AASM Membership Sections Newsletter Issue #2
American Academy
of Sleep Medicine
Home Sleep Testing
by Shyam Subramanian, MD
The field of sleep medicine is evolving in multiple ways. One of the criti-
cal changes involves the growing, and increasingly mandated, adoption
of home sleep testing (HST) as the preferred testing modality for the
diagnosis of sleep apnea. The technology itself is not new, but previously,
over the years, has not been well endorsed as an acceptable modality for
establishing the diagnosis of OSA. In a comprehensive review in 2003 by
the ATS, AASM and ACCP, HST was considered acceptable when at-
tended, but its widespread use discouraged. It was only after Medicare
approved HST as an acceptable modality for diagnosis of OSA was there
some early adoption of HST. Recent studies have demonstrated that HST
does have acceptable degree of specificity and sensitivity in diagnosing
OSA in a carefully selected and circumscribed population of patients
Sleep Related Breathing
Disorders Section
Ofer Jacobowitz, MD, PhD
Tucker Woodson, MD
Kathe Henke, PhD
Kin M. Yuen, MD
Shyam Subramanian, MD
In obstructive sleep apnea (OSA), airway obstruction occurs with sleep
where loss of muscle tone contributes to episodic partial or complete
airway obstruction and arousal from sleep. Positive airway pressure is
efficacious at eliminating airway obstruction in OSA patients, acting
as a pneumatic splint, but is often not tolerated or accepted. Treatment
using oral appliances or surgical reconstruction of the airway is also not
without acceptance, tolerance or partial effectiveness problems. There is
considerable interest therefore in novel therapies, such as neurostimula-
tion of the tongue muscles for the treatment of OSA.
Hypoglossal Neurostimulation Science
The tongue is thought to be a major contributor to airway obstruction in
OSA and hence hypoglossal nerve and tongue stimulation were investi-
gated for OSA treatment. The tongue narrows the oropharyngeal space
in humans whereas in other mammals, who do not develop OSA, the
tongue is entirely present in the oral cavity (Davidson 2003). Relative
macroglossia is a common characteristic of OSA patients as noted using
imaging (Tsuiki 2008) and physical examination. During wakefulness,
Neurostimulation for OSA
by Ofer Jacobowitz, MD, PhD
Steering Committee
Ofer Jacobowitz, MD, PhD
Dr Jacobowitz completed the
medical scientist training program
at Mount Sinai School of Medi-
cine and graduated with a PhD in
Pharmacology and an MD degree.
He performed his postgradu-
ate training in Otolaryngology/
Head and Neck Surgery at Mount
Sinai Medical Center. He is board
certified in otolaryngology/ Head
and Neck Surgery, as well as Sleep
Medicine and has been in private
practice in Middletown, NY for
the last decade. He serves as the
associate director of the center for
sleep disorders at Orange Regional
Medical Center and is an assistant
professor at Columbia University
in New York. His clinical focus
is the diagnosis and multimodal
treatment of sleep-related breath-
ing disorders, including advanced
surgical techniques. His research
interests are the diagnosis and
surgical treatment of OSA as well
as hypoglossal neurostimulation
for OSA. He has published peer-
reviewed research and review
articles on OSA and serves as a
reviewer for journals. He enjoys
teaching externs from the Mas-
sachusetts Institute of Technology,
residents and medical students.
His hobbies include photography