Official Blog of the American Academy of Dental Sleep Medicine

The AADSM Blog Has Been Relocated

2011-07-13T09:47:00.000-07:00

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.

Common Symptoms of OSA Patients Vary By Age and Gender

2011-05-13T11:09:00.000-07:00

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.

Virtual Choir 2.0 Praises the Beauty of Sleep

2011-04-25T06:16:00.001-07:00

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.

President Obama Calls Attention to Air Traffic Safety

2011-04-15T12:19:00.000-07:00

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.

Pediatric Sleep Apnea Treatment Effective Two Years Later

2011-04-04T08:13:00.000-07:00

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.

Driver Fatigue Investigated After NYC Bus Crash

2011-03-21T12:44:00.000-07:00

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.

Can OSA Jeopardize Brain Power?

2011-03-16T08:55:00.001-07:00

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

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

2011-03-04T08:43:00.000-08:00

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.

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.

Heavyweights Tag-Teamed by Sleep Apnea’s Partners

2011-02-17T09:26:00.001-08:00

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

The ABC’s of Snoring and Childhood Cognition

2011-02-08T13:52:00.000-08:00

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.

Going Under: Chinese Anesthesiologists Score Low on OSA Knowledge

2011-01-28T14:27:00.000-08:00

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

Gotta Go! Frequent Nighttime Urination May Indicate Sleep Apnea

2011-01-14T14:01:00.000-08:00

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.

Two New Studies Incentivize Weight Loss in 2011

2010-12-29T07:51:00.000-08:00

United Press International (UPI) reports that researchers are studying a potentially life-threatening correlation among obstructive sleep apnea (OSA) and obesity.

Scientists at the Lynn Health Science Research Institute in Oklahoma City are recruiting volunteers for the study of obesity and OSA, a disorder that causes pauses in breathing during sleep.

Obesity has been found to be the main cause of OSA, mostly because obese people have larger tonsils and tongues, which interfere with air flow during sleep.

Seventy percent of sleep apnea patients are obese, researchers say.

According to Kelly Shepherd, a research fellow from Australia, and one of the researchers working at the Lynn Health Science Research Institute, those who suffer from OSA can stop breathing from five to 130 times per hour. They are at risk for heart attacks, car wrecks, depression and lost work productivity caused by daytime sleepiness, she said.

Drowsy driving has become a major public health concern as obesity rates rise.

The LA Times reported last week that a new study in the American Journal of Emergency Medicine found that obese drivers are more likely to die in a serious car wreck than drivers of normal weight.

Researchers at the University at Buffalo in New York examined drivers' body sizes and the number of car crash deaths between 2000 and 2005 from data in the Fatality Analysis Reporting System. The study calculated an increased risk factor of dying at 21 percent for moderately obese drivers and 56 percent for morbidly obese drivers.

"Many people think they just sleep badly and wake up feeling terrible the next day," said Shepherd. "Many don't know why."

Experts estimate that 80 to 90 percent of people with OSA are undiagnosed and untreated.

Learn more about OSA here. Sleep apnea can be diagnosed at an AASM-accredited sleep center.

Image by John K.

Zaps for ZZZs: Scientists Shock the Tongue to Keep Air Flowing

2010-12-27T13:54:00.000-08:00

The Associated Press reports that a new implant might be able to block obstructive sleep apnea (OSA).

Scientists are testing to see if an implanted pacemaker-like device might help certain sufferers keep their airways open by zapping the tongue during sleep.

OSA occurs when the tongue and upper-airway collapse during sleep, blocking the airway – sometimes for a minute or more repeatedly throughout the night.

The experimental implant intends to stimulate the nerve that controls the base of the tongue with a mild electrical current during sleep to make it stay toned and in place like it does during the day.

Three companies are already developing implants and planning studies to test the results.

"In this kind of research, we're not looking for little changes," says Dr. Meir Kryger, a sleep medicine specialist at Gaylord Hospital in Connecticut, who is helping to lead Inspire's study. "What we're looking for is actually cure."

The American Academy of Sleep Medicine (AASM) estimates that more than 18 million Americans suffer from sleep apnea.

One patient who had success with the early testing of hypoglossal nerve stimulation was Rik Krohn, 67, of suburban Minneapolis.

"It got to the point where I'd dread going to bed," says Krohn. Sleep studies showed his apnea was awakening him an average of 35 times an hour. He tried five different CPAP masks unsuccessfully before giving up in frustration, and surgeons turned him away.

These experiments are only now beginning, with a handful of implants performed so far — and while it's an interesting concept, frustrated patients should try some proven steps first, cautions, Dr. Amy Atkeson of Columbia University Medical Center in New York.

The American Academy of Sleep medicine recommends weight loss, oral appliance therapy, and CPAP for OSA treatment.

Image by Tiago Daniel

Snoring: Fixing what a Punch in the Shoulder Can't Solve

2010-12-15T14:25:00.000-08:00

According to a recent New York Times piece, treating snoring and sleep apnea often requires trial and error.

A common misconception about sleep apnea is that it only affects older, overweight men. But sleep apnea can affect anyone, even children.

The article tells how Dr. Elizabeth Walton, a 43-year-old mother of two, has a common and sometimes embarrassing health problem – snoring.

“We laugh and joke about snoring,” said Dr. Nancy A. Collop, president elect of the American Academy of Sleep Medicine, “but it can be pretty annoying and disruptive to couples.”

Almost half of the adult population snores at least occasionally and for half of them, snoring may be a sign of sleep apnea, a serious medical condition.

After trying CPAP and finally settling on opal appliance therapy, Dr. Walton, and her partner, are both sleeping better.

Because Dr. Walton has obstructive sleep apnea (OSA) instead of primary snoring, medical insurance has covered most of her treatments.

Oral appliances are custom-made mouthguards that move your lower jaw forward to open your airway during sleep.

A dentist who specializes in sleep medicine fits an appliance to your mouth, usually for $1,500 to $3,000. That price should include all follow-up visits and any adjustments that need to be made, said Dr. Sheri Katz, president of the American Academy of Dental Sleep Medicine. Medicare reimburses patients for oral appliance therapy if they meet certain medical criteria.

Studies show that custom-fit appliances ease mild to moderate sleep apnea in about 75 percent of patients and snoring in 80 to 90 percent of patients who use them regularly, said Dr. Katz.

Putting a Name to Sleep Apnea: NAMES Screening Tool a Success

2010-12-03T14:24:00.000-08:00

Sleep experts estimate that 80 to 90 percent of obstructive sleep apnea (OSA) patients are undiagnosed and untreated.

Many patients do not know they have a problem because they are unaware that they wake up throughout the night to breathe. Bed partners often detect OSA because of the loud snoring that can accompany the breathing disorder.

Because dentists see patients on a regular basis, they frequently screen patients for sleep apnea. If screening shows the patient is at risk for OSA, he or she will then go to sleep physician for a diagnosis and treatment.

A new study in the journal Sleep and Breathing examined a new screening method that combined symptoms with a physical exam to predict the presence of sleep apnea. The NAMES assessment looked at neck circumference, airway classification, related diseases, Epworth scale, and snoring.

By including self-reported historical factors with physical exam findings, researchers were able to better screen for OSA.

The study included 150 adult subjects. They had never been diagnosed with sleep apnea but were referred to sleep center because they showed signs of the condition.

The study results indicate that the NAMES assessment is an effective, inexpensive screening strategy for screening patients for moderate to severe OSA.

Another screening tool includes STOP.

“Let’s Get Together:” New Treatment Combo Tag Teams Sleep Apnea

2010-11-19T09:40:00.000-08:00

Doctors recommend continuous positive airway pressure (CPAP) as the gold standard of sleep apnea treatment. But 25 to 50 percent of patients do not use the treatment on a regular basis because they can’t tolerate the pressure produced by CPAP. To increase compliance and effectiveness of CPAP, some doctors are combining CPAP treatment with oral appliance therapy.

New research in the journal Sleep and Breathing shows that combination therapy normalized breathing disturbances in sleep apnea patients who were otherwise intolerant to CPAP. When CPAP was used with an oral appliance, patients were able to tolerate their treatment better than CPAP by itself.

Typically, the two treatments are given separately. Oral appliances are fitted by dentists trained in dental sleep medicine. These devices fit like sports mouth guards and move the jaw and tongue forward to open the airway. Oral appliances are most effective with mild to moderate sleep apnea patients.

This study included 10 OSA patients who didn’t tolerate CPAP. They were using oral appliance therapy but still experiencing pauses in breath during sleep.

The patients were taken off oral appliance therapy for one week. They then wore CPAP and an oral appliance together for three nights. Oxygen levels were recorded during a sleep study and patients took the Epworth Sleepiness Scale. A free version is available here.

Results show that the oral appliance/CPAP combination was well tolerated by all participants.

The number of times patients stopped breathing per hour of sleep was reduced from 11 times per hour to three times per hour after combination therapy.

Before treatment, the average sleepiness score was 12. After oral appliance therapy, their average score was reduced to 9. After combination treatment, the score was further reduced to 7. This decrease shows that they had more energy during the day due to combination therapy.

