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Advances in sleep technology are transforming how neurologists identify and manage obstructive sleep apnea, a condition that affects up to 70% of patients with certain neurologic disorders and can negatively impact cognitive and neurologic outcomes if left untreated. In this episode, Dr. Joyce Lee-Iannotti discusses the growing role of wearable and nearable sleep-monitoring devices, when home sleep studies are appropriate, and how emerging technologies are expanding access to diagnosis and treatment. Learn practical strategies for screening patients, interpreting sleep data, and partnering with sleep specialists to improve long-term neurologic health through better sleep. In this episode, Casey S. Albin, MD, FAAN, speaks with Joyce K. Lee-Iannotti, MD, FAAN, FAASM, author of the article "Sleep Diagnostics and Monitoring Technology in Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Lee-Iannotti is a Professor of Neurology at the Barrow Neurological Institute, University of Arizona College of Medicine, and Creighton School of Medicine in Phoenix, Arizona. Additional Resources Read the article: Sleep Diagnostics and Monitoring Technology in Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @jleeiannotti Full episode transcript available here Dr Albin: Through the neurology of sleep issue, I think we have all been convinced that we all need better sleep, both for ourselves and for our patients. And fortunately, there is an abundance of new technology that can enable us to diagnose sleep problems, and then also make sure that our patients are getting the rest that's going to give them the best chance at a good cognitive recovery, and improve their cognitive function even if they are not currently suffering from a neurologic condition. Today, I am so excited to dive deeper into this topic. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello, this is Dr. Casey Albin. Today I'm interviewing Dr. Joyce Lee-Iannotti about her article on sleep diagnostics and monitoring technology in obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Welcome to the podcast, I'd love to just start by having you introduce yourself to our audience. Dr Lee-Iannotti: Sure. Thank you so much for having me, Dr. Albin. I'm Joyce Lee-Iannotti. I'm a professor of neurology at Barrow Neurological Institute. I am boarded in general neurology, stroke, and sleep, but I spend most of my time in the sleep world, so I jokingly say that I get more sleep doing sleep than I certainly did in stroke. Dr Albin: Absolutely. I mean, wow, what a fascinating career, and I suspect that we're actually gonna get to some of how all of those pathophysiologies might overlap in the world of sleep. But you had the really exciting task of trying to distill this exciting, rapidly evolving field of sleep diagnostics, and I suspect it's relevant to many of the patients who end up in the neurology clinic, and I suspect that it's actually pretty relevant to many of our listeners who themselves might actually be wearing sleep tracking devices. And all of us probably wonder, well, how can we use that data to improve our own cognitive function and certainly make our patient's life even better? Before we even get into some of the meat and potatoes of this, I thought it would be really helpful for us to define some terms that come up in your article, one of which is wearables. We might figure that out, but the other is nearable. Walk us through what's a wearable, what's a nearable, how are they different? Dr Lee-Iannotti: I'm happy to do that. First of all, the article is entitled Sleep Diagnostics and Monitoring Technology, and this was a super fun article for me to write because it's very practical, and it's generalizable to everybody. So, I'm going to start with a wearable, and a wearable is really a device that is simply worn on the body. And we're all familiar with wearables like smart watches, they're rings, they're patches, they're headbands, and the most validated form of a wearable that you've probably heard about is actigraphy, which we use in the sleep clinic. Dr Albin: Tell us a little bit more. So, what is actigraphy? I've heard the word before, but don't actually know what it means. Dr Lee-Iannotti: Actigraphy has been a tool that we've used in the sleep clinic for a really long time. Traditionally, we used it to monitor circadian rhythm patterns in people who are night owls or morning larks. And then more currently, we actually use it to track sleep patterns in people with suspected narcolepsy. So, before they come in for a sleep study, we actually have them wear an actigraphy for about a week just to get a sense of their sleep duration and their circadian pattern. Dr Albin: Got it. And what is it monitoring? Our movement or the patterns that we may or may not make? Dr Lee-Iannotti: It's really based on movement. You're exactly right. Dr Albin: Cool. Okay, so most of this is based on gold standard monitoring with actigraphy. What other things can be incorporated into these wearable devices? Dr Lee-Iannotti: Yeah, the technology is really advanced, and every day it changes, which is super exciting. So, on top of movement, these wearables can look at temperature. They can look at even EEG, like limited EEG, heart rate variability, and a really big word that we like to use in sleep technology, which is PPG, or photoplethysmography data, and that's really looking at heart rate variability and oxygenation, saturations, and following those levels as well. Dr Albin: Wow, so you basically can get most of the data that you might have historically needed to go to a sleep lab to get. Dr Lee-Iannotti: Most of them. They're still a surrogate. You'll hear me emphasize in the article as well that the gold standard remains the in-lab polysomnogram, but these are good surrogate markers that patients can wear long term to look at trends and patterns. Dr Albin: Absolutely. And we're gonna unpack a little bit about who specifically those are best for and, really what it gives you in the clinic. But before we jump into that, what's a nearable, and how is that different? Dr Lee-Iannotti: Yeah. Nearables are really exciting too. So, these are devices that monitor sleep but don't require direct contact on the body. So, these are devices that our patients will use, but it'll be at the bedside table. They're devices that actually go underneath the mattress, or they can be in, like, the ambient environment to detect sleep patterns. Dr Albin: Oh my gosh. How is it doing that if it's not actually something you're wearing? Dr Lee-Iannotti: I know. It seems a little Big Brother-ish, doesn't it? Dr Albin: Yes. Dr Lee-Iannotti: So, they use a technology called radio frequency signals, sometimes radar, sometimes sonar, pressure sensors, even microphones, and they're picking up things like respiration, movement, snoring, and that's how they can decipher sleep patterns. Dr Albin: Crazy. I mean, I guess the benefit of that is that it's less disruptive to the user 'cause it's not actually on them and having contact with them, and I suspect there's probably some downsides in terms of just it's a more limited data set you're getting. Dr Lee-Iannotti: Absolutely. Yeah, you're exactly right. It's more convenient because it's not touching them, so, in theory, they're gonna sleep more comfortably. But I would like to think that the most validated forms of devices that we use to track sleep have to have some form of contact with the body, and this technology is new and probably needs a few layers of more sophistication to be as accurate as the wearables. Dr Albin: Absolutely. I feel like we're going to have this conversation in five, maybe even less than that, years, and this data will have become like, oh, we all have something in our room that's monitoring everything. The world is crazy. All right. One of the places where your article really stood out to me is that sleep diagnostics have really taken off, particularly when we're thinking about obstructive sleep apnea. And I think we all might sort of scratch our heads and be like, "This is a neurology podcast. Why should I, as a neurologist, care about obstructive sleep apnea?" But I think you laid out a very convincing argument in the article. Walk us through why we should care about this. Dr Lee-Iannotti: Absolutely. So, for neurologists, sleep matters, and I hope that my article translates that. Obstructive sleep apnea, which I'm gonna call OSA, is incredibly common in all of our neurologic patients, whether you see epilepsy, Parkinson's, stroke, Alzheimer's, neuromuscular, or even chronic headache patients. The prevalence of sleep apnea is as high as 70% in these patients. Dr Albin: Wow. That's incredible. That is an incredibly high number. Dr Lee-Iannotti: And if I can add, Dr. Albin, there's growing literature in multiple studies across the literature that show that untreated sleep apnea negatively impacts neurologic outcomes in our patients. So, it is really important to ask the question about sleep, and if the red flags pop up, to then screen for sleep apnea in particular. Dr Albin: I think that that's a great point for us to drill down on, and obviously you're a sleep neurologist. You're very used to screening people in the clinic. But say someone comes in, and I'm gonna have you put your former stroke hat on, and say someone comes into the stroke clinic, and you're just making sure that they're optimized on their aspirin or dual antiplatelet therapy, and you're doing secondary risk modification. How would screening for OSA fit into that? Dr Lee-Iannotti: It would be a part of that screening process to look at preventative ways to prevent strokes, whether it be primary or secondary prevention. So, we did a survey a while back, and it actually showed that 17% of stroke neurologists are screening for sleep apnea. It has quadrupled, fortunately, in the last few years due to public awareness and a lot of education that the AAN has done, in fact. So, at this point, I would say not asking about sleep apnea to a stroke patient is similar to not asking about diabetes. Dr Albin: So, we really have to be cognizant and conscious about saying, you know, "Do you snore at night? Do you have episodes of apnea, or does someone witness you stop?" Are there things that you ask that maybe I wouldn't be aware and thinking of? Dr Lee-Iannotti: Those are the right questions, and then very practically, very easy questionnaires to implement that literally take a minute that your nurses or medical assistants can administer to the patient, and the most commonly one that is used in stroke patients is called the STOP BANG, S-T-O-P B-A-N-G, which is a validated questionnaire to screen for symptoms. Dr Albin: Absolutely. So okay, so this is easy to do. We should all be doing this. If you're not, now's the time. And I suspect if they screen positive, next steps, it can be hard to get into a sleep lab, and we're gonna talk about some workarounds, but I think some of our listeners may never have spent time in the actual sleep lab. So, let's say you refer a patient and you actually can get them in for a gold standard in-lab sleep study. What's gonna happen in that sleep study? Dr Lee-Iannotti: Yeah. And I just want to preface this by saying that my article hopefully highlights that we've come a long way where we understand that there are many neurologic populations then that can undergo home ambulatory sleep studies with just as much accuracy as an in-lab polysomnogram. But with that, I wanna say an in-lab polysomnogram is actually a highly sophisticated physiologic recording overnight, typically, unless somebody is a day sleeper. So, if I could take a minute to kinda describe the data that we're monitoring throughout the night. There is a limited EEG. We concentrate on frontal, central, occipital leads to look at sleep staging. We have eye leads. We have EMG leads on the chin and the leg. We look at EKG, flow monitors, belt, and then we also do pulse oximetry, snoring mics, and even body position sensors. So, a lot is going on. Dr Albin: This is incredible. Yeah, it truly is. I mean, this is like... I'm a neurointensivist, and so I think that you have just really outdone what I consider multimodal monitoring in your sleep study patients. I'm not even sure our neuro ICU patients accumulate that much data. All right, so tell me, they go through, and they can get this. But like you said, there's actually a lot of data that