What do the cartoon character Dagwood, corporate executives,

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1 Summer 2010 The Promise ofresearch From Our Chief Medical Officer Sometimes, understanding a new disease is like peeling back layers of an onion. Each layer of knowledge reveals more. More questions, more intricate connections among the body s systems and other diseases, and, ultimately, more knowledge as researchers strive to make sense of the layered details. Our experience with sleep disorders seems to be evolving that way. Everyone knows the disappointing feeling of waking up and not feeling refreshed. And many of us have snored the night away causing bad sleep for the snorer and others around us! It s difficult to have a productive day when you re sleep-deprived. Some see it as a national epidemic. But why is the American Lung Association concerned about sleep disorders? Many sleep disorders are breathing disorders! Sleep disorders certainly are nothing new to mankind, but our understanding of them scientifically is only about 25 years old. There is much to continued page 2 JUST SNORING OR A SERIOUS MEDICAL ISSUE? What do the cartoon character Dagwood, corporate executives, truck drivers, and, most likely, a few of your neighbors and friends have in common? Sleep and breathing problems! Some experts view America s profile as a sleep-deprived nation as an epidemic. Far too many of us are not getting enough sleep or bad sleep. It is a public health issue that is linked to a host of chronic diseases, learning disabilities, and psychological effects in individuals. Sleepiness is a major cause of auto accidents with as many as 1.9 million drivers admitting to having had a car crash or a near miss due to drowsiness last year. 1 The mechanics of sleep affect everyone s breathing. When you sleep, your muscles relax, including the ones in the back of your throat. This narrows your airways as you inhale, and breathing can stop for a moment. When the oxygen level in your blood drops from that paused breathing, the part of your brain that controls breathing wakes you up to force you to breathe again. Typically, almost everyone stops breathing once or twice a night. But when that number climbs up to at least five times an hour, the person has the most common sleep disorder obstructive sleep apnea. Dagwood s napping, overeating, loudly snoring character brilliantly personifies the traits that scientists now understand as part of a very serious, common medical condition. Sleep apnea is estimated to affect more than 12 million Americans. The most common type of sleep apnea, obstructive sleep apnea, occurs when the soft tissues at the back of your throat block air as you inhale. Central sleep apnea is caused by a malfunction in the part of your brain that controls breathing. Complex sleep apnea is a combination of the two. Research into this relatively new disease area has paid off, resulting in new areas of study and connections among other diseases, and effective treatments such as CPAP (continuous positive air pressure). CPAP is the most effective >> In this issue... Sleep Apnea Patient Profile continued page 4 Researcher Profile Awards

2 >> Patient Profile From Exhaustion to an Energized, Healthy Lifestyle A couple decades of Steve s* life passed without a restful night s sleep. How he kept his life moving forward productively is a testament to his strong-willed nature and positive energy whatever energy remained after his sleep apneaplagued nights. I have no idea how many years I ve had sleep apnea, but my wife, who is a nurse, would tell me that I d stop breathing in the middle of the night, and for years she told me that I snored so bad that the rest of the family couldn t sleep, explains Steve, 53, also a registered nurse and father of two. Diagnosed 18 months ago with severe obstructive sleep apnea, Steve s life has changed dramatically since he began his nightly treatment with CPAP (continuous positive air pressure). God help the person who comes between me and my CPAP machine or even more so, whoever comes between that machine and my wife! he jokes about how treatment has affected every aspect of his life. Before being diagnosed and treated, Steve would drink coffee and eat all day to stay awake (and subsequently gain weight, which typically makes sleep apnea worse) and slug his way through the day s work, pushing headstrong through his daily exhaustion. Even though he had always been an athlete, Steve s activity level dropped, as he had minimal energy for exercise. The seeming simplicity of a restful night s sleep has had a profound effect on Steve s life, and he has new perspective on his now-diagnosed illness and his overall health. I don t know why I didn t deal with this 15 years ago, he says. Even as a medical professional, knowing the damage sleep apnea can do, I just tried to deal with life being tired every day. I have a family history of heart disease and daily stress with work. What damage did I do to myself? And it was hard to find the energy to deal with the day. Today, he is reaping the residual benefits of being treated successfully for sleep apnea: waking up refreshed and having stamina throughout the day, having a renewed sense of the importance of proper nutrition and exercise, losing more than 50 pounds, and investing energy in healthy activities. I tell people, don t deny it, Steve says. If you re wife is telling you you re stopping breathing at night, go see your doctor. It has happened with a few of my friends, and you come to it in your own good time. But this is a no-brainer! The difference in your health, lifestyle, and the way you just feel every day is profound. Although Steve s legendary snoring once cleared out an entire camp site of Boy Scouts, today he packs up the battery pack to his CPAP machine when he and his son head off for the tranquility of the woods. Steve sleeps soundly under the stars with no complaints thus far from the critters. *Steve s last name is not used to protect privacy. From Our Chief Medical Officer (continued from page 1) discover, to peel away, as researchers and physicians work to understand all that sleep disorders are affecting and how the body s own physiology and neurology lead to sleep disorders. In this issue of Promise of Research we take a broad look at sleeping disorders and what we are learning in this young, emerging area of pulmonology. We meet a physician-researcher whose work is on the cutting edge of a new treatment for sleep and breathing disorders in COPD patients, and a patient who suffered with sleep apnea for years before seeking treatment that has transformed his quality of life. Their two stories personify the promise medical research has for dramatically improving lives. It is why the American Lung Association remains committed to medical research the promise of effective treatment and cures for lung disease. Norman H. Edelman, MD Chief Medical Officer 2 : The Promise of Research: Summer 2010

