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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.

Tuesday, August 31, 2010

Dangers of Sleep Apnea

Sleep apnea is the cessation of breathing for more than 10 seconds while you are asleep. Most people who suffer from sleep apnea experience several episodes per night. Beyond just the regular tiredness and snoring associated with sleep apnea, sleep apnea can have serious side effects.

Due to the lack of sleep, since sleep apnea sufferers generally wake a few times per hour without knowing, patients may experience depression, irritability, and anxiety. They often combat these symptoms with pharmaceutical drugs, but it does not treat the root of the problem: sleep apnea. Addressing your sleep apnea can improve your mood and undo the negative effects lack of sleep was having on your personality.

A lack of sleep can also cause patients to lose concentration and gain weight. Your performance at work or at home can be negatively affected by your body's inability to sleep through the night. Weight gain is also commonly associated with inadequate sleep due to an increased appetite.

Sleep apnea has been linked with more serious side effects such as heart complications. The lack of oxygen to the brain is dangerous and can cause the body to function improperly.

Sleep apnea is dangerous, but you do not have to suffer with CPAP to help you sleep through the night. Let one of our dentists at I Hate CPAP! help you sleep soundly tonight by contacting them today. We serve patients all over the U.S.

posted by Nathan Graber at 2:29 PM

Sunday, August 29, 2010

ORAL APPLIANCES TREATING SLEEP APNEA REDUCE BLOOD PRESSURE SIMILAR TO CPAP.

WELL IT IS WELL ESTABLISHED THAT ORAL APPLIANCES ARE EFFECTIVE IN TREATING SLEEP APNEA AND SNORING THIS ARTICLE SHOWS IT ALSO REDUCES BLOOD PRESSURE SIMILAR TO CPAP TREATMENT.

HEAVY SNORING HAS BEEN SHOWN TO INCREASE CAROTID ATHEROSCLEROSIS DUE TO VIBRATIONS. THIS IS ALSO WELL TREATED BY ORAL APPLIANCE THERAPY.

IF SLEEP APNEA IS ELIMINATED THAN THE DISORDERS RELATED TO THE DISORDER WILL ALSO BE ELIMINATED. I EXPECT THAT RESEARCH WILL CONTINUE TO SHOW THAT ORAL APPLIANCES ARE EQUAL TO CPAP WHEN SLEEP APNEA IS SUCCESSFULLY TREATED.

BECAUSE 60% OF PATIENTS ABANDON CPAP IT IS INEFFECTIVE FOR THOSE PATIENTS. SIMPLY STATED CPAP DOES NOT SUCCESSFULLY TREAT ANY DISORDERS IN THE 60% OF PATIENT WHO DO NOT USE IT.

WHAT IS THE BEST SLEEP APNEA TREATMENT? THE BEST SLEEP APNEA TREATMENT IS BOTH EFFECTIVE AND IS USED BY PATIENTS.

THE BEST TREATMENT WILL ALWAYS BE A TREATMENT THAT IS USED BY THE PATIENT. COMFORTABLE ORAL APPLIANCES ARE PREFERRED OVER CPAP BY MOST PATIENTS OFFERED A CHOICE.

Sleep. 2004 Aug 1;27(5):934-41.
Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial.

Gotsopoulos H, Kelly JJ, Cistulli PA.
Department of Respiratory & Sleep Medicine, St George Hospital, The University of New South Wales, Sydney Australia.
Comment in:
Sleep. 2004 Aug 1;27(5):842-3.

Abstract

STUDY OBJECTIVE: To investigate the short-term effect (4 weeks) of oral appliance therapy for obstructive sleep apnea on blood pressure.
DESIGN: Randomized, controlled, crossover trial.
SETTING: Multidisciplinary sleep disorders clinic in a university teaching hospital.
PATIENTS: Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography (apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms--daytime sleepiness, snoring, witnessed apneas, fragmented sleep; age > 20 years; and minimum mandibular protrusion of 3 mm).
INTERVENTION: A mandibular advancement splint (MAS) and control oral appliance for 4 weeks each.
MEASUREMENTS AND RESULTS: Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period. Patients showed a 50% reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index. There was a significant reduction with the MAS in mean (+/- SEM) 24-hour diastolic blood pressure (1.8 +/- 0.5 mmHg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. Awake blood-pressure variables were reduced with the MAS by an estimated mean (+/- SEM) of 3.3 +/- 1.1 mmHg for systolic blood pressure (P = .003) and 3.4 +/- 0.9 mmHg for diastolic blood pressure (P < .0001). There was no significant difference in blood pressure measured asleep.
CONCLUSION: Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy.

