Thursday, October 28, 2010

Researchers Encourage Sleep Apnea Screening Before Surgery

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

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

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

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

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

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

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

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

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

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

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

Tuesday, October 19, 2010

It’s All About Personality

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

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

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

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

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

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

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

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

Thursday, October 14, 2010

Treatment Found to Reduce Heart Failure in Sleep Apnea Patients

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

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

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

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

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

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

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

Thursday, October 7, 2010

Sleep Apnea Unmasked

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

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

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

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

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

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

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

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

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

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

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.