Monday, June 28, 2010

Walk It Off: Walking and Bicycling Keep Weight Off Long-Term

Excess weight is a major risk factor for developing sleep apnea. And once sleep apnea is present, it can be hard to shed extra pounds.

The American Academy of Sleep Medicine recommends that people with sleep apnea combine weight loss with oral appliance therapy or CPAP.

Keeping a healthy weight can help prevent the onset of this sleep apnea.

“Women gain average 20 pounds in 16 years - but don't have to,” reported USA Today. The article reported on a new study that found that a little bit of exercise can make a big impact on health.

The researchers noted that as little as five minutes each day helped to control weight.
Women who want to prevent weight gain as they age should hop on a bike or take a brisk walk.

The study included data from more than 18,000 premenopausal women. Data came from the Nurses Health Study II, a research project that began 1989. The women answered questions on their medical, exercise and lifestyle habits over this time period. They were free from chronic diseases such as diabetes, cancer, or cardiovascular disease.

While women gained an average of 20 pounds over 16 years, those who biked or walked briskly on a regular basis were less likely to gain.

Women with excess weight benefited the most from bike riding. According to a press release, overweight and obese women who bicycled two or three hours a week were 56 percent times less likely to gain weight.

Anne Lusk, a research fellow at Harvard School of Public Health, noted that slow walking doesn’t do much. Women who walked less than 3 miles per hour still gained weight.

The study was published by the journal Archives of Internal Medicine.

Image by Sacha Fernandez

Friday, June 25, 2010

Treating Sleep Apnea from the Dental Chair

A recent article on Dentistry IQ highlights the tie between sleep apnea and dentistry.

The article notes that only ten percent of the 18 million Americans with OSA know they have the condition. This lack of awareness makes the condition difficult to treat. People with sleep apnea stop breathing repeatedly during their sleep.

If they don’t treat sleep apnea, it causes serious health problems. Sleep apnea can lead to depression, memory loss, impaired concentration, high blood pressure, heart disease, and stroke. It can also increase driving and work-related accidents.

The article poses an important question: “how does this relate to dentistry?” While sleep apnea is a medical condition, dentists can screen for and treat it. Most people see their dentist more than their primary doctor, so dentists have regular opportunities to notice signs of sleep apnea.

Signs include enlarged tongue or tonsils, or a medical history of high blood pressure, stroke, diabetes, obesity, or GERD. Snoring, morning headaches and daytime sleepiness are also signs of this condition.

Dentists are not permitted to diagnose sleep apnea. But they can screen for the condition and direct their patients to a sleep center for diagnosis. Once diagnosed, oral appliance therapy is a safe and effective treatment option.

The standard treatment right now is CPAP (Continuous Positive Airway Pressure). But 25 to 50 percent of patients do not comply with or tolerate it.

Oral appliances reposition the tongue and lower jaw forward during sleep to maintain airflow.

The American Academy of Dental Sleep Medicine (AADSM) offers courses and study clubs for dentists new to oral appliance therapy. They also host advanced educational opportunities.

Thursday, June 24, 2010

AASM Past President Dr. Clete Kushida Explains Sleep Apnea

Stanford Hospital and Clinics posted an excellent YouTube video on obstructive sleep apnea (OSA). In it, Clete Kushida, MD, PhD, describes the top three treatment options for OSA. Dr. Kushida was President of the American Academy of Sleep Medicine from 2009-2010. He is the Director of Stanford’s Sleep Medicine Center.



The three main treatments options are:

- Continuous Positive Airway Pressure (CPAP)- Surgery- Oral appliance therapy

He explains that oral appliances fit like mouth guards. They reposition the tongue or lower jaw forward. This action keeps the airway open.

Dr. Kushida says that in addition to pauses in breath, sleep apnea can negatively affect the body. It can cause morning headaches and dry mouth upon awakening. He notes that it can also lead to night sweats.

More importantly, untreated OSA can damage the cardiovascular system. It can also cause cognitive problems.

