Friday, May 28, 2010

Brushing Teeth for Heart Health

According to new research, people who don't brush their teeth twice a day have an increased risk of heart disease. The British-based study included nearly 12,000 adults. The study was published today in the British Medical Journal.

Over an eight-year period, there were 555 heart attacks or other serious coronary problems among participants. The effect of regular teeth brushing was significant.

After adjusting the data for other heart risk factors such as social class, obesity, smoking and family history, people who reported less teeth brushing had a 70 percent extra risk of heart disease compared to those who brushed twice daily.

Lead author Dr. Richard Watt explained to Reuters that people with gum disease are more likely to develop heart disease and diabetes because inflammation in the body, including in the mouth and gums, plays a role in the build up of clogged arteries.

"In a way, it's really quite an old story, because back in the early 19th century there was a theory called focal sepsis, and people believed that infections in the mouth caused disease in the whole body," Watt said.

Today, many dentists address patients’ overall health. Dentists trained in dental sleep medicine screen for and treat Sleep apnea. Sleep apnea requires treatment. Left untreated, the condition raises patients’ risk for heart attack, stroke, diabetes, and other problems.

More than 18 million Americans have sleep apnea. But 80 to 90 percent of these people are undiagnosed and untreated. Dentists are in a position to help because they see patients on a regular basis.

In the British study, 63 percent of people visited their dentists every six months.

The World Health Organization reports that heart disease is the leading killer of men and women in Europe and the United States. Together with diabetes, it accounts for almost a third of all deaths around the world in 2005.

Find-a-dentist near you who knows how to screen for sleep apnea.

Tuesday, May 25, 2010

Different Strokes for Different Folks: Screening for Sleep Apnea Across Cultures

People differ from place to place. Likewise, predictive tools predict vary between populations.

New research in the journal Sleep and Breathing compared the diagnostic characteristics of two prediction models in a population. Results indicate that a model’s ability to predict sleep apnea may differ by culture.

This Singapore-based study included 117 people, of which 77 had moderate to severe sleep apnea. The researchers developed a predictive model from their evaluations and characteristics. This tool became the local model.

The diagnostic characteristics of the local model were compared with those of a foreign model. The local model and the foreign model were then applied to 52 local patients.

The models produced similar accuracy. However, the foreign model produced different diagnostic characteristics from the local model.

The researchers suggest that the predictive outcomes may vary because cultures perceive and report symptoms, such as snoring, differently.

All participants took an overnight sleep test. Model accuracy is important because it helps patients avoid unnecessary tests.

The authors note that in some areas of the world, it is not possible to diagnose sleep apnea with a sleep test. When equipment is unavailable, doctors may use prediction models to screen for sleep disorders.

The study suggests that screening tools should be local for the best results.

Friday, May 21, 2010

Parkinson's Disease May Raise Risk for Sleep Disorders

A new study indicates that Parkinson’s disease (PD) patients may have a higher risk for sleep-disordered breathing (SDB). The study was published by the journal Sleep and Breathing.

Sleep-disordered breathing includes everything from harmless snoring to the serious medical condition called obstructive sleep apnea.

The study involved 134 PD patients and 94 control subjects. The participants had no prior diagnosis of SDB.

Each person’s risk for SDB was assessed by the Berlin Questionnaire. Participants also took questionnaires that assessed their quality of life.

Results indicate that PD patients have increased risk for SDB. High risk for SDB was apparent in 49.3 percent of PD patients. In contrast, 34.8 percent of the controls showed high risk.

After adjusting for age, gender, and body mass index, PD subjects still had a higher risk.

PD patients at high risk for SDB had higher BMIs and Epworth scores. In the general population, excess weight and sleepiness are also factors for SDB.

Data showed that SDB might substantially affect depression and lower quality of life in PD patients.

The researchers suggest that screening for, diagnosing and treating SDB in PD patients could significantly raise their quality of life.

Wednesday, May 19, 2010

Under the Scope: Sleep Apnea and Complications

A new study in the journal Sleep and Breathing assessed whether obstructive sleep apnea (OSA) raises the risk of cardiorespiratory complications during endoscopic procedures.

