Wednesday, July 13, 2011

The AADSM Blog Has Been Relocated

Thank you for following the AADSM blog. We’ve moved the location of this blog to the patient resources section of the newly revamped AADSM.org, the official website of the American Academy of Sleep Medicine. Visit the new AADSM blog to continue to follow the latest news and research in dental sleep medicine and related fields.

Friday, May 13, 2011

Common Symptoms of OSA Patients Vary By Age and Gender

A new study in the journal Sleep and Breathing examined obstructive sleep apnea (OSA) symptoms common to different age and gender groups. The study used demographic, subjective complaints and medical history.

Data was collected from 23,806 patients. Patients ranged from 21 to 80 years of age. The group was divided into 24 groups by gender and 5-year age intervals. Each patient took an overnight sleep study between the years 2000 and 2009.

The researchers found the gender-specific relationship between AHI and age. They then used this data to determine the best fitting AHIs for each age and gender group.

The study showed that OSA characteristics are not uniform across gender and age. They may also vary between obese and non-obese patients. These findings should be taken into account in the clinicians’ diagnosis of OSA.

Seventy percent of patients had an AHI greater than 10, indicating the presence of at least mild OSA. Men had consistently higher AHI than women. The best fitting AHI cutoff point increased with age in both genders. Results showed that in obese men, AHI increased from age 20 to 40 years and remained stable thereafter. Alternatively, there was a linear increase in AHI with age in both obese and non-obese women.

The results indicate that OSA severity varies with age and gender, with women having less severe syndrome in all ages. Obesity and snoring are OSA predictors in men and women of all ages. Excessive daytime sleepiness and hypertension were OSA predictors all participants except for women 21 to 40 years of age.

Read more about age and OSA here.

Monday, April 25, 2011

Virtual Choir 2.0 Praises the Beauty of Sleep

Dr. Larry Barsh, founder of Snoring Isn’t Sexy, posted a fascinating video on his blog recently. The video spotlights Eric Whitacre’s Virtual Choir 2.0 ‘Sleep’ – an interesting twist on traditional music.

Sleep disorders affect 50-70 million Americans. Obstructive sleep apnea (OSA) alone causes breathing problems for more than 18 million Americans. While 80 to 90 percent of OSA patients are undiagnosed and untreated, there are numerous treatments available:

Oral appliance therapy: a custom-fit mouth guard may move the jaw and tongue forward to increase airflow.

Upper-airway surgery: jaw adjustments or the removal of the tonsils may improve airflow.

Positive airway pressure: a steady stream of airflow is provided via a nose and mouth mask to keep the airway open.

Behavior therapy: Side-sleeping and losing weight via diet and exercise can reduce sleep apnea in conjunction with the above three treatments.

Find a sleep center. Find a dentist qualified in dental sleep medicine.

Friday, April 15, 2011

President Obama Calls Attention to Air Traffic Safety

President Obama drew attention to the issue of air traffic safety today on Good Morning America. The dangers of shift work is receiving growing awareness as several air traffic controllers have fallen asleep on the job recently. The effects of shift work, and sleep disorders like insomnia and obstructive sleep apnea, can cause dangerous working situations. Sleep deprivation has been found to increase the risk of work-related accidents in transportation and medical industries.

Monday, April 4, 2011

Pediatric Sleep Apnea Treatment Effective Two Years Later

A new study in the journal Sleep and Breathing found that rapid maxillary expansion (RME) was effective in treating obstructive sleep apnea (OSA) in children. The results of the treatment were apparent two years after treatment ended. RME involves widening the jaws using oral appliances.

The researchers evaluated the objective and subjective data over a 36-month follow-up period to determine whether RME is effective in the long-term treatment of OSA. The study included 14 children. The children's mean age was 6.6 years at entry and 9.7 years at the end of follow-up. Each child underwent an orthodontic assessment to detect possible jaw deviation from normal occlusion: deep bite, retrusive bite and crossbite.

A high angle face can cause breathing problems for children. Another common cause of OSA is large tonsils or adenoids. Removing the tonsils or readjusting the jaw line can help children breathe more easily during sleep.

All 14 children completed a 12-month therapeutic trial using RME and 10 enrolled in the follow-up study. Of the 10 children, five were male and five were female. The ten children took an overnight polysomnography (PSG) to test for the presence of OSA at baseline, after one year of treatment, and two years after treatment completion.

Results show that the apnea-hypopnea index (AHI) decreased and the clinical symptoms had resolved by the end of the treatment period. Twenty-four months after the end of the treatment, no significant changes in the AHI or in other variables were observed.

The researchers concluded that RME may be a useful approach in children with malocclusion and OSA, as the effects of such treatment were found to persist 24 months after the end of treatment.

Learn more about children and sleep here.

