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, July 4, 2010

Obstructive Sleep Apnea Is An Independent Risk Factor For Stroke. Prevent Strokes with Treatment!

This blog entry is a reprint of a recent press release:

A recent article looked at the severe medical problems associated with sleep apnea and found that apnea increased the risk of stroke. CPAP and Oral Appliances are accepted as First Line Treatments for Sleep Apnea and Snoring.

FOR IMMEDIATE RELEASE

PRLog (Press Release) – Jul 03, 2010 – A recent article "Is obstructive sleep apnea an independent risk factor for stroke?: a critically appraised topic." in Neurologist. 2010 Jul;16(4):269-73 (see PubMed abstract below) looked at the risks of sleep apnea. Their background information stated "Obstructive sleep apnea (OSA) is associated with hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, and diabetes. These disorders are also risk factors for stroke"

Sleep apnea is a very dangerous condition and CPAP is usually the first line of treatment. Unfortunately the majority of patients refuse CPAP or abandon CPAP use. I HATE CPAP! is a frequent complaint among sleep apnea patients and many of these patients are never told that comfortable oral appliances (http://www.ihatecpap.com/oral_appliance.html ) are considered a first line treatment (along with CPAP) for mild to moderate sleep apnea. More than half of patients suspend CPAP completely. Even patients who use CPAP average only 4-5 hours a night not the recommended 7-7 1/2 hours. What is frightening is that most strokes occur in the early morning hours after the majority of CPAP users have discontinued use. The website http://www.ihatecpap.com offers valuable and timely information to patients who do not tolerate CPAP.

The raw data is quite scary with the authors rporting "he unadjusted analysis revealed that OSA (apnea-hypopnea index >5) was associated with stroke or death from any cause (hazard ratio, 2.24; 95% confidence interval [CI], 1.30-3.86; P = 0.004). The adjusted OSA analysis retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95% CI, 1.12-3.48; P = 0.01). In separate unadjusted analyses, OSA was associated with death and stroke with relative risks of 1.68 (95% CI, 1.10-2.25) and 5.16 (95% CI, 3.72-6.60), respectively." and concluding that Obstructive Sleep Apnea " independently contributes to stroke risk."

It is incumbent medically-legally for sleep physicians to inform patients of the fact that CPAP has poor compliance overall and that part-time use may be dangerous as well. Should all physicians inform patients who have difficulties with CPAP about Dental Sleep Medicine.

Dental Sleep Medicine offers comfortable Oral Appliances that most patients prefer to CPAP. Oral Appliances are considered a first line treatment for mild to moderate sleep apnea and an alternative to CPAP for severe apnea when patients do not tolerate CPAP. It has been shown to be more efficacious and have lower morbidity than most surgical procedures. Surgery is not considered a first line treatment for sleep apnea, CPAP and Oral Appliances are first line treatment approaches according to the Academy of Sleep Medicine .
Patients in Chicago, Chicago Suburbs, Northern Illinois and Southern Wisconsin who feel they may be canidates for an oral appliance should contact Dr Ira L Shapira a Diplomate of The American Board of Dental Sleep Medicine and a Pioneer in the field of Dental Sleep Medicine.

CALL DR SHAPIRA TODAY! 1-8-NO-PAP-MASK Treat your Sleep Apnea and avoid the possibly severe medical consequences, including stroke.

http://www.chicagoland.ihatecpap.com/
http://www.delanydentalcare.com/sleep_apnea.html
http://WWW.IHATECPAP.COM
http://www.IHATEHEADACHES.org

Neurologist. 2010 Jul;16(4):269-73.
Is obstructive sleep apnea an independent risk factor for stroke?: a critically appraised topic.
Capampangan DJ, Wellik KE, Parish JM, Aguilar MI, Snyder CR, Wingerchuk D, Demaerschalk BM.

From the *Department of Neurology, Mayo Clinic, Scottsdale, AZ; daggerDepartment of Library Services, Division of Education Administration, Mayo Clinic, Scottsdale, AZ; and double daggerDivision of Pulmonary Medicine and Sleep Disorders Center, Mayo Clinic, Scottsdale, AZ.
Abstract
BACKGROUND:: Obstructive sleep apnea (OSA) is associated with hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, and diabetes. These disorders are also risk factors for stroke. OBJECTIVE:: To determine whether OSA increases the risk of stroke independently of other cerebrovascular risk factors. METHODS:: The objective was addressed through the development of a structured critically appraised topic. This evidence-based methodology included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of sleep medicine and vascular neurology. RESULTS:: A large observational cohort study was selected and appraised to address this prognostic question. The unadjusted analysis revealed that OSA (apnea-hypopnea index >5) was associated with stroke or death from any cause (hazard ratio, 2.24; 95% confidence interval [CI], 1.30-3.86; P = 0.004). The adjusted OSA analysis retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95% CI, 1.12-3.48; P = 0.01). In separate unadjusted analyses, OSA was associated with death and stroke with relative risks of 1.68 (95% CI, 1.10-2.25) and 5.16 (95% CI, 3.72-6.60), respectively. CONCLUSIONS:: OSA independently contributes to stroke risk.

PMID: 20592572 [PubMed - in process]

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Dr Shapira is the founder of I HATE CPAP LLC that promotes awareness of the dagers of sleep apnea and value of Dental Sleep Medicine.

Dr Shapira is a Diplomate of the American Board of Dental Sleep Medicine and founder of Chicagoland Dental Sleep Medicine Associates. He is a former Assistant Professor at Rush Medical School's Sleep center and has been involved in research and treatment of sleep apnea with oral appliances since the early 1980's. Dr Shapira also founded I HATE Headaches LLC and the website www.ihateheadaches.org. He has several device and/or method patents on collection of stem cells from the jaws and developing wisdom tooth buds.

Dr Shapira is the Dental Section Editor of Sleep and Health Journal and has chaptered a chapter in a bmedical textbook on Anti-Aging Medicine.

Delany Dental Care was founded in 1984 as a general dental practice with special emphasis on treating sleep apnea, snoring, headaches, migraines and Temporomandibular (TMJ) disorders.

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posted by Dr Shapira at 7:11 PM