The study was retrospective. Researchers identified patients who had undergone an endoscopic procedure under conscious sedation from January 2001 to May 2008. Each patient also took a sleep study in that period.

Patients composed four groups. The groups included 130 people with no OSA, 135 with mild OSA, 125 with moderate OSA, and 249 with severe OSA.

The patients were an average of 60.5 years of age. Ninety-three percent were male. Their mean body mass index was 33.7, indicating obesity.

Colonoscopies accounted for 68.5 percent of procedures. Upper endoscopies accounted for 20.2 percent. Combined procedures represented 11.3 percent.

The researchers tracked procedure complications.

Minor complications included problems like hypertension and oxygen desaturation.

Major complications included chest pain, respiratory distress, and cardiorespiratory arrest. Major problems required intervention.

Seven percent of patients had major complications and 19 percent had minor ones.

Importantly, complication rates did not significantly differ between the patients with and without OSA.

Results indicate that OSA does not clearly increase the risk of cardiorespiratory complications in patients undergoing endoscopy procedures.

Sleep apnea is a serious medical condition that can raise a person’s risk for heart problems. It requires treatment. Learn more here.

Tuesday, May 18, 2010

Sleeping It Off: Depression and Sleep

Depression is commonly associated with obstructive sleep apnea (OSA). But new research shows that it may not be caused by OSA. Instead, it may be due to factors also associated with the sleep disorder.

The study was recently published by the journal Sleep and Breathing. It included 45 patients. OSA affected 34 of them. Eleven people experienced snoring without OSA. Nineteen people were controls. Diagnosis was determined from sleep studies.

The patients were 20 to 69 years of age. Patients with psychiatric disorders were excluded.

Each patient took the Epworth Sleepiness Scale (ESS). Find your ESS score here.

They also took the Beck Depression Inventory and Profile of Mood States (POMS).

Patients with primary snoring or OSA reported significantly more depression than the control subjects. Depression severity did not differ between snorers and mild OSA patients. Both groups indicated that fatigue contributed to their depression.

OSA patients often snore loudly. They also experience dangerous pauses in breath during sleep. People who snore without OSA, breathe normally during sleep.

Results indicate that fatigue as measured by the POMS was the primary predictor of depression.
The article notes that OSA increases a person’s rate of depression – 15 to 56 percent of OSA patients suffer from it. In contrast, 6.6 percent of the general population has a depressive disorder.

The researchers note that doctors should be aware that snorers without OSA also report depression and fatigue. They suggest that the depression found in OSA patients and snorers could indicate common factors.

Monday, May 17, 2010

Trucking Leaders Discuss Road Safety and Sleep

Industry leaders are taking steps to reduce untreated obstructive sleep apnea (OSA) among truck drivers, reported a recent article at eTrucker.com. These industry experts met at the Sleep Apnea & Trucking Conference last week in Baltimore, MD.

Mary Gunnels, director, Federal Motor Carrier Safety Administration (FMCSA) Medical Programs, acknowledged that sleep apnea among truckers is a public health concern.

A 2002 study found that almost a third of truck drivers suffer from OSA. This condition raises their risk for driving accidents.

Dr. William K. Sieber, National Institute for Occupational Health and Safety, discussed the Institute’s goals to reduce obesity and cardiovascular disease among commercial drivers. Older age and excess weight are two common factors linked with OSA.

Dr. Lawrence Epstein, chairman, American Academy of Sleep Medicine Adult Obstructive Sleep Apnea Task Force, also spoke. He focused on OSA, its causes and treatments. Dr. Epstein said the most common treatments are CPAP and oral appliances.

Beyond safety concerns, there are financial benefits to ensuring driver health.

An article in Occupational Health and Safety reported on a new study that found that treating OSA can reduce health costs, work absences, and short-term disability.

In the study, when drivers with sleep apnea were treated, their health plan costs decreased by an average of $2,700 in the first year. The costs decreased by another $3,100 in the second year.

Read more about the study in this April blog post.

