Winter 2019

Sleep Apnea Signals

Researchers from the medical and dental schools work together to improve diagnosis and monitoring.

By Courtney Hollands

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Illustration: Shutterstock

About thirty million U.S. adults have obstructive sleep apnea (OSA), a condition associated with stroke, heart disease, and neurocognitive dysfunction, among other serious conditions—and its prevalence is on the rise.

The gold standard for diagnosing OSA is the polysomnogram, an overnight study that monitors various factors, such as airflow and oxygen, during sleep. But the procedure is costly and usually has a long waiting list. Meanwhile, many people with sleep apnea don’t receive medical attention at all, since they aren’t aware of or don’t exhibit the common symptoms, which can include excessive daytime sleepiness, snoring, excessive nighttime urination, and diminished concentration. As obesity rates rise, more people are being diagnosed with OSA, as carrying extra weight can lead to breathing issues during sleep.

For all these reasons, researchers from the School of Dental Medicine and the School of Medicine—and the associated Center for Sleep Medicine at Tufts Medical Center—have come together to find new ways to improve diagnosis and monitoring of the condition. With the help of a Tufts Collaborates grant, the team will examine blood samples from subjects participating in a pilot study to pinpoint biomarkers for OSA.

“We are trying to expand and develop the care of OSA,” said Leopoldo Correa, associate professor, director of the Dental Sleep Medicine Fellowship program and division head of Dental Sleep Medicine Section at the Craniofacial Pain Center. “The vision of the study is to identify biomarkers for sleep apnea that may lead to an earlier diagnosis and more personalized and effective treatment.”

In the study, Tufts researchers are measuring patients’ plasma extracellular miRNA (Ex-miRNA)—small noncoding RNA molecules—which are markedly altered by the hypoxia, or oxygen deficiency, caused by sleep apnea. They then compare the Ex-miRNA before and after the patients’ use of a common therapy for sleep apnea, the continuous positive airway pressure device, or CPAP, over the course of ninety days. Through this, the researchers hope to discover the components in the blood that best measure the response to CPAP therapy. Down the road, this research could lead to a blood test akin to the HbA1c, an important diagnostic tool used for evaluating long-term blood glucose control in diabetic patients and identifying patients at risk for diabetes.

While co-investigator Khalid Ismail—director of the Sleep Medicine Fellowship program at Tufts Medical Center and an assistant professor at Tufts University School of Medicine—said the test isn’t meant to completely replace the overnight sleep study, “it will be a good way to screen, depending on how sensitive and specific it is.”

Armed with results from the pilot study, the team will then seek funding from the National Institutes of Health for a larger study. “There is a need for a multidisciplinary approach for the management of these patients,” Correa said. “Here at Tufts, we are already doing that— we are leading the field of dental sleep medicine due to a very strong and close collaboration with the medical school.”

Ismail agreed. “We’re lucky to have a division of Dental Sleep Medicine that works on fabricating mandibular advancement devices for treating OSA,” he said. “We send our fellows there; they send their fellows to our clinic. We collaborate on seminars and residency programs.”

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