To find out if you have sleep apnea: you can take this quick questionnaire. If you score nine or more, you should contact a sleep center.

Tuesday, June 22, 2010

Patient / Dentist Testimonial for Oral Appliance Therapy

There are more than 18 million Americans suffering from obstructive sleep apnea (OSA). This disorder causes pauses in breathing and repetitive arousals during sleep.

Once diagnosed with OSA, many patients treat their sleep disorder with CPAP. This treatment involves connecting a facemask to a hose that pumps air through the airway during sleep. CPAP is an effective treatment. But 25 to 50 percent of patients do not tolerate it.

Patients who do not use their CPAP mask have an increased risk of heart disease, diabetes, stroke and other health problems. It is important that they use an alternative treatment.

Many dentists treat sleep apnea with oral appliances. These dental devices fit like sports mouth guards to keep airways open. They ensure that patients can breathe during the night. Oral appliance therapy works best for patients with mild to moderate sleep apnea. But people with severe sleep apnea can also benefit. Find-a-dentist near you who is trained to treat OSA.

Interested in oral appliance therapy? The below FOX news clip provides some great patient and dentist testimonials.

Monday, June 21, 2010

OSA Characteristics Vary by Onset Age

A new study published in the journal CHEST found that obstructive sleep apnea (OSA) may affect people who developed the condition during middle-aged more than those who developed it later in life.

Death due to OSA is increased in the elderly population. But the characteristics of OSA in elderly patients have not been determined. This study clarified differences between patients with middle-age onset and elderly onset.

Each patient was 65 years of age or more at the time of the study. The patients were split into groups depending on the age they developed OSA. The middle-age onset group included 32 people. They developed OSA before 50 years of age. The elderly onset group included 31 people. They developed OSA at 60 years or age or more.

The groups were compared in several ways. Researchers examined demographics. They also looked at sleep study results. Daytime sleepiness and treatment outcomes were also observed.

Results indicate that body mass index and underlying cardiovascular disorders were lower in the elderly onset group than in the middle-age onset group.

No significant differences in apnea-hypopnea index (AHI) or Oxygen levels were found. AHI represents the average number of full breaks and partial breaks in breathing that occur per hour of sleep.

The elderly-onset group required lower CPAP levels for treatment. They also reported less daytime sleepiness.

Compared with the middle-age onset group, OSA characteristics in the elderly onset group seemed milder.

Researchers noted that this finding is possibly because of the smaller physiologic response to respiratory events in elderly patients.

Wednesday, June 16, 2010

Biochemical Markers Help Detect Sleep Apnea

“If you're not getting good sleep—especially if it's due to sleep apnea, a condition in which you stop breathing for short amounts of time repeatedly throughout the night—your health could be in trouble,” wrote Woman’sDay Health Director, Amy Brightfield, in today’s Daily Dose.

Ms. Brightfield’s concern comes from a new study published by the American Journal of Respiratory and Critical Care Medicine.

People with obstructive sleep apnea (OSA) have higher risk for cardiovascular disease (CVD). The association between OSA and CVD is uncertain. Some researchers believe the risk might relate to OSA-related stresses contributing to plaque build up on the arteries. The current study indicates that patients’ biochemical profiles may explain their increased risk for CVD.

The study included 537 Cleveland Family Study adults. The researchers controlled for body mass index, age, sex and other conditions.

Thrombosis is a known contributor to cardiovascular disease. The researchers observed the patients’ pro-thrombotic markers. Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were both measured.

Results indicated that these levels increased with breathing problem severity in mild and moderate OSA patients, suggesting that SDB levels increase pro-thrombotic processes.

A third pro-thrombotic marker D-dimer, was observed. No level increases were found.

Increased morning PAI-1 was significantly associated with sleep-disordered breathing (SDB) severity in those with mild to moderate SDB, suggesting that morning may be a reflection of overnight SDB-related physiologic stress. Researchers suggest that PAI-1 may be a good biomarker for assessing SDB stress.

They noted that biochemical changes were not evident in severe sleep apnea patients.