you've presented that, you know, not everyone needs to go to the in-lab sleep study. So how do you decide who actually needs to be in a sleep lab versus who can do this at home? And then how do you set them up with getting this done at home? Dr Lee-Iannotti: Yeah. The home sleep studies are really more accessible ways for us to assess for sleep apnea in our neurologic patients, especially patients who live in very rural areas and don't have access or have very long wait times for an in-lab polysomnogram. With that being said, though, Dr. Albin, I will say that there are a subset of patients who have to go into the lab, and those are patients where you suspect a sleep disorder other than obstructive sleep apnea, so like parasomnias or central sleep apnea, patients with severe cognitive or physical debilitation, like our stroke patients who are hemiplegic and won't be able to apply the home sleep study. But for the most part, I do feel like a home sleep study is a good beginner study to screen the patient. And if there are red flags, then you can always get the in-lab afterwards. Dr Albin: That's super helpful. And just from a pragmatic standpoint, will insurance cover the home sleep study? Dr Lee-Iannotti: They will, yes, and it's all about documenting. So, if I could get really practical, for neurologists, it really just requires documenting snoring, for one, whether it's noted by the patient or by their bed partner, and then any form of hypersomnia, which is daytime sleepiness or even a sense of fatigue, having low energy or napping during the day. Dr Albin: I suspect so many of our patients meet those criterias. That seems, like, wildly simple to do. Dr Lee-Iannotti: Yes. And if you wanna be the favorite referral person to your sleep neurologist or your sleep specialist, then take another step and do that STOP-Bang. And if you record a score greater than three, that automatically gets them at least a home sleep study. Dr Albin: It's amazing. And then when you get this data, again, this is really practical, pragmatic stuff, how do you get the report? Does it integrate in your electronic medical record? Does the patient bring it in? How do you get that data back? Dr Lee-Iannotti: Yeah, so this is where technology is amazing, Dr. Albin. Now we have disposable devices. Sometimes they sync to the WatchPat, or the greater Wi-Fi. So we can get them all through password-protected internet forums that transmits the data, so sometimes the patients don't even have to come back to give us the data. And then we have different forms where we can actually relay the results as well, either through the electronic medical record or through systems themselves to relay those results directly to the patient. Dr Albin: Yeah, and your article really laid out in beautiful tables, like, all the different devices that are available to patients, and it's honestly mind-blowing how many of these companies and devices exist. So, seems like the world is your oyster in terms of picking from them. Dr Lee-Iannotti: Absolutely. I think there's... The last time I counted, there was over 20 different home sleep study devices for obstructive sleep apnea. And it's a great thing to have, but sometimes too many choices can be a little bit confusing. So that's where I do say partner with your sleep specialist close by, and they will find the right type of home sleep study device for your particular patient. Dr Albin: Drilling down a little further, let's say your patient does get diagnosed with OSA. One of the things that really stuck out to me is that there's a whole range of now devices that are new that make this treatment easy so that we can actually prevent and treat neurological conditions by just improving patient sleep. So, walk us through a little bit about how that landscape has changed. Dr Lee-Iannotti: Sure. And I'll start with the gold standard of treatment, which is still CPAP, which is continuous positive airway pressure. Not only can we monitor the pressure, look at adherence, change the humidification for the patient all remotely through, again, password-protected internet forums, but we can even change the pressure with patients 300-plus miles away. Dr Albin: Wow. Dr Lee-Iannotti: It's really cool, right? It prevents patients, especially with significant neurologic debilitation, from having to come into the office for adjustments. The other thing I wanted to mention, Dr. Albin, is for patients, a lot of patients like positive feedback on a daily basis. And a lot of these companies, if you are on CPAP, have come up with a smartphone app that you can look at how many hours you used your CPAP device. They give you a score, and they even tell you how many times you had stoppage of breathing that night. Dr Albin: I think that this is what's really exciting about where we are in neurology and, like, neurologic care, is we have gotten so much better at getting patients their own data and allowing people to really see that data, integrate lifestyle changes, and see how it impacts them. And that positive feedback loop, I think, is a really powerful tool for our patients to say, "Look, this makes me better," or, "Oh, this makes me worse." I'm just really excited by how much data we can give directly to our patients. Dr Lee-Iannotti: I agree. It's so empowering. You know, as a CPAP user myself, you want that positive affirmation that all of your efforts at night and cleaning your mask and your machine paid off, and everybody likes to see an A+ on their report card. Dr Albin: I love that. Now I'm going to ask you on the flip side, I imagine, and I myself am a sleep tracker, like I have my little device and I look at, you know, the score in the morning and I kind of perseverate on like what makes it better, what makes it worse, and I can imagine that sometimes in sleep clinic, people are coming in to you and they have just pages and pages and, you know, they're flipping through all their data from the last year. And I imagine that's pretty overwhelming when you have just the insane amount of data that these devices can generate. So, from another pragmatic, practical standpoint, how are you integrating all that data when someone comes in for a sleep visit? Dr Lee-Iannotti: I love that question. So first of all, I will say myself, and I think a lot of my sleep colleagues, we love objective data, right? Because it's something that we can see. We can see whether it matches their subject's symptoms. Sometimes it can be a lot of reassurance that, "Look, you actually got more sleep than you thought you did." But sometimes patients will bring in like a month's worth, and that's really hard to analyze, you know, in a 30 or 60-minute visit. So oftentimes what I do is I look at like the last week or last two weeks, and I look at trends. And I think a lot of the apps for whatever device you decide to use have done a really good job in terms of visual graphics to show how much sleep on average you're getting, how much deep sleep or REM sleep or wake-up times that you have. So, I, again, I feel like the technology has really helped us consolidate a lot of data, but also be efficient with the messaging that we relay to our patients. Dr Albin: Absolutely. And I know personally, at least for the sleep tracker I wear, it also allows you to diary. So, you can say like, "Oh, last night I had a glass of wine," or, "Yesterday I had a really hard workout," or, "I stayed out late with friends," or, "I was on call." Turns out call is really, really bad for my sleep. But it does allow you to sort of track what behaviors, and I wonder how much of that informs what you're counseling patients to do in terms of trying to notice the things that either improve their sleep performance or their subjective feeling of restlessness or restfulness, and how all of that plays into what you're doing in the clinic. Dr Lee-Iannotti: I love all of those comments. It is validation for the patient. Again, it's empowering for them to look at, what did I do last night to get more REM sleep than the night prior? I want to mention that the best people who do this so well are professional athletes, and they look at, how am I going to cater my day to make sure that I'm sleeping well, that I reduce my risk of injury and concussion and increase my reaction time? And I feel like all of us should do that. That's such a great philosophy, to analyze how we can do things better. Dr Albin: I love that. This whole issue, but this article in particular, really emphasized to me that sleep, again, it's not a passive time that we're taking a nap. It's a really active form of sort of neurologic healing. There's important removal of toxins through the lymphatics. And like there's a lot happening in sleep, and there are so many more tools that allow us to unpack that sort of peak performance of sleep, which again, sort of is that athletic mentality of like, how can I make this better? Not just to treat a neurologic condition, but also really importantly, to prevent one. Dr Lee-Iannotti: I often refer to sleep as icing on the cake. With our patients, when you're doing everything right, for example, a multiple sclerosis patient, they're on the right medications, they are exercising, they're participating in rehab, their mood is good, but they're just not getting to the quality-of-life metric that they want to be, it usually is sleep. And if you can add that as a neurologist to your piece of the algorithm to help your patient, it really does improve their quality of life and ultimately their neurologic outcome. I'm a true believer of that. Dr Albin: I was a true believer. I've been made even more of a true believer through your article and getting to talk to you. I always like to close by asking the person I'm interviewing, what's one really exciting thing in this field? What are you kind of most looking forward to as you think about sleep medicine and its impact in neurology in the next five or 10 years? Dr Lee-Iannotti: Oh, I love that question, too. So, the thing I'm most excited about in the field of sleep, and specifically sleep neurology, is the power of preventative care. When I did a lot of stroke, I would see young people, older people, healthy people, people with a lot of genetic risk factors come in, and one minute they were totally normal. The second minute, they're paralyzed and can't speak. And for a lot of these patients, I would ask, "Why am I seeing you now? Why couldn't I have seen you 10 years earlier, worked on risk factors, and prevented this outcome?" And I truly believe that is exactly where sleep lies. If you work on sleep, whether you're an adolescent, 20 year old, 30, et cetera, you are ultimately going to prevent horrible cardiovascular, cerebrovascular, neurologic diseases in the long run. Dr Albin: So important. I really want to direct our listeners back to your article because all of the articles are really practical, but this one in particular looks at how do you do this? What are your options? How do you get this to patients? It really is sort of a step-by-step guidebook on like, A, why this is important, how you should screen, what you should do if someone screens positive for needing to have a sleep study.There's so much more technology that allows really anyone anywhere to have access to the testing that they need to get the right diagnosis, to improve their sleep, to improve their cognitive outcomes, to improve their neurologic health. It's pretty amazing. Dr Lee-Iannotti: It is amazing. And in the article, I do allude to certain devices and then websites that are very helpful. If I can announce, Dr. Albin, I'm super excited about this. Through work with the American Academy of Sleep Medicine, endorsement with the AAN, we are coming out with a new clinical guideline specifically on home sleep study devices and looking at the validation studies. So, I think that's going to be very helpful. But I hope that everybody after listening to this picks up the phone, call your friendly sleep specialist, and align with them and partner with them. And this will ultimately help your patients, I guarantee it. Dr Albin: Again, today I've been interviewing Dr. Joyce Lee-Iannotti about her article on sleep diagnostics and monitoring technology in obstructive sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners, and thank you, Dr. Lee-Iannotti, for joining us today. Dr Lee-Iannotti: Thank you. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audiocme. Thank you for listening to Continuum Audio.