Image by Elliot Margolies

State Rep. Robert Donatucci’s Death Related to Sleep Apnea

2010-11-11T11:27:00.000-08:00

The Philadelphia Inquirer reports that Pennsylvania's State Representative Robert Donatucci’s early death was caused by untreated sleep apnea.

State Rep. Robert C. Donatucci, 58, received 84 percent of the vote last week in being elected to his 16th House term. He died asleep in his bed in South Philadelphia early Tuesday, his family said.

His death was related to sleep apnea, for which he was being treated, said his brother Ronald, the city register of wills.

He found the mask uncomfortable and did not complete the test, but had resolved to lose a few pounds, his brother said. He had no history of heart problems.

Fire rescue personnel were called to the house when his wife, Marie, discovered he was not breathing.

"Bobby's style was very simple," his brother said. "His word was his reputation. If he was for something, you could go to sleep on it."

Like Representative Roberts, 25 to 50 percent of OSA patients do not use their CPAP machine. Sleep apnea is a serious medical condition and should not go untreated. Oral appliances are a safe and effective alternative.

Oral appliance therapy is recommended for patients with mild to moderate sleep apnea who cannot tolerate or comply with CPAP, or for severe patients who cannot tolerate CPAP.

More than 2,100 dentists belong to the American Academy of Dental Sleep Medicine. They are trained to screen for and treat sleep apnea. Find-a-Dentist in your area.

Fall Back Into Standard Time with an Extra Hour of Sleep

2010-11-05T14:12:00.000-07:00

An article on WomensHealth.gov explains that when you turn your clocks back an hour this weekend, it might be a good opportunity to think about whether you're getting enough sleep.

The switch from Daylight Saving Time to Standard Time officially occurs at 2 a.m. Sunday morning, and it moves one hour of daylight from the evening to the morning.

While you'll appreciate the extra hour of sleep you gain by returning to Standard Time, it won't be enough to eliminate any major sleep debt you may have accumulated due to a hectic lifestyle, experts say.

Chronic sleep deprivation can affect attention levels, reaction time and mood, leading to decreased productivity at work, increased family stress, and potential health problems, according to the American Academy of Sleep Medicine (AASM).

"People tend to ignore the need for sleep in order to get other things done, but sleep is as important as what you eat, how much you exercise, and other healthy lifestyle practices," says Dr. Nancy A. Collop, director of the Emory Sleep Center and president-elect of the AASM.

"It's important to acknowledge the role that sleep plays in our daily lives, and recognize that how we feel, think and perform is all dictated by the amount of sleep we get."

The amount of sleep needed for good health and optimum daytime performance varies by age: preschoolers need 11 to 13 hours a night; school-age children should get 10 to 11 hours; teens must have at least nine hours; and adults should get seven to eight hours each night.

The AASM offers these tips for a good night's sleep:

•Don't exercise or have caffeine, alcohol, nicotine or heavy meals close to bedtime.
•It's fine to eat a small snack before bedtime to avoid going to sleep hungry.
•Follow a consistent bedtime routine.
•Keep your bedroom quiet, dark and cool.
•Don't sleep in on the weekends. That just makes it harder to wake up on Monday.

Read more at USA Today or check out this video by myFOXdetroit:

Researchers Encourage Sleep Apnea Screening Before Surgery

2010-10-28T07:51:00.001-07:00

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.

It’s All About Personality

2010-10-19T09:22:00.000-07:00

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.

Treatment Found to Reduce Heart Failure in Sleep Apnea Patients

2010-10-14T13:11:00.001-07:00

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.

Sleep Apnea Unmasked

2010-10-07T14:22:00.000-07:00

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.

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.

Cost of Obesity Weighs Down on North Americans

2010-09-27T14:25:00.000-07:00

Researchers at George Washington University recently published data on the individual costs of being overweight and obese in the United States. It is the first-ever report on the individual cost of having excess weight.

According to the study, the annual cost of being obese in the U.S. is $4,879 for women and $2,646 for men. The researchers analyzed prior research to determine the "real-life costs" of obesity. They examined loss of productivity at work, employee sick days and the need for additional gasoline, among other factors.

Taking into account the economic value of lost life pushed the annual cost of obesity to $8,365 for women and $6,518 for men.

The study notes that obesity increases a person’s risk for sleep apnea. Losing weight has been shown to improve sleep apnea, but the AASM recommends that weight loss be combined with CPAP or oral appliance therapy. Treatment should be directed by a sleep physician.

Obesity also raises the prevalence of type II diabetes, hypertension, cardiovascular disease, asthma, certain types of cancer, and other conditions.

A new report from the Organization for Economic Cooperation and Development found that Americans have the highest rate of obesity in the world.

The report notes that the lifespan of an obese person is up to 8 to 10 years shorter than that of a normal-weight person.

Unfortunately, obesity is a problem that is being adopting by children. This Montreal Gazette article reported on a new Canadian study that found most pediatricians believe parents are not taking their child’s weight seriously.

The study included 860 pediatricians. When asked to identify key barriers to child weight loss, more than 60 percent of the surveyed doctors noted:

- Parents who are overweight themselves
- Parents who become defensive when the topic of their child’s weight is raised
- Parents who show little interest in helping their child lose weight

Not sure if you have a weight problem. Check your body mass index here.

Sleep Apnea Screening Tool Now Available in Thai

2010-09-23T07:19:00.000-07:00

A new study published in the journal Sleep and Breathing tested the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS). The ESS is a simple questionnaire used to screen for obstructive sleep apnea (OSA). You can take the ESS here for free.

The researchers also assed the relationship between the ESS score and the severity of OSA.

This study involved 228 subjects - 149 males and 79 females. Thirty-two healthy volunteers and 39 snorers made up the control group. After polysomnography, 126 were diagnosed with obstructive sleep apnea (OSA).

Scores between the two groups were significantly different. The average ESS score for control subjects was 6. In contrast, OSA patients scored about a 10.

Thirty-one OSA patients were successfully treated with CPAP or upper-airway surgery. They took the ESS 3-6 months after treatment. Their ESS scores decreased significantly.

The researchers concluded that the Thai version of the ESS successfully screens for OSA. It can also asses response to treatment. However, the tool was unable to differentiate severity levels of sleep apnea.

The authors recommend combining the Thai ESS with a more comprehensive clinical evaluation.

In April, this blog reported that the ESS was successfully translated into Korean.

A Decade of Weight Loss and Still Shedding Pounds

2010-09-15T11:34:00.001-07:00

The Biggest Loser is gearing up for Season Ten of its popular weight loss reality TV show. This year’s season premier will air September 21 at 8/7c on NBC.

According to this press release, Nationwide Medical and Philips Respironics will pair up for a third season of testing and treating the contestants.

Last year, the SleepEducation blog reported that all 16 candidates had obstructive sleep apnea. Former AASM President Dr. Clete Kushida worked with the contestants to ensure that they received the maximum benefit from ongoing treatment.

Like in Season Nine, contestants will continue to receive assistance once their time on the show comes to an end.

Obesity increases risk for this sleep-related breathing disorder because excess weight around the neck can cut off airflow during sleep.

Losing weight can help people treat their condition. But the American Academy of Sleep Medicine recommends that sleep apnea patients combine weight loss with CPAP treatment or oral appliance therapy.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. Sleep apnea is a potentially life-threatening condition. Diagnosis and treatment are available at an AASM-accredited sleep center.

Vikings Player Tackles His Obstrucitve Sleep Apnea

2010-09-13T08:17:00.001-07:00

According to Kevin Seifert’s recent ESPN blog post, Minnesota Vikings’ player Percy Harvin recently started treating his obstructive sleep apnea.

Harvin experienced a migraine and lost consciousness during practice on August 19. The doctors gave him an overnight sleep test, which showed that his troubles were rooted in sleep. Harvin’s results indicated that his breathing frequently stopped for up to ten seconds, depriving him of oxygen.

He told NBCSports.com that he no longer takes his migraine medication, which he blames for his collapse. Instead, he uses continuous positive airway pressure (CPAP) to treat his OSA. This device pumps air into his nose to regulate his breathing during sleep.

Sleep apnea is a common problem in professional football players.

In June, this blog reported on a new study from the journal SLEEP that found that more than 19 percent of NFL players might have sleep apnea.

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.

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 25 percent.

Experts estimate that sleep apnea affects four percent of men in the general population. They suspect that 18 million Americans have the condition.

Image by Brandi Korte

Why Some Kids Can’t Get Enough Shuteye

2010-09-08T14:47:00.000-07:00

Dr. Richard Kravitz, director of Duke’s Pediatric Sleep Laboratory, recently discussed pediatric sleep apnea on DukeHealth.org.

Dr. Kravitz noted that obstructive sleep apnea (OSA), in which the airway becomes partially or completely blocked during sleep, occurs in one to three percent of otherwise healthy children. It prevents a child from getting restful sleep

OSA is most common in children two to seven years of age, but it can also affect infants and adolescents. While the most common cause of OSA in children is enlarged adenoids and tonsils, obesity is an increasingly common culprit. Children with Down syndrome also experience a high risk.