The researchers recommend that further studies determine if OSA treatment decreases the markers of thrombosis.

This research was funded by the National Heart Lung Blood Institute.

Image by Chemical Heritage Foundation

Tuesday, June 15, 2010

Study Shows that Diabetes Might Affect Half of Women with Sleep Apnea

A new study in the Journal of Clinical Sleep Medicine examined the influence of gender and obstructive sleep apnea (OSA) on the development of diabetes.

Past research indicates that low sleep duration can impair insulin metabolism – indicating that sleep loss, as experienced with OSA, might contribute to diabetes.

The study included 261 middle-aged subjects. None of them had diabetes in 1991. The researchers determined how many had diabetes 16 years later.

Subjects were asked to complete a postal questionnaire – 168 patients participated. They reported features such as height, weight, and OSA status. Participants also noted if a doctor had diagnosed them with diabetes.

A quarter of people with OSA developed diabetes. In contrast, 10.8 percent of people without OSA got diabetes. Increased risk varied between men and women.

Diabetes affected 19 percent of men with OSA verses 11 percent of men without OSA.

Women showed the biggest difference. Half of women with OSA got diabetes. Less than 10 percent of women without OSA had the condition.

In men, body mass index (BMI) predicted OSA presence. The association between OSA and diabetes was independent of age and BMI in women.

Results indicate that women with OSA have a high risk of developing diabetes.

Monday, June 14, 2010

Snorers Should Avoid Alcohol Before Bed

A new study in the July issue of the European Archives of Oto-Rhino-Laryngology shows that alcohol can worsen snoring for already-loud sleepers.

Nighttime alcohol use is known to increase obstructive sleep apnea. It is assumed that snoring also increases under the influence of alcohol. These Germany-based researchers wanted to provide data to support this hypothesis.

This study examined the influence of nocturnal alcohol intake on the properties of snoring.

The study included 20 healthy men. Ten men were non-snorers while 10 were snorers. They each took a sleep test on three randomly assigned nights. Their blood alcohol level varied from 0.0, 0.5 and 0.8 per thousand depending on the night.

Snoring events were recorded using room and body microphones.

Loudness and incidence of snoring were calculated and correlated to the sleep time, body position and sleep stages. The results indicate that nocturnal alcohol ingestion affects individuals with a reported history of snoring to a greater extent than non-snorers. Non-snorers did not turn into snorers under increasing alcohol influence.

Higher BAC increased snorers’ apnea-hypopnea-index (AHI). Their incidence and loudness of snoring also increased with regard to the sleep time.

Snoring increased to a bigger extent in a supine position compared to non supine. It worsened during REM stage and Non REM 3/4 stage.

Non-snorers did not present any effect of alcohol on the snoring properties with regard to sleep time, body position and sleep stage.

The researchers suggest that snorers avoid alcohol intake prior to sleep.

Snoring can affect almost anyone. Habitual affects an estimated 24 percent of adult women and 40 percent of adult men. Both men and women are more likely to snore as they age.

Snoring itself does not endanger one’s health. But snoring can be a sign of a more serious condition called obstructive sleep apnea (OSA). About 50 percent of people who snore loudly have sleep apnea. OSA is a serious medical condition that should be diagnosed at a sleep center.

Friday, June 11, 2010

Research Shows Benefits of Dentists Learning to Treat Sleep Apnea

United Press International (UPI) recently reported on two award-winning abstracts presented at the AADSM’s 19th Annual Meeting in San Antonio, Texas.

The first study suggested that dentists are in a unique position to screen children for sleep-disordered breathing (SDB). SDB includes obstructive sleep apnea, upper-airway resistance syndrome and snoring.

Researchers at the University of British Columbia in Vancouver found that dentists seeing patients on a regular basis may have more opportunity than a physician for screening for these disorders. Lead author Dr. Hiroko Tsuda emphasized that patients at risk for sleep disorders should go to a sleep specialist for diagnosis.

"Based on this study, family dentists may find the preliminary risks of sleep disordered breathing by using simple questionnaires," Tsuda said.

