Justine Amdur: Thank you so much for joining us today. We currently have over 270 people registered to join us throughout the day. 80% of those are patients. The remainder are healthcare providers, caregivers, physicians, and professionals, so we want to thank you all for joining us and give a little quick shoutout to the people that are joining us worldwide from Ireland, Greece, Canada, India, the Netherlands, the United Kingdom, and Israel. So, we’re going global today and that is really, really exciting for the American Sleep Apnea Association. As you could see, our goal here and our mission is to improve the lives of sleep apnea patients, and whether we are able to see you in person at our summits or have something online like this, we feel that we can get that community connection going. So, I’ll let Adam go ahead with the next slide.
Adam Amdur: So, at the core of it all as the American Sleep Apnea Association or sleepapnea.org where most people enter our, our community and our, and our, and our channels, we are patient-driven. We are patients at the core as, as Justine so eloquently said earlier. 80% of the registrants for today’s virtual AWAKE summit meeting during this COVID era are, are patients. So, not only are we patient run, and led by an all patient board, we’re patient-centered. We’ve had our hands in, in, in the tech-savvy world as far as from the devices and looking at CPAP data, all the way to the consumer devices and a four-year ongoing sleep house study we did with the Apple Research Kit that just – we just wound down this past month.
The data for that study will be available with Sage Bionetworks in July for qualified researchers to look at. At the same time as we’re doing some of this groundbreaking mobile research, we are now very much education-focused which is – brings us to where we’re at today, our AWAKE program. AWAKE is the acronym Alert, Well, And Keeping Energetic. Considering that the world has changed and we’re now in a COVID era, and we are all confined one way or another, whether by ourselves in a solitary domicile or with our family or if, if we have to be a frontline essential worker and we’re going to have a lot of different doctors from all over the world hopefully frontline reporting from Italy, from the state of Washington with Dr. Vitiello. We are going to find out what is going on about COVID from a, from the patients asking the questions.
And once we sort of identify the biggest 800-pound elephant in the room, we’re going to start to look at the potential research that we probably should start to prioritize going down the road, and then what are the outcomes most important for our community. We can’t touch on everything today, but this is a start. Bear with us, it’s all virtual, so everyone’s connecting from all over the world, and we’re happy to have you all here. I’d like to always say this is Friday, and it’s Friday Night Live, it’s Friday Afternoon Live, but we’re AWAKE live, coming from the frontlines of Italy, state of Washington, and all over. And what it amounts to is this is really our opportunity to learn from the crisis. And as patients that have been sitting home and have been socially isolated, we have some of the most world-renowned experts and you’ll be seeing in the first panel coming up.
We’ll be led off by Doctor – Professor Maurice Ohayon from Stanford Sleep Epidemiology Research Center, is going to help guide us through to make sense of all this data that we are hearing about on the media, in the paper, online, and see if we can start to make sense of it and what it means for us today and tomorrow going forward, since this appears to be a marathon.
Justine Amdur: So, I just – I’ll take this opportunity just to talk a little bit about some of our current initiatives that maybe you have participated in or have seen in the past and if you haven’t, maybe this will be the opportunity for you to, you know, move forward and engage that way. You know, with education and awareness we do have our AWAKE network which includes the, the summit, our Facebook groups, our online forum. We have implemented a weekly speaker series within the past month or so, hopefully, you’ve been able to watch those with the physicians and experts that we’ve been able to have. And this coming fall, we will have the annual SLEEPtember Campaign coming up.
In regards to advocacy, we still have our interaction with the FDA. I had mentioned earlier in 2018, we had our AWAKE meeting, PFMPD with both the device and pharma side of the FDA –
Adam Amdur: Before you start throwing out, throwing out acronyms, Justine, PFMPD means Patient-Focused Medical Product Development. We were the first disease that the FDA actually brought CDRH the pharmaceutical side, their division, together with the device side to look out our disease to realize that we aren’t so siloed that we’re looking at this disease, because we’re mixing and matching all these interventions. Sorry to interrupt.
