53:36,786 --> 02:53:42,258 ABILITY TO ADAPT AND SUSTAIN 4876 02:53:42,258 --> 02:53:42,825 TREATMENT. 4877 02:53:42,825 --> 02:53:44,026 AGAIN THIS IS IS GOING BACK TO 4878 02:53:44,026 --> 02:53:46,262 THE CONTEXTUAL FACTORS AND EVEN 4879 02:53:46,262 --> 02:53:47,696 IF WE FOCUS ON THE INDIVIDUAL 4880 02:53:47,696 --> 02:53:49,198 LEVEL FACTORS, WE KNOW THAT THE 4881 02:53:49,198 --> 02:53:50,433 CONTEXT IS ULTIMATELY GOING TO 4882 02:53:50,433 --> 02:53:54,603 IP FLTOINFLUENCE IMPLEMENTATION. 4883 02:53:54,603 --> 02:53:56,138 SEX AND GENDER ROLES ARE OFTEN 4884 02:53:56,138 --> 02:54:01,911 VERY INTERWOVEN TO THE FABRIC OF 4885 02:54:01,911 --> 02:54:02,978 SOCIAL, ECONOMIC, EVEN 4886 02:54:02,978 --> 02:54:03,846 BIOLOGICAL FACTORS, AND WE 4887 02:54:03,846 --> 02:54:04,947 SHOULD CONSIDER OW SEX AND 4888 02:54:04,947 --> 02:54:06,649 GENDER BEYOND JUST A LOT OF THE 4889 02:54:06,649 --> 02:54:07,983 BIOLOGY TALKED ABOUT TODAY, 4890 02:54:07,983 --> 02:54:10,920 ABOUT HOW SEX AND GENDER ROLES, 4891 02:54:10,920 --> 02:54:12,788 IDENTITY RELATIONS AND 4892 02:54:12,788 --> 02:54:13,956 INSTITUTIONALIZED GENDER 4893 02:54:13,956 --> 02:54:14,824 INFLUENCE THESE FACTORS AT A 4894 02:54:14,824 --> 02:54:18,327 VARIETY OF LEVELS. 4895 02:54:18,327 --> 02:54:20,162 SO WE SHOULD CONSIDER ASKING 4896 02:54:20,162 --> 02:54:21,697 QUESTIONS SUCH AS, YOU KNOW, IN 4897 02:54:21,697 --> 02:54:23,032 THINKING ABOUT, FOR EXAMPLE, 4898 02:54:23,032 --> 02:54:25,034 DIAGNOSIS AND TREATING SLEEP 4899 02:54:25,034 --> 02:54:26,068 APNEA, AGAIN, WE SHOULD BE 4900 02:54:26,068 --> 02:54:27,670 ASKING QUESTIONS BEYOND THE 4901 02:54:27,670 --> 02:54:29,472 BIOLOGY THAT INFLUENCED REAL 4902 02:54:29,472 --> 02:54:31,006 WORLD PRACTICE AND HOW CAN WE 4903 02:54:31,006 --> 02:54:32,808 CONSIDER GENDER ROLES HELPING US 4904 02:54:32,808 --> 02:54:34,677 TO UNDERSTAND AND ANTICIPATE 4905 02:54:34,677 --> 02:54:36,412 BARRIERS AND OPPORTUNITIES 4906 02:54:36,412 --> 02:54:37,947 FACING HEALTHCARE PROFESSIONALS 4907 02:54:37,947 --> 02:54:44,720 AND UPTAKE OF NEW INTERVENTIONS. 4908 02:54:44,720 --> 02:54:45,721 SO ONE EXAMPLE IS CLINICALLY AS 4909 02:54:45,721 --> 02:54:47,590 A PHYSICIAN, I'VE HAD NUMEROUS 4910 02:54:47,590 --> 02:54:49,158 PATIENTS WHO IDENTIFY AS FEMALE 4911 02:54:49,158 --> 02:54:53,262 OVER THE YEARS SAY THAT THEY'VE 4912 02:54:53,262 --> 02:54:54,230 DELAYED IN ACCESSING CARE FOR 4913 02:54:54,230 --> 02:54:55,798 SLEEP APNEA BECAUSE OF STIGMA 4914 02:54:55,798 --> 02:54:57,333 RELATED TO BODY WEIGHT AND BEING 4915 02:54:57,333 --> 02:55:00,503 AN UNHEALTHY -- THAT AFFECT 4916 02:55:00,503 --> 02:55:02,037 WOMEN AS WELL, WE'VE HEARD 4917 02:55:02,037 --> 02:55:02,905 EARLIER THAT YOUNGER WOMEN 4918 02:55:02,905 --> 02:55:04,273 ACTUALLY HAVE THE LOWEST RATES 4919 02:55:04,273 --> 02:55:05,140 OF CPAP TO ADHERENCE. 4920 02:55:05,140 --> 02:55:07,409 SO AGAIN, THERE'S SEX AND GENDER 4921 02:55:07,409 --> 02:55:08,310 ISSUES. 4922 02:55:08,310 --> 02:55:12,648 AND ALSO THINKING ABOUT A 4923 02:55:12,648 --> 02:55:13,182 PARTICULAR DECISION-MAKING 4924 02:55:13,182 --> 02:55:14,183 GROUP, AGAIN THESE ARE PEOPLE 4925 02:55:14,183 --> 02:55:16,919 WHO INFLUENCE THE ADOPTION OF 4926 02:55:16,919 --> 02:55:18,787 POLICIES, HOW WE MIGHT ACTUALLY 4927 02:55:18,787 --> 02:55:19,722 CONSIDER INSTITUTIONALIZED 4928 02:55:19,722 --> 02:55:19,955 GENDER. 4929 02:55:19,955 --> 02:55:22,258 THIS IS JUST AN EXAMPLE, MAYBE 4930 02:55:22,258 --> 02:55:23,792 MORE SUBTLE, IN MY OWN PRACTICE 4931 02:55:23,792 --> 02:55:25,761 WE HAVE MANNEQUINS OF VARIOUS 4932 02:55:25,761 --> 02:55:28,063 MASKS IN THE CLINIC BUT AGAIN, 4933 02:55:28,063 --> 02:55:29,465 THEY'RE ALL MANNEQUINS, THEY'RE 4934 02:55:29,465 --> 02:55:30,799 ALL REPRESENTATIONS OF MALE 4935 02:55:30,799 --> 02:55:32,535 FIGURES WEARING CPAP. 4936 02:55:32,535 --> 02:55:34,570 NONE OF MY FEMALE PATIENTS 4937 02:55:34,570 --> 02:55:36,672 ACTUALLY HAVE ANY EXAMPLES OR 4938 02:55:36,672 --> 02:55:38,941 VISUALS OF WOMEN WITH CPAP IN 4939 02:55:38,941 --> 02:55:39,608 OUR CLINICAL SPACE. 4940 02:55:39,608 --> 02:55:41,911 SO AGAIN, THAT'S MAYBE A SORT OF 4941 02:55:41,911 --> 02:55:43,445 AN IMPLICIT BIAS TOWARDS WHOEVER 4942 02:55:43,445 --> 02:55:44,747 PURCHASED THE MANNEQUIN FOR OUR 4943 02:55:44,747 --> 02:55:46,248 CLINIC, BUT IT'S IMPORTANT TO 4944 02:55:46,248 --> 02:55:48,884 THINK ABOUT HOW BOTH ON AN 4945 02:55:48,884 --> 02:55:49,985 INDIVIDUAL PRACTICE LEVEL AND 4946 02:55:49,985 --> 02:55:52,388 EVEN IPS TEUTIONALLIZE HOW SEX 4947 02:55:52,388 --> 02:55:54,590 AND GENDER ROLES MAY ACTUALLY 4948 02:55:54,590 --> 02:55:55,658 EVENTUALLY INFLUENCE OUR ABILITY 4949 02:55:55,658 --> 02:55:57,993 TO TREAT THE VARIETY OF PATIENTS 4950 02:55:57,993 --> 02:56:00,362 WE SEE IN SLEEP APNEA. 4951 02:56:00,362 --> 02:56:02,398 AND AGAIN, ONE EXAMPLE IS HOW DO 4952 02:56:02,398 --> 02:56:04,166 WE CONSIDER GENDER WHEN ROLLING 4953 02:56:04,166 --> 02:56:06,135 OUT PAP EDUCATION MATERIALS AND 4954 02:56:06,135 --> 02:56:10,139 PROGRAMS. 4955 02:56:10,139 --> 02:56:11,574 SO THE NEXT PART OF THE TALK, 4956 02:56:11,574 --> 02:56:12,875 I'M GOING TO FOCUS BRIEFLY ON 4957 02:56:12,875 --> 02:56:14,643 SHOWING EXAMPLES OF HOW 4958 02:56:14,643 --> 02:56:17,012 DIFFERENT RESEARCHERS HAVE 4959 02:56:17,012 --> 02:56:18,013 LEVERAGED IMPLEMENTATION SCIENCE 4960 02:56:18,013 --> 02:56:19,214 AGAIN ACROSS THE TRANSLATIONAL 4961 02:56:19,214 --> 02:56:19,548 STUDY. 4962 02:56:19,548 --> 02:56:23,586 SO THE FIRST EXAMPLE IS TO SHOW 4963 02:56:23,586 --> 02:56:24,520 PATIENTS LEVERAGING 4964 02:56:24,520 --> 02:56:27,456 IMPLEMENTATION SCIENCE. 4965 02:56:27,456 --> 02:56:29,058 I'M GOING TO SORT OF SUMMARIZE 4966 02:56:29,058 --> 02:56:31,126 SOME OF THE CORE ELEMENTS THAT 4967 02:56:31,126 --> 02:56:32,595 SORT OF ARE CONSISTENT ABOUT 4968 02:56:32,595 --> 02:56:33,796 STUDIES AND HOW WE'VE BEEN ABLE 4969 02:56:33,796 --> 02:56:36,365 TO LEVERAGE THIS ROBUST 4970 02:56:36,365 --> 02:56:36,665 METHODOLOGY. 4971 02:56:36,665 --> 02:56:39,101 SO SOME OF THE CORE ELEMENTS 4972 02:56:39,101 --> 02:56:41,403 INCLUDE USING DIFFERENT 4973 02:56:41,403 --> 02:56:43,305 THEORIES, MODELS AND FRAME WORKS 4974 02:56:43,305 --> 02:56:44,506 TO DESIGN STUDIES AND TO THINK 4975 02:56:44,506 --> 02:56:46,275 ABOUT COLLECTING OUTCOMES AND 4976 02:56:46,275 --> 02:56:47,910 IMPLEMENTING THE STUDIES 4977 02:56:47,910 --> 02:56:49,345 THEMSELVES. 4978 02:56:49,345 --> 02:56:50,546 STAKEHOLDER COLLABORATOR 4979 02:56:50,546 --> 02:56:51,280 ENGAGEMENT. 4980 02:56:51,280 --> 02:56:53,382 SELECTION OF INTERVENTIONS, 4981 02:56:53,382 --> 02:56:54,950 EVALUATION MEASURES AND AS WELL 4982 02:56:54,950 --> 02:57:01,657 AS IMPLEMENTATION STRATEGIES. 4983 02:57:01,657 --> 02:57:04,193 WHICH WE'LL TALK ABOUT IN A BIT. 4984 02:57:04,193 --> 02:57:07,396 THIS REALLY DESCRIBES AN ATTEMPT 4985 02:57:07,396 --> 02:57:09,732 TO GUIDE RESEARCHERS THINKING 4986 02:57:09,732 --> 02:57:11,700 ABOUT IMPLEMENTATION STUDIES OF 4987 02:57:11,700 --> 02:57:12,468 EVIDENCE-BASED INTERVENTIONS. 4988 02:57:12,468 --> 02:57:13,902 SO THE FIRST PART WHEN YOU'RE 4989 02:57:13,902 --> 02:57:14,837 SORT OF APPROACHING AND THINKING 4990 02:57:14,837 --> 02:57:16,171 ABOUT WHERE IS MY RESEARCH ON 4991 02:57:16,171 --> 02:57:17,906 THE IMPLEMENTATION SCIENCE 4992 02:57:17,906 --> 02:57:18,474 SPECTRUM IS TO IDENTIFY A 4993 02:57:18,474 --> 02:57:19,041 PRACTICE OF INTEREST. 4994 02:57:19,041 --> 02:57:20,909 THIS IS AN EVIDENCE-BASED 4995 02:57:20,909 --> 02:57:21,243 PRACTICE. 4996 02:57:21,243 --> 02:57:22,978 IT CAN BE A PROCEDURE, IT CAN BE 4997 02:57:22,978 --> 02:57:24,647 A GUIDELINE, IT CAN BE A 4998 02:57:24,647 --> 02:57:26,148 PRACTICE CARE PATHWAY, AND THE 4999 02:57:26,148 --> 02:57:30,152 FIRST QUESTION TO ASK IS, DOES 5000 02:57:30,152 --> 02:57:32,888 THIS -- IS THIS POI EFFICACIOUS. 5001 02:57:32,888 --> 02:57:34,323 SO IS THERE EFFICACY. 5002 02:57:34,323 --> 02:57:36,025 AND THEN IF THE ANSWER IS NO, 5003 02:57:36,025 --> 02:57:40,429 THEN YOU'RE GOING TO DESIGN YOUR 5004 02:57:40,429 --> 02:57:48,270 RESEARCH ALONG THIS RED PATHWAY. 5005 02:57:48,270 --> 02:57:49,571 IT'S IMPORTANT TO KEEP IN MIND 5006 02:57:49,571 --> 02:57:50,939 EVEN THOUGH THIS EFFICACY 5007 02:57:50,939 --> 02:57:52,641 RESEARCH IS NOT YET IN THE 5008 02:57:52,641 --> 02:57:54,476 YELLOW OR GREEN ZONE WHERE WE 5009 02:57:54,476 --> 02:57:55,644 REALLY START TO DEFINE 5010 02:57:55,644 --> 02:57:56,979 IMPLEMENTATION RESEARCH, AS 5011 02:57:56,979 --> 02:57:58,380 DR. TOBIN POINTED OUT, YOU COULD 5012 02:57:58,380 --> 02:58:00,349 DESIGN FOR IMPLEMENTATION OR FOR 5013 02:58:00,349 --> 02:58:01,216 DISSEMINATION IN MIND. 5014 02:58:01,216 --> 02:58:03,952 AGAIN, IF YOU HAVE A VERY 5015 02:58:03,952 --> 02:58:06,555 COMPLICATED, CLUNKY IP 5016 02:58:06,555 --> 02:58:07,222 INTERVENTION, IT'S JUST NOT 5017 02:58:07,222 --> 02:58:08,290 GOING TO MAKE IT OUT IN THE REAL 5018 02:58:08,290 --> 02:58:09,525 WORLD SETTING, SO IT'S IMPORTANT 5019 02:58:09,525 --> 02:58:11,393 TO THINK ABOUT THESE PRINCIPLES. 5020 02:58:11,393 --> 02:58:13,829 SO DR. WILLIAMSON, THIS IS SORT 5021 02:58:13,829 --> 02:58:16,198 OF AN EXEMPLAR MODEL DESIGNING 5022 02:58:16,198 --> 02:58:17,666 FOR DISSEMINATION IMPLEMENTATION 5023 02:58:17,666 --> 02:58:19,401 IN MIND WHEN SHE WAS DEVELOPING 5024 02:58:19,401 --> 02:58:24,540 AND ADAPTING BEHAVIORAL 5025 02:58:24,540 --> 02:58:25,207 INTERVENTIONS FOR YOUNG CHILDREN 5026 02:58:25,207 --> 02:58:29,778 OF LOW SES OR RACIAL/ETHNICALLY 5027 02:58:29,778 --> 02:58:30,646 MINORITIES BACKGROUNDS AGAIN IN 5028 02:58:30,646 --> 02:58:32,514 THE PRIMARY CARE SETTING AND AS 5029 02:58:32,514 --> 02:58:33,716 A FIRST STEP RATHER THAN SAYING 5030 02:58:33,716 --> 02:58:34,583 HERE'S THE INTERVENTION I WANT 5031 02:58:34,583 --> 02:58:36,318 TO IMPLEMENT IN THIS SPACE, 5032 02:58:36,318 --> 02:58:37,653 REALLY WHEN SPOKE WITH 5033 02:58:37,653 --> 02:58:40,189 CAREGIVERS OF FAMILY MEMBERS, 5034 02:58:40,189 --> 02:58:43,258 CAREGIVERS OF THESE KIDS, 5035 02:58:43,258 --> 02:58:45,961 PATIENT CLINICIANS, HAVING AN 5036 02:58:45,961 --> 02:58:46,528 ADVISORY BOARD, SPEAKING TO 5037 02:58:46,528 --> 02:58:48,697 PRIMARY CARE STAFF AND 5038 02:58:48,697 --> 02:58:49,598 UNDERSTANDING WHAT WOULD 5039 02:58:49,598 --> 02:58:51,233 ACTUALLY WORK IN THIS 5040 02:58:51,233 --> 02:58:53,235 INTERVENTION, SO SHE USED THIS 5041 02:58:53,235 --> 02:58:54,737 TO IDENTIFY NOT JUST THE 5042 02:58:54,737 --> 02:58:56,171 INTERVENTION CONTENT BUT ALSO 5043 02:58:56,171 --> 02:58:57,940 WHAT ARE THE IMPLEMENTATION 5044 02:58:57,940 --> 02:58:59,575 STRATEGIES I CAN CONSIDER USING 5045 02:58:59,575 --> 02:59:00,776 DOWN THE LINE AND THEN WENT 5046 02:59:00,776 --> 02:59:02,444 THROUGH AN ITERATIVE PROCESS TO 5047 02:59:02,444 --> 02:59:04,947 REFINE BOTH THE CONTENT AND THE 5048 02:59:04,947 --> 02:59:05,614 IMPLEMENTATION OF THE CONTENT 5049 02:59:05,614 --> 02:59:07,583 AND ACTUALLY GAIN INSIGHTS TO 5050 02:59:07,583 --> 02:59:09,084 HOW THIS MIGHT BE IMPLEMENTED 5051 02:59:09,084 --> 02:59:10,652 FOR FUTURE STUDIES AND THEN 5052 02:59:10,652 --> 02:59:12,521 EFFICIENTLY TESTED IN AGAIN A 5053 02:59:12,521 --> 02:59:14,356 HYBRID EFFECTIVENESS 5054 02:59:14,356 --> 02:59:15,791 IMPLEMENTATION, WHICH DR. TOBIN 5055 02:59:15,791 --> 02:59:16,992 REFERRED TO BUT WE'LL TALK ABOUT 5056 02:59:16,992 --> 02:59:17,826 MORE. 5057 02:59:17,826 --> 02:59:20,996 SO WHEN WE THINK ABOUT MOVING 5058 02:59:20,996 --> 02:59:22,431 DOWN THAT INTO THE YELLOW LINE 5059 02:59:22,431 --> 02:59:23,966 WHEN SOMETHING IS EFFICACIOUS, 5060 02:59:23,966 --> 02:59:25,000 THEN WE CAN MOVE INTO 5061 02:59:25,000 --> 02:59:26,201 EFFECTIVENESS, WHERE WE BRING 5062 02:59:26,201 --> 02:59:27,569 THINGS INTO THE REAL WORLD TO 5063 02:59:27,569 --> 02:59:29,671 SEE DO THEY WORK ACROSS 5064 02:59:29,671 --> 02:59:31,140 DIFFERENT POPULATIONS. 5065 02:59:31,140 --> 02:59:33,542 AND SITTING BETWEEN THAT T3 AND 5066 02:59:33,542 --> 02:59:36,678 T4 ARE THE HYBRID DESIGNS. 5067 02:59:36,678 --> 02:59:37,312 THE HYBRID IS THE MIX OF THE 5068 02:59:37,312 --> 02:59:39,014 EFFECTIVENESS AND IMPLEMENTATION 5069 02:59:39,014 --> 02:59:39,281 RESEARCH. 5070 02:59:39,281 --> 02:59:41,350 THIS IS THE SAME FIGURE THAT WE 5071 02:59:41,350 --> 02:59:43,452 JUST SAW ABOUT HALF AN HOUR AGO, 5072 02:59:43,452 --> 02:59:45,754 WHERE THESE -- AND THESE HYBRID 5073 02:59:45,754 --> 02:59:47,389 TRIALS BLEND EFFECTIVENESS 5074 02:59:47,389 --> 02:59:48,824 TRIALS WITH IMPLEMENTATION 5075 02:59:48,824 --> 02:59:51,460 TRIALS, SO AGAIN, THE HYBRID RUN 5076 02:59:51,460 --> 02:59:52,895 IS RELITTLE TESTING 5077 02:59:52,895 --> 02:59:53,962 EFFECTIVENESS, THEY'RE DESIGNED 5078 02:59:53,962 --> 02:59:55,564 LIKE TYPICAL COMPARATIVE 5079 02:59:55,564 --> 02:59:56,131 EFFECTIVENESS STUDY BUT 5080 02:59:56,131 --> 02:59:57,900 OBSERVING THE IMPLEM TEATION TO 5081 02:59:57,900 --> 02:59:59,968 INFORM HOW WHEN I USE THIS -- 5082 02:59:59,968 --> 03:00:01,236 WHEN AT THE END OF THE STUDY HOW 5083 03:00:01,236 --> 03:00:02,504 AM I GOING TO IMPLEMENT IT, AND 5084 03:00:02,504 --> 03:00:04,039 IT'S A REALLY EFFICIENT DESANE 5085 03:00:04,039 --> 03:00:05,808 BECAUSE IF YOU'RE DOING 5086 03:00:05,808 --> 03:00:07,109 IMPLEMENTING A TRIAL IN THE 5087 03:00:07,109 --> 03:00:08,744 CONTEXT WHERE IT WILL BE 5088 03:00:08,744 --> 03:00:10,946 DELIVERED, WHY NOT COLLECT GOOD 5089 03:00:10,946 --> 03:00:11,980 INFORMATION ABOUT HOW IT MAY 5090 03:00:11,980 --> 03:00:13,182 WORK GOING FORWARD. 5091 03:00:13,182 --> 03:00:14,616 AT THE OTHER END OF THE 5092 03:00:14,616 --> 03:00:16,251 SPECTRUM, THE HYBRID 3 TRIALS 5093 03:00:16,251 --> 03:00:17,886 REALLY ARE OBSERVING 5094 03:00:17,886 --> 03:00:20,522 EFFECTIVENESS AND TESTING THE 5095 03:00:20,522 --> 03:00:21,390 IMPLEMENTATION STRATEGY. 5096 03:00:21,390 --> 03:00:25,160 SO WE HAVE THE CURRENT NHLBI 5097 03:00:25,160 --> 03:00:25,994 FUNDED HYBRID EFFECTIVENESS, 5098 03:00:25,994 --> 03:00:28,564 IT'S A HYBRID 1 EFFECTIVENESS 5099 03:00:28,564 --> 03:00:31,099 IMPLEMENTATION TRIAL EVALUATING 5100 03:00:31,099 --> 03:00:32,201 BEHAVIORAL TREATMENTS FOR 5101 03:00:32,201 --> 03:00:34,369 INSOMNIA AMONG SOCIOECONOMICALLY 5102 03:00:34,369 --> 03:00:35,137 DISADVANTAGED ADULTS IN THE 5103 03:00:35,137 --> 03:00:36,872 PRIMARY CARE SETTING, AND THIS 5104 03:00:36,872 --> 03:00:38,106 I'M NOT GOING TO TALK TOO MUCH 5105 03:00:38,106 --> 03:00:39,441 ABOUT OUR TRIAL BUT OUR SPECIFIC 5106 03:00:39,441 --> 03:00:40,943 AIMS ARE REALLY SET UP LIKE 5107 03:00:40,943 --> 03:00:42,177 TYPICAL COMPARATIVE 5108 03:00:42,177 --> 03:00:45,013 EFFECTIVENESS STUDY WHERE WE'RE 5109 03:00:45,013 --> 03:00:45,681 COMPARING TWO DIFFERENT 5110 03:00:45,681 --> 03:00:47,950 BEHAVIORAL TREATMENTS, ONE IS A 5111 03:00:47,950 --> 03:00:49,351 BRIEFER FORM OF COGNITIVE 5112 03:00:49,351 --> 03:00:50,719 BEHAVIORAL THERAPY, THE OTHER IS 5113 03:00:50,719 --> 03:00:53,455 IS TRADITIONAL COGNITIVE 5114 03:00:53,455 --> 03:00:54,556 BEHAVIORAL THERAPY DELIVERED BY 5115 03:00:54,556 --> 03:00:56,491 TELEPHONE TO IMPROVE ACCESS IN 5116 03:00:56,491 --> 03:00:58,093 THIS TARGET POPULATION OF 5117 03:00:58,093 --> 03:00:59,228 INTEREST AND WITHIN THE PRIMARY 5118 03:00:59,228 --> 03:01:04,099 CARE SETTING, WITH A 5119 03:01:04,099 --> 03:01:05,200 NON-INFERIORITY AIM COMMON IN 5120 03:01:05,200 --> 03:01:05,868 THESE TRIALS. 5121 03:01:05,868 --> 03:01:08,036 SO THE OUTCOMES OF THIS AIM 5122 03:01:08,036 --> 03:01:09,037 WHERE WE'RE REALLY COMPARING 5123 03:01:09,037 --> 03:01:11,006 QUALITY OF LIFE AND OTHER 5124 03:01:11,006 --> 03:01:11,907 SYMPTOMS, THESE AGAIN ARE SET UP 5125 03:01:11,907 --> 03:01:13,442 LIKE COMMON EFFECTIVENESS 5126 03:01:13,442 --> 03:01:15,077 STUDIES AND AS WE TALKED ABOUT, 5127 03:01:15,077 --> 03:01:17,412 TO THINK ABOUT HOW IT'S 5128 03:01:17,412 --> 03:01:18,213 IMPORTANT TO TAKE THE NEXT STEP 5129 03:01:18,213 --> 03:01:20,182 IN MOVING TO THE REAL WORLD IS 5130 03:01:20,182 --> 03:01:22,851 THINKING ABOUT EXPLORING THAT 5131 03:01:22,851 --> 03:01:23,452 HETEROGENEITIMENT WE TALKED A 5132 03:01:23,452 --> 03:01:24,386 LOT ABOUT THIS CONFERENCE, HOW 5133 03:01:24,386 --> 03:01:28,423 MIGHT THESE OUTCOMES VARY BY OSA 5134 03:01:28,423 --> 03:01:30,025 ENDOTYPES AND PHENOTYPES, HOW 5135 03:01:30,025 --> 03:01:31,293 ARE SOME OF THESE DIFFERENCES 5136 03:01:31,293 --> 03:01:32,494 EXPLAINED BY SEX AND GENDER 5137 03:01:32,494 --> 03:01:33,695 DIFFERENCES, BUT I THINK WHERE 5138 03:01:33,695 --> 03:01:34,863 SOME OF THE IMPLEMENTATION 5139 03:01:34,863 --> 03:01:36,365 SCIENCE COMES IN IS REALLY 5140 03:01:36,365 --> 03:01:39,534 THINKING ABOUT THE CONTEXT 5141 03:01:39,534 --> 03:01:40,936 THEY'RE DELIVERED, HOW MIGHT SEX 5142 03:01:40,936 --> 03:01:42,738 AND GENDER ROLES SUCH AS 5143 03:01:42,738 --> 03:01:43,972 OCCUPATION, BREAD WINNER STATUS, 5144 03:01:43,972 --> 03:01:46,041 TIME DOING HOUSEHOLD CHORES AND 5145 03:01:46,041 --> 03:01:48,777 CAREGIVING RESPONSIBILITIES, 5146 03:01:48,777 --> 03:01:50,512 ALSO INFLUENCE THE OUTCOMES THAT 5147 03:01:50,512 --> 03:01:53,081 ACTUALLY ARE REAL WORLD BARRIERS 5148 03:01:53,081 --> 03:01:55,183 AND SOMETIMES FACILITATORS THAT 5149 03:01:55,183 --> 03:01:56,585 MAY RESULT IN SOME OF THE 5150 03:01:56,585 --> 03:02:00,088 VARIATION WE SEE ACROSS SEX AND 5151 03:02:00,088 --> 03:02:04,059 GENDERED GROUPS. 5152 03:02:04,059 --> 03:02:07,029 THE REAL INNOVATIVE PARTS ARE 5153 03:02:07,029 --> 03:02:09,097 THESE IMPLEMENTATION AIMS OR 5154 03:02:09,097 --> 03:02:10,799 WHERE THEY FORMALLY EMBED THEM 5155 03:02:10,799 --> 03:02:11,233 INTO THE STRUCTURE. 5156 03:02:11,233 --> 03:02:13,835 FOR OUR STUDY OUR AIM 2 IS TO 5157 03:02:13,835 --> 03:02:15,404 EVALUATE THE BARRIERS, 5158 03:02:15,404 --> 03:02:19,041 FACILITATORS AND RECOMMEND -- 5159 03:02:19,041 --> 03:02:20,542 RECOMMENDATIONS FOR BEHAVIORAL 5160 03:02:20,542 --> 03:02:22,544 TREATMENT OF INSOMNIA 5161 03:02:22,544 --> 03:02:23,178 IMPLEMENTATION AND PRIMARY CARE. 5162 03:02:23,178 --> 03:02:25,981 SO HERE WE'RE USING ONE OF A 5163 03:02:25,981 --> 03:02:28,684 VERY HEAVILY FRAMEWORK CALLED 5164 03:02:28,684 --> 03:02:31,954 THE CONSOLIDATED PRAIM QORK, 5165 03:02:31,954 --> 03:02:33,488 WHICH WE ARE GOING TO CONDUCT 5166 03:02:33,488 --> 03:02:35,257 INTERVIEWS WITH STAKEHOLDERS 5167 03:02:35,257 --> 03:02:37,359 INCLUDING PATIENTS, CLINICIANS, 5168 03:02:37,359 --> 03:02:38,527 MEDICAL DIRECTOR ADMINISTRATORS 5169 03:02:38,527 --> 03:02:40,529 AND STAFF AS WELL AS SOME OTHER 5170 03:02:40,529 --> 03:02:41,496 QUANTITATIVE WORK TO REALLY 5171 03:02:41,496 --> 03:02:44,633 START THINKING ABOUT IF THIS -- 5172 03:02:44,633 --> 03:02:48,971 IF BBTI IS NOT INFERIOR TO CBTI, 5173 03:02:48,971 --> 03:02:49,905 HOW DO WE ACTUALLY START 5174 03:02:49,905 --> 03:02:51,540 IMPLEMENTING THIS AND EMBEDDING 5175 03:02:51,540 --> 03:02:53,408 IT IN PRIMARY CARE IN A WAY THAT 5176 03:02:53,408 --> 03:02:54,176 ACTUALLY WORKS. 5177 03:02:54,176 --> 03:02:54,843 AND THEN ADDING AGAIN SOME OF 5178 03:02:54,843 --> 03:02:57,112 THESE HYBRID OUT COME TRIALS OF 5179 03:02:57,112 --> 03:02:58,280 IMPLEMENTATION ADOPTION, PEOPLE 5180 03:02:58,280 --> 03:02:59,481 ARE GOING TO USE IT, IS IT 5181 03:02:59,481 --> 03:03:00,449 APPROPRIATE FOR THE POPULATION, 5182 03:03:00,449 --> 03:03:02,985 IS IT FEASIBLE, CAN WE DELIVER 5183 03:03:02,985 --> 03:03:09,758 IT WITH FIDELITY AS WELL AS CO 5184 03:03:09,758 --> 03:03:09,958 COST. 5185 03:03:09,958 --> 03:03:11,893 AGAIN E IT'S IMPORTANT TO THINK 5186 03:03:11,893 --> 03:03:13,528 ABOUT HOW THIS MAY BE LAYERED 5187 03:03:13,528 --> 03:03:18,500 WITH DIFFERENT SEX AND GENDER 5188 03:03:18,500 --> 03:03:21,570 ISSUES, HOW THE REACH MIGHT VARY 5189 03:03:21,570 --> 03:03:23,772 BY MALE, FEMALE OR TRANSGENDER 5190 03:03:23,772 --> 03:03:25,407 INDIVIDUALS, SHOULD THE 5191 03:03:25,407 --> 03:03:26,742 IMPLEMENTATION, THE INTERVENTION 5192 03:03:26,742 --> 03:03:28,276 CAN CONSIDER GENDER IDENTITY OR 5193 03:03:28,276 --> 03:03:29,578 SEXUAL ORIENTATION, AND YOU KNOW 5194 03:03:29,578 --> 03:03:30,245 EARLIER YESTERDAY WE WERE 5195 03:03:30,245 --> 03:03:32,114 TALKING ABOUT PREGNANT PEOPLE 5196 03:03:32,114 --> 03:03:37,085 AND PEOPLE WHO ARE 5197 03:03:37,085 --> 03:03:38,353 PERIMENOPAUSAL AND MENOPAUSAL 5198 03:03:38,353 --> 03:03:39,654 PEOPLE, AND AGAIN IF WE THINK 5199 03:03:39,654 --> 03:03:41,256 ABOUT IMPLEMENTING SOME OF THE 5200 03:03:41,256 --> 03:03:41,990 SLEEP APNEA TREATMENTS AND 5201 03:03:41,990 --> 03:03:43,959 PROTOCOLS AND NOT JUST IN 5202 03:03:43,959 --> 03:03:46,628 PRIMARY CARE CLINICS, OB-GYN, 5203 03:03:46,628 --> 03:03:48,563 HOW MIGHT THE MESSAGES AND 5204 03:03:48,563 --> 03:03:50,632 PROCEDURES AND IMPLEMENTATION 5205 03:03:50,632 --> 03:03:51,199 MIGHT DIFFER. 5206 03:03:51,199 --> 03:03:53,602 SO AS WE START MOVING ALONG THE 5207 03:03:53,602 --> 03:03:54,703 PIPELINE, WE TALKED ABOUT 5208 03:03:54,703 --> 03:03:55,570 EFFICACY RESEARCH, WE TALKED 5209 03:03:55,570 --> 03:03:58,206 ABOUT A HYBRID EFFECTIVENESS 5210 03:03:58,206 --> 03:03:59,975 IMPLEMENTATION TRIAL BUT REALLY 5211 03:03:59,975 --> 03:04:02,310 MOVING INTO THE MEATY PART OF 5212 03:04:02,310 --> 03:04:04,012 THE SUBWAY LINE AND TALK ABOUT 5213 03:04:04,012 --> 03:04:05,380 THE REAL IMPLEMENTATION 5214 03:04:05,380 --> 03:04:06,748 RESEARCH, WE TALK ABOUT MIXED 5215 03:04:06,748 --> 03:04:07,949 METHODS TO REALLY START 5216 03:04:07,949 --> 03:04:09,051 UNDERSTANDING THE CONTEXT AND 5217 03:04:09,051 --> 03:04:14,556 THEN DESIGNING IMPLEMENTATION 5218 03:04:14,556 --> 03:04:16,425 AND TESTING IMPLEMENTATION 5219 03:04:16,425 --> 03:04:17,726 STRATEGIES FOR REAL WORLD USE. 5220 03:04:17,726 --> 03:04:20,228 JUST TO QUICKLY SUMMARIZE SOME 5221 03:04:20,228 --> 03:04:21,396 OF THE PRINCIPLES DR. TOBIN 5222 03:04:21,396 --> 03:04:23,165 REFERRED TO THAT WE APPLY THESE 5223 03:04:23,165 --> 03:04:24,699 FRAME WORKS AND THESE ARE 5224 03:04:24,699 --> 03:04:26,468 PROPOSED MODEL OF FACTORS THAT 5225 03:04:26,468 --> 03:04:28,303 LIKELY IMPACT THE IMPLEMENTATION 5226 03:04:28,303 --> 03:04:29,171 SUSTAINABILITY OF EVIDENCE-BASED 5227 03:04:29,171 --> 03:04:30,839 PRACTICES, AND THEN WE USE THESE 5228 03:04:30,839 --> 03:04:32,674 FRAME WORKS TO IDENTIFY FACTORS 5229 03:04:32,674 --> 03:04:34,543 THAT HELP US TO SELECT THE RIGHT 5230 03:04:34,543 --> 03:04:37,612 STRATEGY OR STRATEGIES TO USE 5231 03:04:37,612 --> 03:04:38,547 DURING THE IMPLEMENTATION 5232 03:04:38,547 --> 03:04:39,147 PROCESS. 5233 03:04:39,147 --> 03:04:42,317 THESE IMPLEMENTATION STRATEGIES 5234 03:04:42,317 --> 03:04:44,686 ARE THEN USED TO ADOPT OR 5235 03:04:44,686 --> 03:04:46,855 INTEGRATE THE EVIDENCE-BASED 5236 03:04:46,855 --> 03:04:47,722 INNOVATIONS INTO CARE. 5237 03:04:47,722 --> 03:04:50,358 SO WE USE THE MODELS TO IDENTIFY 5238 03:04:50,358 --> 03:04:51,126 THE FACTORS THAT ARE THEN GOING 5239 03:04:51,126 --> 03:04:54,162 TO HELP US TO SELECT THE RIGHT 5240 03:04:54,162 --> 03:04:56,498 STRATEGIES OR AS JEFF CURR. 5241 03:04:56,498 --> 03:04:57,365 A N SAYS, WHAT ARE WE GOING TO 5242 03:04:57,365 --> 03:04:59,034 DO TO MAKE PEOPLE DO THE THING? 5243 03:04:59,034 --> 03:05:01,903 AND THESE CAN BE CONCEPTUALIZED 5244 03:05:01,903 --> 03:05:04,172 OR CLASSIFIED IN DIFFERENT WAYS. 5245 03:05:04,172 --> 03:05:05,273 ONE NOMENCLATURE REFERS TO THEM 5246 03:05:05,273 --> 03:05:06,541 AS PLANNING STRATEGIES, 5247 03:05:06,541 --> 03:05:09,611 EDUCATIONAL STRATEGY, FINANCIAL, 5248 03:05:09,611 --> 03:05:10,178 RESTRUCTURING, QUALITY 5249 03:05:10,178 --> 03:05:13,381 MANAGEMENT OR POLICY STRATEGIES. 5250 03:05:13,381 --> 03:05:14,049 SO IT'S REALLY COLLECTING 5251 03:05:14,049 --> 03:05:15,183 INFORMATION ABOUT HOW TO GET 5252 03:05:15,183 --> 03:05:17,686 PEOPLE BEST TO DO THE THING AND 5253 03:05:17,686 --> 03:05:19,421 IT'S OFTEN ADVISED TO USE MORE 5254 03:05:19,421 --> 03:05:19,821 THAN ONE STRATEGY. 