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Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, October 30, 2008

Epilepsy and Sleep Apnea

A third or more of epilepsy patients may suffer from sleep apnea, and the number may be even higher in cases of treatment-resistant epilepsy. Some researchers have suggested that treating sleep apnea may be an important step toward reducing the frequency of epileptic seizures. A recent case study by researchers in Brazil make an important causal link between apneic events and epileptic seizures and suggest that all patients with treatment-resistant epilepsy should be evaluated for sleep apnea.

The study followed a 28-year old obese man who suffered both epilepsy and sleep apnea following brain trauma. They used a combination of EEG and polysomnography to monitor him for both seizures and apneic events. They detected both obstructive sleep apneas and central sleep apneas. They also found that there seemed to be a reinforcing effect between the two conditions. Sometimes apneic events were brought on by seizures, and sometimes seizures were brought on by apneic events.

As part of the case study, the researchers recommended that all epileptic patients whose condition is resistant to treatment, whether they present snoring or not, should be studied using a polysomnogram to determine both the presence of sleep apnea and what relationship it might have to their epilepsy.

Epilepsy is just one of many conditions that can be worsened by sleep apnea. If you have a medical condition that is resistant to treatment, it is possible that sleep apnea is a contributing factor. Consult with your doctor and contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, to schedule a sleep apnea consultation.

posted by Dr. Candelaria at 9:39 AM

Thursday, October 23, 2008

PBS Feature on Sleep Apnea Neglects Oral Appliance Therapy

PBS' NewsHour is one of the most respected in-depth news programs on television. Known for its long investigative pieces that daily delve into important news stories, these reports give vital minutes to stories that receive only seconds of attention even from 24-hour news networks. Therefore, a recent feature, first aired on August 13, was a vital opportunity to educate and inform Americans about the potentially deadly effects of one of our nation's most underdiagnosed conditions: sleep apnea. For the most part, the story, which used a narrative focus on a number of patients to explore the risks, diagnosis, and treatment of sleep apnea, did its job of being informative.

The story showed three men, one who was just being diagnosed with sleep apnea, one who was getting ready to begin treatment for sleep apnea, and one who had been undergoing treatment with CPAP successfully for three years. The man prepared to begin treatment was fitted with a CPAP mask, and openly expressed his distaste for the machine. The story revealed that CPAP treatment only works for about 25 % of patients, and that the man who was fitted with the CPAP mask didn't feel he had slept any better with it than without it.

However, the story failed to give any mention to CPAP alternatives, such as oral appliance therapy. Oral appliance therapy is not for everyone, but neither is CPAP, and with the potentially deadly effects of sleep apnea, people need to be informed of all their options so they can find the treatment that works best for them.

If you have been diagnosed with sleep apnea and are trying to undergo treatment, but are finding that CPAP just isn't working for you, schedule a consultation with the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today.

posted by Dr. Candelaria at 9:38 AM

Thursday, October 16, 2008

You Can Lose the Weight and Not the Apnea

In a study published August 15 in the Journal of Clinical Sleep Medicine, researchers studied 24 adults with obstructive sleep apnea through bariatric surgery. Before the surgery, subjects had an average BMI of 51, while after the surgery they had a BMI of 32. What they found was that, one year after surgery, only 4 % of the subjects had resolved their sleep apnea, and the majority of them still had moderate to severe sleep apnea, putting them at an elevated risk for mortality.

The study would seem to lend credibility to the theory we talked about last time: that obesity is an effect, not a cause, of sleep apnea, but it may not be true. It is important to remember that while all the patients experienced a dramatic reduction in BMI, they were by no means reduced to patients with an ideal BMI. Although they were no longer severely morbidly obese, they were still technically obese following their surgery.

More importantly, the study also found that although patients were still suffering from a potentially deadly degree of sleep apnea, the majority of them had discontinued use of their sleep apnea treatment, which in the study was CPAP. Most of them thought their sleep apnea was resolved, but this was probably due to the increase in energy they felt as a result of their weight loss. Once they felt this increase in energy, they were happy to be rid of the nuisance and discomfort of CPAP forever. It's possible that if the study had involved people being treated with oral appliance therapy, more of them might have continued their treatment following surgery.

If you have had bariatric surgery or lost a great deal of weight through diet and exercise, you may think your apnea is cured, but most likely it is not. However, there may be a more comfortable treatment option for your sleep apnea than your CPAP. To learn more about oral appliance therapy for sleep apnea, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today to schedule your sleep apnea consultation.

posted by Dr. Candelaria at 9:36 AM

Thursday, October 9, 2008

Obesity and Sleep Apnea: A New Chicken-and-Egg Paradox

We have mentioned several times that obesity puts people at significant risk for sleep apnea. Obese people have a much greater risk of suffering from obstructive sleep apnea than people of a more ideal body weight. But correlation doesn't equal causation, and there is some evidence that in some, many, or all cases, the causal arrow may point the other way.

In human beings, two hormones that have a powerful effect on appetite are leptin and ghrelin. It is more complicated than this, but in general leptin suppresses appetite, while ghrelin stimulates appetite. In studies, the level of both hormones were found to be correlated with low sleep levels. In fact, in a Wisconsin Sleep Cohort Study of 1024 individuals, shorter sleep time was found to correlate both with increased ghrelin levels and lower leptin levels. Since leptin also stimulates the body to burn energy, the combination of elevated ghrelin levels and reduced leptin levels will lead to decreased energy consumption and increased appetite, leading to higher levels of obesity. The study's only caveat is that because of the population it contained more snorers than the overall population.

Interestingly, not all studies have confirmed these results. Some have found sleep apnea sufferers have elevated levels of leptin, not ghrelin, while others suggest that sleep apnea sufferers seem to have elevated levels of both hormones. What is agreed by all the studies, however, is that sleep deficiencies can have a significant impact on the levels of these hormones. And there is evidence that sleep apnea treatment with CPAP can regulate the level of these hormones. It is likely that in cases where oral appliance treatment is called for, it will also help regulate these levels.

So if you are a sleep apnea sufferer who is overweight, it is possible that your apnea is the cause of your weight gain, not the other way around. And if you have been trying to lose weight but have so far been unsuccessful, it may be due to sleep apnea. If you would like to learn more about the possible benefits of sleep apnea treatment, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today to schedule your sleep apnea consultation.

posted by Dr. Candelaria at 9:35 AM