Signs of sleep apnea include loud, frequent snoring and pauses in breath followed by gasps. Dr. Kravitz explained that snoring appears in 10 percent of otherwise healthy children and does not always indicate OSA.

Restless tossing and turning may also reflect sleep troubles.

Untreated OSA can cause physical and behavioral problems including daytime sleepiness, excessive napping, behavior changes, hyperactivity, concentration troubles, poor growth, bedwetting, high blood pressure and cardiac problems.

Diagnosis of sleep apnea takes place at a sleep center. A sleep test will monitor how many times a child stops breathing during sleep. The test also monitors brainwaves, heartbeats, and oxygen and carbon dioxide levels. These factors provide evidence of airway obstruction.

An article in today’s Chicago Tribune reported on how some hospitals have created sleep centers specifically designed for children’s needs. Many traditional sleep centers also treat children.

Sleep center rooms look similar to bedrooms. A parent is encouraged to spend the night with their child to provide comfort and confirm how closely the night of observed sleep reflected home sleep patterns.

After a diagnosis, there are several treatment options. Weight loss, tonsil removal, continuous positive airway pressure, and oral appliances are several common treatments.

A list of sleep centers is available here.

Sleep Apnea Worsens Insulin Resistance in Teens

2010-09-02T14:26:00.000-07:00

A new study in the Sept. 1 issue of SLEEP indicates that obstructive sleep apnea (OSA) worsens insulin resistance in obese teens. Insulin resistance is a risk factor for type 2 diabetes.

OSA has been linked to diabetes and cardiovascular problems. Obesity increases a person’s risk for sleep apnea, but after adjusting for obesity, sleep apnea is an independent risk factor for insulin resistance and hypertension in adults.

The researchers hypothesized that OSA was associated with worse insulin resistance.

The study included 98 children, of which 42 were female and 56 were male.

“Prepubertal” children were seven years of age on average. There were 37 prepubertal children.

“Pubertal” children were 13 years on average. There were 61 pubertal children.

Each child took an overnight sleep test and had their insulin resistance assessed.

The results?

In obese pubertal children, OSA was associated with worse insulin resistance, putting them at greater risk for developing type 2 diabetes.

Sunshine State Asks Sleepy Drivers to Stay Off the Roads

2010-09-01T07:10:00.000-07:00

The state of Florida's first "Drowsy Driving Awareness Week” takes place September 6-10. Gov. Charlie Crist signed into law the “RonShay Dugans Act.” It aims to create greater awareness about the dangers of drowsy driving, making Florida the 18th state to do so.

The definition of drowsy driving varies from state to state, but every state's definition revolves around the concept of a fatigued driver.

Excessive daytime sleepiness (EDS) can cause impaired reaction time, memory problems, mood changes and driving accidents. It can increase a person’s risk for deadly motor vehicle accidents by 15 times.

Motor vehicle accidents due to “drowsy driving” account for $48 billion in medical costs each year. The National Highway Traffic Safety Administration says drowsy driving is responsible for about 100,000 car crashes a year.

Drowsy driving can be as dangerous as drunk driving. Current legislation recommends that commercial drivers get screened and treated for obstructive sleep apnea (OSA), a common cause of EDS. But there are many non-commercial drivers who do not know that they have OSA.

Florida’s drowsy driving week honors an eight-year old Tallahassee girl. ABC reported that RonShay Dugans was going to the Boys and Girls Club in a bus in 2008 when a drowsy driver behind the wheel of a cement truck slammed into the back of the bus and killed her.

Chief Leroy Smith of the Florida Highway Patrol told ABC that it's no different than driving under the influence. “With regard to drowsy driving, it is just as dangerous as drunk driving just as alcohol and drugs could impair one’s normal faculties, so could sleepiness and drowsiness. It could also slow one’s reaction time.”

RonShay’s adoptive father, Perry West, said RonShay’s legacy is an important reminder for all drivers. “We are reminded every day when we get up in the morning of just what we lost and so with this we are also mindful of the price that was paid to get this legislation passed.”

In 2003, New Jersey was the first state to pass a law aimed specifically at fatal accidents involving sleepy motorists - estimated at about 1,500 a year nationwide. Such drivers can now be charged with vehicular homicide. That offense is punishable in New Jersey by up to 10years in prison and a $100,000 fine.

Learn more about the risks of drowsy driving here.

A Dog’s Life: How Sleep Troubles Can Plague Our Canine Counterparts

2010-08-30T08:03:00.000-07:00

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

Patients Find Trouble Fitting Boil-and-Bite Oral Appliances

2010-08-26T07:43:00.000-07:00

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

Dentists Overcome Challenging Sleep Apnea Case

2010-08-24T12:17:00.000-07:00

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.

Reversing Infertility with Sleep Apnea Treatment

2010-08-23T13:52:00.000-07:00

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.

Bariatric Surgery Helps Prevent Sleep Apnea in Morbidly Obese

2010-08-19T08:18:00.000-07:00

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.

Floating Down The River Without A Care (or Cellphone)

2010-08-17T14:55:00.000-07:00

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

Strength-Training in Your Sleep: OSA Treatment Improves Body’s Ability to Fight Acid Reflux

2010-08-16T14:13:00.000-07:00

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.

Dealing with It: How the Brain Handles Sleep Loss

2010-08-13T14:17:00.000-07:00

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.

Study Examines Risk Factors for Sleep Apnea in Young Europeans

2010-08-09T10:46:00.000-07:00

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

Rise and Shine: Sleep Apnea Treatment Improves Bed Partner’s Depression

2010-08-05T13:36:00.000-07:00

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

Dentists Take Front Line against Sleep Apnea

2010-08-04T12:52:00.000-07:00

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.

New Heart Research Pumps Blood Into Sleep Apnea Awareness

2010-08-03T12:38:00.000-07:00

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: http://sleepcenters.org/.

Source: Medscape

Truckers Asked to Hit the Gym Before Hitting the Road

2010-08-02T13:14:00.001-07:00

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

Federal Disaster Response Plan Now Includes Dentists

2010-07-30T14:02:00.000-07:00

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.

Proteins Key to Sleep Disturbed Morning Migranes

2010-07-29T14:22:00.000-07:00

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.

Sleep Apnea & Married Couples that Sleep Alone

2010-07-26T14:27:00.000-07:00

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.

Sleep Study Meets Social Media in Live Sleepup

2010-07-22T11:14:00.000-07:00

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.

Is your sleep apnea depressing your partner?

2010-07-20T13:59:00.000-07:00

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.

CPAP-Based Test for OSA Compared to Standard Sleep Study

2010-07-19T15:03:00.000-07:00

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.

Men With Sleep Apnea Face Larger Heart Hazard

2010-07-13T08:33:00.000-07:00

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

Different Approach to Sleep Studies May Reduce Wait Times

2010-07-12T09:01:00.000-07:00

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.

Neck thickness: sleep apnea sign and body fat indicator?

2010-07-09T14:45:00.000-07:00

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:

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

Girls
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.

September 11 Rescue Workers At-Risk for Obstructive Sleep Apnea

2010-07-07T12:17:00.000-07:00

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

Oral Appliance Therapy for Acid Reflux

2010-07-06T11:47:00.000-07:00

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.

Cognitive-Behavioral Therapy can Improve Adherence to OSA Treatments

2010-07-02T13:15:00.000-07:00

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.

OSA Concerns Grow Among U.S. Military Veterans

2010-07-01T09:44:00.000-07:00

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

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

2010-06-28T15:04:00.001-07:00

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

Treating Sleep Apnea from the Dental Chair

2010-06-25T14:36:00.000-07:00

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.

AASM Past President Dr. Clete Kushida Explains Sleep Apnea

2010-06-24T12:03:00.000-07:00

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.

Patient / Dentist Testimonial for Oral Appliance Therapy

2010-06-22T12:57:00.000-07:00

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.

OSA Characteristics Vary by Onset Age

2010-06-21T08:17:00.000-07:00

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.

Biochemical Markers Help Detect Sleep Apnea

2010-06-16T11:31:00.000-07:00

“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

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

2010-06-15T14:13:00.000-07:00

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.

Snorers Should Avoid Alcohol Before Bed

2010-06-14T14:24:00.000-07:00

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.

Research Shows Benefits of Dentists Learning to Treat Sleep Apnea

2010-06-11T13:51:00.001-07:00

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.

Suspected Attention Disorders May Mask Sleep Disorders in Kids

2010-06-10T12:14:00.000-07:00

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.

Nasendoscopy Proves Useful in Predicting Treatment Success in Sleep Apnea Patients

2010-06-05T14:58:00.000-07:00

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

2010-06-05T08:23:00.000-07:00

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

Tackling Sleep Disorders in the National Football League

2010-06-01T13:55:00.000-07:00

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

Brushing Teeth for Heart Health

2010-05-28T12:29:00.000-07:00

According to new research, people who don't brush their teeth twice a day have an increased risk of heart disease. The British-based study included nearly 12,000 adults. The study was published today in the British Medical Journal.

Over an eight-year period, there were 555 heart attacks or other serious coronary problems among participants. The effect of regular teeth brushing was significant.