5255 03:05:19,821 --> 03:05:21,323 AND THERE IS A CURRENT STUDY 5256 03:05:21,323 --> 03:05:23,959 GOING ON FUNDED THROUGH THE V.A. 5257 03:05:23,959 --> 03:05:27,896 SYSTEM IN WHICH YOU'RE TRYING TO 5258 03:05:27,896 --> 03:05:28,897 IMPROVE THE DIAGNOSIS AND 5259 03:05:28,897 --> 03:05:32,033 TREATMENT OF SLEEP APNEA AND 5260 03:05:32,033 --> 03:05:33,702 TREATMENT WITH PAP AMONG 5261 03:05:33,702 --> 03:05:36,138 PATIENTS WITH STROKE, AND THIS 5262 03:05:36,138 --> 03:05:38,406 IS TO INFLUENCE GUIDELINE 5263 03:05:38,406 --> 03:05:40,075 CONCORDANT CARE WITHIN THE V.A., 5264 03:05:40,075 --> 03:05:41,376 AS WE KNOW THAT SINCE THESE 5265 03:05:41,376 --> 03:05:42,444 GUIDELINES HAVE COME OUT, 5266 03:05:42,444 --> 03:05:46,014 THEY'VE ACTUALLY SEEN NOT ONLY 5267 03:05:46,014 --> 03:05:47,349 LOW BUT ACTUALLY NO CHANGE IN 5268 03:05:47,349 --> 03:05:49,417 SLEEP STUDY UTILIZATION FOR 5269 03:05:49,417 --> 03:05:51,520 PATIENTS IN THE V.A. SYSTEM WHO 5270 03:05:51,520 --> 03:05:53,388 HAD A STROKE AND TIA EVEN WITHIN 5271 03:05:53,388 --> 03:05:56,992 A YEAR OF HAVING THE EVENT. 5272 03:05:56,992 --> 03:05:58,026 SO ESSENTIALLY THEIR GUIDELINES 5273 03:05:58,026 --> 03:05:59,761 RECOMMENDING TO DO SLEEP TESTING 5274 03:05:59,761 --> 03:06:00,729 AMONG THESE INDIVIDUALS, BUT 5275 03:06:00,729 --> 03:06:01,596 IT'S NOT HELPING. 5276 03:06:01,596 --> 03:06:05,133 AND SO THIS WORK IS LED BY JASON 5277 03:06:05,133 --> 03:06:08,870 SICO, WHO'S BASED IN THE V.A. 5278 03:06:08,870 --> 03:06:10,238 CONNECTICUT HEALTHCARE SYSTEM, 5279 03:06:10,238 --> 03:06:11,773 AND THEY ARE FUNDED IN THEIR 5280 03:06:11,773 --> 03:06:16,945 STUDY CALLED ASAP TO UTILIZE 5281 03:06:16,945 --> 03:06:18,980 RANDOMIZED TRIAL ACROSS SIX AP 5282 03:06:18,980 --> 03:06:20,382 VA MEDICAL CENTERS TO IMPLEMENT 5283 03:06:20,382 --> 03:06:21,683 AND EVALUATE THE EFFECTIVENESS 5284 03:06:21,683 --> 03:06:23,585 AND SUSTAINABILITY OF 5285 03:06:23,585 --> 03:06:25,220 IMPLEMENTATION STRATEGIES TO 5286 03:06:25,220 --> 03:06:27,289 IMPROVE THE DIAGNOSIS OF SLEEP 5287 03:06:27,289 --> 03:06:28,523 APNEA MANAGEMENT. 5288 03:06:28,523 --> 03:06:29,591 SO THE THING THAT THEY'RE 5289 03:06:29,591 --> 03:06:31,593 ACTUALLY TESTING IS A SYSTEMS 5290 03:06:31,593 --> 03:06:32,894 REDESIGN VIRTUAL COLLABORATIVE 5291 03:06:32,894 --> 03:06:34,429 AND DATA MONITORING, SO IT'S 5292 03:06:34,429 --> 03:06:35,330 ACTUALLY TRACKING HOW MANY 5293 03:06:35,330 --> 03:06:37,499 PEOPLE ARE GETTING TESTED, ARE 5294 03:06:37,499 --> 03:06:38,934 THEY USING CPAP AND MONITORING 5295 03:06:38,934 --> 03:06:41,403 THAT DATA, AND THEN THEY'RE ALSO 5296 03:06:41,403 --> 03:06:42,938 TESTING HOW TO GET PEOPLE TO DO 5297 03:06:42,938 --> 03:06:44,139 THE THING, AND THEY'RE LOOKING 5298 03:06:44,139 --> 03:06:45,907 AT, AGAIN, IMPLEMENTATION 5299 03:06:45,907 --> 03:06:48,310 STRATEGIES SUCH AS LOCAL 5300 03:06:48,310 --> 03:06:52,280 ADAPTATION, CHANN CHAMPIONS, EXL 5301 03:06:52,280 --> 03:06:53,882 FACILITATION, AUDIT AND 5302 03:06:53,882 --> 03:06:54,149 FEEDBACK. 5303 03:06:54,149 --> 03:06:55,116 AND THEY'RE LOOKING AT 5304 03:06:55,116 --> 03:06:55,984 DIFFERENT -- THEIR OUTCOMES ARE 5305 03:06:55,984 --> 03:06:57,385 IN DIFFERENT LEVELS, THEY'RE 5306 03:06:57,385 --> 03:07:00,222 LOOKING AT FACILITY DIAGNOSIS 5307 03:07:00,222 --> 03:07:01,990 RATES, 90-DAY RECURRENCE OF 5308 03:07:01,990 --> 03:07:04,059 VASCULAR EVENTS, TREATMENT 5309 03:07:04,059 --> 03:07:06,228 RATES, PAP ADHERENCE AND 90-DAY 5310 03:07:06,228 --> 03:07:06,661 MORTALITY. 5311 03:07:06,661 --> 03:07:08,997 SO THAT'S AN EXAMPLE OF TESTING 5312 03:07:08,997 --> 03:07:10,832 HOW ARE WE ACTUALLY GOING TO 5313 03:07:10,832 --> 03:07:12,033 IMPLEMENT THIS SCREENING AND 5314 03:07:12,033 --> 03:07:13,235 TREATMENT ACROSS THESE DIVERSE 5315 03:07:13,235 --> 03:07:20,909 MEDICAL CENTERS. 5316 03:07:20,909 --> 03:07:22,077 AGAIN IMPORTANT TO THINK ABOUT 5317 03:07:22,077 --> 03:07:23,578 HOW SHOULD THESE IMPLEMENTATION 5318 03:07:23,578 --> 03:07:25,380 INTERVENTIONS BE TAILORED TO THE 5319 03:07:25,380 --> 03:07:26,715 SEX GENDER DIVERSITY OF THE 5320 03:07:26,715 --> 03:07:27,249 TARGET AUDIENCE. 5321 03:07:27,249 --> 03:07:28,516 I THINK THIS IS ALL SOMETHING WE 5322 03:07:28,516 --> 03:07:31,086 CAN THINK ABOUT IN OUR WORK. 5323 03:07:31,086 --> 03:07:32,921 IT'S ALSO IMPORTANT TO THINK 5324 03:07:32,921 --> 03:07:34,689 ABOUT AGAIN DESIGNING FOR 5325 03:07:34,689 --> 03:07:35,757 DISSEMINATION, HOW CAN MESSAGES 5326 03:07:35,757 --> 03:07:37,859 BE CRAFTED IN A WAY THAT 5327 03:07:37,859 --> 03:07:39,894 RESPONDS TO SEX AND GENDER 5328 03:07:39,894 --> 03:07:40,895 RELATED FACTORS WITHOUT 5329 03:07:40,895 --> 03:07:43,164 REPRODUCING OR EXPLOITING ANY 5330 03:07:43,164 --> 03:07:47,035 NEGATIVE STEREOTYPES EMBEDDED IN 5331 03:07:47,035 --> 03:07:47,569 INSTITUTIONALIZED GENDER. 5332 03:07:47,569 --> 03:07:49,638 SO THE LAST SECTION, JUST GOING 5333 03:07:49,638 --> 03:07:51,306 TO END ON KNOWLEDGE GAPS IN 5334 03:07:51,306 --> 03:07:52,307 FUTURE REACCEPT. 5335 03:07:52,307 --> 03:07:56,611 I RESEARCH.I KNOW THIS SOUNDS GT 5336 03:07:56,611 --> 03:07:57,879 MANY OF YOU ARE SAYING WHY DOES 5337 03:07:57,879 --> 03:07:59,714 IT MATTER, I'M NOT AN 5338 03:07:59,714 --> 03:08:00,215 IMPLEMENTATION SCIENCE. 5339 03:08:00,215 --> 03:08:02,017 BUT I DO THINK HOPEFULLY I'VE 5340 03:08:02,017 --> 03:08:02,717 CONVINCED YOU THAT THESE 5341 03:08:02,717 --> 03:08:04,252 PRINCIPLES AND CORE ELEMENTS OF 5342 03:08:04,252 --> 03:08:06,321 IMPLEMENTATION SCIENCE CAN BE 5343 03:08:06,321 --> 03:08:07,656 USEFUL BEYOND JUST 5344 03:08:07,656 --> 03:08:08,290 IMPLEMENTATION RESEARCH AND 5345 03:08:08,290 --> 03:08:09,157 HOPEFULLY ILLUSTRATE HOW 5346 03:08:09,157 --> 03:08:10,258 APPLYING THESE CORE ELEMENTS 5347 03:08:10,258 --> 03:08:12,560 EVEN AS EARLY AS THE 5348 03:08:12,560 --> 03:08:13,061 CONCEPTUALIZATION OF THE 5349 03:08:13,061 --> 03:08:15,096 TREATMENTS THEMSELVES AND EARLY 5350 03:08:15,096 --> 03:08:16,298 EFFICACY WORK ADD RIGOR AND 5351 03:08:16,298 --> 03:08:18,833 RELEVANCE TO THE RESEARCH, AND I 5352 03:08:18,833 --> 03:08:19,434 THINK IT'S EVEN MORE IMPORTANT 5353 03:08:19,434 --> 03:08:20,468 AS WE'VE TALKED ABOUT IN TERMS 5354 03:08:20,468 --> 03:08:23,538 OF SEX AND GENDER DIFFERENCES 5355 03:08:23,538 --> 03:08:25,473 THROUGHOUT THE OSA TREATMENT, 5356 03:08:25,473 --> 03:08:26,808 YOU KNOW, TREATMENT COURSE IN 5357 03:08:26,808 --> 03:08:28,443 TERMS OF THE BIOLOGY BUT ALSO 5358 03:08:28,443 --> 03:08:34,249 THE IMPLEMENTATION AND UP TAKE 5359 03:08:34,249 --> 03:08:35,717 OF EFFICACIOUS AND EMERGING 5360 03:08:35,717 --> 03:08:36,351 TREATMENTS. 5361 03:08:36,351 --> 03:08:37,986 FOR THOSE OF YOU INTERESTED, 5362 03:08:37,986 --> 03:08:40,722 THERE'S A FEW COMMENTARIES ON 5363 03:08:40,722 --> 03:08:43,958 SLEEP IMPL IMPLEMENTATION SCIEN. 5364 03:08:43,958 --> 03:08:45,293 I LIKE TO SHOW PEOPLE MY 5365 03:08:45,293 --> 03:08:47,128 NEW YORK ROOTS TO QUOTE YOGI 5366 03:08:47,128 --> 03:08:48,463 BERRA, IF YOU DON'T KNOW WHERE 5367 03:08:48,463 --> 03:08:49,397 YOU'RE GOING, YOU MIGHT WIND UP 5368 03:08:49,397 --> 03:08:49,831 SOMEPLACE ELSE. 5369 03:08:49,831 --> 03:08:51,566 AND TO THINK ABOUT WHERE YOU ARE 5370 03:08:51,566 --> 03:08:54,169 ON THIS SUBWAY MAP, AND REALLY 5371 03:08:54,169 --> 03:08:56,438 OUR GOAL I THINK AS A FIELD IS 5372 03:08:56,438 --> 03:08:59,574 TO IMPROVE SLEEP -- OBSTRUCTIVE 5373 03:08:59,574 --> 03:09:01,376 SLEEP APNEA HEALTH ON A 5374 03:09:01,376 --> 03:09:03,478 POPULATIONAL LEVEL ACROSS A 5375 03:09:03,478 --> 03:09:04,646 DIVERSE NUMBER OF PATIENTS, AND 5376 03:09:04,646 --> 03:09:06,281 IT'S IMPORTANT TO THINK ABOUT 5377 03:09:06,281 --> 03:09:08,650 THE END OF THE SUBWAY LINE EARLY 5378 03:09:08,650 --> 03:09:09,718 AND WHERE YOU ARE. 5379 03:09:09,718 --> 03:09:11,853 I JUST WAP TO GIVE A SHOUT OUT 5380 03:09:11,853 --> 03:09:13,355 EARLIER THIS YEAR, 5381 03:09:13,355 --> 03:09:14,923 DR. WILLIAMSON AND I STARTED A 5382 03:09:14,923 --> 03:09:17,359 SLEEP IMPLEMENTATION SCIENCE 5383 03:09:17,359 --> 03:09:18,326 LISTSERV, SO IF YOU'RE 5384 03:09:18,326 --> 03:09:22,397 INTERESTED, YOU CAN SCAN THIS QR 5385 03:09:22,397 --> 03:09:23,732 CODE OR EMAIL US, WE'LL BE HAPPY 5386 03:09:23,732 --> 03:09:24,933 TO JOIN YOU TO EXCHANGE 5387 03:09:24,933 --> 03:09:26,334 INFORMATION AND KNOWLEDGE AND 5388 03:09:26,334 --> 03:09:28,036 CREATE A COMMUNITY OF 5389 03:09:28,036 --> 03:09:30,105 RESEARCHERS INTERESTED IN SLEEP 5390 03:09:30,105 --> 03:09:32,707 DISSEMINATION IMPLEMENTATION 5391 03:09:32,707 --> 03:09:32,941 SCIENCE. 5392 03:09:32,941 --> 03:09:34,576 SO JUST TO WRAP UP SORT OF THE 5393 03:09:34,576 --> 03:09:35,844 MEAN OPPORTUNITIES I SEE IN THIS 5394 03:09:35,844 --> 03:09:38,480 FIELD IS HOW CAN SLEEP APNEA 5395 03:09:38,480 --> 03:09:39,881 RESEARCHERS EXPLICITLY CONSIDER 5396 03:09:39,881 --> 03:09:43,418 SEX AND GENDER ISSUES IN OSA 5397 03:09:43,418 --> 03:09:44,953 EVALUATION AND ADAPTATION 5398 03:09:44,953 --> 03:09:46,388 DELIVERING IMPLEMENTATION OF OSA 5399 03:09:46,388 --> 03:09:47,589 INTERVENTIONS IN REAL WORLD 5400 03:09:47,589 --> 03:09:52,560 SETTINGS. 5401 03:09:52,560 --> 03:09:54,095 HOW DO WE IDENTIFY PRACTICAL 5402 03:09:54,095 --> 03:09:56,064 STRATEGIES AND OPPORTUNITIES TO 5403 03:09:56,064 --> 03:09:57,165 USE IMPLEMENTATION SCIENCE FRAME 5404 03:09:57,165 --> 03:09:59,200 WORKS AND METHODS TO BROADEN OUR 5405 03:09:59,200 --> 03:10:00,001 PERSPECTIVES THAT INFORM 5406 03:10:00,001 --> 03:10:02,404 TREATMENT AND IMPLEMENTATION IN 5407 03:10:02,404 --> 03:10:06,408 REAL WORLD SETTINGS, AND HOW CAN 5408 03:10:06,408 --> 03:10:08,710 OSA PROTOCOLS AND PROGRAMS MORE 5409 03:10:08,710 --> 03:10:10,645 EXPLICITLY CONSIDERED SOCIAL 5410 03:10:10,645 --> 03:10:11,279 DETERMINANTS OF HEALTH AND 5411 03:10:11,279 --> 03:10:12,414 SEXUAL AND GENDER DISCRIMINATION 5412 03:10:12,414 --> 03:10:13,715 IN SCOPE AND COULD BE TEXT AND 5413 03:10:13,715 --> 03:10:15,717 WHAT ARE SOME OF THE UNINTENDED 5414 03:10:15,717 --> 03:10:16,351 CONSEQUENCES OF SOME OF THIS 5415 03:10:16,351 --> 03:10:16,551 WORK. 5416 03:10:16,551 --> 03:10:19,020 SO I REALLY LOOK FORWARD TO THE 5417 03:10:19,020 --> 03:10:21,556 DISCUSSION TODAY, A THA AND THAU 5418 03:10:21,556 --> 03:10:24,926 ALL FOR YOUR ATTENTION. 5419 03:10:24,926 --> 03:10:29,898 >> THANK YOU, DR. BERTISCH. 5420 03:10:29,898 --> 03:10:31,633 I WOULD LIKE TO INVITE ALL OUR 5421 03:10:31,633 --> 03:10:34,035 PANEL SPEAKERS, DISCUSSANTS, TO 5422 03:10:34,035 --> 03:10:42,644 JOIN THE DISCUSSION, AND DURING 5423 03:10:42,644 --> 03:10:43,711 THE SESSION WE LEARNED ABOUT THE 5424 03:10:43,711 --> 03:10:46,848 KEY ELEMENTS OF IMPLEMENTATION 5425 03:10:46,848 --> 03:10:47,982 SCIENCE AND WHAT CERTAIN TYPES 5426 03:10:47,982 --> 03:10:51,553 OF TRIALS WE CAN PLAN, VERY 5427 03:10:51,553 --> 03:10:55,490 INTERESTING, THOSE HYBRID 5428 03:10:55,490 --> 03:10:56,257 TRIALS, PERSONALLY I'M 5429 03:10:56,257 --> 03:10:58,259 INTERESTED IN THEM, AND LET ME 5430 03:10:58,259 --> 03:10:58,426 SEE. 5431 03:10:58,426 --> 03:11:04,632 ARE THERE ANY QUESTIONS FROM THE 5432 03:11:04,632 --> 03:11:04,833 PANEL? 5433 03:11:04,833 --> 03:11:05,700 I'M TRYING TO SEE IF THERE ARE 5434 03:11:05,700 --> 03:11:07,435 ANY HANDS UP THERE. 5435 03:11:07,435 --> 03:11:10,705 MAYBE I CAN ASK THE FIRST 5436 03:11:10,705 --> 03:11:15,310 QUESTION. 5437 03:11:15,310 --> 03:11:18,947 SO TO ALL THE PANELISTS, HAVING 5438 03:11:18,947 --> 03:11:20,415 HEARD THE DAY ONE TALKS AND 5439 03:11:20,415 --> 03:11:21,716 TODAY'S TALKS, WHAT DO YOU THINK 5440 03:11:21,716 --> 03:11:25,386 THAT OUR FIELD, THE OSA FIELD, 5441 03:11:25,386 --> 03:11:26,054 WHERE SHOULD WE START? 5442 03:11:26,054 --> 03:11:29,557 YOU SHOWED US ALL THESE 5443 03:11:29,557 --> 03:11:30,525 DIFFERENT OPPORTUNITIES, AND 5444 03:11:30,525 --> 03:11:32,393 DIFFERENT TYPES OF TRIALS. 5445 03:11:32,393 --> 03:11:36,831 WHAT WILL BE YOUR THOUGHTS, FOR 5446 03:11:36,831 --> 03:11:37,799 EXAMPLE, JONATHAN, WHAT DO YOU 5447 03:11:37,799 --> 03:11:39,667 THINK WE SHOULD BE DESIGNING AS 5448 03:11:39,667 --> 03:11:43,738 OUR NEXT STUDY? 5449 03:11:43,738 --> 03:11:45,306 >> SO FIRST OF ALL, I JUST WANT 5450 03:11:45,306 --> 03:11:46,941 TO SAY, I LEARNED SO MUCH FROM 5451 03:11:46,941 --> 03:11:47,842 THE WHOLE CONFERENCE AND 5452 03:11:47,842 --> 03:11:50,712 ESPECIALLY FROM THIS PANEL. 5453 03:11:50,712 --> 03:11:52,013 I THINK THERE'S A LOT WE CAN 5454 03:11:52,013 --> 03:11:52,914 LEARN FROM THE WORK THAT HAS 5455 03:11:52,914 --> 03:11:54,182 ALREADY BEEN DONE, SO I THINK IN 5456 03:11:54,182 --> 03:11:58,419 THE WAY THAT WE WOULD APPROACH 5457 03:11:58,419 --> 03:11:59,721 META-ANALYSIS OF EFFECTIVENESS 5458 03:11:59,721 --> 03:12:01,823 OUTCOMES, WE SHOULD BEGIN BY 5459 03:12:01,823 --> 03:12:03,124 LOOKING AT THE DIFFERENT 5460 03:12:03,124 --> 03:12:04,392 PRACTICE SETTINGS, THE DIFFERENT 5461 03:12:04,392 --> 03:12:07,896 PATIENT POPULATIONS, AND BEGIN 5462 03:12:07,896 --> 03:12:09,531 TO ASSIGN SOME SENSE OF HOW 5463 03:12:09,531 --> 03:12:11,366 THOSE VARY. 5464 03:12:11,366 --> 03:12:12,667 THE FOREST PLOT IS THE PREFERRED 5465 03:12:12,667 --> 03:12:13,101 WAY TO DO THAT. 5466 03:12:13,101 --> 03:12:16,604 I THINK THAT WILL GIVE US SOME 5467 03:12:16,604 --> 03:12:17,772 INSIGHT INTO WHICH ARE THE MORE 5468 03:12:17,772 --> 03:12:18,873 PROMISING SETTINGS AND 5469 03:12:18,873 --> 03:12:19,841 APPROACHES AND WHICH ARE THE 5470 03:12:19,841 --> 03:12:23,912 MORE PROMISING INTERVENTION 5471 03:12:23,912 --> 03:12:25,046 STRATEGIES THAT WE HEARD A LOT 5472 03:12:25,046 --> 03:12:26,347 ABOUT IN THE LAST TALK, AND THEN 5473 03:12:26,347 --> 03:12:28,116 I THINK THE NEXT STEP IS TO 5474 03:12:28,116 --> 03:12:30,818 BEGIN TO DESIGN TRIALS THAT 5475 03:12:30,818 --> 03:12:32,887 PROSPECTIVELY AND WITH 5476 03:12:32,887 --> 03:12:34,289 RANDOMIZATION IN USING 5477 03:12:34,289 --> 03:12:35,390 PATIENT-REPORTED OUTCOMES AS 5478 03:12:35,390 --> 03:12:39,260 WELL AS CLINICAL OUTCOMES IN 5479 03:12:39,260 --> 03:12:41,696 PRAGMATIC DESIGNS, HYBRID 5480 03:12:41,696 --> 03:12:42,463 EFFECTIVENESS, IMPLEMENTATION, 5481 03:12:42,463 --> 03:12:44,866 ALL OF THAT INTO THE NEXT ROUND 5482 03:12:44,866 --> 03:12:54,909 OF MULTISITE CLINICAL TRIALS. 5483 03:12:54,909 --> 03:12:55,243 >> THANK YOU. 5484 03:12:55,243 --> 03:12:58,546 ARE THERE ANY QUESTIONS? YES, 5485 03:12:58,546 --> 03:12:59,614 DR. STROLLO. 5486 03:12:59,614 --> 03:13:00,915 >> DR. TOBIN, YOUR TALK WAS 5487 03:13:00,915 --> 03:13:04,352 GRIET, AND TGREAT. 5488 03:13:04,352 --> 03:13:05,253 TRYING TO REACH OUT TO RURAL 5489 03:13:05,253 --> 03:13:06,754 COMMUNITIES IS A REAL CHALLENGE, 5490 03:13:06,754 --> 03:13:07,422 PARTICULARLY FOR ADULT CARE, 5491 03:13:07,422 --> 03:13:09,090 THERE ARE ACCESS ISSUES AND THEN 5492 03:13:09,090 --> 03:13:10,325 THERE ARE ALSO ISSUES IN TERMS 5493 03:13:10,325 --> 03:13:12,393 OF INITIATING CARE AND 5494 03:13:12,393 --> 03:13:14,429 INTEGRATING CARE. 5495 03:13:14,429 --> 03:13:17,832 FROM YOUR EXPERIENCE, IN OTHER 5496 03:13:17,832 --> 03:13:19,467 VENUES, DO YOU HAVE WORDS OF 5497 03:13:19,467 --> 03:13:24,839 WISDOM THAT KIND OF HELP? 5498 03:13:24,839 --> 03:13:26,307 >> SO THE MOST IMPORTANT THING 5499 03:13:26,307 --> 03:13:27,609 WHICH I THINK WE'VE HEARD A 5500 03:13:27,609 --> 03:13:28,810 COUPLE OF TIMES WHICH HAS DO 5501 03:13:28,810 --> 03:13:30,545 WITH ENGAGING THE WIDE RANGE OF 5502 03:13:30,545 --> 03:13:34,282 STAKEHOLDERS, AND SO OFTENTIMES, 5503 03:13:34,282 --> 03:13:35,683 WE CAN GET A GROUP OF 5504 03:13:35,683 --> 03:13:36,551 INVESTIGATOR, CLINICIANS AND 5505 03:13:36,551 --> 03:13:37,952 OTHERS TOGETHER AND COME UP WITH 5506 03:13:37,952 --> 03:13:38,720 SOME GREAT IDEAS. 5507 03:13:38,720 --> 03:13:41,889 BUT I THINK THAT'S NOT 5508 03:13:41,889 --> 03:13:43,191 SUFFICIENT AND PART OF IT, I 5509 03:13:43,191 --> 03:13:46,327 BELIEVE, IS REALLY UNDERSTANDING 5510 03:13:46,327 --> 03:13:47,962 WHAT THE BARRIERS OF DIFFERENT 5511 03:13:47,962 --> 03:13:49,397 POPULATIONS BOTH ON THE SERVICE 5512 03:13:49,397 --> 03:13:51,766 DELIVERY SIDE AND ON THE PATIENT 5513 03:13:51,766 --> 03:13:55,370 EXPERIENCE SIDE ARE, AND THEN 5514 03:13:55,370 --> 03:13:56,904 ENGAGE THOSE STAKEHOLDERS IN THE 5515 03:13:56,904 --> 03:13:58,640 DESIGN FOR DISSEMINATION 5516 03:13:58,640 --> 03:14:00,675 APPROACH SO THAT THEIR FEEDBACK 5517 03:14:00,675 --> 03:14:03,411 IS INCORPORATED EARLY ON. 5518 03:14:03,411 --> 03:14:06,047 JUST A BRIEF ANECDOTE, I ONCE 5519 03:14:06,047 --> 03:14:09,250 WORKED WITH A GROUP TO DESIGN A 5520 03:14:09,250 --> 03:14:10,785 NUTRITIONAL INTERVENTION FOR 5521 03:14:10,785 --> 03:14:11,552 HOMELESS INDIVIDUALS, WE WERE 5522 03:14:11,552 --> 03:14:13,621 VERY PROUD OF OURSELVES AND THEN 5523 03:14:13,621 --> 03:14:15,256 ONE OF THE PARTICIPANTS SAID, 5524 03:14:15,256 --> 03:14:16,991 WELL, I EAT OUT OF THE GARBAGE 5525 03:14:16,991 --> 03:14:18,292 PAIL, WHAT GOOD IS ANY OF THIS 5526 03:14:18,292 --> 03:14:20,094 INFORMATION TO ME? 5527 03:14:20,094 --> 03:14:22,296 AND JUST MADE ME FEEL RIDICULOUS 5528 03:14:22,296 --> 03:14:24,699 AT THAT POINT BECAUSE WE DIDN'T 5529 03:14:24,699 --> 03:14:26,567 ENGAGE THE END USERS IN A WAY 5530 03:14:26,567 --> 03:14:28,936 THAT WOULD HELP US DESIGN A 5531 03:14:28,936 --> 03:14:30,338 PROGRAM THAT WOULD ACTUALLY BE 5532 03:14:30,338 --> 03:14:31,639 HELPFUL, SO I THINK ENGAGEMENT 5533 03:14:31,639 --> 03:14:35,243 IS THE KEY. 5534 03:14:35,243 --> 03:14:36,210 >> DO YOU HAVE ANY OTHER 5535 03:14:36,210 --> 03:14:39,380 INSIGHTS IN TERMS OF LOW 5536 03:14:39,380 --> 03:14:41,549 SOCIOECONOMIC GROUPS IN URBAN 5537 03:14:41,549 --> 03:14:42,650 POPULATION VERSUS RURAL 5538 03:14:42,650 --> 03:14:44,185 POPULATIONS ON THE BASIS OF YOUR 5539 03:14:44,185 --> 03:14:44,385 WORK? 5540 03:14:44,385 --> 03:14:46,254 >> SO HOUSING IS A CHALLENGE IN 5541 03:14:46,254 --> 03:14:48,289 BOTH SETTINGS, IN HOUSING 5542 03:14:48,289 --> 03:14:51,159 DENSITY IN THE URBAN SETTING, 5543 03:14:51,159 --> 03:14:53,227 NOISE, I THINK ALL OF THESE 5544 03:14:53,227 --> 03:14:54,696 CONSIDERATIONS THAT DISRUPT 5545 03:14:54,696 --> 03:14:55,797 SLEEP ARE REALLY IMPORTANT, SO 5546 03:14:55,797 --> 03:14:59,400 THIS GOES BACK TO THE VIGNETTE I 5547 03:14:59,400 --> 03:15:00,601 JUST SHARED, AND I THINK WE 5548 03:15:00,601 --> 03:15:04,272 REALLY HAVE TO UNDERSTAND THE 5549 03:15:04,272 --> 03:15:05,173 HOME ENVIRONMENT IN ORDER TO BE 5550 03:15:05,173 --> 03:15:06,374 ABLE TO DESIGN INTERVENTIONS 5551 03:15:06,374 --> 03:15:08,876 THAT ARE LIKELY TO HAVE UPTAKE 5552 03:15:08,876 --> 03:15:09,977 ADHERENCE AND SUSTAINABILITY. 5553 03:15:09,977 --> 03:15:14,549 SO I THINK IT'S VERY DIFFERENT 5554 03:15:14,549 --> 03:15:17,385 DESIGNING FOR DISSEMINATION IN A 5555 03:15:17,385 --> 03:15:18,152 RURAL SETTING WHERE PEOPLE LIVE 5556 03:15:18,152 --> 03:15:20,121 IN LARGER SPACES THAN IN A MORE 5557 03:15:20,121 --> 03:15:21,422 CROWDED SETTING. 5558 03:15:21,422 --> 03:15:22,690 THAT'S NOT TO SAY THERE AREN'T 5559 03:15:22,690 --> 03:15:24,559 GOING TO BE CHALLENGES THERE, 5560 03:15:24,559 --> 03:15:25,860 BUT AGAIN, I THINK THE 5561 03:15:25,860 --> 03:15:26,494 ENVIRONMENTAL ASSESSMENT IS 5562 03:15:26,494 --> 03:15:29,630 GOING TO BE REALLY CRITICAL 5563 03:15:29,630 --> 03:15:33,868 TOITY SUCCESS. 5564 03:15:33,868 --> 03:15:36,237 >> THANK YOU. 5565 03:15:36,237 --> 03:15:37,238 >> THANK YOU. 5566 03:15:37,238 --> 03:15:38,506 I WOULD LIKE TO BRING UP THIS 5567 03:15:38,506 --> 03:15:39,941 INTERESTING QUESTION FROM 5568 03:15:39,941 --> 03:15:41,142 DR. OWENS THAT'S BEEN SOMEWHAT 5569 03:15:41,142 --> 03:15:43,444 ANSWERED IN THE CHAT, BUT IT 5570 03:15:43,444 --> 03:15:45,146 SEEMS LIKE MANY OF THE 5571 03:15:45,146 --> 03:15:47,115 IMPLEMENTATION TRIALS MENTIONED 5572 03:15:47,115 --> 03:15:48,449 TRY TO GET MORE PATIENTS IN THE 5573 03:15:48,449 --> 03:15:52,053 CLINIC, BUT THE CLINICS AND OUR 5574 03:15:52,053 --> 03:15:54,522 SLEEP STUDIES ARE BACKED UP, 5575 03:15:54,522 --> 03:15:55,857 POTENTIALLY WEARABLES IS A WAY 5576 03:15:55,857 --> 03:15:57,058 AROUND OR BRINGING, YOU KNOW, 5577 03:15:57,058 --> 03:15:59,527 THE CARE TO THE PRIMARY CARE AS 5578 03:15:59,527 --> 03:16:02,830 WE TALKED ABOUT EARLIER. 5579 03:16:02,830 --> 03:16:04,031 WHO WOULD LIKE TO TAKE THIS 5580 03:16:04,031 --> 03:16:12,507 QUESTION? 5581 03:16:12,507 --> 03:16:14,275 DR. HONAKER FROM A PEDIATRIC 5582 03:16:14,275 --> 03:16:14,675 PERSPECTIVE? 5583 03:16:14,675 --> 03:16:15,777 BECAUSE YOU'VE SHOWN SOME 5584 03:16:15,777 --> 03:16:16,544 EXCITING INITIATIVES. 5585 03:16:16,544 --> 03:16:24,585 >> YEAH, AND IN A LOT OF SENSE, 5586 03:16:24,585 --> 03:16:26,420 I'M LUCKY, IN UNANIMOUSLY, WE 5587 03:16:26,420 --> 03:16:28,055 HAVE 14 -- OR 16 PEDIATRIC BEDS, 5588 03:16:28,055 --> 03:16:30,658 AND SO WHEN I ENGAGED IN THIS 5589 03:16:30,658 --> 03:16:34,796 WORK TO INCREASE THE VOLUME OF 5590 03:16:34,796 --> 03:16:36,564 REFERRALS, WE WERE ABLE TO 5591 03:16:36,564 --> 03:16:39,934 MANAGE THAT. 5592 03:16:39,934 --> 03:16:41,602 THAT SAID, THAT IS CERTAINLY NOT 5593 03:16:41,602 --> 03:16:46,340 THE CASE EVERYWHERE, AND I'M 5594 03:16:46,340 --> 03:16:47,308 PERSONALLY VERY EXCITED ABOUT 5595 03:16:47,308 --> 03:16:53,414 THE IDEA OF SORT OF WEARABLES OR 5596 03:16:53,414 --> 03:16:55,283 CAMERAS DETECTING RISK WHERE WE 5597 03:16:55,283 --> 03:16:58,553 COULD AT LEAST HELP TO STRATIFY 5598 03:16:58,553 --> 03:17:02,590 WHICH KIDS ACTUALLY NEED PSG, 5599 03:17:02,590 --> 03:17:04,125 AND WHICH KIDS WOULD BENEFIT 5600 03:17:04,125 --> 03:17:06,727 FROM WATCHFUL WAITING AND WHICH 5601 03:17:06,727 --> 03:17:07,829 KIDS MAYBE SHOULD JUST GO 5602 03:17:07,829 --> 03:17:10,665 STRAIGHT TO SURGERY, AND I'M 5603 03:17:10,665 --> 03:17:11,766 REALLY EXCITED ABOUT WHAT THE 5604 03:17:11,766 --> 03:17:14,902 NEXT FIVE YEARS WILL BRING IN 5605 03:17:14,902 --> 03:17:16,103 TERMS OF DIAGNOSTIC AND 5606 03:17:16,103 --> 03:17:17,004 TREATMENT STRATEGIES. 5607 03:17:17,004 --> 03:17:18,439 BUT WE STILL NEED TO WORK ON 5608 03:17:18,439 --> 03:17:19,774 DOING A GOOD JOB OF FINDING THE 5609 03:17:19,774 --> 03:17:28,850 KIDS WHO ARE AT RISK AS WELL. 5610 03:17:28,850 --> 03:17:31,352 >> SUSHMITA, DO YOU HAVE A 5611 03:17:31,352 --> 03:17:31,719 QUESTION? 5612 03:17:31,719 --> 03:17:33,588 WE CANNOT HEAR YOU FOR SOME 5613 03:17:33,588 --> 03:17:33,821 REASON. 5614 03:17:33,821 --> 03:17:40,294 OR AT LEAST I CAN'T. 5615 03:17:40,294 --> 03:17:44,432 I GUESS MAYBE I CAN READ THE 5616 03:17:44,432 --> 03:17:47,068 QUESTION. 5617 03:17:47,068 --> 03:17:49,103 IT'S ABOUT RESOLVING THE TENSION 5618 03:17:49,103 --> 03:17:51,505 BETWEEN PRAGMATIC TRIALS AND 5619 03:17:51,505 --> 03:17:52,406 PERSONALIZED INDIVIDUALIZED 5620 03:17:52,406 --> 03:17:54,108 THERAPIES, HOW DO WE BALANCE 5621 03:17:54,108 --> 03:17:55,977 SORT OF THE REAL WORLD 5622 03:17:55,977 --> 03:17:57,178 APPLICABILITY OF PRECISION 5623 03:17:57,178 --> 03:17:57,778 MEDICINE? 5624 03:17:57,778 --> 03:17:59,480 I GUESS THIS IS A KEY QUESTION 5625 03:17:59,480 --> 03:18:06,187 INDEED. 5626 03:18:06,187 --> 03:18:07,321 >> I CAN JUMP IN. 5627 03:18:07,321 --> 03:18:08,856 >> THIS IS SOMETHING IN 5628 03:18:08,856 --> 03:18:11,592 LISTENING TO SPEAKERS TALK, 5629 03:18:11,592 --> 03:18:12,727 FIRST I UNDERSTAND THAT THERE 5630 03:18:12,727 --> 03:18:15,162 SEEMS TO BE THIS DICHOTOMY 5631 03:18:15,162 --> 03:18:16,597 BETWEEN WHAT'S PRAGMATIC AND 5632 03:18:16,597 --> 03:18:19,200 WHAT'S PERSONALIZED, BUT I DO 5633 03:18:19,200 --> 03:18:21,802 THINK TRYING TO GET LARGER 5634 03:18:21,802 --> 03:18:23,104 CLINICAL TRIALS FUNDED IN WHICH 5635 03:18:23,104 --> 03:18:27,808 WE COULD EXPLORE LIKE 5636 03:18:27,808 --> 03:18:32,647 HETEROGENEITY BECAUSE WITH THE 5637 03:18:32,647 --> 03:18:33,881 CLINICAL TRIAL METHODOLOGY, IT'S 5638 03:18:33,881 --> 03:18:35,316 VERY HARD TO GET SOMETHING 5639 03:18:35,316 --> 03:18:35,750 PERSONALIZED. 