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:

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

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.

Thursday, July 1, 2010

OSA Concerns Grow Among U.S. Military Veterans

An underreported war on the domestic front is beginning to grab the attention of the U.S. military. Veterans are four times more likely to have obstructive sleep apnea, and the government is spending more than $500 million per year treating the disorder.

A June report from the Department of Veteran Affairs found more than 63,000 former troops receive benefits for obstructive sleep apnea. Military medical professionals estimate as many as 20 percent of veterans have sleep apnea. That statistic is bound to rise as baby boomers grow older.

A combination of factors makes former troops especially susceptible to sleep-disordered breathing. Veterans who were once physically fit may gain a large amount of weight as they get older because of inactivity due to debilitating injuries or the civilian lifestyle.

Wartime exposure to airborne toxins, smoke and dust in places like Iraq and Afghanistan may also contribute to sleep-disordered breathing.

Many of these veterans use disability benefits to pay for CPAP, the first-line treatment for obstructive sleep apnea (Continuous Positive Airway Pressure). Although the treatment is effective in reducing the various risks associated with sleep apnea, it’s estimated between 25 and 50 percent of patients do not comply or tolerate it.

Oral appliance therapy is an effective alternative for patients with mild to moderate sleep apnea. The treatment is available through a dental sleep specialist near you.
Image courtesy the U.S. Army


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.