After adjusting the data for other heart risk factors such as social class, obesity, smoking and family history, people who reported less teeth brushing had a 70 percent extra risk of heart disease compared to those who brushed twice daily.

Lead author Dr. Richard Watt explained to Reuters that people with gum disease are more likely to develop heart disease and diabetes because inflammation in the body, including in the mouth and gums, plays a role in the build up of clogged arteries.

"In a way, it's really quite an old story, because back in the early 19th century there was a theory called focal sepsis, and people believed that infections in the mouth caused disease in the whole body," Watt said.

Today, many dentists address patients’ overall health. Dentists trained in dental sleep medicine screen for and treat Sleep apnea. Sleep apnea requires treatment. Left untreated, the condition raises patients’ risk for heart attack, stroke, diabetes, and other problems.

More than 18 million Americans have sleep apnea. But 80 to 90 percent of these people are undiagnosed and untreated. Dentists are in a position to help because they see patients on a regular basis.

In the British study, 63 percent of people visited their dentists every six months.

The World Health Organization reports that heart disease is the leading killer of men and women in Europe and the United States. Together with diabetes, it accounts for almost a third of all deaths around the world in 2005.

Find-a-dentist near you who knows how to screen for sleep apnea.

Different Strokes for Different Folks: Screening for Sleep Apnea Across Cultures

2010-05-25T14:20:00.000-07:00

People differ from place to place. Likewise, predictive tools predict vary between populations.

New research in the journal Sleep and Breathing compared the diagnostic characteristics of two prediction models in a population. Results indicate that a model’s ability to predict sleep apnea may differ by culture.

This Singapore-based study included 117 people, of which 77 had moderate to severe sleep apnea. The researchers developed a predictive model from their evaluations and characteristics. This tool became the local model.

The diagnostic characteristics of the local model were compared with those of a foreign model. The local model and the foreign model were then applied to 52 local patients.

The models produced similar accuracy. However, the foreign model produced different diagnostic characteristics from the local model.

The researchers suggest that the predictive outcomes may vary because cultures perceive and report symptoms, such as snoring, differently.

All participants took an overnight sleep test. Model accuracy is important because it helps patients avoid unnecessary tests.

The authors note that in some areas of the world, it is not possible to diagnose sleep apnea with a sleep test. When equipment is unavailable, doctors may use prediction models to screen for sleep disorders.

The study suggests that screening tools should be local for the best results.

Parkinson's Disease May Raise Risk for Sleep Disorders

2010-05-21T12:34:00.001-07:00

A new study indicates that Parkinson’s disease (PD) patients may have a higher risk for sleep-disordered breathing (SDB). The study was published by the journal Sleep and Breathing.

Sleep-disordered breathing includes everything from harmless snoring to the serious medical condition called obstructive sleep apnea.

The study involved 134 PD patients and 94 control subjects. The participants had no prior diagnosis of SDB.

Each person’s risk for SDB was assessed by the Berlin Questionnaire. Participants also took questionnaires that assessed their quality of life.

Results indicate that PD patients have increased risk for SDB. High risk for SDB was apparent in 49.3 percent of PD patients. In contrast, 34.8 percent of the controls showed high risk.

After adjusting for age, gender, and body mass index, PD subjects still had a higher risk.

PD patients at high risk for SDB had higher BMIs and Epworth scores. In the general population, excess weight and sleepiness are also factors for SDB.

Data showed that SDB might substantially affect depression and lower quality of life in PD patients.

The researchers suggest that screening for, diagnosing and treating SDB in PD patients could significantly raise their quality of life.

Under the Scope: Sleep Apnea and Complications

2010-05-19T08:59:00.000-07:00

A new study in the journal Sleep and Breathing assessed whether obstructive sleep apnea (OSA) raises the risk of cardiorespiratory complications during endoscopic procedures.

The study was retrospective. Researchers identified patients who had undergone an endoscopic procedure under conscious sedation from January 2001 to May 2008. Each patient also took a sleep study in that period.

Patients composed four groups. The groups included 130 people with no OSA, 135 with mild OSA, 125 with moderate OSA, and 249 with severe OSA.

The patients were an average of 60.5 years of age. Ninety-three percent were male. Their mean body mass index was 33.7, indicating obesity.

Colonoscopies accounted for 68.5 percent of procedures. Upper endoscopies accounted for 20.2 percent. Combined procedures represented 11.3 percent.

The researchers tracked procedure complications.

Minor complications included problems like hypertension and oxygen desaturation.

Major complications included chest pain, respiratory distress, and cardiorespiratory arrest. Major problems required intervention.

Seven percent of patients had major complications and 19 percent had minor ones.

Importantly, complication rates did not significantly differ between the patients with and without OSA.

Results indicate that OSA does not clearly increase the risk of cardiorespiratory complications in patients undergoing endoscopy procedures.

Sleep apnea is a serious medical condition that can raise a person’s risk for heart problems. It requires treatment. Learn more here.

Sleeping It Off: Depression and Sleep

2010-05-18T14:38:00.000-07:00

Depression is commonly associated with obstructive sleep apnea (OSA). But new research shows that it may not be caused by OSA. Instead, it may be due to factors also associated with the sleep disorder.

The study was recently published by the journal Sleep and Breathing. It included 45 patients. OSA affected 34 of them. Eleven people experienced snoring without OSA. Nineteen people were controls. Diagnosis was determined from sleep studies.

The patients were 20 to 69 years of age. Patients with psychiatric disorders were excluded.

Each patient took the Epworth Sleepiness Scale (ESS). Find your ESS score here.

They also took the Beck Depression Inventory and Profile of Mood States (POMS).

Patients with primary snoring or OSA reported significantly more depression than the control subjects. Depression severity did not differ between snorers and mild OSA patients. Both groups indicated that fatigue contributed to their depression.

OSA patients often snore loudly. They also experience dangerous pauses in breath during sleep. People who snore without OSA, breathe normally during sleep.

Results indicate that fatigue as measured by the POMS was the primary predictor of depression.
The article notes that OSA increases a person’s rate of depression – 15 to 56 percent of OSA patients suffer from it. In contrast, 6.6 percent of the general population has a depressive disorder.

The researchers note that doctors should be aware that snorers without OSA also report depression and fatigue. They suggest that the depression found in OSA patients and snorers could indicate common factors.

Trucking Leaders Discuss Road Safety and Sleep

2010-05-17T14:47:00.000-07:00

Industry leaders are taking steps to reduce untreated obstructive sleep apnea (OSA) among truck drivers, reported a recent article at eTrucker.com. These industry experts met at the Sleep Apnea & Trucking Conference last week in Baltimore, MD.

Mary Gunnels, director, Federal Motor Carrier Safety Administration (FMCSA) Medical Programs, acknowledged that sleep apnea among truckers is a public health concern.

A 2002 study found that almost a third of truck drivers suffer from OSA. This condition raises their risk for driving accidents.

Dr. William K. Sieber, National Institute for Occupational Health and Safety, discussed the Institute’s goals to reduce obesity and cardiovascular disease among commercial drivers. Older age and excess weight are two common factors linked with OSA.

Dr. Lawrence Epstein, chairman, American Academy of Sleep Medicine Adult Obstructive Sleep Apnea Task Force, also spoke. He focused on OSA, its causes and treatments. Dr. Epstein said the most common treatments are CPAP and oral appliances.

Beyond safety concerns, there are financial benefits to ensuring driver health.

An article in Occupational Health and Safety reported on a new study that found that treating OSA can reduce health costs, work absences, and short-term disability.

In the study, when drivers with sleep apnea were treated, their health plan costs decreased by an average of $2,700 in the first year. The costs decreased by another $3,100 in the second year.

Read more about the study in this April blog post.

Image by Cromely

Punching in on a Good Night’s Sleep

2010-05-12T08:48:00.000-07:00

Want a healthy heart? Try to punch out of work on time.

A new study published in the European Heart Journal indicates that working three to four hours of overtime may damage your heart.

In contrast to people with seven-hour workdays, people with 10 to 11 hour workdays had a 60 percent higher risk of having heart problems. These problems included death due to coronary heart disease (CHD), non-fatal heart attacks and angina.

The study involved more than 6,000 male and female British civil servants. All of the participants were London-based. Participants entered the study when they were 39 to 61 years old. The study began between 1991 and 1994. At that time, participants were free from CHD. They all worked full time.

Eleven years later, 369 heart-related problems had taken place.

The researchers found that the association between long workdays and CHD was independent of 21 risk factors. Risk factors included smoking, excess weight and high cholesterol.

In a press release, the researches noted that not sleeping enough or having enough time to unwind before sleep might have contributed to the results.

Working overtime was related to type A aggressive behavior patterns, depression and anxiety. The researchers suggested that employees who work overtime might be more likely to work while ill, ignore symptoms of ill health, and not seek medical help.

In an editorial on the research, Dr. Gordon McInnes, explained that if the effect is causal, overtime-induced work stress might contribute to a large portion of cardiovascular disease.

In February, Sleep Education reported on two studies that examined the tie between sleep and heart health.

The blog cited a study of heart attacks in Sweden. It found that heart attacks rose by five percent in the week after daylight saving time. The researchers suggested that the results reflected sleep deprivation caused by the time change.

