Friday, June 18, 2010

BME summer immersion 2010 week 1

The first week of summer immersion went smoother than I had anticipated. Having never set foot in New York City before, I was a bit apprehensive, having doubts about my ability to navigate such a redoubtable concrete jungle as New York. However, my reservations proved unfounded; New York (or at least Manhattan) turned out to be easily navigable, being laid out in an orderly and intuitive manner. Grocery stores, restaurants, and sources of other essentials were found to be within walking distance.

Bioethics seminars attempted to ensure that we will act in a proper way when interacting with patients.

Early in the week I met with my mentor, Dr. Matthew Ebben, Assistant Professor in the Department of Neurology and Neuroscience at Weill Medical College. He is the Director of Laboratory Operations at the Center for Sleep Medicine, a brand new, state-of-the-art facility located near Presbyterian Hospital.

While sleep disorders may be discounted by some as not particularly important, they in fact represent a very serious health issue. Sleep disorders encompass a myriad of problems including sleep apnea, insomnia, narcolepsy, recurring nightmares, circadian rhythm issues, among others. Sleep disorders are particularly insidious as they strike a person while unconscious. The person is unaware of any problem. A person with a sleep disorder like sleep apnea will wake feeling tired, unrested, irritable, and may have problems concentrating or recalling information. Performance on the job or at school may suffer. Personal relationships may sour owing to sleep deprivation-induced irritability.

Dr. Ebben introduced me to the other staff members as well as the technicians who are responsible for data collection and analysis. He gave me a tour of the Center for Sleep Medicine, which features a suite of 12 rooms, each equipped with sensors designed to assess the quality of a person's sleep. A central control room houses the technicians who monitor the patients throughout the night. The quality of a person's sleep is assessed in a quantitative manner to ascertain the best course of treatment. I was able to observe the preparation of two patients for sleep studies.

The most common sleep disorder that the Center treats is sleep apnea, a condition characterized by frequent temporary cessations in breathing. This condition is common in larger, heavier-set individuals and is increasing in occurrence as more and more people are becoming overweight. Patients at the Center are either monitored to assess the severity of their condition or to test the efficacy of a sleep apnea treatment, most commonly a CPAP (continuous positive air pressure) device which assists in breathing throughout the course of the night. In either case, a nocturnal polysomnogram sleep study report is generated. Biosignals such as heart rate, brain wave activity, muscle activity, and blood oxygen levels are displayed on a computer terminal and recorded for later analysis.

I was particularly interested in a plot of a person's body position during sleep. The plot charted the patient's body position (back or supine, stomach or prone, left and right lateral) throughout the course of the night. Sleep apnea is most severe when a patient is on his back and is ameliorated when he is on his stomach. The chart reminded me of timing diagrams, which I encountered in my undergraduate digital circuits class. However, I was surprised to learn that this chart is based on visual observation of the person, i.e. a technician annotates the polysomnogram with labels corresponding to body position. Despite dozens of sensors and electrodes being employed to generate the polysomnogram, no automated way to track something as seemingly simple as body position was in place.

Through discussions with my advisor, a tentative research project topic involving scoring the quality of patients' sleep emerged.

I also witnessed the importance of having strong interpersonal skills when interacting with patients. While a sleep study is non-invasive, it still represents a disconcerting experience, involving the attachment of dozens of electrodes to the body. It is definitely a foreign experience for most people. Technicians who can engage the patient in an affable manner (for instance, discussing the basketball game on television), help to put the patient at ease, essential for the successful acquisition of sleep data.

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