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floridafocusfloridafocusfloridafocusfloridafocusfloridafocusfloridafocusfloridafocusTracking ApneaIn the sleep study graph below, each line represents the signal from a different electrode on thebody. By tracking brain waves, breathing, heart rate and muscle movements, technicians canidentify sleep patterns and disturbances, such as the apnea evidenced here by the halt in airflowthrough the nose and mouth (green box).BRAIN ACTIVITYFACIAL MOVEMENTSHEARTBEATLEG MOVEMENTCPAP AIRFLOWNOSE AND MOUTH AIRFLOWCHEST AND ABDOMINAL MOVEMENTBLOOD OXYGEN LEVELHEART RATEof diabetes and impaired blood sugar (glucose)tolerance.With the dangerous effects of sleep disordersbetter defi ned, the latest industry researchand development efforts have focusedon successful treatments. Recently anew sleeping pill, eszopiclone, was determinedsafe for use for up to 12 months.“The conventional wisdom was thatsleeping pills shouldn’t be taken for morethan two to three weeks,” says Dr. Smolley.“The whole sleep community is in a bit of anupheaval regarding any possible change inthe AASM’s recommendations on how longa sleeping pill can be taken.”Dr. Smolley believes the controversy isgoing to be between behavioral and cognitivetherapists and pharmacologists whostudy drug therapies. He says that he typicallyfi nds success treating disorders, suchas insomnia, with behavioral therapies includingrelaxation techniques and havingpatients get out of bed when not drowsy insteadof “trying too hard” to fall asleep.Dr. Smolley also applies his behavioral expertiseto introducing the CPAP machinegradually. The Sleep Center team regularlyholds talks on sleep apnea and CPAP for atriskgroups, such as seniors and gastric bypasssurgery candidates. Education aboutsleep apnea and the benefits of CPAP treatmentand gradual acclimation to the deviceare crucial to an individual sticking with thetreatment, says Dr. Smolley. “A CPAP machineis like a pair of dress shoes: It takessome getting used to.”To further enhance the comfort and effectivenessof CPAP treatment, Dr. Smolley expectsan explosion in engineering for newCPAP masks and interfaces in coming years,offering more consistent pressure and customizedcomfort. He also anticipates thefine-tuning of “smart” CPAP machine designsthat automatically adjust air pressureon the fly to improve the effectiveness for patientssuch as Bartolotta.“I would like to not have to use CPAPsomeday,” says Bartolotta. “But until thatday comes, I’m really glad it’s there.”In addition to the Sleep Center in Weston, Fla., TheCleveland Clinic operates a Sleep Disorders Centerwith a sleep lab in Cleveland, Ohio.RATE YOUR SLEEP ONLINEDo you wake up tired? Wonder if you should undergo a sleep study? The Epsworth Sleepiness Scale isa screening tool that helps determine whether individuals are candidates for a sleep study. Take the quiz online atwww.clevelandclinic.org/<strong>clevelandclinicmagazine</strong>.40 cleveland clinic magazine
onthehorizononthehorizononthehorizononthehorizononthehorizononthehorizononthehorizonLights, Camera...Prevent Knee InjuriesAnd the Oscar goes to...a Cleveland Clinic research scientist?That’s right. Antonie J. van den Bogert,Ph.D., with the Lerner Research Institute’sBiomedical Engineering Department, wonan Academy Award earlier this year forhis technical work in developing motioncapture software, which is being used bytop Hollywood producers to create threedimensionalanimation based on humanmovements. His software helped to buildsome of the animated characters in blockbustermovies such as “The Lord of theRings” trilogy and “I-Robot.”So what does all of this have to do withhealth care? Plenty.Knee damage is the most commoninjury for high school, college and professionalathletes. While advances in orthopedicsurgery can repair knee injuries, mostathletes who have had such injuries sufferosteoarthritis when they are only in their30s or 40s (most people don’t get arthritisuntil their 70s). What’s more, womenathletes are five times more likely to injuretheir knees, but no one knows why. Dr.van den Bogert’s research aims to find theanswer to that question and to determinewhether new athletic techniques can bedeveloped to help athletes reduce or preventknee injuries.Dr. van den Bogert recently brought in10 men and 10 women college basketballathletes to record their common movementswith special, high-speed cameras.The athletes wore tiny balls that acted asmarkers on their bodies, tracking theirmotions. The balls reflect light back to thecamera, creating a three-dimensional, highcontrast image. All of this information isthen fed into the motion capture software.“We created a computer model of eachperson and that computer model performsthe same movements as the athlete,”says Dr. van den Bogert. “Because thecomputer model moves the same waythat the athlete does, we can do hundredsof experiments on the computer modelrather than on the person.” For example,by manipulating the computer model,researchers can find out what kind ofknee stress is produced when the feet areplaced in different positions.“We think that these knee injuries occurin athletes not because they run and jumpalong, but because their movement ispoorly controlled,” he says. “We’re hopingthat our computer simulations will give usinsights about improving the control of anathlete’s movements to see whether wecan reduce the propensity for injury.”Dr. van den Bogert’s software also isbeing used to study foot and ankle injuriesincurred on uneven surfaces, and in gaitand posture rehabilitation.Data from the athlete’s motions are fedthrough motion capture software and a model(image, far left) is created that can be usedagain and again to simulate human movementsand develop injury prevention strategies.www.clevelandclinic.org 41
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