Obstructive sleep apnea affects approximately one in four adults and is especially common among patients with neurologic disorders, including stroke, Parkinson disease, dementia, epilepsy, and neuromuscular conditions. In this episode, Dr. Stephanie Stahl discusses why neurologists should routinely screen for OSA, highlights key symptoms and risk factors, reviews important considerations when interpreting sleep studies, and outlines current treatment options beyond CPAP. Learn how recognizing and treating sleep apnea can improve quality of life, optimize management of neurologic disease, and reduce long-term health risks. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Stephanie M. Stahl, MD, FAASM, author of the article "Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Stahl is an Associate Professor of Clinical Medicine and Sleep Medicine Fellowship Program Director at Indiana University School of Medicine in Indianapolis, Indiana, where she also serves as Sleep Laboratory Medical Director in the Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine. Additional Resources Read the article: Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Obstructive sleep apnea is very common. It can cause or contribute to common neurologic symptoms, such as headache and impaired cognition, and it's a risk factor for stroke. And yet, if you're like me, you may not know too much more about sleep apnea than that. Today, I have the pleasure of talking to sleep expert Dr. Stephanie Stahl to learn what every neurologist should know about OSA. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Berkowitz: This is Dr. Aaron Berkowitz. Today I'm interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the 2026 Continuum issue on Neurology of Sleep. Welcome to the podcast, Dr. Stahl, and could you please introduce yourself to our audience? Dr Stahl: Yeah. Thank you for having me. I'm a sleep medicine physician and neurologist and medical director of the Indianapolis Sleep Lab at Indiana University Health. I serve as the director of the Sleep Medicine Fellowship program. I'm faculty advisor for our very first student interest group in sleep medicine at Indiana University School of Medicine. I'm also actively involved in some national leadership roles, including the incoming chair of the American Academy of Sleep Medicine's Education Committee and co-chair of the Academy's Inter-Scorer Reliability Gold Standard Panel. So, I really appreciate this opportunity. I look forward to our discussion. Dr Berkowitz: Me too, and we appreciate the opportunity too to get to talk to you. You have so much expertise in this area, and I certainly encourage our listeners to look at your article, which is very comprehensive and up to date, and I learned a ton from it. I didn't get much exposure to sleep neurology as a trainee, and I've always worked in academic centers where we have a sleep group and we can refer patients there. So, I have to admit, sleep may probably be the area of neurology I know the least about, and felt like I was learning something new from pretty much every line of your article, and I know our readers will too. So, your article has a lot of excellent detail for our readers on the diagnosis and treatment of this very common condition. But I'd like to keep our interview relatively high level today and focus on the essentials for the practicing general neurologist. So, to start, can you just give us a sense of what obstructive sleep apnea is, and what every neurologist should know about it? Dr Stahl: Yeah. So obstructive sleep apnea is characterized by either partial or full obstructions in the upper airway. That may sound pretty simple, but this leads to a whole bunch of issues. It leads to oxygen desaturations, arousals from sleep, leading to sleep fragmentation. This can then lead to sympathetic nervous system activation, cerebral hypoperfusion, leading to a whole bunch of symptoms or neurologic conditions. Dr Berkowitz: Great. And you mentioned this in your article, but just to emphasize, how common is obstructive sleep apnea in the general population? Dr Stahl: Yeah. So, about a quarter of the general population have obstructive sleep apnea. Much more common in many neurologic conditions. Dr Berkowitz: Yeah, so very common disorder. We are seeing patients with it quite frequently, whether that's the reason they are seeing us in neurology or not. And this leads to my next question, which is what neurologic symptoms or presenting concerns of a patient should make us think about OSA and the differential diagnosis, and what factors based on the history or the exam or the context would make you suspicious for OSA as the cause of a neurologic symptom? In other words, the patient's presenting with classic symptoms of OSA, and that's why they're seeing a neurologist or seeing a primary care doctor, but is coming for evaluation of, say, headache or other symptoms. And what symptoms would make you think of wanting to consider OSA, and then what aspects of the history or otherwise would make you want to evaluate the patient for OSA? Dr Stahl: I think a really important takeaway is for neurologists to know that obstructive sleep apnea is very common in neurologic conditions and has that potential to worsen a lot of these conditions or their associated symptoms. And so, it should be on our radar. There are certainly some basic questions and signs and symptoms that we can ask patients about or, or take a look at on exam. And so particular symptoms include snoring. Anybody that snores loudly or frequently, that's a strong risk factor for obstructive sleep apnea. If someone's seeing them stop breathing in their sleep, if they are waking up a lot throughout the night. There are some other symptoms that we may not necessarily attribute upfront to obstructive sleep apnea, such as nocturia, nocturnal reflux, night sweats. There are some daytime symptoms, of course, too, like unrefreshing sleep, daytime sleepiness, morning headaches, an important one in neurology. And then we take a look at the patient's exam. And so, some things that neurologists might want to be thinking about are people with obesity are certainly at a risk for obstructive sleep apnea. But it's also very important to know that someone does not need to have obesity in order to have obstructive sleep apnea. We look at neck size, other morphologic characteristics, such as how much that we can see in the back of their mouth. Can we see their uvula? Does their tongue size appear large in their mouth? And then some other risk factors too, such as male gender, older age, family history, post-menopausal state in women. All that being said, though, sometimes in neurologic conditions, we don't have all of those symptoms or risk factors to be thinking about. And so, in certain neurologic conditions such as stroke where obstructive sleep apnea is very common and has the potential to increase the risk of another stroke, we may need to be thinking about testing these patients even with minimal symptoms or other risk factors. Dr Berkowitz: That's very helpful. So, you mentioned their headache might be the presenting symptom, right, to a neurologist, and we should certainly be thinking about obstructive sleep apnea as a potential diagnosis, even the cause of the patient's headache, particularly you said patients with morning headache. I often try to think about in patients presenting with, for memory loss, or other cognitive concerns, and that may be due more to inattention from poor sleep, so asking about sleep and symptoms of sleep apnea in those contexts. Are there any other presenting neurologic symptoms not particularly related to sleep? I'm thinking of headache, memory loss, other symptoms that would make you think, "Oh, I should actually screen this patient for sleep apnea also." Dr Stahl: Yeah, other symptoms to think about in pediatrics, hyperactivity, people that have impaired vigilance, as you alluded to, that poor attention. Sometimes people get misdiagnosed with ADHD, and it's actually just a manifestation of obstructive sleep apnea. Dr Berkowitz: You alluded to this, Dr. Stahl, that stroke, for example, patients are at higher risk of developing sleep apnea as a result of stroke, and it's also a risk factor for stroke. What other neurologic conditions, primary neurologic diseases, put patients at a higher risk of OSA? And again, similar to the last question I asked you, what are some clues that we should evaluate for? We might be following a patient for their post-stroke care over time and not necessarily thinking about diagnosing a separate condition in them since we're following them for their stroke or their degenerative disease. What are the conditions that put patients at a higher risk of OSA as a result of the condition, and then when would you think about screening them for it? Dr Stahl: Some particular neurologic conditions where obstructive sleep apnea are very common, in addition to stroke and, and TIA, include Parkinson disease. It can worsen a lot of the motor, cognitive symptoms, sleep disruption that we can see in Parkinson disease. Very common in all causes of dementia, but in particular Alzheimer disease and Lewy body dementia. Very common in neuromuscular conditions. We should definitely have obstructive sleep apnea and all forms of sleep-disordered breathing high on our radar. In conditions like myotonic dystrophy. Charcot-Marie-Tooth is another one where obstructive sleep apnea is very common. Myasthenia gravis, it can worsen the symptoms of that. In particular, a pearl is if somebody has morning weakness in myasthenia gravis, obstructive sleep apnea should be high on your radar. And also, as you mentioned, any forms of headaches. There are some other things too. If somebody has poor seizure control, especially nocturnal seizures, you might have obstructive sleep apnea on your radar as well. Dr Berkowitz: So, I think you've covered essentially every category of neurologic disease, right? We have cerebrovascular, movement, neurodegenerative, neuromuscular, epilepsy, all conditions where either the disorder itself, such as stroke or the, correct me if I'm wrong, the neurodegenerative disease puts the patient at risk. Or the patient may be at risk for exacerbations of their disease, as you mentioned in myasthenia. I love that pearl. Not fatiguable at the end of the day, but if the patient with myasthenia is telling you they're feeling weaker at the beginning of the day, then think about obstructive sleep apnea and that obstructive sleep apnea worsening control of epilepsy due to poor sleep. So really a lot of bidirectional interactions with this common condition. Okay, so if we're concerned about obstructive sleep apnea, again, myself, a general neurologist speaking perhaps on behalf of other general neurologists, we see a patient with headache or reporting memory loss that we find to be impaired attention, or we see exacerbation of their underlying primary neurologic disease. As you mentioned, we think, "Oh, I've listened to this podcast. I've read Dr. Stahl's article. I should probably be thinking about OSA in this patient, and I should order a sleep study." Now, I admit when I get the sleep study back, I scroll to the bottom, I see they do have obstructive sleep apnea, I'm going to send them over to a sleep specialist. But for the general neurologist, what are some high-yield pearls and some pitfalls