“Necessity,” the saying goes, “is the mother of invention.”It’s a notion that has been proven once again in the lab of Dr. John Remmers. Specifically, saving patients who were dying needlessly is what drove the Heritage researcher to develop the first of several patented devices used to diagnose and treat sleep disorders.
He didn’t set out to be an inventor. In fact, Remmers started out as a bench scientist whose main preoccupation was to better understand how the lungs work and how the brain controls breathing. But as his career progressed, he became a clinical scientist (he holds a medical degree) and his focus shifted increasingly to working with respiratory patients. The discovery of sleep apnea came in the 1970s, at around the same time as this professional shift in focus. Fast-forward to the present, and Remmers is a well-established sleep-disorder expert, and President and CEO of SagaTech Electronics Inc., a company that manufactures sleep-disorder technologies.
Origins of invention
“People were dying from sleep apnea,” Remmers says of the early days of working in the sleep lab. “We knew how to treat them; we just didn’t have the technology to do it.”
Out of that frustration was born the nasal CPAP (continuous positive airway pressure) device, which consisted of a small bedside blower that generated low-level air pressure to force the air passage open and allow the patient to breathe normally. The device proved to be highly effective for treating sleep apnea, and it caused few side effects, but it was cumbersome, and many patients had difficulty tolerating the fixed pressure it supplied. To remedy this, Remmers developed autoCPAP, a “smart” device that assesses the degree of airway obstruction and automatically adjusts the pressure supplied to the nose.
Funding from the Health Research Fund, administered by AHFMR for Alberta Health and Wellness, provided enough initial support to develop and test the device, which is still used to treat the disorder.
Sleep interrupted
Sleep apnea is a potentially life-threatening condition that interrupts breathing during sleep. The most common types of the condition are obstructive and central sleep apnea.
Obstructive sleep apnea, also known as “the snoring disease,” is a chronic condition which causes patients to stop breathing briefly while asleep. This phenomenon occurs when the flesh and muscles of the tongue and throat relax so much that the airway is blocked and airflow is prevented. The consequent lack of oxygen in the blood prompts the patient to wake up and begin breathing again; this may occur with a loud snort or body jerk.
Central sleep apnea is the condition that occurs when the brain “forgets” to tell the muscles of the chest and diaphragm to keep breathing. Patients just stop breathing periodically, instead of jerking awake in order to resume breathing.
Apnea episodes can occur as many as 100 times per hour. As a result, patients rarely feel refreshed when they wake up, even if they’ve had 10 hours of “sleep”.
Sleep apnea can have a dramatic effect on patients’ physical and mental health. Such frequent disturbances in sleep often affect patients’ ability to cope with their day-to-day routine. In addition to fatigue and excessive daytime sleepiness, patients are often irritable, depressed, and unable to think clearly; they may suffer from headaches. Body organs can be affected by the lack of oxygen. Apnea episodes may put increased pressure on the heart, causing it to work harder; this can increase blood pressure and put patients at risk for stroke.
Designing over beer
As Remmers tells it, his latest invention was born over beers at a sports bar one afternoon after clinic rounds. “My colleagues and I didn’t really know what we were doing back then, but maybe that’s the ultimate in creativity,” Remmers says. “You have a general idea of what you need, but the specifics are unknown to you.” That first discussion eventually resulted in the SnoreSat Sleep Recorder, a portable recording device that can help make an in-home diagnosis of sleep apnea.
Waiting for help
There are two waiting lists in Calgary, where Remmers is based. Getting diagnosed and treated for sleep apnea is often a long and arduous process. A patient must first be referred to a sleep doctor by a family physician. After that, it can take up to eighteen months to see a sleep specialist, another six months to get into the sleep lab to be evaluated, and up to two more months to receive therapy. That two-year process is common for uncomplicated forms of sleep apnea, although a patient suspected of having a more serious form of the disorder is seen sooner. “It’s demoralizing for the family doctors, and it’s demoralizing for the patients to know that it will take up to two years before they’ll be treated,” Remmers says.
In the meantime, the symptoms of sleep apnea can seriously affect a patient’s personal and professional life. Severe sleep deprivation may contribute to reduced productivity at work, increased car and industrial accidents—sometimes leading to death—and increased healthcare costs.
