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- Sandra Trop
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    Awake at the Wheel: Then and Now

    April 15th, 2013

    Awake at the Wheel, LLC traces its origins to the steel mills and foundries and trucking terminals of Pittsburgh, Pennsylvania in the 1950s and 60s. It was there, as the son of a truck driver, I came to know worry and fear and dread. My father would be gone for days at a time, traveling to such exotic places as Buffalo and Rochester and Syracuse, summer and winter. I remember sleeping by the telephone when he was away, so that I would be the first in the family to get the call from either the Pennsylvania or New York State police, the call that told us his Mack truck had gone off the road, and that the worst had happened. I wanted to be the first person in the family to hear that news. And I remember the sound of his keys in the lock of our front door as he let himself into our house at 3 or 4 in the morning. I remember the pancakes he’d make for us, dinner for him and breakfast for me in the 3 or 4 hours I would have to see him before I went to school and he went into a darkened bedroom to sleep during the day, before the enforced separation of father and son would repeat itself, and he would again be gone to highway by the time I returned home from school later that day.

    It is no surprise then that I entitled my 2010 presentation to the New York State Motor Trucking Association WORRIED SICK: A TRUCKDRIVER’S SON BECOMES A DOCTOR. Since then I have been blessed to know Mike Chellis not only as a patient and officer of NYSMTSA who first invited me to present the topic of sleep medicine to his group in 2010, but also as a friend and partner in what has become our determined mission to keep the hard working women and men of the commercial motor vehicle industries safely on the job, supporting their families.
    As my father before me, I too have had to make a journey. I’ve translated beautiful and exciting medical concepts into images anybody can understand, changing the title of my presentation to SLEEP MEDICINE FOR FAMILIES. On my journey I have formulated The Syracuse Model, a socio-medical-technologic explanation of the forces these drivers must endure to support their families. The further along I got in my journey, the more apparent it became that it is eminently possible to screen, test, diagnose and treat those hard working drivers who might have sleep disordered breathing without them missing so much as an hour of service.

    It has become obvious since 2010, when I first presented “Worried Sick,” that the many caregivers and stake holders in the landscape of healthcare and healthcare financing must work in synergy if we are to protect these drivers, their families, their employers, and the public. Again, I have been blessed to have support and encouragement, from sources as seemingly diverse as Mercedes-Benz to home care companies. It is my hope and prayer that long before Commercial Medical Vehicle medical recommendations become law, those of us meeting here today in New York will summon the wherewithal to make the various diverse systems responsible for public and private health at least equal to the sum of their parts, and hopefully greater, and in so doing put at ease the hearts and minds of children who wait nervously to make sure Mom or Dad will make it home safely, as well as the hearts and minds of parents who whisper a prayer of thanks every time their child steps out of a school bus at the end of the day, knowing that they will whisper another prayer when their child steps onto the bus the following morning. This is the charge I bring to all of us today.

    David J. Davin MD, FCCP, PLLC
    President, AWAKE AT THE WHEEL, LLC.

    Sleep apnea: Damage on your heart similar to diabetes!

    January 7th, 2013

    Heart Risks From Sleep Apnea Similar To Those From Diabetes: Study
    Posted: 12/17/2012 8:51 am EST Huffpost Healthy Living

    The early heart damage seen in diabetes patients is also seen in people with obstructive sleep apnea, a condition where a person may stop breathing during sleep, according to a small new study.

    The study, conducted by Romanian researchers, shows that people with obstructive sleep apnea have stiffer arteries than people without the condition — similar to the arterial stiffness witnessed in people with diabetes. Stiff arteries are known to contribute to heart risks.

    The study “suggests that OSA [obstructive sleep apnea] is associated with a high risk for cardiovascular disease,” study researcher Dr. Raluca Mincu said in a statement.

    The study included 20 people without diabetes, who had moderate to severe obstructive sleep apnea, as well as 20 people with diabetes and 20 people who are healthy. Researchers analyzed how well their arteries were able to function with a series of tests.

    Researchers found that the stiff arteries were similar between the diabetes and obstructive sleep apnea groups, and their arteries were both stiffer than the healthy people.

    The findings were presented at the EUROECHO and other Imaging Modalities 2012 meeting; because they have yet to be published in a peer-reviewed journal, they should be regarded as preliminary.

    Still, previous research has also drawn a link between sleep apnea and negative arterial effects. One study in mice, conducted by Baylor College of Medicine researchers, showed that sleep apnea could have an impact on the ability of the brain’s blood vessels to function — which could potentially increase risk of stroke.

    Sleep-disordered breathing & pregnant women

    January 7th, 2013

    Treating Sleep-Disordered Breathing In Pregnant Women Could Improve Fetal Health: Study Huffpost
    Posted: 01/07/2013 8:23 am EST

    Pregnant women who snore because of mild sleep-disordered breathing could do their unborn babies a favor by getting treated for their sleep condition, a small new study suggests.