to be aware of when we get sleep studies for obstructive sleep apnea, and we are looking at the results? Dr Stahl: The first thing is to understand that there are two main types of sleep studies: in-lab polysomnography and home sleep apnea test. In-lab studies are typically what we consider the more accurate type of study. Main reason for that is that we have EEG, so we can see if someone is awake versus asleep. Most home sleep apnea tests do not utilize EEG, and so when we're looking at respiratory events, apneas or hypopneas, we're looking at over the total recording time rather than the total sleep time. So, we know we're going to capture some time where a person is awake, where we don't have sleep apnea events, and that can be a big amount of time in people with insomnia, poor sleep efficiency. And as a result of that, it can lead to an underestimation of the apnea-hypopnea index. That's really important for people to understand that that means we can end up with a false negative home sleep apnea test, or it can put them in a category of lower severity than what they actually have. And so, if you get a home sleep study report back that's negative for sleep apnea and you remain concerned, you need to go on to do an in-lab study, where about twenty to fifty percent of people will go on to have a positive in-lab study. You can also get false positives with home sleep apnea tests too, and so ideally, we should only be doing home sleep apnea tests in people that are at high risk of having obstructive sleep apnea to decrease our chance of false positive study. When we get that sleep study report, what's important to take a look at? So the main number that we look at currently is the apnea-hypopnea index. The number of apneas, which are full obstructions in that upper airway, or hypopneas, partial obstructions in the upper airway where either there's an oxygen desaturation or an arousal associated with that. Less than five is considered to be normal. Anything five or more gives them a diagnosis of obstructive sleep apnea, and then we stratify them based on the AHI. But it's important to take a look at more than just the apnea-hypopnea index. And while my eyes too on various reports like echocardiograms want to jump to the impression, it is important to take a look at that full report, see what their oxygen levels averaged and what they dipped down to. The arousal index, which is how many times a patient may have woken up briefly throughout the night. Take a look at the histogram, usually an image at the bottom of their report that shows what sleep fragmentation may have been like so that you can take that all in and make that decision. How important are these study findings, and is this a person that would benefit from treatment? Dr Berkowitz: That's a fantastic overview of sleep studies and some of the highlights to look out for, even if we won't be understanding every detail as you would to know most importantly the caveats about home sleep testing having a fairly high percentage of false negative and false positive results. So being wary if our suspicion is high, and that test is normal or inconclusive to get an in-lab sleep study. And if our suspicion is low or maybe we haven't ordered the test and the patient has had it done elsewhere, and the history doesn't really match up to know that there are false positives on the home studies as well, and again, an in-lab study to settle the diagnosis. Is that right? Dr Stahl: Yes. Dr Berkowitz: Okay. Now, for most neurologists, probably if we diagnose OSA, we will be referring the patient to a sleep specialist like yourself for treatment. I think we're all familiar with CPAP and patients being on CPAP. Your article mentions a number of treatment modalities I admit I have not heard of before or maybe heard of in passing, acknowledging most general neurologists are not going to be prescribing or knowing with the nuance that you do as an expert how to decide which treatment a patient would most benefit from or most qualify for. So, can you just give us a broad overview, again, for the general neurologist acknowledging we might see a patient whose past medical history says OSA being treated with fill in the blank. What are the different treatment modalities, and how do you think, just so we can learn from you in broad brush strokes, about particular treatments for particular patients? Dr Stahl: As you mentioned, most people are familiar with positive airway pressure or PAP therapy, and that does remain our most efficacious treatment. The way I explain it to patients is why PAP therapy is the most effective treatment is it's the only treatment that can take all of the tissues of that upper airway and open them up. Whereas all of our other treatments, we're going to target smaller spaces of that upper airway. So, our first option is if we can get somebody on PAP therapy, we know that that's going to be the best option for the majority. PAP therapy works by basically acting as an air splint to open up the air tissues. Know that masks are not interchangeable. There are masks that cover the nose and go over the nose and mouth and under the nose. Full face masks that cover the nose and mouth, they do typically require higher pressures, also tend to be less comfortable for a lot of patients as well. In addition to different PAP masks, there's different modalities of positive airway pressure therapy too. There are machines that auto-adjust, some that provide fixed pressure, bi-level PAP that provides a higher inspiratory pressure, lower expiratory pressure. Then outside of PAP therapy, there are, as you alluded to, a lot of options and more, continuing to come down the pipeline as well. Mandibular advancement devices or a form of oral appliances has been around for a while. This is device that somebody wears in their mouth. It's preferably customized for their teeth and titratable, meaning that they can make adjustments that pulls their mandible forward in relation to the maxilla in order to pull those tongue tissues further away from the back of the upper airway. That's ideally managed by a qualified sleep dentist or someone that specializes in oral appliance management. Other treatments include surgical options, including hypoglossal nerve stimulation, which is an implanted device that causes the tongue to protrude repetitively throughout their sleep period to hopefully open up the airspace. There's some other surgical options too that open up various places of the upper airway. There's a daytime treatment of obstructive sleep apnea, transoral neuromuscular electrical stimulation that changes the muscle fiber type of the tongue. And then there's some adjunctive treatments that can be helpful too, such as positional therapy, oral facial myofunctional therapy that helps a person breathe better through their nose and may help train the upper airway muscles. Dr Berkowitz: Great. Well, that's a very helpful overview, and again, I refer our listeners to your article, which talks about all of those modalities in very comprehensive detail. So, Dr. Stahl, as we wrap up our conversation, you have a captive audience of neurologists and neurology trainees here. What would you like to leave us with that every neurologist should know about obstructive sleep apnea? Dr Stahl: The most important, again, is for neurologists to know that obstructive sleep apnea is so common in your patient population, and it can have a significant negative impact on quality of life and health, including many neurologic conditions. And at the same time, obstructive sleep apnea is very treatable. We have so many options nowadays that we can usually get someone onto adequate treatment. And treatment has that potential to improve several neurologic symptoms and disorders, even at times when you don't think that there's an opportunity to improve symptoms such as say in, headache. So, neurologists really should be screening for signs and symptoms of obstructive sleep apnea, as well as considering testing in high-risk, potentially asymptomatic or minimally symptomatic patients. Dr Berkowitz: That's a fantastic overview of some of the many pearls that you shared with us today, as well as in your article. So, thank you so much again. Today, I've been interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining today, and thank you again, Dr. Stahl. Dr Stahl: Thank you again for having me. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
A 42-year-old man walked into my office.Blood pressure: 165 over 100.His doctor had already written the prescription. He was sitting across from me, looked me in the eye, and said:“I don't want to just manage this. I want to fix it.”Four weeks later, his blood pressure was completely normal. No medication change. No direct blood pressure treatment.Because here's the thing — we never once directly treated his blood pressure.We treated the system that was producing it.That's what this episode is about.The Reframe That Changes EverythingMost people — and most conventional medical appointments — treat blood pressure like it is the problem. The number is high, so we lower the number. Done.But blood pressure is not the problem. It's a report card. It's your body's way of showing you — in a very measurable, very undeniable way — that something upstream has gone wrong.Think of it like the check engine light in your car. You don't put tape over it and drive off. You open the hood.So today, we're opening the hood.Before we do — let's make sure we're speaking the same language. Blood pressure is two numbers:* Systolic (top number): pressure when your heart contracts and pushes blood out* Diastolic (bottom number): pressure when your heart is relaxing between beatsConventionally, 130/80 or above is classified as Stage 1 hypertension. A lot of people are sitting in that zone, being told to “keep an eye on it.”That advice isn't enough. Something created that pressure. And until we find out what, we're managing a symptom — not solving a problem.The 6 Root Drivers of High Blood PressureFrom a functional and metabolic medicine standpoint, there are six primary root drivers I look at when someone walks in with elevated blood pressure. Almost every time, it's not one of these in isolation — it's a combination.1. Insulin ResistanceThis is the big one. And it is criminally underdiagnosed.Here's the mechanism: when insulin is chronically elevated — from too much processed food, too much sugar, not enough movement — the kidneys start holding onto sodium. More sodium means more water in the bloodstream. More volume means more pressure. Basic physics.On top of that, high insulin activates your sympathetic nervous system — your fight-or-flight response — which causes blood vessels to constrict. Less room for the same amount of blood? Pressure goes up.Here's what makes this especially tricky: your blood sugar can look completely normal on a standard lab panel, and you can still have significant insulin resistance. That's why I don't just check fasting glucose. I look at fasting insulin, hemoglobin A1C, and when needed, a glucose tolerance test with insulin levels drawn at multiple time points.2. Chronic InflammationInflammation damages the endothelium — the delicate inner lining of your blood vessels. When it's damaged, vessels lose their flexibility. They can't dilate and constrict properly.And a key molecule called nitric oxide — your body's natural