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posted by Dr Shapira at 7:17 PM

Tuesday, August 24, 2010

The Best Snoring Treatment Is an Oral Appliance

Snoring is a warning sign of sleep apnea. Even snoring without sleep apnea is dangerous. A recent stuy showed snorers had an increased risk of carotid atherosclerosis and/or stroke. Patients with snoring have up to 300% increase in motor vehicle accidents. An Oral Appliance used for sleep apnea will also eliminate snoring. There are many appliances to control snoring and apnea. The TAP appliance has a volume control for the bed partner of the snorer.

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posted by Dr Shapira at 8:35 PM

ORAL APPLIANCES TREATING SLEEP APNEA REDUCE BLOOD PRESSURE SIMILAR TO CPAP.

A FREQUENT QUESTION IS WHETHER SLEEP APNEA IS BEST TREATED WITH CPAP OR ORAL APPLIANCES. ARE THE MEDICAL RESULTS AS EFFECTIVE WITH ORAL APPLIANCES? THE RESEARCH SAYS ORAL APPLIANCES ARE AS EFFECTIVE AS CPAP IN REDUCING SYMPTOMS WHEN IT IS USED EFFECTIVELY.

THE BEST SLEEP APNEA TREATMENT IS ONE THAT IS USED ON A REGULAR BASIS. IT IS WELL ESTABLISHED THAT CPAP FAILS THE MAJORITY OF PATIENTS DUE TO COMPLIANCE ISSUES. WHEN COMPLIACE IS FACTORED INTO TREATMENT EFFECTIVENESS ORAL APPLIANCES ARE THE MOST EFFECTIVE AND BEST TREATMENT OF MILD TO MODERATE SLEEP APNEA. ORAL APPLIANCE EFFICACY MUST BE CONFIRMED BY OVERNIGHT POLYSOMNOGRAPHY.

CARDIOLOGISTS ARE RECOGNIZING THAT CPAP TYHERAPY IS INEFFECTIVE IN MOST PATIENTS DUE TO POOR COMPLIANCE.

Sleep. 2004 Aug 1;27(5):934-41.
Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial.

Gotsopoulos H, Kelly JJ, Cistulli PA.
Department of Respiratory & Sleep Medicine, St George Hospital, The University of New South Wales, Sydney Australia.
Comment in:
Sleep. 2004 Aug 1;27(5):842-3.

Abstract

STUDY OBJECTIVE: To investigate the short-term effect (4 weeks) of oral appliance therapy for obstructive sleep apnea on blood pressure.
DESIGN: Randomized, controlled, crossover trial.
SETTING: Multidisciplinary sleep disorders clinic in a university teaching hospital.
PATIENTS: Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography (apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms--daytime sleepiness, snoring, witnessed apneas, fragmented sleep; age > 20 years; and minimum mandibular protrusion of 3 mm).
INTERVENTION: A mandibular advancement splint (MAS) and control oral appliance for 4 weeks each.
MEASUREMENTS AND RESULTS: Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period. Patients showed a 50% reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index. There was a significant reduction with the MAS in mean (+/- SEM) 24-hour diastolic blood pressure (1.8 +/- 0.5 mmHg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. Awake blood-pressure variables were reduced with the MAS by an estimated mean (+/- SEM) of 3.3 +/- 1.1 mmHg for systolic blood pressure (P = .003) and 3.4 +/- 0.9 mmHg for diastolic blood pressure (P < .0001). There was no significant difference in blood pressure measured asleep.
CONCLUSION: Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy

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posted by Dr Shapira at 7:52 PM

WHAT IS THE BEST ORAL APPLIANCE:MAD VS TRD

I AM FREQUENTLY ASKED WHAT IS THE BEST ORAL APPLIANCE. THIS IS A RECENT ARTICLE PUBLISHED IN THE JOURNAL SLEEP.

IT COMPARES TONGUE STABILIZATION WITH MANDIBULAR ADVANCEMENT APPLIANCES.

MANDIBULAR ADVANCEMENT APPPLIANCES HAVE BETTER COMPLIANCE, IE PATIENTS USED THEM MORE. I THINK THAT PATIENTS NEED TO SEE SLEEP APNEA DENTISTS WITH EXPERIENCE WITH MANY TYPES OF APPLIANCE AND WHO UNDERSTAND TMJ DISORDERS AND NEUROMUSCULAR DENTISTRY.

THERE IS NO BEST ORAL APPLIANCE BUT THERE MAY BE A BEST APPLIANCE FOR A SPECIFIC PATIENT AND SPECIFIC SYMPTOMS AN ANATOMY.