5640 03:18:35,750 --> 03:18:37,919 THAT WOULD BE LIKE AN N OF 5641 03:18:37,919 --> 03:18:39,353 1 TYPE OF STUDY, SO IN TRYING TO 5642 03:18:39,353 --> 03:18:43,758 IDENTIFY SOME OF THE PATIENT 5643 03:18:43,758 --> 03:18:45,660 PHENOTYPES OR ENDO TYPES THROUGH 5644 03:18:45,660 --> 03:18:47,395 THE LARGE STUDIES BY FIRST 5645 03:18:47,395 --> 03:18:48,596 EXPLORING HETEROGENEITY IN OUR 5646 03:18:48,596 --> 03:18:51,565 COMPARATIVE EFFECTIVENESS TRIAL 5647 03:18:51,565 --> 03:18:53,267 TO THEN KIND OF USE THAT AS A 5648 03:18:53,267 --> 03:18:54,635 TOOL TO THEN TAYLOR TREATMENT 5649 03:18:54,635 --> 03:18:55,703 RATHER THAN I FEEL LIKE WHAT 5650 03:18:55,703 --> 03:18:57,838 WE'RE DOING NOW IS TRYING TO GET 5651 03:18:57,838 --> 03:19:02,443 SO PERSONALIZED AND WE'RE NOT -- 5652 03:19:02,443 --> 03:19:03,844 THE SCIENCE IN SOME WAYS SEEMS 5653 03:19:03,844 --> 03:19:07,315 TO ME TO BE GETTING STALLED 5654 03:19:07,315 --> 03:19:09,951 EARLY IN THAT RED PART OF THE 5655 03:19:09,951 --> 03:19:11,252 LOOP WITH SAYING OH, IT DOESN'T 5656 03:19:11,252 --> 03:19:13,654 WORK, WE NEED TO GET 5657 03:19:13,654 --> 03:19:14,522 PERSONALIZED, OR IT SEEMS LIKE 5658 03:19:14,522 --> 03:19:16,590 WE NEED TO BRING THINGS MORE 5659 03:19:16,590 --> 03:19:17,825 MAYBE INTO THE COMPARATIVE 5660 03:19:17,825 --> 03:19:19,393 EFFECTIVENESS SPACE AND DO 5661 03:19:19,393 --> 03:19:20,528 LARGER STUDIES COMPARING 5662 03:19:20,528 --> 03:19:22,163 TREATMENTS AND TRY TO MAKE THEM 5663 03:19:22,163 --> 03:19:23,597 BIG ENOUGH WHERE WE MAY BE ABLE 5664 03:19:23,597 --> 03:19:27,068 TO POWER FROM SOME OF THE 5665 03:19:27,068 --> 03:19:28,703 HETEROGENEITY, THEN GROUPS MAYBE 5666 03:19:28,703 --> 03:19:30,438 SEE SIGNALS AND THEN DO MORE 5667 03:19:30,438 --> 03:19:32,039 DEDICATED STUDIES, RATHER THAN 5668 03:19:32,039 --> 03:19:34,475 JUST TRYING TO PERFECT A CERTAIN 5669 03:19:34,475 --> 03:19:36,344 THOUGHT OR CERTAIN TREATMENT IN 5670 03:19:36,344 --> 03:19:37,211 THESE HIGHLY CONTROLLED 5671 03:19:37,211 --> 03:19:39,180 SETTINGS. 5672 03:19:39,180 --> 03:19:40,748 I THINK -- WHAT I THINK ABOUT 5673 03:19:40,748 --> 03:19:42,083 WITH MY CLINICIAN HAT ON, WHEN I 5674 03:19:42,083 --> 03:19:43,284 HAVE DISCUSSIONS WITH MY 5675 03:19:43,284 --> 03:19:45,119 PATIENTS ABOUT THESE ARE ALL THE 5676 03:19:45,119 --> 03:19:46,420 OPTIONS FOR SLEEP APNEA, YES, I 5677 03:19:46,420 --> 03:19:47,621 DON'T KNOW YET WHAT IS GOING TO 5678 03:19:47,621 --> 03:19:49,290 WORK FOR YOU. 5679 03:19:49,290 --> 03:19:50,458 WE DON'T HAVE A LOT OF 5680 03:19:50,458 --> 03:19:51,659 COMPARATIVE EFFECTIVENESS 5681 03:19:51,659 --> 03:19:57,898 STUDIES TO EVEN MAKE THOSE 5682 03:19:57,898 --> 03:19:59,233 SHARED DECISION-MAKING 5683 03:19:59,233 --> 03:19:59,834 INFORMATIVE TO BEGIN WITH AND 5684 03:19:59,834 --> 03:20:00,668 IT'S GOING TO TAKE US A LONG 5685 03:20:00,668 --> 03:20:01,869 TIME TO PER FOACT OUR 5686 03:20:01,869 --> 03:20:03,571 PERSONALIZED STRATEGIES SO I 5687 03:20:03,571 --> 03:20:05,239 DON'T SEE THEM AS NECESSARILY 5688 03:20:05,239 --> 03:20:05,539 DICHOTOMOUS. 5689 03:20:05,539 --> 03:20:07,541 I THINK WE SHOULD JUST MAYBE 5690 03:20:07,541 --> 03:20:09,243 REFRAME THE WAY WE'RE ACTUALLY 5691 03:20:09,243 --> 03:20:09,910 PRODUCING THE CLINICAL KNOWLEDGE 5692 03:20:09,910 --> 03:20:13,214 THROUGH THE TRIALS. 5693 03:20:13,214 --> 03:20:13,614 >> THANKS. 5694 03:20:13,614 --> 03:20:15,649 I DON'T KNOW IF YOU CAN HEAR ME 5695 03:20:15,649 --> 03:20:15,883 NOW. 5696 03:20:15,883 --> 03:20:16,083 YEAH? 5697 03:20:16,083 --> 03:20:16,851 >> YES, WE CAN. 5698 03:20:16,851 --> 03:20:17,852 >> OKAY, GOOD. 5699 03:20:17,852 --> 03:20:19,286 THANK YOU FOR THAT. 5700 03:20:19,286 --> 03:20:23,024 I GUESS I WAS THINKING ALSO IN 5701 03:20:23,024 --> 03:20:24,558 THE CONTEXT OF THE PRAGMATIC 5702 03:20:24,558 --> 03:20:26,360 TRIALS WHERE YOU TRY TO HAVE -- 5703 03:20:26,360 --> 03:20:28,195 MAKE SURE IT'S GENERALIZABLE TO 5704 03:20:28,195 --> 03:20:31,232 YOUR POPULATION, YOUR INCLUSION 5705 03:20:31,232 --> 03:20:34,635 CRITERIA IS QUITE BROAD. 5706 03:20:34,635 --> 03:20:37,271 HERE WE ARE THINKING OF 5707 03:20:37,271 --> 03:20:38,973 SUBGROUPS, SO PUTTING THAT AS A 5708 03:20:38,973 --> 03:20:40,207 DESIGN, HOW DO WE DESIGN THOSE 5709 03:20:40,207 --> 03:20:41,409 TRIALS, I THINK WE'VE DISCUSSED 5710 03:20:41,409 --> 03:20:43,677 IN THE PAST THOSE ADAPTIVE 5711 03:20:43,677 --> 03:20:44,645 TRIALS AND KIND OF THESE MORE 5712 03:20:44,645 --> 03:20:47,181 NOVEL METHODS BUT ALSO SHOULD WE 5713 03:20:47,181 --> 03:20:51,085 BE STRATIFYING BASED ON 5714 03:20:51,085 --> 03:20:51,952 SUBGROUPS BUT ALSO KIND OF 5715 03:20:51,952 --> 03:20:52,820 KEEPING OUR GENERAL POPULATION 5716 03:20:52,820 --> 03:20:55,322 IN A WAY THAT'S FAIRLY BROAD AND 5717 03:20:55,322 --> 03:21:05,099 THAT WE CAN APPLY TO PRACTICE. 5718 03:21:05,099 --> 03:21:08,569 >> I WANTED TO FOLLOW UP ON THE 5719 03:21:08,569 --> 03:21:10,938 QUESTION FOR DR. HONAKER ABOUT 5720 03:21:10,938 --> 03:21:12,006 PEDIATRICS AND WEARABLES. 5721 03:21:12,006 --> 03:21:13,240 ONE OF OUR CHALLENGES IN THIS 5722 03:21:13,240 --> 03:21:14,742 FIELD THAT WAS TOUCHED ON 5723 03:21:14,742 --> 03:21:15,843 EARLIER TODAY WAS WE CAN'T 5724 03:21:15,843 --> 03:21:16,710 REALLY AGREE UPON WHAT'S SLEEP 5725 03:21:16,710 --> 03:21:24,752 APNEA IN CHILDREN, AND IN 5726 03:21:24,752 --> 03:21:25,986 POLYSONOGRAPHY IN LABS, WE 5727 03:21:25,986 --> 03:21:29,256 FREQUENTLY RELY ON 5728 03:21:29,256 --> 03:21:31,492 HYPOVENTILATION MEASURES SUCH AS 5729 03:21:31,492 --> 03:21:33,727 CO2 WHICH IS VERY DIFFICULT TO 5730 03:21:33,727 --> 03:21:35,062 IMPLEMENT WITH A WEARABLE IN AN 5731 03:21:35,062 --> 03:21:35,596 OUTPATIENT SETTING. 5732 03:21:35,596 --> 03:21:37,531 WE CAN USE A WEARABLE. 5733 03:21:37,531 --> 03:21:39,166 DO YOU THINK THAT -- IT SEEMS TO 5734 03:21:39,166 --> 03:21:40,701 ME THERE NEEDS TO BE MORE 5735 03:21:40,701 --> 03:21:42,203 RESEARCH TO UNDERSTAND THE PREA 5736 03:21:42,203 --> 03:21:43,404 SITION OF THIS MEASUREMENT, 5737 03:21:43,404 --> 03:21:46,707 PARTICULARLY IN A PEDIATRIC 5738 03:21:46,707 --> 03:21:47,708 POPULATION. 5739 03:21:47,708 --> 03:21:49,543 >> NO, I THINK THAT MAKES A LOT 5740 03:21:49,543 --> 03:21:51,479 OF SENSE EVEN WITHIN THE PSG, 5741 03:21:51,479 --> 03:21:53,781 THERE IS SOME CONTROVERSY ABOUT 5742 03:21:53,781 --> 03:21:56,517 WHAT METRICS ARE MOST IMPORTANT 5743 03:21:56,517 --> 03:22:00,888 AND YOU KNOW, AND ALSO A THINK 5744 03:22:00,888 --> 03:22:01,689 THIS WAS ALLUDED TO IN ONE OF 5745 03:22:01,689 --> 03:22:04,492 THE EARLIER TALKS, THAT PSG 5746 03:22:04,492 --> 03:22:06,026 POTENTIALLY IDENTIFIES SEVERITY 5747 03:22:06,026 --> 03:22:06,760 BUT IT DOESN'T TELL YOU WHERE 5748 03:22:06,760 --> 03:22:10,798 THE OBSTRUCTION IS ANATOMICALLY, 5749 03:22:10,798 --> 03:22:18,239 AND SO THERE ARE SOME 5750 03:22:18,239 --> 03:22:20,407 TECHNOLOGIES THAT SEEM REALLY 5751 03:22:20,407 --> 03:22:21,809 EXCITING THAT CANNOT JUST 5752 03:22:21,809 --> 03:22:25,079 IDENTIFY OSA BUT POTENTIALLY 5753 03:22:25,079 --> 03:22:26,714 SIDE OF OBSTRUCTION TO GUIDE 5754 03:22:26,714 --> 03:22:27,581 TREATMENT. 5755 03:22:27,581 --> 03:22:28,782 THAT SAID, VALIDATION, IT'S ALL 5756 03:22:28,782 --> 03:22:29,350 VERY COMPLEX. 5757 03:22:29,350 --> 03:22:30,384 I JUST THINK SOMETIMES PERFECT 5758 03:22:30,384 --> 03:22:34,722 CAN BE THE ENEMY OF GOOD, RIGHT, 5759 03:22:34,722 --> 03:22:40,761 AND WE DON'T HAVE GREAT IDEAL 5760 03:22:40,761 --> 03:22:41,629 TREATMENT PATHWAYS OR 5761 03:22:41,629 --> 03:22:43,664 PERSONALIZED APPROACHES BY ALL 5762 03:22:43,664 --> 03:22:45,799 THESE VARIABLES BUT I MEAN WE 5763 03:22:45,799 --> 03:22:48,269 KNOW THAT MOST KIDS RESPOND TO 5764 03:22:48,269 --> 03:22:53,507 TNA TO SOME DEGREE, AND SO I 5765 03:22:53,507 --> 03:22:57,211 THINK -- AND THE PSG WORKS WELL 5766 03:22:57,211 --> 03:22:58,946 ENOUGH, SO I THINK WHILE WE'RE 5767 03:22:58,946 --> 03:23:01,015 SORT OF TRYING TO GET A BETTER 5768 03:23:01,015 --> 03:23:03,450 HANDLE ON BEST PRACTICES FOR 5769 03:23:03,450 --> 03:23:05,419 DIAGNOSIS AND TREATMENT, WE 5770 03:23:05,419 --> 03:23:06,954 STILL NEED TO BE DOING WHAT WE 5771 03:23:06,954 --> 03:23:09,456 CAN WITH THE TREATMENTS THAT WE 5772 03:23:09,456 --> 03:23:12,626 HAVE. 5773 03:23:12,626 --> 03:23:13,594 >> THANK YOU. 5774 03:23:13,594 --> 03:23:15,329 THANK YOU TO ALL OUR SPEAKERS. 5775 03:23:15,329 --> 03:23:16,864 I'M SURE THERE ARE MORE 5776 03:23:16,864 --> 03:23:17,798 QUESTIONS, MORE DISCUSSION, 5777 03:23:17,798 --> 03:23:19,800 WHICH WE CAN DO DURING OUR 5778 03:23:19,800 --> 03:23:22,203 ROUNDTABLE. 5779 03:23:22,203 --> 03:23:26,473 AND I AM NOW ANNOUNCING OUR 5780 03:23:26,473 --> 03:23:27,441 BREAK. 5781 03:23:27,441 --> 03:23:28,209 BRITTANY, COULD YOU TELL ME WHEN 5782 03:23:28,209 --> 03:23:32,513 WE SHOULD BE BACK? 5783 03:23:32,513 --> 03:23:34,114 >> OF COURSE. 5784 03:23:34,114 --> 03:23:36,650 WE'LL ALL BE BACK AT 3:45. 5785 03:23:36,650 --> 03:23:37,718 >> 3:45. 5786 03:23:37,718 --> 03:23:39,053 THANK YOU SO MUCH. 5787 03:23:39,053 --> 03:23:42,184 >> YOU'RE WELCOME. 5788 03:23:42,184 --> 03:23:43,252 >> WELCOME BACK, EVERYONE. 5789 03:23:43,252 --> 03:23:45,387 SO FOR THE LAST SESSION WE HAVE 5790 03:23:45,387 --> 03:23:49,558 WHAT US A CALLED ROUNDTABLE AND 5791 03:23:49,558 --> 03:23:53,696 MYSELF, ANKIT AND ESRA WILL 5792 03:23:53,696 --> 03:23:54,363 MODERATE. 5793 03:23:54,363 --> 03:23:55,331 ANYONE WHO'S ACTIVE IN THE 5794 03:23:55,331 --> 03:23:56,532 DISCUSSION WE HAVE, PLEASE TURN 5795 03:23:56,532 --> 03:23:58,167 YOUR VIDEO ON SO WE CAN SEE YOUR 5796 03:23:58,167 --> 03:24:00,903 FACE AS WELL. 5797 03:24:00,903 --> 03:24:02,871 WE'LL DO OUR BEST TO MODERATE IN 5798 03:24:02,871 --> 03:24:05,040 THE CHAT AND ALSO IN THE Q & A. 5799 03:24:05,040 --> 03:24:09,945 IF THERE ARE QUESTIONS. 5800 03:24:09,945 --> 03:24:12,982 GENERALLY, WE'RE GOING TO FOCUS 5801 03:24:12,982 --> 03:24:14,750 IN THE FIRST 20 MINUTES ON 5802 03:24:14,750 --> 03:24:16,051 SESSIONS ONE AND TWO FROM 5803 03:24:16,051 --> 03:24:17,152 YESTERDAY, THEN I'LL TURN THE 5804 03:24:17,152 --> 03:24:19,788 MIC OVER TO ANKIT, HE'LL 5805 03:24:19,788 --> 03:24:20,756 MODERATE FOR ANOTHER 20 MINUTES 5806 03:24:20,756 --> 03:24:22,358 ON SESSIONS THREE AND FOUR AND 5807 03:24:22,358 --> 03:24:23,759 THEN WE'LL FINISH UP WITH SOME 5808 03:24:23,759 --> 03:24:25,094 OF THE DISCUSSION TODAY AND ESRA 5809 03:24:25,094 --> 03:24:26,762 WILL CLOSE OUT WITH THE LAST 20 5810 03:24:26,762 --> 03:24:27,630 MINUTES. 5811 03:24:27,630 --> 03:24:32,835 SO I THINK THAT THERE WERE MANY 5812 03:24:32,835 --> 03:24:33,402 DIFFERENT QUESTIONS AND 5813 03:24:33,402 --> 03:24:34,603 DISCUSSIONS THAT WE WILL GO 5814 03:24:34,603 --> 03:24:35,371 FORWARD WITH TODAY. 5815 03:24:35,371 --> 03:24:36,772 I'M GLAD WE HAVE A LOT MORE 5816 03:24:36,772 --> 03:24:37,106 TIME. 5817 03:24:37,106 --> 03:24:38,741 BUT I DID WANT TO SORT OF START 5818 03:24:38,741 --> 03:24:40,909 A LITTLE BIT, AGAIN, I THINK 5819 03:24:40,909 --> 03:24:44,046 MARISHKA HAD SORT OF ASKED WHAT 5820 03:24:44,046 --> 03:24:48,117 ARE WE BRINGING INTO THE CLINIC, 5821 03:24:48,117 --> 03:24:49,318 AND SORT OF WHAT'S THE MOST 5822 03:24:49,318 --> 03:24:50,786 INTERESTING. 5823 03:24:50,786 --> 03:24:51,754 SORRY, I THINK WE'RE ALL GETTING 5824 03:24:51,754 --> 03:24:53,055 DISTRACTED BY MOVING AROUND HERE 5825 03:24:53,055 --> 03:24:56,025 ON THE VIDEO, BUT YOU KNOW, I 5826 03:24:56,025 --> 03:24:57,092 THINK AS I'VE PRACTICED OVER THE 5827 03:24:57,092 --> 03:24:59,328 LAST 10 YEARS OR SO, THE THINGS 5828 03:24:59,328 --> 03:25:01,063 THAT HAVE REALLY BEEN 5829 03:25:01,063 --> 03:25:02,031 INTERESTING, I THINK SORT OF 5830 03:25:02,031 --> 03:25:02,798 LEARNING THAT MAYBE WE DON'T 5831 03:25:02,798 --> 03:25:05,668 NEED TO TREAT AN AHI OF 6. 5832 03:25:05,668 --> 03:25:08,003 I THINK WE HAVE NEW THERAPIES 5833 03:25:08,003 --> 03:25:10,205 LIKE HYPOGLOSSAL NERVE 5834 03:25:10,205 --> 03:25:11,306 STIMULATOR, I THINK THE WEIGHT 5835 03:25:11,306 --> 03:25:12,274 MANAGEMENT POTENTIAL IS REALLY 5836 03:25:12,274 --> 03:25:12,474 HUGE. 5837 03:25:12,474 --> 03:25:15,444 I WANTED TO START AND ASK 5838 03:25:15,444 --> 03:25:17,046 DR. STROLLO, CAN YOU REFLECT A 5839 03:25:17,046 --> 03:25:18,080 LITTLE BIT ON HOW YOUR CLINICAL 5840 03:25:18,080 --> 03:25:21,650 PRACTICE HAS CHANGED, AND OF THE 5841 03:25:21,650 --> 03:25:23,719 SCIENCE AND TALKS WE SAW FROM 5842 03:25:23,719 --> 03:25:25,320 DAY ONE, OSA ACROSS THE 5843 03:25:25,320 --> 03:25:26,055 LIFESPAN, WHAT ARE THE THINGS 5844 03:25:26,055 --> 03:25:27,322 THAT YOU'RE EXCITED ABOUT GOING 5845 03:25:27,322 --> 03:25:30,526 FORWARD? 5846 03:25:30,526 --> 03:25:35,164 >> I THINK THE GOAL OF THIS 5847 03:25:35,164 --> 03:25:38,667 WORKSHOP IS REALLY TO TRY TO 5848 03:25:38,667 --> 03:25:39,635 APPROACH PERSONALIZING CARE, AND 5849 03:25:39,635 --> 03:25:42,071 WHEN WE STARTED THIS FIELD, 5850 03:25:42,071 --> 03:25:43,272 EVERYTHING WAS CPAP. 5851 03:25:43,272 --> 03:25:46,108 AND NOW WE HAVE A LOT MORE TOOLS 5852 03:25:46,108 --> 03:25:47,109 IN THE TOOLBOX. 5853 03:25:47,109 --> 03:25:50,713 AND THERE ARE GOING TO BE 5854 03:25:50,713 --> 03:25:52,681 DIFFERENTIAL EFFECTS FOR PEOPLE 5855 03:25:52,681 --> 03:25:56,118 OF COLOR AND WOMEN, LIKE ONE OF 5856 03:25:56,118 --> 03:25:57,586 THE THINGS THAT WE'VE LEARNED 5857 03:25:57,586 --> 03:26:02,257 JUST WITH THE HYPOGLOSSAL NERVE 5858 03:26:02,257 --> 03:26:03,492 STIMULATION SPACE IS THAT WOMEN 5859 03:26:03,492 --> 03:26:06,862 ACTUALLY RESPOND BETTER TO UPPER 5860 03:26:06,862 --> 03:26:08,630 AIRWAY STIMULATION THAN MEN, 5861 03:26:08,630 --> 03:26:10,466 ALTHOUGH THEY ARE FREENGT 5862 03:26:10,466 --> 03:26:17,773 FREFREQUENTLYDENIED INSURANCE, T 5863 03:26:17,773 --> 03:26:19,007 AN UNCOMMON PROBLEM, THAT'S ALSO 5864 03:26:19,007 --> 03:26:22,244 FOR ALL MEDICAL DEVICES FOR A 5865 03:26:22,244 --> 03:26:24,813 DEPDEFIBRILLATOR, A WOMAN IS MOE 5866 03:26:24,813 --> 03:26:26,115 LIKELY TO BE DENIED BY 5867 03:26:26,115 --> 03:26:26,381 INSURANCE. 5868 03:26:26,381 --> 03:26:27,850 SO I THINK THAT'S A GAP WE WANT 5869 03:26:27,850 --> 03:26:28,917 TO ACKNOWLEDGE AND TRY TO FIX 5870 03:26:28,917 --> 03:26:30,919 AND THOSE DATA WERE PRETTY WELL 5871 03:26:30,919 --> 03:26:32,488 SORTED OUT WITH SOME OF THE 5872 03:26:32,488 --> 03:26:33,522 PAPERS WE HAD PUBLISHED 5873 03:26:33,522 --> 03:26:35,924 PREVIOUSLY. 5874 03:26:35,924 --> 03:26:39,094 I THINK YOUR OTHER POINT, BOB, 5875 03:26:39,094 --> 03:26:42,030 IN TERMS OF WHO DO YOU TREAT, 5876 03:26:42,030 --> 03:26:45,100 YOU KNOW, WE DIDN'T REALLY TALK 5877 03:26:45,100 --> 03:26:51,774 ABOUT IN THIS WORKSHOP, ARE 5878 03:26:51,774 --> 03:26:52,975 THERE PEOPLE THAT WE SHOULDN'T 5879 03:26:52,975 --> 03:26:57,045 TREAT BECAUSE ALITTLE A LITTLEF 5880 03:26:57,045 --> 03:26:58,080 SLEEP APNEA MIGHT BE GOOD FOR 5881 03:26:58,080 --> 03:27:00,482 YOU AND MAYBE THIS NOTION OF 5882 03:27:00,482 --> 03:27:01,150 PREISCHEMIC CONDITION. 5883 03:27:01,150 --> 03:27:04,753 SUSAN WAS INVOLVED IN A PAPER 5884 03:27:04,753 --> 03:27:07,790 WITH ALI LOOKING AT RELATIVELY 5885 03:27:07,790 --> 03:27:09,124 LOW HYPOXIC BURDEN, ALTHOUGH IT 5886 03:27:09,124 --> 03:27:13,796 WASN'T THAT LOW, VERSUS HIGH 5887 03:27:13,796 --> 03:27:17,099 HYPOXIC BURDEN IN THE ISAAC 5888 03:27:17,099 --> 03:27:19,168 TRIAL AND PEOPLE EXPOSED TO CPAP 5889 03:27:19,168 --> 03:27:20,903 HAD WORSE CARDIOVASCULAR 5890 03:27:20,903 --> 03:27:23,071 OUTCOMES THAN PEOPLE WITH HIGH 5891 03:27:23,071 --> 03:27:24,706 HYPOXIC BURDEN, WHICH IS AN 5892 03:27:24,706 --> 03:27:25,240 INTERESTING OBSERVATION. 5893 03:27:25,240 --> 03:27:26,475 SO I THINK WE HAVE TO BE CAREFUL 5894 03:27:26,475 --> 03:27:28,877 IN WHO WE TREAT. 5895 03:27:28,877 --> 03:27:29,945 WE DON'T REALLY UNDERSTAND WHAT 5896 03:27:29,945 --> 03:27:30,712 THE THRESHOLD IS. 5897 03:27:30,712 --> 03:27:33,749 AND I THINK NARESH VERY NICE 5898 03:27:33,749 --> 03:27:35,951 LEHIGH LIGHTED ON THE FIRST DAY 5899 03:27:35,951 --> 03:27:37,820 THAT WE HAVE SO MANY DIFFERENT 5900 03:27:37,820 --> 03:27:40,422 METRICS THAT WE'RE REALLY -- 5901 03:27:40,422 --> 03:27:41,423 THERE'S A LOT OF UNCERTAINTY, 5902 03:27:41,423 --> 03:27:43,992 EVEN IN THE ADULT SPACE AS 5903 03:27:43,992 --> 03:27:45,294 OPPOSED TO THE PEDIATRIC SPACE 5904 03:27:45,294 --> 03:27:46,829 WHICH IS EVEN MORE CHALLENGING. 5905 03:27:46,829 --> 03:27:49,464 SO THOSE WOULD BE MY THOUGHTS, 5906 03:27:49,464 --> 03:27:51,166 BUT I THINK PERSONALIZED CARE IS 5907 03:27:51,166 --> 03:27:53,001 GOING TO REQUIRE A VARIETY OF 5908 03:27:53,001 --> 03:27:55,971 DIFFERENT METRICS AND MAYBE LIKE 5909 03:27:55,971 --> 03:27:59,908 WHAT ALLEN SAID, POLYGENETIC 5910 03:27:59,908 --> 03:28:03,178 RISKS, DIEGO HAS BEEN WORKING IN 5911 03:28:03,178 --> 03:28:04,479 THAT AREA, WILL HELP GUIDE US. 5912 03:28:04,479 --> 03:28:06,114 I THINK THE LAST THING I WILL 5913 03:28:06,114 --> 03:28:07,249 SAY IN TERMS OF WHAT I THOUGHT 5914 03:28:07,249 --> 03:28:08,417 WAS REALLY EXCITING WAS THE 5915 03:28:08,417 --> 03:28:10,285 WHOLE NOTION OF SIMULATION, AND 5916 03:28:10,285 --> 03:28:13,655 BEING ABLE TO SIMULATE A PATIENT 5917 03:28:13,655 --> 03:28:16,525 BASED ON A DEEP DIVE INTO THE 5918 03:28:16,525 --> 03:28:18,894 DATA TO TRY TO TARGET THE 5919 03:28:18,894 --> 03:28:21,230 APPROPRIATE TREATMENT UP FRONT, 5920 03:28:21,230 --> 03:28:23,332 BECAUSE RIGHT NOW WE USUALLY 5921 03:28:23,332 --> 03:28:24,733 APPROACH PATIENTS, GIVE THEM 5922 03:28:24,733 --> 03:28:26,602 CPAP, THAT DOESN'T WORK, WE'LL 5923 03:28:26,602 --> 03:28:29,738 GO TO OTHER OPTIONS THAT ARE 5924 03:28:29,738 --> 03:28:31,073 MORE AGGRESSIVE. 5925 03:28:31,073 --> 03:28:32,174 >> THANKS. 5926 03:28:32,174 --> 03:28:33,375 I'VE ALWAYS THOUGHT OUR SLEEP 5927 03:28:33,375 --> 03:28:35,410 STUDY RIGHT NOW HAS ALL THESE 5928 03:28:35,410 --> 03:28:36,845 METRICS INCLUDING AHI AND A 5929 03:28:36,845 --> 03:28:38,814 BILLION OTHER STATISTICS. 5930 03:28:38,814 --> 03:28:40,415 WE COULD TALK ABOUT HOW MAYBE WE 5931 03:28:40,415 --> 03:28:42,184 AS A FIELD COULD ACTUALLY 5932 03:28:42,184 --> 03:28:42,951 STANDARDIZE OUR SLEEP REPORTS SO 5933 03:28:42,951 --> 03:28:44,586 WE DON'T LOOK LIKE REALLY SLOW 5934 03:28:44,586 --> 03:28:46,388 WHEN WE'RE TRYING TO READ AN 5935 03:28:46,388 --> 03:28:47,222 OUTSIDE REPORT, BUT THE BEST 5936 03:28:47,222 --> 03:28:49,524 SLEEP STUDY WOULD BE HERE'S WHY 5937 03:28:49,524 --> 03:28:52,294 YOU HAVE SLEEP APNEA, HERE'S THE 5938 03:28:52,294 --> 03:28:53,428 TREATMENTS THAT MIGHT WORK FOR 5939 03:28:53,428 --> 03:28:54,897 YOU, AND HERE'S HOW YOU'D FEEL. 5940 03:28:54,897 --> 03:28:56,198 YOU'D FEEL LIKE YOU GOT TWO MORE 5941 03:28:56,198 --> 03:28:58,901 HOURS OF SLEEP, OR YOUR BLOOD 5942 03:28:58,901 --> 03:28:59,568 PRESSURE WOULD GET BETTER OR 5943 03:28:59,568 --> 03:29:00,168 WHATEVER. 5944 03:29:00,168 --> 03:29:07,776 LET ME ASK NAJIB, WHAT DO YOU 5945 03:29:07,776 --> 03:29:09,344 THINK HAVE BEEN THE BIG 5946 03:29:09,344 --> 03:29:10,479 PRACTICES OVER YOUR CAREER IN 5947 03:29:10,479 --> 03:29:12,147 TERMS OF HOW WE TREAT SLEEP 5948 03:29:12,147 --> 03:29:14,016 APNEA, ONE WE SAW WITH SOME OF 5949 03:29:14,016 --> 03:29:15,651 THESE OUTCOMES, ARE THERE THINGS 5950 03:29:15,651 --> 03:29:17,052 YOU WERE EXCITED ABOUT FROM THE 5951 03:29:17,052 --> 03:29:18,320 FIRST COUPLE SESSIONS? 5952 03:29:18,320 --> 03:29:20,122 >> JUST FOR THE SAKE -- I WORK 5953 03:29:20,122 --> 03:29:24,026 IN CANADA SEW WE ACTUALLY DON'T 5954 03:29:24,026 --> 03:29:25,127 HAVE HYPOGLOSSAL NERVE 5955 03:29:25,127 --> 03:29:25,527 STIMULATION HERE. 5956 03:29:25,527 --> 03:29:26,929 I DON'T KNOW IF MY CLINICAL 5957 03:29:26,929 --> 03:29:28,263 PRACTICE HAS REALLY CHANGED THAT 5958 03:29:28,263 --> 03:29:29,831 MUCH IN THE LAST 10 YEARS. 5959 03:29:29,831 --> 03:29:31,900 I THINK 10, 15 YEARS AGO, I WAS 5960 03:29:31,900 --> 03:29:33,235 GETTING AN AHI ON PEOPLE AND 5961 03:29:33,235 --> 03:29:35,737 PUTTING PEOPLE ON CPAP AND 5962 03:29:35,737 --> 03:29:37,172 TELLING PEOPLE TO LOSE WEIGHT IF 5963 03:29:37,172 --> 03:29:38,040 THEY CAN, AND I THINK I'M KIND 5964 03:29:38,040 --> 03:29:39,775 OF DOING THE SAME THING NOW. 5965 03:29:39,775 --> 03:29:41,376 HONESTLY QUITE A FEW YEARS AGO, 5966 03:29:41,376 --> 03:29:42,077 A LITTLE BIT DOWN ON THE FIELD 5967 03:29:42,077 --> 03:29:44,346 TO BE HONEST BECAUSE I JUST FELT 5968 03:29:44,346 --> 03:29:46,114 LIKE WE'RE DOING THE SAME THINGS 5969 03:29:46,114 --> 03:29:46,448 OVER AND OVER. 5970 03:29:46,448 --> 03:29:47,549 I THINK IN THE LAST COUPLE OF 5971 03:29:47,549 --> 03:29:49,017 YEARS I'M MORE HOPEFUL BECAUSE 5972 03:29:49,017 --> 03:29:50,786 OF A LOT OF THIS WORK THAT'S 5973 03:29:50,786 --> 03:29:51,086 BEING DONE. 5974 03:29:51,086 --> 03:29:51,920 I DON'T KNOW IF A LOT OF THE 5975 03:29:51,920 --> 03:29:53,522 STUFF YOU PRESENTED HERE IS 5976 03:29:53,522 --> 03:29:54,489 NECESSARILY READY FOR PRIME TIME 5977 03:29:54,489 --> 03:29:56,058 OR THOSE KINDS OF THINGS, BUT IT 5978 03:29:56,058 --> 03:29:57,793 LOOKS PRETTY HOPEFUL AND LOOKS 5979 03:29:57,793 --> 03:29:58,460 PRETTY EXCITING AS WELL. 5980 03:29:58,460 --> 03:30:00,996 LIKE IF I COULD THINK OF THINGS 5981 03:30:00,996 --> 03:30:02,597 THAT I THINK PEOPLE ARE REALLY 5982 03:30:02,597 --> 03:30:05,968 EXCITED ABOUT IN GENERAL, EVEN 5983 03:30:05,968 --> 03:30:06,601 PEOPLE WHO AREN'T IN THE SLEEP 5984 03:30:06,601 --> 03:30:07,903 FIELD, JUST GENERAL RESPIRATORY 5985 03:30:07,903 --> 03:30:09,171 AS WELL, I THINK THAT THINGS 5986 03:30:09,171 --> 03:30:12,808 THAT WE ARE HOPEFUL ABOUT IS 5987 03:30:12,808 --> 03:30:13,976 PROBABLY THE PHARMACEUTICAL 5988 03:30:13,976 --> 03:30:14,609 APPROACHES TO SLEEP APNEA AND I 5989 03:30:14,609 --> 03:30:16,044 THINK THAT THAT LENDS ITSELF TO 5990 03:30:16,044 --> 03:30:18,547 SORT OF THE PHYSIOLOGIC 5991 03:30:18,547 --> 03:30:20,849 ENDOTYPING AND MAKES PHYSIOLOGY 5992 03:30:20,849 --> 03:30:22,150 MO IMPORTANT AS WELL. 5993 03:30:22,150 --> 03:30:24,786 I THINK THE WHOLE THING WITH THE 5994 03:30:24,786 --> 03:30:27,422 LINKS BETWEEN OBESITY AND HAVING 5995 03:30:27,422 --> 03:30:28,423 TREATMENT TO TREAT THE OBESITY 5996 03:30:28,423 --> 03:30:29,257 AND TREAT THE SLEEP APNEA I 5997 03:30:29,257 --> 03:30:30,926 THINK IT'S GOING TO CHANGE THE 5998 03:30:30,926 --> 03:30:34,096 WAY WE PROBABLY MANAGE THESE 5999 03:30:34,096 --> 03:30:36,832 PATIENTS AND THE LINKS BETWEEN 6000 03:30:36,832 --> 03:30:37,799 WHETHER WE START PRESCRIBING 6001 03:30:37,799 --> 03:30:39,668 SOME OF THESE MEDICATIONS AND 6002 03:30:39,668 --> 03:30:40,635 MORE SYSTEMATICALLY AS WELL. 6003 03:30:40,635 --> 03:30:42,070 I THINK ALL THESE NEWER METRICS 6004 03:30:42,070 --> 03:30:43,972 I THINK IS VERY EXCITING AS 6005 03:30:43,972 --> 03:30:44,806 WELL, BUT I WOULD GIVE THE 6006 03:30:44,806 --> 03:30:46,775 CAVEAT THAT I THINK IT WAS ALLEN 6007 03:30:46,775 --> 03:30:50,679 PACK OR MAYBE IT WAS ANKIT WHO 6008 03:30:50,679 --> 03:30:51,913 SAID THEY ARE KIND OF 6009 03:30:51,913 --> 03:30:52,948 PROLIFERATING VERY QUICKLY. 6010 03:30:52,948 --> 03:30:54,216 THE PROBLEM YOU GET INTO IS IT'S 6011 03:30:54,216 --> 03:30:55,917 VERY EASY TO GENERATE A LOT OF 6012 03:30:55,917 --> 03:30:56,551 THESE METRICS AND THE QUESTION 6013 03:30:56,551 --> 03:30:58,353 IS WHAT DO THEY MEAN 6014 03:30:58,353 --> 03:31:00,789 BIOLOGICALLY, AND YOU KNOW, WHAT 6015 03:31:00,789 --> 03:31:02,090 EXTRA INFORMATION DO THEY OFFER. 6016 03:31:02,090 --> 03:31:04,793 SO IF THEY MAKE YOUR PREDICTION 6017 03:31:04,793 --> 03:31:06,762 FROM 89 TO 89.5, I'M JUST NOT 6018 03:31:06,762 --> 03:31:08,397 SURE IF IT'S REALLY WORTH IT SO 6019 03:31:08,397 --> 03:31:09,798 I THINK WE KIND OF HAVE TO 6020 03:31:09,798 --> 03:31:10,599 FIGURE OUT WHICH OF THESE 6021 03:31:10,599 --> 03:31:14,503 METRICS ARE ACTUALLY GIVING NEW 6022 03:31:14,503 --> 03:31:15,404 INFORMATION VERSUS JUST SORT OF 6023 03:31:15,404 --> 03:31:16,805 REDUNDANT INFORMATION, DO THESE 6024 03:31:16,805 --> 03:31:17,906 EXTRA DIMENSIONALITIES MAKE THAT 6025 03:31:17,906 --> 03:31:19,474 MUCH SENSE OR ARE THEY MEASURING 6026 03:31:19,474 --> 03:31:20,409 OTHER ASPECTS OF THE DISEASE AS 6027 03:31:20,409 --> 03:31:20,742 WELL. 6028 03:31:20,742 --> 03:31:22,277 BUT YEAH, I THINK IT'S AN 6029 03:31:22,277 --> 03:31:23,612 EXCITING TIME BECAUSE I THINK 6030 03:31:23,612 --> 03:31:25,047 JUST LIKE WHAT YOU SAID, BOB, I 6031 03:31:25,047 --> 03:31:26,114 THINK IT WOULD BE NICE TO BE 6032 03:31:26,114 --> 03:31:28,884 ABLE TO GET THIS SLEEP STUDY OR 6033 03:31:28,884 --> 03:31:31,153 MAYBE INCORPORATE CLINICAL 6034 03:31:31,153 --> 03:31:32,487 STUFF, BAY OWE CHEMICAL STUFF AS 6035 03:31:32,487 --> 03:31:33,789 WELL, AND BE ABLE TO TELL THE 6036 03:31:33,789 --> 03:31:35,524 PERSON AND SAY LIKE YOU SAID 6037 03:31:35,524 --> 03:31:37,926 WELL THIS IS THE LOCATION OF 6038 03:31:37,926 --> 03:31:38,727 WHERE YOUR SLEEP APNEA IS, THIS 6039 03:31:38,727 --> 03:31:40,028 MIGHT BE WHY YOU MIGHT HAVE IT, 6040 03:31:40,028 --> 03:31:41,530 THESE ARE THE THERAPIES THAT 6041 03:31:41,530 --> 03:31:43,632 WOULD WORK BEST IN YOU, AND THE 6042 03:31:43,632 --> 03:31:44,966 PROBABILITY THAT THEY WOULD 6043 03:31:44,966 --> 03:31:45,834 WORK. 6044 03:31:45,834 --> 03:31:47,903 THESE ARE HOW YOU WOULD FEEL OR 6045 03:31:47,903 --> 03:31:50,472 IN TERMS OF QUALITY OF LIFE, YOU 6046 03:31:50,472 --> 03:31:53,842 KNOW, IMPROVEMENTS OR SLEEPINESS 6047 03:31:53,842 --> 03:31:55,210 IMPROVEMENTS, IF YOU GET 6048 03:31:55,210 --> 03:31:55,811 TREATMENT THESE ARE THINGS YOU 6049 03:31:55,811 --> 03:31:56,978 ARE AT RISK OF LONG TERM, 6050 03:31:56,978 --> 03:32:00,282 WHETHER IT BE DEMENTIA, HEART 6051 03:32:00,282 --> 03:32:01,850 DISEASE, HYPERTENSION OR THOSE 6052 03:32:01,850 --> 03:32:02,517 THINGS AS WELL, I THINK IT WOULD 6053 03:32:02,517 --> 03:32:04,319 BE ABLE TO BE NICE TO GIVE 6054 03:32:04,319 --> 03:32:06,955 PEOPLE A NUANCE OF WHAT'S GOING 6055 03:32:06,955 --> 03:32:07,522 ON. 6056 03:32:07,522 --> 03:32:08,490 SO I THINK WE ARE HEADED IN THAT 6057 03:32:08,490 --> 03:32:08,824 DIRECTION. 