blood vessel relaxer — drops off significantly when the endothelium is inflamed.Less nitric oxide, stiffer vessels, higher pressure. Every time.I test this with high-sensitivity CRP, homocysteine, and sometimes oxidized LDL. These aren't on a standard panel, but they tell me everything about what's happening inside those vessels.3. HPA Axis Dysregulation (Chronic Stress)Your hypothalamic-pituitary-adrenal axis — your stress response system — when chronically activated, keeps you pumping out cortisol and adrenaline. Both cause vasoconstriction. Both tell your kidneys to hold onto sodium. Both keep your heart rate elevated.Your body was designed to activate this system in short bursts — run from a predator, deal with a crisis. It was never designed to do this 24 hours a day in response to emails, traffic, and financial pressure.But that's the world most of us are living in. And for a lot of people, their blood pressure reflects it.4. Mineral DeficienciesMagnesium is the most important mineral almost nobody talks about in the context of blood pressure.It's a natural calcium channel blocker — and calcium channel blockers are literally one of the most prescribed blood pressure medications on the market.Magnesium helps blood vessels relax. It regulates the sodium-potassium pump in your cells. When it's low — and estimates suggest 60 to 80% of Americans are suboptimal — vessels stay tight.Potassium works hand-in-hand with magnesium and sodium to regulate fluid balance and vascular tone. I look at sodium-to-potassium ratios, not just absolute numbers, because that ratio matters enormously for cardiovascular regulation.5. Sleep Deprivation & Circadian DisruptionYour blood pressure is supposed to dip 10 to 20 percent during sleep. This is called nocturnal dipping, and it's when your cardiovascular system gets its nightly repair window.When you're not sleeping enough — or sleep quality is poor — that dip doesn't happen. Your heart works overtime, around the clock. Over weeks and months and years, that creates a chronically elevated baseline.Obstructive sleep apnea is a massive, underdiagnosed contributor here. If you wake up tired, snore loudly, or wake with morning headaches, please get tested. The connection between sleep apnea and hypertension is direct and well-established.Poor sleep also elevates cortisol and inflammatory markers — feeding every other driver on this list simultaneously.6. Mitochondrial DysfunctionThis one is underappreciated even in functional medicine circles.Your mitochondria — the energy factories inside every cell — are responsible for generating the ATP that powers your heart muscle, your vascular smooth muscle, everything. When they're dysfunctional — from chronic stress, poor nutrition, environmental toxins, or oxidative damage — cellular energy production drops.Your cardiovascular system then has to compensate by working harder. Blood pressure creeps up as a downstream consequence of your cells simply not having enough energy to function efficiently.We'll come back to this when we get to the quantum biology piece — because this is where it gets really interesting.This is the part most people have never heard anywhere. Lean in.Quantum biology examines the role of light, water, electrons, and quantum mechanical processes inside living cells. When it comes to blood pressure specifically, three things stand out.Light and the MitochondriaYour mitochondria are not just calorie-burning machines. They are fundamentally light-responsive.Near-infrared light — the kind emitted by the sun in the morning and evening, and also by incandescent and red light sources — directly stimulates cytochrome c oxidase, a key enzyme in the mitochondrial electron transport chain.When properly stimulated by light, mitochondria produce more ATP, more structured water, and more nitric oxide. There's that word again — nitric oxide. The natural vasodilator. The thing that keeps blood vessels relaxed and flexible.When people stop getting morning sunlight and spend their entire day under blue-shifted artificial light, mitochondrial function degrades. Nitric oxide drops. Blood vessels stiffen. Pressure rises.This isn't fringe science. There is solid, published research connecting light exposure — particularly morning sunlight — to cardiovascular and blood pressure outcomes.Circadian BiologyYour body has a master clock in a region of the brain called the suprachiasmatic nucleus. Nearly every cell in the body has its own peripheral clock synchronized to it.Blood pressure has a natural circadian rhythm. It should be lower at night, begin rising about an hour before waking, peak in the late morning, and modulate through the day. When circadian rhythm is disrupted — by artificial light at night, irregular eating, shift work, or poor sleep — that rhythm breaks down.A disrupted circadian clock is directly linked to hypertension. The mechanisms involve cortisol timing, aldosterone regulation, and inflammatory gene expression — all of which influence vascular tone.This is why I ask every patient about their light environment. When do you go outside? What does your bedroom look like at night? What time do you eat your last meal? These feel like lifestyle questions. They are cardiovascular questions.Structured Water and Vascular FunctionResearcher Gerald Pollack at the University of Washington has done groundbreaking work on what he calls the fourth phase of water — EZ water, or exclusion zone water. This is a gel-like, structured form of water that forms at hydrophilic surfaces, including the inner lining of blood vessels.EZ water is negatively charged and creates a kind of biological battery that powers cellular function and supports smooth, low-friction blood flow — essentially a lubrication layer inside your vascular system.What builds EZ water? Sunlight (particularly infrared), movement, grounding, and proper hydration with mineralized water.What degrades it? Dehydration, toxic load, poor light environment, chronic EMF exposure.When the vascular lining is not properly hydrated at this structured level, blood viscosity changes, endothelial function suffers, and blood pressure goes up.The bottom line: your blood pressure is not just a plumbing problem. It's a biological energy problem. And the inputs that drive cellular energy — light, water, minerals, sleep, movement, stress — are the same inputs that drive blood pressure.What This All Means: A Quick RecapHere's the picture pulled together:* Blood pressure is a symptom, not the root problem* The six root drivers are: insulin resistance, chronic inflammation, HPA axis dysregulation, mineral deficiencies (especially magnesium and potassium), sleep deprivation and circadian disruption, and mitochondrial dysfunction* Applied kinesiology provides a way to assess how structural and neurological interference contributes to sympathetic dominance and vascular dysregulation* From a quantum biology perspective, your light environment, your circadian rhythm, and the quality of structured water in your vascular system directly influence how your vessels function and how your cells produce energy* When you address these upstream drivers — as we did with Marcus — the blood pressure number takes care of itself5 Things You Can Do TodayThese are not theoretical. Start here.1. Get morning sunlight — today. Within 30 to 60 minutes of waking, get outside and get natural light in your eyes and on your skin for at least 10 to 20 minutes. No sunglasses. This sets your circadian clock, starts stimulating mitochondrial function, and triggers nitric oxide production in the skin. It costs nothing.2. Cut refined carbohydrates and added sugars for two weeks. Not forever — just try it. This single change drops fasting insulin in most people within days. Lower insulin means less sodium retention, less sympathetic nervous system activation, and lower blood pressure. No prescription required.3. Start magnesium supplementation. Magnesium glycinate or magnesium malate — 300 to 400 mg in the evening. This is one of the safest, most evidence-backed interventions for vascular health. It supports vessel relaxation, improves sleep quality, and aids mitochondrial energy production. Ask your practitioner about your specific dose.4. Treat sleep like a clinical intervention. Because it is. Target 7 to 9 hours. Create a dark, cool sleeping environment. Eliminate screens 60 to 90 minutes before bed. Blue light at night suppresses melatonin, disrupts circadian rhythm, and keeps your nervous system in sympathetic mode. If you have signs of sleep apnea — waking up tired, loud snoring, morning headaches — get tested. This is non-negotiable.5. Prioritize resistance training. 30 minutes, three to four times a week. Strength training improves insulin sensitivity, builds mitochondrial density, supports nitric oxide production, and reduces arterial stiffness. Muscle is metabolic medicine.Ready to Go Deeper?If you read this and thought “this sounds like me” — or you've been told your blood pressure is borderline and you're not sure what to do about it — the next step is a conversation.I offer a free 45-minute Metabolic Audit Call where we look at what's actually driving your numbers — your symptoms, your history, your labs — and map out the highest-leverage moves for your specific situation.Spots are limited each week.Until next time — Be well. And Aloha.
Obstructive sleep apnea (OSA) is a condition that affects millions globally, causing daytime sleepiness, lack of oxygen, and higher risks of developing cardiac issues. A new randomized control trial, called the Pavlov study, evaluated the efficacy and long-term conditioning effects of a positional therapy device for treating positional obstructive sleep apnea. Irene Cano-Pumarega, MD, PhD, Ramón y Cajal Hospital, discusses how she and her team developed the study, the initial results, and what future positional treatments for OSA could look like on this episode of the ATS Breathe Easy podcast.
When we think of Obstructive Sleep Apnea (OSA), we usually think of snoring, disrupted sleep, and daytime fatigue. But there is a critical link between OSA and dysphagia. In this episode, we sit down with Prof. Ankita Bhutada from Northwestern University to explore how upper airway collapse and chronic respiratory disruption can profoundly impact swallowing function. We cover: Understanding OSA: What is obstructive sleep apnea, its primary risk factors, and why it is a major public health concern. The link to dysphagia: Understanding the sensorimotor mechanisms and neuromuscular changes that connect sleep-disordered breathing to swallowing dysfunction. Clinical Presentation: How dysphagia typically manifests in individuals with OSA Diagnostics: Why clinicians should consider routinely screening people with OSA for dysphagia and how to adapt existing assessment tools for this population. High-Risk Groups: Identifying which specific patient profiles within the OSA population face the highest risk for airway compromise. Management & Treatment: A look at current and emerging treatment approaches for dysphagia in people with OSA. Literature that we discuss: Bhutada et al. (2022). Predictors of Patient-Reported Dysphagia and Reflux Symptoms in Obstructive Sleep Apnea. Bhutada et al. (2020). Obstructive sleep apnea syndrome (OSAS) and swallowing function—A systematic review. Bhutada et al. (2025). Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study.
