Wednesday, December 29, 2010

Two New Studies Incentivize Weight Loss in 2011

United Press International (UPI) reports that researchers are studying a potentially life-threatening correlation among obstructive sleep apnea (OSA) and obesity.

Scientists at the Lynn Health Science Research Institute in Oklahoma City are recruiting volunteers for the study of obesity and OSA, a disorder that causes pauses in breathing during sleep.

Obesity has been found to be the main cause of OSA, mostly because obese people have larger tonsils and tongues, which interfere with air flow during sleep.

Seventy percent of sleep apnea patients are obese, researchers say.

According to Kelly Shepherd, a research fellow from Australia, and one of the researchers working at the Lynn Health Science Research Institute, those who suffer from OSA can stop breathing from five to 130 times per hour. They are at risk for heart attacks, car wrecks, depression and lost work productivity caused by daytime sleepiness, she said.

Drowsy driving has become a major public health concern as obesity rates rise.

The LA Times reported last week that a new study in the American Journal of Emergency Medicine found that obese drivers are more likely to die in a serious car wreck than drivers of normal weight.

Researchers at the University at Buffalo in New York examined drivers' body sizes and the number of car crash deaths between 2000 and 2005 from data in the Fatality Analysis Reporting System. The study calculated an increased risk factor of dying at 21 percent for moderately obese drivers and 56 percent for morbidly obese drivers.

"Many people think they just sleep badly and wake up feeling terrible the next day," said Shepherd. "Many don't know why."

Experts estimate that 80 to 90 percent of people with OSA are undiagnosed and untreated.

Learn more about OSA here. Sleep apnea can be diagnosed at an AASM-accredited sleep center.

Image by John K.

Monday, December 27, 2010

Zaps for ZZZs: Scientists Shock the Tongue to Keep Air Flowing

The Associated Press reports that a new implant might be able to block obstructive sleep apnea (OSA).

Scientists are testing to see if an implanted pacemaker-like device might help certain sufferers keep their airways open by zapping the tongue during sleep.

OSA occurs when the tongue and upper-airway collapse during sleep, blocking the airway – sometimes for a minute or more repeatedly throughout the night.

The experimental implant intends to stimulate the nerve that controls the base of the tongue with a mild electrical current during sleep to make it stay toned and in place like it does during the day.

Three companies are already developing implants and planning studies to test the results.

"In this kind of research, we're not looking for little changes," says Dr. Meir Kryger, a sleep medicine specialist at Gaylord Hospital in Connecticut, who is helping to lead Inspire's study. "What we're looking for is actually cure."

The American Academy of Sleep Medicine (AASM) estimates that more than 18 million Americans suffer from sleep apnea.

One patient who had success with the early testing of hypoglossal nerve stimulation was Rik Krohn, 67, of suburban Minneapolis.

"It got to the point where I'd dread going to bed," says Krohn. Sleep studies showed his apnea was awakening him an average of 35 times an hour. He tried five different CPAP masks unsuccessfully before giving up in frustration, and surgeons turned him away.

These experiments are only now beginning, with a handful of implants performed so far — and while it's an interesting concept, frustrated patients should try some proven steps first, cautions, Dr. Amy Atkeson of Columbia University Medical Center in New York.

The American Academy of Sleep medicine recommends weight loss, oral appliance therapy, and CPAP for OSA treatment.

Image by Tiago Daniel

Wednesday, December 15, 2010

Snoring: Fixing what a Punch in the Shoulder Can't Solve

According to a recent New York Times piece, treating snoring and sleep apnea often requires trial and error.

A common misconception about sleep apnea is that it only affects older, overweight men. But sleep apnea can affect anyone, even children.

The article tells how Dr. Elizabeth Walton, a 43-year-old mother of two, has a common and sometimes embarrassing health problem – snoring.

“We laugh and joke about snoring,” said Dr. Nancy A. Collop, president elect of the American Academy of Sleep Medicine, “but it can be pretty annoying and disruptive to couples.”

Almost half of the adult population snores at least occasionally and for half of them, snoring may be a sign of sleep apnea, a serious medical condition.

After trying CPAP and finally settling on opal appliance therapy, Dr. Walton, and her partner, are both sleeping better.

Because Dr. Walton has obstructive sleep apnea (OSA) instead of primary snoring, medical insurance has covered most of her treatments.

Oral appliances are custom-made mouthguards that move your lower jaw forward to open your airway during sleep.

A dentist who specializes in sleep medicine fits an appliance to your mouth, usually for $1,500 to $3,000. That price should include all follow-up visits and any adjustments that need to be made, said Dr. Sheri Katz, president of the American Academy of Dental Sleep Medicine. Medicare reimburses patients for oral appliance therapy if they meet certain medical criteria.

Studies show that custom-fit appliances ease mild to moderate sleep apnea in about 75 percent of patients and snoring in 80 to 90 percent of patients who use them regularly, said Dr. Katz.

Friday, December 3, 2010

Putting a Name to Sleep Apnea: NAMES Screening Tool a Success

Sleep experts estimate that 80 to 90 percent of obstructive sleep apnea (OSA) patients are undiagnosed and untreated.

Many patients do not know they have a problem because they are unaware that they wake up throughout the night to breathe. Bed partners often detect OSA because of the loud snoring that can accompany the breathing disorder.

Because dentists see patients on a regular basis, they frequently screen patients for sleep apnea. If screening shows the patient is at risk for OSA, he or she will then go to sleep physician for a diagnosis and treatment.

A new study in the journal Sleep and Breathing examined a new screening method that combined symptoms with a physical exam to predict the presence of sleep apnea. The NAMES assessment looked at neck circumference, airway classification, related diseases, Epworth scale, and snoring.

By including self-reported historical factors with physical exam findings, researchers were able to better screen for OSA.

The study included 150 adult subjects. They had never been diagnosed with sleep apnea but were referred to sleep center because they showed signs of the condition.

The study results indicate that the NAMES assessment is an effective, inexpensive screening strategy for screening patients for moderate to severe OSA.

Another screening tool includes STOP.

Friday, November 19, 2010

“Let’s Get Together:” New Treatment Combo Tag Teams Sleep Apnea

Doctors recommend continuous positive airway pressure (CPAP) as the gold standard of sleep apnea treatment. But 25 to 50 percent of patients do not use the treatment on a regular basis because they can’t tolerate the pressure produced by CPAP. To increase compliance and effectiveness of CPAP, some doctors are combining CPAP treatment with oral appliance therapy.

New research in the journal Sleep and Breathing shows that combination therapy normalized breathing disturbances in sleep apnea patients who were otherwise intolerant to CPAP. When CPAP was used with an oral appliance, patients were able to tolerate their treatment better than CPAP by itself.

Typically, the two treatments are given separately. Oral appliances are fitted by dentists trained in dental sleep medicine. These devices fit like sports mouth guards and move the jaw and tongue forward to open the airway. Oral appliances are most effective with mild to moderate sleep apnea patients.

This study included 10 OSA patients who didn’t tolerate CPAP. They were using oral appliance therapy but still experiencing pauses in breath during sleep.

The patients were taken off oral appliance therapy for one week. They then wore CPAP and an oral appliance together for three nights. Oxygen levels were recorded during a sleep study and patients took the Epworth Sleepiness Scale. A free version is available here.

Results show that the oral appliance/CPAP combination was well tolerated by all participants.

The number of times patients stopped breathing per hour of sleep was reduced from 11 times per hour to three times per hour after combination therapy.

Before treatment, the average sleepiness score was 12. After oral appliance therapy, their average score was reduced to 9. After combination treatment, the score was further reduced to 7. This decrease shows that they had more energy during the day due to combination therapy.

Image by Elliot Margolies

Thursday, November 11, 2010

State Rep. Robert Donatucci’s Death Related to Sleep Apnea

The Philadelphia Inquirer reports that Pennsylvania's State Representative Robert Donatucci’s early death was caused by untreated sleep apnea.