6058 03:32:08,824 --> 03:32:11,126 I THINK ONE OF THE ISSUES IS I 6059 03:32:11,126 --> 03:32:13,595 DON'T KNOW IF WE HAVE ENOUGH 6060 03:32:13,595 --> 03:32:14,830 DATA TO ACTUALLY DO A LOT OF 6061 03:32:14,830 --> 03:32:17,566 THINGS THAT WE WANT TO DO, SO 6062 03:32:17,566 --> 03:32:20,001 ONCE YOU'RE LOOKING AT THESE 6063 03:32:20,001 --> 03:32:21,403 HIGH DIMENSIONALITY OR MULTIPLE 6064 03:32:21,403 --> 03:32:22,504 DIMENSIONS, I THINK DOING A 6065 03:32:22,504 --> 03:32:24,439 COHORT OF A THOUSAND OR 5,000 6066 03:32:24,439 --> 03:32:25,073 PEOPLE, I JUST DON'T KNOW IF 6067 03:32:25,073 --> 03:32:26,675 THAT'S ENOUGH THERE, SO I THINK 6068 03:32:26,675 --> 03:32:27,776 THAT ANYTHING WE CAN DO TO KIND 6069 03:32:27,776 --> 03:32:29,344 OF PULL DATASETS TOGETHER TO 6070 03:32:29,344 --> 03:32:30,545 KIND OF REALLY GET THAT MUCH 6071 03:32:30,545 --> 03:32:33,014 DATA SO WE CAN APLAY THESE A.I. 6072 03:32:33,014 --> 03:32:34,249 TECHNIQUES OR THESE THINGS 6073 03:32:34,249 --> 03:32:35,450 WITHOUT REALLY OVERFITTING DATA 6074 03:32:35,450 --> 03:32:37,853 AND JUST COMING UP WITH STUFF 6075 03:32:37,853 --> 03:32:39,621 WHICH ENDS UP NOT BEING TRUE, I 6076 03:32:39,621 --> 03:32:40,155 THINK ARE IMPORTANT. 6077 03:32:40,155 --> 03:32:41,356 BUT OBVIOUSLY THESE THINGS NEED 6078 03:32:41,356 --> 03:32:44,092 TO BE TESTED BEFORE WE PUT THEM 6079 03:32:44,092 --> 03:32:45,594 INTO CLINICAL PRACTICE AS WELL. 6080 03:32:45,594 --> 03:32:46,995 SO THOSE ARE JUST MY MAJOR 6081 03:32:46,995 --> 03:32:48,196 THOUGHT AT THIS POINT. 6082 03:32:48,196 --> 03:32:51,066 >> SO I FEEL LIKE A LOT OF WHAT 6083 03:32:51,066 --> 03:32:51,933 YOU TOUCHED ON, GREAT PERSON TO 6084 03:32:51,933 --> 03:32:53,702 TALK ABOUT THAT IS GOING TO BE 6085 03:32:53,702 --> 03:32:55,337 DIEGO, SO I'M SORT OF PUTTING 6086 03:32:55,337 --> 03:32:57,572 YOU ON DECK HERE FOR A SECOND. 6087 03:32:57,572 --> 03:32:58,974 BUT LIKE YOU SAID, I THINK DELTA 6088 03:32:58,974 --> 03:33:00,175 HEART RATE, I THINK IS A 6089 03:33:00,175 --> 03:33:01,176 GREAT -- IT'S A REALLY 6090 03:33:01,176 --> 03:33:02,010 INTERESTING METRIC. 6091 03:33:02,010 --> 03:33:05,313 I ALWAYS WONDER, IS THAT A SLEEP 6092 03:33:05,313 --> 03:33:05,780 APNEA-SPECIFIC THING? 6093 03:33:05,780 --> 03:33:06,948 IS THAT THE IMPACT OF OSA OR IS 6094 03:33:06,948 --> 03:33:08,150 THAT LIKE A STRESS TEST EVERY 6095 03:33:08,150 --> 03:33:11,887 TIME YOU HAVE AN AROUSAL FROM 6096 03:33:11,887 --> 03:33:12,187 SLEEP? 6097 03:33:12,187 --> 03:33:14,623 INSTEAD OF HAVING A RESPIRATORY 6098 03:33:14,623 --> 03:33:16,892 AROUSAL, SOMEBODY COULD AROUSE 6099 03:33:16,892 --> 03:33:17,659 YOU FROM SLEEP AND YOU WOULD SEE 6100 03:33:17,659 --> 03:33:19,628 SOME OF THE SAME INFORMATION, SO 6101 03:33:19,628 --> 03:33:20,529 IS THAT SLEEP APNEA SPECIFIC, IS 6102 03:33:20,529 --> 03:33:22,464 THAT JUST A METRIC OF THE 6103 03:33:22,464 --> 03:33:25,000 CARDIOVASCULAR SYSTEM? 6104 03:33:25,000 --> 03:33:27,602 SO DIEGO, MY QUESTIONS TO YOU 6105 03:33:27,602 --> 03:33:31,006 ARE, YOU KNOW, DO WE HAVE ENOUGH 6106 03:33:31,006 --> 03:33:32,741 DATA, AND THEN HOW EASY WOULD IT 6107 03:33:32,741 --> 03:33:36,578 BE TO KIND OF GENERATE SOME OF 6108 03:33:36,578 --> 03:33:40,081 YOUR WORK, PUTTING PEOPLE IN 6109 03:33:40,081 --> 03:33:40,782 DIFFERENT CLUSTERS, HOW COULD WE 6110 03:33:40,782 --> 03:33:41,616 GET THAT INTO THE CLINIC? 6111 03:33:41,616 --> 03:33:44,486 WHAT WOULD IT TAKE TO DO THAT? 6112 03:33:44,486 --> 03:33:45,554 >> I THINK THAT'S A GREAT POINT 6113 03:33:45,554 --> 03:33:47,756 AND I THINK THAT CAN REALLY -- 6114 03:33:47,756 --> 03:33:49,624 IF WE PUT TOGETHER ALL THE 6115 03:33:49,624 --> 03:33:52,460 DIFFERENT CLINICAL DATASETS THAT 6116 03:33:52,460 --> 03:33:53,795 MANY OF THE SLEEP LABS AROUND 6117 03:33:53,795 --> 03:33:56,097 THE WORLD ARE WORKING ON, AND WE 6118 03:33:56,097 --> 03:33:57,732 HAVE TO DO THIS LIKE REALLY 6119 03:33:57,732 --> 03:33:59,167 WELL, RIGHT, I'M ASSUMING THAT 6120 03:33:59,167 --> 03:34:00,802 THERE'S A LOT OF HETEROGENEITY 6121 03:34:00,802 --> 03:34:02,837 ON HOW DATA IS COLLECTED, WHAT 6122 03:34:02,837 --> 03:34:05,807 INFORMATION IS AVAILABLE. 6123 03:34:05,807 --> 03:34:08,577 I CAN JUST TALK ABOUT TALK ABOUT 6124 03:34:08,577 --> 03:34:10,312 SOME OF THE WORK DONE AT THE 6125 03:34:10,312 --> 03:34:11,613 SLEEP APNEA CONSORTIUM WHICH WAS 6126 03:34:11,613 --> 03:34:12,814 VERY CHALLENGING TO JUST LIKE 6127 03:34:12,814 --> 03:34:14,449 PULL THOSE SLEEP STUDIES 6128 03:34:14,449 --> 03:34:15,483 TOGETHER, WHEN YOU'RE PULLING, 6129 03:34:15,483 --> 03:34:19,588 YOU KNOW, SIGNALS WITH DIFFERENT 6130 03:34:19,588 --> 03:34:22,557 NAMES AND DIFFERENT LANGUAGES, 6131 03:34:22,557 --> 03:34:24,092 CHANNELS, DIFFERENT WAYS LIKE 6132 03:34:24,092 --> 03:34:24,993 SAMPLING RATES AND THINGS LIKE 6133 03:34:24,993 --> 03:34:28,263 THAT, SO I THINK THAT A LOT OF 6134 03:34:28,263 --> 03:34:32,267 WHAT WE LEARNED FROM LIKE THE 6135 03:34:32,267 --> 03:34:33,435 NATIONAL -- RESOURCE WHICH WAS A 6136 03:34:33,435 --> 03:34:35,737 FANTASTIC EFFORT TO TRY TO 6137 03:34:35,737 --> 03:34:36,938 AGGREGATE SOME OF THOSE MORE 6138 03:34:36,938 --> 03:34:38,240 LIKE RESEARCH LEVEL SORT OF 6139 03:34:38,240 --> 03:34:40,208 STUDIES, WE NEED TO LEARN FROM 6140 03:34:40,208 --> 03:34:41,876 THAT EXPERIENCE AND THEN NOT 6141 03:34:41,876 --> 03:34:42,744 TAKE ON THE NEXT CHALLENGE OF 6142 03:34:42,744 --> 03:34:46,281 HOW WE CAN DO THESE ACROSS VERY 6143 03:34:46,281 --> 03:34:47,148 HETEROGENEOUS CLINICAL 6144 03:34:47,148 --> 03:34:47,415 PRACTICES. 6145 03:34:47,415 --> 03:34:48,550 NOW THIS IS ONLY ONE POINT OF 6146 03:34:48,550 --> 03:34:51,519 DATA THAT COULD MATTER TO US BUT 6147 03:34:51,519 --> 03:34:53,321 IT A REALLY FUNDAMENTAL ONE 6148 03:34:53,321 --> 03:34:54,389 BECAUSE IT CAN HELP US ADDRESS 6149 03:34:54,389 --> 03:34:58,326 THOSE QUESTIONS LIKE WE HAVE 6150 03:34:58,326 --> 03:34:59,261 NOW -- THE GREAT HYPOTHESIS 6151 03:34:59,261 --> 03:35:01,496 ABOUT THE IMPACT OF THOSE TRAITS 6152 03:35:01,496 --> 03:35:03,698 OR THOSE DIFFERENT NOVEL MARKERS 6153 03:35:03,698 --> 03:35:04,866 FROM COMMUNITY-BASED STUDIES, 6154 03:35:04,866 --> 03:35:06,468 EVEN FROM SOME CLINICAL 6155 03:35:06,468 --> 03:35:07,636 POPULATIONS AS WELL. 6156 03:35:07,636 --> 03:35:08,837 BUT WE DON'T REALLY HAVE A LOT 6157 03:35:08,837 --> 03:35:11,139 OF INFORMATION ABOUT HOW THEY 6158 03:35:11,139 --> 03:35:12,240 WILL IMPACT THERAPY. 6159 03:35:12,240 --> 03:35:14,209 NOW, IF WE THINK ABOUT 6160 03:35:14,209 --> 03:35:15,210 RETROSPECTIVELY, WE HAVE 6161 03:35:15,210 --> 03:35:16,044 THOUSANDS, MILLIONS OF PATIENTS 6162 03:35:16,044 --> 03:35:17,178 THAT HAVE BEEN TREATED FOR SLEEP 6163 03:35:17,178 --> 03:35:18,079 APNEA. 6164 03:35:18,079 --> 03:35:22,417 SO IF WE PUT REALLY A GREAT 6165 03:35:22,417 --> 03:35:25,487 EFFORT OF TRYING TO CREATE THOSE 6166 03:35:25,487 --> 03:35:26,588 CLINICAL DATA REPOSITORIES IN 6167 03:35:26,588 --> 03:35:27,689 COLLABORATION, ENSURING THAT 6168 03:35:27,689 --> 03:35:29,124 STUDIES CAN BE HARMONIZED ACROSS 6169 03:35:29,124 --> 03:35:32,394 THE BOARD, THEN WE CAN START 6170 03:35:32,394 --> 03:35:35,463 SOME OF THE METHODS THAT ANKIT 6171 03:35:35,463 --> 03:35:37,198 BROUGHT YESTERDAY LIKE DIGITAL 6172 03:35:37,198 --> 03:35:38,633 TWINS, WE MIGHT BE ABLE TO FIND 6173 03:35:38,633 --> 03:35:41,269 SUFFICIENT PEOPLE WHERE WE CAN 6174 03:35:41,269 --> 03:35:44,205 TASK -- LIKE -- BETWEEN THAT DID 6175 03:35:44,205 --> 03:35:46,274 RECEIVE THE THERAPY, INDIGENOUS 6176 03:35:46,274 --> 03:35:47,609 WOMEN DIDN'T, YOU KNOW, ACROSS 6177 03:35:47,609 --> 03:35:48,710 MILLIONS OF PATIENTS AROUND THE 6178 03:35:48,710 --> 03:35:53,114 WORLD, AND START INFERRING THOSE 6179 03:35:53,114 --> 03:35:53,481 CAUSAL EFFECTS. 6180 03:35:53,481 --> 03:35:54,849 SO TO TIE THIS WITH SOME OF THE 6181 03:35:54,849 --> 03:35:56,918 DISCUSSION WE HAD LAST, CAN WE 6182 03:35:56,918 --> 03:35:58,820 LEARN FROM THE DATA THAT'S BEEN 6183 03:35:58,820 --> 03:36:00,121 COLLECTED RETROSPECTIVELY TO 6184 03:36:00,121 --> 03:36:02,857 THEN INFORM WHAT'S GOING TO BE 6185 03:36:02,857 --> 03:36:04,926 THE NEXT PERSPECTIVE PRAGMATIC 6186 03:36:04,926 --> 03:36:06,094 TRIAL YOU WANT TO DO. 6187 03:36:06,094 --> 03:36:08,129 AND I THINK THERE'S A LOT OF 6188 03:36:08,129 --> 03:36:09,531 ROOM OPPORTUNITY ON TRYING TO 6189 03:36:09,531 --> 03:36:10,899 ACCOMPLISH THIS, AND I THINK THE 6190 03:36:10,899 --> 03:36:14,602 FIRST STEP IS REALLY JOINING AS 6191 03:36:14,602 --> 03:36:16,671 A TEAM TO START HARMONIZING, 6192 03:36:16,671 --> 03:36:19,841 ORGANIZING THIS DATA AND JUST 6193 03:36:19,841 --> 03:36:20,942 PUTTING THAT TOGETHER SO WE CAN 6194 03:36:20,942 --> 03:36:23,745 START ASKING THOSE QUESTIONS 6195 03:36:23,745 --> 03:36:24,746 PRIOR TO WHAT WE DO TRIALS. 6196 03:36:24,746 --> 03:36:26,848 >> I LOVE THE IDEA OF THE 6197 03:36:26,848 --> 03:36:29,317 INSILICO, YOU KNOW, VIRTUAL 6198 03:36:29,317 --> 03:36:30,318 THERAPY AND SEE WHAT THAT LOOKS 6199 03:36:30,318 --> 03:36:31,720 LIKE FOR A PATIENT AND COME 6200 03:36:31,720 --> 03:36:32,153 BACK. 6201 03:36:32,153 --> 03:36:35,690 SO I WANT TO HAVE MONICA, IF 6202 03:36:35,690 --> 03:36:37,225 YOU'RE ABLE TO COME ON TO VIDEO 6203 03:36:37,225 --> 03:36:38,426 AND SORT OF ASK YOUR QUESTION, 6204 03:36:38,426 --> 03:36:40,061 BECAUSE I USE PERSONALIZED 6205 03:36:40,061 --> 03:36:41,696 MEDICINE AND PRECISION 6206 03:36:41,696 --> 03:36:42,297 INTERCHANGEABLY AND MAYBE YOU 6207 03:36:42,297 --> 03:36:45,633 COULD ASK YOUR QUESTION AND THEN 6208 03:36:45,633 --> 03:36:46,968 SUSAN I'D LIKE TO PUT YOU ON 6209 03:36:46,968 --> 03:36:48,303 DECK AND TALK FOR JUST A MINUTE 6210 03:36:48,303 --> 03:36:49,704 ABOUT THE CHALLENGES OF GETTING 6211 03:36:49,704 --> 03:36:51,940 THE NSRR UP AND RUNNING, YOU 6212 03:36:51,940 --> 03:36:54,242 KNOW, WHAT DID THAT TAKE AND 6213 03:36:54,242 --> 03:36:55,310 WHAT WOULD IT TAKE TO EXPAND 6214 03:36:55,310 --> 03:36:57,579 THAT BY 10 OR 100? 6215 03:36:57,579 --> 03:36:58,680 BUT MONICA, ARE YOU ABLE TO ASK 6216 03:36:58,680 --> 03:36:59,981 YOUR QUESTION ON VIDEO? 6217 03:36:59,981 --> 03:37:01,516 ITHERE YOU ARE, THANK YOU. 6218 03:37:01,516 --> 03:37:02,851 >> THANKS, BOB. 6219 03:37:02,851 --> 03:37:06,254 NO, I HEARD BOTH THE TERMS 6220 03:37:06,254 --> 03:37:09,290 MENTIONED TODAY, AND IN SOME 6221 03:37:09,290 --> 03:37:10,725 INSTANCES, THE SPEAKERS WERE 6222 03:37:10,725 --> 03:37:12,160 USING THEM INTERCHANGEABLY, SO I 6223 03:37:12,160 --> 03:37:14,996 JUST WANT TO BE CLEAR IN WHAT 6224 03:37:14,996 --> 03:37:16,865 CONTEXT ARE WE USING 6225 03:37:16,865 --> 03:37:17,832 PERSONALIZED MEDICINE VERSUS 6226 03:37:17,832 --> 03:37:20,568 PRECISION MEDICINE. 6227 03:37:20,568 --> 03:37:22,470 IN MY MIND THEY ARE TWO VERY 6228 03:37:22,470 --> 03:37:22,871 DIFFERENT THINGS. 6229 03:37:22,871 --> 03:37:25,073 I THINK THE FIELD WANTS TO 6230 03:37:25,073 --> 03:37:26,941 EVENTUALLY GET TO PRECISION 6231 03:37:26,941 --> 03:37:27,909 MEDICINE, A VERY TARGETED TYPE 6232 03:37:27,909 --> 03:37:29,344 OF TREATMENT SO THE RIGHT 6233 03:37:29,344 --> 03:37:31,746 TREATMENT FOR THE RIGHT PATIENT 6234 03:37:31,746 --> 03:37:32,514 AT THE RIGHT TIME. 6235 03:37:32,514 --> 03:37:34,249 WE'RE NOT THERE YET, BUT I THINK 6236 03:37:34,249 --> 03:37:36,985 THAT'S WHERE WE WANT TO BE. 6237 03:37:36,985 --> 03:37:38,586 THE DEFINITION OF PRECISION 6238 03:37:38,586 --> 03:37:40,188 MEDICINE HAS BEEN EVOLVING IN MY 6239 03:37:40,188 --> 03:37:42,157 SENSE FOR THE PAST FEW YEARS. 6240 03:37:42,157 --> 03:37:43,358 ARE WE THERE YET? 6241 03:37:43,358 --> 03:37:44,692 DO WE EXACTLY KNOW WHAT THE 6242 03:37:44,692 --> 03:37:46,661 DEFINITION IS? 6243 03:37:46,661 --> 03:37:49,130 PERSONALIZED MEDICINE DEFINITION 6244 03:37:49,130 --> 03:37:51,499 HAS BEEN AROUND FOR A WHILE, BUT 6245 03:37:51,499 --> 03:37:52,267 I THINK I JUST WANTED TO HEAR 6246 03:37:52,267 --> 03:37:53,468 YOUR THOUGHT ON THAT AND WHERE 6247 03:37:53,468 --> 03:37:55,970 DOES THIS FIELD WANT TO BE 6248 03:37:55,970 --> 03:37:59,073 EVENTUALLY? 6249 03:37:59,073 --> 03:38:00,708 >> I WILL DEFINITELY LEAVE THAT 6250 03:38:00,708 --> 03:38:03,545 OPEN FOR ANOTHER PANELIST, 6251 03:38:03,545 --> 03:38:05,713 BECAUSE I THINK I OFTEN USE 6252 03:38:05,713 --> 03:38:07,215 PERSONALIZED, PRECISION, AND 6253 03:38:07,215 --> 03:38:10,685 OTHER TERMS INTERCHANGEABLY. 6254 03:38:10,685 --> 03:38:12,420 >> -- USE PRECISION MEDICINE 6255 03:38:12,420 --> 03:38:15,256 QUITE A BIT AND THEY RELY ANNOT 6256 03:38:15,256 --> 03:38:16,691 ON GENETICS, BUT I THINK IT 6257 03:38:16,691 --> 03:38:18,460 NEEDS TO BE MORE THAN THAT. 6258 03:38:18,460 --> 03:38:19,527 I WOULD LOVE TO HEAR YOUR 6259 03:38:19,527 --> 03:38:20,094 THOUGHTS ON THAT. 6260 03:38:20,094 --> 03:38:21,463 I THINK THAT'S A GREAT WAY FOR 6261 03:38:21,463 --> 03:38:22,964 US TO AT LEAST DEFINE WHERE WE 6262 03:38:22,964 --> 03:38:25,033 WANT TO BE AS A SLEEP APNEA 6263 03:38:25,033 --> 03:38:25,600 FIELD. 6264 03:38:25,600 --> 03:38:31,940 >> SO SUSHMITA HAS HER HAND UP, 6265 03:38:31,940 --> 03:38:33,041 MAYBE SHE'S WILLING TO ANSWER 6266 03:38:33,041 --> 03:38:33,241 THAT. 6267 03:38:33,241 --> 03:38:34,909 >> VERY INTERESTING QUESTION. 6268 03:38:34,909 --> 03:38:35,677 I THINK I'M GUILTY OF THE SAME, 6269 03:38:35,677 --> 03:38:37,045 OF USING IT INTERCHANGEABLY. 6270 03:38:37,045 --> 03:38:38,079 BUT I THINK ONE OF THE THINGS 6271 03:38:38,079 --> 03:38:39,314 THAT WE HAVEN'T TALKED A LOT 6272 03:38:39,314 --> 03:38:40,715 ABOUT TODAY THAT MIGHT BE MORE 6273 03:38:40,715 --> 03:38:41,916 RELEVANT TO PERSONALIZED 6274 03:38:41,916 --> 03:38:43,351 MEDICINE IS PATIENT PREFERENCES 6275 03:38:43,351 --> 03:38:46,187 AND PATIENT CHOICE. 6276 03:38:46,187 --> 03:38:48,256 SO REALLY PATIENT LEVEL OF 6277 03:38:48,256 --> 03:38:50,225 CHARACTERISTICS ON WHAT 6278 03:38:50,225 --> 03:38:53,628 TREATMENT THEY PREFER OR LIKE OR 6279 03:38:53,628 --> 03:38:56,030 DISLIKE, MAYBE WITH RESPECT TO 6280 03:38:56,030 --> 03:38:58,666 THEIR UNIQUE ENVIRONMENT OR 6281 03:38:58,666 --> 03:38:59,634 OTHER SORT OF SOCIAL SITUATION. 6282 03:38:59,634 --> 03:39:01,503 SO I WONDER IF THAT'S SOMETHING 6283 03:39:01,503 --> 03:39:03,171 THAT DOESN'T REALLY GET 6284 03:39:03,171 --> 03:39:04,038 INCORPORATED INTO PRECISION 6285 03:39:04,038 --> 03:39:05,673 MEDICINE BECAUSE I SEE THAT MORE 6286 03:39:05,673 --> 03:39:09,777 AS AN OMICS-TYPE MOLECULAR -- 6287 03:39:09,777 --> 03:39:11,179 BUT I DON'T KNOW. 6288 03:39:11,179 --> 03:39:16,451 IT'S JUST A THOUGHT. 6289 03:39:16,451 --> 03:39:18,786 >> IRINA, YOU HAVE YOUR HAND UP? 6290 03:39:18,786 --> 03:39:20,522 >> SO I JUST WANTED TO PUT A 6291 03:39:20,522 --> 03:39:22,023 COUPLE OF THOUGHTS AS A 6292 03:39:22,023 --> 03:39:23,758 STATISTICIAN AND QUANTITATIVE 6293 03:39:23,758 --> 03:39:24,025 PERSON. 6294 03:39:24,025 --> 03:39:25,426 AT THE UNIVERSITY OF MICHIGAN WE 6295 03:39:25,426 --> 03:39:26,861 HAVE A PRECISION MEDICINE CENTER 6296 03:39:26,861 --> 03:39:28,596 AND EVEN THOUGH THAT INITIATIVE 6297 03:39:28,596 --> 03:39:31,666 STARTED WITH COLLECTING GENETICS 6298 03:39:31,666 --> 03:39:35,336 DATA, THE TERM ITSELF AS 6299 03:39:35,336 --> 03:39:36,371 PRECISION MEDICINE WENT FURTHER 6300 03:39:36,371 --> 03:39:38,239 BEYOND JUST THE GENETICS AND 6301 03:39:38,239 --> 03:39:39,641 OTHER CHARACTERISTICS, BUT I 6302 03:39:39,641 --> 03:39:44,045 REALLY WANT TO AGREE WITH 6303 03:39:44,045 --> 03:39:44,712 SUSHMITA'S POINT THAT I FEEL 6304 03:39:44,712 --> 03:39:46,681 LIKE WHEN WE TALK ABOUT 6305 03:39:46,681 --> 03:39:47,615 PERSONALIZED, WE HAVE TO TAKE 6306 03:39:47,615 --> 03:39:49,017 INTO ACCOUNT THE PATIENT'S 6307 03:39:49,017 --> 03:39:50,218 PREFERENCES IN TERMS OF THE 6308 03:39:50,218 --> 03:39:51,653 OUTCOMES THAT WOULD BE IMPORTANT 6309 03:39:51,653 --> 03:39:54,088 FOR THEM AND WHAT ARE THINGS 6310 03:39:54,088 --> 03:39:55,156 THAT THEY WILL BE WILLING AND 6311 03:39:55,156 --> 03:39:56,491 NOT WILLING TO DO AS A 6312 03:39:56,491 --> 03:39:57,125 TREATMENT. 6313 03:39:57,125 --> 03:40:00,428 WHEREAS PRECISION WOULD BE MORE 6314 03:40:00,428 --> 03:40:00,828 TALKING ABOUT THE 6315 03:40:00,828 --> 03:40:01,529 CHARACTERISTICS OF A HUB IN 6316 03:40:01,529 --> 03:40:03,431 TERMS OF THE POTENTIAL EFFICACY 6317 03:40:03,431 --> 03:40:07,335 OF THE TREATMENT. 6318 03:40:07,335 --> 03:40:09,270 >> I WANT TO HOLD ON SOME OF THE 6319 03:40:09,270 --> 03:40:09,637 QUESTIONS. 6320 03:40:09,637 --> 03:40:10,538 SUSAN ARE YOU ABLE TO GIVE SORT 6321 03:40:10,538 --> 03:40:12,373 OF A ONE MINUTE ON HOW MUCH 6322 03:40:12,373 --> 03:40:14,509 BLOOD, SWEAT AND TEARS DID IT 6323 03:40:14,509 --> 03:40:18,012 TAKE TO GET NSRR GOING? 6324 03:40:18,012 --> 03:40:19,247 AND MAYBE THAT WOULD BE REALLY 6325 03:40:19,247 --> 03:40:20,481 HELPFUL. 6326 03:40:20,481 --> 03:40:20,982 >> THAT'S A REALLY GOOD 6327 03:40:20,982 --> 03:40:21,249 QUESTION. 6328 03:40:21,249 --> 03:40:23,284 I DON'T THINK IT WAS A PROBLEM 6329 03:40:23,284 --> 03:40:26,454 GETTING GOING. 6330 03:40:26,454 --> 03:40:28,222 IT'S ONGOING EFFORT, AP AGAIN, I 6331 03:40:28,222 --> 03:40:30,124 NEED TO ACKNOWLEDGE NHLBI HAS 6332 03:40:30,124 --> 03:40:32,493 BEEN INCREDIBLY SUPPORTIVE 6333 03:40:32,493 --> 03:40:34,796 BEGINNING WITH MICHAEL AND NOW 6334 03:40:34,796 --> 03:40:36,664 WITH MARISHKA BROWN IN REALLY 6335 03:40:36,664 --> 03:40:37,665 GIVING US THE FUNDING TO 6336 03:40:37,665 --> 03:40:38,967 ACTUALLY WORK WITH THE 6337 03:40:38,967 --> 03:40:41,169 COMMUNITY. 6338 03:40:41,169 --> 03:40:42,937 I PUT THE REFERENCE IN THE CHAT, 6339 03:40:42,937 --> 03:40:45,340 AND THE BIGGEST PROBLEMS ARE 6340 03:40:45,340 --> 03:40:46,541 TWOFOLD. 6341 03:40:46,541 --> 03:40:49,043 ONE IS REALLY JUST THE 6342 03:40:49,043 --> 03:40:50,445 WILLINGNESS OF PEOPLE TO SHARE 6343 03:40:50,445 --> 03:40:52,213 THEIR DATA, AND I WANT TO -- YOU 6344 03:40:52,213 --> 03:40:53,948 KNOW, AND I THINK EVERYONE NOW 6345 03:40:53,948 --> 03:40:58,219 WHO GETS NIH FUNDING TO DO SLEEP 6346 03:40:58,219 --> 03:40:59,754 RESEARCH IN THE U.S. HAS A 6347 03:40:59,754 --> 03:41:01,723 MANDATE TO SHARE THAT DATA, AND 6348 03:41:01,723 --> 03:41:04,592 I DO HOPE THAT EVERYONE TAKES 6349 03:41:04,592 --> 03:41:07,228 THAT SERIOUSLY AND I KNOW THAT 6350 03:41:07,228 --> 03:41:08,763 NHLBI OR NATIONAL CENTER FOR 6351 03:41:08,763 --> 03:41:13,501 SLEEP DISORDERS RESEARCH IS A 6352 03:41:13,501 --> 03:41:15,703 HAS ENCOURAGED SLEEP RESEARCHERS 6353 03:41:15,703 --> 03:41:17,672 TO CONTACT NSR AND WE WILL WORK 6354 03:41:17,672 --> 03:41:18,439 WITH YOU. 6355 03:41:18,439 --> 03:41:20,174 SO JUST WANTED TO SAY THAT THE 6356 03:41:20,174 --> 03:41:23,077 FIRST BARRIER -- THEN THERE ARE 6357 03:41:23,077 --> 03:41:25,313 REGULATORY ISSUES BUT I THINK 6358 03:41:25,313 --> 03:41:27,715 GOING FORWARD, IF YOU COLLECT 6359 03:41:27,715 --> 03:41:32,854 YOUR DATA USING SORT OF THE 6360 03:41:32,854 --> 03:41:38,359 COMMON PROTOCOL, ET, YOU CAN -- 6361 03:41:38,359 --> 03:41:39,560 LANGUAGE FOR DATA SHARE, THERE'S 6362 03:41:39,560 --> 03:41:43,264 NO REASON TO HIDE BEHIND THAT. 6363 03:41:43,264 --> 03:41:44,565 WHERE I THINK THE BIGGEST 6364 03:41:44,565 --> 03:41:45,833 PROBLEM DIEGO IS REFERRING TO IS 6365 03:41:45,833 --> 03:41:48,670 THE AMOUNT OF EFFORT MY STAFF 6366 03:41:48,670 --> 03:41:52,273 SPENDS IN CLEANING DATA WE GET 6367 03:41:52,273 --> 03:41:53,841 FROM SAIR JUST SOURCES BECAUSE 6368 03:41:53,841 --> 03:41:58,613 OF ALL THE INCONSIST 1 TENNESSES 6369 03:41:58,613 --> 03:42:02,283 AND LACK OF HARMONIZATION WITH 6370 03:42:02,283 --> 03:42:03,084 DEVICES, PEOPLE LABEL CHANNELS, 6371 03:42:03,084 --> 03:42:07,055 THE FILTERS THAT GET PUT IN, AND 6372 03:42:07,055 --> 03:42:08,556 I VA TO SAY WE'RE WORKING VERY 6373 03:42:08,556 --> 03:42:10,725 HARD AND MY COLLEAGUE SHAWN 6374 03:42:10,725 --> 03:42:12,193 PURCELL HAS CREATED SOME REALLY 6375 03:42:12,193 --> 03:42:13,895 NICE OPEN SOURCE TOOLS, SO A LOT 6376 03:42:13,895 --> 03:42:16,664 OF THAT WORK OF SHARING DATA, 6377 03:42:16,664 --> 03:42:18,766 WHICH YOU KNOW, REALLY THE -- 6378 03:42:18,766 --> 03:42:21,169 WHICH SLOWS US DOWN IS DOING 6379 03:42:21,169 --> 03:42:25,139 THAT SECONDARY HARM NIGH STATION 6380 03:42:25,139 --> 03:42:26,774 IN CLEANING UP, AND WHAT WE ARE 6381 03:42:26,774 --> 03:42:30,044 NOW DOING IS CREATING MSR 6382 03:42:30,044 --> 03:42:32,480 VERSIONS OF BOTH THE ROTH 6383 03:42:32,480 --> 03:42:33,715 SIGNAL, THE METADATA AND THE 6384 03:42:33,715 --> 03:42:34,682 SUMMARY VARIABLE, BUT IF THAT 6385 03:42:34,682 --> 03:42:37,351 COULD BE DONE BY EACH OF YOU UP 6386 03:42:37,351 --> 03:42:39,120 FRONT, IT TAKES OFF A HUGE 6387 03:42:39,120 --> 03:42:41,289 AMOUNT OF WORK. 6388 03:42:41,289 --> 03:42:43,224 AND WE ARE WORKING AT 6389 03:42:43,224 --> 03:42:46,160 PUBLICIZING IT AND I KNOW I 6390 03:42:46,160 --> 03:42:47,795 SPOKE TO -- DIEGO AND I HAVE 6391 03:42:47,795 --> 03:42:50,965 TALKED ABOUT EVEN ENGAGING THE 6392 03:42:50,965 --> 03:42:52,633 COMMUNITY MORE INTERACTIVELY, SO 6393 03:42:52,633 --> 03:42:55,136 IT'S NOT JUST THE MSR GROUP 6394 03:42:55,136 --> 03:42:57,238 THAT'S PUTTING THE STANDARDS OUT 6395 03:42:57,238 --> 03:43:00,141 THERE, AND MSR IS '04 FOR 6396 03:43:00,141 --> 03:43:01,342 HOSTING WEBINARS OVER THE NEXT 6397 03:43:01,342 --> 03:43:03,311 FEW MONTHS TO, AGAIN, CONTINUE 6398 03:43:03,311 --> 03:43:04,779 TO ENGAGE THE COMMUNITY SO WE 6399 03:43:04,779 --> 03:43:05,847 COULD DO THIS TOGETHER. 6400 03:43:05,847 --> 03:43:07,482 AND I ALSO WANTED TO MENTION, 6401 03:43:07,482 --> 03:43:09,484 SOME OF THESE ISSUES ARE GOING 6402 03:43:09,484 --> 03:43:11,786 TO BE DISCUSSED ON WEDNESDAY 6403 03:43:11,786 --> 03:43:15,623 WITH A BIO -- CATALYST WEBINAR 6404 03:43:15,623 --> 03:43:16,390 WHERE WE'LL TALK ABOUT SOME OF 6405 03:43:16,390 --> 03:43:16,858 THE THINGS. 6406 03:43:16,858 --> 03:43:18,392 SO IF THE COMMUNITY WORK 6407 03:43:18,392 --> 03:43:20,027 TOGETHER, I WOULD SAY THE LIFT 6408 03:43:20,027 --> 03:43:23,531 IS NOT HIGH, AND THERE IS NO 6409 03:43:23,531 --> 03:43:27,535 LIMIT TO SHARING OF DATA. 6410 03:43:27,535 --> 03:43:30,772 >> JUST SO -- AN EXTRA TO WHAT 6411 03:43:30,772 --> 03:43:32,640 SUSAN JUST SAID WHICH IS AN 6412 03:43:32,640 --> 03:43:39,413 EFFORT THAT THE SLEEP -- THIS 6413 03:43:39,413 --> 03:43:40,748 TASK FORCE, THE RESEARCH 6414 03:43:40,748 --> 03:43:41,516 NETWORK, SO MANY ON THIS CALL 6415 03:43:41,516 --> 03:43:44,385 ARE ACTUALLY MEMBERS, INCLUDING 6416 03:43:44,385 --> 03:43:47,488 SUSAN AND ARI WILLIAMSON. 6417 03:43:47,488 --> 03:43:48,790 WE'RE TRYING TO COLLECT 6418 03:43:48,790 --> 03:43:50,758 INFORMATION ABOUT HOW DIFFERENT 6419 03:43:50,758 --> 03:43:52,727 CLINICAL SITES AND SLEEP ARE 6420 03:43:52,727 --> 03:43:55,062 REALLY COLLECTING YOUR DATA AND 6421 03:43:55,062 --> 03:43:56,164 WHAT OTHER INFORMATION IS 6422 03:43:56,164 --> 03:43:58,933 AVAILABLE THAT COULD BE LINKED, 6423 03:43:58,933 --> 03:44:00,735 FROM THE EHR OR THERAPY DATA. 6424 03:44:00,735 --> 03:44:04,305 SO WE LEARNED A LOT ABOUT OVER 6425 03:44:04,305 --> 03:44:06,941 25 SITES, BUT IF ANYONE IS 6426 03:44:06,941 --> 03:44:07,475 INTERESTED IN SHARING THE 6427 03:44:07,475 --> 03:44:08,176 INFORMATION ABOUT YOUR OWN SITE 6428 03:44:08,176 --> 03:44:10,678 AND YOUR OWN CENTER TO HELP US 6429 03:44:10,678 --> 03:44:14,982 DESIGN HOW WE CAN PROPOSE AN 6430 03:44:14,982 --> 03:44:15,650 APPROACH THAT CAN FACILITATE 6431 03:44:15,650 --> 03:44:16,951 THIS WORK FOR EVERYBODY, I THINK 6432 03:44:16,951 --> 03:44:20,555 WE ARE GETTING CLOSER TO OUR 6433 03:44:20,555 --> 03:44:22,023 ULTIMATE GOAL HERE, WHICH IS 6434 03:44:22,023 --> 03:44:24,559 FACILITATE THE NEXT STEP -- 6435 03:44:24,559 --> 03:44:25,126 THANKS, SUSAN. 