Justine Amdur: No, I appreciate it because I realized I said it, and then I couldn’t remember what it meant. So, I’m glad you, I’m glad you came in for, for that. And, and we are still engaged with the FDA and their patient-caregiver connection program. So, in regards to research, I’ll let Adam talk a little bit about that and give a quick update on the Sleep Health App, which he had mentioned just a couple of seconds ago and then our O2verlap Study with the COPD Foundation.
Adam Amdur: So, when, when we’ve been talking to our doctors online for the last few months with some of our AWAKE speaker series, we find out that when patients show up to the hospital, they’re, they’re labeled as PUI, Patient Under Investigation. And that’s really what we’re doing today. We’re going to sort of do an overall investigation of the consequences of confinement on our population in this era. We have done it in a pilot format with, with a mobile study with the Apple Research Kit for the last four years, but that is what I like to call pre-COVID. We’ve done it with – been an advisor and working with Dr. Sai Parthasarathy at the University of Arizona in his Peer Buddies Program that he’s done in Arizona. We’re trying to work with Procuri to be able to scale that nationally, so we can train peer to peer mentors all over the country.
Because unfortunately now that we’re seeing in this COVID era, the support, the education, and the handholding for our cognitively impaired patients has fallen off the radar. One of those programs that we’ve been running for the last few years is the CPAP Assistance Program which in light of the COVID era, we had patients and, and family members were, were sending us gently used and old machines. Because they’re most likely infected with virus, we’re no longer accepting them. However, we are offering our AWAKE Angels Program which we brought out of retirement after a couple of years ago during the hurricanes in, in Texas. And actually, Dr. Swick was one of the beneficiaries of that who you’ll hear from later on from Takeda Pharmaceutical.
And AWAKE Angels is very simple, is that people can make donations to sleepapnea.org and they can help provide replacement factory sealed masks for our patients that can’t afford them. Right now, we have a lot of patients furloughed, we have a lot of patients obviously on unemployment. We have a lot of patients that don’t have insurance, that are underinsured, that can’t afford their premium. So, the most important thing we can do for those that are at home right now is make sure that they have access to their re-supplies. So, come to sleepapnea.org, visit our CPAP Assistance Program and see that if you need re-supplied mask, CPAP masks, that we have them there for you. And that’s sort of – you know, we’ve helped over 7,000 individual patients get a full, full machine and mask hook-up over the last few years and we’re proud of that. But we know obviously right now, in this day and age, there’s, there’s a major need for machines and masks and, and anything we can do to get them out to our patients is, is, is what we want to do.
Justine Amdur: Looking ahead for our organization as Adam mentioned, we are, this year, 2020, increasing our virtual assistance options that, that we had. We’ll talk a little bit more about that later today. We have some new education materials coming out during SLEEPtember, in September of this year. We are really making a full effort to continue to build our community and give you the resources that you need, and then also be able to provide you with some opportunities for impactful research. Adam, before I tell everybody about the chat and Q and A, is there anything else that you would like to say in opening?
Adam Amdur: I just want to, I just want to let people know that we’re going to be focusing on the consequences of the depression that we’re dealing with, the anxiety, the disorientation, the cognitive decline. Dr. Vitiello’s going to be talking about the perspective from the geriatric community and what’s going on and what he’s seeing in his backyard. And if, if we’re lucky enough to get Dr. Plazzi reporting directly from Italy and Bologna, we’ll be able to ask him about what’s going on with all these new pediatric stories. But with that, I would love, and I’m honored and humbled to introduce – go ahead, Justine.
Justine Amdur: Sorry, before, before you introduce your, your next group, I just wanted to speak directly to our attendees and tell you that if you have – down on the bottom of your screen, you have a chat function and, and a Q and A function. And I will be monitoring the Q and A function for the panels, and so after the experts and individuals speak, if you would like me to review those questions and post them to the, the expert speakers, please put them in the Q and A. The chat function enables you to speak to the panelists or to other attendees. We do have a lot of our staff in there as attendees to help you with some questions. There’s a lot going on so I’ll try my best if you pose a question to the panelists in chat to answer, but I’ll just leave it at that. It’s a, it’s a new Zoom world and, and we’re excited to have everybody here today. And so, thank you for your patience, and thank you for your understanding of – as we all work through this together. So, with that, I’ll let Adam go ahead and get ready for the, for the first talk.