Every CRNA school interview panel asks about shock. Most applicants can name the four types. What separates the answers that land is mechanism — Frank-Starling in hypovolemic, the afterload trap in cardiogenic, iNOS-driven nitric oxide collapse in distributive, RV dilation and septal shift in obstructive. This episode covers all four shock states at the cellular level: hemodynamic profiles, bedside clues, and the exact language to use when a program asks you to walk through shock in an interview. We have a full shock states lesson inside The CRNA Club learning library — hemodynamic profiles for every shock type, built for CCRN prep and CRNA interview practice. Start your free seven-day trial. FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - Find out if your GPA is competitive for CRNA school 9-Step Application Checklist - Every step you need to apply to CRNA school, in order CRNA School Database - Search and compare 140+ CRNA programs Certification Planner - Your personalized CCRN study schedule Timeline Generator - Build your personalized application timeline Try The CRNA Club FREE for 7 days - The only tool personalized to YOUR CRNA school journey CHAPTERS: [00:00] Cold open: warm post-op patient, ambiguous shock type [01:30] Welcome and shared framework: shock as inadequate tissue perfusion [02:30] Tank, pump, pipes, obstruction overview [03:00] Hypovolemic shock: Frank-Starling, sympathetic compensation, why pressors alone fail [06:00] Mid-episode: learning library shock lesson [07:00] Cardiogenic shock: calcium handling failure, the afterload trap, inotrope rationale [10:00] Distributive shock: iNOS, nitric oxide, why norepinephrine targets the right receptor [13:00] Obstructive shock: PE anatomy, tension pneumo, tamponade — and Beck's triad caveat [15:00] How to answer the shock question in your CRNA interview [16:30] Three clinical takeaways and cold open callback Follow us on Instagram: @thecrnaclub More resources at THECRNACLUB.COM
Dr Peter Wallbridge (sleep and respiratory physician) joins Dr Preeya again after multiple requests from the audience for another chat on sleep! Obstructive sleep apnea - why it can present differently in women, options for management and all the super interesting stuff everyone wants to know on dreaming, sleep walking and talking!Instagram: @doctor.preeya.alexanderBooks: Eat, Sleep, Play, Love by Dr Preeya AlexanderFull Plate, out nowTo find out more about AIA Australia head to www.aia.com.au
In this episode, we review the high-yield topic of Obstructive Shock from the Cardiovascular section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, Dr Dave McCarty returns to discuss why sleep apnea is often misunderstood and oversimplified. He introduces his “Five Reasons to Treat” and “Five-Finger Approach” frameworks, helping patients and practitioners better understand the deeper causes of sleep-disordered breathing. The discussion explores: Obstructive vs central sleep apnea Nasal breathing and nitric oxide ADHD and sleep disorders Mouth breathing and facial development Narrative-based medicine The dangers of relying solely on labels Empowering patients through understanding This episode challenges conventional thinking and provides a more holistic, personalized way to approach sleep health. Dr Dave McCarty Dr Dave McCarty is a sleep physician, educator, writer, illustrator, and creator of the Empowered Sleep Apnea Project. He is known for making complex sleep science understandable through storytelling, cartoons, patient education, and narrative-based medicine. His work focuses on helping people understand sleep apnea beyond labels and empowering patients to become active participants in their healthcare journey. Website: Empowered Sleep Apnea Social Media: Dr Dave McCarty on LinkedIn Empowered Sleep Apnea YouTube Featured Books: The Nose Rules Empowered Sleep Apnea ✍️
Lisa Salberg and Dr. Marty Maron break down major new clinical trial results that could change treatment for patients with non obstructive HCM. They explain what the Acacia HCM trial found, why experts call it a transformative moment, and what the next steps could mean for patients around the world. This conversation was recorded May 5, 2026.
Valerie Dehondt, PharmD, and Lies Lahousse, PharmD, PhD, join CHEST® Journal Podcast Moderator Gretchen Winter, MD, to discuss their research into the association between long-term proton pump inhibitor use and exacerbation risk in patients with chronic obstructive airway diseases. DOI: 10.1016/j.chest.2026.01.002 Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.
Drs. Maron and Rowin review how treatment for symptomatic obstructive hypertrophic cardiomyopathy has evolved from mainly using beta blockers and invasive procedures to now including newer cardiac myosin inhibitor drugs. These newer medications more reliably reduce obstruction and improve patient symptoms and exercise capacity, but require careful safety monitoring with regular heart function checks.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WMQ865. CME/MOC/AAPA/IPCE credit will be available until April 28, 2027.Cardiac Myosin Inhibition in the Real World: What Have We Learned From Long-Term Experience in Obstructive HCM? In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc.. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an educational grant from Bristol Myers Squibb.Disclosure information is available at the beginning of the video presentation.
Drs. Maron and Rowin provide an overview of hypertrophic cardiomyopathy, explaining how it is diagnosed by heart imaging and classified into obstructive and non-obstructive forms. They highlight that obstruction is a major cause of symptoms and stress the importance of carefully assessing patients' day-to-day limitations to guide treatment decisions.
CME credits: 1.00 Valid until: 19-05-2027 Claim your CME credit at https://reachmd.com/programs/cme/modern-obstructive-hcm-care-from-unmet-needs-to-individualized-myosin-inhibitor-therapy/56979/ This activity examines the evolving management of obstructive hypertrophic cardiomyopathy (oHCM), from persistent unmet needs to precision-based therapy with cardiac myosin inhibitors. Faculty review ongoing symptom burden and functional limitations despite guideline-directed first-line therapy with beta-blockers and analyze mechanistic, pharmacokinetic, and pharmacodynamic differences among available agents, including their effects on peak VO₂, left ventricular outflow tract gradients, and patient-reported outcomes. Through expert discussion and case-based application, the activity highlights practical considerations for treatment selection, individualized dosing and titration, safety monitoring, and treatment transitions to support evidence-based strategies that optimize hemodynamics and improve quality of life in patients with oHCM.
CME credits: 1.00 Valid until: 26-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/from-beta-blockers-to-myosin-inhibitors-initial-decision-making-in-obstructive-hcm/54843/ This activity examines the evolving management of obstructive hypertrophic cardiomyopathy (oHCM), from persistent unmet needs to precision-based therapy with cardiac myosin inhibitors. Faculty review ongoing symptom burden and functional limitations despite guideline-directed first-line therapy with beta-blockers and analyze mechanistic, pharmacokinetic, and pharmacodynamic differences among available agents, including their effects on peak VO₂, left ventricular outflow tract gradients, and patient-reported outcomes. Through expert discussion and case-based application, the activity highlights practical considerations for treatment selection, individualized dosing and titration, safety monitoring, and treatment transitions to support evidence-based strategies that optimize hemodynamics and improve quality of life in patients with oHCM.*Please stay tuned for additional content to this activity available for credit. The maximum amount of credit(s) available for the entire activity is 1.00.
Joe and Anthony get back together for an hor full of crazy news and filled with Joe's giggle machine.. How they get from here to there is anyone's guess, maybe you can figure it out, shows on Mondays, every other week at chiampa.org (otherwise it's a repeat of a previous cast)
In this episode of the Heart podcast, Digital Media Editor Professor James Rudd is joined by Dr Craig Balmforth from the University of Edinburgh. They discuss the rationale for identifying high-risk plaque, how imaging can help, and emerging therapies, including PCI. If you enjoy the show, please leave us a positive review wherever you get your podcasts. It helps us to reach more people - thanks! Link to published paper: https://heart.bmj.com/content/112/1/13.long
Aficamten or Metoprolol Monotherapy for Obstructive Hypertrophic Cardiomyopathy
In this podcast accompanying the October issue of DTB (https://dtb.bmj.com/content/63/10) David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor). David and Julian discuss the editorial that highlights a few of the challenges associated with the introduction of an orphan medicine into clinical practice (https://dtb.bmj.com/content/63/10/146). They talk about a DTB Select article that summarises a randomised clinical trial that assessed the effect of allopurinol on cardiovascular outcomes in people with ischaemic heart disease who did not have gout (https://dtb.bmj.com/content/63/10/147). They finish by discussing the main article that provides an overview of the evidence for mavacamten (▼Camzyos) for the treatment of symptomatic obstructive hypertrophic cardiomyopathy in adults (https://dtb.bmj.com/content/63/10/150). Links GP Evidence: https://gpevidence.org/ Preventing Overdiagnosis 2025 International Conference: https://www.cebm.ox.ac.uk/preventing-overdiagnosis Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.