6436 03:44:25,126 --> 03:44:27,428 >> THE ONLY THING I JUST WANT TO 6437 03:44:27,428 --> 03:44:30,498 ADD, AGAIN FOR RESEARCHERS, 6438 03:44:30,498 --> 03:44:31,699 SOUNDS LIKE YOU'RE STARTING YOUR 6439 03:44:31,699 --> 03:44:32,133 STUDIES. 6440 03:44:32,133 --> 03:44:33,901 I WOULD BEGIN WITH DESANING YOUR 6441 03:44:33,901 --> 03:44:35,970 DATA COLLECTION PROACTIVELY, SO 6442 03:44:35,970 --> 03:44:37,405 THERE'S NOT A LOT OF CLEAN-UP 6443 03:44:37,405 --> 03:44:39,407 THAT GET DONE, AND IF YOU LIKE 6444 03:44:39,407 --> 03:44:42,276 TO DEPOSIT AN NSR, MY STAFF WILL 6445 03:44:42,276 --> 03:44:44,779 HELP WORK WITH YOU TO CREATE 6446 03:44:44,779 --> 03:44:47,882 STANDARDIZED METADATA AND SPHAL 6447 03:44:47,882 --> 03:44:49,517 LABELS AND TO FORTH. 6448 03:44:49,517 --> 03:44:50,518 SO THANKS. 6449 03:44:50,518 --> 03:44:52,787 >> I THINK WHEN YOU WRITE YOUR 6450 03:44:52,787 --> 03:44:56,424 DATA SHARING PG PLAN FOR AN NIH 6451 03:44:56,424 --> 03:44:57,658 GRANT, I THINK YOU ASSUME YOU 6452 03:44:57,658 --> 03:44:59,293 HAVE THE DATA AND THEN YOU'LL 6453 03:44:59,293 --> 03:45:02,163 SHARE IT LATER, BUT I LOVE YOU 6454 03:45:02,163 --> 03:45:03,931 HAVE SOME SUGGESTED FORMATS FOR 6455 03:45:03,931 --> 03:45:07,869 BEFORE YOU COLLECT YOUR DATA. 6456 03:45:07,869 --> 03:45:08,970 NAJIB, I SEE YOUR HAND UP, ONE 6457 03:45:08,970 --> 03:45:12,373 OF THE COMMENTS IN THE Q & A 6458 03:45:12,373 --> 03:45:16,978 FROM EMMA COOKSEY IS ABOUT 6459 03:45:16,978 --> 03:45:17,912 PROLIFERATION OF THESE DIFFERENT 6460 03:45:17,912 --> 03:45:18,346 OUTCOMES. 6461 03:45:18,346 --> 03:45:19,847 NOT ONLY IS IT CONFUSING FOR US, 6462 03:45:19,847 --> 03:45:21,716 BUT IT'S CONFUSING FOR PATIENTS, 6463 03:45:21,716 --> 03:45:25,453 AND SHE'S ASKING IS THERE ONE 6464 03:45:25,453 --> 03:45:28,623 METRIC THAT CAN BE -- I WANT TO 6465 03:45:28,623 --> 03:45:30,825 START TALKING ABOUT IS THERE ONE 6466 03:45:30,825 --> 03:45:32,360 METRIC THAT RULES THEM ALL OR DO 6467 03:45:32,360 --> 03:45:33,794 WE ACTUALLY NEED ALL THESE 6468 03:45:33,794 --> 03:45:35,096 DIFFERENT METRICS BECAUSE SLEEP 6469 03:45:35,096 --> 03:45:37,565 IS SO IMPORTANT? 6470 03:45:37,565 --> 03:45:39,166 >> WHEN YOU SAY OUTCOMES, I 6471 03:45:39,166 --> 03:45:40,801 ASSUME YOU MEAN MORE LIKE 6472 03:45:40,801 --> 03:45:42,436 PHYSIOLOGIC METRICS OR SOMETHING 6473 03:45:42,436 --> 03:45:44,272 FROM PSG OR THOSE THINGS? 6474 03:45:44,272 --> 03:45:45,573 I'M NOT SURE -- 6475 03:45:45,573 --> 03:45:49,477 >> YEAH, AHI 3% -- 6476 03:45:49,477 --> 03:45:54,215 >> I WAS THINKING MORE LIKE 6477 03:45:54,215 --> 03:46:00,788 DYING NOSTIVE WITH DECIDE ON A 6478 03:46:00,788 --> 03:46:05,159 TREATMENT OPTION AND THE 6479 03:46:05,159 --> 03:46:07,061 CLINICIAN IS GIVING THEM OPTIONS 6480 03:46:07,061 --> 03:46:07,662 BUT THEY'RE PRESENTING IT BY 6481 03:46:07,662 --> 03:46:09,363 SAYING CPAP, WE'RE GOING TO AIM 6482 03:46:09,363 --> 03:46:11,666 TO REDUCE YOUR AHI UNDER 5 AND 6483 03:46:11,666 --> 03:46:13,734 THE SAME WITH ORAL APPLIANCES, 6484 03:46:13,734 --> 03:46:15,069 BUT NOW IT SEEMS LIKE WHEN WE'RE 6485 03:46:15,069 --> 03:46:17,605 TALKING ABOUT ESPECIALLY SOME OF 6486 03:46:17,605 --> 03:46:18,839 THE NEW MEDICATIONS, A LOT OF 6487 03:46:18,839 --> 03:46:21,409 THE TALK SEEMS TO BE AROUND 6488 03:46:21,409 --> 03:46:28,449 HYPOXIC BURDEN, AND SO FOR A 6489 03:46:28,449 --> 03:46:29,283 PATIENTS IT CAN BE REALLY 6490 03:46:29,283 --> 03:46:29,617 CHALLENGING. 6491 03:46:29,617 --> 03:46:32,453 SO I'M NOT SURE IF IT'S ONE 6492 03:46:32,453 --> 03:46:34,488 METRIC OR IF WE NEAT MULTIPLE TO 6493 03:46:34,488 --> 03:46:35,923 DECIDE ON THE RIGHT TREATMENT 6494 03:46:35,923 --> 03:46:36,157 OPTION. 6495 03:46:36,157 --> 03:46:37,458 >> I DON'T HAVE AN ANSWER FOR 6496 03:46:37,458 --> 03:46:38,993 YOU, OTHER PEOPLE MAY. 6497 03:46:38,993 --> 03:46:40,027 I THINK WE'VE SORT OF HUNG OUR 6498 03:46:40,027 --> 03:46:42,596 HAT ON AHI FOR MANY, MANY YEARS. 6499 03:46:42,596 --> 03:46:44,365 I'M NOT TOO SURE WHY. 6500 03:46:44,365 --> 03:46:46,300 YOU CAN ARGUE AND SAY OH, IT'S 6501 03:46:46,300 --> 03:46:47,601 JUST THIS FREQUENCY BASED 6502 03:46:47,601 --> 03:46:53,240 METRIC, IS IT 3%, BUT THAT'S 6503 03:46:53,240 --> 03:46:53,941 WHAT WE'VE HUNG OUR HAT ON AND 6504 03:46:53,941 --> 03:46:55,109 WHAT WE HAVE THE MOST EXPERIENCE 6505 03:46:55,109 --> 03:46:56,410 WITH, SO I GUESS AT THIS POINT 6506 03:46:56,410 --> 03:46:57,979 FROM A CLINICAL STANDPOINT, I 6507 03:46:57,979 --> 03:47:03,584 GUESS THAT ES WHAT I THAT'S WHAL 6508 03:47:03,584 --> 03:47:05,252 PATIENTS CLINICALLY. 6509 03:47:05,252 --> 03:47:07,755 THE HOPE DOWN THE ROAD IS THAT 6510 03:47:07,755 --> 03:47:08,856 HOPEFULLY -- THE POINT I WOULD 6511 03:47:08,856 --> 03:47:12,727 MAKE AS WELL, IT SEEMS HIGHLY 6512 03:47:12,727 --> 03:47:14,028 UNLIKELY THAT ONE METRIC IS 6513 03:47:14,028 --> 03:47:15,830 GOING TO PREDICT ALL THE 6514 03:47:15,830 --> 03:47:16,764 OUTCOMES ASSOCIATED WITH SLEEP 6515 03:47:16,764 --> 03:47:17,565 APNEA. 6516 03:47:17,565 --> 03:47:19,633 SO I THINK THAT GIVEN AS BOP 6517 03:47:19,633 --> 03:47:21,936 SAID HOW MUCH SLEEP AFFECTS KIND 6518 03:47:21,936 --> 03:47:25,239 OF EVERYTHING, WHETHER IT BE 6519 03:47:25,239 --> 03:47:27,308 MOOD, CRASH RISK, BLOOD PRESSURE 6520 03:47:27,308 --> 03:47:34,015 OR THOSE KIND OF THINGS, IT 6521 03:47:34,015 --> 03:47:35,483 SEEMS HIGHLY UNLIKELY THAT ONE 6522 03:47:35,483 --> 03:47:37,351 METRIC IS GOING TO RULE 6523 03:47:37,351 --> 03:47:38,319 EVERYTHING LIKE "LORD OF THE 6524 03:47:38,319 --> 03:47:40,187 RINGS" OR SOMETHING SO IT'S VERY 6525 03:47:40,187 --> 03:47:41,822 LIKELY THAT CERTAIN METRICS WILL 6526 03:47:41,822 --> 03:47:44,258 BE BETTER FOR PREDICTING 6527 03:47:44,258 --> 03:47:45,493 ALZHEIMER'S DISEASE SO IT 6528 03:47:45,493 --> 03:47:52,466 WOULDN'T -- IT MIGHT BE -- IT'S 6529 03:47:52,466 --> 03:47:53,667 CERTAINLY POSSIBLE THAT SOME OF 6530 03:47:53,667 --> 03:47:55,302 THE BIOLOGICAL MARKERS YOU GET 6531 03:47:55,302 --> 03:47:56,437 SOME BLOOD, IT WOULDN'T SURPRISE 6532 03:47:56,437 --> 03:47:57,938 ME IF THOSE WOULD BE MORE 6533 03:47:57,938 --> 03:48:00,474 EFFECTIVE IN PREDICTING CARD JOE 6534 03:48:00,474 --> 03:48:01,108 VASCULAR DISEASE OR THOSE KINDS 6535 03:48:01,108 --> 03:48:02,276 OF THINGS AS WELL. 6536 03:48:02,276 --> 03:48:04,245 SO YA I DON'T KNOW. 6537 03:48:04,245 --> 03:48:05,813 MY GUT FEELING IS THAT 10 YEARS 6538 03:48:05,813 --> 03:48:08,549 FROM NOW, THIS THING ABOUT OHI 6539 03:48:08,549 --> 03:48:11,719 AND HI THIS -- WHY ARE WITH 6540 03:48:11,719 --> 03:48:12,853 DOING THAT? 6541 03:48:12,853 --> 03:48:17,258 I THINK YOU WANT TO GIVE -- TO 6542 03:48:17,258 --> 03:48:18,893 THIS ENTIRE PANEL SAYING THESE 6543 03:48:18,893 --> 03:48:20,628 ARE THE DIFFERENT DIMENSIONS AND 6544 03:48:20,628 --> 03:48:23,197 THE DANGERS AS STUFF LAKE THAT 6545 03:48:23,197 --> 03:48:24,865 AS WELL, EVEN CANCER RISK, I 6546 03:48:24,865 --> 03:48:26,867 THINK IT'S HIGHLY UNLIKELY THAT 6547 03:48:26,867 --> 03:48:28,202 THE SAME THINGS THAT PREDICT 6548 03:48:28,202 --> 03:48:29,470 SOMEONE GETTING STROKE IS GOING 6549 03:48:29,470 --> 03:48:31,038 TO BE THE SAME AS SOMEONE 6550 03:48:31,038 --> 03:48:33,941 GETTING LUNG CANCER OR BREAST 6551 03:48:33,941 --> 03:48:35,009 CANCER, MELANOMA OR THOSE THINGS 6552 03:48:35,009 --> 03:48:37,545 AS WELL, SO THAT'S KIND OF MY 6553 03:48:37,545 --> 03:48:37,845 FEELING. 6554 03:48:37,845 --> 03:48:39,780 THE ONLY POINT I WANTED TO MAKE, 6555 03:48:39,780 --> 03:48:42,183 I'M NOT AN EXPERT OF THE 6556 03:48:42,183 --> 03:48:46,320 PHYSICIAN VERSUS PERSONALIZED 6557 03:48:46,320 --> 03:48:46,687 CARE. 6558 03:48:46,687 --> 03:48:49,657 WHEN I THINK OF PR PRECISION I 6559 03:48:49,657 --> 03:48:50,925 USUALLY THINK OF HIGH-THROUGHPUT 6560 03:48:50,925 --> 03:48:52,293 TYPE OF DATA, LIKE WHETHER IT BE 6561 03:48:52,293 --> 03:48:58,799 OWE MINGOMICS OR GENETICS, I WOT 6562 03:48:58,799 --> 03:49:00,000 HIGH-THROUGHPUT PHYSIOLOGY IN 6563 03:49:00,000 --> 03:49:02,803 THAT CATEGORY AS WELL, LET'S SAY 6564 03:49:02,803 --> 03:49:04,738 IF YOU HAVE CIRCUMFERENTIAL 6565 03:49:04,738 --> 03:49:07,374 NARROWING YOU DON'T DO WELL WITH 6566 03:49:07,374 --> 03:49:08,576 HYPO -- THAT SEEMS LIKE MORE OF 6567 03:49:08,576 --> 03:49:09,777 A PERSONALIZED KIND OF APPROACH 6568 03:49:09,777 --> 03:49:11,011 THAT I THINK WE YOU A KIND OF 6569 03:49:11,011 --> 03:49:12,213 TRY TO DO AS OPPOSED TO 6570 03:49:12,213 --> 03:49:12,580 PRECISION. 6571 03:49:12,580 --> 03:49:13,747 I THINK THE ULTIMATE GOAL WOULD 6572 03:49:13,747 --> 03:49:15,416 BE REALLY TOWARDS GETTING MORE 6573 03:49:15,416 --> 03:49:16,517 PRECISION CARE APPROACH LIKE 6574 03:49:16,517 --> 03:49:17,885 ANKIT SAID WHERE YOU CAN KIND OF 6575 03:49:17,885 --> 03:49:19,353 INTEGRATE ALL THIS DATA TOGETHER 6576 03:49:19,353 --> 03:49:22,056 AND REALLY FIGURE OUT WHAT WORKS 6577 03:49:22,056 --> 03:49:23,524 BEST FOR THE PATIENTS. 6578 03:49:23,524 --> 03:49:24,125 I THINK THE STUFF WE'RE DOING 6579 03:49:24,125 --> 03:49:29,063 NOW IN TERMS OF, OH, THE WOMAN 6580 03:49:29,063 --> 03:49:31,198 LIKES A DELL APPLIANCE BETTER 6581 03:49:31,198 --> 03:49:33,501 THAN CPAP OR SOMETHING, I THINK 6582 03:49:33,501 --> 03:49:35,035 THAT'S PART OF PERSONALIZED 6583 03:49:35,035 --> 03:49:36,337 MEDICINE, I THINK WE ALL 6584 03:49:36,337 --> 03:49:39,140 PRACTICE THAT OR TRY TO, BUT I 6585 03:49:39,140 --> 03:49:40,241 EVENTUALLY IT WOULD BE NICE TO 6586 03:49:40,241 --> 03:49:43,944 GET TO A MORE DECISION BASED 6587 03:49:43,944 --> 03:49:45,713 GOAL I WAS GOING TO MAKE. 6588 03:49:45,713 --> 03:49:46,180 >> THANK YOU. 6589 03:49:46,180 --> 03:49:50,217 SO I'M GOING TO HAND OVER TO 6590 03:49:50,217 --> 03:49:53,587 ANKIT AFTER SUSHMITA'S COMMENT. 6591 03:49:53,587 --> 03:49:53,854 THANK YOU. 6592 03:49:53,854 --> 03:49:54,188 >> THANK YOU. 6593 03:49:54,188 --> 03:49:55,189 I JUST WANTED TO ADD TO THAT 6594 03:49:55,189 --> 03:49:56,857 ABOUT THE METRICS, AND IN 6595 03:49:56,857 --> 03:50:00,528 THINKING ABOUT WHAT WAS 6596 03:50:00,528 --> 03:50:05,232 PRESENTED YESTERDAY AND NISHA'S 6597 03:50:05,232 --> 03:50:06,467 DATA, THE ONE SLIDE ABOUT HOW 6598 03:50:06,467 --> 03:50:09,036 MANY WOMEN HAVE BEEN INCLUDED IN 6599 03:50:09,036 --> 03:50:09,503 CLINICAL TRIALS. 6600 03:50:09,503 --> 03:50:11,605 TO DATE, I DON'T THINK WE REALLY 6601 03:50:11,605 --> 03:50:14,241 KNOW A LOT YET ABOUT WHAT METRIC 6602 03:50:14,241 --> 03:50:19,847 IS BEST IN PARTICULAR IN WOMEN. 6603 03:50:19,847 --> 03:50:21,282 I THINK THOSE DESERVE FURTHER 6604 03:50:21,282 --> 03:50:21,916 EVALUATION. 6605 03:50:21,916 --> 03:50:23,350 OBVIOUSLY IT'S A BALANCE BETWEEN 6606 03:50:23,350 --> 03:50:25,186 GETTING TOO MUCH AND 6607 03:50:25,186 --> 03:50:26,487 OVERDIAGNOSING VERSUS 6608 03:50:26,487 --> 03:50:27,488 UNDERDIAGNOSING AND MISSING A 6609 03:50:27,488 --> 03:50:32,593 LOT OF CLINICALLY RELEVANT 6610 03:50:32,593 --> 03:50:34,228 INDIVIDUALS WHO MIGHT RESPOND, 6611 03:50:34,228 --> 03:50:34,895 SO I THINK WE'RE STILL LEARNING 6612 03:50:34,895 --> 03:50:36,263 A LOT CERTAINLY IN WOMEN AND IN 6613 03:50:36,263 --> 03:50:38,732 PREGNANCY, SO I TEND TO KEEP MY 6614 03:50:38,732 --> 03:50:40,267 MIND OPEN IN THAT PARTICULAR 6615 03:50:40,267 --> 03:50:40,568 POPULATION. 6616 03:50:40,568 --> 03:50:41,902 I'M NOT SURE IF WE KNOW 6617 03:50:41,902 --> 03:50:47,174 EVERYTHING YET. 6618 03:50:47,174 --> 03:50:47,808 >> GREAT. 6619 03:50:47,808 --> 03:50:50,544 I THINK OVERALL, THIS SEEMS TO 6620 03:50:50,544 --> 03:50:51,912 BE HEADING IN THE RIGHT 6621 03:50:51,912 --> 03:50:52,580 DIRECTION WHERE EVEN AT THE END 6622 03:50:52,580 --> 03:50:56,617 OF THIS SEMINAR, WE'LL BE ABLE 6623 03:50:56,617 --> 03:51:00,487 TO DEFINE PERSONALIZED VERSUS 6624 03:51:00,487 --> 03:51:01,889 PRECISION, I THINK THAT WILL BE 6625 03:51:01,889 --> 03:51:02,990 HELPFUL TO THE PATIENTS. 6626 03:51:02,990 --> 03:51:05,159 ONE OF THE QUESTIONS I HAD FOR 6627 03:51:05,159 --> 03:51:06,260 THE PANELISTS JUST TO SORT OF 6628 03:51:06,260 --> 03:51:08,362 KICK OFF THIS THING, IN TERMS OF 6629 03:51:08,362 --> 03:51:10,898 THE DIFFERENT DEVICES, THE 6630 03:51:10,898 --> 03:51:11,565 WEARABLES AND SO ON THAT ARE 6631 03:51:11,565 --> 03:51:15,369 COMING ON AND PEOPLE ARE USING 6632 03:51:15,369 --> 03:51:17,137 IT, THE REQUIREMENTS BY FDA ARE 6633 03:51:17,137 --> 03:51:18,806 NOT AS RESTRICTIVE OR AS STRICT 6634 03:51:18,806 --> 03:51:21,642 AS WE WOULD LIKE IN TERMS OF THE 6635 03:51:21,642 --> 03:51:22,343 HETEROGENEITY OF THE DISORDER 6636 03:51:22,343 --> 03:51:27,181 AND TAKING THAT INTO ACCOUNT. 6637 03:51:27,181 --> 03:51:29,550 ESPECIALLY FOR THE GLUCOSE 6638 03:51:29,550 --> 03:51:31,218 MONITORING DEVICES, SO I'M JUST 6639 03:51:31,218 --> 03:51:32,686 CURIOUS TO SORT OF HEAR THOUGHTS 6640 03:51:32,686 --> 03:51:36,290 FROM PEOPLE WORKING WITH 6641 03:51:36,290 --> 03:51:38,592 WEARABLES AND NEW DATA AND SO 6642 03:51:38,592 --> 03:51:40,928 ON, HOW USING THESE WEARABLES 6643 03:51:40,928 --> 03:51:42,496 AND SO ON THAT PATIENTS OR EVEN 6644 03:51:42,496 --> 03:51:46,033 RESEARCH PARTICIPANTS ALWAYS 6645 03:51:46,033 --> 03:51:46,900 SORT OF BRING UP TO THE CLINIC 6646 03:51:46,900 --> 03:51:48,369 AND TO THE RESEARCHERS SAYING 6647 03:51:48,369 --> 03:51:51,739 I'M WEARING THIS FITBIT, CAN YOU 6648 03:51:51,739 --> 03:51:54,041 LOOK AT MY DATA, CAN YOU TELL ME 6649 03:51:54,041 --> 03:51:55,276 HOW IS MY SLEEP LOOKING, ARE YOU 6650 03:51:55,276 --> 03:51:56,610 ABLE TO INTEGRATE THAT INTO MY 6651 03:51:56,610 --> 03:51:57,645 CLINIC SORT OF OUT COME AND SO 6652 03:51:57,645 --> 03:51:58,445 ON. 6653 03:51:58,445 --> 03:51:59,780 SO I'M JUST TRYING TO SORT OF 6654 03:51:59,780 --> 03:52:01,315 UNDERSTAND FROM THE PANELISTS 6655 03:52:01,315 --> 03:52:05,486 WHAT WOULD ALLOW YOU OR LET YOU 6656 03:52:05,486 --> 03:52:06,587 USE THOSE WEARABLES DATA AS WELL 6657 03:52:06,587 --> 03:52:08,489 AS CLINICAL OUTCOMES OR RATHER 6658 03:52:08,489 --> 03:52:09,890 JUST TELL THE PATIENTS YOU KNOW 6659 03:52:09,890 --> 03:52:11,825 WHAT, I DON'T THINK THIS DI VICE 6660 03:52:11,825 --> 03:52:16,664 DEVICEIS ACCURATE, YOU SHOULDN'E 6661 03:52:16,664 --> 03:52:17,031 LOOKING AT THAT. 6662 03:52:17,031 --> 03:52:18,632 >> I THINK THAT'S ONE OF THE 6663 03:52:18,632 --> 03:52:20,601 CHALLENGES THAT WE HAVE 6664 03:52:20,601 --> 03:52:21,969 CURRENTLY IN THE FIELDS, THAT A 6665 03:52:21,969 --> 03:52:24,605 LOT OF THE WEARABLES ARE NOT 6666 03:52:24,605 --> 03:52:27,541 REALLY -- DON'T HAVE THE 6667 03:52:27,541 --> 03:52:29,510 VALIDATION THAT WE WOULD LIKE. 6668 03:52:29,510 --> 03:52:32,680 ONE OF MY COLLEAGUES I WORK 6669 03:52:32,680 --> 03:52:34,114 WITH, HE CALLS THEM TOYS. 6670 03:52:34,114 --> 03:52:37,985 SO IT HARD TO MAKE GOOD CLINICAL 6671 03:52:37,985 --> 03:52:42,356 DECISIONS ON SOME OF THESE 6672 03:52:42,356 --> 03:52:42,723 WEARABLES. 6673 03:52:42,723 --> 03:52:45,125 IT'S GETTING BETTER, THE APPLE 6674 03:52:45,125 --> 03:52:46,827 WATCH IS NOW GOING TO BE 6675 03:52:46,827 --> 03:52:48,329 FDA-APPROVED, SO WE'RE MOVING IN 6676 03:52:48,329 --> 03:52:48,962 THE RIGHT DIRECTION, BUT I THINK 6677 03:52:48,962 --> 03:52:51,799 YOU HAVE TO BE VERY CAUTIOUS IN 6678 03:52:51,799 --> 03:52:53,300 TERMS OF WHAT YOU GAIN FROM LIKE 6679 03:52:53,300 --> 03:53:01,675 A FITBIT OR A W UH-UH K STRAP OR 6680 03:53:01,675 --> 03:53:03,877 WHATEVER IN TERMS OF INTEGRATING 6681 03:53:03,877 --> 03:53:05,579 INTO CLINICAL DECISION-MAKING. 6682 03:53:05,579 --> 03:53:06,747 HAVING SAID THAT, I THINK THE 6683 03:53:06,747 --> 03:53:07,948 FUTURE OF OUR FIELD IS GOING TO 6684 03:53:07,948 --> 03:53:09,616 MOVE BEYOND THE SLEEP 6685 03:53:09,616 --> 03:53:10,050 LABORATORY. 6686 03:53:10,050 --> 03:53:12,219 WE'LL STILL HAVE THE SLEEP 6687 03:53:12,219 --> 03:53:15,289 LABORATORY FOR CAREFUL 6688 03:53:15,289 --> 03:53:17,358 PHYSIOLOGY AND FOR SELECTED 6689 03:53:17,358 --> 03:53:20,627 PATIENTS, BUT IN ORDER TO REALLY 6690 03:53:20,627 --> 03:53:25,499 IMPLEMENT THERAPY, YOU KNOW, 6691 03:53:25,499 --> 03:53:26,667 IT'S A BOTTLENECK. 6692 03:53:26,667 --> 03:53:31,705 >> I'LL LET ESRA KNOW AND THEN 6693 03:53:31,705 --> 03:53:32,706 ARI, YOU CAN GO. 6694 03:53:32,706 --> 03:53:36,377 >> I AGRA WITH WHAT DR. STROLLO 6695 03:53:36,377 --> 03:53:37,811 SAID, BUT I THINK IN MY 6696 03:53:37,811 --> 03:53:38,479 PRESENTATION WHAT I SHOWED ABOUT 6697 03:53:38,479 --> 03:53:39,913 SORT OF THIS METRIC THAT CAN 6698 03:53:39,913 --> 03:53:42,549 CHANGE OUR THINKING OR HOW WE 6699 03:53:42,549 --> 03:53:44,451 DEFINE TREATMENT ADHERENCE WAS 6700 03:53:44,451 --> 03:53:45,886 BASED ON WEARABLES, SO PEOPLE 6701 03:53:45,886 --> 03:53:49,156 WHO USE THEIR MASKS AND JUDGED 6702 03:53:49,156 --> 03:53:52,593 UPON THEIR MASK ON TIME-BASED ON 6703 03:53:52,593 --> 03:53:54,027 OUR CURRENT CRITERIA, MANY OF 6704 03:53:54,027 --> 03:53:56,530 THEM ARE WEARING FITBIT, MANY OF 6705 03:53:56,530 --> 03:53:57,698 THEM ARE WEARING DIFFERENT 6706 03:53:57,698 --> 03:53:58,732 WEARABLES. 6707 03:53:58,732 --> 03:54:00,934 AND TO INTEGRATE THAT 6708 03:54:00,934 --> 03:54:03,971 INFORMATION INTO OUR THERAPIES 6709 03:54:03,971 --> 03:54:06,240 IS -- TO ME IS REALLY 6710 03:54:06,240 --> 03:54:06,774 FUNDAMENTAL. 6711 03:54:06,774 --> 03:54:10,177 WE HAVE A TREATMENT HERE, IT MAY 6712 03:54:10,177 --> 03:54:11,879 WORK FOR SOME POPULATION, OF 6713 03:54:11,879 --> 03:54:13,814 COURSE WE HAVE DIFFERENT 6714 03:54:13,814 --> 03:54:14,815 MODALITIES FOR SLEEP APNEA 6715 03:54:14,815 --> 03:54:16,049 TREATMENT TODAY. 6716 03:54:16,049 --> 03:54:19,620 BUT WE DO NOT HAVE THE CORRECT 6717 03:54:19,620 --> 03:54:20,487 DOSE FOR THIS. 6718 03:54:20,487 --> 03:54:22,856 WE KNOW THE CORRECT DOSE IS THE 6719 03:54:22,856 --> 03:54:26,260 NIGHTLY SLEEP DURATION. 6720 03:54:26,260 --> 03:54:27,895 IT'S JUST ALMOST PRESCRIBING AN 6721 03:54:27,895 --> 03:54:33,233 ASTHMA INHALER, TELL THE 6722 03:54:33,233 --> 03:54:34,701 PATIENT, PRESS AS MANY PUFFS AS 6723 03:54:34,701 --> 03:54:35,369 YOU CAN. 6724 03:54:35,369 --> 03:54:36,904 IT'S ALMOST LIKE GIVING A BLOOD 6725 03:54:36,904 --> 03:54:38,439 PRESSURE PILL ARBITRARILY 6726 03:54:38,439 --> 03:54:39,840 BECAUSE ASSUMING THE BEDTIME IS 6727 03:54:39,840 --> 03:54:41,208 EIGHT HOURS TO TELL THEM FOUR 6728 03:54:41,208 --> 03:54:41,875 HOURS IS ENOUGH. 6729 03:54:41,875 --> 03:54:48,215 SO I THINK THAT WE NEAT TO -- 6730 03:54:48,215 --> 03:54:49,817 MOVE BEYOND THIS SO WE CAN MAKE 6731 03:54:49,817 --> 03:54:51,552 IMPACT AND INFLUENCE TO OTHER 6732 03:54:51,552 --> 03:54:53,620 DISCIPLINES LIKE CARDIOLOGY, I 6733 03:54:53,620 --> 03:54:56,423 THINK WE NEED TO REALLY MOVE 6734 03:54:56,423 --> 03:55:03,096 FORWARD WITH OUR THINKING OF HOW 6735 03:55:03,096 --> 03:55:07,801 DEFINING OUR ADHERENCE TRACKING. 6736 03:55:07,801 --> 03:55:14,708 AND WHERABLES WHERE WEARABLES A 6737 03:55:14,708 --> 03:55:17,678 FANTASTIC WAY TO ACHIEVE THAT. 6738 03:55:17,678 --> 03:55:20,447 >> WEARABLES PROVIDE A VERY 6739 03:55:20,447 --> 03:55:22,950 POWERFUL OPPORTUNITY TO OBTAIN 6740 03:55:22,950 --> 03:55:26,453 OBJECTIVE MEASUREMENTS IN THE 6741 03:55:26,453 --> 03:55:27,855 ENVIRONMENT THAT THE PATIENT IS 6742 03:55:27,855 --> 03:55:29,957 IN, BUT I ALSO WANT TO PUT A 6743 03:55:29,957 --> 03:55:33,360 COUNTER POINT THAT I PERSONALLY 6744 03:55:33,360 --> 03:55:38,131 FEEL THAT WHEN WE COMBINE ALL 6745 03:55:38,131 --> 03:55:39,433 WEARABLES TOGETHER AND THINK OF 6746 03:55:39,433 --> 03:55:40,934 THEM AS A WHOLE, WE WOULD NOT 6747 03:55:40,934 --> 03:55:41,935 MAKE PROGRESS AND WE NEED TO 6748 03:55:41,935 --> 03:55:43,804 THINK OF WEARABLES WITHIN A 6749 03:55:43,804 --> 03:55:44,571 SPECIFIC DOMAIN. 6750 03:55:44,571 --> 03:55:46,540 WHAT I MEAN BY THAT, IF WE WANT 6751 03:55:46,540 --> 03:55:49,009 TO THINK OF, LET'S SAY, GLUCOSE, 6752 03:55:49,009 --> 03:55:50,844 WHICH IS MY AREA OF EXPERTISE, 6753 03:55:50,844 --> 03:55:53,013 WE'LL LOOK AT THE CONTINUOUS 6754 03:55:53,013 --> 03:55:54,114 GLUCOMONITORS AND WE CAN TALK 6755 03:55:54,114 --> 03:55:55,749 WITHIN THAT DOMAIN WHAT IS AN 6756 03:55:55,749 --> 03:55:57,518 ACCEPTABLE AND NOT ACCEPTABLE 6757 03:55:57,518 --> 03:56:01,889 MEASURE, AND HOW WE CAN USE IT. 6758 03:56:01,889 --> 03:56:04,558 AND USING THE CPAP MACHINE, THAT 6759 03:56:04,558 --> 03:56:06,627 IS ANOTHER SPECIFIC DOMAIN WE 6760 03:56:06,627 --> 03:56:08,161 ARE TALKING ABOUT AND WE CAN 6761 03:56:08,161 --> 03:56:09,596 TALK ABOUT WHETHER THE 6762 03:56:09,596 --> 03:56:10,964 MEASUREMENTS WE GET SUFFICIENTLY 6763 03:56:10,964 --> 03:56:12,499 ACCURATE OR NOT, SUSHTLY 6764 03:56:12,499 --> 03:56:12,833 ACCURATE. 6765 03:56:12,833 --> 03:56:14,134 WHEN WE TALK ABOUT THE BLOOD 6766 03:56:14,134 --> 03:56:15,502 PRESSURE, TOLD YOU THE SAME 6767 03:56:15,502 --> 03:56:18,005 THING, WHEN WE TALK ABOUT THE 6768 03:56:18,005 --> 03:56:18,672 PHYSICAL ACTIVITY, IT WOULD BE 6769 03:56:18,672 --> 03:56:19,439 THE SAME THING. 6770 03:56:19,439 --> 03:56:21,775 SO I FEEL LIKE WE CANNOT JUST 6771 03:56:21,775 --> 03:56:23,010 SPLIT ALL THE WEARABLES 6772 03:56:23,010 --> 03:56:24,778 TOGETHER, BUT WE HAVE TO LOOK 6773 03:56:24,778 --> 03:56:25,646 SPECIFICALLY WITHIN THE DOMAIN 6774 03:56:25,646 --> 03:56:27,414 THAT WE WANT THEM TO MEASURE, 6775 03:56:27,414 --> 03:56:28,882 AND THEN EVALUATE WHETHER THEY 6776 03:56:28,882 --> 03:56:31,585 CAN BE USEFUL OR NOT USEFUL AND 6777 03:56:31,585 --> 03:56:35,989 WHAT IS THE PROGRESS TO BE MADE. 6778 03:56:35,989 --> 03:56:37,591 >> DIEGO, GO AHEAD. 6779 03:56:37,591 --> 03:56:39,259 >> WHICH I THINK TIES IN VERY 6780 03:56:39,259 --> 03:56:41,695 WELL WITH THE PROPOSAL THAT 6781 03:56:41,695 --> 03:56:44,565 ANKIT SUGGESTED YESTERDAY ABOUT 6782 03:56:44,565 --> 03:56:46,099 HOW WE COULD DEFINE SLEEP APNEA 6783 03:56:46,099 --> 03:56:49,269 AS THE SERIES OF DOMAINS THAT 6784 03:56:49,269 --> 03:56:51,638 MIGHT BE IMPACTING SLEEP 6785 03:56:51,638 --> 03:56:53,607 FRAGMENTATION, MIGHT BE 6786 03:56:53,607 --> 03:56:54,374 IMPACTING OXYGEN SATURATION, 6787 03:56:54,374 --> 03:56:55,576 MIGHT BE AFFECTING HEART 6788 03:56:55,576 --> 03:56:56,376 FUNCTION. 6789 03:56:56,376 --> 03:56:57,077 THERE'S MANY DOMAINS. 6790 03:56:57,077 --> 03:57:01,515 I THINK WE ALL RECOGNIZE THERE'S 6791 03:57:01,515 --> 03:57:06,453 MANY DOMAINS SLEEP APNEA IS 6792 03:57:06,453 --> 03:57:08,188 IMPACTING. 6793 03:57:08,188 --> 03:57:10,123 IF IN THINKING ABOUT BOTH 6794 03:57:10,123 --> 03:57:11,158 DIAGNOSING AND CHARACTERIZING 6795 03:57:11,158 --> 03:57:12,526 BUT ALSO MAKING SURE THAT WE'RE 6796 03:57:12,526 --> 03:57:14,227 MONITORING THE DISEASE WELL AND 6797 03:57:14,227 --> 03:57:17,397 WHAT SORT OF WEARABLE TRACK WHAT 6798 03:57:17,397 --> 03:57:18,498 NEEDS TO BE TRACKED FOR THAT 6799 03:57:18,498 --> 03:57:20,400 PATIENT, I THINK IF WE SOMEHOW 6800 03:57:20,400 --> 03:57:22,202 IDENTIFY WHAT'S THE PRIMARY 6801 03:57:22,202 --> 03:57:23,704 DOMAIN THAT'S BEING IMPACTED BY 6802 03:57:23,704 --> 03:57:26,640 EACH PATIENT, AND THEN PERHAPS A 6803 03:57:26,640 --> 03:57:28,675 SPECIFIC WEARABLE MOVING FORWARD 6804 03:57:28,675 --> 03:57:30,644 TO TRACK HOW WELL THEY ARE 6805 03:57:30,644 --> 03:57:31,578 MANAGING THEIR DISEASE PROBABLY 6806 03:57:31,578 --> 03:57:39,486 WOULD BE ONE WAY TO GO. 6807 03:57:39,486 --> 03:57:40,287 >> NAJIB? 