Sleep Education cited another study from the University of Chicago. This second study found that longer sleep duration was associated with a lower rate of coronary artery calcification, a predictor of CHD.

Swedish Researchers Pull the Bell Cord on Sleepy Bus Drivers

2010-05-11T14:22:00.000-07:00

Researchers from the University of Gothenburg in Sweden found that professional drivers have a high rate of sleep apnea – raising questions about road safety.

The study included 116 bus and tram drivers. Results show that 23 percent of the drivers suffered from daytime sleepiness. Nineteen percent had sleep apnea.

In contrast, an estimated 4 percent of men and 2 percent of women in the general population have sleep apnea.

One of the most common symptoms of sleep apnea is daytime sleepiness. This sleepiness can cause driving accidents.

The U.S. also has problems with droopy-eyed drivers. A 2006 Institute of Medicine report found that drowsiness costs $150 billion each year in accidents and lost productivity. Another $48 billion in medical costs result from auto accidents involving sleepy drivers.

In a press release, lead author Mahssa Karimi, noted that CPAP treatment reduced daytime sleepiness in drivers with sleep apnea.

Oral appliance therapy is another treatment option.

"Our findings suggest that it's important to systematically examine professional drivers and other professional groups entrusted with the safety of others in order to be able to treat any sleep disorders,” says Karimi. “Their work demands alertness and concentration at all times."

The results will be presented at the annual Swedish Sleep Medicine Congress in Gothenburg. The meeting takes place this April 21 to 23.

Image by Andreas Nilsson

Sleep and Insulin: Understanding Sleep Apnea’s Relation to Diabetes

2010-05-07T09:43:00.001-07:00

A study in the June issue of the Journal of Clinical Endocrinology & Metabolism, found that just one night of sleep deprivation can induce insulin resistance. Insulin resistance is a component of type II diabetes.

These results give insight into why sleep apnea raises a person’s risk for type II diabetes. Untreated sleep apnea prevents people from getting restorative sleep.
Previous studies found that short sleep duration over multiple nights resulted in impaired glucose tolerance. This is the first study to examine the effects of only a single night of partial sleep restriction.

The study included nine healthy subjects. Five of the subjects were men. Four of the subjects were women. The researchers measured insulin sensitivity of each participant. They used the hyperinsulinemic euglycemic clamp method.

This method uses catheters to infuse glucose and insulin into the bloodstream. They determined insulin sensitivity by measuring the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia.

The measurement was taken after two separate nights of sleep. On the first night, participants slept eight hours. One the second night, they slept four hours.

Insulin resistance was noted after the shorter night of sleep.

“Our data indicate that insulin sensitivity is not fixed in healthy subjects, but depends on the duration of sleep in the preceding night,” said Dr. Esther Donga, lead author of the study, in a press release.

The researchers suggest that improving sleep duration may help stabilize glucose levels in diabetes patients.

Pregnancy May Invalidate Sleep Apnea Screening Tool

2010-05-06T13:47:00.000-07:00

A new study by researchers at Baylor College of Medicine shows that the Berlin Sleep Questionnaire, which is a common screening tool, does not accurately identity sleep apnea in pregnant women.

Past studies using the questionnaire connected sleep apnea during pregnancy with infants born small. Some of these studies also connected sleep apnea with a mother’s risk for a pregnancy complication called preeclampsia.

The lead author, Dr. Kjersti Aagaard, explained in a press release that his team sought to validate the questionnaire in pregnant women. The form asks questions about snoring, sleepiness and excess weight, which are common complaints in pregnant women. So they suspected that the observed complication rate might not have been caused by the sleep apnea.

The study included 100 women in the last third of pregnancy. The women took the questionnaire, and then underwent sleep apnea and fetal heart rate monitoring for at least three hours.

Results indicated that the questionnaire did not accurately screen for sleep apnea. It identified just over one-third of women who actually had sleep apnea and just under two-thirds of those who did not have the condition.

The researchers also found no concerning changes in the fetal heart rate pattern in women with sleep apnea.

The researchers suggest that these findings raise questions regarding data linking sleep apnea and adverse pregnancy outcomes. They recommend that the questionnaire be modified for pregnant women.

Funding for this work came from the National Institutes of Health New Innovator Award.

Sleep Apnea Prevalence in Iran

2010-05-05T12:54:00.000-07:00

A study in the journal Sleep and Breathing reported data on the prevalence of obstructive sleep apnea (OSA) in Iran. In the first Iranian study of its kind, researchers sought to identify people at-risk for developing OSA.

The study included 3,529 Iranians aged 18 to 70 years old. Fifty-three percent of the participants were female.

Each of the subjects took the Berlin Sleep Questionnaire, which is a common test used to gauge risk for sleep apnea. The questionnaire was translated into Persian and then back into English to ensure its validity.

The participants’ body mass indexes were also calculated using height and weight.

Based on their responses, 176 subjects were considered at-risk for OSA, of which 58 percent were female. The results indicate that an estimated five percent of the Iranian population is at-risk for the sleep disorder.

In the U.S., an estimated four percent of men and two percent of women are at risk for the condition.

Like in the U.S., OSA risk in Iran increased with age and weight. People more than 50 years of age had a higher risk for OSA. Ninety percent of the at-risk patients were overweight or obese. Smoking tobacco products, which can raise a person’s risk, was practiced by more than 22 percent of the Iranian men.

In contrast to the U.S., Iranian women were more likely than Iranian men to suffer from OSA. The researchers note that snoring is not socially acceptable in Iran, so the men may have under-reported snoring habits while the women reported more honestly.

This is not the first time that an English OSA screening tool was translated into another language. In April, this blog reported on researchers that translated the Epworth Sleepiness Scale into Korean to help gauge OSA prevalence in South Korean.

Life-Work Balance: Poor Sleep at Home Can Lead to Injuries at Work

2010-05-05T08:05:00.000-07:00

A common symptom of sleep apnea is daytime sleepiness. Left untreated, this sleepiness can cause driving or work-related accidents.

According to a study in the May issue of the journal SLEEP, trouble falling asleep or staying asleep can cause similar problems.

Researchers used data from the Canadian Health Survey Cycle (CCHS). The survey occurred in 2000 and 2001. Respondents reported having trouble falling asleep or staying asleep “never,” “some of the time,” or “most of the time.”

The current study examined people from 15 to 64 years of age who had worked part or full-time over the past 12 months. It included 65,485 people who had not experienced an injury in the past twelve months. It also included 4,099 people who had had a work-related injury.

This Canadian-based study compared the risk of work-related injuries across different job sectors. It sought to identify at-risk groups for prevention efforts.

The percentage of workers reporting a work injury increased with sleep troubles. The association was strongest for women.

Men and women who had problems “most of the time” experienced higher work-related injury rates than those who “never” had sleep problems. Trouble sleeping “sometimes” was also associated with a larger number of work injuries in women.

People who slept three to six hours per night reported the highest risk. Women who slept five to six hours per night had a higher risk than those who slept seven to nine hours per night.

An increased risk of injury do to sleep troubles was apparent in most industries. The most at-risk groups included women in processing, manufacturing, farming, forestry and fishing. People working rotating or split shifts also had high-risk for work-related accidents.

You Snooze, You Lose: How Sleeping Can Help Shed Pounds

2010-05-03T11:38:00.000-07:00

In April, this blog explained that sleeping eight hours a night can help reduce your diet by a Big-Mac’s worth of calories.

An article in yesterday’s Chicago Tribune goes into more detail on how sleep regulates your hormones to help you stay healthy. It reports on new findings by Harvard researchers that show that the hormonal changes and neurochemical reactions that occur during sleep may have serious implications for your weight and fitness.

These results support past studies that link sleep and weight loss.

According to Dr. Fran Mason, two weight-regulating hormones — ghrelin and leptin — are controlled by the amount of time you sleep and can affect your health goals.

"Ghrelin levels elevate slowly as you sleep; when you don't sleep, ghrelin levels rise more sharply, by as much as 15 to 28 percent,” Mason says.

This increase can cause weight gain of as much as five to 15 pounds.

Likewise, the higher your leptin levels are, the smaller your appetite will be because your body perceives energy stores.

"When you cut back on sleep, your leptin levels drop almost 20 percent," Mason says.

Your brain perceives this drop the same way as a 30 percent reduction in calories, producing the same appetite you would have if you cut your food intake by a third.

Sleep loss can have broader implications than just weight gain.

"Research shows that you have fewer white blood cells in circulation when you sleep less," Mason says. "These ‘natural killer cells' fight infection and represent the frontline in your ability to ward off illness."

Mason explains that markers of inflammation go up when you sleep less. Inflammation can cause pain, muscle soreness, arthritis, tendinitis, and other muscle and skeletal problems. Inflammation is also linked to asthma and heart disease.

More than 70 million Americans suffer from one or more sleep disorders, but many people are unaware of their condition. Visit Sleep Education to learn more.