State Rep. Robert C. Donatucci, 58, received 84 percent of the vote last week in being elected to his 16th House term. He died asleep in his bed in South Philadelphia early Tuesday, his family said.

His death was related to sleep apnea, for which he was being treated, said his brother Ronald, the city register of wills.

He found the mask uncomfortable and did not complete the test, but had resolved to lose a few pounds, his brother said. He had no history of heart problems.

Fire rescue personnel were called to the house when his wife, Marie, discovered he was not breathing.

"Bobby's style was very simple," his brother said. "His word was his reputation. If he was for something, you could go to sleep on it."

Like Representative Roberts, 25 to 50 percent of OSA patients do not use their CPAP machine. Sleep apnea is a serious medical condition and should not go untreated. Oral appliances are a safe and effective alternative.

Oral appliance therapy is recommended for patients with mild to moderate sleep apnea who cannot tolerate or comply with CPAP, or for severe patients who cannot tolerate CPAP.

More than 2,100 dentists belong to the American Academy of Dental Sleep Medicine. They are trained to screen for and treat sleep apnea. Find-a-Dentist in your area.

Friday, November 5, 2010

Fall Back Into Standard Time with an Extra Hour of Sleep

An article on WomensHealth.gov explains that when you turn your clocks back an hour this weekend, it might be a good opportunity to think about whether you're getting enough sleep.

The switch from Daylight Saving Time to Standard Time officially occurs at 2 a.m. Sunday morning, and it moves one hour of daylight from the evening to the morning.

While you'll appreciate the extra hour of sleep you gain by returning to Standard Time, it won't be enough to eliminate any major sleep debt you may have accumulated due to a hectic lifestyle, experts say.

Chronic sleep deprivation can affect attention levels, reaction time and mood, leading to decreased productivity at work, increased family stress, and potential health problems, according to the American Academy of Sleep Medicine (AASM).

"People tend to ignore the need for sleep in order to get other things done, but sleep is as important as what you eat, how much you exercise, and other healthy lifestyle practices," says Dr. Nancy A. Collop, director of the Emory Sleep Center and president-elect of the AASM.

"It's important to acknowledge the role that sleep plays in our daily lives, and recognize that how we feel, think and perform is all dictated by the amount of sleep we get."

The amount of sleep needed for good health and optimum daytime performance varies by age: preschoolers need 11 to 13 hours a night; school-age children should get 10 to 11 hours; teens must have at least nine hours; and adults should get seven to eight hours each night.

The AASM offers these tips for a good night's sleep:

•Don't exercise or have caffeine, alcohol, nicotine or heavy meals close to bedtime.
•It's fine to eat a small snack before bedtime to avoid going to sleep hungry.
•Follow a consistent bedtime routine.
•Keep your bedroom quiet, dark and cool.
•Don't sleep in on the weekends. That just makes it harder to wake up on Monday.

Read more at USA Today or check out this video by myFOXdetroit:

Thursday, October 28, 2010

Researchers Encourage Sleep Apnea Screening Before Surgery

According to a recent article in Sleep Review, research indicates that physicians should screen for obstructive sleep apnea (OSA) before performing surgery.

With excess weight and OSA becoming more prevalent in modern society, some researchers say extra precautions need to occur before surgery.

A clinical study presented at Anesthesiology 2010 indicates that OSA screening is necessary in order to properly manage the patient in the operating room.

“If patients with unidentified obstructive sleep apnea undergo surgery, they may have an increased chance of experiencing complications during and after surgery,” said Dr. Frances Chung.

Study participants underwent an overnight sleep study or a home sleep test. Researchers looked at the apnea hypopnea index (AHI) to classify a patient as having OSA. Higher AHI scores reflect a greater number of pauses in breath per hour of sleep.

People with severe OSA stop breathing 30 or more times per hour for ten seconds or more. These pauses can cause serious medical problems.

“A growing amount of evidence suggests that obstructive sleep apnea is associated with heart and lung disease, diabetes mellitus, and a higher rate of early death,” said Chung.

This study included 819 patients. Tests showed that 536 patients had OSA. Notably, 84 percent of the OSA patients reported at least one OSA-related symptom such as snoring, daytime drowsiness, or an observed pause in breath.

Surgeons and anesthesiologists were not informed of the results. Overall, 85 percent of the patients with severe OSA were not identified by surgeons, and 47 percent of the patients with severe OSA were not identified by anesthesiologists, despite apparent symptoms.

“The results suggest that implementation of a screening procedure would be in the best interest of patient care and will serve to significantly reduce undiagnosed cases of obstructive sleep apnea during the perioperative period,” said Chung.

Sleep apnea should be diagnosed at an AASM-accredited sleep center.

Tuesday, October 19, 2010

It’s All About Personality

A new study in the journal Sleep and Breathing found that personality might help researchers predict what patients will follow doctors’ orders.

Sleep experts estimate that 25 to 50 percent of obstructive sleep apnea (OSA) patients do not comply with CPAP, the standard therapy. But doctors cannot always predict which patients will follow their treatment plan and which ones will leave their condition untreated.

Adherence is considered wearing a CPAP mask for at least four hours per night, 70 percent of nights. Compliance can be measured via data collected from the CPAP machine.

This study examined the relationship between adherence and three measures of personality and coping strategies. There were 63 subjects, including 31 men and 32 women previously diagnosed with OSA.

Ratings on the behavioral inhibition system/behavioral activation system (BIS/BAS) scales, the ways of coping inventory, and a broad personality measure (mini-IPIP) were analyzed.

Elevated BIS was the strongest predictor of nonadherence, followed by neuroticism. The method correctly classified 73 percent of participants as adherent or nonadherent.

Nonadherence is associated with elevated BIS scores and neuroticism, indicating that personality factors play a role in determining adherence to CPAP.

CPAP is not the only OSA treatment available. Oral appliance therapy is a good alternative for patients who do not tolerate or comply with CPAP.

Thursday, October 14, 2010

Treatment Found to Reduce Heart Failure in Sleep Apnea Patients

A new study in the journal Sleep and Breathing found that sleep apnea treatment reduced the risk of death and hospitalization in advanced heart failure (HF) patients.
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The study included 18 patients with advanced HF and sleep apnea. All patients were stable for at least three months at the study start. They were 18 to 80 years of age. Five patients were women and 13 were men.
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Eleven patients underwent CPAP therapy. They used CPAP for at least four hours per night, 70 percent of nights.

The remaining seven patients refused treatment after a two-week trial with CPAP. They were called the control group.

Follow-up occurred every two months for a 12-month period. The researchers compared death and hospitalizations due to heart failure during this time.

Two patients, or 18 percent, of the CPAP group were hospitalized. In contrast, four patients, or 57 percent, of the control group were hospitalized.

All of the treated patients survived. Two of the seven patients who did not receive treatment, or 28 percent, died.

The researchers concluded that sleep apnea treatment had a positive impact on cardiac function, exercise tolerance, and quality of life six months into the study. They found that heart function remained improved after 12 months.

CPAP is a common sleep apnea treatment, but 25 to 50 percent of patients cannot tolerate it. Oral appliances are an alternative treatment offered by dentists.

Thursday, October 7, 2010

Sleep Apnea Unmasked

A recent New York Times blog post discusses the dangers of sleep apnea masquerading as dementia.

Last year, Alzheimer’s specialist Dr. Ronald Petersen met a new patient at the Mayo Clinic. She was only in her 60s but had trouble concentrating.
“She couldn’t follow a television program or stay focused during a conversation,” said Dr. Petersen.

What first seemed like early symptoms of dementia, soon indicated a sleep disorder.
Although she was unaware of having any sleep problems, her son reported that “she was snoring like a freight train.”