3 >> Spotlight on... >> Researcher Profile: Cynthia Brown, M.D. Finding Solutions to COPD Patients Common Sleep Problem Cynthia Brown, M.D. views herself as a problem-solver who has always strived to conquer whatever seemed most challenging. Only the second person in her family to attend college, she now is also an American Lung Association Scholar viewed by her peers as one of the best and the brightest researchers throughout the U.S. As a physician specializing in sleep disorders and other pulmonary diseases, Dr. Brown has found her niche working to solve a very common problem among people with chronic obstructive pulmonary disease (COPD) and to improve their individual daily lives. Through her first American Lung Association-funded research project, Dr. Brown has studied the effectiveness of a new device to improve COPD patients quality of sleep. More than 12 million Americans have been diagnosed with COPD, which often causes poor sleep, but scientists do not yet fully understand the underlying causes of the sleep problems. While everyone s muscles, including those at the back of the throat, relax during sleep, COPD patients may have greater difficulty adapting to these changes. The underlying disease prevents them from being able to exhale fully, and it takes more time to exhale, Dr. Brown explains. Our hypothesis is that there s an improper balance between the time COPD patients need to inhale and exhale. The device As I treated people with COPD, I realized how prevalent sleep problems are and how little we know about them. We don t have a solution yet, but we are working to understand the problem so that we can improve patients sleep. she and her team have tested, a nasal insufflation device, sends warmed and humidified air into the nostrils to create a small amount of pressure in the back of the throat. The pressure What is COPD? relieves the patient s muscle changes as he or she inhales and exhales; it improves air flow as people inhale and allows them to maintain their normal breathing patterns. The device is a larger, specialized version of an oxygen cannula, which is used to deliver oxygen through the nose. Dr. Brown s initial results show promise for improving sleep with nasal insufflation. During brief trials of the device during sleep, individuals have less wakenings, breathe more deeply while sleeping, and have lower carbon dioxide levels. In addition to addressing COPD patients sleep problems, the results may add to medicine s understanding of the effectiveness of patients nighttime-only use of oxygen, which is often prescribed. continued page 4 COPD is a lung disease that over time makes it hard to breathe. COPD (short for Chronic Obstructive Pulmonary Disease) includes chronic bronchitis and emphysema. Obstruction that occurs in COPD means that there is less flow of air in and out of the lungs than there should be. When that happens, less oxygen gets into the body tissues and it becomes harder to get rid of carbon dioxide, which is the waste gas. As the disease gets worse, it is harder to remain active due to shortness of breath. The good news is that COPD is often preventable and treatable.the more you can learn about COPD, the better you and your loved ones can manage living with this disease, making the most of every day, and maintaining the quality of life that is important to you. To learn more, visit us online at www. LungUSA.org or call the Lung Helpline at : The Promise of Research: Summer 2010