Obstructive sleep apnea affects a whopping 30 million Americans, yet millions remain undiagnosed or abandon CPAP therapy due to its discomfort and inconvenience. Recent innovations in oral appliance therapy, however, are opening up new possibilities for patients seeking safe, effective, and lasting solutions. With sleep apnea linked to virtually every chronic disease—from heart disease to diabetes—the stakes couldn't be higher.So, what if there were a way to actually remodel the airway and reduce dependence on CPAP altogether? Could a non-surgical, dental-based approach reshape the future of sleep apnea treatment?Welcome to I Don't Care. In the latest episode, host Dr. Kevin Stevenson speaks with R. Kirk Huntsman, Chairman and CEO of Vivos Therapeutics. Together, they explore how airway remodeling through oral appliances may offer patients an alternative to CPAP, why craniofacial development is so central to sleep disorders, and how innovations in treatment are changing lives across the country.In this episode, you'll learn:How Vivos Therapeutics' oral appliance technology works by repositioning and redeveloping the jaws to create wider, more functional airways.Why environmental, genetic, and lifestyle factors have led to narrower airways in modern populations—and how this contributes to the rise of sleep apnea.What patients can expect in terms of treatment timelines, insurance coverage, and long-term outcomes, including reducing or eliminating dependence on CPAP.R. Kirk Huntsman is a seasoned healthcare entrepreneur with over 35 years of experience founding and leading companies in dental practice management, medical devices, and healthcare services. He built and scaled Dental One, Inc. into a $70M business before its sale, and later co-led the merger that created DentalOne Partners, operating over 150 practices nationwide. Currently Chairman and CEO of Vivos Therapeutics, he focuses on strategic growth, capital acquisition, and innovative technologies to advance treatment for sleep and airway disorders.
Ischemia with No Obstructive Arteries (INOCA) in 2024 Guest: Claire Raphael, M.B.B.S., Ph.D. Host: Sharonne Hayes, M.D. INOCA is a common condition. It is an acronym that stands for ischemia with non-obstructive coronary artery disease. We discuss when to consider a diagnosis of INOCA, how to diagnose it and how to treat patients. Topics Discussed: What is INOCA? Who is at risk for INOCA? How do we manage INOCA? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
Stephen Grootes speaks to Carol Paton, Editor-at-Large at Fin24, about South Africa’s obstructive stance at the WTO, which she calls embarrassing and clearly misguided. Stephen Grootes speaks to veteran broadcaster Neil Andrews about his remarkable journey from horse-racing commentary to becoming one of South Africa’s most beloved sports presenters, highlighting the passion, versatility, and humility that have defined his decades-long career. The Money Show is a podcast hosted by well-known journalist and radio presenter, Stephen Grootes. He explores the latest economic trends, business developments, investment opportunities, and personal finance strategies. Each episode features engaging conversations with top newsmakers, industry experts, financial advisors, entrepreneurs, and politicians, offering you thought-provoking insights to navigate the ever-changing financial landscape. Thank you for listening to a podcast from The Money Show Listen live Primedia+ weekdays from 18:00 and 20:00 (SA Time) to The Money Show with Stephen Grootes broadcast on 702 https://buff.ly/gk3y0Kj and CapeTalk https://buff.ly/NnFM3Nk For more from the show, go to https://buff.ly/7QpH0jY or find all the catch-up podcasts here https://buff.ly/PlhvUVe Subscribe to The Money Show Daily Newsletter and the Weekly Business Wrap here https://buff.ly/v5mfetc The Money Show is brought to you by Absa Follow us on social media 702 on Facebook: https://www.facebook.com/TalkRadio702 702 on TikTok: https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/CapeTalk 702 on YouTube: https://www.youtube.com/@radio702 CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/Radio702 CapeTalk on YouTube: https://www.youtube.com/@See omnystudio.com/listener for privacy information.
AUA2025: John Duckett Memorial Lecture: Obstructive Bladder Disease: Molecular Insights and Therapeutic Opportunities Presenter: Rosalyn M. Adam, PhD
Commentary by Dr. Jian'an Wang.
Atypical sleep apnoea in women, often presenting as fatigue, insomnia or anxiety Why all pregnant women in their second trimester should be screened Loud snoring and hyperactivity in children are red flags for sleep apnoea Home sleep test access, Medicare criteria, and private options explained Supporting CPAP setup, troubleshooting and when to refer Host: Dr David Lim | Total Time: 41 mins Expert: Dr Alison Wimms, Director of Medical Affairs Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.
Commentary by Dr. Jian'an Wang.
Primary and Secondary Outcomes of the Women's Ischemia Trial to Reduce Events in Non-Obstructive Coronary Artery Disease
Obstructive sleep apnea (OSA) is an increasingly common diagnosis. Yet most behavioral health providers are unaware that they can play a role in both the assessment and treatment of OSA in their patients. Today we're joined by an expert in the subfield of sleep psychology, Dr. Phil Gehrman. He shares basic information about what OSA is, how providers can effectively screen for it, and how they can facilitate treatment for this dangerous condition. Despite what you might have heard before, Dr. Gehrman posits that behavioral health providers can play “a huge potential role that really is untapped.” Dr. Phil Gehrman is Professor of Psychology in the Department of Psychiatry of the University of Pennsylvania School of Medicine. He directs the Sleep, Neurobiology and Psychopathology lab at Penn. He has an active research program exploring the mechanisms and treatment of sleep and circadian dysregulation in the context of mental health disorders. Dr. Gehrman's clinical specialization is on the delivery of cognitive behavioral and chronotherapeutic interventions for insomnia, circadian rhythm disorders, and other sleep disorders. The overarching goal of his work is to advance the understanding of the links between sleep and mental illness through translational research that spans biology to therapeutics.Resources mentioned in this episode: STOP Screening tool for Obstructive Sleep Apnea: https://deploymentpsych.org/content/insomnia-toolsMotivational Interviewing for CPAP Adherence: Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C and Castelnuovo G (2021) Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front. Psychol. 12:705364. doi: 10.3389/fpsyg.2021.705364Motivational Interviewing resources: https://deploymentpsych.org/Clinical-Skills-ResourcesSystematic desensitization: https://www.veterantraining.va.gov/insomnia/docs/PAP_Desensitization.pdfPractical for Your Practice voice mail: speakpipe.com/cdpp4pPractical for Your Practice email: cdp-podcast-ggg@usuhs.edu Calls-to-action: Incorporate the STOP into your practiceBecome familiar with behavioral and motivational approaches listed aboveConnect with your local sleep medicine clinicReach out to us via Speakpipe with your questions and commentsSubscribe to the Practical for Your Practice PodcastSubscribe to The Center for Deployment Psychology Monthly Email at https://deploymentpsych.org/CDP-MED-Opt-In
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Investigating the Anrep Effect in Hypertrophic Obstructive Cardiomyopathy With Invasive Pressure-Volume Analysis.
Be alert to atypical symptoms, such as fatigue or reduced exercise tolerance, particularly in younger patients Serial Holter monitoring and attention to atrial ectopy burden can guide suspicion Wearables like the Apple Watch and Samsung Galaxy Watch are effective adjuncts for rhythm detection Early ablation may be appropriate, even in younger patients with a low CHA₂DS₂-VASc score, if they are symptomatic Collaboration between healthcare professionals and Electrophysiologists is essential to optimise patient outcomes The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia who attended Healthed’s face-to-face seminars. Atrial fibrillation – it's not an uncommon arrhythmia in Australia, is it? What are some of the environmental factors that have been identified as contributing to atrial fibrillation, apart from COVID? Why are we picking up more cases of atrial fibrillation? Are patients becoming more symptomatic? Obstructive sleep apnoea doesn't cause atrial fibrillation, but can it make it permanent? How can the pulmonary veins cause a cardiac arrhythmia? What are the indications for treating patients with ablation? How is it managed? What's the current thinking? How far should a healthcare professionals go in trying to detect atrial fibrillation in patients with unusual symptoms? Host: David Lim | Total Time: 32 mins Expert: Prof Rukshen Weerasooriya, Sub-specialist Cardiac Electrophysiologist Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.
In this special episode on Obstructive Sleep Apnea our host, Dr. Neil Skolnik will discuss an overview of OSA. In Part 2 we will take a deep dive into diagnosis, Part 3 will discuss treatment options, and Part 4 will look at cases. This special episode is supported by an independent educational grant from Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Paul Doghramji, MD – Medical Director of Health Services at Ursinus College, Attending Family Physician at Collegeville Family Practice Selected references: Diagnosis and Management of Obstructive Sleep Apnea - A Review. JAMA. 2020;323(14):1389-1400 Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments. Sleep Medicine Reviews 2024;78:1-12
In this Healthed lecture, Prof Brendon Yee explains how GPs and specialists can work together to ensure effective management, balancing road safety with appropriate return-to-driving protocols after successful treatment.See omnystudio.com/listener for privacy information.
Story at-a-glance Obstructive sleep apnea (OSA) affects nearly a billion people worldwide. It causes breathing interruptions during sleep that prevent you from reaching restorative sleep stages Common symptoms include loud snoring, gasping/choking during sleep, morning headaches, daytime fatigue, difficulty concentrating and mood changes that are often mistaken for normal tiredness Risk factors for OSA include age, excess throat tissue, weak throat muscles, structural airway abnormalities and vitamin D deficiency, which affects sleep regulation and quality Untreated sleep apnea leads to serious health complications including cardiovascular disease, Type 2 diabetes, cognitive decline, weakened immune function and increased accident risk Treatment options include CPAP therapy, oral appliances, orofacial myofunctional therapy and lifestyle changes like optimizing breathing habits, maintaining healthy weight and adjusting sleep position
In today's VETgirl online veterinary continuing education podcast, we discuss a potential way to help smooth out surgical recovery in those tricky brachycephalic patients. Listen along to hear the benefits one study found in having owners present to help recover their canine companion following airway surgery, as supported in the veterinary journal article, "Owner-assisted Recovery and Early Discharge After Surgical Treatment in Dogs with Brachycephalic Obstructive Airway Syndrome."
