Expert Interview: Dr. A. Joseph Borelli

OutaSync wrote:I signed up but never got an email with instructions on how to dial in. Can someone share theirs?

PM sent

Thank you, Tom.

When: Tuesday, April 23th, 2013
Time: 8:00 P.M. Eastern / 5:00 P.M. Pacific

Three Ways to Listen in:

1. By phone: For local call-in number: click here. Access PIN 208027#

2. Or to listen in on your computer's browser, click hereat the designated time.

3. Via Skype: Call join conference and enter PIN 208027#

Duration: Approx. 60 Minutes

Hosted By: Dr. Steven Y. Park of http://www.doctorstevenpark.com

Teleseminar Title: Expert Interview: Dr. A. Joseph Borelli on Brain Dysfunction and Sleep Apnea

Wow, great information in this interview. Turns out that not being compliant with cpap seems to be a highway to dementia (that's putting it in my words *smile*). And the relationship between sleep breathing disorders and Alzheimer's is being looked into as well. Also, mentions of titrating for arousals versus just open airway, and lots more.

There was one interesting tidbit about a future potential cpap replacement involving a tongue muscle stimulator via neurostimulation that causes your airway to be clear without using cpap when sleeping. Under study and development (ImThera.com: http://imtheramedical.com/), and pilot studies are being put together. Makes sense, remains to be seen what class of problems can be helped and how effective it is, of course *smile*.

Get the MP3 if you can and listen to this one, it's very interesting. I think that this URL should work, worked for me:

http://archive.org/details/Borelli

That is cool RogerSC. Thanks for the link. I will try to listen to it in the next couple of days.

Very interested to hear what he has to say about dementia. But based on experiences with friends and family members, I am already 100% convinced that untreated sleep apnea plays the major role in the proliferation of dementia.

Will a text of the interview be published?

I listened to part of the interview.

Interesting what he said about titrating to the arousals not the airway.

If true, this shoots a big hole in the theory prevalent here that we can use data from our CPAP machines to get a good titration?????

Not Fade wrote:I listened to part of the interview.

Interesting what he said about titrating to the arousals not the airway.

If true, this shoots a big hole in the theory prevalent here that we can use data from our CPAP machines to get a good titration?????

I believe that Stanford is the ONLY lab in the country that titrates this way and I'm not sure if they do 100 percent of the time or only for patients that still feel like a daily train wreck in spite of their low AHI.

I still have a high AHI so I can't remember exactly what was said.....seriously, I can't remember.

I still have a high AHI so I can't remember exactly what was said.....seriously, I can't remember.

I understand. Thanks for the comments.

Praying that you get that AHI to healthy levels.

Not Fade wrote:

I still have a high AHI so I can't remember exactly what was said.....seriously, I can't remember.

I understand. Thanks for the comments.

Praying that you get that AHI to healthy levels.

On a more serious note it IS an interesting concept - titrating to prevent arousals as shown by EEG.

But I am curious as how they determine that the arousal was caused by a breathing event and not RLS or something else.

I guess it's easier if there's an apnea that only lasts 8-9 seconds....which of course doesn't meet the 10 second minimum at the same time as the arousal. I guess if you have several hundred of these a night it's easy to understand why the patient is experiencing daytime sleepiness despite the low AHI.

It's very interesting (at least to me) and perhaps in a few years it will be THE way all titrations are performed.

In a way it might explain why some members here only feel rested when their AHI is in the 0.0-2.0 range and feel awful when it creeps up to the 3.0-4.0 range (numerous arousals).

Edit: Added last sentence.

What about arousals due to a person being new to cpap therapy?
Or arousals due to the lab itself?
I can see opportunities for subsequent retesting.

chunkyfrog wrote:What about arousals due to a person being new to cpap therapy?
Or arousals due to the lab itself?
I can see opportunities for subsequent retesting.

My understanding of the broadcast was that most (if not all) labs titrate a patient's CPAP pressure/machine type to minimize the patient's AHI and will continue with additional sleep studies only if it remains above 5.

Standford titrates the patient's pressure to minimize the number of EEG arousals. I didn't get the impression they weren't concerned with AHI but they weren't content if the patient still had a large number of arousals even though the AHI was 5 or below.

Dr Borelli was actually a patient at Standford because he was still experiencing the 'bad effects' of OSA even though his AHI was reasonably low on CPAP.

During his titration at Standford the lab kept increasing his minimum pressure in an effort to reduce the amount of arousals even though his Obstructive Apnea was under control.

If someone else understood the material differently please feel free to join in.

Edit:

I understand what you're saying (now that I've re-read your post several times - it's too late in the day for me) about the titration itself causing arousals but perhaps this type of titration is more for patients that have gotten used to CPAP but still aren't feeling as good as they think they should than it is for first timers.

chunkyfrog wrote:What about arousals due to a person being new to cpap therapy?
Or arousals due to the lab itself?
I can see opportunities for subsequent retesting.

I'd respectfully suggest that you listen to the whole presentation direct from Dr. Borelli, and see if that sheds some light on your questions. If you haven't already, that is, in my own opinion it is worth the time.

As to the questions, I'm not sure how much information can be gotten from the EEG as to the source of the arousal, what sort of characteristic waveforms that they see. Your question leads to the idea of a home study for this, that should be possible for this at some point with some sort of embedded technology equivalent to an EEG (without having to have an EEG operator there *smile*).

As far as "new to cpap", I see your point. It may be that these are "subsequent" studies, only done if the baseline "keep the airway open" studies don't give you sufficient therapy; e.g. you're using cpap and still have symptoms of sleep breathing disorders. Then the individual wouldn't be new to cpap. Or maybe that can be controlled for somehow, I don't know, good questions.

And yes, if the symptoms persist, there should be subsequent testing, for sure.

Wow, titrating to the arousals. I like the sound of that. That would be huge to UARS patients who see more RERAs then obstructions. I sure hope this is a trend that catches on...

NotLazyJustTired wrote:Wow, titrating to the arousals. I like the sound of that. That would be huge to UARS patients who see more RERAs then obstructions. I sure hope this is a trend that catches on...

That's exactly the problem Dr. Borelli had himself, UARS...titrating to open airway didn't help him at all. He said that only Stanford is doing this at the moment. That's one of the things that made his talk so interesting, he has a personal stake in all this as well as being a researcher.