Goldilocks and the Three Bears: Getting the Right Amount of Sleep May Save Your Life

2010-05-03T06:55:00.000-07:00

Like in the fairytale, finding the perfect fit in any situation can be hard. But getting the right amount of sleep is worth the effort, according to a study from the May issue of the journal SLEEP, which found that sleeping too much or too little can raise a person’s risk for death.

The researchers reviewed 16 past studies, which included more than 1.3 million male and female participants. The participants came from eight different countries. Anyone under 60 years of age was considered younger. Anyone 60 or more years of age was considered older.

The researchers assessed sleep duration through questionnaires and study outcomes through death certificates.

Short sleep duration was considered less than seven hours, although it was often less than five hours. Long sleep duration was considered anything more than eight or nine hours of sleep.

In contrast to people who slept seven to eight hours per night, the results indicate that short sleep duration raised people’s risk for death by 12 percent.

Long sleep duration raised people’s risk for death by 30 percent. The researchers suggest that sleeping nine hours or more per night may indicate undiagnosed health issues.

The results did not differ by gender or socioeconomic status.

The researchers suggest that in the U.S., sleeping less than seven hours per night may contribute to more than 25 million deaths in people twenty years or older per year.

These results support a growing body of evidence that too much sleep or too little sleep can lead to poor heath outcomes.

Many people with sleep apnea do not know that they have the condition and that it keeps them from getting restorative sleep. Although they may try to get a healthy amount of sleep, their brain wakes them up throughout the night to breathe. This fragmented sleep pattern decreases the number of restful hours of sleep they get each night, which is why sleep apnea requires treatment.

Get tested for sleep apnea at a sleep center.

Image by Valerie

Charles Dickens and The Pickwick Papers

2010-04-29T14:20:00.001-07:00

According to a recent article in Tufts Journal, sleep apnea was once known as “Pickwickian syndrome,” after the character Joe in Charles Dickens’ first novel, The Pickwick Papers. Joe’s obesity and tendency to fall asleep during the day led to the book title’s association with sleep apnea.

Almost two centuries after Joe’s sleep troubles, obesity and obstructive sleep apnea (OSA) is affecting a growing number of people.

Excess fat around the neck can put pressure on the throat during sleep, causing airway collapses. Sedatives such as alcohol and prescription drugs can cause further slackening of the upper-airway tissues.

The article relays a patient success story of a 54-year-old man named Tim, who asked that his last name not be used.

Three years ago, Tim was drinking too much and gaining weight. His wife complained about his snoring and daytime sleepiness. He took a sleep test and was diagnosed with moderate sleep apnea.

Tim could not get used to the CPAP device that his physician recommended for treatment.

“I tried it, but I couldn’t tolerate it,” he says. “The mask fell off constantly, no matter how many times I had it adjusted.”

Tim’s doctor referred him to an AADSM-member dentist to be fitted for a custom-made oral appliance. His two-piece mouth guard held his lower jaw slightly forward during sleep to maintain a steady airflow.

During the next year, Tim visited his dentist every two or three months for tiny adjustments to the mouth guard.

“There was some initial drooling,” Tim reported. “But the body adjusts over time. I’m very used to it now.”

Forty-pounds lighter, Tim is feeling awake during the day and sleeping soundly at night. “I’m back upstairs with my wife,” he said, happy to no longer be sleeping on the living room sofa.

Image by Wigwam Jones

Stomach Acid and Spontaneous Arousals From Sleep

2010-04-28T11:18:00.000-07:00

By Guest Blogger Dr. Steven Y. Park, M.D.

Gastro-esophageal reflux and laryngopharyngeal reflux disease are commonly seen in patients with obstructive sleep apnea. Many people with sleep apnea will have the typical throat clearing, post-nasal drip, chronic cough or hoarseness that's seen with laryngopharyngeal reflux disease. Sleep apnea causes your normal stomach juices to leak up into the throat, which not only causes you to wake up, but also causes swelling and inflammation in the throat.

We know that any form of breathing obstruction (apnea, hypopnea, respiratory effort-related arousal) can cause you to wake up. But any degree of acid in the throat can stimulate chemical receptors, which causes you to wake up so you can swallow. It's thought that this is needed to prevent aspiration of stomach juices into your lungs.

A recent Japanese study not only confirmed these concepts, but found an interesting additional observation: While people with severe obstructive sleep apnea have mostly arousals due to breathing pauses, those with mild to moderate sleep apnea have a higher number of spontaneous arousals. Spontaneous arousals are noted on a sleep study when your brain waves go from deep sleep to light sleep or temporary awakening, without any objective evidence of breathing pauses.

An obstruction causes a tremendous vacuum effect that's created in the throat, literally suctioning up your normal stomach juices. This initial obstruction will lead to the typical respiratory arousal, but lingering juices will irritate the throat leading to spontaneous arousals. Think of your stomach juices as a sort of sensory form of stimulation, like a loud noise or a bright light. Your throat has a number of very sensitive chemical and pressure receptors that can cause your brain to wake up, without any physical obstruction.

I've always felt that spontaneous arousals are somehow related to breathing pauses. This study only confirms my suspicion that too many spontaneous arousals may be a sign of upper-airway resistance syndrome or early obstructive sleep apnea.

What's your opinion on this? Do you have any of the above symptoms?

About the Author: Dr. Steven Y. Park is a board certified otolaryngologist – head & neck surgeon in private practice in New York City. He’s the author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, which is endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and others.

Visit Dr. Park’s Web site and Blog.

Success Story: Woman Enjoys Her Best Night of Sleep in Years

2010-04-27T14:34:00.000-07:00

When Mary Keeler, now 61, arrived at Tufts University’s Dental Clinic, she hadn’t had a good night’s sleep for almost 15 years, reports Tufts Journal.

Since 1993, excessive daytime sleepiness (EDS) had damaged Keeler’s health, mood, work and relationships.

“I was sleeping my life away, but I couldn’t seem to get to the bottom of it,” said Keeler.

Keeler described her path to diagnosis and treatment as a winding and frustrating one. At first, her EDS was mistaken for a symptom of depression. But in 2006, Keeler underwent a sleep study and was diagnosed with moderate obstructive sleep apnea.

Her initial treatment was CPAP, which involved sleeping with a face mask connected to an air pump. Keeler found the mask awkward and uncomfortable. Her husband could not sleep in the same room as the CPAP machine, which produced what Keeler described as “white noise.”

“Well, I hated it. I absolutely hated it,” she said.

After a decade and a half, Keeler found her answer at the dentist’s office. Her sleep physician referred Keeler to her dentist to get a custom-made oral appliance.

A follow-up sleep study found that while the sleep apnea was gone, Keeler was not getting enough REM sleep. Her sleep physician prescribed medication, which in combination with the oral appliance therapy, solved her sleep problems.

“All of a sudden, I woke up like a new person,” said Keeler. “I thought, ‘So that’s what it feels like to get a good night’s sleep.’”

Oral appliance therapy is recommended for patients with mild to moderate sleep apnea. Find-a-dentist in your area who is trained to treat sleep apnea.

Steering Clear of Road Blocks: Study Recommends OSA Treatment for Commercial Drivers

2010-04-26T14:20:00.000-07:00

Road safety advocates will be pleased with a new study in the May issue of the Journal of Occupational and Environmental Medicine.

The study indicates that treating truck drivers with obstructive sleep apnea (OSA) lowers healthcare costs and disability rates.

Lead author Dr. Benjamin Hoffman explained in a press release that treating OSA in truck drivers has economic, health and safety benefits.

The researchers used insurance claims records to evaluate the effects of OSA treatment in commercial drivers. The study included 248 OSA patients. Treatment was given to 156 of the drivers. The remaining 92 drivers went untreated.

For treated drivers, health plan costs decreased by an average of $2,700 in the first year. The costs decreased by another $3,100 in the second year. Untreated OSA patients did not experience changes in their health plan costs.

The treated drivers missed 4.4 fewer days of work in the first year. They also had lower short-term disability costs over two years.

On average, OSA treatment led to more than $6,000 in total health savings per treated driver.

The results indicate that, in addition to lowering accident rates, treating OSA can reduce health costs, work absences, and short-term disability.

Past studies have found that OSA treatment can lower the number of drowsy driving accidents. Screening and treatment for OSA has recently been recommended for commercial drivers. Read more here.

Image by Christian

Sleep Interrupted: A Public Health Issue

2010-04-23T14:23:00.000-07:00

Obstructive sleep apnea (OSA) affects an estimated 18 million adults in the U.S. OSA occurs when the tongue and soft tissues in the throat collapse into the airway, causing pauses in breath during sleep. Apneas can occur hundreds of times a night.

OSA patients can sleep for hours but still feel exhausted. This excessive daytime drowsiness can pose hazards on the road and in the workplace.

A 2006 Institute of Medicine report found that drowsiness costs $150 billion each year in accidents and lost productivity. Another $48 billion in medical costs result from auto accidents involving sleepy drivers. The IOM report found that 20 percent of all serious car accidents are caused by sleep-deprived drivers.

Qualified dentists can treat patients with oral appliance therapy (OAT). A feature article in the spring issue of Tufts Journal asked AADSM Immediate Past President Jeffrey Prinsell, DMD, MD, how dentists have addressed this public health issue.