In today's VETgirl online veterinary continuing education podcast, Dr. Amy Kaplan, cVMA, DACVECC, MRCVS discusses a potential way to help smooth out surgical recovery in those tricky brachycephalic patients. Listen along to hear the benefits one study found in having owners present to help recover their canine companion following airway surgery, as supported in the veterinary journal article, "Owner-assisted Recovery and Early Discharge After Surgical Treatment in Dogs with Brachycephalic Obstructive Airway Syndrome."
This episode covers hypertrophic obstructive cardiomyopathy.Written notes can be found at https://zerotofinals.com/paediatrics/cardiology/hypertrophicobstructivecardiomyopathy/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.
Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. Obstructive sleep apnea (OSA) is the most common type of sleep apnea, characterized by repeated episodes of partial or complete blockage of the airway during sleep. These blockages occur when the muscles at the back of the throat relax excessively, causing the airway to narrow or close, and momentarily stopping breathing. This condition contrasts with central sleep apnea, where the brain fails to send proper signals to the muscles that control breathing. When the brain is deprived of oxygen during sleep, OSA can lead to a number of serious conditions affecting not only quality of life, but brain health and function. It is important to seek medical attention.Omid B. Mehdizadeh, MD, is an otolaryngology-head & neck (ENT) surgeon with particular expertise in voice, swallowing and airway conditions at Pacific Neuroscience Institute (PNI). A Los Angeles native, his career has spanned treating world-class opera and Broadway singers to surgical mission trips serving underprivileged and indigenous populations of Central America. Outside PNI, he has focused his time on educating medical and undergraduate students and providing medical care to disenfranchised populations through community clinics.
In this episode, Dr. Valentin Fuster highlights the Forest HCM study, which focuses on the withdrawal of standard care medications in patients with obstructive hypertrophic cardiomyopathy receiving afficantin. The study shows promising results: nearly half of the patients who attempted to reduce or stop their medications did so successfully, with significant improvements in functional class and symptoms. While the findings suggest that afficantin may allow for the reduction of traditional therapies, caution is advised, as not all patients may benefit equally.
In this episode, Dr. Valentin Fuster introduces a dedicated focus on hypertrophic cardiomyopathy, featuring a pivotal study by Dr. Martin Maron and Dr. lacopo Olivotto on the impact of aficamptin. This pre-specified sub-analysis from the SEQUOIA HCM trial aims to comprehensively evaluate the drug's effects on various aspects of disease burden, enhancing our understanding of its clinical efficacy.
In this episode, Dr. Valentin Fuster delves into the latest research on hypertrophic cardiomyopathy, highlighting the significant health status improvements achieved with the new cardiac myosin inhibitor, Aficamten, compared to placebo. The findings from the Sequoia HCM study reveal that Aficamten markedly enhances patients' quality of life and alleviates symptoms like chest pain and shortness of breath, paving the way for more effective treatments in this challenging condition.
This week I'm talking to Dr Jane Ladlow. Jane is a veterinary surgeon who is widely known as an expert on BOAS, or brachycephalic obstructive airway syndrome. BOAS is the umbrella disorder that covers a variety of different airflow obstructions in different flat-faced breeds such as the pug, French bulldog, and English bulldog. Jane developed the Respiratory Function Grading Scheme, a straightforward clinical exam which allows grading of a BOAS-effected dog. Jane works with the Kennel Club in the UK to promote this scheme, which is also being rolled out in other countries including the US. I was really pleased to get to talk to Jane about BOAS, her grading scheme, and what this means for breeding healthy brachycephalic dogs.
Obstructive sleep apnea in adults (1:40), e-cigarettes (5:30), breastfeeding support for healthy mothers and infants (7:40), hematologic emergencies (10:20), midodrine for recurrent vasovagal syncope (15:30), and cranberry products for preventing urinary tract infections (17:20).
CardioNerds Dr. Josh Saef and Dr. Tommy Das join Dr. Omkar Betageri, Dr. Andrew Geissler, Dr. Philip Lacombe, and Dr. Cashel O'Brien from the Maine Medical Center in Portland, Maine to enjoy an afternoon by the famous Portland headlight. They discuss a case of a patient who presents with obstructive cardiogenic shock. Dr. Bram Geller and Dr. Jon Donnelly provide the Expert CardioNerd Perspectives & Review segment for this episode. Dr. Maxwell Afari, the Maine Medical Center cardiology fellowship program director highlights the fellowship program. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. This is the case of a 42 year-old woman born with complicated Tetralogy of Fallot repair culminating in a 29mm Edwards Sapiens (ES) S3 valve placement within a pulmonary homograft for graft failure who was admitted to the cardiac ICU for progressive cardiogenic shock requiring vasopressors and inotropic support. Initial workup showed lactic acidosis, acute kidney injury, elevated NT-proBNP, and negative blood cultures. TTE showed at least moderate biventricular systolic dysfunction. She was placed on furosemide infusion, blood cultures were drawn and empiric antibiotics initiated. Right heart catheterization demonstrated elevated right sided filling pressures, blunted PA pressures with low PCWP, low cardiac index, and low pulmonary artery pulsatility index. Intracardiac echocardiography (ICE) showed a large mass within the ES valve apparatus causing restrictive valve motion with a low gradient across the pulmonic valve in the setting of poor RV function. Angiography revealed a large filling defect and balloon valvuloplasty was performed with immediate hemodynamic improvement. Blood cultures remained negative, she was gradually weaned off of inotropic and vasopressor support, and discharged. Despite empiric treatment for culture negative endocarditis and ongoing anticoagulation, she was readmitted for recurrent shock one month later at which time the pulmonic mass was revisualized on ICE. A valve-in-valve transcatheter pulmonary valve (29mm ES S3) was placed to compress what was likely pannus, with an excellent hemodynamic result and no visible mass on ICE. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls - Obstructive Cardiogenic ShocK Tetralogy of Fallot is the most common cyanotic defect and can lead to long term complications after surgical repair including chronic pulmonary insufficiency, RV dysfunction, residual RVOT obstruction and branch pulmonary artery stenoses. Chronic RV failure may be more indicative of a structural defect and therefore require interventional or surgical management. Valve thrombosis, infective endocarditis and obstructive pannus formation should be considered in the differential of a patient with obstructive shock with a prosthetic valve. Bioprosthetic pulmonic valve obstruction may be effectively managed with balloon valvuloplasty in patients who present in acute extremis but TCPV will likely provide a more lasting result. While valvular gradients are typically assessed via echocardiography, invasive hemodynamics can serve as a critical adjunctive tool in its characterization. Show Notes - Obstructive Cardiogenic ShocK Notes were drafted by Drs. Omkar Betageri, Philip Lacombe, Cashel O'Brien, and Andrew Geissler. What are the common therapies and management for Tetralogy of Fallot? Tetralogy of Fallot is the most common cyanotic defect in children beyond the age of one year Anatomic Abnormalities: Anterior and Superior deviation of the conal septum creating a SubAo VSD and encroachment on the RVOT.
Obstructive shock may be the least common type of shock, but it's no less critical. As part of Nurse PodCrawl 2024, Bryan Boling and Brandon Oto from the Critical Care Scenarios podcast join host Sarah Lorenzini in this episode to talk about the critical care management of obstructive shock. Together, they walk nurses through a patient scenario, detailing the diagnostic process of obstructive shock due to pulmonary embolism.Sarah, Bryan and Brandon review the three main causes of obstructive shock: pulmonary embolism, tension pneumothorax, and cardiac tamponade. They also discuss the importance of clinical assessments and diagnostic tools like ultrasound to distinguish between each cause, as well as considerations for treatment.This episode is the perfect resource for nurses who want to deepen their understanding of obstructive shock. Tune in now to hear insights from three experienced pros!Topics discussed in this episode:Patient assessment and key diagnostic toolsDiagnosing obstructive shock due to pulmonary embolismTreating obstructive shock due to pulmonary embolismTreatment implications for major causes of obstructive shockDiagnosis and treatment of tension pneumothoraxTreatment strategies for cardiac tamponadeKey takeaways on obstructive shock managementCheck out the rest of Nurse PodCrawl 2024 episodes around cardiogenic, hypovolemic, and distributive shock!Critical Care Scenarios: https://podcasts.apple.com/us/podcast/critical-care-scenarios/id1491559787How Not to Kill Your Patient: https://podcasts.apple.com/us/podcast/how-not-to-kill-your-patient/id1612099061Nurse Dose Podcast: https://podcasts.apple.com/us/podcast/nurse-dose-podcast/id1486427611The Q Word Podcast: https://podcasts.apple.com/us/podcast/the-q-word-podcast/id1407523803Straight A Nursing: https://podcasts.apple.com/us/podcast/straight-a-nursing-study-for-nursing-school-exams-nclex/id1210975738Up My Nursing Game: https://podcasts.apple.com/us/podcast/up-my-nursing-game/id1527032817Mentioned in this episode:Nurse's Week 2024 SpecialHAPPY NURSE'S WEEK! You can use code: NURSESWEEK2024 When you check out to get 50% off your first month of Rapid Response AcademyRapid Response and Rescue Intro CourseCONNECT
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