Adam Amdur: As they say, the show must go on and we were always scheduled to have our summit today, and this is our third annual and we- this is now – we’ve, we’ve done one in D.C., we did one in the Presidio in San Francisco last year, and this year, we’re lucky enough to have doctor – Professor Maurice Ohayon from the Stanford Sleep Epidemiology Research Center come and moderate and help us lead and understand what is going on with all the information that we are getting out there from all the different channels now that everyone is home and confined and isolated and somewhat disorientated and, and you’ll see as we go through today, even this new sort of virtual world of doing webinars when everyone’s not in the same room, it’s one thing to broadcast out, it’s another to try to get everyone to connect with, with their high-speed connections and bandwidth and things of that nature.
Dr. Ohayon’s going to moderate the, the panel and Dr. Michael Vitiello from the University of Washington, who’s a specialist in psychiatry in the geriatric world will be joining us to give us a first-hand account from the state of Washington. And if we’re lucky enough to get Dr. Giuseppe Plazzi from University of Bologna in Italy to, to log in, we’ll be able to get a first-hand account of what’s going on. Unfortunately, Dr. Plazzi, to the best of our knowledge, as of last night, there’s been some relapses in Italy, and might have been called away. So, if we’re lucky to get him, it’ll be great. If not, we can always touch base with him post-meeting. So, with that, I’d like to introduce my friend, a mentor, and someone who’s been a great guide for sleepapnea.org and the American Sleep Apnea Association, since last summer with the, the passing of the baton and the torch from Dr. Christian Guilleminault. Professor Ohayon is, is a – has a lot of skills and brings a lot of worldly and global knowledge as an MD, as a Ph.D., as a statistician, as an informatician, as a behavioral expert.
And will be able to help us make sense of our sleep, our sleep apnea, the sleep quality, and what this confinement is doing to us right now and how we best can adjust to it going forward. So, with that, welcome Dr. Ohayon.
Professor Ohayon: Welcome and thank you very much for your welcome, and for the introduction of our discussion. Like you said, we have, we have the problem with Dr. Plazzi, that presently he is held by the emergency room in Italy and maybe he will join us. I, I wish to have his presence, but presently we have Dr. Vitiello with us and Professor Vitiello is a professor at the University of Washington and Seattle and he is professor of psychiatry and behavioral sciences, and he will speak with us about the consequence of confinement. Confinement is one of the most important elements that is for sure appearing with the COVID epidemic and the consequence on the sleep, on the mental health are really very important.
And I hope to see Michael Vitiello joining us. First, Michael, around you, in the state of Washington, and in Seattle, in particular, what are you seeing presently?
Dr. Michael Vitiello: Well, we are a microcosm of, of the United States and of course, of the world. We were the first identifiable case at least, for the moment, identifiable case appeared here in Seattle, actually at a long-term care and nursing home facility. So, the geriatric population has been particularly affected by this. As people who have been following this know, most of the deaths actually in New York, for example, have been in long-term care and community facilities. And I don’t just mean nursing homes, for older adults, but all of the congregate living facilities that, that older adults tend to use, whether it be a retirement facility or a continuous care facility that goes from independent living to nursing home facilities, are being severely impacted.
There’s a count in King County that we are seeing COVID cases and I think it’s over 200 of these facilities now and there have been a considerable number of deaths. The problem that we’re all experiencing with confinement I think is particularly acute in the older population, for a number of reasons. Many of them are in confinement in small units, in these homes. And they’ve lost really all the indicators, the social indicators, the temporal indicators that allow for normal life, you know. Maurice, you alluded to the relationship between sleep and mental health, well both mental health and sleep rely on good circadian rhythms. And you have a weakening of the circadian rhythm in older adults anyway.
