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.

Sunday, February 7, 2010

Acne, ulcers, sores and other skin irritation from CPAP masks leads to dermatologists referrals

Several years ago I treated a patient with severe obstructive sleep apnea who had facial sores and acne from her CPAP mask. I treated her with a TAP appliance and we eliminated the sleep apnea. She has worn an appliance now for several years with no problems and loves it. Her dermatologist who had treated her sores, ulcers and acne did not see her after the oral appliance because the probleems were eliminated. Later she went in for a different problem and told her doctor about theTAP appliance and he came in shortly after and was fitted for an appliance. He did not mind the CPAP but his wife hated the CPAP noise. He has worn an appliance for several years now.

The interesting part of the story is this dermatologist became one of my best referring physicians. I have a few pulmonologists and neurologists who frequently refer patients and many internists. What is interesting is that I only have one cardiologist who ever refers patients for oral appliances, and he owns a sleep lab. With over half of patients not using their CPAP you would think that cardiologists would be on top of this critical patient care concern. Cardiologists are very good at referring patients to sleep centers but do not seem to follow-up to evaluate continued CPAP use.

A frequent time for diagnosis of apnea is after a first heart attack and apnea is witnessed by nurses in intensive care. I have seen more than a few patients who were diagnosed with sleep apne, rejected CPAP and went untreated until a cardiac event put the issue back on the table.

It is crucial that sleep apnea be treated, especially in cardiac patients. It does not matter if the treatment is CPAP, Oral Appliances or surgical intervention but treatment is essential.

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posted by Dr Shapira at 8:44 AM