6808 03:57:40,287 --> 03:57:41,521 >> THIS IS MORE OF A QUESTION 6809 03:57:41,521 --> 03:57:42,789 FOR THE PANEL ACTUALLY TO BE 6810 03:57:42,789 --> 03:57:44,625 HONEST WITH YOU. 6811 03:57:44,625 --> 03:57:46,593 LIKE I READ THESE PSGs, WE GET 6812 03:57:46,593 --> 03:57:48,028 ALL THIS INFORMATION AND I FEEL 6813 03:57:48,028 --> 03:57:50,230 LIKE I'M ALMOST SCHOOLING MYSELF 6814 03:57:50,230 --> 03:57:52,332 INTO THINKING THIS ACTUALLY 6815 03:57:52,332 --> 03:57:54,201 REFLECTS WHAT THEY DO AT HOME 6816 03:57:54,201 --> 03:57:57,004 AND NUMBER ONE AM I FOOLING 6817 03:57:57,004 --> 03:57:59,172 MYSELF INTO THINKING THAT THIS 6818 03:57:59,172 --> 03:58:01,842 IS EXACTLY THE SAME AS EVERY 6819 03:58:01,842 --> 03:58:03,610 SINGLE NIGHT THEY'VE HAD NOR THE 6820 03:58:03,610 --> 03:58:05,245 LAST SIX MONTHS OR LAST FIVE 6821 03:58:05,245 --> 03:58:08,782 YEARS OR WHATEVER, AND IT'S BEEN 6822 03:58:08,782 --> 03:58:10,384 SHOWN -- LIKE MATTRESSES AND 6823 03:58:10,384 --> 03:58:12,119 STUFF ISN'T THAT GREAT, SO PART 6824 03:58:12,119 --> 03:58:14,087 OF MY KIND OF THINKS WE GET ALL 6825 03:58:14,087 --> 03:58:16,056 THESE THINGS UPDATED, WE CAN 6826 03:58:16,056 --> 03:58:16,990 GENERATE ALL THESE METRICS FROM 6827 03:58:16,990 --> 03:58:18,291 THE PSG AND WE REALLY KNOW WHAT 6828 03:58:18,291 --> 03:58:20,694 THEY'RE DOING THAT NIGHT, I JUST 6829 03:58:20,694 --> 03:58:22,229 DON'T KNOW HOW REFLECTIVE IT IS 6830 03:58:22,229 --> 03:58:26,066 TO SAY THIS TRULY -- AND THEN BY 6831 03:58:26,066 --> 03:58:28,301 THE SAME TOKEN, EVEN THOUGH I 6832 03:58:28,301 --> 03:58:30,270 THINK THERE'S ALL THESE ISSUES 6833 03:58:30,270 --> 03:58:31,838 WITH WEARABLES, WILL YOU 6834 03:58:31,838 --> 03:58:33,407 ACTUALLY GET BETTER DATA IF YOU 6835 03:58:33,407 --> 03:58:34,408 JUST GET A LITTLE BIT OF DATA 6836 03:58:34,408 --> 03:58:36,476 EVERY DAY BUT YOU COLLECT IT FOR 6837 03:58:36,476 --> 03:58:37,411 LIKE THREE OR FOUR MONTH, IS 6838 03:58:37,411 --> 03:58:38,612 THAT GOING TO BE BETTER THAN 6839 03:58:38,612 --> 03:58:40,380 GETTING A ONE NIGHT PSG, ARE 6840 03:58:40,380 --> 03:58:41,081 THEY COMPLEMENTARY? 6841 03:58:41,081 --> 03:58:43,083 THAT'S WHY I STRUGGLED WITH AS 6842 03:58:43,083 --> 03:58:44,651 WELL WHEN WE'RE COMING UP WITH 6843 03:58:44,651 --> 03:58:46,820 ALL THESE METRICS, AND I'M 6844 03:58:46,820 --> 03:58:48,789 HOPING THAT AFTER ONE NIGHT OF 6845 03:58:48,789 --> 03:58:50,557 PSG, THE PERSON IS GOING TO HAVE 6846 03:58:50,557 --> 03:58:54,394 CANCER IN FIVE -- 6847 03:58:54,394 --> 03:58:56,329 >> I'M GOING TO MAKE A POINT AND 6848 03:58:56,329 --> 03:58:57,664 THEN LET BOB GO ON. 6849 03:58:57,664 --> 03:59:00,634 SO YOU KNOW, THIS IS SORT OF 6850 03:59:00,634 --> 03:59:02,502 MAYBE A CONTRARIAN VIEW AND 6851 03:59:02,502 --> 03:59:04,337 MAYBE EVEN CONTROVERSIAL TO SOME 6852 03:59:04,337 --> 03:59:06,073 EXTENT, BUT IN THE PURSUIT OF 6853 03:59:06,073 --> 03:59:07,607 SORT OF KNOWING MORE AND MORE 6854 03:59:07,607 --> 03:59:09,810 ABOUT SLEEP APNEA, HAVE WE PUT 6855 03:59:09,810 --> 03:59:12,079 OURSELVES IN A HOLE BY LOOKING 6856 03:59:12,079 --> 03:59:13,613 AT SEVERAL DIFFERENT DOMAINS AND 6857 03:59:13,613 --> 03:59:17,284 SHOULD A SLEEP APNEA TEST BE 6858 03:59:17,284 --> 03:59:18,285 INCLUDED IN SO MANY DIFFERENT 6859 03:59:18,285 --> 03:59:27,160 DOMAINS INCLUDING EEG, ECG, THIS 6860 03:59:27,160 --> 03:59:29,763 IS YOUR TEST, THIS IS WHAT 6861 03:59:29,763 --> 03:59:30,997 YOU'RE GULF COAST TO LOOK AT. 6862 03:59:30,997 --> 03:59:33,300 EVEN THOUGH THOSE CARDIAC 6863 03:59:33,300 --> 03:59:34,501 PROBLEMS ARE TO SOME EXTENT 6864 03:59:34,501 --> 03:59:35,569 GOING TO AFFECT BRAIN FUNCTION 6865 03:59:35,569 --> 03:59:36,570 AND OTHER THINGS. 6866 03:59:36,570 --> 03:59:38,238 SO HAVE WE IN THE PURSUIT OF 6867 03:59:38,238 --> 03:59:39,172 SORT OF KNOWING EVERYTHING WE 6868 03:59:39,172 --> 03:59:42,542 WANT TO KNOW ABOUT SLEEP APNEA, 6869 03:59:42,542 --> 03:59:45,378 EXPANDED PSG TO SUCH A LARGE 6870 03:59:45,378 --> 03:59:46,680 DIMENSION THAT WE NOW DON'T KNOW 6871 03:59:46,680 --> 03:59:48,515 WHAT TO DO WITH IT AND ARE 6872 03:59:48,515 --> 03:59:50,150 ACTUALLY TRYING TO FIND SIGNAL 6873 03:59:50,150 --> 03:59:52,786 AND NOISE AND SORT OF GOING 6874 03:59:52,786 --> 03:59:55,188 BEHIND THAT WHEN WE SHOULDN'T BE 6875 03:59:55,188 --> 03:59:57,824 DOING THAT? 6876 03:59:57,824 --> 03:59:59,159 WHICH IS HAVING THEM SORT OF USE 6877 03:59:59,159 --> 03:59:59,526 IT. 6878 03:59:59,526 --> 04:00:01,061 SO I'VE MADE THAT POINT AND THEN 6879 04:00:01,061 --> 04:00:07,100 LET BOB GO ON. 6880 04:00:07,100 --> 04:00:08,735 >> SURE, I THINK I GENERALLY 6881 04:00:08,735 --> 04:00:11,972 AGREE WITH WHAT YOU AND MAJIB 6882 04:00:11,972 --> 04:00:12,405 SAID. 6883 04:00:12,405 --> 04:00:14,474 WHEN I SEE SOMEBODY WHO SLEEPS 6884 04:00:14,474 --> 04:00:16,510 IN THE SLEEP LAB FOR 95% OF THE 6885 04:00:16,510 --> 04:00:20,914 NIGHT AND THEIR -- THEY'RE 6886 04:00:20,914 --> 04:00:22,415 CHRONICALLY SLEEP DEPRIVED AND 6887 04:00:22,415 --> 04:00:24,017 THEIR ONE NIGHT IN THE LAB IS 6888 04:00:24,017 --> 04:00:25,552 THE BEST NIGHT SLEEP THEY'VE 6889 04:00:25,552 --> 04:00:30,123 HAD, AND WE HAVE ALL THESE 6890 04:00:30,123 --> 04:00:31,358 THINGS -- WE ALSO DID A STUDY 6891 04:00:31,358 --> 04:00:34,127 WHERE WE WERE LOOKING AT WEIGHT 6892 04:00:34,127 --> 04:00:37,931 GAIN IN FRESHMAN. 6893 04:00:37,931 --> 04:00:39,232 THE ADVANTAGE OF WEARABLES, 6894 04:00:39,232 --> 04:00:40,033 WE'RE LOOKING AT SLEEP TIME 6895 04:00:40,033 --> 04:00:41,835 WHICH DID GO DOWN, BUT WEIGHT 6896 04:00:41,835 --> 04:00:42,936 STAYED THE SAME AND IT BECAUSE 6897 04:00:42,936 --> 04:00:44,437 THE WEARABLE ALSO LET US KNOW 6898 04:00:44,437 --> 04:00:46,473 THAT THEIR ACTIVITY, THEIR STEP 6899 04:00:46,473 --> 04:00:47,707 COUNT DOUBLED WHEN THEY CAME ON 6900 04:00:47,707 --> 04:00:48,909 TO CAMPUS AND THEY WEREN'T 6901 04:00:48,909 --> 04:00:50,577 DRIVING AND LIVING AT HOME. 6902 04:00:50,577 --> 04:00:53,814 SO I'M A BIG FAN OF THE 6903 04:00:53,814 --> 04:00:56,783 WEARABLES, YOU HAVE TO HAVE 6904 04:00:56,783 --> 04:00:58,518 CAVEATS, BUT THEY'RE MEASURING I 6905 04:00:58,518 --> 04:00:59,920 THINK MUCH CLOSER TO WHAT IS 6906 04:00:59,920 --> 04:01:01,655 ACTUALLY HAPPENING ON A REGULAR 6907 04:01:01,655 --> 04:01:01,988 BASIS. 6908 04:01:01,988 --> 04:01:04,391 I THINK THIS IS AN EXCITING TIME 6909 04:01:04,391 --> 04:01:05,058 BECAUSE WE ARE GOING TO START TO 6910 04:01:05,058 --> 04:01:06,326 GET A LOT OF WEARABLE 6911 04:01:06,326 --> 04:01:06,993 INFORMATION THAT'S NOT JUST 6912 04:01:06,993 --> 04:01:08,061 ABOUT SLEEP AND BREATHING AND 6913 04:01:08,061 --> 04:01:11,097 HEART RATE, BUT ACTIVITY. 6914 04:01:11,097 --> 04:01:12,299 PEOPLE WHO HAVE TROUBLE SLEEPING 6915 04:01:12,299 --> 04:01:13,733 AT NIGHT, WHAT ARE THEY DOING 6916 04:01:13,733 --> 04:01:17,137 DURING THE DAY? 6917 04:01:17,137 --> 04:01:19,406 I'M SORT OF PRO WEARABLE, I 6918 04:01:19,406 --> 04:01:21,241 THINK WE'RE A LITTLE SLOW ON THE 6919 04:01:21,241 --> 04:01:21,808 UPTAKE FOR THESE. 6920 04:01:21,808 --> 04:01:22,542 SO I'LL STOP THERE. 6921 04:01:22,542 --> 04:01:24,711 I THINK YOUR OTHER COMMENTS, 6922 04:01:24,711 --> 04:01:26,813 THOUGH, HOPEFULLY THE OTHER 6923 04:01:26,813 --> 04:01:28,215 PANELIST CAN COME ON, THEY'RE 6924 04:01:28,215 --> 04:01:29,749 REALLY GOOD. 6925 04:01:29,749 --> 04:01:31,751 >> THANKS. 6926 04:01:31,751 --> 04:01:33,053 >> THANKS. 6927 04:01:33,053 --> 04:01:33,687 FASCINATING TOPIC. 6928 04:01:33,687 --> 04:01:34,821 I THINK WE ALL SEE THE PATIENTS 6929 04:01:34,821 --> 04:01:36,957 WHO COME IN AND SHOW US THEIR, 6930 04:01:36,957 --> 04:01:39,125 YOU KNOW, THEIR PHONE WITH THEIR 6931 04:01:39,125 --> 04:01:40,861 DATA LIKE THIS IS WHAT'S 6932 04:01:40,861 --> 04:01:41,761 HAPPENING, I HAVE SLEEP APNEA, 6933 04:01:41,761 --> 04:01:43,663 YOU KNOW, DO SOMETHING. 6934 04:01:43,663 --> 04:01:46,399 SO YEAH, I AGREE WITH THE NEED 6935 04:01:46,399 --> 04:01:47,801 FOR VALIDATION AND OBVIOUSLY THE 6936 04:01:47,801 --> 04:01:49,169 TECHNOLOGY IS MOVING SO QUICKLY 6937 04:01:49,169 --> 04:01:50,170 SO THAT MAKES IT CHALLENGING 6938 04:01:50,170 --> 04:01:52,138 WITH ALL THE NEW DEVICES AND 6939 04:01:52,138 --> 04:01:56,109 ALGORITHMS THAT ARE OUT THERE. 6940 04:01:56,109 --> 04:01:57,177 JUST TO SAY I THINK THERE IS 6941 04:01:57,177 --> 04:01:58,011 SOMETHING DEFINITELY ABOUT NIGHT 6942 04:01:58,011 --> 04:01:58,879 TO NIGHT VARIABILITY WITH YOU 6943 04:01:58,879 --> 04:02:02,515 WE'VE ALL TALKED ABOUT BEFORE, 6944 04:02:02,515 --> 04:02:05,118 AND ALSO ON SLEEP QUALITY, IN 6945 04:02:05,118 --> 04:02:07,921 ADDITION TO THE SLEEP APNEA 6946 04:02:07,921 --> 04:02:09,022 METRICS, THE SLEEP QUALITY COULD 6947 04:02:09,022 --> 04:02:10,991 BE SOMETHING OF VALUE IN 6948 04:02:10,991 --> 04:02:12,559 PARTICULAR IF THAT'S VALIDATED. 6949 04:02:12,559 --> 04:02:14,327 THE OTHER PIECE IS JUST TO SAY 6950 04:02:14,327 --> 04:02:16,296 WHEN WE'RE DOING STUDIES WITH 6951 04:02:16,296 --> 04:02:19,532 OUR PATIENT PARTNERS, SOMETHING 6952 04:02:19,532 --> 04:02:22,636 THEY'VE ASKED FOR, INCLUDED IN A 6953 04:02:22,636 --> 04:02:24,604 VARIABLE AND THEY REALLY LIKE 6954 04:02:24,604 --> 04:02:26,106 KNOWING WHAT'S GOING ON. 6955 04:02:26,106 --> 04:02:28,842 SO WE'VE LISTENS TO OUR -- WE'RE 6956 04:02:28,842 --> 04:02:31,678 GOING TO BE LOOKING AT HOW IT 6957 04:02:31,678 --> 04:02:32,879 DETERMINES THEIR ABILITY TO 6958 04:02:32,879 --> 04:02:33,847 MONITOR THEIR THERAPY. 6959 04:02:33,847 --> 04:02:35,916 SO FOR US, WE'RE LOOKING AT 6960 04:02:35,916 --> 04:02:37,217 PREGNANCY WITH ALTERNATIVE 6961 04:02:37,217 --> 04:02:38,919 TREATMENT OPTIONS SO NOT JUST 6962 04:02:38,919 --> 04:02:39,119 CPAP. 6963 04:02:39,119 --> 04:02:39,786 SO COULD BE SOMETHING THAT COULD 6964 04:02:39,786 --> 04:02:42,656 BE USEFUL. 6965 04:02:42,656 --> 04:02:46,693 I DO AGREE IT NEEDS FURTHER 6966 04:02:46,693 --> 04:02:47,894 ALLEGATION WITH RESPECT TO THE 6967 04:02:47,894 --> 04:02:49,296 EFFICACY METRICS BUT IT COULD 6968 04:02:49,296 --> 04:02:50,196 YIELD SOME IMPORTANT 6969 04:02:50,196 --> 04:02:50,497 INFORMATION. 6970 04:02:50,497 --> 04:02:52,465 >> I'D JUST LIKE TO MAKE ANOTHER 6971 04:02:52,465 --> 04:02:53,566 COUPLE COMMENTS. 6972 04:02:53,566 --> 04:02:58,571 SO WE DO MO MOSTLY HOME SLOPE 6973 04:02:58,571 --> 04:02:59,773 TESTING QUITE FRANKLY CLINICALLY 6974 04:02:59,773 --> 04:03:02,375 AND WHAT I USUALLY TELL 6975 04:03:02,375 --> 04:03:06,880 PATIENTS, IS THIS I THINK YOU 6976 04:03:06,880 --> 04:03:08,648 GET MORE ACCURATE INFORMATION 6977 04:03:08,648 --> 04:03:10,150 THAN PUTTING SOMEBODY ALL WIRED 6978 04:03:10,150 --> 04:03:12,719 UP ON THEIR BACK, UNCOMFORTABLE. 6979 04:03:12,719 --> 04:03:15,021 IF YOU'RE DOING CAREFUL 6980 04:03:15,021 --> 04:03:16,723 PHYSIOLOGY, IT'S ONE THING. 6981 04:03:16,723 --> 04:03:18,291 BUT IF YOU'RE TRYING TO FIGURE 6982 04:03:18,291 --> 04:03:19,693 OUT A SIGNAL OF WHAT IS ACTUALLY 6983 04:03:19,693 --> 04:03:22,929 GOING ON IN THE BEDROOM, I THINK 6984 04:03:22,929 --> 04:03:24,698 HOME SLEEP TESTING IS BETTER. 6985 04:03:24,698 --> 04:03:26,900 I WAS STRUCK BY ESRA'S DATA WITH 6986 04:03:26,900 --> 04:03:31,771 HER APP THAT SHE WAS USING, THAT 6987 04:03:31,771 --> 04:03:33,306 YOU CAN HAVE SOMEBODY THAT'S 6988 04:03:33,306 --> 04:03:35,041 100% COMPLIANT BUT SLEEPS FIVE 6989 04:03:35,041 --> 04:03:35,475 HOURS. 6990 04:03:35,475 --> 04:03:39,312 IN PATIENTS THAT WE SEE IF 6991 04:03:39,312 --> 04:03:42,582 CLINIC, THAT'S WHERE WI WE REALY 6992 04:03:42,582 --> 04:03:43,583 LEVERAGE THE DATA DOWNLOADS. 6993 04:03:43,583 --> 04:03:45,051 IT'S NOT UNCOMMON WHEN YOU SEE 6994 04:03:45,051 --> 04:03:46,052 SOMEBODY SLEEPING FIVE HOURS A 6995 04:03:46,052 --> 04:03:47,454 NIGHT OR EVEN SIX HOURS A NIGHT 6996 04:03:47,454 --> 04:03:49,389 AND THEY'RE COMPLAINING OF 6997 04:03:49,389 --> 04:03:50,190 SLEEPINESS. 6998 04:03:50,190 --> 04:03:51,825 WELL, THAT'S MORE THAN SLEEP 6999 04:03:51,825 --> 04:03:53,360 APNEA THAT YOU'RE TRYING TO DEAL 7000 04:03:53,360 --> 04:03:54,427 WITH THE PATIENT. 7001 04:03:54,427 --> 04:03:55,795 AND YOU CAN GET A LOT OF THAT 7002 04:03:55,795 --> 04:03:56,629 INFORMATION FROM THE DATA 7003 04:03:56,629 --> 04:03:57,697 DOWNLOADS AND USUALLY PATIENTS 7004 04:03:57,697 --> 04:03:59,899 WANT TO INTERACT WITH THAT. 7005 04:03:59,899 --> 04:04:02,469 A WEARABLE GIVES YOU, I THINK, 7006 04:04:02,469 --> 04:04:03,837 SOME ADDITIONAL INFORMATION IN 7007 04:04:03,837 --> 04:04:05,238 TERMS OF SLEEP QUALITY, BUT 7008 04:04:05,238 --> 04:04:07,440 AGAIN, MY ONLY CAUTION WOULD BE 7009 04:04:07,440 --> 04:04:09,809 THAT YOU HAVE TO MAKE SURE THAT 7010 04:04:09,809 --> 04:04:14,247 IT'S ACCURATE INFORMATION. 7011 04:04:14,247 --> 04:04:15,415 >> SUSAN? 7012 04:04:15,415 --> 04:04:19,819 >> SO JUST TO MAYBE BUILD ON 7013 04:04:19,819 --> 04:04:20,754 THAT, THE WAY I KIND OF THINK 7014 04:04:20,754 --> 04:04:22,589 ABOUT THINGS A LITTLE BIT IS IT 7015 04:04:22,589 --> 04:04:25,225 NEVER EITHER/OR. 7016 04:04:25,225 --> 04:04:26,626 AND WHERE I REALLY THINK THE 7017 04:04:26,626 --> 04:04:30,563 EXCITEMENT OF TRYING TO BECOME 7018 04:04:30,563 --> 04:04:32,832 PRAGMATIC AND GET MORE RELIABLE 7019 04:04:32,832 --> 04:04:34,567 WAYS TO PHENOTYPE PEOPLE AND GET 7020 04:04:34,567 --> 04:04:38,838 THEM INTO TREATMENT IS USE WHAT 7021 04:04:38,838 --> 04:04:43,877 I'LL REFER TO AS OUR DEEP OF 7022 04:04:43,877 --> 04:04:54,287 PHENOTYPING WHETHER IT'S PO 7023 04:04:54,287 --> 04:04:57,657 POLYSOMOGRPH -- THEY MAY NOT 7024 04:04:57,657 --> 04:04:59,392 DIRECTLY TELL US ABOUT THE 7025 04:04:59,392 --> 04:05:00,927 MECHANISMS IN THE PATHWAYS, BUT 7026 04:05:00,927 --> 04:05:04,197 THEY MAY BE PRACTICALLY BE ABLE 7027 04:05:04,197 --> 04:05:05,932 TO BE HARNESSED IN THE REAL 7028 04:05:05,932 --> 04:05:06,900 WORLD. 7029 04:05:06,900 --> 04:05:08,001 THE KINDS OF WORK THAT EXCITE 7030 04:05:08,001 --> 04:05:09,836 ME, I DO THINK SOME OF THE 7031 04:05:09,836 --> 04:05:10,603 WEARABLES ARE REALLY 7032 04:05:10,603 --> 04:05:14,340 INTERESTING, I THINK ONE OF THE 7033 04:05:14,340 --> 04:05:17,277 SIGNALS THAT MANY WEARABLES HAVE 7034 04:05:17,277 --> 04:05:18,912 NOW IS THE PPG SIGNAL. 7035 04:05:18,912 --> 04:05:20,814 THAT'S A READOUT OF MANY THINGS 7036 04:05:20,814 --> 04:05:21,981 INCLUDING POTENTIALLY 7037 04:05:21,981 --> 04:05:23,216 SYMPATHETIC INNERVATION AND 7038 04:05:23,216 --> 04:05:24,250 VARIATION IN BLOOD PRESSURE AND 7039 04:05:24,250 --> 04:05:24,551 PULSE. 7040 04:05:24,551 --> 04:05:28,822 AND YOU KNOW, I THINK A REALLY 7041 04:05:28,822 --> 04:05:30,156 INTERESTING QUESTION IS QA 7042 04:05:30,156 --> 04:05:32,092 FEATURES OF THAT PPG SIGNAL 7043 04:05:32,092 --> 04:05:35,261 MIGHT TELL US ABOUT PHENOTYPE X 7044 04:05:35,261 --> 04:05:38,465 OR SLEEP APNEA CLUSTER X VERSUS 7045 04:05:38,465 --> 04:05:39,032 Y, BECAUSE THAT COULD 7046 04:05:39,032 --> 04:05:41,434 POTENTIALLY BE USED WITH SOME OF 7047 04:05:41,434 --> 04:05:42,836 THESE WINGS AND WATCHES OVER 7048 04:05:42,836 --> 04:05:44,304 MULTIPLE DAYS. 7049 04:05:44,304 --> 04:05:45,839 AND I THINK AS A FIELD, WE 7050 04:05:45,839 --> 04:05:49,109 EVENTUALLY ARE GOING TO HAVE TO 7051 04:05:49,109 --> 04:05:51,177 KNOW THAT MAYBE IT'S NOT ABOUT 7052 04:05:51,177 --> 04:05:52,812 ACCURATE -- WE HAVE TO RE-THINK 7053 04:05:52,812 --> 04:05:54,314 ACCURACY AS MAYBE PREDICTION. 7054 04:05:54,314 --> 04:05:57,283 SO I THINK THE ACCURACY AND THE 7055 04:05:57,283 --> 04:05:59,085 MECHANISMS ARE THAT DEEP 7056 04:05:59,085 --> 04:06:01,488 PHENOTYPING WORK WE DO, BUT 7057 04:06:01,488 --> 04:06:06,726 ULTIMATELY I THINK WE WANT 7058 04:06:06,726 --> 04:06:08,094 PRAGMATIC TOOLS TO BE ABLE TO 7059 04:06:08,094 --> 04:06:09,329 PREDICT WHO'S AT RISK AND WHO'S 7060 04:06:09,329 --> 04:06:11,865 GOING TO RESPOND AND THEY 7061 04:06:11,865 --> 04:06:13,600 ACTUALLY MAY NOT BE MEASURING 7062 04:06:13,600 --> 04:06:14,367 THE PERFECT PHYSIOLOGIC TRAIT 7063 04:06:14,367 --> 04:06:15,668 BUT THEY WILL BE USEFUL 7064 04:06:15,668 --> 04:06:16,169 CLINICALLY. 7065 04:06:16,169 --> 04:06:17,403 SO I JUST WANTED TO PUT THAT 7066 04:06:17,403 --> 04:06:18,338 PITCH OUT. 7067 04:06:18,338 --> 04:06:20,373 AND I KIND OF SEE THAT COMING. 7068 04:06:20,373 --> 04:06:23,977 AGAIN, I SEE HOW MANY PEOPLE 7069 04:06:23,977 --> 04:06:26,246 ACCESS THE NSRR TO LOOK AT SOME 7070 04:06:26,246 --> 04:06:28,214 OF THESE DATA, AND I FEEL LIKE 7071 04:06:28,214 --> 04:06:29,249 THERE ARE PEOPLE THAT ARE GOING 7072 04:06:29,249 --> 04:06:31,417 TO COME OUT WITH SOME REALLY 7073 04:06:31,417 --> 04:06:35,021 COOL ALGORITHMS. 7074 04:06:35,021 --> 04:06:37,090 >> THERE'S ONE QUESTION FROM THE 7075 04:06:37,090 --> 04:06:39,159 VIDEOCAST I'D LIKE TO TAKE, IT 7076 04:06:39,159 --> 04:06:40,426 SAYS NICE TO HAVE THESE 7077 04:06:40,426 --> 04:06:41,528 PERSONALIZED APPROACHES WITH 7078 04:06:41,528 --> 04:06:43,062 COMBINED CLINICAL PHYSIOLOGY, 7079 04:06:43,062 --> 04:06:44,831 IMAGING, ALL THE DIFFERENT 7080 04:06:44,831 --> 04:06:45,832 DOMAINS. 7081 04:06:45,832 --> 04:06:47,066 FROM A RESEARCH PERSPECTIVE, HOW 7082 04:06:47,066 --> 04:06:48,268 FEASIBLE WILL THEY BE IN THE 7083 04:06:48,268 --> 04:06:50,470 CONTEXT OF LIMITED FUNDING AND 7084 04:06:50,470 --> 04:06:52,539 LACK OF A SLEEP NETWORK THAT 7085 04:06:52,539 --> 04:06:54,407 OTHERS HAVE SUGGESTED AS SOME OF 7086 04:06:54,407 --> 04:06:55,808 THE SOCIETIES ARE BUILDING UP 7087 04:06:55,808 --> 04:06:56,242 ON. 7088 04:06:56,242 --> 04:06:59,212 BUT WHAT IS OUR IN GENERAL 7089 04:06:59,212 --> 04:07:02,682 PERSPECTIVE, HO YOU DO WE SORT 7090 04:07:02,682 --> 04:07:04,217 OF -- THESE ALL A.I. APPROACHES 7091 04:07:04,217 --> 04:07:05,618 AND SO ON ARE GREAT AND VERY 7092 04:07:05,618 --> 04:07:07,954 NOVEL AND EXCITING, BUT HOW DO 7093 04:07:07,954 --> 04:07:10,123 WE SORT OF UTILIZE THAT? 7094 04:07:10,123 --> 04:07:13,259 I'LL START OUT MAYBE ASKING 7095 04:07:13,259 --> 04:07:14,127 DIEGO, ONE OF THE THINGS HIM AND 7096 04:07:14,127 --> 04:07:16,095 I LEARNED TOGETHER WAS WHEN WE 7097 04:07:16,095 --> 04:07:18,064 WANTED TO USE THESE NEW 7098 04:07:18,064 --> 04:07:20,333 GENERATIVE A.I. APPROACHES AND 7099 04:07:20,333 --> 04:07:22,402 SO ON, EVERY CALL WE WOULD MAKE 7100 04:07:22,402 --> 04:07:26,206 TO THESE LARGE LANGUAGE MODELS 7101 04:07:26,206 --> 04:07:26,839 BY FACEBOOK AND OTHER COMPANIES 7102 04:07:26,839 --> 04:07:27,840 REQUIRES US TO PAY A LOT OF 7103 04:07:27,840 --> 04:07:28,374 MONEY. 7104 04:07:28,374 --> 04:07:29,442 NIH HAS SOME OF THE 7105 04:07:29,442 --> 04:07:31,411 OPPORTUNITIES SO THERE'S NIH 7106 04:07:31,411 --> 04:07:33,613 STRIDES INITIATIVE AND OTHERS, 7107 04:07:33,613 --> 04:07:34,714 WHICH OFFER FUNDING FOR SORT OF 7108 04:07:34,714 --> 04:07:36,015 USE OF THAT, BUT THERE'S NEVER 7109 04:07:36,015 --> 04:07:37,717 GOING TO BE A SITUATION WHERE WE 7110 04:07:37,717 --> 04:07:40,920 WOULD BE ABLE TO COMPETE WITH 7111 04:07:40,920 --> 04:07:42,455 THESE LARK COMPANIES WHO ARE 7112 04:07:42,455 --> 04:07:44,490 TRYING TO UTILIZE ALL THE DATA 7113 04:07:44,490 --> 04:07:45,858 AND JUST TO SORT OF PUT FORTH 7114 04:07:45,858 --> 04:07:47,260 ANOTHER LITTLE POINT IS, 7115 04:07:47,260 --> 04:07:48,561 23ANDME, ALL THEIR GENETIC DATA 7116 04:07:48,561 --> 04:07:50,430 IS GOING TO GO TO THE HIGHEST 7117 04:07:50,430 --> 04:07:52,065 BIDDER, AND SO WHOEVER HAS THE 7118 04:07:52,065 --> 04:07:54,267 COMPUTING POWER CAN ACTUALLY USE 7119 04:07:54,267 --> 04:07:57,003 AND UTILIZE IT AS IT IS. 7120 04:07:57,003 --> 04:07:58,304 SO WHAT IS YOUR PERSPECTIVE ON 7121 04:07:58,304 --> 04:07:58,504 THAT? 7122 04:07:58,504 --> 04:08:00,473 >> I THINK THAT'S A VERY 7123 04:08:00,473 --> 04:08:01,040 INTERESTING IMPORTANT POINT. 7124 04:08:01,040 --> 04:08:03,009 I THINK, YOU KNOW, I THINK YOU 7125 04:08:03,009 --> 04:08:04,310 TOUCHED UPON DATA PRIVACY 7126 04:08:04,310 --> 04:08:05,278 CONCERNS, WHICH I THINK IT'S 7127 04:08:05,278 --> 04:08:09,415 ALSO ANOTHER LEVEL LIKE IT'S 7128 04:08:09,415 --> 04:08:10,617 CHALLENGING LIKE WE ALL HAVE 7129 04:08:10,617 --> 04:08:12,919 THIS PROSPECT OF USING LLMs TO 7130 04:08:12,919 --> 04:08:15,021 REALLY HELP WITH -- ASPECTS, SO 7131 04:08:15,021 --> 04:08:16,589 IT'S CHALLENGING TO ALLOW -- 7132 04:08:16,589 --> 04:08:17,857 TALK TO YOUR INSTITUTION TO SAY 7133 04:08:17,857 --> 04:08:20,693 CAN I PUT MY PATIENT'S NOTE INTO 7134 04:08:20,693 --> 04:08:23,529 CHATGPT OR LLAMA 3 AND TRY TO 7135 04:08:23,529 --> 04:08:24,530 GET SYMPTOM INFORMATION. 7136 04:08:24,530 --> 04:08:26,766 SO IT'S NOT AS SIMPLE, WHICH 7137 04:08:26,766 --> 04:08:30,870 GOES BACK TO WHAT WE'VE JUST -- 7138 04:08:30,870 --> 04:08:33,473 WE ARE STILL PROBABLY IN THE 7139 04:08:33,473 --> 04:08:36,442 VERY EARLY STAGE OF TRYING TO 7140 04:08:36,442 --> 04:08:37,844 DETERMINE HOW EFFECTIVE SOME OF 7141 04:08:37,844 --> 04:08:39,479 THOSE TOOLS ARE IN ORDER TO GIVE 7142 04:08:39,479 --> 04:08:44,617 US ADDITIONAL INFORMATION THAT 7143 04:08:44,617 --> 04:08:45,952 WILL BE RELEVANT, AND PERHAPS 7144 04:08:45,952 --> 04:08:47,053 THAT IS AN OPPORTUNITY THERE 7145 04:08:47,053 --> 04:08:49,622 EVEN TO ASSESS IN A MORE 7146 04:08:49,622 --> 04:08:51,457 SYSTEMATIC WAY, AND THEN ONCE 7147 04:08:51,457 --> 04:08:53,326 YOU DEMONSTRATE THAT, WE 7148 04:08:53,326 --> 04:08:54,661 DEMONSTRATE THAT IT COULD BE 7149 04:08:54,661 --> 04:08:56,929 FEASIBLE, PERHAPS THERE COULD BE 7150 04:08:56,929 --> 04:08:58,898 A PACKAGE NOW DEPLOYED IN 7151 04:08:58,898 --> 04:09:03,069 DIFFERENT SITUATIONS, 7152 04:09:03,069 --> 04:09:05,705 INCORPORATING MORE OF THOSE 7153 04:09:05,705 --> 04:09:06,673 SETTINGS IN THE CLIN. 7154 04:09:06,673 --> 04:09:08,074 I THINK TECHNOLOGY ALWAYS 7155 04:09:08,074 --> 04:09:10,176 EVOLVES MORE RAPIDLY THAN 7156 04:09:10,176 --> 04:09:11,244 IMPLEMENTATION, AND I THINK 7157 04:09:11,244 --> 04:09:12,245 IT'S -- THAT'S A GOOD THING. 7158 04:09:12,245 --> 04:09:14,647 I THINK YOU WANT TO ALWAYS PUSH 7159 04:09:14,647 --> 04:09:16,316 THE BRAKES, BUT WE CANNOT REALLY 7160 04:09:16,316 --> 04:09:17,583 JUST STOP THE CAR, RIGHT? 7161 04:09:17,583 --> 04:09:18,885 SO THAT'S MY PERSPECTIVE ON 7162 04:09:18,885 --> 04:09:22,188 THAT. 7163 04:09:22,188 --> 04:09:23,923 >> GREAT. 7164 04:09:23,923 --> 04:09:26,659 I'LL TAKE THIS QUESTION -- AS 7165 04:09:26,659 --> 04:09:28,294 YOU SUGGESTED AND SOME OF THE 7166 04:09:28,294 --> 04:09:33,666 OTHER DATA ABOUT SORT OF BEING 7167 04:09:33,666 --> 04:09:35,368 IMPORTANT AND THERE'S PROBABLY A 7168 04:09:35,368 --> 04:09:37,570 PHENOTYPE AS WELL. 7169 04:09:37,570 --> 04:09:38,438 ESSENTIALLY IT IS IMPORTANT TO 7170 04:09:38,438 --> 04:09:41,941 DO A LONG TERM MONITORING STUDY 7171 04:09:41,941 --> 04:09:46,746 IN PREGNANCY ALONG WITH -- WHEN 7172 04:09:46,746 --> 04:09:48,715 WE ARE LOOKING AT ALL THE 7173 04:09:48,715 --> 04:09:50,383 EXISTING DATA THAT WAS USED IS 7174 04:09:50,383 --> 04:09:51,484 EITHER ONE NIGHT OR TWO NIGHT 7175 04:09:51,484 --> 04:09:52,819 BUT NOW WE'RE TALKING ABOUT MORE 7176 04:09:52,819 --> 04:09:54,854 LONG TERM MONITORING WITH THESE 7177 04:09:54,854 --> 04:09:56,989 NEW WEARABLE DEVICES AND SO ON, 7178 04:09:56,989 --> 04:09:58,191 THEY DON'T HAVE THAT INFORMS 7179 04:09:58,191 --> 04:09:59,625 THAT HAS ACTUALLY INFORMED US 7180 04:09:59,625 --> 04:10:01,227 THE IMPORTANCE OF LOOKING AT 7181 04:10:01,227 --> 04:10:06,599 SOME OF THE CHARACTERISTICS. 7182 04:10:06,599 --> 04:10:11,204 >> WOW, THAT'S A TOUGH QUESTION. 7183 04:10:11,204 --> 04:10:12,939 I HAVE TO SAY, IT'S EVEN A BIT 7184 04:10:12,939 --> 04:10:17,610 MORE COMPLICATED IN PREGNANCY 7185 04:10:17,610 --> 04:10:18,511 BECAUSE THEY'RE EVOLVING IN 7186 04:10:18,511 --> 04:10:20,580 THEIR PREGNANCY AND AS THEY 7187 04:10:20,580 --> 04:10:22,315 EVOLVE, THAT FLOW LIMITATION 7188 04:10:22,315 --> 04:10:27,120 MAY, IN FACT, CHANGE TO OVERT 7189 04:10:27,120 --> 04:10:28,121 HAPPENINGS AND THERE ARE CASE 7190 04:10:28,121 --> 04:10:30,423 REPORTS OF THAT, AND WE'VE 7191 04:10:30,423 --> 04:10:35,294 CERTAINLY SEE THAT, WHAT DOES 7192 04:10:35,294 --> 04:10:37,730 THAT REALLY MEAN, AT WHAT POINT 7193 04:10:37,730 --> 04:10:42,001 IS IT RELEVANT, I THES, THIS IS 7194 04:10:42,001 --> 04:10:43,269 SOMETHING THAT WE'VE BEEN 7195 04:10:43,269 --> 04:10:45,671 PUTTING OUR HEADS TOGETHER FOR 7196 04:10:45,671 --> 04:10:46,739 TOM TIME. 7197 04:10:46,739 --> 04:10:49,475 AS YOU RECALL I KNOW YOUR GROUP 7198 04:10:49,475 --> 04:10:52,111 HAS BEEN DOING WORK IN THIS AS 7199 04:10:52,111 --> 04:10:53,646 WELL, WITH INDU AND OF COURSE 7200 04:10:53,646 --> 04:10:55,715 NOW THAT THERE'S THIS VALIDATED 7201 04:10:55,715 --> 04:10:57,550 ALGORITHM THAT WAS USED IN THE 7202 04:10:57,550 --> 04:11:02,188 NEW MOM TO BE COHORT BY RACHEL 7203 04:11:02,188 --> 04:11:04,190 AND SCOTT, I THINK IT KIND OF 7204 04:11:04,190 --> 04:11:06,125 OPENED OUR EYES A LITTLE MORE AS 7205 04:11:06,125 --> 04:11:08,294 TO THE DIFFERENT SIGNALS AND 7206 04:11:08,294 --> 04:11:12,865 OUTCOMES, SO I THINK IT'S STILL 7207 04:11:12,865 --> 04:11:15,601 VERY EARLY FOR ME, WORKING WITH 7208 04:11:15,601 --> 04:11:16,903 RACHEL AND SCOTT AS WELL TO LOOK 7209 04:11:16,903 --> 04:11:20,740 THE AT DATA ON GESTATIONAL 7210 04:11:20,740 --> 04:11:22,508 DIABETES TO SEE WHAT COMES OUT 7211 04:11:22,508 --> 04:11:24,343 OF -- YOU'D KNOW AND THE NEW MOM 7212 04:11:24,343 --> 04:11:26,012 TO BE DATA, THERE WAS NO SIGNAL 7213 04:11:26,012 --> 04:11:28,815 WITH GESTATIONAL DIABETES, SO 7214 04:11:28,815 --> 04:11:31,584 JUST CURIOUS, I THINK WE JUST 7215 04:11:31,584 --> 04:11:37,890 NEED MORE ANOUN S ANNOUNCEES. 