The patient was sent for an overnight sleep study. The results indicated that she had obstructive sleep apnea (OSA). This condition causes pauses in breath during sleep. These pauses prevent oxygen flow and REM sleep. Risk for OSA increases with age and weight gain. Symptoms can exacerbate or mimic dementia symptoms.
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There are several successful treatment options including continuous positive airway pressure (CPAP) and oral appliance therapy. Treating sleep apnea often reduces the feeling of excessive daytime sleepiness.

Within a year of starting CPAP treatment, the patient’s scores on neuropsychological tests were normal range.

Dr. Sonia Ancoli-Israel has studied OSA for 30 years. She noted that almost half of older adults experience apnea to some degree, with even higher rates among those with dementia. Seniors who live alone may not know they snore. They may also think it’s normal to feel sleepy during the day.

It’s important to know the signs of OSA. Unfortunately, 80 to 90 percent of people with sleep apnea are unaware of their condition. Untreated OSA is frequently linked to cognitive decline. It also raises the risk for heart disease, stroke, diabetes and driving accidents.

“If you’re waking up hundreds of times a night and you’re not getting enough oxygen to the brain, of course you’ll see the effect,” said Dr. Ancoli-Israel.

She and her team, in a study published in 2008 in The Journal of the American Geriatrics Society, found that treating sleep apnea with CPAP improved attention, judgment and decision-making.

Dr. Ancoli-Israel is currently investigating whether CPAP might reduce cognitive damage from Parkinson’s disease.

Monday, September 27, 2010

Cost of Obesity Weighs Down on North Americans

Researchers at George Washington University recently published data on the individual costs of being overweight and obese in the United States. It is the first-ever report on the individual cost of having excess weight.

According to the study, the annual cost of being obese in the U.S. is $4,879 for women and $2,646 for men. The researchers analyzed prior research to determine the "real-life costs" of obesity. They examined loss of productivity at work, employee sick days and the need for additional gasoline, among other factors.

Taking into account the economic value of lost life pushed the annual cost of obesity to $8,365 for women and $6,518 for men.

The study notes that obesity increases a person’s risk for sleep apnea. Losing weight has been shown to improve sleep apnea, but the AASM recommends that weight loss be combined with CPAP or oral appliance therapy. Treatment should be directed by a sleep physician.

Obesity also raises the prevalence of type II diabetes, hypertension, cardiovascular disease, asthma, certain types of cancer, and other conditions.

A new report from the Organization for Economic Cooperation and Development found that Americans have the highest rate of obesity in the world.

The report notes that the lifespan of an obese person is up to 8 to 10 years shorter than that of a normal-weight person.

Unfortunately, obesity is a problem that is being adopting by children. This Montreal Gazette article reported on a new Canadian study that found most pediatricians believe parents are not taking their child’s weight seriously.

The study included 860 pediatricians. When asked to identify key barriers to child weight loss, more than 60 percent of the surveyed doctors noted:

- Parents who are overweight themselves
- Parents who become defensive when the topic of their child’s weight is raised
- Parents who show little interest in helping their child lose weight

Not sure if you have a weight problem. Check your body mass index here.

Thursday, September 23, 2010

Sleep Apnea Screening Tool Now Available in Thai

A new study published in the journal Sleep and Breathing tested the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS). The ESS is a simple questionnaire used to screen for obstructive sleep apnea (OSA). You can take the ESS here for free.

The researchers also assed the relationship between the ESS score and the severity of OSA.

This study involved 228 subjects - 149 males and 79 females. Thirty-two healthy volunteers and 39 snorers made up the control group. After polysomnography, 126 were diagnosed with obstructive sleep apnea (OSA).

Scores between the two groups were significantly different. The average ESS score for control subjects was 6. In contrast, OSA patients scored about a 10.

Thirty-one OSA patients were successfully treated with CPAP or upper-airway surgery. They took the ESS 3-6 months after treatment. Their ESS scores decreased significantly.

The researchers concluded that the Thai version of the ESS successfully screens for OSA. It can also asses response to treatment. However, the tool was unable to differentiate severity levels of sleep apnea.

The authors recommend combining the Thai ESS with a more comprehensive clinical evaluation.

In April, this blog reported that the ESS was successfully translated into Korean.

Wednesday, September 15, 2010

A Decade of Weight Loss and Still Shedding Pounds

The Biggest Loser is gearing up for Season Ten of its popular weight loss reality TV show. This year’s season premier will air September 21 at 8/7c on NBC.

According to this press release, Nationwide Medical and Philips Respironics will pair up for a third season of testing and treating the contestants.

Last year, the SleepEducation blog reported that all 16 candidates had obstructive sleep apnea. Former AASM President Dr. Clete Kushida worked with the contestants to ensure that they received the maximum benefit from ongoing treatment.

Like in Season Nine, contestants will continue to receive assistance once their time on the show comes to an end.

Obesity increases risk for this sleep-related breathing disorder because excess weight around the neck can cut off airflow during sleep.

Losing weight can help people treat their condition. But the American Academy of Sleep Medicine recommends that sleep apnea patients combine weight loss with CPAP treatment or oral appliance therapy.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. Sleep apnea is a potentially life-threatening condition. Diagnosis and treatment are available at an AASM-accredited sleep center.

Monday, September 13, 2010

Vikings Player Tackles His Obstrucitve Sleep Apnea

According to Kevin Seifert’s recent ESPN blog post, Minnesota Vikings’ player Percy Harvin recently started treating his obstructive sleep apnea.

Harvin experienced a migraine and lost consciousness during practice on August 19. The doctors gave him an overnight sleep test, which showed that his troubles were rooted in sleep. Harvin’s results indicated that his breathing frequently stopped for up to ten seconds, depriving him of oxygen.

He told NBCSports.com that he no longer takes his migraine medication, which he blames for his collapse. Instead, he uses continuous positive airway pressure (CPAP) to treat his OSA. This device pumps air into his nose to regulate his breathing during sleep.

Sleep apnea is a common problem in professional football players.

In June, this blog reported on a new study from the journal SLEEP that found that more than 19 percent of NFL players might have sleep apnea.

The study included 137 NFL players from six teams. Each athlete took an at-home sleep test. This test determined if a player stopped breathing during his sleep. It also measured how often the pauses occurred and for how long.

Five percent of the players had moderate to severe sleep apnea. Fourteen percent had a mild form of the condition.

The NFL players also took a sleep questionnaire. Snoring was reported by 100 percent of the players. Observed pauses in breathing and daytime sleepiness were reported by 25 percent.

Experts estimate that sleep apnea affects four percent of men in the general population. They suspect that 18 million Americans have the condition.

Image by Brandi Korte

Wednesday, September 8, 2010

Why Some Kids Can’t Get Enough Shuteye

Dr. Richard Kravitz, director of Duke’s Pediatric Sleep Laboratory, recently discussed pediatric sleep apnea on DukeHealth.org.

Dr. Kravitz noted that obstructive sleep apnea (OSA), in which the airway becomes partially or completely blocked during sleep, occurs in one to three percent of otherwise healthy children. It prevents a child from getting restful sleep

OSA is most common in children two to seven years of age, but it can also affect infants and adolescents. While the most common cause of OSA in children is enlarged adenoids and tonsils, obesity is an increasingly common culprit. Children with Down syndrome also experience a high risk.

Signs of sleep apnea include loud, frequent snoring and pauses in breath followed by gasps. Dr. Kravitz explained that snoring appears in 10 percent of otherwise healthy children and does not always indicate OSA.

Restless tossing and turning may also reflect sleep troubles.

Untreated OSA can cause physical and behavioral problems including daytime sleepiness, excessive napping, behavior changes, hyperactivity, concentration troubles, poor growth, bedwetting, high blood pressure and cardiac problems.

Diagnosis of sleep apnea takes place at a sleep center. A sleep test will monitor how many times a child stops breathing during sleep. The test also monitors brainwaves, heartbeats, and oxygen and carbon dioxide levels. These factors provide evidence of airway obstruction.

An article in today’s Chicago Tribune reported on how some hospitals have created sleep centers specifically designed for children’s needs. Many traditional sleep centers also treat children.