Dr. Prinsell explained that sleep apnea requires treatment. “These patients are extremely tired; their performance at work suffers; they lose their libido; their bed partners leave them. And if [the sleep apnea] is left untreated, these people could die at night in their sleep,” he said.

“It’s very important we get some sort of treatment that lets these people function,” said Dr. Prinsell. He helped create Dentists Against Drowsy Driving, a public health campaign launched by the AADSM in November 2008. The program aims to raise awareness among health-care providers and the public about OSA.

Most OSA patients respond to some combination of CPAP or OAT. But some patients require surgery. Dentists who are oral and maxillofacial surgeons can perform these surgeries. They include remodeling nasal passages, adjusting the jaw, repositioning the tongue or removing the tonsils.

The article highlights Tufts University’s new program in dental sleep medicine. Read more about the program here.

The Golden Years: Is Old Age All in Your Mind?

2010-04-22T08:19:00.000-07:00

A new study shows that treating sleep apnea may play an important role in maintaining brain function during old age.

The study was published by the American Journal of Repertory and Critical Care Medicine.

Natural aging is associated with cognitive deficits similar to those found in obstructive sleep apnea (OSA) patients. OSA can cause memory and concentration problems.

People affected by OSA or healthy aging can experience cerebral compensation during cognitive activities. This study examined if the presence of both old age and OSA caused stronger compensatory response than those factors alone. They suspected that the presence of both OSA and old age might overwhelm the brain’s capacity to maintain performance.

The study involved 14 OSA patients. The patients were 25 to 59 years-old. Fourteen age-matched controls also took part. People less than 45-years-old were “young.” “Middle-age” patients and controls were 45-years-old or more.

Each participant took a sleep study. They also took a functional MRI session to test their attention and verbal encoding skills.

The researchers compared the results between the middle-age and young OSA patients and middle-age and young controls.

Middle-age OSA patients showed reduced performance for immediate word recall. They also had slower reaction times during sustained attention activities.

For both tasks, decreased activation was detected in the Middle-age OSA group in contrast to the young OSA and control groups.

These results suggest that the dual-presence of OSA and increasing age overwhelmed the brain’s capacity to respond to cognitive challenges.

This study underscores the importance of early diagnosis and treatment of OSA.

Image by Tree & J Hensdill

Hear Becky's Story: The Wife of a Snoring and Sleep Apnea Patient Treated With an Oral Device

2010-04-20T09:17:00.000-07:00

By Guest Blogger Dr. Lydia Sosenko, DDS, D.ABDSM

For more than 12 years, my dental practice, Dental Sleep Medicine of Illinois, has focused on treating people suffering from snoring and obstructive sleep apnea (OSA).

People often ask me how I became involved in treating these conditions with oral appliance therapy (OAT). I have two events that I remember specifically that started the ball rolling: the first, a Grand Canyon group expedition, and the second, a ski trip. During both of these trips, the snoring of one person put strain on the whole group, especially the light sleepers.

Years later, I was able to help a middle-aged couple treat snoring using OAT. The gratitude they showed me was overwhelming. Soon afterwards, I befriended colleagues in dental sleep medicine, which strengthened my commitment to this area of dentistry.

One of my patients, Becky, is featured in the below video. In it, she describes the changes in her and her husband’s lives since he started OAT.

OAT is a non-surgical treatment option recommended by physicians for the use of mild to moderate OSA. It is also recommended for patients that cannot tolerate CPAP. Oral appliances are worn in the mouth similar to sports mouth guards or orthodontic retainers. Many patients find that an oral appliance is comfortable, convenient and affordable. In fact, medical insurance often covers OAT.

About the author: Dr. Lydia Sosenko (picture) is a general dentist devoted to treating sleep apnea. She is a Diplomate of the American Board of Dental Sleep Medicine and a member of the AADSM Public Relations Committee. She has appeared on WGN’s Healthwatch and is dedicated to helping the public sleep with the use of OAT.

Visit her blog here.

Sleep Disturbances and Quality of Life

2010-04-19T09:56:00.000-07:00

A new study from the Journal of Clinical Sleep Medicine gives insight into how sleep disorders can affect people’s quality of life (QOL). The researchers compared sleep’s impact on QOL between three racial/ethnic groups.

The participants were part of the Sleep Heart Health Study (SHHS). They included more than 5,000 men and women. Five percent of the people were Hispanic, nine percent were African American/Black and 86 percent were Caucasian/White. The participants were all at least 40-years-old.

Each person took a sleep study and the SF-36. The SF-36 is a short questionnaire from the Medical Outcomes Study. It measures QOL by examining aspects of physical and mental wellness. The test is self-reported. Some healthcare providers use the SF-36 to assess care outcomes in adult patients.

United Press International explains that the participants had a high rate of sleep problems. Forty-six percent had obstructive sleep apnea (OSA), 34 percent frequent snoring, 30 percent insomnia symptoms and 25 percent excessive daytime sleepiness (EDS).

There were no significant differences involving OSA by race. But there were some differences between the races.

African Americans with frequent snoring, insomnia, and EDS reported lower physical QOL. In contrast, Hispanics with frequent snoring, insomnia and EDS reported lower mental QOL.

The researchers explained that this study helped determine norms for physical and mental QOL in people suffering from sleep disorders. This set of norms can help doctors gauge the impact of sleep disorders on their patients.

Earlier this month, the Official Blog of the AADSM reported more results from the SHHS. The research found that men with sleep apnea were twice as likely as men without sleep apnea to have a stroke. This risk increased with OSA severity. Men with moderate to severe sleep apnea were nearly three times more likely to have a stroke than men without sleep apnea or with mild OSA.

Coexisting Conditions: Insomnia and Sleep Apnea

2010-04-15T14:39:00.000-07:00

You might think that having obstructive sleep apnea (OSA) means that you don’t have insomnia. After all, OSA often causes excessive daytime sleepiness while insomnia is characterized by elevated alertness. But several studies indicate that the two disorders often coexist.

A study in the April issue of the Journal of Clinical Sleep Medicine examined 20 previous studies that compared the two conditions. Their results indicated that insomnia symptoms were reported in 39 to 58 percent of OSA patients.

Insomnia symptoms include difficulty falling asleep and staying asleep. Insomniacs often experience early awakenings or feel unrefreshed after sleeping.

Experts estimate that 30 percent of adults have insomnia symptoms. An estimated 10 percent of adults have chronic insomnia.

Just as OSA patients displayed signs of insomnia, many insomniacs exhibited signs of OSA. Between 29 and 69 percent of insomnia patients had an AHI of more than five. This score indicates OSA.

People who suffer from OSA and insomnia have some similar symptoms. Both conditions can lower work productivity and increase driving accidents. They also can raise one’s risk for cardiovascular disease.

Both sleep disorders lowered patients’ quality of life. And people in each group felt tired and experienced mood problems.

Because insomnia and sleep apnea are two common sleep disorders, the researchers were unsurprised by the patient overlap.

The researchers suggest that ignoring one of the disorders may worsen the other disorder. So it is important to treat both conditions. Sleep disorders can be diagnosed at a sleep center.

In March, this blog reported on a study that found that men and women with OSA sometimes have different symptoms. The study showed that 17 percent of women complained of insomnia. In contrast, five percent of men complained of insomnia.

Sleep and Weight Loss: “I’m Loving It”

2010-04-13T13:02:00.000-07:00

As catchy as McDonald’s “I’m loving it” slogan sounds, new research shows that sleeping eight hours per night can cut a Big-Mac’s worth of calories from your diet – and that is something to love.

The study found that normal-weight men ate 560 more calories per day when they had four hours of sleep the night before, in contrast to eight hours.

The study involved 12 healthy young men. The researches examined how sleep affected food intake and physical activity during two 48-hour sessions.

Two days served as a control period. The study participants maintained normal routines and tracked their sleep, eating and activities in a diary.

During the second two-day period, the men went to bed at midnight and woke up at 8 a.m. on one day. On the other day, they went to bed at 2 a.m. and woke up at 6 a.m. They were allowed to eat as much as they liked.

After the night of short sleep, the men consumed an average of 22 percent more calories than when they slept for eight hours.

The findings make it clear that people need to do their best to get an adequate amount of sleep so their bodies can function properly, the researchers told Reuters Health.

This study was the first of its kind to look at what happens to a normal-weight person's eating patterns when he or she sleeps less. Results indicate that one night of reduced sleep can increase food intake and decrease physical activity.

The authors suggest that sleep deprivation may contribute to the current rise in obesity.

Whether you are trying to maintain a healthy weight or lose a few extra pounds, getting enough sleep is important. Excess weight can contribute to developing sleep apnea. In December, this blog reported that weight loss can reduce the severity of sleep apnea.

Image by Dain Sandoval

The Language of Sleep: Popular Screening Tool Translated Into Korean

2010-04-09T14:30:00.000-07:00

A new study in the journal Sleep and Breathing shows that the recently created Korean Epworth Sleepiness Scale (ESS) is a reliable and valid tool for screening patients with obstructive sleep apnea (OSA). The ESS was translated into Korean and then retranslated into English to ensure its validity.

