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:

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


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.