And when you take away the normal cues of the ability to get out of your apartment, to exercise, to eat at a regular time, all of these things are being impacted severely and probably adding to the burden on, on individuals. And individuals that are compromised with some cognitive compromise, they may be exacerbating their compromise. And as a result, you get this kind of, if you will, spiraling of poor sleep, inability to cope, poor response to the stress of confinement, which further exacerbates things, makes sleep somewhat worse. So, it’s, it’s a difficult situation and –
Professor Ohayon: Do, do you see consequences on the sleep duration and the sleepiness of these elderly people?
Dr. Michael Vitiello: To be honest, we don’t have that data yet. You know, this is an emerging problem and I’m only seeing it not from a research point of view or even an extensive clinical point of view, but simply can infer from what we know about how sleep responds to perturbations, that in all probability, what we’re going to see is people have more opportunity to sleep because they’re locked in their homes, and that there’s probably going to be a breakdown in the circadian phase of sleep, that is a principle sleep period and you’ll probably see people doing napping and fragmenting their sleep which we know is not a healthy response.
Professor Ohayon: Yeah. But in terms of sleepiness, in terms of sleep duration, oversleeping, do you see some, some consequences that you, you, you are afraid to see appearing in this population?
Dr. Michael Vitiello: Well, I can’t say directly but, but yes. I mean if we know that, that severe changes in sleep increase the likelihood of morbidities and mortality. It may be that we’re going to see additional burden added onto these people. I don’t know what the direct effects would be on say sleep apnea per se, but if people are sleeping more and out of circadian phase and with fragmentation, you can increase their risk of daytime functional limitations, increased risks of falls, all these, all these of things follow when sleep is significantly disturbed.
Professor Ohayon: And in the institution, do you have some return from – institution for elderly people?
Dr. Michael Vitiello: I’m sorry, I don’t follow that question.
Professor Ohayon: Yeah. Is – do you have some feedback from institution of elderly people in the region of Seattle?
Dr. Michael Vitiello: Ah. Well, to a degree. I can’t speak to individuals. I have some experience with some of these group living situations, and I know that they are trying to do the best they can with their elderly residents and, and it varies tremendously. One thing I do want to point out is that although we’ve seen a lot of COVID morbidity in lower socioeconomic status, lower socioeconomic status people, this is not a respecter of, of economic status in older populations. Even some of the most elaborately funded and high well-healed independent living facilities in Seattle have seen COVID cases and indeed deaths where some of the middle of the road have not. So – go ahead.
Adam Amdur: Let, let me ask, let me ask you, let me ask you a question, doctor. Is, is – I know on the west coast, you know, there, you know, there’s I guess a different sense and sensibility as far as – are, are they sending those elderly or geriatric or, or long-term care patients back to the homes with the virus?
Dr. Michael Vitiello: There are – well –
Adam Amdur: There’s a lot of that going on in the east coast obviously.
Dr. Michael Vitiello: Yes, certainly. When the lockdown began, people were – it was explained that for most people they were expected to hunker in, hunker down in place. People – families had the option of bringing their elderly home if they wanted to but the vast majority in, certainly in independent living situations, have stayed in place. But what you have is a situation where you have congregate living, you have people that are isolated into their individual units but are still being exposed, if you will, to the staff. And you know, and these – and if I may speak about risk, these are the young people that we’re now seeing go to the bars in states that are opening and not socially distancing and not wearing masks, and interacting very closely, and quite honestly, they’re going to be the ones that communicate these diseases – this disease, if you will, to the older populations.
And that’s the thing that people don’t recognize. It’s not – if you’re 20, you take the attitude well nobody dies when you’re 20. No, but you’re potentially spreading it to the people that may, may die, and have much greater risk.
Adam Amdur: Yeah, I guess as a behavioralist, I think we’re going to learn a lot about what, what’s really going to happen now with, you know, the young voters, the young kids who, who – whether they show up to vote, do they care anymore? Do they, you know, there’s, there’s some of the negative connotations going on with this is the so-called baby boomer disease, but we’re seeing it doesn’t discriminate. What shape or size or, or what, what socioeconomic background you’re from, or even what country you’re from.