The study included 189 children. They were seven to 15 years of age.

Parents or guardians filled out two questionnaires for their child. One questionnaire, which included questions on symptoms and caregiver concerns, found two children at risk. A second questionnaire, with 22 "yes, no, or don't know" type questions, found 11 children at risk.

The second study reported on by UPI found that measuring the tongue might help dentists supply an oral appliance that successfully treats sleep apnea.

Lead author Whitney Mostafiz of the Harvard School of Dental Medicine said that oral appliances have been shown to be safe and effective sleep apnea treatments. But dentists cannot always predict which patients will have success with the treatment.

Patients who responded had a larger tongue volume for a given oral cavity size. The researchers suggest determining this ratio may help predict treatment success.

Mostafiz explained that the results indicate that oral appliances help correct anatomical imbalances.

Thursday, June 10, 2010

Suspected Attention Disorders May Mask Sleep Disorders in Kids

A new article on Dr. Sanjay Gupta’s blog, Paging Dr. Gupta, reports on research from the 19th Annual Meeting of the American Academy of Dental Sleep Medicine. The meeting took place in San Antonio, Texas from June 4-6, 2010.

The results indicate that attention-deficit disorder or attention-deficit hyperactivity disorder in children could be a misdiagnosed sleep disorder.

The study included 100 children. They were seven to 17 years old. Slightly more than half were female. The group was three-quarters Caucasian.

The parents or guardians of each child answered a sleep questionnaire. Results show that 18 percent of patients in the study were at risk for sleep-disordered breathing, including sleep apnea and snoring.

Dr. Rose Sheats from the University of North Carolina helped lead the research.

Past studies found that facial features help dentists detect sleep disorders in children. But Sheats said that their research indicates "you can't rely on the type of face a child has, to assume that they are or are not at risk for sleep-disordered breathing."

The scientists compared race, age, gender, body mass index and skull X-rays. They found no associations between these factors and sleep apnea, making the condition hard to detect in the kids.

Sheats explained that sleep questionnaires can help dental professionals detect the disorders in children.

"We as orthodontists and dentists who see children regularly have an opportunity to recognize the possibility that a child is at risk for sleep apnea or disordered breathing," Sheats said. "If you treat it, many of these conditions can be reversible at a young age."

For parents, Sheats said, it's important for your child's dentist or orthodontist to be asking a few simple but relevant questions about their sleep pattern and behaviors, including snoring, inattention in class, misbehaving in class or waking up having a hard time breathing in the middle of the night.

The child can then be referred for a sleep study and seen by a physician.

Saturday, June 5, 2010

Nasendoscopy Proves Useful in Predicting Treatment Success in Sleep Apnea Patients

According to new research that was presented today, nasendoscopy may help dentists predict oral appliance therapy success in sleep apnea patients. This research will receive the Clinical Research Award at the 19th Annual Meeting of the AADSM.

Nasendoscopy involves a flexible endoscope being inserted through the nasal cavity.

Oral appliance therapy is indicated for use in patients with mild to moderate OSA on the basis of the apnea-hypopnea index (AHI). But some patients with severe OSA also benefit from OAT, suggesting that patients should not be selected for OAT based on AHI alone.

This Japan-based study included 21 severe OSA patients. There were 18 men and three women. OSA severity was diagnosed with overnight polysomnography (PSG). Subjects ranged from 35 to 78 years of age.

During the nasendoscopy, patients laid supine in a dental chair. Researchers observed changes in the width of the velopharynx and oro-/hypopharynx.

After several weeks of wearing an oral appliance during sleep, each subject took a second PSG with the device. AHI reduction rates from OAT were compared between patients who did and did not show throat widening during the nasendoscopy.

All severe OSA patients showed improved AHI following OAT. All subjects experienced oro-/hypopharyngeal widening, but only 16 subjects demonstrated velopharyngeal widening.

The AHI reduction rate for patients with velopharyngeal widening was 79 percent. The reduction rate for patients without velopharyngeal widening was 45 percent. The difference between the two groups was significant. The direction of the velopharyngeal widening, ‘all-round’ or ‘lateral dominant,’ was independent of patient response.