Sleep center rooms look similar to bedrooms. A parent is encouraged to spend the night with their child to provide comfort and confirm how closely the night of observed sleep reflected home sleep patterns.

After a diagnosis, there are several treatment options. Weight loss, tonsil removal, continuous positive airway pressure, and oral appliances are several common treatments.

A list of sleep centers is available here.

Thursday, September 2, 2010

Sleep Apnea Worsens Insulin Resistance in Teens

A new study in the Sept. 1 issue of SLEEP indicates that obstructive sleep apnea (OSA) worsens insulin resistance in obese teens. Insulin resistance is a risk factor for type 2 diabetes.

OSA has been linked to diabetes and cardiovascular problems. Obesity increases a person’s risk for sleep apnea, but after adjusting for obesity, sleep apnea is an independent risk factor for insulin resistance and hypertension in adults.

The researchers hypothesized that OSA was associated with worse insulin resistance.

The study included 98 children, of which 42 were female and 56 were male.

“Prepubertal” children were seven years of age on average. There were 37 prepubertal children.

“Pubertal” children were 13 years on average. There were 61 pubertal children.

Each child took an overnight sleep test and had their insulin resistance assessed.

The results?

In obese pubertal children, OSA was associated with worse insulin resistance, putting them at greater risk for developing type 2 diabetes.

Wednesday, September 1, 2010

Sunshine State Asks Sleepy Drivers to Stay Off the Roads

The state of Florida's first "Drowsy Driving Awareness Week” takes place September 6-10. Gov. Charlie Crist signed into law the “RonShay Dugans Act.” It aims to create greater awareness about the dangers of drowsy driving, making Florida the 18th state to do so.

The definition of drowsy driving varies from state to state, but every state's definition revolves around the concept of a fatigued driver.

Excessive daytime sleepiness (EDS) can cause impaired reaction time, memory problems, mood changes and driving accidents. It can increase a person’s risk for deadly motor vehicle accidents by 15 times.

Motor vehicle accidents due to “drowsy driving” account for $48 billion in medical costs each year. The National Highway Traffic Safety Administration says drowsy driving is responsible for about 100,000 car crashes a year.

Drowsy driving can be as dangerous as drunk driving. Current legislation recommends that commercial drivers get screened and treated for obstructive sleep apnea (OSA), a common cause of EDS. But there are many non-commercial drivers who do not know that they have OSA.

Florida’s drowsy driving week honors an eight-year old Tallahassee girl. ABC reported that RonShay Dugans was going to the Boys and Girls Club in a bus in 2008 when a drowsy driver behind the wheel of a cement truck slammed into the back of the bus and killed her.

Chief Leroy Smith of the Florida Highway Patrol told ABC that it's no different than driving under the influence. “With regard to drowsy driving, it is just as dangerous as drunk driving just as alcohol and drugs could impair one’s normal faculties, so could sleepiness and drowsiness. It could also slow one’s reaction time.”

RonShay’s adoptive father, Perry West, said RonShay’s legacy is an important reminder for all drivers. “We are reminded every day when we get up in the morning of just what we lost and so with this we are also mindful of the price that was paid to get this legislation passed.”

In 2003, New Jersey was the first state to pass a law aimed specifically at fatal accidents involving sleepy motorists - estimated at about 1,500 a year nationwide. Such drivers can now be charged with vehicular homicide. That offense is punishable in New Jersey by up to 10years in prison and a $100,000 fine.

Learn more about the risks of drowsy driving here.

Monday, August 30, 2010

A Dog’s Life: How Sleep Troubles Can Plague Our Canine Counterparts

A blog post by Dr. Michael J. Breus, inspired by Dr. Patty Khuly’s FullyVetted blog post, reports on the dangers of a snoring dog.

Dr. Breus is a Clinical Psychologist and a Diplomate of the American Board of Sleep Medicine.

Despite being man’s best friend, snoring dogs can be worst enemies to a good night’s sleep.

This is because, like humans, dogs can suffer from sleep apnea. The difference, explains Dr. Breus, is that we’re not always as inclined to kick them out as we would a snoring spouse.

To avoid sleep disruptions, he recommends that people, especially those with allergies or insomnia, give dogs a sleeping space of their own.

Sleep apnea is caused by the airway collapsing during sleep, producing loud snoring sounds and respiratory problems.

Dogs that snore are almost always experiencing some degree of respiratory problems that affects their waking lives too.

Canines don’t sweat. They regulate their body temperature through panting—using their tongue and airway as a cooling mechanism. If they are unable to move air efficiently, they are more likely to suffer heat stress and less likely to oxygenate their blood efficiently. This relationship helps explain why snore-prone breeds can suffer from chronic fatigue.

Which dogs are at-risk for sleep-related breathing problems?

A recent Associated Press story reported on dogs that die while traveling on planes. Short-snouted dogs like bulldogs, pugs, and similar breeds made up about half of deaths in the past 5 years. These "brachycephalic" breeds have a skull formation that affects their airways. They can’t cool themselves off so easily and are prone to heat distress and, in severe cases, death.

Like dogs, humans that suffer from obstructive sleep apnea often experience excessive daytime sleepiness. Left untreated, this condition can also raise our risk for heart attack, stroke, diabetes, depression, and cognitive problems. We also experience higher rates of driving and work-related accidents.

In people, certain jaw features, neck size, and body weight can indicate sleep apnea. This blog post reviews signs of sleep apnea in humans. Sleep apnea can be diagnosed at an AASM-accredited sleep center.

Image by Niranj Vaidyanathan

Thursday, August 26, 2010

Patients Find Trouble Fitting Boil-and-Bite Oral Appliances

Oral appliances used to treat sleep apnea can be custom-made by dentists or home-made. Custom-made appliances are “titrated,” or adjusted, over a period of time to ensure effective treatment. At-home “boil-and-bite” devices are created like sports mouth guards.

A new study in the journal Sleep and Breathing found that the number one reason patients stop using boil-and-bite devices is that they have difficulty finding the optimal fit.

The researchers collected the data with a mail questionnaire. The questionnaire was sent to 84 patients six months after the delivery of an OA.

Feedback was given by 47 of the patients. Compared to non-responders, responders did not differ in terms of baseline age, body mass index (BMI), OSA severity or daytime sleepiness.

After six months, 25 percent of the patients had stopped using their appliance. Of the nonusers, almost 80 percent stopped using the OA in the first three months. Non-users reported that their device was “uncomfortable” and ill-fitting. Nonusers had a higher BMI and higher daytime sleepiness when compared with users.

Of the responding patients, 35 continued to use the appliance. More than 80 percent of these users felt that their symptoms improved and more than 60 percent were satisfied with the therapy. Many users complained about a dry mouth and excessive salivation.

Fifty percent of the nonusers and 75 percent of the users previously used CPAP.

The American Academy of Sleep Medicine (AASM) recommends the use of OAs for mild to moderate apnea patients if they prefer the appliance to CPAP, cannot tolerate CPAP, or cannot use positional therapy or weight loss to control their apnea. OAs are also recommended for severe patients if they are unable to tolerate CPAP.

Last November, this blog reported on a cornerstone study comparing the effectiveness of custom-made verses boil-and-bite devices.

Find-a-dentist in your area who is trained to make custom-made oral appliances for sleep apnea treatment.

Image by ex.libris

Tuesday, August 24, 2010

Dentists Overcome Challenging Sleep Apnea Case

A new study in the Journal of Oral Rehabilitation evaluated the use of an oral appliance (OA) for the treatment of obstructive sleep apnea (OSA) in a patient with severe dental problems and multiple missing teeth.

Dentists used a custom-made mandibular advancement device (MAD). This type of device moves the lower jaw and tongue base forward during sleep to keep the airway open.

The patient was 58 years of age and male. He had moderate OSA and experienced pauses in breath more than 20 times per hour of sleep. With only ten teeth, the patient exhibited severe dental and periodontal concerns.