Centrepiece technology
At present, a patient still goes to a sleep lab for diagnosis. If deemed necessary, a polysomnogram, a complicated test that measures 16 variables recorded during an overnight stay, is administered to help diagnose sleep apnea. An expert technician monitors the sleeping patient during the procedure, which can cost as much as $2000.
That may soon change, however. The SnoreSat Sleep Recorder allows a patient to be tested at home, eliminating inconvenient and expensive hospital stays. It’s necessary to come to the hospital only to pick up the small device and get instructions on its use. The costs are $150 to administer.
Inventive work
It’s been a long road to creating a viable product—about ten years from the time Remmers first saw a need, to the development, testing, and refinement of the sleep recorder. Remmers credits Eric Hajduk and Dr. Ron Platt, his partners in SagaTech Inc., the company that manufactures SnoreSat™, for their work in developing the device.He met Hajduk when he was working in the sleep lab at Foothills Hospital. “SnoreSat was Eric’s first project with me,” Remmers says. “And since he was a mechanical engineer, I thought he could figure out how to measure all of the variables we’d determined to test for sleep apnea.” A key breakthrough in the process came when Hajduk found a way to measure snoring sound with a microphone that senses the movement of the skin. The technique has now become the industry standard.
Platt, who was a graduate student working in a respiratory physiology lab at the hospital, teamed up with Hajduk to help develop SnoreSat. “We literally started out tinkering around in our basements,” explains Platt, who holds a Ph.D. in respiratory medicine and an electrical engineering degree.
What the two novice inventors eventually helped create is an easy-to-use device about the size of a clock radio. Patients simply hook themselves up to three sensors—an oxygen probe is applied to the index finger, a microphone is taped to the base of the neck, and nasal cannulas are applied to the nose—turn on the bedside recorder, turn off the lights, and go to sleep. In the morning, the machine is turned off and returned to the sleep lab for analysis by computer and interpretation by a sleep expert. Results are then forwarded to the family doctor.
Clinical testing
SnoreSat is currently being used in home-care respiratory wellness programs in Kelowna, Calgary, Lethbridge, Cranbrook, and Winnipeg. Primary-care physicians order a sleep test, and the device is supplied by a home-care dealer. An expert—at this point, Remmers—interprets the data. This diagnostic pathway has already saved at least one life.
“I see lots of sick patients, but today I diagnosed one of the sickest folks I’ve seen since I was an intern 35 years ago,” Remmers says. “Without SnoreSat, I don’t think his condition would have been detected, and he probably would have died.” The patient is now being treated successfully and enjoying a normal life.
Remmers hopes that once SnoreSat is in widespread use, it will help speed diagnosis of sleep apnea, allow sleep specialists to focus on severe cases, and free up sleep labs for their intended purpose: to treat serious sleep disorders.
Opportunities abound
Things have progressed quickly since Hajduk and Platt set up SagaTech Inc. as a manufacturing arm for Remmers’ research. They moved into their current office in south Calgary when Remmers became a partner two years ago.
Currently, SagaTech is planning for major clinical trials of the sleep recorder across North America. The pilot project has already proven the device’s worth, but wider, neutral trials must be conducted to further establish its credibility. In addition, the company is working with Dr. Val Kirk, a pediatric respirologist, to adapt SnoreSat for use with children. They’ve added two channels that address the differences between child and adult sleep apnea.
SagaTech Inc. has also just received Technology Commercialization funding to develop sophisticated software that works with the SnoreSat Sleep Recorder monitor. The software will use additional information from SnoreSat to provide a variety of diagnoses. SagaTech is also developing other medical devices for the diagnosis and treatment of sleep disorders. The company has received Phase II TC funding to fine-tune a dental device that can help treat mild to moderate sleep apnea.
Dr. John Remmers is a Heritage Scientist and a Professor in the Department of Medicine and the Department of Physiology and Biophysics at the University of Calgary. He also receives research support from from the Canadian Institutes of Health Research (CIHR).
Recent publication:
Vázquez JC, Tsai WH, Flemons WW, Masuda A, Brant R, Hajduk E, Whitelaw WA, Remmers JE. Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea. Thorax 2000; 55: 302-307.