Results indicate that patients who showed velopharyngeal widening during a nasendoscopy responded most effectively to OAT. These findings suggest that velopharyngeal widening observed when advancing the mandible from the centric occlusal position is associated with better OAT outcome.

Lead author Yasuhiro Sasao, DDS, PhD, suggested that this procedure can help dentists predict patient response to OAT, reducing waste of resources and time.

“In Japan, nasendoscopy is used in dentistry and medicine to diagnose or evaluate oral function such as speech and swallowing – the system is simple and relatively inexpensive,” said Sasao

Tongue Measurements May Help Dentists Determine Oral Appliance Therapy Success in Sleep Apnea Patients

According to new research that received the Graduate Student Research Award on Friday, June 4, the ratio between tongue volume and bony enclosure size in patients with obstructive sleep apnea (OSA) may help dentists calculate oral appliance therapy success. The award was presented at the 19th Annual Meeting of the American Academy of Dental Sleep Medicine.

OAT has been shown to be a safe and effective treatment for OSA. But patient outcome is hard to predict.

The researchers assessed whether anatomical factors were associated with treatment outcome. These factors included craniofacial size and upper-airway soft tissue volume. They also examined the anatomical balance between these features.

The study included 49 OSA patients. Patients were at least 18 years of age. They had mild to severe sleep apnea. The patients had no other sleep disorders or serious comorbid medical or psychiatric disorders.

Each patient was fitted for a custom two-piece oral appliance, which was worn during sleep. Treatment outcome was assessed by polysomnography after approximately six weeks of OAT.

Of the 49 patients, 24 responded to the treatment. They demonstrated an apnea-hypopnea index (AHI) reduction of 50 percent or more.

Body mass index and age did not differ between responders and non-responders. Responders did have a lower baseline AHI, indicating that their sleep apnea was less severe before treatment.

Tongue cross-sectional area (CSA) was measured in a subset of 28 patients, including 12 responders and 16 non-responders. The measurements were taken using cephalometric soft-tissue imaging.

Responders had a larger tongue CSA than non-responders, but there was no difference in the bony oral enclosure CSA. The ratio of tongue to bony enclosure CSA significantly differed between responders and non-responders, indicating the ratio as a significant predictor of response to treatment.

Because patients who responded to oral appliance treatment had a larger tongue volume for a given oral cavity size, the researchers suggest that determining this ratio may help predict treatment success.

“While this study re-affirms the difficulties in predicting OSA treatment response to mandibular advancement splints, responders seem to have a larger tongue volume for a given oral cavity site, suggesting that oral appliances may help correct anatomical imbalances,” said lead author Whitney Mostafiz

Tuesday, June 1, 2010

Tackling Sleep Disorders in the National Football League

A new study in the journal SLEEP found that football players have a higher risk of sleep-related breathing disorders (SRBD) than men in the general population.

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.

Results indicated that 19 percent of the football players had sleep apnea. In contrast, experts estimate that sleep apnea affects four percent of men in the U.S.

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 approximately a quarter of players.

Surprisingly, linemen did not demonstrate a higher risk of SRBD than non-linemen. Past studies indicate that linemen have an especially high risk of sleep apnea.

One study found that linemen had a 50 percent greater chance of death due to heart disease than the general population. That study also indicated that they had a 3.5 times greater risk in comparison to other football players.

The reason? Linemen often have a higher body mass index. They also have heavier weights and larger neck sizes. These factors can contribute to sleep apnea.

Untreated sleep apnea can raise a person’s risk for cardiovascular disease and death. Physicians recommend treating sleep apnea with oral appliance therapy or CPAP.

Reggie White was a Pro Football Hall of Fame member who suddenly died in 2004. Reports show that sleep apnea may have played a role in his death. After his death, NFL trainers encouraged larger players to get tested.

The Pittsburgh Steelers raised awareness for sleep apnea last December. Read more here.

Image by Joy Banerjee

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.