Sleeping Better, Looking Better

These images show a patient before and after CPAP treatment for sleep apnea. In the study, independent raters who didn't know which was which were able to tell the difference two-thirds of the time.   Photo: University of Michigan
These images show a patient before and after CPAP treatment for sleep apnea. In the study, independent raters who didn't know which was which were able to tell the difference two-thirds of the time. Photo: University of Michigan

Getting treatment for a common sleep problem may do more than help you sleep better – it may help you look better too, according to a new research study published in the Journal of Clinical Sleep Medicine.  Researchers from Michigan Technological University and the University of Michigan Health System conducted the study.

The findings aren’t just about “looking sleepy” after a late night, or being bright-eyed after a good night’s rest.

For the first time, researchers have shown specific improvement in facial appearance after at-home treatment for sleep apnea, a condition marked by snoring and breathing interruptions. Sleep apnea affects millions of adults—most undiagnosed—and puts them at higher risk for heart-related problems and daytime accidents.

Using a sensitive “face mapping” technique usually used by surgeons and a panel of independent appearance raters, the researchers detected changes in 20 middle-aged apnea patients just a few months after they began using a system called CPAP to help them breathe better during sleep and overcome chronic sleepiness.

Sleep neurologist Dr. Ronald Chervin, director of the University of Michigan Sleep Disorders Center, led the study. His long-time collaborator, Joseph Burns, a signal analysis expert and engineer at the Michigan Tech Research Institute in Ann Arbor, developed a way to precisely map the colors of patients’ facial skin before and after CPAP treatment.

MTRI Signal Processing Skills

Over the past decade, Burns has worked with Chervin and the U-M Sleep Disorders Laboratory staff to develop quantitative signal and data processing techniques to diagnose and assess sleep disorders and their resulting impact on health.  Remote sensing and signal processing are specialties of MTRI.

The collaboration has generated several novel algorithms that have resulted in numerous publications and two patents. The Face of Sleepiness project is the first attempt to use digital imagery of patients to assess the impact of sleep-disordered breathing. The project leveraged MTRI expertise in processing of remote sensing data.

"A technical challenge was to identify a color decomposition of the raw data from the commercial 3D camera that detected subtle color changes, but was not sensitive to the data collection conditions,” says Burns.

Chervin says the study grew out of anecdotal evidence that sleep center staff often saw in sleep apnea patients when they came for follow-up visits after using CPAP.  The team, including research program manager Deborah Ruzicka, sought a more scientific way to assess patients’ appearance before and after sleep treatment.

“We perceived that our CPAP patients often looked better, or reported that they’d been told they looked better, after treatment, Chervin explains. “But no one has ever actually studied this.”

They teamed with U-M plastic and reconstructive surgeon Dr. Steven Buchman to use a precise face-measuring system called photogrammetry to take an array of images of the patients under identical conditions before CPAP and a few months after. Capable of measuring tiny differences in facial contours, the system helps surgeons plan operations and assess their impact.

The researchers also used a subjective test of appearance: 22 independent raters were asked to look at the photos, without knowing which were the “before” pictures and which the “after” pictures of each patient. The raters were asked to rank attractiveness, alertness and youthfulness – and to pick which picture they thought showed the patient after sleep apnea treatment.

Results show improvement

About two-thirds of the time, the raters thought the patients in the post-treatment photos looked more alert, more youthful and more attractive. The raters also correctly identified the post-treatment photo two-thirds of the time.

Objective measures of facial appearance showed that patients’ foreheads were less puffy, and their faces were less red after CPAP treatment. However, the researchers note, they didn’t see a big change in facial characteristics that popular lore associates with sleepiness. “We were surprised that our approach could not document any improvement, after treatment, in tendency to have dark blue circles or puffiness under the eyes,” says Chervin. “Further research is needed, to assess facial changes in more patients and over a longer period of CPAP treatment.”

Burns, Chervin and colleagues hope to continue to study the effect of sleep apnea treatment on many aspects of a person’s life, including further research on appearance. “We want sleep to be on people’s minds, and to educate them about the importance of getting enough sleep and getting attention for sleep disorders,” Chervin says.

The research was supported by the Covault Memorial Foundation for Sleep Disorders Research, established in memory of Jonathan Covault, an attorney who died young and whose undertreated sleep apnea may have contributed to his premature death.

The research team also included Arshia Vahabzadeh and Margaret C. Burns.

Journal citation:J Clin Sleep Med 2013;9(9):845-852.

Michigan Technological University is a public research university, home to more than 7,000 students from 54 countries. Founded in 1885, the University offers more than 120 undergraduate and graduate degree programs in science and technology, engineering, forestry, business and economics, health professions, humanities, mathematics, and social sciences. Our campus in Michigan’s Upper Peninsula overlooks the Keweenaw Waterway and is just a few miles from Lake Superior.