Wearing the MAD produced a significant decrease in his OSA. Instead of 20 pauses in breath, the patient experienced only eight pauses per hour – more than halving the severity of his condition.

Dental and periodontal treatments were also performed to reestablish his oral health. The OA was modified after each treatment to adapt it to each new oral condition.

After 18 months, the oral health was reestablished and the patient received a final MAD.

Three years later, no side effects related to the OA treatment were detected.

These results show the feasibility of treating OSA patients with OA despite poor oral conditions and missing teeth.

Click here to read a recent study in Sleep and Breathing that discussed performing oral appliance therapy on a sleep apnea patient with no teeth.

Some patients who wear oral appliances to treat sleep apnea experience side effects. These effects include:

• Jaw, tooth, gum, tongue, or facial pain
• Dry mouth
• Salvation
• Gagging
• Changes in the biting surface of the teeth

The American Academy of Sleep Medicine (AASM) recommends the use of OAs for mild to moderate apnea patients if they prefer the appliance to CPAP, cannot tolerate CPAP, or cannot use positional therapy or weight loss to control their apnea. OAs are also recommended for severe patients if they are unable to tolerate CPAP.

The American Academy of Dental Sleep Medicine trains dentists to treat OSA patients with custom-made oral appliances. Find an AADSM-Member here.

Monday, August 23, 2010

Reversing Infertility with Sleep Apnea Treatment

Couples who are having trouble getting pregnant should consider their sleep health.

A new study in the journal Sleep and Breathing found that treating sleep apnea may help reverse infertility.

Obstructive sleep apnea (OSA) is associated with numerous health problems. Changes in the serum prolactin (PRL) secretion, which affects fertility, is one of these issues.

This study examined the effect of CPAP therapy on the serum PRL in patients with OSA.

The study included 10 men. Seven men were obese and three were overweight. The men were 57 years of age on average. They experienced five to 28 pauses in breath per hour of sleep.

Each man received an overnight sleep study. Serum PRL was measured at 7:00 a.m. after the sleep study, and again after 11 to 39 months of CPAP therapy.

The results found that CPAP therapy was associated with a significant decrease in serum PRL levels. It lowered and, in some cases, normalized the serum PRL in OSA patients.

Several studies have investigated this topic in the past but have had mixed results.

Thursday, August 19, 2010

Bariatric Surgery Helps Prevent Sleep Apnea in Morbidly Obese

According to a new Sleep Review article, patients who were denied bariatric surgery for insurance reasons developed numerous obesity-related diseases and conditions, including obstructive sleep apnea (OSA), within 3 years of follow-up. This research was presented at the 27th Annual Meeting of the American Society for Metabolic & Bariatric Surgery.

This Wisconsin-based study compared the medical records of 587 patients who had laparoscopic gastric bypass (LGB) with 189 patients who were medically eligible, but denied bariatric surgery by their insurance provider between 2001 and 2007.

At the time of initial medical evaluation, patients in both groups had an average body mass index (BMI) of about 48. The article notes that people who are considered eligible for this surgery are morbidly obese and have a BMI of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as OSA, Type 2 diabetes, or heart disease.

The researchers tracked the development of five obesity-related conditions in patients who received treatment verses those who were denied treatment.

After 3 years, the average BMI in the surgical group had dropped to 30.5 and less than one percent of patients developed new obesity-related conditions. In contrast, a large number of patients in the denial group grew unhealthier.

Though BMIs remained stable in the denial group, 34 percent developed OSA. More than 40 percent developed hypertension. Nearly 20 percent developed gastroesophageal reflux disease (GERD). Type 2 diabetes developed in nine percent. And lipid disorders developed in 11 percent.

“It is well known that bariatric surgery treats obesity-related diseases; our study now shows that it can prevent new diseases from occurring,” said Lead Author Dr. Shanu N. Kothari.

Previous studies have shown the benefits of bariatric surgery. A 2004 study from the Journal of the American Medical Association demonstrated that bariatric surgery eliminated OSA in 85 percent of patients.
...
The American Academy of Sleep Medicine recommends that people with sleep apnea combine weight loss with oral appliance therapy or CPAP.

Tuesday, August 17, 2010

Floating Down The River Without A Care (or Cellphone)

A recent New York Times article investigated how being outdoors and away from technology affects the brain.

The article reports on five neuroscientists who spent a week drifting down the San Juan River, camping on the banks and hiking the canyons.

No cell phones. No e-mail. No laptops.

They set out in nature to better understand how technology alters our thoughts and behavior, and how nature might reverse those changes.

They focused on how attention, memory and learning are affected when technology is removed from a person’s physical landscape.

The travelers discussed a seminal study from the University of Michigan that showed people can better learn after walking in the woods than after walking a busy street.

The study indicates that learning centers in the brain become taxed when asked to process information, even during the relatively passive experience of taking in an urban setting.
Sleep Medicine experts are also interested in how technology impacts children’s sleep patterns and ability to learn.

Recent studies found that adolescents used multiple forms of technology late into the night, including gaming systems, cell phones, and computers. As a result, they demonstrated difficulty staying awake and alert throughout the day.

This press release from the American Academy of Sleep Medicine explains why it’s important to remove technology from the bedroom. It provides tips on improving sleeping habits and, as a result, overall health.

Pre-bedtime activities like drinking milk, taking a bath, teeth-brushing, and reading a non-stimulating book will signal to the brain that it’s time to sleep. Exercise, caffeine, and sugary foods should be avoided. The ideal sleeping atmosphere is a dark, quiet room that is kept below 75 F.

Image by Inaz

Monday, August 16, 2010

Strength-Training in Your Sleep: OSA Treatment Improves Body’s Ability to Fight Acid Reflux

A new study in the journal Sleep and Breathing found that obstructive sleep apnea (OSA) treatment may reduce gastroesophageal reflux (GER) by decreasing strain where the esophagus and stomach meet.

GER is characterized by symptoms such as heartburn and acid reflux. When awake, GER events are usually brief because of powerful mechanisms like swallowing.

When patients are asleep, these protective mechanisms end, resulting in longer GER events that increase risk of esophageal injury.

People with OSA exhibit an increase in both daytime and nighttime GER symptoms and events.

GER is usually prevented by the lower esophageal sphincter (LES). The LES is located between the esophagus and stomach. Baseline LES barrier pressure was low in these OSA patients. The results indicated that OSA may increase GER events as it strains the LES. CPAP treatment seemed to reduce this strain, consequently decreasing the events.

The study included eight patients with OSA and nocturnal GER. They each took a sleep study. The first half of the night was spent without treatment. The second half was spent with continuous positive airway pressure (CPAP).

When patients were off CPAP, they experienced an average of 2.7 GER events per hour and 70 obstructed respiratory events per hour. There was no direct relationship between the occurrence of GER and OSA events.

In April, Dr. Steven Park wrote a guest post for this blog. His post explained that OSA causes normal stomach juices to leak up into the throat, which not only causes arousal, but also causes swelling and inflammation in the throat. Dr. Park noted that too many spontaneous arousals may be a sign of upper-airway resistance syndrome or early OSA.

Friday, August 13, 2010

Dealing with It: How the Brain Handles Sleep Loss

A new study from the Proceedings of the National Academy of Sciences, shows that the brain copes with short- and long-term sleep loss similarly.

The University of Wisconsin-Madison-based researchers found that five nights of restricted sleep affects the brain the same way as acute total sleep deprivation.

Dr. Chiara Cirelli noted in a press release that even mild sleep restriction for several nights can affect performance on cognitive tasks.

Recent studies found that five days with only four hours of sleep per night result in cognition problems that do not fully recover after one night of sleep, even if 10 hours in bed are allowed.

Cirelli and her team kept rats awake 20 hours a day over five days while continuously recording the animals' brain waves with a sophisticated EEG as they were asleep and awake. The EEGs measured slow wave activity (SWA). It is the best marker of an individual's need to sleep as well as the intensity of sleep that follows wakefulness.