4 >> Spotlight Sleep Apnea on... (continued from page 1) treatment for obstructive sleep apnea. In CPAP, a small portable machine delivers air at a constant pressure through a tubing and mask, which the person wears while sleeping. The pressure keeps the airways open and gives the person an uninterrupted, restful night s sleep. CPAP machines are small, lightweight, and fairly quiet. The noise that they make is soft and rhythmic. Scientific study of sleep apnea is evolving, as investigators are finding more variations of sleep-disordered breathing. We now know that sleep apnea is sometimes the first domino in a chain of poor health hardening of the arteries, plaque buildup in the arteries, heart attack, and stroke. New research suggests a link between sleep apnea and metabolic disorders such as insulin resistance and high cholesterol. Scientists believe the impact of sleep apnea may be greater on individuals who have other cardiovascular risk factors such as high blood pressure or high cholesterol. Researchers today are working to understand these relationships more deeply. They are studying how sleep apnea may affect a range of chronic diseases, like fibromyalgia, and how controlling sleep apnea can improve heart disease and other serious illnesses. New treatments under study include nasal insufflation, which uses a warm, humid, high-volume flow of air through nasal tubing to increase pressure in the nasal cavity; it is less intrusive than CPAP. An evolving area of research involves the broader category of sleep disorders that are linked to a metabolic syndrome that impacts obesity, high blood pressure, abnormal cholesterol levels, or elevated insulin levels. This disorder is a strong predictor of Type II diabetes. Research is focusing on the connections between these disorders to better diagnose and treat each. The future of research into sleep apnea is just beginning to emerge into an important public health problem. In the broad scope of medicine, scientific understanding of sleep apnea is in its infancy. The growing spectrum of research promises deeper knowledge of sleep apnea and its relationships with other diseases, with a focus on better treatment and quality of life for patients. (Endnotes) 1 National Sleep Foundation, 1.9 Million Drivers Have Fatigue-Related Car Crashes or Near Misses Each Year. November 2, 2009 news release. 3 Types of Sleep Apnea Obstructive sleep apnea is the most common type of sleep apnea. It most often happens when your airway has collapsed or is blocked during sleep. This causes shallow breathing, or your breathing pauses. When you try to breathe, you might snore loudly from air that squeezes past the blockage or not be able to breathe at all. Central sleep apnea happens when the part of your brain that controls breathing doesn t send correct signals. This means you make no effort to breathe for brief periods of time. Complex sleep apnea is a combination of obstructive and central sleep apnea. To learn more, visit us online at or call the Lung Helpline at Researcher Profile (continued from page 3) Dr. Brown s research focuses on sleep disorders inadvertently brought her back to her basic desire to take on and conquer a challenge. I had once thought that sleep medicine was simplistic in some ways, that I d be bored seeing the same type of patient day after day, she confesses. But as it turns out, the COPD patients I see as part of my general pulmonology work have a very prevalent sleep problem that we don t have a solution to yet. I want to sit with a person and figure out how to help them. Through this research, I m able to investigate not only the problem but how we can improve sleep to improve the quality of life for COPD patients. The research is all about helping people live the best life possible! she says. 4 : The Promise of Research: Summer 2010

5 >> Awards Who Can Get Sleep Apnea? Anyone can have sleep apnea, even children. But there are certain factors that may put you at risk for the different types of sleep apnea. Things that put you at risk for having obstructive and complex sleep apnea: Being overweight Smoking High blood pressure Family history of sleep apnea Gender males are more likely to have sleep apnea than females Being older than 65 Using alcohol or sedatives before going to sleep Fighting for: The American Lung Association is fighting for a world free of lung disease. We re fighting for healthy lungs, both young and old, and for all the things that make air worth breathing. Join the fight at FightingForAir.org. Certain endocrine abnormalities Obstruction of the nose and throat; many children have sleep apnea due to enlarged tonsils and adenoids Things that put you at risk factors for central sleep apnea: Gender males are more likely to have central sleep apnea than females Heart disease Stroke or brain tumor To learn more, visit us online at or call the Lung Helpline at a day when we can all breathe easier. The American Lung Association is pleased to announce the Nationwide Award and Grant Program Portfolio. Application materials for the American Lung Association Nationwide Awards and Grants Research Program are now available on proposalcentral: proposalcentral.altum.com. The goal of the American Lung Association Nationwide Award and Grant Program is to foster laboratory, patient-centered and social-behavioral research designed to find cures and to prevent and relieve the suffering associated with lung disease. The majority of the American Lung Association awards will support trainees and/or junior investigators early in their careers. It is believed that supporting researchers at this critical juncture is essential to ensure long term commitments to lung disease research, as well as, to maintain an adequate supply of scientists dedicated to lung disease. The deadline for application submission is October 21, Three paper copies are of the applications are also required and must be postmarked October 21, For more information on this year s offerings, or on the American Lung Association Research Program in general, please refer to the Finding Cures page of our public website 5 : The Promise of Research: Summer 2010