7216 04:11:37,890 --> 04:11:39,992 I DONE KNOW HOW THAT'S GOING TO 7217 04:11:39,992 --> 04:11:41,961 BE -- BY WEARABLES AND I DON'T 7218 04:11:41,961 --> 04:11:45,665 KNOW IF IT'S SHOULD. 7219 04:11:45,665 --> 04:11:53,239 >> SO LET'S LET ESRA TAKE OVER 7220 04:11:53,239 --> 04:11:55,641 AND MODERATE SOME OF THE OTHER 7221 04:11:55,641 --> 04:11:55,908 QUESTIONS. 7222 04:11:55,908 --> 04:11:59,145 >> THANK YOU, ANKIT. 7223 04:11:59,145 --> 04:12:00,580 JUST TO COMMENT TO THE EARLIER 7224 04:12:00,580 --> 04:12:04,617 COMMENTS THAT DR. STROLLO AND 7225 04:12:04,617 --> 04:12:05,518 DR. REDLINE MADE, WHETHER A 7226 04:12:05,518 --> 04:12:07,687 PERSON WHO'S UTILIZING THEIR 7227 04:12:07,687 --> 04:12:10,089 CPAP FOR FOUR OR FIVE HOURS IS 7228 04:12:10,089 --> 04:12:12,291 STILL SLEEPY IN OUR CLINIC, I 7229 04:12:12,291 --> 04:12:14,460 THINK THIS REALLY BRINGS THE 7230 04:12:14,460 --> 04:12:16,028 POINT ABOUT MULTICOMPONENT 7231 04:12:16,028 --> 04:12:16,762 INNINGS VENGS, RIGHT? 7232 04:12:16,762 --> 04:12:26,739 SO THEN WE CAN PO BE PERSONALIZG 7233 04:12:26,739 --> 04:12:28,040 THIS PATIENT'S TREATMENT. 7234 04:12:28,040 --> 04:12:29,509 THAT PATIENT DOESN'T NEED A 7235 04:12:29,509 --> 04:12:31,143 POTENTIALLY MORE ADVICE ON 7236 04:12:31,143 --> 04:12:33,880 TELLING THEM TO USE C PAT MORM, 7237 04:12:33,880 --> 04:12:37,250 AND TAKING INTO ACCOUNT WHETHER 7238 04:12:37,250 --> 04:12:41,521 THIS IS A SEX AND GENDER 7239 04:12:41,521 --> 04:12:44,156 DIFFERENCES, OW WE'RE GOING TO 7240 04:12:44,156 --> 04:12:47,293 APPROACH THAT SLEEP EXTENSION TO 7241 04:12:47,293 --> 04:12:47,760 AN OPTIMAL RANGE. 7242 04:12:47,760 --> 04:12:51,030 AND SOME OF THESE STUDENTS ARE 7243 04:12:51,030 --> 04:12:53,065 DEVELOPING THESE TOOLS, HOW 7244 04:12:53,065 --> 04:12:58,271 WOULD YOU OPTIMIZE IN A PERS 7245 04:12:58,271 --> 04:12:59,505 PERSON -- THAT HEALTHY BEHAVIOR 7246 04:12:59,505 --> 04:13:02,742 THAT'S GOING TO AFFECT PRETTY 7247 04:13:02,742 --> 04:13:03,943 MUCH DIFFERENT DOMAINS OF THEIR 7248 04:13:03,943 --> 04:13:06,212 LIVES, AND THEN REALLY BALANCING 7249 04:13:06,212 --> 04:13:08,214 OUT SOME PHENOTYPEING WITH SOME 7250 04:13:08,214 --> 04:13:10,049 PRACTICAL MEASURES, BECAUSE THIS 7251 04:13:10,049 --> 04:13:16,055 BRINGS TO THE NEXT SESSION, NEXT 7252 04:13:16,055 --> 04:13:17,723 ROUND DISCUSSION THE PATIENTS 7253 04:13:17,723 --> 04:13:19,492 ARE NOT ACCEPTING WHAT WE ARE 7254 04:13:19,492 --> 04:13:20,126 ASKING THEM TO DO. 7255 04:13:20,126 --> 04:13:22,295 IF THEY'RE COMEING WITH THEIR 7256 04:13:22,295 --> 04:13:22,929 WEARABLE INFORMATION TO US, IF 7257 04:13:22,929 --> 04:13:24,263 THEY'RE ASKING THESE QUESTIONS, 7258 04:13:24,263 --> 04:13:28,868 IF THEY WANT TO BE JUST AN N OF 7259 04:13:28,868 --> 04:13:30,736 1 TO BE TAKEN CARE OF, THEN WE 7260 04:13:30,736 --> 04:13:32,905 NEED TO REALLY, YOU KNOW, DO 7261 04:13:32,905 --> 04:13:33,139 THIS. 7262 04:13:33,139 --> 04:13:38,210 SO I WOULD LIKE TO ASK IFABLE I 7263 04:13:38,210 --> 04:13:39,679 AM OLD-FASHIONED WITH ALL THESE 7264 04:13:39,679 --> 04:13:43,182 BLACK CAMERAS, SO IF THE SESSION 7265 04:13:43,182 --> 04:13:44,784 5 AND 6 SPEAKERS, IF YOU CAN 7266 04:13:44,784 --> 04:13:50,289 TURN ON YOUR CAMERAS, THEN WE 7267 04:13:50,289 --> 04:13:53,559 CAN START THE ROUNDTABLE 7268 04:13:53,559 --> 04:13:54,860 DISCUSSION. 7269 04:13:54,860 --> 04:13:57,063 I SEE KLAR'S CAMERA ON. 7270 04:13:57,063 --> 04:13:59,799 I REALLY ENJOYED YOUR TALK, 7271 04:13:59,799 --> 04:14:01,200 KLAR. 7272 04:14:01,200 --> 04:14:01,567 OBVIOUSLY THESE 7273 04:14:01,567 --> 04:14:02,335 PHARMACOTHERAPIES ARE REALLY, 7274 04:14:02,335 --> 04:14:06,272 YOU KNOW, MOVING OUR FIELD 7275 04:14:06,272 --> 04:14:08,674 FORWARD, AND I WANTED TO ASK 7276 04:14:08,674 --> 04:14:09,775 MAYBE TOO GENERAL OF A QUESTION 7277 04:14:09,775 --> 04:14:13,145 IS, HOW CLOSE DO YOU THINK WE 7278 04:14:13,145 --> 04:14:14,780 ARE TO REALLY THEN BRIDGING TO 7279 04:14:14,780 --> 04:14:16,549 THE LAST SESSION, IMPLEMENTING 7280 04:14:16,549 --> 04:14:22,254 THOSE TO THE CLINICAL PRACTICE? 7281 04:14:22,254 --> 04:14:23,756 >> THAT'S A WONDERFUL QUESTION. 7282 04:14:23,756 --> 04:14:25,625 I THINK THESE ROUNDTABLE 7283 04:14:25,625 --> 04:14:26,125 DISCUSSIONS WERE A GREAT 7284 04:14:26,125 --> 04:14:26,626 ADDITION TO THIS. 7285 04:14:26,626 --> 04:14:29,495 I'D LIKE IT MAKE SOME COMMENTS 7286 04:14:29,495 --> 04:14:32,765 TO SORT OF BRIDGE PRECISION 7287 04:14:32,765 --> 04:14:36,836 MEDICINE, OUR FIELD NOW ENTERING 7288 04:14:36,836 --> 04:14:39,105 PHARMACOLOGIC THERAPIES FOR 7289 04:14:39,105 --> 04:14:42,074 TREATMENTS FOR OUR PATIENTS, AND 7290 04:14:42,074 --> 04:14:45,678 PERHAPS IMPLEMENTATION. 7291 04:14:45,678 --> 04:14:47,880 I THINK ONE OF THE THINGS NAJIB 7292 04:14:47,880 --> 04:14:49,081 SAID AT THE BEGINNING REALLY 7293 04:14:49,081 --> 04:14:49,348 RESONATED. 7294 04:14:49,348 --> 04:14:50,816 I ACTUALLY HAVE A FAMILY MEMBER 7295 04:14:50,816 --> 04:14:58,824 WHO IS GOING THROUGH BREARS BRET 7296 04:14:58,824 --> 04:15:00,393 CANCER TREATMENTS RIGHT NOW AND 7297 04:15:00,393 --> 04:15:02,395 I HAVE BEEN BLOWN AWAY WITH WHAT 7298 04:15:02,395 --> 04:15:03,729 IS POSSIBLE IN THAT FIELD WITH 7299 04:15:03,729 --> 04:15:06,565 RESPECT TO PHENOTYPING AND CARE. 7300 04:15:06,565 --> 04:15:08,200 YOU KNOW YOUR STAGE, YOU GET THE 7301 04:15:08,200 --> 04:15:11,704 ONCOTYPE OF YOUR TUMOR, YOU'RE 7302 04:15:11,704 --> 04:15:12,905 POST-MENOPAUSAL, THIS TRIAL 7303 04:15:12,905 --> 04:15:13,439 GIVES YOU THIS THERAPY. 7304 04:15:13,439 --> 04:15:15,641 AND IT IS PRECISION MEDICINE ON 7305 04:15:15,641 --> 04:15:17,376 STEROIDS, AND I THINK WE CAN 7306 04:15:17,376 --> 04:15:22,548 ONLY DREAM OF HAVING THAT KIND 7307 04:15:22,548 --> 04:15:27,319 OF DATA AND SCIENCE. 7308 04:15:27,319 --> 04:15:30,289 I THINK AS A FIELD AS WE SORT OF 7309 04:15:30,289 --> 04:15:34,427 ENTER PHARMACOLOGIC THERAPY FOR 7310 04:15:34,427 --> 04:15:36,429 SLEEP DISORDER BREATHING IN 7311 04:15:36,429 --> 04:15:37,863 PARTICULAR, I THINK AS 7312 04:15:37,863 --> 04:15:39,799 CLINICIANS, WE NEED TO, I THINK, 7313 04:15:39,799 --> 04:15:45,237 BE MORE BROADLY THINKING ABOUT 7314 04:15:45,237 --> 04:15:45,871 THE CARDIOMETABOLIC MENTAL 7315 04:15:45,871 --> 04:15:47,573 HEALTH, COGNITIVE HEALTH OF OUR 7316 04:15:47,573 --> 04:15:53,012 PATIENTS, AND ENGAGING IN THAT 7317 04:15:53,012 --> 04:15:53,212 CARE. 7318 04:15:53,212 --> 04:15:54,146 I THINK THAT MANY OF OUR 7319 04:15:54,146 --> 04:15:56,215 COLLEAGUES IN OTHER SPECIALTIES 7320 04:15:56,215 --> 04:15:58,184 KNOW ABSOLUTELY NOTHING ABOUT 7321 04:15:58,184 --> 04:16:03,756 SLEEP, AND CIRCADIAN SCIENCE. 7322 04:16:03,756 --> 04:16:05,758 I THINK WE SEE INCREDIBLY HIGH 7323 04:16:05,758 --> 04:16:08,561 RISK PATIENTS IN OUR CLINICS, 7324 04:16:08,561 --> 04:16:11,330 WITH CARDIOMETABOLIC DISEASE, 7325 04:16:11,330 --> 04:16:14,266 END STAGE COPD, END STAGE HEART 7326 04:16:14,266 --> 04:16:16,368 FAILURE, AND THERE IS NO REASON 7327 04:16:16,368 --> 04:16:18,137 WHY WE SHOULDN'T BE ENGAGING 7328 04:16:18,137 --> 04:16:18,337 THIS. 7329 04:16:18,337 --> 04:16:24,009 I THINK OUR HEALTHCARE SYSTEM IS 7330 04:16:24,009 --> 04:16:25,644 SO FRAGMENTED RIGHT NOW. 7331 04:16:25,644 --> 04:16:27,279 AND THE IDEA OF ONE-STOP 7332 04:16:27,279 --> 04:16:28,914 SHOPPING WHERE WE OWN EVERYTHING 7333 04:16:28,914 --> 04:16:30,783 RELATED TO SLEEP HEALTH OR 7334 04:16:30,783 --> 04:16:31,550 CIRCADIAN HEALTH OF THESE 7335 04:16:31,550 --> 04:16:33,319 PATIENTS IS REALLY -- REALLY 7336 04:16:33,319 --> 04:16:37,156 APPEALS TO THE SORT OF INTERNIST 7337 04:16:37,156 --> 04:16:38,791 IN ME. 7338 04:16:38,791 --> 04:16:43,696 I THINK ALSO REGARDING SORT OF 7339 04:16:43,696 --> 04:16:46,365 IMPLEMENTATION SCIENCE AND WHERE 7340 04:16:46,365 --> 04:16:48,501 WE SHOULD BE MOVING IN THAT 7341 04:16:48,501 --> 04:16:50,269 DOMAIN, I PUT THIS IN ONE SMALL 7342 04:16:50,269 --> 04:16:57,243 COMMENT IN THE CHAT, AS A.I. IS 7343 04:16:57,243 --> 04:16:58,577 COMING ON BOARD FOR SCORING 7344 04:16:58,577 --> 04:17:00,846 SLEEP STUDIES, AND I THINK WE'RE 7345 04:17:00,846 --> 04:17:05,551 MOVING MORE AND MORE TOWARDS 7346 04:17:05,551 --> 04:17:09,488 DOING HO HOME SLEEP TESTING 7347 04:17:09,488 --> 04:17:11,757 WEARABLE DEVICES, I THINK ONE 7348 04:17:11,757 --> 04:17:12,658 REALLY UNDERREPRESENTED 7349 04:17:12,658 --> 04:17:13,893 HEALTHCARE PROVIDER IN OUR FIELD 7350 04:17:13,893 --> 04:17:19,799 IS THE SLEEP TECHNOLOGIST. 7351 04:17:19,799 --> 04:17:21,700 IT IS EMBARRASSING HOW LITTLE WE 7352 04:17:21,700 --> 04:17:25,171 HAVE THIS PROVIDER ENGAGED IN 7353 04:17:25,171 --> 04:17:26,238 PATIENT FACING ACTIVITIES. 7354 04:17:26,238 --> 04:17:27,439 AS THEY'RE NOT GOING TO BE 7355 04:17:27,439 --> 04:17:29,341 NEEDING TO SCORE STUDIES AS MUCH 7356 04:17:29,341 --> 04:17:32,311 AND DO OVERNIGHT STUDIES, WE 7357 04:17:32,311 --> 04:17:33,579 SHOULD ENROLL THEM IN THE CARE 7358 04:17:33,579 --> 04:17:36,649 DAWRNG THE DAY TIME OF OUR 7359 04:17:36,649 --> 04:17:38,184 PATIENTS. 7360 04:17:38,184 --> 04:17:42,922 AND I THINK ALSO RELATED TO 7361 04:17:42,922 --> 04:17:47,159 IMPLEMENTATION SCIENCE, WE NEED 7362 04:17:47,159 --> 04:17:48,894 TO START THINKING ABOUT SLEEP 7363 04:17:48,894 --> 04:17:50,462 HEALTHCARE ACROSS HEALTH SYSTEMS 7364 04:17:50,462 --> 04:17:53,199 RIGHT NOW, AND RIGHT NOW, I 7365 04:17:53,199 --> 04:17:55,367 THINK WHAT WE'RE DOING IN 7366 04:17:55,367 --> 04:17:57,469 ACADEMIC CENTERS IS SETTING UP 7367 04:17:57,469 --> 04:17:59,672 INDIVIDUAL SLEEP LABORATORIES AT 7368 04:17:59,672 --> 04:18:03,375 EVERY HOSPITAL, AND THERE'S NO 7369 04:18:03,375 --> 04:18:06,979 REASON THAT WE NEED FIVE OR SIX 7370 04:18:06,979 --> 04:18:08,414 DIFFERENT SLEEP CENTERS IN A 7371 04:18:08,414 --> 04:18:08,848 HEALTHCARE SYSTEM. 7372 04:18:08,848 --> 04:18:11,250 I THINK WE NEED MAYBE ONE OR TWO 7373 04:18:11,250 --> 04:18:12,585 THAT CAN DO REALLY COMPLICATED 7374 04:18:12,585 --> 04:18:14,453 IN-LAB TESTING AND REALLY 7375 04:18:14,453 --> 04:18:16,589 EMBRACE THINGS LIKE TELEHEALTH 7376 04:18:16,589 --> 04:18:18,357 AND REALLY THINK ABOUT HOW WE 7377 04:18:18,357 --> 04:18:20,459 CAN BETTER STREAMLINE THE CARE. 7378 04:18:20,459 --> 04:18:23,295 ALL OF OUR SLEEP CENTERS ARE 7379 04:18:23,295 --> 04:18:24,730 OVERWHELMED WITH PATIENTS. 7380 04:18:24,730 --> 04:18:25,931 WE'RE SPENDING SO MUCH TIME 7381 04:18:25,931 --> 04:18:28,868 RIGHT NOW ON ANNUAL VISIT FOR 7382 04:18:28,868 --> 04:18:31,070 INSURANCE PURPOSES, AND I THINK 7383 04:18:31,070 --> 04:18:32,905 REALLY THINKING CRITICALLY IN 7384 04:18:32,905 --> 04:18:35,908 THAT SORT OF HEALTH SERVICES 7385 04:18:35,908 --> 04:18:39,812 RESEARCH, ALSO IMPLEMENTATION 7386 04:18:39,812 --> 04:18:43,182 SCIENCE, TO ALLOW US TO DO THIS 7387 04:18:43,182 --> 04:18:44,617 MORE COMPLICATED CARE IN PATIENT 7388 04:18:44,617 --> 04:18:45,651 IS WHERE WE NEED TO GO. 7389 04:18:45,651 --> 04:18:48,454 >> THANK YOU, KLAR. 7390 04:18:48,454 --> 04:18:49,655 I SEE SEVERAL HANDS UP. 7391 04:18:49,655 --> 04:18:49,822 BOB? 7392 04:18:49,822 --> 04:18:51,757 >> I WANTED TO GO BACK, SO 7393 04:18:51,757 --> 04:18:53,859 BEFORE KLAR JUST RAISED A WHOLE 7394 04:18:53,859 --> 04:18:54,927 BUNCH OF GREAT QUESTIONS WHICH I 7395 04:18:54,927 --> 04:18:55,928 ALSO HAVE QUESTIONS ABOUT, IN 7396 04:18:55,928 --> 04:18:58,030 THE CHAT, ESRA, YOU ASKED 7397 04:18:58,030 --> 04:18:58,864 ACTUALLY ABOUT THE 7398 04:18:58,864 --> 04:18:59,632 PHARMACOTHERAPY FOR OSA AND YOU 7399 04:18:59,632 --> 04:19:03,769 ASKED ABOUT SOME OF THE NEWER 7400 04:19:03,769 --> 04:19:07,606 STUDIES AND THE INCREASE IN 7401 04:19:07,606 --> 04:19:09,041 HEART RATE. 7402 04:19:09,041 --> 04:19:10,776 KLAR, YOU SAID HEY, WE USED 7403 04:19:10,776 --> 04:19:12,344 THESE DRUGS AND WE'RE GOING TO 7404 04:19:12,344 --> 04:19:12,711 MONITOR PEOPLE. 7405 04:19:12,711 --> 04:19:13,646 BUT ARE YOU GOING TO TREAT 7406 04:19:13,646 --> 04:19:14,914 PEOPLE WHO DON'T HAVE SYMPTOMS 7407 04:19:14,914 --> 04:19:17,750 AND YOU'LL SAY WELL, THE AHI IS 7408 04:19:17,750 --> 04:19:19,785 BETTER, BUT NOW I'VE INCREASED 7409 04:19:19,785 --> 04:19:21,120 THE HEART RATE, ARE YOU GOING TO 7410 04:19:21,120 --> 04:19:22,421 TREAT PEOPLE WHO ARE TRYING TO 7411 04:19:22,421 --> 04:19:25,758 MINIMIZE THEIR CARDIOVASCULAR 7412 04:19:25,758 --> 04:19:28,193 RISK TO GET THE AHI LOWER BUT 7413 04:19:28,193 --> 04:19:29,328 GET THE HEART RATE UP? 7414 04:19:29,328 --> 04:19:31,430 MY SENSE IS THERE ARE PATIENTS 7415 04:19:31,430 --> 04:19:32,298 IN WHOM THOSE DRUGS ARE GOING TO 7416 04:19:32,298 --> 04:19:36,001 BE USEFUL, BUT IT'S GOING TO BE 7417 04:19:36,001 --> 04:19:37,803 SYMPTOMATIC PEOPLE, BUT I'M 7418 04:19:37,803 --> 04:19:38,537 ASSUMING YOU'RE NOT GOING TO 7419 04:19:38,537 --> 04:19:40,072 PRESCRIBE THESE DRUGS TO TREAT 7420 04:19:40,072 --> 04:19:44,209 THE SLEEP APNEA TO REDUCE 7421 04:19:44,209 --> 04:19:44,777 CARDIOVASCULAR RISK AT LEAST 7422 04:19:44,777 --> 04:19:45,377 BASED ON THE STUDIES WE HAVE 7423 04:19:45,377 --> 04:19:45,744 NOW. 7424 04:19:45,744 --> 04:19:47,279 BUT I'M CURIOUS, I DON'T KNOW 7425 04:19:47,279 --> 04:19:48,847 HOW I'M GOING TO USE THESE DRUGS 7426 04:19:48,847 --> 04:19:49,982 COMPLETELY IF THEY ARE APPROVED. 7427 04:19:49,982 --> 04:19:51,517 >> I'M CURRENTLY NOT PRESCRIBING 7428 04:19:51,517 --> 04:19:55,521 ANY OF THAT'S DRUGS FOR THE CARE 7429 04:19:55,521 --> 04:20:02,494 OF SLEEP APNEA, THE NOR 7430 04:20:02,494 --> 04:20:05,564 ADRENERGICS OR THE 7431 04:20:05,564 --> 04:20:06,231 ANTIMUSCARINICS. 7432 04:20:06,231 --> 04:20:08,734 THE HEART RATE GOES UP -- ON 7433 04:20:08,734 --> 04:20:10,135 SOME OF THESE, THAT IS 7434 04:20:10,135 --> 04:20:10,669 ABSOLUTELY THE CASE. 7435 04:20:10,669 --> 04:20:11,971 SO WE NEED TO FIGURE OUT WHICH 7436 04:20:11,971 --> 04:20:14,273 TARGET POPULATION BENEFITS FROM 7437 04:20:14,273 --> 04:20:18,444 THESE SPECIFIC NOW MULTIPLE 7438 04:20:18,444 --> 04:20:19,945 PHARMACOLOGIC OPTIONS. 7439 04:20:19,945 --> 04:20:22,481 I THINK MY POINT TO ESRA'S 7440 04:20:22,481 --> 04:20:27,386 POINT, I THINK IT'S TRUE, BUT 7441 04:20:27,386 --> 04:20:30,222 MANY OF THESE THERAPIES ARE IN 7442 04:20:30,222 --> 04:20:31,957 WIDESPREAD USE, MANY OF OUR 7443 04:20:31,957 --> 04:20:33,225 PATIENTS ARE COMING IN ON THESE 7444 04:20:33,225 --> 04:20:34,860 TREATMENTS, YOU THINK THE 7445 04:20:34,860 --> 04:20:37,930 ADDERALL, WITH THE OVERLAP OF 7446 04:20:37,930 --> 04:20:44,503 ADHD, IT'S A NOR ADRENERGIC. 7447 04:20:44,503 --> 04:20:45,471 AND WE SHOULD BECOME MORE 7448 04:20:45,471 --> 04:20:46,572 FAMILIAR WITH THEIR USE AND HOW 7449 04:20:46,572 --> 04:20:49,775 DO YOU MONITOR THEM ON THESE 7450 04:20:49,775 --> 04:20:50,075 MEDICATIONS. 7451 04:20:50,075 --> 04:20:52,311 >> I'D LIKE TO JUST FOLLOW UP ON 7452 04:20:52,311 --> 04:20:53,278 THAT, KLAR. 7453 04:20:53,278 --> 04:20:55,247 WE WERE TALKING ABOUT 7454 04:20:55,247 --> 04:20:56,248 HETEROGENEITY IN OUR PATIENT 7455 04:20:56,248 --> 04:20:56,782 POPULATION. 7456 04:20:56,782 --> 04:20:58,217 BUT YOU KNOW, WHAT I'M SEEING 7457 04:20:58,217 --> 04:21:01,987 NOW IS OLDER AND OLDER PATIENTS 7458 04:21:01,987 --> 04:21:03,455 COMING IN AND THEY MAY BE ON A 7459 04:21:03,455 --> 04:21:07,426 STIM LANDSTIMULANT FOR EXCESSIVE 7460 04:21:07,426 --> 04:21:09,495 SLEEPINESS AND IT MAKES ME 7461 04:21:09,495 --> 04:21:10,362 INCREMENTALLY NERVOUS TO GIVE 7462 04:21:10,362 --> 04:21:12,231 THEM SOMETHING THAT'S GOING TO 7463 04:21:12,231 --> 04:21:14,133 POTENTIALLY HAVE AN ADVERSE 7464 04:21:14,133 --> 04:21:15,000 CARDIOVASCULAR IMPACT. 7465 04:21:15,000 --> 04:21:16,535 WE REALLY HAVEN'T STUDIED THESE 7466 04:21:16,535 --> 04:21:21,807 DRUGS THAT WELL IN THE ELDERLY. 7467 04:21:21,807 --> 04:21:22,541 THAT'S A VULNERABLE POPULATION. 7468 04:21:22,541 --> 04:21:24,743 THE QUESTION I HAD FOR YOU, 7469 04:21:24,743 --> 04:21:28,680 THOUGH, IS, THAT WAS A GREAT 7470 04:21:28,680 --> 04:21:31,183 REVIEW OF WHAT'S ON THE HORIZON 7471 04:21:31,183 --> 04:21:34,253 IN TERMS OF ANTIOBESITY DRUGS, 7472 04:21:34,253 --> 04:21:35,687 BUT ONE IN THE THINGS IN THE 7473 04:21:35,687 --> 04:21:37,022 V.A. THAT'S GOING ON RIGHT NOW 7474 04:21:37,022 --> 04:21:40,626 IS THERE'S THIS THING CALLED THE 7475 04:21:40,626 --> 04:21:43,896 VASER TRIAL WHERE THEY'RE 7476 04:21:43,896 --> 04:21:45,230 LEVERAGING PHARMACOGENOMICS TO 7477 04:21:45,230 --> 04:21:47,332 IDENTIFY THE BEST DRUG FOR A 7478 04:21:47,332 --> 04:21:49,068 GIVEN PATIENT USING THE GENOMIC 7479 04:21:49,068 --> 04:21:49,501 SIGNATURE. 7480 04:21:49,501 --> 04:21:52,471 AND YOU KNOW, WHEN WE ONLY HAD 7481 04:21:52,471 --> 04:21:54,506 CPAP AND ORAL APPLIANCES, 7482 04:21:54,506 --> 04:21:55,541 PHARMACOJEA KNOW MIX WAS NOT A 7483 04:21:55,541 --> 04:21:57,509 THING, BUT I THINK THAT IS GOING 7484 04:21:57,509 --> 04:22:01,013 TO BE AN OPPORTUNITY FOR US AS 7485 04:22:01,013 --> 04:22:02,181 WE GET MORE AND MORE DRUGS IN 7486 04:22:02,181 --> 04:22:03,649 THE TREATMENT SPACE, AND I JUST 7487 04:22:03,649 --> 04:22:07,453 WANTED TO GET YOUR REACTION TO 7488 04:22:07,453 --> 04:22:10,355 THAT AS A NOTION. 7489 04:22:10,355 --> 04:22:12,091 >> I THINK THE V.A. HAS BEEN A 7490 04:22:12,091 --> 04:22:13,959 LEADER IN SO MANY WAYS WITH 7491 04:22:13,959 --> 04:22:16,895 MILLION VETERAN PROGRAM AND WE 7492 04:22:16,895 --> 04:22:18,764 HEARD ABOUT SOME OF THE SCIENCE 7493 04:22:18,764 --> 04:22:22,367 IN SLEEP THAT WAS COMING OUT OF 7494 04:22:22,367 --> 04:22:23,469 THAT TODAY. 7495 04:22:23,469 --> 04:22:24,470 I THINK THE CARE IS OUTSTANDING 7496 04:22:24,470 --> 04:22:28,640 AT THE VA. 7497 04:22:28,640 --> 04:22:31,810 WITH LIMITED RESOURCES. 7498 04:22:31,810 --> 04:22:34,012 I THINK IN ADDITION TO 7499 04:22:34,012 --> 04:22:34,646 PHARMACOGENETICS, I THINK SOME 7500 04:22:34,646 --> 04:22:38,150 VERY INTERESTING QUESTIONS FOR 7501 04:22:38,150 --> 04:22:42,087 OUR FIELD ARE THAT WE'RE JUST 7502 04:22:42,087 --> 04:22:47,459 STARTING TO TOUCH ON IS THE IDEA 7503 04:22:47,459 --> 04:22:48,660 OF CHRONOTHERAPEUTICS, WHEN DO 7504 04:22:48,660 --> 04:22:50,062 WE TIME ALL OF THESE DIFFERENT 7505 04:22:50,062 --> 04:22:50,395 MEDICATIONS. 7506 04:22:50,395 --> 04:22:54,032 THERE'S SOME NASCENT LITERATURE 7507 04:22:54,032 --> 04:22:55,667 ON ANTI HYPERTENSIVES MAY BE 7508 04:22:55,667 --> 04:22:58,937 MORE EFFECTIVE AT NIGHTTIME, 7509 04:22:58,937 --> 04:23:01,039 CHOLESTEROL MEDICATIONS, THAT'S 7510 04:23:01,039 --> 04:23:01,707 REALLY IMPORTANT SCIENCE WE NEED 7511 04:23:01,707 --> 04:23:02,708 TO BE ENGAGING WITH AS WELL. 7512 04:23:02,708 --> 04:23:05,210 SO ALL OF THIS, I THINK 7513 04:23:05,210 --> 04:23:06,645 HOPEFULLY WILL MOVE US TOWARDS 7514 04:23:06,645 --> 04:23:13,685 MORE PRECISION-BASED APPROACHES. 7515 04:23:13,685 --> 04:23:16,722 >> I'LL GIVE YOU ONE ANECDOTE, I 7516 04:23:16,722 --> 04:23:18,357 SAW A PATIENT A FEW WEEKS AGO 7517 04:23:18,357 --> 04:23:20,025 WHO HAD LIVER CIRRHOSIS AND 7518 04:23:20,025 --> 04:23:21,093 PORTAL HYPERTENSION AND WAS 7519 04:23:21,093 --> 04:23:23,262 DOSING WITH A BETA-BLOCKER IN 7520 04:23:23,262 --> 04:23:25,898 THE MORNING AND WAS FALLING 7521 04:23:25,898 --> 04:23:26,465 ASLEEP. 7522 04:23:26,465 --> 04:23:29,334 HE STOPPED TAKING THE 7523 04:23:29,334 --> 04:23:29,868 BETA-BLOCKER AND WAS FINE. 7524 04:23:29,868 --> 04:23:32,504 I SAID HAVE YOU TRIED TAKING IT 7525 04:23:32,504 --> 04:23:33,705 AT NIGHT? 7526 04:23:33,705 --> 04:23:34,773 IF YOU'RE SLEEPY? 7527 04:23:34,773 --> 04:23:37,709 AND YOU KNOW, THAT WAS NOT PART 7528 04:23:37,709 --> 04:23:40,179 OF THE CONVERSATION THAT HE HAD 7529 04:23:40,179 --> 04:23:45,450 WITH HIS HEPATO LOGIST. 7530 04:23:45,450 --> 04:23:47,753 I THINK YOU'RE RIGHT, TIMING AND 7531 04:23:47,753 --> 04:23:49,655 CIRCADIAN RHYTHM ALIGNMENT WITH 7532 04:23:49,655 --> 04:23:51,290 NOW DRUGS THAT WE HAVE WOULD BE 7533 04:23:51,290 --> 04:23:53,792 AN IMPORTANT PART OF THE SLEEP 7534 04:23:53,792 --> 04:23:54,760 HOME FOR TOTAL CARE. 7535 04:23:54,760 --> 04:24:02,768 VERY GOOD. 7536 04:24:02,768 --> 04:24:03,969 >> TURNING TO MAYBE DAVID AND 7537 04:24:03,969 --> 04:24:07,706 CHRISTOPHER TO THE -- RELATED TO 7538 04:24:07,706 --> 04:24:08,807 SESSION 5, WHAT ARE YOUR 7539 04:24:08,807 --> 04:24:13,845 THOUGHTS HOW CLOSE WE ARE TO 7540 04:24:13,845 --> 04:24:15,414 IMPLEMENTING SOME OF THE REALLY 7541 04:24:15,414 --> 04:24:19,451 EXCITING THERAPEUTICS YOU SHOWED 7542 04:24:19,451 --> 04:24:22,921 IN YOUR PRESENTATIONS? 7543 04:24:22,921 --> 04:24:26,458 AND THEN HOW WOULD THIS 7544 04:24:26,458 --> 04:24:27,759 INFLUENCE PATIENTS' PERCEIVED 7545 04:24:27,759 --> 04:24:30,596 CARE AND CAREGIVERS? 7546 04:24:30,596 --> 04:24:31,930 WE HAD A LITTLE BIT OF THAT 7547 04:24:31,930 --> 04:24:33,131 DISCUSSION BUT MAYBE TO EXPAND 7548 04:24:33,131 --> 04:24:36,969 ON THAT. 7549 04:24:36,969 --> 04:24:38,403 >> AND MAYBE JUST WITH REGARDS 7550 04:24:38,403 --> 04:24:40,138 TO THE NASOPHARYNGEAL STENT, I 7551 04:24:40,138 --> 04:24:43,542 THINK THE POPULATIONS THAT WERE 7552 04:24:43,542 --> 04:24:44,977 UTILIZING IT ARE SOME OF THE 7553 04:24:44,977 --> 04:24:46,745 MOST COMPLEX CHALLENGING 7554 04:24:46,745 --> 04:24:50,682 POPULATIONS, AND SO NATURALLY 7555 04:24:50,682 --> 04:24:52,851 THE QUESTION AROSE, WELL, HOW 7556 04:24:52,851 --> 04:25:00,192 ABOUT OTHERWISE HEALTHY ADULT OR 7557 04:25:00,192 --> 04:25:02,027 MORE RUN OF THE MILL OBSTRUCTIVE 7558 04:25:02,027 --> 04:25:02,394 SLEEP APNEA. 7559 04:25:02,394 --> 04:25:05,998 SO THAT'S SOMETHING WE'RE REALLY 7560 04:25:05,998 --> 04:25:07,633 INTERESTED IN PURSUING SOME 7561 04:25:07,633 --> 04:25:09,067 ADDITIONAL EXTRAMURAL FUNDING 7562 04:25:09,067 --> 04:25:09,935 FOR. 7563 04:25:09,935 --> 04:25:14,106 INTERNALLY, WE HAVE A PILOT 7564 04:25:14,106 --> 04:25:17,276 STUDY THAT WE'RE GOING TO 7565 04:25:17,276 --> 04:25:19,244 INITIATE JUST FOR KIND OF THE 7566 04:25:19,244 --> 04:25:20,445 ADULT OBSTRUCTIVE SLEEP APNEA. 7567 04:25:20,445 --> 04:25:26,885 AND THEN AGAIN, WE'RE IN YEAR 7568 04:25:26,885 --> 04:25:32,190 FOUR OR FIVE OF OUR SINGLE SITE 7569 04:25:32,190 --> 04:25:33,825 TRIAL, SO WE'LL BE REALLY 7570 04:25:33,825 --> 04:25:40,032 EXCITED TO ANALYZE THAT DATA AND 7571 04:25:40,032 --> 04:25:42,234 WORKING WITH THE FDA ACTIVELY, 7572 04:25:42,234 --> 04:25:43,568 AND I THINK THAT THE NATURE OF 7573 04:25:43,568 --> 04:25:44,936 THE DEVICE BEING NON-SURGICAL 7574 04:25:44,936 --> 04:25:48,473 AND EASY TO MONITOR, EASY TO 7575 04:25:48,473 --> 04:25:49,975 KIND OF REMOVE OR REMEDY IF 7576 04:25:49,975 --> 04:25:55,213 THERE'S ANY CONCERNS, MY HOPE IS 7577 04:25:55,213 --> 04:25:59,284 THAT DISCUSSION IN PROCESS WITH 7578 04:25:59,284 --> 04:26:02,688 THE FDA IS RELATIVELY EXPEDIENT. 7579 04:26:02,688 --> 04:26:05,090 >> I THINK JUST BROADLY WE'RE 7580 04:26:05,090 --> 04:26:08,527 POISED T TO DO IT. 7581 04:26:08,527 --> 04:26:09,261 IF YOU THINK ABOUT THE 7582 04:26:09,261 --> 04:26:10,562 COMPONENTS THAT ARE NEEDED, YOU 7583 04:26:10,562 --> 04:26:12,030 LOOK AT PEOPLE ON THE SCREEN 7584 04:26:12,030 --> 04:26:14,833 HERE, LIKE DR. HONAKER AND 7585 04:26:14,833 --> 04:26:15,500 DR. WILLIAMSON WHO ARE 7586 04:26:15,500 --> 04:26:17,035 PSYCHOLOGISTS THAT DEAL WITH A 7587 04:26:17,035 --> 04:26:18,270 LOT OF EXPERTISE IN BEHAVIORAL 7588 04:26:18,270 --> 04:26:19,271 SLEEP MEDICINE AND THEN ALSO 7589 04:26:19,271 --> 04:26:22,107 HAVE REALLY TAKEN A LARGE 7590 04:26:22,107 --> 04:26:24,276 INTEREST IN OBSTRUCTIVE SLEEP 7591 04:26:24,276 --> 04:26:25,177 APNEA OUTSIDE OF THE PHYSICIANS 7592 04:26:25,177 --> 04:26:28,246 THAT ARE TREATING, GETTING 7593 04:26:28,246 --> 04:26:28,880 DIFFERENT PERSPECTIVES. 7594 04:26:28,880 --> 04:26:32,284 THAT'S PART OF THE WAY THAT 7595 04:26:32,284 --> 04:26:33,085 SLEEP MEDICINES AND PEDIATRICS 7596 04:26:33,085 --> 04:26:33,719 HAS PRACTICED. 