In general, the longer awake, the higher is SWA in the subsequent sleep. Cirelli explained that the researchers knew that this was true after short-term sleep deprivation. But this research indicated that same result for chronic sleep restriction.

According to the rat cumulative SWA measures, the sleep restriction produced intense recovery sleep following each wake cycle, with both longer and deeper sleep. The more effective the researchers were in keeping the animals awake during those 20 hours, the larger the sleep rebound they saw during the following four hours.

Even when the animals seemed awake and were moving around, heightened SWA was evident in their "wake" EEG.

"Monitoring SWA levels during waking time is very important in understanding the whole picture," she says. "High SWA levels during periods of both sleeping and waking signal that you need to go to sleep."

Researchers can use what they learn from short-term deprivation and apply it to long-term deprivation. This application is important, as more than 70 million Americans suffer from sleep disorders.

Monday, August 9, 2010

Study Examines Risk Factors for Sleep Apnea in Young Europeans

A new study in the journal Sleep and Breathing investigated the risk factors for OSA in young people living in Brussels, Belgium.

The study included 121 patients. Medical data was collected from patients under 40 years of age who were referred by a physician for an overnight sleep test between 2007 and 2009. Researchers then assessed their shared characteristics.

The group included 17 women and 104 men. It was 55 percent Caucasian and 42 percent African.

OSA severity is determined by how many times a person stops breathing per hour of sleep. This number is called the AHI. A sleep test determines this rate. An AHI of 30 or more indicates severe sleep apnea.

The median AHI of this group was 39 in men and 23 in women. The median AHI was 30 in Caucasians and 39 in Africans.

Body mass index (BMI) positively correlated to AHI. BMI is a common factor for OSA because excess weight increases OSA risk.

In patients less than 40 years of age with OSA, disease severity was associated with high BMI, large neck circumference, male sex, and African origin. African origin, smoking, and neck circumference predicted AHI, independently of BMI.

Upper-airway abnormalities did not predict AHI. Facial abnormalities can be a factor in OSA patients, especially in people with Down syndrome.

The researchers also looked at other diseases experienced by OSA patients. They found that the following diseases were common with the patients.

• High blood cholesterol – 27 percent
• Hypertension – 20 percent
• Diabetes - 13 percent
• Depression - 13 percent
• Reflux and gastric ulcer - 13 percent
• Asthma – 9 percent
• Allergies – 8 percent
• Hypothyroidism - 5 percent

OSA is a serious medical condition that requires treatment. You can get tested for sleep apnea at an accredited sleep center.

Image by Gregory Melle

Thursday, August 5, 2010

Rise and Shine: Sleep Apnea Treatment Improves Bed Partner’s Depression

A new study from the journal Sleep and Breathing found that treating primary snoring and obstructive sleep apnea (OSA) can improve your bed partner’s depression.

OSA is known to influence mood and daytime sleepiness in patients, but this study confirms its impact on bed partners.

The study included 36 participants who snored or had OSA. They were 24 to 63 years of age. Each person took a full-night polysomnogram (PSG).

They had two sessions of radio-frequency tissue ablation (RFTA). This surgery tries to shrink the palate or tongue with microwaves.

Results indicated that treatment improved depression scores for the bed partners of snoring and OSAHS patients during a short follow-up period.

A follow-up PSG was given within two to three months after the second RFTA session. AHI decreased from 13.16 to 10.69 for the entire group of patients.

Participants also took the Beck Depression Inventory-Second Edition (BDI-II) to assess the changes in emotional state of patients’ bed partners.

The average BDI-II scores decreased from 12.69 to 9.17 for the entire group of bed partners, indicating improved mood.

Sleep plays an important role with emotions.

In March, this blog reported on a new study that found that lack of sleep impairs recognition of human emotion. The research showed that sleep deprivation dulls people’s ability to judge facial expressions.

Image by Jack

Wednesday, August 4, 2010

Dentists Take Front Line against Sleep Apnea

According to AADSM member Dr. Michael Simmons, sleep medicine is being introduced at the majority of U.S. dental schools, but the total hours taught are inadequate given the epidemic proportion of people with OSA.

"Dental students and dentists need to screen for sleep-related breathing disorders as part of patients' routine workups," Dr. Simmons told Dr. Bicuspid in a recent interview. “Then, with additional interest and adequate training, they can learn to cotreat these serious medical conditions with their patients' physicians as an integral part of the sleep medicine team."

According to his latest research, dental students spend an average of 2.9 instruction hours during their four years of dental school studying sleep disorders.

More than 18 million American suffer from OSA. But 80 to 90 percent of these people are undiagnosed.

Dentists are beginning to play an important role in screening patients for OSA. Because patients see dentists on a more regular basis than they see physicians, dentists can notice early warning signs of sleep disorders.

"Physicians don't always look at the patient's throat, but dentists have to look in the patient's mouth," said Dr. Mansoor Madani. "They may save the patient's life by doing that simple exam.”
A person with OSA may stop breathing for 10 to 30 seconds or even longer, leading to serious drops in the oxygen level in the blood and eventually waking the person to breathe.

"If someone has a pre-existing heart disorder, and they are not breathing properly, they are more predisposed to heart attack or stroke because of that lack of oxygen," Dr. Madani said.

Untreated OSA can cause a range of health effects, including memory problems, headaches, decreased libido, hypertension, stroke, heart attack, and sudden death during sleep. It also raises a person’s risk for driving accidents.

Dr. Madani advises dentists to spend less than 2 minutes looking at the patient's neck size, body weight, airway, tonsils, and uvula. If OSA is suspected, the patient should be referred to a sleep physician. The patient will need to take a sleep test for a final diagnosis.

The American Academy of Dental Sleep Medicine trains dentists to screen for and treat this serious medical condition. Find a trained dentist near you.

Tuesday, August 3, 2010

New Heart Research Pumps Blood Into Sleep Apnea Awareness

A new study examined whether obstructive sleep apnea (OSA) is associated with heart failure or coronary heart disease (CHD). The study was published online by the journal Circulation.

The trial, known as the Sleep Heart Health Study (SHHS), followed patients who were free of these conditions at baseline. It included 1,927 men and 2,495 women. Participants were 40 years of age or more.

In the study, 24 percent of the men and 11 percent of the women had severe OSA.

In men under 70 years of age, OSA was a significant predictor of CHD and CHD-related death. Among men 40 to 70 years of age, those with severe OSA were 68 percent more likely to develop CHD than men without OSA.

The association between OSA and heart disease was weaker in this study than in past research. Previous studies suggested an increased risk of CHD-related death from OSA in people ages 30 to 50. The researchers suggest that this risk might be greatest at a relatively young age.

Results indicated that men with severe OSA have almost 60 percent higher risk than men without OSA of developing heart failure.

"It’s really time for us to perform clinical trials to assess whether CHD risk can be reduced in patients with severe sleep apnea by treating the apnea,” Gottlieb says.

Despite these high numbers, evidence shows that OSA may increase the risk of stroke more than the risk of CHD. In April, this blog reported research from the SHHS, which indicated that OSA doubles the risk of stroke in men.

"The take-away from our study is that obstructive sleep apnea is a serious condition that warrants medical treatment," said lead author Dr Daniel Gottlieb.

"It’s important for anyone who suspects they have obstructive sleep apnea to discuss it with their primary-care physician."

Doctors at accredited sleep centers can test for OSA: http://sleepcenters.org/.

Source: Medscape

Monday, August 2, 2010

Truckers Asked to Hit the Gym Before Hitting the Road

Regulators want truckers to shape up, explains NPR’s Frank Morris in a recent “All Things Considered” piece. Hear the whole story at NPR.

Federal regulators have announced plans to step up scrutiny of obstructive sleep apnea (OSA) in truckers – making some professional drivers evaluate their eating and exercise habits.