Image by Cromely

Wednesday, May 12, 2010

Punching in on a Good Night’s Sleep

Want a healthy heart? Try to punch out of work on time.

A new study published in the European Heart Journal indicates that working three to four hours of overtime may damage your heart.

In contrast to people with seven-hour workdays, people with 10 to 11 hour workdays had a 60 percent higher risk of having heart problems. These problems included death due to coronary heart disease (CHD), non-fatal heart attacks and angina.

The study involved more than 6,000 male and female British civil servants. All of the participants were London-based. Participants entered the study when they were 39 to 61 years old. The study began between 1991 and 1994. At that time, participants were free from CHD. They all worked full time.

Eleven years later, 369 heart-related problems had taken place.

The researchers found that the association between long workdays and CHD was independent of 21 risk factors. Risk factors included smoking, excess weight and high cholesterol.

In a press release, the researches noted that not sleeping enough or having enough time to unwind before sleep might have contributed to the results.

Working overtime was related to type A aggressive behavior patterns, depression and anxiety. The researchers suggested that employees who work overtime might be more likely to work while ill, ignore symptoms of ill health, and not seek medical help.

In an editorial on the research, Dr. Gordon McInnes, explained that if the effect is causal, overtime-induced work stress might contribute to a large portion of cardiovascular disease.

In February, Sleep Education reported on two studies that examined the tie between sleep and heart health.

The blog cited a study of heart attacks in Sweden. It found that heart attacks rose by five percent in the week after daylight saving time. The researchers suggested that the results reflected sleep deprivation caused by the time change.

Sleep Education cited another study from the University of Chicago. This second study found that longer sleep duration was associated with a lower rate of coronary artery calcification, a predictor of CHD.

Tuesday, May 11, 2010

Swedish Researchers Pull the Bell Cord on Sleepy Bus Drivers

Researchers from the University of Gothenburg in Sweden found that professional drivers have a high rate of sleep apnea – raising questions about road safety.

The study included 116 bus and tram drivers. Results show that 23 percent of the drivers suffered from daytime sleepiness. Nineteen percent had sleep apnea.

In contrast, an estimated 4 percent of men and 2 percent of women in the general population have sleep apnea.

One of the most common symptoms of sleep apnea is daytime sleepiness. This sleepiness can cause driving accidents.

The U.S. also has problems with droopy-eyed drivers. A 2006 Institute of Medicine report found that drowsiness costs $150 billion each year in accidents and lost productivity. Another $48 billion in medical costs result from auto accidents involving sleepy drivers.

In a press release, lead author Mahssa Karimi, noted that CPAP treatment reduced daytime sleepiness in drivers with sleep apnea.

Oral appliance therapy is another treatment option.

"Our findings suggest that it's important to systematically examine professional drivers and other professional groups entrusted with the safety of others in order to be able to treat any sleep disorders,” says Karimi. “Their work demands alertness and concentration at all times."

The results will be presented at the annual Swedish Sleep Medicine Congress in Gothenburg. The meeting takes place this April 21 to 23.

Image by Andreas Nilsson

Friday, May 7, 2010

Sleep and Insulin: Understanding Sleep Apnea’s Relation to Diabetes

A study in the June issue of the Journal of Clinical Endocrinology & Metabolism, found that just one night of sleep deprivation can induce insulin resistance. Insulin resistance is a component of type II diabetes.

These results give insight into why sleep apnea raises a person’s risk for type II diabetes. Untreated sleep apnea prevents people from getting restorative sleep.
Previous studies found that short sleep duration over multiple nights resulted in impaired glucose tolerance. This is the first study to examine the effects of only a single night of partial sleep restriction.

The study included nine healthy subjects. Five of the subjects were men. Four of the subjects were women. The researchers measured insulin sensitivity of each participant. They used the hyperinsulinemic euglycemic clamp method.

This method uses catheters to infuse glucose and insulin into the bloodstream. They determined insulin sensitivity by measuring the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia.

The measurement was taken after two separate nights of sleep. On the first night, participants slept eight hours. One the second night, they slept four hours.