Dr. Michael Vitiello: Oh, yeah. And we’ve seen that in some of our political leadership who have expressed an attitude of well, they’re kind of old anyway and they’ve got illnesses so what the heck? But it’s a very different thing when it’s your family member.
Professor Ohayon: Do you see a surge of mental health problem in this population consequently with confinement?
Dr. Michael Vitiello: Well, you’re going to see increases in anxiety, you may see increases in depression. It’s going to vary from individual to individual but I think if we’re, if we’re able to do population surveys, we would see much more situational anxiety and depression, especially given the nature of what – how we know confinement works. I need to use a crude analogy but we use solitary confinement as a punishment in the prison systems. Well, we’ve effectively enforced through this through a greater or lesser degree on everyone in our culture. And it’s one thing to be confined in a family unit, it’s another thing to be an older adult or an older couple that are then isolated from everything they know and all I can say is heaven bless our technology because you know a lot of these facilities that I’m talking about, one of the upsides is, they’re trying to facilitate social connection with their populations by making available these kinds of technologies, even if the older individual doesn’t have one. That they can provide iPads that are linked to Zoom and linked to the other, the other social media that allow for, at least some contact, even if it’s only virtual.
Professor Ohayon: Yeah. I think that is a way also to fight this sleepiness that must be present, inactivity in all these institutions, is to put the people in contact, also virtual contact, and to fight this mental isolation. Because in fact, the confinement, at the end, with the elderly population, is going on mental isolation of the people.
Dr. Michael Vitiello: Oh, absolutely. I mean, again, there’s a total breakdown in the social and environmental cues that allow us to maintain regular good quality sleep. You know, even meals. Let me give you the example of meals. We don’t think of that as a zeitgeber , as a timekeeper that helps maintain our circadian rhythms and, and therefore inform good sleep. But it is one of the multiple factors. It’s just that light is the most powerful. Well, you’re now less likely to go out and get light. You are getting meals not at the normal standard times that you’ve typically experienced them but at times that the facility can provide meals because they’re not set up to go around and drop trays off in all of these houses, in all of these units, but that’s what they have to do.
So, some days, you’ll get your lunch at 11, and some days you’ll get your lunch at two, the same thing for your dinner. So, you’re getting this wide variability in all of these social cues. You can’t go out and exercise, so you’re not getting as much light. You know, you’re not regularly doing the things that you do. And they can’t do group activities. So, all of the activities that used to be organized, now you have to worry about social distancing or masking or whether we can do them, and these things will change over time as this becomes, I hate to say it, but a more – I won’t say normal, but more – that we become more experienced with it, and we have more practice at it. But if we don’t continue to do these things, we will see even greater morbidity and mortality in the older population.
Adam Amdur: I’d, I’d be remiss to say we’re all working from home, that’s why we don’t have masks on but I’m sure as, as two gentlemen of science, that you’re, you’re the first to put on your masks when you go outside the door, knowing that you got to protect yourself, but also those around us. And this behavioral change alone is, is, is – it’s going to be a – it’s not the new normal, this is what we have to do to adapt to this new world we’re in.
Dr. Michael Vitiello: Yeah. Well, it is as Dr. Fauci suggested, he thinks that handshakes should cease.
Professor Ohayon: Yeah. And to continue on that, one of the biggest consequences of elderly people is also the fact that they are isolated from their grandchildren. Children are not going with them, they are more isolated from their family and all of that I suppose has a big impact on their mental ability because they are really isolated, the interaction are minimal, actually in the institution, I suppose that the restriction in Canada must be as bad as what we have here in America. Very severe.
Dr. Michael Vitiello: Yeah, in Canada, actually, yeah, they, they are in lockdown. There’s been some significant differences that I don’t fully understand in Canada, but Quebec has been particularly hit whereas most of the rest of the Canadian provinces have not been. It may have something to do with the social structure and the French-Canadian population, that they interacted more often and more intimately and more rapidly. Well, you spend time in Canada, Maurice.