Monday, March 21, 2011

Driver Fatigue Investigated After NYC Bus Crash

In Dr. David Volpi's recent Huffington Post article, he writes that last week's bus accident that killed 15 people after crashing near the Bronx, NY, has raised multiple questions for federal investigators. The National Transportation Safety Board will investigate if the bus driver was so fatigued he was incapable of driving properly.

Dr. Volpi notes that there is no question that fatigue might have contributed to this crash since it is a major cause of crashes -- not just for buses, but for trucks, airplanes, trains and boating accidents, as well.

Drowsy driving is more prevalent than previously expected. Last fall, the American Automobile Association (AAA) Foundation for Traffic Safety polled 2,000 drivers. One-third of them admitted to either nodding off or completely falling asleep while they were driving in the past year.

More than half of those polled by AAA reported they fell asleep on a high-speed highway. Although it might seem more common to doze off during long car rides, 59 percent said they'd been driving under an hour before they had fallen asleep. Drowsy driving can happen at any time. Twenty-six percent reported that it happened in the middle of the day, between noon and 5 p.m.

The National Highway Traffic Safety Administration estimates that drowsy driving "results in 1,550 deaths, 71,000 injuries and more than 100,000 accidents each year" and that 57 percent of driving crashes caused by fatigue involved the driver drifting into other lanes or even off the road.

Motor vehicle accidents due to “drowsy driving” account for $48 billion in medical costs each year.

To prevent drowsy driving, the American Academy of Sleep Medicine recommends the following tips:

• Get a full night of seven to eight hours of sleep before driving.
• Avoid driving late at night.
• Avoid driving alone.
• On a long trip, share the driving with another passenger.
• Pull over at a rest stop and take a nap.
• Use caffeine for a short-term boost.
• Take a short nap after consuming caffeine to maximize the effect.
• Arrange for someone to give you a ride home after working a late shift.

Learn more about drowsy driving here.

Wednesday, March 16, 2011

Can OSA Jeopardize Brain Power?

The association between moderate to severe obstructive sleep apnea (OSA) and impaired neurocognitive function is well established. It is unclear whether this association is related to low oxygen levels or the repeated arousals during sleep.

A new study in the journal Sleep and Breathing examined the association between cogitative function and OSA.

Researchers aimed to describe verbal memory and executive function in adults using the Berlin Questionnaire. It also investigated the relationship between cognitive function and OSA severity. .
They study included 290 adults with an average age of 48 years. Fifty-five percent of participants were female. They received the Berlin Questionnaire by mail and demonstrated a high-risk for OSA.

Participants’ verbal memory was assessed by Rey Auditory Verbal Learning Test and executive function by the Stroop test. OSA severity indicators were measured by polysomnography (PSG).

Results show that average oxygen saturation was the indicator of OSA severity most strongly associated with cognitive function. Researchers found that adults at high risk of OSA demonstrated verbal memory and executive function impairments.

Find out if OSA is affecting your brain power.

Image by Rich Lyons

Friday, March 4, 2011

CDC Finds 1 in 20 Drivers Nod Off at the Wheel!

This ABC video reports on the new Center for Disease Control (CDC) study examining American's sleep habits. It was the first time they looked at drowsy driving. One in twenty Americans admitted to nodding off at the wheel in the past month! The Department of Transportation estimates that drowsy driving accounts from more than 1,500 deaths and 40,000 injuries per year.
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The report also found that 1/3 of Americans report getting less that the recommended 7 hours of sleep. Forty percent said they fell asleep unintentionally in the past month.

The Institute of Medicine estimates that 50 to 70 million Americans have a sleep disorder.

To date, there are about 90 official sleep disorders, the three most common being insomnia, restless leg syndrome, and sleep apnea, a potentially life-threatening disorder in which people stop breathing during sleep, Dr. Philip Westbrook, former president of the American Academy of Sleep Medicine, recently told Women’s Health.

Read more here.

Thursday, February 17, 2011

Heavyweights Tag-Teamed by Sleep Apnea’s Partners

A new study in the journal Sleep and Breathing shows that people with obstructive sleep apnea (OSA) may pit themselves against more than just a breathing disorder.

OSA occurs when a person’s throat collapses during sleep, disrupting their breath and repeatedly arousing them from sleep. It is associated with snoring and daytime sleepiness. OSA affects approximately four percent of men and two percent of women in the U.S.

A group of India-based researchers found that OSA patients were three times more likely to experience obesity, hypertension, diabetes, mellitus and hyperlipidemia (HLP). People with HLP have high blood cholesterol and triglycerides.

The study included 234 adults 54 years of age or more who tested positive for OSA. Compared to members of the 56 control group, who demonstrated an average of one pause in breath per hour, members of the OSA group experienced 31 pauses in breath per hour.

Body weight also varied between the control group and OSA patients. The body mass index was 36 among OSA patients in contrast to 29 for the control group.