    The findings, published in the journal SLEEP, show that fetal movements are higher when a woman with preeclampsia and mild sleep-disordered breathing receives CPAP treatment for the sleep condition, compared with not receiving the treatment. Fetal movements are a positive sign of the fetus’s well-being.

    “What would otherwise have been considered clinically unimportant or minor ‘snoring’ likely has major effects on the blood supply to the fetus, and that fetus in turn protects itself by reducing movements,” study researcher Colin Sullivan, Ph.D., of the University of Sydney, explained in a statement. “This can be treated with readily available positive airway pressure therapy and suggests that measurement of fetal activity during a mother’s sleep may be an important and practical method of assessing fetal well-being.”

    The study was conducted in three parts. In the first part, researchers examined the fetal activity in 20 women who were in the third trimester of their pregnancies. In the second part, 20 pregnant women with preeclampsia (moderate to severe high blood pressure and urine protein during pregnancy) and 20 healthy pregnant women had their fetal movement monitored overnight. Researchers found in this second part that the healthy pregnant women had more fetal movements than the women with the preeclampsia — 689 movements compared to 289.

    The third part of the study included 10 women with moderate to severe preeclampsia, whose fetal movement was measured for two nights in a row. The first night, the women did not receive CPAP treatment; the second night, they did.

    Researchers found that the women in the study who had mild sleep-disordered breathing and received the CPAP therapy had higher fetal movement than the women with the sleep condition who didn’t receive the treatment.

    The findings raise “the possibility that a simple, noninvasive therapy for SDB [sleep disordered breathing] may improve fetal well-being,” commentary author Louise M. O’Brien, Ph.D., of the University of Michigan, said in a statement.

    Awake at the Wheel

    January 7th, 2013

    DWT…Driving While Tired is dangerous and could account for over a million crashes annually. Check out this awesome product! http://www.awakeatthewheel.com/

    Sleep Apnea & Brain Damage in Women

    December 12th, 2012

    Women With Sleep Apnea Face More Severe Brain Damage Than Men: Study

    Posted: 12/07/2012 8:26 am EST |  Updated: 12/07/2012 4:16 pm EST reposted from the Huffington Post

    Women who have sleep apnea experience more damage to their brain cells as a result of the condition than men with obstructive sleep apnea, according to a new study from the University of California, Los Angeles.

    Previous research had indicated that obstructive sleep apnea is linked with brain cell damage in men. The new findings, published in the journal SLEEP, show that women experience more damage than men to cells in the cingulum bundle and the anterior cingulate cortex brain regions, which are involved in the regulation of moods and decision-making.

    “While there are a great many brain studies done on sleep apnea and the impact on one’s health, they have typically focused on men or combined groups of men and women, but we know that obstructive sleep apnea affects women very differently than men,” study researcher Paul Macey, an assistant professor and associate dean of information technology and innovations at the UCLA School of Nursing, said in a statement.

    “This study revealed that, in fact, women are more affected by sleep apnea than are men and that women with obstructive sleep apnea have more severe brain damage than men suffering from a similar condition,” Macey said.

    Obstructive sleep apnea is a condition where a person stops breathing during sleep; it’s commonly marked by snoring, according to the Mayo Clinic.

    Anywhere from 4 to 9 percent of middle aged men experience obstructive sleep apnea, and 2 to 4 percent of middle aged women experience the condition, according to the American College of Physicians. However, as many as 90 percent of people with obstructive sleep apnea have not been diagnosed.

    The new study included 80 people; 10 were women newly diagnosed with obstructive sleep apnea who had not received treatment for their condition, 20 were men newly diagnosed who also hadn’t received treatment, and 50 were healthy men and women with no diagnosis of sleep apnea.

    Researchers analyzed the brain nerve fibers of the study participants to find differences in brain cell damage between those with sleep apnea and those without, as well as between men and women with the obstructive sleep apnea.

    In addition to finding a higher severity of brain cell damage in the women with sleep apnea than the men, they also found that the women with the sleep condition had more symptoms of depression and anxiety than the men.

    However, researchers cautioned more research is needed. “What we don’t yet know is, did sleep apnea cause the brain damage, did the brain damage lead to the sleep disorders, or do the common comorbidities, such as depression, dementia or cardiovascular issues, cause the brain damage, which in turn leads to sleep apnea,” Macey said in the statement.

    Art of Medicine

    March 11th, 2010

    According to JD Kleinke, doctors won’t warm to the idea of emailing patients or using the internet more broadly in their practices until issues such as reimbursement and legal liabilities are addressed. But he also provides another perspective on why information technology has yet to succeed in health care. In the end, “the practice of medicine is really an art,” he says. “It is too complex to be digitized; it involves elements of chaos theory that the typical information- technology vendor would be hard pressed to grasp intellectually, let alone incorporate into product design; and most importantly, it involves a level of accountability that no other class of professionals in our economy ever comes close to facing.”

    JD Kleinke
    Medical Economist