Insulin resistance was noted after the shorter night of sleep.

“Our data indicate that insulin sensitivity is not fixed in healthy subjects, but depends on the duration of sleep in the preceding night,” said Dr. Esther Donga, lead author of the study, in a press release.

The researchers suggest that improving sleep duration may help stabilize glucose levels in diabetes patients.

Thursday, May 6, 2010

Pregnancy May Invalidate Sleep Apnea Screening Tool

A new study by researchers at Baylor College of Medicine shows that the Berlin Sleep Questionnaire, which is a common screening tool, does not accurately identity sleep apnea in pregnant women.

Past studies using the questionnaire connected sleep apnea during pregnancy with infants born small. Some of these studies also connected sleep apnea with a mother’s risk for a pregnancy complication called preeclampsia.

The lead author, Dr. Kjersti Aagaard, explained in a press release that his team sought to validate the questionnaire in pregnant women. The form asks questions about snoring, sleepiness and excess weight, which are common complaints in pregnant women. So they suspected that the observed complication rate might not have been caused by the sleep apnea.

The study included 100 women in the last third of pregnancy. The women took the questionnaire, and then underwent sleep apnea and fetal heart rate monitoring for at least three hours.

Results indicated that the questionnaire did not accurately screen for sleep apnea. It identified just over one-third of women who actually had sleep apnea and just under two-thirds of those who did not have the condition.

The researchers also found no concerning changes in the fetal heart rate pattern in women with sleep apnea.

The researchers suggest that these findings raise questions regarding data linking sleep apnea and adverse pregnancy outcomes. They recommend that the questionnaire be modified for pregnant women.

Funding for this work came from the National Institutes of Health New Innovator Award.

Wednesday, May 5, 2010

Sleep Apnea Prevalence in Iran

A study in the journal Sleep and Breathing reported data on the prevalence of obstructive sleep apnea (OSA) in Iran. In the first Iranian study of its kind, researchers sought to identify people at-risk for developing OSA.

The study included 3,529 Iranians aged 18 to 70 years old. Fifty-three percent of the participants were female.

Each of the subjects took the Berlin Sleep Questionnaire, which is a common test used to gauge risk for sleep apnea. The questionnaire was translated into Persian and then back into English to ensure its validity.

The participants’ body mass indexes were also calculated using height and weight.

Based on their responses, 176 subjects were considered at-risk for OSA, of which 58 percent were female. The results indicate that an estimated five percent of the Iranian population is at-risk for the sleep disorder.

In the U.S., an estimated four percent of men and two percent of women are at risk for the condition.

Like in the U.S., OSA risk in Iran increased with age and weight. People more than 50 years of age had a higher risk for OSA. Ninety percent of the at-risk patients were overweight or obese. Smoking tobacco products, which can raise a person’s risk, was practiced by more than 22 percent of the Iranian men.

In contrast to the U.S., Iranian women were more likely than Iranian men to suffer from OSA. The researchers note that snoring is not socially acceptable in Iran, so the men may have under-reported snoring habits while the women reported more honestly.

This is not the first time that an English OSA screening tool was translated into another language. In April, this blog reported on researchers that translated the Epworth Sleepiness Scale into Korean to help gauge OSA prevalence in South Korean.

Life-Work Balance: Poor Sleep at Home Can Lead to Injuries at Work

A common symptom of sleep apnea is daytime sleepiness. Left untreated, this sleepiness can cause driving or work-related accidents.

According to a study in the May issue of the journal SLEEP, trouble falling asleep or staying asleep can cause similar problems.

Researchers used data from the Canadian Health Survey Cycle (CCHS). The survey occurred in 2000 and 2001. Respondents reported having trouble falling asleep or staying asleep “never,” “some of the time,” or “most of the time.”

The current study examined people from 15 to 64 years of age who had worked part or full-time over the past 12 months. It included 65,485 people who had not experienced an injury in the past twelve months. It also included 4,099 people who had had a work-related injury.