7597 04:26:33,719 --> 04:26:35,587 IN TERMS OF IMPLEMENTATION, IF 7598 04:26:35,587 --> 04:26:37,255 YOU LOOK WITHIN OUR VERY, VERY, 7599 04:26:37,255 --> 04:26:38,790 VERY SMALL FIELD, WE BRING OTHER 7600 04:26:38,790 --> 04:26:41,393 PEOPLE IN LIKE OTOLARYNGOLOGISTS 7601 04:26:41,393 --> 04:26:44,062 LIKE DR. ZOPF AND THEN OUR 7602 04:26:44,062 --> 04:26:45,263 COLLEAGUES KIND OF ACROSS THE 7603 04:26:45,263 --> 04:26:46,331 SPECTRUM INCLUDING THE 7604 04:26:46,331 --> 04:26:48,233 SPECIALISTS THAT MANAGE 7605 04:26:48,233 --> 04:26:48,867 PRIMARILY THESE VERY COMPLICATED 7606 04:26:48,867 --> 04:26:49,534 PATIENTS THAT WE SEE. 7607 04:26:49,534 --> 04:26:52,037 AND THEN THE OTHER COMPONENT I 7608 04:26:52,037 --> 04:26:55,440 THINK IS JUST GENERATING THESE 7609 04:26:55,440 --> 04:26:55,707 NETWORKS. 7610 04:26:55,707 --> 04:26:56,475 PEOPLE LIKE DR. REDLINE THAT 7611 04:26:56,475 --> 04:26:58,110 HAVE REALLY BEEN ABLE TO BRING 7612 04:26:58,110 --> 04:26:59,211 TOGETHER MULTIPLE SITES THAT ARE 7613 04:26:59,211 --> 04:27:03,081 ABLE TO RECRUIT PATIENTS INTO 7614 04:27:03,081 --> 04:27:05,250 THESE MULTICENTER STUDIES 7615 04:27:05,250 --> 04:27:06,885 STARTSTARTING WITH CHAD AND SOMF 7616 04:27:06,885 --> 04:27:08,854 THESE OTHER TRIALS, IT BEEN HUGE 7617 04:27:08,854 --> 04:27:09,654 TO BE ABLE TO HAVE THESE NETWORK 7618 04:27:09,654 --> 04:27:11,056 OF SITES THAT CAN DO THAT KIND 7619 04:27:11,056 --> 04:27:11,490 OF WORK. 7620 04:27:11,490 --> 04:27:13,425 THEN THE NEXT STAGE WOULD BE 7621 04:27:13,425 --> 04:27:14,793 THEN TRYING TO ROLL IT OUT TO 7622 04:27:14,793 --> 04:27:15,894 POTENTIALLY LIKE SMALLER SITES, 7623 04:27:15,894 --> 04:27:19,631 UPLOOKING INTERNATIONALLY, AND I 7624 04:27:19,631 --> 04:27:21,066 THINK AGAIN, JUST REFERENCE THE 7625 04:27:21,066 --> 04:27:22,134 INCLUDE NETWORK WHICH I THINK IS 7626 04:27:22,134 --> 04:27:24,035 REALLY STARTING TO PUSH THESE 7627 04:27:24,035 --> 04:27:27,773 KIND OF NETWORKS THAT INCLUDE 7628 04:27:27,773 --> 04:27:29,408 PATIENTS THAT ARE OTHERWISE KIND 7629 04:27:29,408 --> 04:27:30,375 OF HARD TO RECRUIT. 7630 04:27:30,375 --> 04:27:32,043 SO I THINK LEVERAGING SOME OF 7631 04:27:32,043 --> 04:27:33,345 THESE TECHNIQUES AND THESE 7632 04:27:33,345 --> 04:27:34,312 NETWORKS ARE FORMED WITH LIKE 7633 04:27:34,312 --> 04:27:36,648 SOME OF THE OTHER PEOPLE IN THIS 7634 04:27:36,648 --> 04:27:38,550 GROUP THAT HAVE EXPERTISE IN 7635 04:27:38,550 --> 04:27:39,184 IMPLEMENTATION SCIENCE AND HAVE 7636 04:27:39,184 --> 04:27:40,685 AN INTEREST IN PEDIATRICS, DOING 7637 04:27:40,685 --> 04:27:42,254 SOME OF THE SAME WORK YOU'VE 7638 04:27:42,254 --> 04:27:43,221 ALREADY DONE POTENTIALLY IN THE 7639 04:27:43,221 --> 04:27:44,656 ADULT WORLD IN CHILDREN, I THINK 7640 04:27:44,656 --> 04:27:47,592 WE'RE REALLY POISED TO MAKE SOME 7641 04:27:47,592 --> 04:27:49,161 HUGE STRIDES IN THIS AREA, IT'S 7642 04:27:49,161 --> 04:27:50,095 REALLY EXCITING TO HEAR A LOT OF 7643 04:27:50,095 --> 04:27:54,566 THE TALK IN THAT SESSION TODAY. 7644 04:27:54,566 --> 04:27:55,534 >> THANK YOU. 7645 04:27:55,534 --> 04:27:58,737 I'M DEFINITELY FULLY, AS MANY OF 7646 04:27:58,737 --> 04:28:01,239 YOU WOULD AGREE FOR 7647 04:28:01,239 --> 04:28:03,775 INTERDISCIPLINARY RESEARCH AND 7648 04:28:03,775 --> 04:28:04,409 COLLABORATION FOR SURE. 7649 04:28:04,409 --> 04:28:07,179 THERE ARE EXAMPLES FROM OTHER 7650 04:28:07,179 --> 04:28:10,449 FIELDS THAT WHEN A DIABETES 7651 04:28:10,449 --> 04:28:12,350 TRIAL COMES OUT, IT'S HUGE 7652 04:28:12,350 --> 04:28:14,920 SAMPLE SIZES DUE TO THE 7653 04:28:14,920 --> 04:28:16,087 MULTICENTRIC NATURE OF IT, 7654 04:28:16,087 --> 04:28:18,356 SIMILAR WITH CARDIOVASCULAR 7655 04:28:18,356 --> 04:28:19,124 DISEASES. 7656 04:28:19,124 --> 04:28:21,293 SO SARAH, DO YOU HAVE ANY 7657 04:28:21,293 --> 04:28:24,596 COMMENTS ABOUT SOME OF THE TOOLS 7658 04:28:24,596 --> 04:28:29,768 YOU'VE BEEN USING TO TRIGGER A 7659 04:28:29,768 --> 04:28:32,704 PATIENT'S INTEREST OR TO SORT OF 7660 04:28:32,704 --> 04:28:40,345 TRY TO ADDRESS THE DI SPAIRTS IS 7661 04:28:40,345 --> 04:28:41,713 IN DETECTING SLEEP APNEA AND 7662 04:28:41,713 --> 04:28:41,980 TREATING? 7663 04:28:41,980 --> 04:28:45,884 >> YEAH, SO I THINK THAT OTHERS 7664 04:28:45,884 --> 04:28:46,985 HAVE ALLUDED TO THIS QUITE A BIT 7665 04:28:46,985 --> 04:28:48,220 BUT I THINK IT'S VERY, VERY MORE 7666 04:28:48,220 --> 04:28:49,754 THAN TO WORK WITH THE 7667 04:28:49,754 --> 04:28:51,056 STAKEHOLDERS WHENEVER YOU'RE 7668 04:28:51,056 --> 04:28:53,792 DEVELOPING A NEW TOOL. 7669 04:28:53,792 --> 04:29:01,299 SO THAT FIGURE TOORK TOOK US ABA 7670 04:29:01,299 --> 04:29:02,701 YEAR AND A HALF, THEY DIDN'T 7671 04:29:02,701 --> 04:29:06,104 LIKE THIS EMOJI, WE WORKED VERY 7672 04:29:06,104 --> 04:29:07,339 CLOSELY WITH PCPs AND PARENTS 7673 04:29:07,339 --> 04:29:11,042 AND SLEEP MEDICINE PROVIDERS FOR 7674 04:29:11,042 --> 04:29:11,910 ACCURACY. 7675 04:29:11,910 --> 04:29:13,445 WITH THE COMPUTER DECISION 7676 04:29:13,445 --> 04:29:14,446 SUPPORT SYSTEM, WE ALWAYS PILOT 7677 04:29:14,446 --> 04:29:18,316 IT IN ONE CLINIC, AND CHANGE A 7678 04:29:18,316 --> 04:29:20,318 LOT OF THINGS AND WE ALWAYS HAVE 7679 04:29:20,318 --> 04:29:22,988 GROUPS OF PCPs LOOK AT IT AND 7680 04:29:22,988 --> 04:29:24,623 EVERY TIME WITHOUT FAIL THAT WE 7681 04:29:24,623 --> 04:29:26,958 ENGAGE STAKEHOLDER, WE LEARN 7682 04:29:26,958 --> 04:29:28,927 SOMETHING IMPORTANT THAT HELPS 7683 04:29:28,927 --> 04:29:31,229 IT BE SUCCESSFUL. 7684 04:29:31,229 --> 04:29:33,431 BUT IT IS SLOW WORK, AND SO I'M 7685 04:29:33,431 --> 04:29:35,400 REALLY EXCITED ABOUT DISCUSSIONS 7686 04:29:35,400 --> 04:29:38,570 THAT WE'RE HAVING ABOUT ANYTHING 7687 04:29:38,570 --> 04:29:41,439 THAT CAN HELP US, I GUESS, 7688 04:29:41,439 --> 04:29:43,542 COLLABORATE AND SYSTEMS THAT CAN 7689 04:29:43,542 --> 04:29:50,315 HELP US BE MORE EFFICIENT. 7690 04:29:50,315 --> 04:29:51,883 >> I'M CURIOUS, BECAUSE WE HAD 7691 04:29:51,883 --> 04:29:52,984 VERY LITTLE EXPERIENCE WITH THIS 7692 04:29:52,984 --> 04:29:55,053 USER CENTERED DESIGN THAT WE DID 7693 04:29:55,053 --> 04:29:58,390 FOR THE TOOL I PRESENTED, THE 7694 04:29:58,390 --> 04:29:59,457 APP. 7695 04:29:59,457 --> 04:30:03,628 DO PATIENTS MORE LEAN TOWARDS 7696 04:30:03,628 --> 04:30:07,232 SIMPLICITY? 7697 04:30:07,232 --> 04:30:09,100 GOING BACK TO OUR KEYNOTE 7698 04:30:09,100 --> 04:30:16,007 SPEAKER, DR. PUNJABI'S KEYNOTE 7699 04:30:16,007 --> 04:30:17,309 SPEAKER, FOR EXAMPLE IF YOU WANT 7700 04:30:17,309 --> 04:30:18,476 TO PRESENT THEM WITH SO MANY 7701 04:30:18,476 --> 04:30:19,778 DIFFERENT METRICS ON THEIR APP 7702 04:30:19,778 --> 04:30:25,917 ABOUT THEIR RESIDUAL AHI AND 7703 04:30:25,917 --> 04:30:27,786 MASK LEAK AND THEY JUST WANTED 7704 04:30:27,786 --> 04:30:29,754 TO SEE A SIMPLE CIRCLE AND A 7705 04:30:29,754 --> 04:30:32,390 PERCENT GOAL SO DO YOU FEEL LIKE 7706 04:30:32,390 --> 04:30:35,026 WHEN YOU'RE DEVELOPING SOME OF 7707 04:30:35,026 --> 04:30:36,995 THESE SURVEYS THAT THIS IS YOUR 7708 04:30:36,995 --> 04:30:37,295 IMPRESSION? 7709 04:30:37,295 --> 04:30:43,034 >> I THINK THAT A LOT OF TIMES 7710 04:30:43,034 --> 04:30:44,469 IT IS SIMPLER MESSAGES THAT TEND 7711 04:30:44,469 --> 04:30:48,073 TO RESONATE, AND I DON'T THINK 7712 04:30:48,073 --> 04:30:53,578 THAT MAKES THEM WORSE, IT'S JUST 7713 04:30:53,578 --> 04:30:54,245 MORE RELATABLE. 7714 04:30:54,245 --> 04:30:55,347 SO FOR EXAMPLE ONE OF THE FIRST 7715 04:30:55,347 --> 04:30:56,748 CHANGES WE MADE IS WE TOOK ANY 7716 04:30:56,748 --> 04:30:59,818 REFERENCE TO OBSTRUCTIVE SLEEP 7717 04:30:59,818 --> 04:31:00,552 APNEA OUT OF OUR EDUCATION 7718 04:31:00,552 --> 04:31:01,386 MATERIALS BECAUSE WE IMMEDIATELY 7719 04:31:01,386 --> 04:31:05,123 GOT A LOT OF QUESTIONS ABOUT 7720 04:31:05,123 --> 04:31:05,724 WHAT'S OBSTRUCTIVE SLEEP APNEA 7721 04:31:05,724 --> 04:31:06,358 AND HOW IS THAT DIFFERENT THAN 7722 04:31:06,358 --> 04:31:08,860 SLEEP APNEA AND WE SAID OKAY, 7723 04:31:08,860 --> 04:31:10,629 WE'RE JUST GOING TO TAKE OUT 7724 04:31:10,629 --> 04:31:11,796 OBSTRUCTIVE AND IT JUST PLAIN 7725 04:31:11,796 --> 04:31:12,130 SLEEP APNEA. 7726 04:31:12,130 --> 04:31:13,164 SO YOU DON'T KNOW IF YOU DON'T 7727 04:31:13,164 --> 04:31:19,204 ASK. 7728 04:31:19,204 --> 04:31:23,508 >> ANY OTHER QUESTIONS? 7729 04:31:23,508 --> 04:31:26,011 >> I THINK WHAT YOU'RE GETTING 7730 04:31:26,011 --> 04:31:28,747 AT, ESRA, IS THE WHOLE NOTION OF 7731 04:31:28,747 --> 04:31:30,415 HEALTH LITERACY THAT WE DIDN'T 7732 04:31:30,415 --> 04:31:32,450 SPECIFICALLY TALK ABOUT BUT IS 7733 04:31:32,450 --> 04:31:33,585 IMPORTANT WHEN DESIGNING ANY 7734 04:31:33,585 --> 04:31:36,454 SORT OF INTERVENTION. 7735 04:31:36,454 --> 04:31:37,622 MY COLLEAGUE AT THE -- AT 7736 04:31:37,622 --> 04:31:38,657 UNIVERSITY OF WEST VIRGINIA THAT 7737 04:31:38,657 --> 04:31:41,026 I'M FORTUNATE TO BE HIS MENTOR 7738 04:31:41,026 --> 04:31:43,428 FOR ON HIS K AWARD IS LOOKING AT 7739 04:31:43,428 --> 04:31:47,232 HEALTHCARE DELIVERY IN RURAL 7740 04:31:47,232 --> 04:31:49,134 POPULATION, AND THE LOW 7741 04:31:49,134 --> 04:31:51,036 SOCIOECONOMIC GROUP THAT'S AT 7742 04:31:51,036 --> 04:31:53,405 HIGH RISK, AND I WAS GLAD THAT 7743 04:31:53,405 --> 04:31:55,073 KLAR SHOWED THAT WEST VIRGINIA 7744 04:31:55,073 --> 04:31:59,110 IS STILL NUMBER ONE IN OBESITY, 7745 04:31:59,110 --> 04:32:00,311 SO ROB'S WORK IS GOING TO BE 7746 04:32:00,311 --> 04:32:01,413 VERY IMPORTANT, HOPEFULLY HE'LL 7747 04:32:01,413 --> 04:32:03,014 SHOW SOME OF THAT WORK AT A 7748 04:32:03,014 --> 04:32:04,616 SUBSEQUENT WORKSHOP. 7749 04:32:04,616 --> 04:32:05,617 BUT ONE OF THE THINGS THAT WE'VE 7750 04:32:05,617 --> 04:32:10,789 BEEN DOING WITH STAKEHOLDERS AND 7751 04:32:10,789 --> 04:32:12,757 IN ROLLING OUT IS PROGRAM IS 7752 04:32:12,757 --> 04:32:15,727 REALLY TRYING TO ASSESS NOT ONLY 7753 04:32:15,727 --> 04:32:16,294 SOCIOECONOMIC STATUS BUT HOW 7754 04:32:16,294 --> 04:32:17,429 THAT ALIGNS WITH HEALTH LITERACY 7755 04:32:17,429 --> 04:32:19,130 WHEN DEVELOPING MATERIALS, WHICH 7756 04:32:19,130 --> 04:32:21,232 I THINK SARAH WAS GETTING AT IN 7757 04:32:21,232 --> 04:32:22,033 HER COMMENTS. 7758 04:32:22,033 --> 04:32:24,969 >> I SEE A COUPLE OF HANDS, 7759 04:32:24,969 --> 04:32:28,273 DR. WILLIAMSON? 7760 04:32:28,273 --> 04:32:30,475 >> HI, THANKS SO MUCH FOR THESE 7761 04:32:30,475 --> 04:32:31,142 AWESOME TALKS. 7762 04:32:31,142 --> 04:32:32,544 THIS WHOLE WORKSHOP HAS BEEN 7763 04:32:32,544 --> 04:32:34,212 REALLY INFORMATIVE AND I'M SO 7764 04:32:34,212 --> 04:32:36,114 EXCITED TO HEAR ABOUT ALL THE 7765 04:32:36,114 --> 04:32:37,082 GREAT DIRECTIONS PEOPLE ARE 7766 04:32:37,082 --> 04:32:37,749 PURSUING. 7767 04:32:37,749 --> 04:32:41,886 YOU KNOW, I THINK WHEN WE'RE 7768 04:32:41,886 --> 04:32:45,690 THINKING ABOUT HOW WE IMPLEMENT 7769 04:32:45,690 --> 04:32:46,624 ACROSS CONTEXT AND WE KIND OF 7770 04:32:46,624 --> 04:32:48,493 TAKE THINGS INTO ACCOUNT LIKE 7771 04:32:48,493 --> 04:32:50,462 HEALTH LITERACY AND 7772 04:32:50,462 --> 04:32:52,664 SOCIOECONOMIC STATUS BUT ALSO 7773 04:32:52,664 --> 04:32:54,232 MORE OF AN INTERSECTIONAL LENS 7774 04:32:54,232 --> 04:32:55,300 AND THINKING ABOUT ALL THE 7775 04:32:55,300 --> 04:32:57,035 DIFFERENT IDENTITIES THAT PEOPLE 7776 04:32:57,035 --> 04:32:59,304 HOLD, I OFTEN THINK ABOUT IT 7777 04:32:59,304 --> 04:33:00,472 LIKE YOU'RE LOOKING INTO ONE OF 7778 04:33:00,472 --> 04:33:02,107 THOSE FUN HOUSE MIRRORS WHERE 7779 04:33:02,107 --> 04:33:03,975 THERE'S LIKE JUST -- YOU COULD 7780 04:33:03,975 --> 04:33:06,211 ADAPT FOREVER, AND I THINK 7781 04:33:06,211 --> 04:33:07,912 THAT'S A CHALLENGING SCIENTIFIC 7782 04:33:07,912 --> 04:33:09,814 QUESTION WHEN WE THINK ABOUT 7783 04:33:09,814 --> 04:33:13,017 LIKE DOES EVERY ADAPTATION NEED 7784 04:33:13,017 --> 04:33:13,685 AN EVALUATION, AND I THINK ON 7785 04:33:13,685 --> 04:33:14,886 THE FLIP SIDE, AS PEOPLE HAVE 7786 04:33:14,886 --> 04:33:17,288 SAID EARLIER TODAY, REALLY THERE 7787 04:33:17,288 --> 04:33:20,391 IS NO IMPLEMENTATION WITHOUT 7788 04:33:20,391 --> 04:33:23,228 ADAPTATION, SO PART OF THIS I 7789 04:33:23,228 --> 04:33:26,397 THINK IS MAKING SURE WE'RE 7790 04:33:26,397 --> 04:33:28,600 OPTIMIZING FEATURES OF 7791 04:33:28,600 --> 04:33:29,667 INTERVENTIONS AS WELL AS 7792 04:33:29,667 --> 04:33:30,735 IMPLEMENTATION STRATEGIES THAT 7793 04:33:30,735 --> 04:33:33,738 CAN BE APPLIED DIFFERENTIALLY 7794 04:33:33,738 --> 04:33:35,607 ACCORDING TO THE PATIENT AND THE 7795 04:33:35,607 --> 04:33:36,040 CONTEXT. 7796 04:33:36,040 --> 04:33:38,009 SO THERE'S SOME MENTAL HEALTH 7797 04:33:38,009 --> 04:33:40,411 RELATED WORK THAT LOOKS AT, YOU 7798 04:33:40,411 --> 04:33:43,648 KNOW, CLINICIAN DECISION-MATION 7799 04:33:43,648 --> 04:33:44,716 MAIKING AROUND HOW TO MAKE 7800 04:33:44,716 --> 04:33:45,717 EVIDENCE-BASED CULTURAL 7801 04:33:45,717 --> 04:33:46,017 ADAPTATIONS. 7802 04:33:46,017 --> 04:33:48,153 SO I THINK WE CAN APPLY A LOT OF 7803 04:33:48,153 --> 04:33:49,254 THOSE FRAME WORKS TO SOME OF 7804 04:33:49,254 --> 04:33:50,789 WHAT WE'RE TALKING ABOUT HERE. 7805 04:33:50,789 --> 04:33:52,223 SURE, THERE ARE LIKE BROAD 7806 04:33:52,223 --> 04:33:54,125 THINGS WE CAN DO TO MAKE SURE 7807 04:33:54,125 --> 04:33:57,295 THAT HEALTH LITERACY FROM THAT 7808 04:33:57,295 --> 04:33:58,963 PERSPECTIVE SL ACCESSIBLE, BUT I 7809 04:33:58,963 --> 04:34:00,732 THINK, TOO, ABOUT REALLY 7810 04:34:00,732 --> 04:34:02,901 TRAINING CLINICIANS AND 7811 04:34:02,901 --> 04:34:04,569 IMPLEMENTERS IN HOW WE MAKE 7812 04:34:04,569 --> 04:34:06,905 THOSE DECISIONS IN AN 7813 04:34:06,905 --> 04:34:07,672 EVIDENCE-BASED WAY SO IT CAN BE 7814 04:34:07,672 --> 04:34:10,375 MORE APPLICABLE AS WE SCALE. 7815 04:34:10,375 --> 04:34:11,142 >> THANK YOU. 7816 04:34:11,142 --> 04:34:13,645 WE HAVE ABOUT FOUR MINUTES, SO 7817 04:34:13,645 --> 04:34:15,980 MAYBE QUICKLY GOING THROUGH 7818 04:34:15,980 --> 04:34:21,419 RAISED HANDS. 7819 04:34:21,419 --> 04:34:23,588 SUZIE? 7820 04:34:23,588 --> 04:34:23,988 OH, YOU'RE MUTED. 7821 04:34:23,988 --> 04:34:25,657 YOU'RE MUTED. 7822 04:34:25,657 --> 04:34:26,224 >> SORRY. 7823 04:34:26,224 --> 04:34:28,126 I'M JUST GOING TO ECHO SOME OF 7824 04:34:28,126 --> 04:34:30,461 THE COMMENTS MADE BY 7825 04:34:30,461 --> 04:34:33,031 DR. WILLIAMSON AND STROLLO IN 7826 04:34:33,031 --> 04:34:36,100 TERMS OF THINKING MORE ABOUT 7827 04:34:36,100 --> 04:34:38,803 IMPLEMENTATION STRATEGIES AND 7828 04:34:38,803 --> 04:34:39,604 IMPLEMENTATION GAPS IN CLINICAL 7829 04:34:39,604 --> 04:34:40,104 CARE. 7830 04:34:40,104 --> 04:34:41,673 I KNOW WE TALKED ABOUT THE LAST 7831 04:34:41,673 --> 04:34:43,107 TWO DAYS ABOUT HOW MUCH IS 7832 04:34:43,107 --> 04:34:45,243 UNKNOWN AND AS A CLINICIAN, I 7833 04:34:45,243 --> 04:34:47,512 AGREE, I THINK IT WAS IN THE 7834 04:34:47,512 --> 04:34:48,646 COMMENTS ABOUT I JUST FEEL LIKE 7835 04:34:48,646 --> 04:34:50,515 WE HAVE A LITTLE BIT LIKE A CAVE 7836 04:34:50,515 --> 04:34:53,251 WOMAN, LIKE WE HAVE CPAP, WE 7837 04:34:53,251 --> 04:34:54,352 HAVE DEVICE, DO YOU EVEN HAVE 7838 04:34:54,352 --> 04:34:54,786 SLEEP APNEA? 7839 04:34:54,786 --> 04:34:57,255 THERE'S SO MUCH WE DON'T KNOW. 7840 04:34:57,255 --> 04:34:58,890 BUT AT THE END OF THE DAY, WE 7841 04:34:58,890 --> 04:35:01,292 STILL HAVE A LOT OF PEOPLE USING 7842 04:35:01,292 --> 04:35:04,462 CPAP IN MANDIBULAR DEVICES WHO 7843 04:35:04,462 --> 04:35:06,130 ARE DOING WELL, AND I THINK WE 7844 04:35:06,130 --> 04:35:08,333 CAN THINK ABOUT IMPLEMENTATION 7845 04:35:08,333 --> 04:35:10,201 STRATEGIES EVEN WITH THE DATA WE 7846 04:35:10,201 --> 04:35:12,737 HAVE ON SEVERAL EFFECTIVE 7847 04:35:12,737 --> 04:35:14,005 TREATMENTS, AND THAT SOME OF THE 7848 04:35:14,005 --> 04:35:15,773 GAPS ARE JUST RIGHT IN FRONT OF 7849 04:35:15,773 --> 04:35:17,408 US, SO WE KNOW HEALTH LITERACY 7850 04:35:17,408 --> 04:35:19,444 IS A PROBLEM AND WE'VE DONE WORK 7851 04:35:19,444 --> 04:35:20,979 WITH PATIENT ADVOCACY GROUPS 7852 04:35:20,979 --> 04:35:24,182 SUCH AS MONICA'S ASAP GROUP, AND 7853 04:35:24,182 --> 04:35:26,818 SOME OTHER PATIENTS, THEY WANT 7854 04:35:26,818 --> 04:35:28,786 JUST MORE INFORMATION AND WE 7855 04:35:28,786 --> 04:35:31,990 HAVEN'T REALLY THOUGHT ABOUT 7856 04:35:31,990 --> 04:35:34,058 TAILORING INFORMATION AS WAS 7857 04:35:34,058 --> 04:35:36,461 SPOKE ABOUT AND QUESTIONS OF THE 7858 04:35:36,461 --> 04:35:38,997 INTERSECTIONALITY AND HOW TO 7859 04:35:38,997 --> 04:35:40,598 ACTUALLY GET -- BRING PATIENTS 7860 04:35:40,598 --> 04:35:41,966 TO THE TREATMENT. 7861 04:35:41,966 --> 04:35:43,635 WE TALKED ABOUT HOW WHY PAP IS 7862 04:35:43,635 --> 04:35:46,371 SO BAD AND HOW THERE MAY BE BOTH 7863 04:35:46,371 --> 04:35:47,538 BIOLOGICAL AND SOCIAL FACTOR, 7864 04:35:47,538 --> 04:35:54,512 BUT AT THE END OF THE DAY, 7865 04:35:54,512 --> 04:35:56,781 PAP -- ARE NOT THAT FAR BELOW 7866 04:35:56,781 --> 04:35:57,949 ANTIHYPERTENSIVE USE. 7867 04:35:57,949 --> 04:36:01,252 WE DO HAVE SEVERAL JUST EMERGING 7868 04:36:01,252 --> 04:36:02,353 STRATEGIES SO I THINK WE SHOULD 7869 04:36:02,353 --> 04:36:04,255 CONTINUE TO PUSH THE SCIENCE, AS 7870 04:36:04,255 --> 04:36:05,590 IMPERFECT AS IT MAY BE, AND 7871 04:36:05,590 --> 04:36:07,225 REALIZE WE HAVE TOOLS NOW THAT 7872 04:36:07,225 --> 04:36:10,194 WE CAN IMPLEMENT TREATMENTS WE 7873 04:36:10,194 --> 04:36:11,262 HAVE ACROSS THE PERIOD. 7874 04:36:11,262 --> 04:36:13,898 AND I'LL JUST SORT OF TAKE PAT'S 7875 04:36:13,898 --> 04:36:16,000 COMMENT ABOUT HEALTH LITERACY, 7876 04:36:16,000 --> 04:36:17,602 WE NEED HEALTH LITERACY IN OUR 7877 04:36:17,602 --> 04:36:19,871 CLINIC IN URBAN, IN BOSTON, WE 7878 04:36:19,871 --> 04:36:22,440 NEED MORE HEALTH LITERACY, WE 7879 04:36:22,440 --> 04:36:23,574 NEED BETTER PATIENT EDUCATION, 7880 04:36:23,574 --> 04:36:25,176 BECAUSE THOSE ARE ALL FACTORS 7881 04:36:25,176 --> 04:36:27,345 THAT INFLUENCE IMPLEMENTATION AS 7882 04:36:27,345 --> 04:36:29,247 WELL AS THE MULTIPLE HANDOFFS 7883 04:36:29,247 --> 04:36:30,148 AND CARE GAPS. 7884 04:36:30,148 --> 04:36:31,349 WE OBVIOUSLY NEED A BETTER 7885 04:36:31,349 --> 04:36:34,285 SYSTEM OF CARE, AND IT WOULD BE 7886 04:36:34,285 --> 04:36:36,621 NIGHNICE TO SEE HOW SOME OF THEK 7887 04:36:36,621 --> 04:36:38,423 WE TALKED ABOUT TODAY CAN 7888 04:36:38,423 --> 04:36:40,925 INFLUENCE THAT, BUT WE HAVE THE 7889 04:36:40,925 --> 04:36:42,360 FIELD -- SOME IMPLEMENTATION 7890 04:36:42,360 --> 04:36:43,027 DISSEMINATION SCIENCE THAT I 7891 04:36:43,027 --> 04:36:44,829 THINK CAN REDUCE SOME OF THOSE 7892 04:36:44,829 --> 04:36:45,563 CURRENT GAPS THAT WE ALREADY 7893 04:36:45,563 --> 04:36:47,432 HAVE ENOUGH EVIDENCE FOR. 7894 04:36:47,432 --> 04:36:48,733 SO THAT'S JUST MY LITTLE PITCH 7895 04:36:48,733 --> 04:36:49,867 AT THE END. 7896 04:36:49,867 --> 04:36:51,002 >> THANK YOU. 7897 04:36:51,002 --> 04:36:52,403 WE ARE OUT OF TIME, SO I'M GOING 7898 04:36:52,403 --> 04:36:54,706 TO GIVE THE MICROPHONE TO 7899 04:36:54,706 --> 04:36:57,542 ALFONSO FOR CLOSING REMARKS, BUT 7900 04:36:57,542 --> 04:36:59,143 THANK YOU, EVERYONE. 7901 04:36:59,143 --> 04:36:59,610 ALFONSO. 7902 04:36:59,610 --> 04:37:01,412 >> YES, THANK YOU, EVERYBODY, 7903 04:37:01,412 --> 04:37:02,981 AND SORRY TO CUT OFF THIS GREAT 7904 04:37:02,981 --> 04:37:04,182 DISCUSSION. 7905 04:37:04,182 --> 04:37:05,350 SO I JUST WANT TO TAKE A COUPLE 7906 04:37:05,350 --> 04:37:06,451 MINUTES HERE AT THE END TO GIVE 7907 04:37:06,451 --> 04:37:08,086 THANKS TO ALL OF YOU FOR 7908 04:37:08,086 --> 04:37:08,720 PARTICIPATING IN THIS WORKSHOP. 7909 04:37:08,720 --> 04:37:10,188 I THINK WE CAN ALL AGREE, WE 7910 04:37:10,188 --> 04:37:11,956 HEARD A LOT OF GREAT TALKS OVER 7911 04:37:11,956 --> 04:37:13,458 THE LAST COUPLE DAYS AND I THINK 7912 04:37:13,458 --> 04:37:14,525 WE'VE GAINED SOME VALUABLE 7913 04:37:14,525 --> 04:37:16,260 INSIGHTS AND A LOT OF NEW 7914 04:37:16,260 --> 04:37:18,062 QUESTIONS ABOUT THE COMPLEXITIES 7915 04:37:18,062 --> 04:37:20,031 OF OSA AND THE CRITICAL NEED TO 7916 04:37:20,031 --> 04:37:20,865 INCORPORATE PATIENT PREFERENCES 7917 04:37:20,865 --> 04:37:26,104 IN A PERSONALIZED MEDICINE AND 7918 04:37:26,104 --> 04:37:27,171 EFFICIENTLY PRECISE APPROACHES 7919 04:37:27,171 --> 04:37:28,506 TO OSA DIAGNOSIS AND TREATMENT. 7920 04:37:28,506 --> 04:37:29,640 DISCUSSIONS AROUND THE IMPACT OF 7921 04:37:29,640 --> 04:37:31,442 SEX AND RACIAL DIFFERENCES, THE 7922 04:37:31,442 --> 04:37:32,710 APPLICATION OF PERSONAL 7923 04:37:32,710 --> 04:37:33,911 PERSONALIZED APPROACHES AND THE 7924 04:37:33,911 --> 04:37:35,346 ROLE OF EMERGING TECHNOLOGIES 7925 04:37:35,346 --> 04:37:37,015 LIKE A.I. HAVE UNDERSCORED THE 7926 04:37:37,015 --> 04:37:38,349 IMPORTANCE OF TAILORING CARE 7927 04:37:38,349 --> 04:37:39,784 AMONG DIVERSE POPULATIONS AND 7928 04:37:39,784 --> 04:37:41,319 ACROSS THE ENTIRE LIFECOURSE, 7929 04:37:41,319 --> 04:37:42,453 INCLUDING FOR SEX AND GENDER 7930 04:37:42,453 --> 04:37:44,622 DIFFERENCES BUT ALSO INCLUDING 7931 04:37:44,622 --> 04:37:46,324 PEDIATRIC POPULATIONS AND DURING 7932 04:37:46,324 --> 04:37:47,358 LIFE TRANSITIONS LIKE PREGNANCY 7933 04:37:47,358 --> 04:37:49,594 AND MENOPAUSE, AND AMONG 7934 04:37:49,594 --> 04:37:52,330 INDIVIDUALS WITH DEVELOPMENTAL 7935 04:37:52,330 --> 04:37:54,999 AND INTELLECTUAL DISABILITIES 7936 04:37:54,999 --> 04:37:55,566 INCLUDING AS WE HEARD TODAY 7937 04:37:55,566 --> 04:37:57,101 THOSE WITH DOWN SYNDROME. 7938 04:37:57,101 --> 04:37:59,537 WE ALSO EXPLORED THE CHALLENGES 7939 04:37:59,537 --> 04:38:00,972 OF TRANSLATING RESEARCH INTO 7940 04:38:00,972 --> 04:38:02,073 CLINICAL PRACTICE AND THE NEED 7941 04:38:02,073 --> 04:38:03,408 FOR IMPLEMENTATION SCIENCE TO 7942 04:38:03,408 --> 04:38:05,076 ENSURE EFFECTIVE REAL WORLD 7943 04:38:05,076 --> 04:38:05,376 APPLICATION. 7944 04:38:05,376 --> 04:38:06,210 SO MOVING FORWARD, YOU KNOW, IT 7945 04:38:06,210 --> 04:38:07,879 SEEMS CLEAR THAT THERE ARE A LOT 7946 04:38:07,879 --> 04:38:09,814 OF RESEARCH OPPORTUNITIES IN 7947 04:38:09,814 --> 04:38:10,982 ADDRESSING THESE KNOWLEDGE GAPS 7948 04:38:10,982 --> 04:38:12,950 AND UNMET NEEDS WILL LIKELY BE 7949 04:38:12,950 --> 04:38:14,752 KEY TO IMPROVING OUTCOMES FOR 7950 04:38:14,752 --> 04:38:16,521 INDIVIDUALS WITH OSA. 7951 04:38:16,521 --> 04:38:20,224 SO LASTLY, I'D LIKE ON BEHALF OF 7952 04:38:20,224 --> 04:38:22,493 NCSDR AND COLLEAGUES ACROSS 7953 04:38:22,493 --> 04:38:24,228 NHLBI AND NIH, I WANT TO GIVE A 7954 04:38:24,228 --> 04:38:26,864 BIG THANKS TO ALL THE SPEAKERS, 7955 04:38:26,864 --> 04:38:28,433 DISCUSSANTS AND MODERATORS FOR 7956 04:38:28,433 --> 04:38:29,400 VOLUNTEERING THEIR VALUABLE TIME 7957 04:38:29,400 --> 04:38:30,935 TO PARTICIPATE IN THIS WORKSHOP. 7958 04:38:30,935 --> 04:38:32,336 I ALSO WANT TO THANK OUR 7959 04:38:32,336 --> 04:38:33,404 WORKSHOP SUPPORT TEAM, 7960 04:38:33,404 --> 04:38:34,372 PARTICULARLY BRITTANY AND SHAWN 7961 04:38:34,372 --> 04:38:35,907 FOR HELPING THEM RUN THE LAST 7962 04:38:35,907 --> 04:38:38,242 TWO DAYS AND FOR THEIR EFFORTS. 7963 04:38:38,242 --> 04:38:39,777 AND FINALLY, I WANT TO GIVE A 7964 04:38:39,777 --> 04:38:41,179 HUGE SHOUT OUT AND SINCERE THANK 7965 04:38:41,179 --> 04:38:45,883 YOU TO ALL THREE OF OUR 7966 04:38:45,883 --> 04:38:49,387 CO-CHAIRS FOR THEIR TREMENDOUS 7967 04:38:49,387 --> 04:38:49,720 CONTRIBUTIONS. 7968 04:38:49,720 --> 04:38:52,056 YOU HAVE NO IDEA THE TIME AND 7969 04:38:52,056 --> 04:38:52,557 EFFORT THEY PUT INTO THE 7970 04:38:52,557 --> 04:38:53,791 PLANNING OF THIS WORKSHOP OVER 7971 04:38:53,791 --> 04:38:55,993 THE LAST YEAR OR SO. 7972 04:38:55,993 --> 04:38:57,462 THE DEDICATION AND EFFORT REALLY 7973 04:38:57,462 --> 04:38:58,096 HELPED DRIVE THE DEVELOPMENT OF 7974 04:38:58,096 --> 04:39:02,533 THIS WORK SHOM SHOP T WORKSHOP . 7975 04:39:02,533 --> 04:39:04,602 THANKS AGAIN TO EVERYONE FOR 7976 04:39:04,602 --> 04:39:07,605 ATTENDING AND WE'LL BE IN TOUCH 7977 04:39:07,605 --> 04:39:08,272 SOON ABOUT DIFFERENT THINGS THAT 7978 04:39:08,272 --> 04:39:09,140 MAY COME OUT OF THIS WORKSHOP. 7979 04:39:09,140 --> 04:39:12,143 I HOPE EVERYONE HAS A GREAT 7980 04:39:12,143 --> 04:39:13,277 EVENING AND A RESTFUL WEEKEND. 7981 04:39:13,277 --> 04:39:16,647 >> THANK YOU. 7982 04:39:16,647 --> 04:39:18,716 >> THANK YOU. 7983 04:39:18,716 --> 04:39:19,117 THANKS, ALL. 7984 04:39:19,117 --> 04:39:21,085 >> THANK YOU, EVERYONE. 7985 04:39:21,085 --> 04:39:31,229 >> BYE.