Home monitoring of REM most appropriate for those likely to suffer from sleep apnea, and for follow-up of treatment on such patients.
By JUDY SIEGEL-ITZKOVICH
Until now, the only way to identify rapid-eye-movement (REM) sleep - the stage during which you dream - was to spend the night in a sleep lab. But the Technion-Israel Institute in Haifa and Itamar Medical in Cesarea have developed a device that identifies REM sleep at home when it's mounted on the sleeper's wrist and attached to a fingertip.
Technion sleep medicine expert Prof. Peretz Lavie and Itamar Medical's Sarah Herscovici, Avivit Pe'er and Surik Papyan recently published an article in Physiological Measurement about the device, which uses an automatic REM sleep algorithm based on peripheral arterial tone in the finger and movements of the wrist.
Knowing when patients are in the REM phase is important because it is the time when they dream and its amount and timing indicate the quality of sleep. Sleep lab equipment includes encephalographic records, and can't be used in the home.
REM sleep, wrote Lavie and colleagues, is associated "with a characteristic increase in peripheral tone manifested as robust vasoconstriction in the fingers' arterioles" (meaning that when people are in the REM phase, the tiny blood vessels in the fingers constrict, and this can be sensed by the device's finger probe.)
Lavie says that home monitoring with the Watch-PAT, an ambulatory device intended to diagnose sleep apnea and which incorporates the REM detection algorithm, is most appropriate for at least two types of patients - those very likely to suffer from sleep apnea (the obese sleepy snorers), and for follow-up of treatment on such patients.
"This can considerably lower the price of sleep apnea management and allow more time to focus on treatment."
Lavie notes that the device cannot replace sleep lab equipment in every case, as it detects only REM periods that occur after the first 45 minutes of sleep. So it cannot be used for people thought to be suffering from narcolepsy, who start their sleep with a REM period, or other changes in the REM-non-REM cycle. "Narcolepsy, however," he notes, "is a very rare disease among Jews."
However, the device can add important clinical information about those who are diagnosed with sleep apnea, as it shows the effect of the disorder on sleep architecture, and can also identify those patients that have what is termed REM-related breathing disorder - apneic episodes that occur exclusively during REM periods.
The Itamar Medical Device is already sold all over the world to sleep clinics and sleep medicine specialists. Several large American health maintenance organizations - such as Kaiser Permanente, one of the largest private health insurance companies in the US - is using it. It is also available at the Technion's Sleep Medicine Center.
SURF IN YOUR HOSPITAL BED
Instead of just bringing a toothbrush and clean underwear when hospitalized in Clalit Health Services medical centers, patients will soon be able to pack their laptops and surf the Internet using wireless services. The 012 Golden Lines company has won a tender to supply Internet services to the health fund's 14 hospitals, including Wi-Fi. All patients and visitors will be able to use the service free if they have laptops with wireless capability. Such services will also be provided in the main Clalit community clinics.
Rafi Hirsch, director of communications infrastructures and information security at the country's largest health fund, said the service will enable patients and their families to keep in touch with the world outside the hospital via Web sites and e-mail. "We see it as an important contribution to patients' recoveries," he said. The company previously set up wireless services at branches of Yellow stores, Ben-Gurion Airport's Terminal 3, downtown Jerusalem, the Dizengoff Center and various leading hotels.
DRAFTING THE TOOTH FAIRY
A multinational research team headed by University of Southern California dentists has successfully regenerated tooth root and supporting periodontal ligaments in an animal model. The breakthrough, said, chief research Dr. Songtao Shi, holds promise for clinical application in humans.
The study was published in the December 20 issue of PloS ONE. Using stem cells harvested from the extracted wisdom teeth of 18- to 20-year olds, Shi and colleagues created enough root and ligament structure to support a crown restoration in their animal model. The resulting restoration closely resembled the original tooth in function and strength.
The technique relies on stem cells harvested from the root apical papilla, which is responsible for the development of a tooth's root and periodontal ligament.
"The apical papilla provides better stem cells for root structure regeneration. With this technique, the restoration is not quite as strong as the original tooth, but we believe it is sufficient to withstand normal wear and tear," says Shi. He hopes to move the technique to clinical trials within the next several years - a potential boon for dental patients who are not appropriate candidates for implants, or who would prefer living tissue derived from their own teeth.
"Implant patients must have sufficient bone in the jaw to support the implant. For those who don't, this therapy would be a great alternative....We will be able to provide not only this technique, but other new therapies utilizing a patient's own stem cells. This is a very exciting discovery, and one I hope to see in widespread clinical use in the near future," says Shi.
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