This Canadian-based study compared the risk of work-related injuries across different job sectors. It sought to identify at-risk groups for prevention efforts.

The percentage of workers reporting a work injury increased with sleep troubles. The association was strongest for women.

Men and women who had problems “most of the time” experienced higher work-related injury rates than those who “never” had sleep problems. Trouble sleeping “sometimes” was also associated with a larger number of work injuries in women.

People who slept three to six hours per night reported the highest risk. Women who slept five to six hours per night had a higher risk than those who slept seven to nine hours per night.

An increased risk of injury do to sleep troubles was apparent in most industries. The most at-risk groups included women in processing, manufacturing, farming, forestry and fishing. People working rotating or split shifts also had high-risk for work-related accidents.

Monday, May 3, 2010

You Snooze, You Lose: How Sleeping Can Help Shed Pounds

In April, this blog explained that sleeping eight hours a night can help reduce your diet by a Big-Mac’s worth of calories.

An article in yesterday’s Chicago Tribune goes into more detail on how sleep regulates your hormones to help you stay healthy. It reports on new findings by Harvard researchers that show that the hormonal changes and neurochemical reactions that occur during sleep may have serious implications for your weight and fitness.

These results support past studies that link sleep and weight loss.

According to Dr. Fran Mason, two weight-regulating hormones — ghrelin and leptin — are controlled by the amount of time you sleep and can affect your health goals.

"Ghrelin levels elevate slowly as you sleep; when you don't sleep, ghrelin levels rise more sharply, by as much as 15 to 28 percent,” Mason says.

This increase can cause weight gain of as much as five to 15 pounds.

Likewise, the higher your leptin levels are, the smaller your appetite will be because your body perceives energy stores.

"When you cut back on sleep, your leptin levels drop almost 20 percent," Mason says.

Your brain perceives this drop the same way as a 30 percent reduction in calories, producing the same appetite you would have if you cut your food intake by a third.

Sleep loss can have broader implications than just weight gain.

"Research shows that you have fewer white blood cells in circulation when you sleep less," Mason says. "These ‘natural killer cells' fight infection and represent the frontline in your ability to ward off illness."

Mason explains that markers of inflammation go up when you sleep less. Inflammation can cause pain, muscle soreness, arthritis, tendinitis, and other muscle and skeletal problems. Inflammation is also linked to asthma and heart disease.

More than 70 million Americans suffer from one or more sleep disorders, but many people are unaware of their condition. Visit Sleep Education to learn more.

Goldilocks and the Three Bears: Getting the Right Amount of Sleep May Save Your Life

Like in the fairytale, finding the perfect fit in any situation can be hard. But getting the right amount of sleep is worth the effort, according to a study from the May issue of the journal SLEEP, which found that sleeping too much or too little can raise a person’s risk for death.

The researchers reviewed 16 past studies, which included more than 1.3 million male and female participants. The participants came from eight different countries. Anyone under 60 years of age was considered younger. Anyone 60 or more years of age was considered older.

The researchers assessed sleep duration through questionnaires and study outcomes through death certificates.

Short sleep duration was considered less than seven hours, although it was often less than five hours. Long sleep duration was considered anything more than eight or nine hours of sleep.

In contrast to people who slept seven to eight hours per night, the results indicate that short sleep duration raised people’s risk for death by 12 percent.

Long sleep duration raised people’s risk for death by 30 percent. The researchers suggest that sleeping nine hours or more per night may indicate undiagnosed health issues.

The results did not differ by gender or socioeconomic status.

The researchers suggest that in the U.S., sleeping less than seven hours per night may contribute to more than 25 million deaths in people twenty years or older per year.

These results support a growing body of evidence that too much sleep or too little sleep can lead to poor heath outcomes.

Many people with sleep apnea do not know that they have the condition and that it keeps them from getting restorative sleep. Although they may try to get a healthy amount of sleep, their brain wakes them up throughout the night to breathe. This fragmented sleep pattern decreases the number of restful hours of sleep they get each night, which is why sleep apnea requires treatment.

Get tested for sleep apnea at a sleep center.

Image by Valerie

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.