The Official Blog of the AADSM reported on these plans earlier this year.

Excess weight increases a person’s risk for OSA. Truck drivers, who may sit for 10 to 11 hours a day, tend to have a higher risk than most people. Doctors writing federal transportation policy believe that up to 40 percent of professional drivers are significantly overweight.

In the general population, four percent of men and two percent of women have OSA. In the trucking population, that number nears 30 percent!

One of the main risks of OSA is drowsy driving, which contributes to thousands of crashes each year. A federal study shows it to be a factor in 13 percent of truck crashes.

The NPR story notes that truckers have to get a medical exam at least every two years to qualify for their license. But many drivers see doctors who may overlook red flags for OSA, like obesity.

Dr. Maggie Gunnels, who serves on a panel that's rewriting health regulations for truckers, says the panel's job is to remove high-risk operators from the road. "It's safer for them, and it's safer for the American public who travel," Gunnels says.

The panel published proposed rule changes months ago. The Federal Motor Carrier Safety Administration will begin to formalize them soon, starting by establishing a registered pool of approved health screeners with the potential for systematic OSA screening.

Image by Rich

Friday, July 30, 2010

Federal Disaster Response Plan Now Includes Dentists

A series of bills recently passed in congress give dentists a bigger role in providing disaster relief. HR 903, introduced by Michigan Democrat Bart Stupak is among the legislation involving dental sleep specialists:

“Dental Emergency Responder Act of 2009 - Amends the Public Health Service Act to: (1) revise the National Health Security Strategy to include increasing the preparedness, response capabilities, and surge capacity of dental facilities and effective utilization of any available mobile dental assets; and (2) provide that federal dental entities shall carry out activities under the public health and medical response training program.”

One major public health need in the event of an emergency is treatment for obstructive sleep apnea. Natural disasters such as hurricanes, flooding or earthquakes cause people to lose their important belongings. People with sleep apnea may desperately need replacement therapeutic equipment. Enter dental sleep specialists, who with emergency funding can help fit these patients with oral appliances for OSA.

The aftermath of Hurricane Katrina is a case where dentists could have helped. With the help of generous donors The American Sleep Foundation was able to provide more than 1,300 pieces of equipment for Katrina victims with OSA. By mobilizing dentists specializing in dental sleep medicine we may be able to meet the needs of the many patients who can’t adhere to CPAP.

Thursday, July 29, 2010

Proteins Key to Sleep Disturbed Morning Migranes

Researchers are learning more about why people with sleep disorders such as obstructive sleep apnea often have morning headaches or migraines.

Findings show sleep deprivation leads to changes in certain proteins that play a key role in initiating and sustaining migraines. When increased, the proteins allow for the activity of nerves that transmit pain during migraines.

About a third of patients with obstructive sleep apnea get morning headaches. The headaches are most frequent in moderate and severe cases of OSA.

Treating obstructive sleep apnea can solve morning headaches 9 out of 10 times. An oral appliance may be the best answer for moderate cases. If you have headaches caused by OSA and want oral appliance therapy book an appointment with a dentist trained in dental sleep medicine.

Monday, July 26, 2010

Sleep Apnea & Married Couples that Sleep Alone

An article published in the Sunday New York Times documents how sleep habits are changing in America. Several recent polls and studies suggest 1 in 4 married couples may be sleeping in separate beds.

Reasons can include comfort concerns, different sleep schedules or untreated sleep disorders. Obstructive sleep apnea is at the top of that list. The breathing pauses and loud snoring associated with OSA don’t just disturb your own sleep; they can keep your partner awake and even damage your marriage.

The author makes the point that the bed is the last bastion togetherness in our relationships because of our busy lifestyles. People who can’t bear to share their bed may be driving a wedge into the marriage.

The tragic part is both sleep apnea and habitual snoring are treatable. All it takes to make the bed a more welcome place is an appointment with a dentist specializing in sleep medicine. The dentist will fit you with an oral appliance designed to fully open your airway by repositioning your jaw. The oral appliance can solve snoring and moderate cases of obstructive sleep apnea.

Regularly getting a good night sleep takes some work, just like maintaining a marriage. Become a pro and you’ll be better built to last.

Thursday, July 22, 2010

Sleep Study Meets Social Media in Live Sleepup

There’s a great opportunity Thursday night if you’re considering a sleep study or you’re just curious how it works. Swedish Medical Center’s Sleep Medicine Associates in Seattle is hosting a Sleepup, a unique multimedia event combining social media with live streaming video.

Volunteer Paul Balcerak will be the center of all the attention. He’s going in for a sleep study because his wife fears he has obstructive sleep apnea. You’ll see him hooked up in a sleep lab, and later speaking with doctors as he’s diagnosed.

The doctors and technologists will be tweeting all night and taking your questions. They’ll be giving a play by play of the sleep study. The press release claims they’ll use charts, graphs and factoids to educate the public about sleep studies and explain their thought own process during diagnosis.

The Sleepup begins with a live chat with the patient and doctors at 8 p.m. Pacific standard time. The live streaming sleep study starts at 9 p.m. Find out the results and learn the treatment options Friday morning at 7 a.m.

Follow all the tweets by searching the hashtag #sleepup and submit your questions @GoSleepSeattle on Twitter or at the sleep center’s website.

Tuesday, July 20, 2010

Is your sleep apnea depressing your partner?

Treating obstructive sleep apnea isn’t only in your best interest; your partner too will benefit. Nobody wants to share a bed with a loud snorer, and chances are you’re stealing their sleep. New findings show you might also be making your bed partner depressed.

The good news is you can cure their depression by seeking an OSA treatment such as an oral appliance. The less you snore the better your partner will likely feel.

The study involved 36 patients with mild to moderate sleep apnea and their spouses. Each patient underwent a clinical sleep study at the start of the trial to assess their OSA. At the same time their partners were screened for depression and daytime sleepiness.

Researchers then used a two-part surgical procedure called radiofrequency tissue ablation to treat the subjects’ sleep apnea. The patients and their spouses were given the same tests when they returned for a follow up 2-3 months after the second surgical session.

Every patient had fewer measured breathing pauses, and their spouses scored lower on the depression assessments – both significant improvements.

The findings demonstrate reducing the symptoms of obstructive sleep apnea can make your partner feel less depressed, regardless the choice of treatment.

The authors of the study argue the daytime sleepiness, fatigue and cognitive impairment associated with sleep disturbances can undermine relationships with their families. These problems may go away when the cause of the sleep disturbance is eliminated.

AADSM members can read the entire study in the June issue of Sleep and Breathing.

Monday, July 19, 2010

CPAP-Based Test for OSA Compared to Standard Sleep Study

A certain type of CPAP machine may have a promising future an alternative test for obstructive sleep apnea.

A small study published in the June issue of Sleep & Breathing found a test using the CPAP brand REMstar Pro yielded promising results similar to a manually scored polysomnography. The device was effective in measuring for apnea but not hypopnea.

The study involved 10 subjects who were previously diagnosed with obstructive sleep apnea. Each underwent a sleep study while using the CPAP machine. The first three hours used subtherapeutic CPAP while the second used the previously determined CPAP.

Apnea counts at therapeutic CPAP using were similar for both manually scored PSG and REMstar. The hypopnea index was also similar at baseline. However, at therapeutic levels the scores were significantly different.

The authors suggest these results merit further investigation.

Tuesday, July 13, 2010

Men With Sleep Apnea Face Larger Heart Hazard

The silent killer can sneak up if some very audible clues go ignored. Loud gasps for air during sleep are a dead giveaway. But America's leading killer is even more selective in its targets, a new study suggests.

The relationship between obstructive sleep apnea and heart disease may not be so simple. Study results show that men older than 70 and women with sleep apnea don't have an increased risk for heart failure, unlike middle-aged men.

The study published in the journal Circulation tracked heart disease-related incidents between 1998 and 2006. Those included heart attacks, heart bypass operations and deaths.