Excessive daytime sleepiness (EDS) is a common symptom of OSA. The ESS gauges how likely you are to doze off or fall asleep in everyday situations. The test can help you see if you have a problem with EDS. A score of nine or above indicates that you should see your doctor.

The study involved 273 participants. Each person took a polysomnography (PSG) to test for sleep apnea. Of the participants, 37 had mild OSA, 61 had moderate OSA, and 83 had severe OSA. Thirty-two people snored. Sixty people breathed normally during sleep.

Two to four weeks after the PSG, 53 of the participants were randomly selected and given the KESS.

Results indicate that the KESS is a reliable screening tool for Korean-speaking patients. KESS scores were significantly higher in patients with OSA. As OSA severity increased, so did patients’ KESS scores.

The ESS and KESS can help screen for sleep apnea. But OSA should be diagnosed at a sleep center. Once diagnosed, some sleep apnea patients receive treatment from dentists trained in dental sleep medicine.

Dentists from around the world now treat sleep apnea. In March, this blog reported on the launch of the Asian Academy of Dental Sleep Medicine. The Academy is composed of DSM experts from Korea, Japan, Taiwan and Thailand.

Sleep Apnea Doubles Risk of Stroke in Men

2010-04-08T14:42:00.000-07:00

Stroke is the second leading cause of death worldwide. New research shows that treating obstructive sleep apnea (OSA) may help doctors prevent similar deaths in the future.

Researchers from the Sleep Heart Health Study (SHHS) found that OSA is associated with an increased risk of stroke in middle-aged and older adults, especially men.

The study was published by the American Journal of Respiratory and Critical Care Medicine. It is the largest study to-date linking sleep apnea and increased risk of stroke.

Each of the 5,422 participants took an at-home sleep test to determine if they suffered from sleep apnea and, if so, to what extent. Each person was 40 years of age or older. No one had a history of stroke or treatment for sleep apnea.

The researchers followed the participants for nine years. Over this period, 85 men and 108 women had strokes.

On average, men with sleep apnea were twice as likely as men without sleep apnea to have a stroke. This risk increased with OSA severity. Men with moderate to severe sleep apnea were nearly three times more likely to have a stroke than men without sleep apnea or with mild OSA.

"Overall, the increased risk of stroke in men with sleep apnea is comparable to adding 10 years to a man's age,” said Dr. Susan Redline in a news release.

Increased risk was independent of other risk factors such as weight, high blood pressure, race, smoking and diabetes.

The researchers also found a link between sleep apnea and increased risk of stroke in women. Unlike with the men, increased stroke risk in women was only associated with severe OSA.

This landmark study was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. The researchers believe that these results may help doctors learn how cardiovascular problems like strokes and high cholesterol develop.

His and Hers: Body Fat Varies Between the Sexes

2010-04-07T15:10:00.000-07:00

A new study published in the journal SLEEP shows that body fat can predict obstructive sleep apnea (OSA) severity, but that its predictive value varies depending on gender.

Excess body fat increases your risk for OSA. But depending on your sex, where fat is located in your body holds important information.

The study included 36 women and 60 men. The participants had similar waste sizes and body mass indexes (BMI).

The researchers looked at the people’s age, sex, Epworth Sleepiness Score (ESS) and BMI. Body surface and upper airway measurements were also taken.

Each participant took a sleep test and DXA scan. Dual Energy Absorptiometry (DXA) Scanning measures a person’s percentage of fat and lean tissue, and bone density.

The researchers found that the best way to predict the disorder was through DXA scans. They also found that how well fat predicted severe OSA varied between men and women and depended on where the fat resided.

In men, abdominal fat best predicted severe OSA. Neck circumference was associated with severe OSA in both sexes, but especially for men. Neck fat was predictive in women, but not men.

A narrow airway was particularly useful in screening for severe OSA in women. The Epworth Sleepiness Scale was better in predicting severe OSA in men than in women.

Image by Alexandra Moss

Her Side of the Story: Sleep Apnea and Heart Disease

2010-04-06T14:50:00.001-07:00

A recent blog post on EmpowHer describes sleep apnea and snoring from the bed partner’s point of view.

“From time to time, my husband snores. Now, when I say snore, I mean a raising-the-dead-from-the-grave kind of S-N-O-R-E!” said Blogger Mary Kyle.

Kyle joked about muffling her husband’s snoring with “ear muffs designed to block out the sound of gun fire on the range,” but sleepless nights like these are common in many American households.

Snoring can be harmless. But some snoring signals obstructive sleep apnea (OSA). Not all people who snore suffer from OSA. An estimated one in eight Americans snores. Of these 30 million snorers, more than half, or 18 million, suffer from sleep apnea.

Kyle explained her fear that in addition to causing marital strife and general grumpiness, OSA could raise her husband’s risk for heart disease.

Because people with OSA are forced to wake up throughout the night to breathe properly, they fail to get restorative sleep. Left untreated, OSA can increase their risk for heart attacks, strokes and hypertension.

Snoring that is associated with OSA is often loud and frequent. The snorer may make choking or snorting sounds while gasping for air. There may be moments of silence when the person stops breathing altogether. These pauses can last for 10 to 30 seconds or persist for a minute or longer.

Many people do not realize that snoring can merit medical attention. Read here why some experts believe popular media is partially to blame.

Q & A: Why do I fall asleep during the day?

2010-04-05T14:37:00.000-07:00

Can’t keep your eyes open during the day? This Q & A article from the Chicago Daily Herald may explain why.

The reader’s question was as follows:

I often fall asleep as soon as I sit down. It can happen anywhere and anytime. I don't realize I've fallen asleep. I fall asleep when I come home from work, at social functions, when family or friends are visiting, and at the dinner table. I've done this for 25 years but it's getting worse as I get older. Do you know what condition would cause this? Is treatment available?

In his answer, Dr. Howard LeWine describes sleep apnea as the most common cause of excessive daytime sleepiness.

He provides several telltale signs of sleep apnea:

• Loud snoring four or more times per week
• Someone telling you that you stop breathing or gasp for air during sleep
• Daytime drowsiness
• Morning headaches
• A large neck - 17 inches or more in men, 16 inches or more in women
• History of high blood pressure

More risk factors are included in this list. You can use this test to determine your risk for sleep apnea.

Sleep apnea can damage memory and concentration, cause heart problems, and raise your risk for driving accidents.

Speak with your doctor about scheduling a sleep test if you show signs of sleep apnea. A sleep specialist will use a sleep test to diagnose this disorder and decide the best treatment option for you.

All Eyes on Sleep Disorders and Floppy Eyelid Syndrome

2010-04-02T12:25:00.000-07:00

A new study examined the connection between obstructive sleep apnea (OSA) and floppy eyelid syndrome.

This blog post on CNN’s Paging Dr. Gupta explains that people with floppy eyelid syndrome have a high risk of having OSA.

The syndrome causes elastic upper lids that are easily folded up. It often affects obese patients. Overweight or obese people also have a high OSA risk.

The study was published in the April issue of Ophthalmology. It included 102 patients with floppy eyelid syndrome and 102 controls.

The researchers found that one-third of patients with floppy eyelid syndrome also had OSA. The association was still statistically significant when controlling for body mass index.

The study authors suggest that doctors be aware of this association and direct further tests and treatment if necessary. Sleep disorders can be diagnosed at an accredited sleep center.

Floppy eyelid syndrome does not have a treatment, but doctors recommend using artificial tears to help relieve dryness.

Sleep apnea has several safe and effective treatments. CPAP and oral appliance therapy are two popular options.

Because OSA is a serious medical condition, patients should seek treatment. OSA can raise a person’s risk for diabetes, stroke and heart problems. It often leads to excessive daytime sleepiness.

Common signs of OSA include loud snoring and trouble breathing during sleep. Take this quiz to find out your risk for sleep apnea.

Image by Kate Shirley

The Ripple Effect: Sleep Apnea’s Toll on the Body

2010-04-01T14:15:00.001-07:00

A new Gallup poll found that sleep apnea’s effect on the body might go further than people know.

Data indicates that untreated sleep apnea can increase a person’s risk for high blood pressure, diabetes and heart attack.

Now, a poll of 350,000 U.S. adults indicates that these diseases, in turn, can raise a person’s risk for cancer.

Researchers conducted the survey by phone between 2008 and 2009. All of the participants were 18 years or older. When controlled for age, the results remained unchanged.

Five percent of people who did not have high blood pressure had been diagnosed with cancer. In contrast, 11.8 percent of people with high blood pressure had also been diagnosed with cancer.

More than six percent of people without diabetes had been diagnosed with cancer. In contrast, more than 12 percent of people with diabetes had also been diagnosed with cancer.

Americans with a history of heart attacks were three times more likely to report being diagnosed with cancer than people who had never had a heart attack.

The largest gap was found in 18 to 29 year-olds. More than 17 percent of patients who had had a heart attack were also diagnosed with cancer. In contrast, only 1.2 percent of people without a heart attack history had received a cancer diagnosis.

The study notes that while these results do not indicate that one condition causes the other, they do reflect shared risk behaviors like smoking and unhealthy eating habits.

Image by Gary Foulger