Professor Ohayon: Ah, yeah. It’s why I was referring because this morning I was speaking about this situation for the elderly people and that is really a big preoccupation because they are really totally isolated. You have the same situation in France. You have the same situation in Italy, and sure that I, I am sorry to do not have with us our friend Giuseppe Plazzi, that could have spoken about the situation in Italy. That seems to, to go again, not so good. It seems that a number of cases are suddenly increasing again for Bologna, at least.
Dr. Michael Vitiello: Yeah. Well, I am, as you know, not an epidemiologist but I, I do know enough to be dangerous and the approach that’s been taken across the United States is guaranteeing us, guaranteeing us resurgence in, in this virus, and another massive wave of morbidity and mortality. There, there is no way it will not happen. Even though I’m, I’m happy to report that in King County, my county today, for the first time in two months, we have no recorded COVID deaths, first time. Usually, we’ve had ten to fifteen reported daily. But our trajectory is down. But –
Adam Amdur: How long, how long have you been at a stay at home in King County?
Dr. Michael Vitiello: We’ve been, we’ve been, we’ve been – we are now in our ninth week. So, we, we started early. We didn’t start quite as early as many, but we’ve started early and we’ve maintained fairly good control. And as a result, we’ve managed to, to blunt the curve and we’re on a slight somewhat downward trend. New York is similar. A number of the states are similar. But, you know, when we hear that the nation has flattened the curve, that is not true. I repeat that is not true. The reason we see the flattened curve is because the states such as my own and New York, that have succeeded in somewhat wrestling with this beast, have artificially modified the curve because if you take us out of the equation, most of the rest of the country is on an upswing. And has not yet experienced the top of their surge.
Adam Amdur: I, I wanted to remind some of our attendees and, and guests that, that are joining us today. I know that – I see some questions in the chat. It’s easier if you post your questions in the Q and A function on the bottom footer of the, of the Zoom browser. And I did see one, one, one mention that came, that, that really, I think lays a, you know, some groundwork to what you’re talking about Dr. Vit, Vitiello, and that’s that Quebec and border – Quebec is on the border of New York. So, it makes sense that this transmitted one way or the other, across borders or, or I think now that if you’re seeing recurrence in some of these hospitals, it makes sense that these young kids are the ones that are suffering it from the most, and then going out.
Dr. Michael Vitiello: It’s a possibility. But Ottawa is also on the border from New York, and so we don’t see the same thing in the neighboring province just to the left, which is a different ethnic background, for example. The, the bulk of the people. Ottawa is a much more quote British, classic British-Canadian population, and Quebec is really French-Canadian, and they are different, very different cultures. It would be interesting to see if, if Montreal is experiencing similar rates to Quebec City, two cities that are, that are quite different, with Montreal being more metropolitan. Quebec City being more French-Canadian.
Adam Amdur: One, one of, one of our ongoing, one of our ongoing patients and AWAKE leaders, his name is Kevin Bradley, he’s going to be on our Frontline Panel on the second or third panel and he’s, he’s actually a transport, a transplant coordinator nurse in Toronto. So, he’ll be able to give us first hand because he’s – basically, his job has gone to completely COVID, you know, working on the COVID teams, you know. The, the normal world before is not operating. So, I’m sure Kevin will be able to speak to that, on that panel.
Dr. Michael Vitiello: But Adam, you do raise an important point which is borders. Viruses know no borders. And so, it does not matter that Washington and California and Oregon have, have somewhat mastered the beast currently because as soon as people come in from other states that are carriers, we will likely experience new flare-ups.
Adam Amdur: And, and I’d be remiss to say and I meant to say this in the opening, you know, it’s, it’s, it’s – we’ve almost become numb to the world we’re living in, in the last few years, because of the 24-7, and now that we’re confined but, you know, we haven’t even acknowledged in this, in this country, or started to grieve for the, the 86 or the 80 plus thousand that, that we already know that have passed, let alone we know that’s on horizon. I mean we haven’t even started to deal with that from an emotional standpoint. So, we have people at home, they’re confined, they’re separated from their loved ones and their end, end of life. I mean, all the normal societal routines and things that – all the safeguards are gone.