Nearly 2,000 men and 2,500 women with no history of heart problems participated. Clinicians used a sleep study to screen each subject for sleep apnea at the beginning of the study. About half had varying degrees of OSA.

Nearly 500 cardiac events occurred over the length of the study including 76 deaths. The occurrences were 68 percent more likely for men with severe sleep apnea between 40 and 70years of age. The same relationship was not clear for women and older men.

But that doesn’t mean you should let OSA go undetected or untreated. People of any age or gender still face a long list of symptoms and risks including fatigue, memory loss and stroke.

A variety of treatment options are available to suit each patient’s unique needs. Patients with moderate OSA can choose from Continuous Position Airway Pressure (CPAP), surgical options or oral appliance therapy, as described in a recent CNN Headline News segment:




Find out if you have obstructive sleep apnea at a nearby sleep center. If you’ve been diagnosed with OSA, a dental sleep specialist can help you get started with an oral appliance


Image by brick red

Monday, July 12, 2010

Different Approach to Sleep Studies May Reduce Wait Times


With the growing public awareness of obstructive sleep apnea, some clinics face an overwhelming demand for sleep studies. Some patients may have to wait months just to get diagnosed, so researchers are suggesting clinics adopt a new approach.

Typically, patients diagnosed with OSA return at a later date for a treatment-focused second sleep study. A study published in the latest issue of Sleep and Breathing suggests both procedures can be completed in a single night. This change could speed up wait times and cut costs.

The follow-up appointment is typically used to adjust CPAP. But patients who use an oral appliance for sleep apnea have different needs. They face the same bottleneck as CPAP patients because dentists are not permitted to diagnose sleep apnea. Dentists can only screen for the condition and direct their patients to a sleep center.

The study looked at adherence rates and amount of breathing pauses per night when CPAP adjustment happened in the same night compared to a month later. The results were nearly identical.

Nearly a quarter of sleep labs use same-night sleep studies. The AASM reports split-night sleep studies are an acceptable method for diagnosing and treating OSA in certain specific cases.

Dental sleep specialists may be able to treat more patients with oral appliances if an increased number of sleep centers sped up the diagnosis process by adopting split-night sleep studies.

Oral appliances are an excellent alternative for the many patients who are unable to comply with or tolerate CPAP. Oral appliances push forward the tongue and lower jaw during sleep to maintain airflow.

Friday, July 9, 2010

Neck thickness: sleep apnea sign and body fat indicator?

A new study in the journal Pediatrics suggests measuring neck circumference may be a better way to calculate body fat than the Body Mass Index. The authors believe their findings could expand doctors’ ability to detect obstructive sleep apnea.

Researchers tested neck thickness as a predictor for body fat by recording the height, weight and neck circumference of more than 1,100 children. Their necks were measured using a flexible tape at where the adam’s apple is located. Researchers compared the three measurements and came up with these standards for obesity by neck circumference:

Boys
Age 6: 11.2 inches
Age 10: 12.6 inches
Age 14: 14.2 inches
Age 18 15.4 inches

Girls
Age 6: 10.6 inches
Age 10: 12 inches
Age 14: 12.6 inches
Age 18: 13.6 inches

The authors suggest neck circumference would be a suitable replacement for BMI. Public health agencies use BMI to track obesity in various populations. Some critics say the BMI is flawed and inaccurate because it only accounts for height and weight.

More cases of obstructive sleep apnea could be identified and treated earlier if neck circumference were to supplant BMI and become part of regular physical examinations. Neck thickness is one of the main predictors of obstructive sleep apnea. Breathing pauses often occur when extra fatty tissue in the throat keeps air from flowing freely as you sleep.

Wednesday, July 7, 2010

September 11 Rescue Workers At-Risk for Obstructive Sleep Apnea


The men and women who sacrificed their health to save their fellow citizens during America’s darkest hour are likely to develop obstructive sleep apnea, a new study shows. Many emergency responders who rushed to ground zero in the aftermath of the World Trade Center attacks on September 11, 2001 have developed symptoms linked to the sleep disorder.

The study published in the July edition of Sleep and Breathing reports the number of firefighters and emergency medical personnel are at high risk for obstructive sleep apnea continues to increase. In 2005, more than a third of responders were at high risk. 1 in 6 rescuers who had been healthy in 2005 have since developed the symptoms.

The authors assumed rescuers with acid reflux disease or chronic sinus problems (rhinosinusitis) or self-reported health problems were at elevated risk for obstructive sleep apnea. Those who responded early to the attacks or suffered post traumatic stress may also be at risk.

The data came from regular health examinations administered by the FDNY. Members of the department undergo a physical and answer a health questionnaire every 12 to 18 months. In 2005 the FDNY began included questions about sleep problems in the medical screenings.

The study involved 11,700 male firefighters and emergency medical personnel who were on scene at the World Trade Center following the terrorist attacks. The researchers compared the assessment data from 2005 to the results of later screenings.

Exposure to the flying dust and debris at the disaster site is linked to significant irreversible lung damage. The measured drop in lung function for affected rescuers is about 12 times the rate associated with normal aging.

Image by Brian Boyd

Tuesday, July 6, 2010

Oral Appliance Therapy for Acid Reflux


A recent study reveals another advantage of choosing oral appliance therapy to treat obstructive sleep apnea. The findings show oral appliances can reduce symptoms of acid reflux disease.

The study involved a group of 56 dental patients who sought oral appliance therapy for obstructive sleep apnea. After undergoing a sleep study, the participants answered a questionnaire about acid reflux symptoms. Researchers looked for improvements when the patients answered the same questions during a follow-up appointment.

Scores on the acid reflux symptom test improved for both men and women after nightly oral appliance use. The results were best when patients used an oral appliance for six hours per night for more than 20 days per month.

It’s still unclear why oral appliances help reduce acid reflux symptoms due to study limitations. Researchers speculate it may be due to an increase in reflux barrier pressure, a decrease in arousal and fewer breathing pauses.

Gastro-esophageal reflux disease is common for patients with obstructive sleep apnea. Apneic episodes can cause stomach juices to leak up into the throat, leading to swelling and inflammation.

Friday, July 2, 2010

Cognitive-Behavioral Therapy can Improve Adherence to OSA Treatments

A recent study abstract suggests cognitive-behavioral therapy may help patients stick to treatments for obstructive sleep apnea. Participants in the study were more likely to diet, exercise and use CPAP after several group therapy sessions.

Few researchers and clinicians have explored cognitive-behavioral therapy as a form of treatment for sleep apnea. CBT is commonly used to treat other sleep-related disorders and is the treatment of choice for primary insomnia.

The study involved 23 participants who were middle aged and had a severe form of sleep apnea. After responding to an initial survey, each attended a weekly 1.5 hour-long cognitive-behavioral therapy session for three weeks. The group program included three approaches. In the educational session, participants learned about the risks and treatments for obstructive sleep apnea. Therapists challenged their beliefs and attitudes about sleep apnea in the cognitive segment. And in the behavioral portion of the program they were encouraged to diet, exercise and stop drinking.

The participants answered the survey again after completing the program. The improvements were across the board. All of the patients reported using CPAP and more patients said they dieted and exercised.

The results of the study are encouraging. Cognitive-behavioral intervention may prove to effectively supplement primary sleep apnea treatments such as CPAP and oral appliance therapy.

Disclaimer

The Official Blog of the American Academy of Dental Sleep Medicine (AADSM) is intended as an information source only. Content of this blog should not be used for self-diagnosis or treatment, and it is not a substitute for medical care, which should be provided by the appropriate health care professional. If you suspect you have a sleep-related breathing disorder, such as obstructive sleep apnea (OSA), you should consult your personal physician or visit an AASM-accredited sleep disorders center. The AADSM, and the American Academy of Sleep Medicine, as the managing agent of the AADSM, assume no liability for the information contained on the Official Blog of the AADSM or for its use.