Of the OSA group, 30 percent of patients had HLP, 59 percent were diabetic and 86 percent were hypertensives. Nonrestorative sleep, awakening with choking, nocturnal dyspnea, insomnia with frequent awakenings, nocturia, and diaphoresis were observed in more than 80 percent of patients.

Results indicate that sleep-disordered breathing syndrome was strongly associated with the metabolic syndrome.

Weight loss has been shown to reduce OSA severity. The American Academy of Sleep Medicine recommends weight loss, oral appliance therapy, and CPAP for OSA treatment.

Image by Choo Yut Shing

Tuesday, February 8, 2011

The ABC’s of Snoring and Childhood Cognition

Snoring kids can be cute, but snoring may reflect a serious problem. New research in the journal Sleep and Breathing found that primary snoring (PS) is associated with neurocognitive impairments in children.

The community-based study included 1,114 primary school children. The researchers identified 410 children who never snored, and 92 children who habitually snored.

Polysomnogram (PSG) scores distinguished children with PS from those with upper airway resistance syndrome (UARS) or obstructive sleep apnea (OSA). Children with UARS and OSA actually experience pauses in breath that can prevent restorative sleep.

Neurocognitive impairments and poor school performance were compared between children who never snored, those with PS, and those with UARS or OSA.

Of the 92 snorers, 69 had PS while 23 had UARS or OSA.

Compared to children who never snored, children with PS demonstrated significantly more hyperactive and inattentive behavior. They also had a higher risk for poor school performance in mathematics, science and spelling. The risks for PS were on par for children with UARS or OSA.

These results show that children with non-apneic PS may exhibit significant neurocognitive impairments. Consequences may be similar to those associated with UARS or OSA. If confirmed, PS is not “benign” and may require treatment.

Friday, January 28, 2011

Going Under: Chinese Anesthesiologists Score Low on OSA Knowledge

A new study in the journal Sleep and Breathing found that the majority of surveyed anesthesiologists lacked knowledge of obstructive sleep apnea (OSA).

Serious and life-threatening complications may occur in patients with OSA and unrecognized OSA during medical procedures.

Anesthetists should be able to identify OSA patients and feel confident in their ability to deal with a difficult airway.

The Obstructive Sleep Apnea Knowledge and Attitude Questionnaire (OSAKA) was translated into Chinese and distributed to 321 anesthesiologists from Shandong Province.

The questionnaire contained 18 knowledge items and five attitude items.

The mean total knowledge score was 11, with the scores ranging from 2 to 17. The total correct score ratio was 62 percent. Knowledge level corresponded with the participants' job titles and attitude scores. Age, sex, education, and hospital level did not affect the scores.

The survey found that when managing OSA patients, the positive attitude score was mostly below 50 percent. “Attitude” assessed the importance of the disease as a clinical disorder. It also evaluated the importance for anesthesiologists identifying OSA patients before anesthesia. Lastly, it examined the self-confidence of anesthesiologists in the management of OSA patients. With a score below 50 percent, their confidence could use a boost.

The researchers suggested that it is necessary to develop OSA training programs on OSA for Chinese anesthesiologists.

The American Society of Anesthesiologists (ASA) recommended the guidelines for difficult airway management 20 years ago, and they were revised in 2003. In addition, ASA published the guidelines for screening surgical patients with OSA preoperatively and managing OSA perioperatively in 2006.

Image by: ReSurge International

Friday, January 14, 2011

Gotta Go! Frequent Nighttime Urination May Indicate Sleep Apnea

Nocturia, which causes people to wake up during the night to urinate, has been linked to sleep apnea but is not currently used as a screening tool.

New research investigated whether nighttime urination frequency can help physician screen for this serious medical condition that causes a person to stop breathing during sleep.

The study determined the predictive power of nocturia for OSA and compared findings with other markers of OSA commonly used to screen for this disease, such as snoring.

The study was a retrospective chart review. It included 1,007 adult patients who were seeking diagnoses and treatment at one of two New Mexico sleep centers.

Patients completed detailed medical and sleep history questionnaires and took a PSG to determine their apnea–hypopnea index (AHI), which indicates OSA severity.

Some of the measurements included nocturia, snoring, body mass index (BMI), sex and age.

Snoring was reported by 77 percent and nocturia was reported by 83 percent. Eighty percent of the patient sample demonstrated OSA.

Results indicated that patient-reported nocturia predicted OSA severity more than body mass index, sex, age, and self-reported snoring.

Nocturia was very similar to snoring in regard to predictive power for clinical OSA with a comparable sensitivity of 84 percent.

Snorers had a higher mean AHI than non-snorers, and patients with nocturia had an elevated BMI.

Researchers found that nocturia appears comparable to snoring as a screening tool for OSA. Research in urology and primary care clinics is needed to clarify the use of nocturia as a screening tool.

Learn more here.

Image by Chalet Les Cîmes.

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.