Dr. Michael Vitiello: Oh, yeah. You’re right. I mean, this is, this is a, a psychological tragedy in the sense that people get no sicker when they’re dying, other than nurses garbed in, you know, incredible protective gear and then the families can’t attend a funeral. We’re doing mass graves. I mean, realistically, you know, we have bodies stacked up in refrigerator trucks until they can be buried without ceremony. And then we have families that are left with nothing of the standard grieving processes. And then when you speak to the numbers, 80,000 the current number or slightly above, is undoubtedly a lower estimate, and we haven’t even reached the top of the curve yet. So, we can anticipate at least doubling that, at least doubling that. And again, I, I – this is not epidemiology, this is logic 101.
Professor Ohayon: Thank you. So, we were looking at this consequence, but for sleep per se, for the elderly people, because in fact what is happening is that sleep apnea is also is maximum hit with old adults, with people over 50. So, do you see a surge, something happening there?
Dr. Michael Vitiello: Don’t know, but it does raise an interesting question. I mean, we know about all of these risk factors but I haven’t heard any reports and I don’t know if it’s been examined as to whether apnea per se, you know, apnea patients per se are at greater risk. You know, it interacts with obesity, it interacts with age, but is it an individual risk factor? I mean, given that it’s pulmonary in nature, at least, to a degree, does that give COVID, you know, a little extra leverage? As – in terms of confinements’ impact on sleep apnea, I quite honestly do not know.
Professor Ohayon: Yeah. We have, presently, we are too early. I suppose that the data are collected, I am sure the data is collected, our center is trying to collect this data but it’s too early.
Dr. Michael Vitiello: Sure.
Professor Ohayon: Nothing is analyzed, nothing is really on its way to be published or to be correlated with other research.
Dr. Michael Vitiello: Yeah.
Professor Ohayon: Everything is on, ongoing.
Dr. Michael Vitiello: Well, it’s going to be an interesting exercise to tease out because of the, the cross-correlations between, between the other morbidities. I mean if, you know, if you look at it, obesity, if you look at metabolic syndrome, if you look at apnea, there are, there are relationships, amongst those, and then you add COVID on top of that. So, being able to parse it out as indiv – as independent risk factors is going to take some work, Maurice, that you do.
Adam Amdur: I, I think that’s the beauty and, and, and, and if you’re looking to be an optimist in, in, in light of this terrible debacle, is that, that, that’s the crisis and that’s the opportunity that this has presented us, is to sort of finally answer all these correlation, causation, questions, chicken or egg, because it’s, it’s affecting people, whether it’s the heart, the, the, the, the edema, the encephalitis, the respiratory, the autoimmune. What, whatever the reaction that, that people are manifesting as – when we learn back, it’s got to be some sort of sleep component, sleep breathing component.
Dr. Michael Vitiello: Yeah, and we haven’t even touched on the idea that poor sleep can change immune function and increase inflammation. And so, if you have poor sleep and you’ve got compromised immune function, does that put you at greater risk if you’re COVID exposed? All these are, are profoundly interesting questions, that sounds cold, doesn’t it? But, but you know, you’re right, if – when faced with this severe case of lemons, we need to do what we can to learn from it, certainly so that going forward, we’re not as depilated again.
Adam Amdur: I think that’s sort of a good segue, Maurice, for our next sort of discussion which is really the future of, of where the research goes and, and what our job as a patient advocacy association is going to do. Because I, I think those questions are really what’s happening right now. Let’s, let’s, let’s evaluate everything. We’re the one chronic disease that seems to overlap with not only all the devices and, and different things that people are using, but also the pharmaceutical interventions, and also the behavioral. But also, from a, from just a range, it’s everyone sleeps. There’s no one – there’s no exclusion criteria. So, it is a cradle to grave sort of thing that we do all our lives. You know, now that people are home and you know, almost – I think I saw Governor Cuomo say that he’s been doing –
Dr. Michael Vitiello: 75 days.
Adam Amdur: 75 daily briefings. I mean, that’s, that’s, that’s – I mean, we’re getting close to three months now, and this is just the first inning. We know it.
Dr. Michael Vitiello: Yeah, and, and a tip of the hat from the west coast to Governor Cuomo. He’s been a real wartime leader.
Professor Ohayon: So, maybe, thank you, Michael. We can – I suppose, Adam, that we can close the, the discussion saying that again, thank you very much, Michael, for being present today.
Dr. Michael Vitiello: Surely.
Professor Ohayon: And for –
Dr. Michael Vitiello: Chris, Chris – Justine has her hand up.
Adam Amdur: Yes, I was going to say.
Dr. Michael Vitiello: That’s one of these.
Adam Amdur: No, no, no.
Justine Amdur: Oh, no, it’s a question. You’re correct. We had a few questions come in and they – some of them relate to some future topics that we are going to, to touch on, but I just want to pose them to you to see, you know, if, if you have anything to, to say. I think, I think the first question from Doug H is something that’s been coming up a lot in regards to CPAP use and that is the question of using the machine and it errors, and so I don’t know if, if, if either of you feel comfortable talking with that. We do have some other MDs coming later in the day that I can pose the question to, but if there is anything that you have seen, have heard, have, you know, gotten some information on about using CPAP, you know, at your home, with your loved one, your bed partner, taking it to the hospital if, if you know, something does happen.
Dr. Michael Vitiello: I’m going to beg off as a psychologist and, and let the physicians address that.
Justine Amdur: Okay.
Dr. Michael Vitiello: I’ll get in trouble if I talk about treatment.
Justine Amdur: No problem. No problem. I’ll hit them up later. I just figured I would ask, just because I didn’t want Doug to think that I, I didn’t see his question and, and wouldn’t ask.
Dr. Michael Vitiello: It’s an important one.
Justine Amdur: And –
Adam Amdur: It’s, it’s an important question, Justine, and something we’re going to get to today as far as the, the impact of the CPAPs as the primary intervention for, for, for this, for our disease. And, and, and the benefits and risk about that. We’ve been doing that ongoing on the speaker series. It looks like the, the, the, there is no definitive answer yet but I think some of the other doctors are going to have some experienced perspectives on it.
Justine Amdur: Okay.
Adam Amdur: That you know, we’re, we’re seeing an increase in coronary care in cardiac units and cardiac cases because we assume, we won’t know this until later on, that people aren’t using their CPAP because they’ve been scared off by it. So –
Justine Amdur: Someone, Mohammad actually asked a little bit more about the frontline that we’ll talk about later, but he had some questions in regards to light therapy and people that do shift work. Do either of you have a little experience with that?
Dr. Michael Vitiello: Lots.
Justine Amdur: There you go.
Dr. Michael Vitiello: Well, shift work, it depends on whether you’re considered an essential worker and, but most shift work is essential work, more often than not. So, those people are continuing to do their shifts, but we do know that shift work is a risk factor for a lot of negative health consequences. So, we’ll just leave that at that. Light therapy is very useful.
Adam Amdur: Yeah, hold on, doctor. You don’t have to be shy about that. We’ve known that NCIA has known for ten years that, that shift work’s a direct carcinogen for cancer, nobody talks about that.
Dr. Michael Vitiello: Well, no, no, I just, you know, it’s – I can only speak to so much. But if you want to be bold about it, there you go, Adam. I just wanted to also say that certainly light and lightboxes can be very useful in certain situations, particularly if you are, number one, sensitive to light deprivation in winter and might have something like Seasonal Affective Disorder. And particularly, if you’re living in higher latitudes like we do up here in Seattle, where we have significant Seasonal Affective Disorder, and certainly, in Alaska, our colleagues, there’s a lot of light therapy that’s used up there. And that’s usually used to extend the photoperiod and to give better timing signals as to when it’s appropriate to wake up.
Male Speaker: And that concludes our first panel on confinement, impact on sleep, sleep apnea, and sleep quality. We’d like to thank our moderator Professor Maurice Ohayon and our feature panelist Michael Vitiello. Coming up next is implications on the future of sleep apnea research and advocacy. Please stand by and we’ll be ready shortly.