Sleep. 2009 May 1;32(5):648-53.
Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial.

Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA.
Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, Australia.
Erratum in:
Sleep. 2009 Aug 1;32(8):table of contents.

Abstract

STUDY OBJECTIVES: To compare the efficacy of a mandibular advancement splint (MAS) and a novel tongue stabilizing device (TSD) in the treatment of obstructive sleep apnea (OSA).
DESIGN: A randomized crossover design was used.
PATIENTS: Twenty-seven patients (20 male, 7 female), recruited from a tertiary hospital sleep clinic.
MEASUREMENTS AND RESULTS: The apnea-hypopnea index (AHI) was reduced with MAS (11.68 +/- 8.94, P = 0.000) and TSD (13.15 +/- 10.77, P = 0.002) compared with baseline (26.96 +/- 17.17). The arousal index decreased for MAS (21.09 +/- 9.27, P = 0.004) and TSD (21.9 +/- 10.56, P = 0.001) compared with baseline (33.23 +/- 16.41). Sixty-eight percent of patients achieved a complete or partial response with MAS, compared with 45% with TSD. The Epworth Sleepiness Scale (ESS) score was decreased with MAS (P = < 0.001) and TSD (P = 0.002). Subjective improvements in snoring and quality of sleep were reported, with a better response for MAS than TSD. Compliance was poorer for TSD, and the side effect profiles of the 2 modalities were different. All patients were satisfied with MAS compared to TSD, and 91% of patients preferred the MAS.
CONCLUSION: Objective testing showed the MAS and TSD had similar efficacy in terms of AHI reduction. Patients reported improvements with both devices; however, better compliance and a clear preference for MAS was apparent when both devices were offered. Longer term studies are needed to clarify the role of TSD

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posted by Dr Shapira at 7:46 PM

Dangerous Consequences of Pediatric Sleep Apnea: Diagnosing and treating sleep apnea is vital to lifetime quality of life.

Question from Sylvia: What are the most common symptoms in children with sleep apnea? Does it affect their brain if left untreated

Dr Shapira Response: Dear Sylvia,
Great Question! There are many short term and long term problems related to sleep apnea. 80% of all ADD and ADHD are related to apnea. There are studies that show both delayed development and permanent changes in brain devlopment.

There are also hormonal (endocrine) changes that affect growth and development.

It is vitally important to children of all ages to iagnose and treat sleep apnea ASAP. Children may never recover from damages that occur in their first few years of life. I have publishe just a few studies below. Recent studies have shown tonsilectomy and adenoid removal may be insufficient treatment and that palatal widening is usually indicated in these patients. Pediatric may be better treated by doing rapid maxillary expansion prior to T&A surgery to create a better post-op healing situation.

It is never to soon to treat sleep apnea. snoring and even minimal apnea AHI of 1 or more should never be ignored but rather taken as an ominus sign of future developmental problems that can be prevented.

I would like to offer my highest recommendation to Dr Alexander Golbin at Sleep and Behavioral Medicine for Chicago area patients. Dr Ira L Shapira

See Pub Med abstracts below:

Pediatr Pulmonol. 2009 May;44(5):417-22.
Neurocognitive and behavioral impact of sleep disordered breathing in children.
Owens JA.

Department of Ambulatory Pediatrics, Rhode Island Hospital, Providence, Rhode Island 02903, USA. owensleep@gmail.com
Abstract
The consequences of poor quality and/or inadequate sleep in children and adolescents have become a major public health concern, and one in which pediatric health care professionals have become increasingly involved. In particular, insufficient and/or fragmented sleep resulting from primary sleep disorders such as obstructive sleep apnea (OSA), often compounded by the presence of comorbid sleep disorders as well as by voluntary sleep curtailment related to lifestyle and environmental factors, has been implicated in a host of negative consequences. These range from metabolic dysfunction and increased cardiovascular morbidity to impairments in mood and academic performance. The following review will focus on what is currently known about the effects of sleep disordered breathing (SDB) specifically on neurobehavioral and neurocognitive function in children. Because of the scarcity of literature on the cognitive and behavioral impact of sleep disorders in infants and very young children, this review will target largely the preschool/school-aged child and adolescent populations. In addition, the focus will be on a review of the most recent literature, as a supplement to several excellent previous reviews on the topic.

Sleep Med. 2010 Aug;11(7):714-20.
Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea.
Kheirandish-Gozal L, Bhattacharjee R, Gozal D.

Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, IL 60637, USA. lgozal@peds.bsd.uchicago.edu
Abstract
The cardiovascular consequences of obstructive sleep apnea syndrome (OSAS) in children have started to emerge over the last decade. It is clear that the respiratory and sleep alterations that characterize this relatively prevalent condition induce substantial alterations in autonomic nervous system control, ultimately generating high sympathetic outflow and reactivity that reflect an imbalance between sympatho-excitatory and vagal inhibitory inputs. In addition to these important consequences, the constitutive elements of OSAS also elicit a rather extensive activation of systemic inflammatory pathways that in turn pose substantial risk to the integrity and functional homeostasis of the endothelial network. The complex interactions between the multiple injury-associated pathways recruited by OSAS are further compounded by the potential release of angiogenic factors and by the mobilization and homing of progenitor cells that have the potential to repair and restore the OSAS-disrupted vascular function. Improved characterization of the mechanisms involved in every one of these processes and identification of the determinants of susceptibility in pediatric populations along with the interactions with obesity will clearly modify our approaches to OSAS in the future.

PMID: 20620107 [PubMed - in process]

Clin Chest Med. 2010 Jun;31(2):221-34.
Pediatric obstructive sleep apnea syndrome.
Katz ES, D'Ambrosio CM.

Division of Respiratory Diseases, Department of Medicine, Children's Hospital, Mailstop 208, 300 Longwood Avenue, Boston, MA 02115, USA. eliot.katz@childrens.harvard.edu
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and serious cause of metabolic, cardiovascular, and neurocognitive morbidity in children. Children with OSAS have increased upper airway resistance during sleep due to a combination of soft tissue hypertrophy, craniofacial dysmorphology, neuromuscular weakness, or obesity. Consequently, children with OSAS encounter a combination of oxidative stress, inflammation, autonomic activation, and disruption of sleep homeostasis. The threshold amount of OSAS associated with adverse consequences varies widely among children, depending on genetic and environmental factors. The choice of therapy is predicated on the etiology, severity, and natural history of the increased upper airway resistance.

PMID: 20488283 [PubMed - in process]

Pediatr Ann. 2008 Jul;37(7):465-70.
The snoring child.
Perez IA, Ward SL.

Keck School of Medicine, University of Southern California, Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, 90027-6062, USA.
Abstract
Snoring is a common manifestation of obstructive sleep apnea and represents one end of the spectrum of sleep-related breathing disorders. Children with primary snoring initially may develop OSAS later, so inquiring about symptoms of OSAS should be part of each visit. Obstructive sleep apnea can result in serious cardiovascular and metabolic consequences and neurocognitive deficits. Adenotonsillar hypertrophy remains the most common cause of OSA although the rising prevalence of obesity is of increasing importance. Polysomnography remains the gold standard in the diagnoses of OSAS and in assessing the risks associated with surgery. Most children with OSAS can be treated with adenotonsillectomy in the ambulatory surgery center. However, there are children at risk for severe OSAS and for postoperative complications, who will need PICU care. In addition to adenotonsillectomy, OSAS can be treated successfully in referral centers with other surgical approaches and by the use of positive airway pressure. Children with obesity-related OSAS often require CPAP or BPAP for control of OSAS.

PMID: 18710136 [PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 7:00 PM

Tuesday, August 17, 2010

SLEEP APNEA AND RISK OF STROKE: CPAP THAT IS NOT USED INCREASES RISKS OF STROKES. ORAL APPLIANCES ARE AN EXCELLENT ALTERNATIVE TO CPAP.

Several articles detailing increased risk of stroke in patients with sleep apnea and worse medical outcomes have recently been published (see PubMed abstracts below).

One article "Worse Outcome after Stroke in Patients with Obstructive Sleep Apnea: An Observational Cohort Study." suggests that patients who have had strokes should be screened for apnea and patients with sleep apnea are at an increased risk of death. "Our findings suggest that patients considered at high risk for ischemic stroke should be screened for OSA, the prevalence of which may be as high as 60%. Those with definitive diagnosis of OSA before stroke are at increased risk of death within the first month after an acute ischemic stroke."

A second article "Is obstructive sleep apnea an independent risk factor for stroke? A critically appraised topic" concluded that "OSA independently contributes to stroke risk."

These articles show both the danger of sleep apnea and emphasize the fact that treatment is very important. It is also known that the majority of patients abandon CPAP. The best treatment for sleep apnea in patients at risk for strokes or with a history of strokes is one that is used nightly. Recent studies have shown the majority of CPAP users abandon CPAP use. I make the case that the best treatment for sleep apnea is one that is used, hopefully all night every night.

Medicare has recognized the fact that the majority of patients do not continue to use CPAP. They have set standards for minimal usage for medicare reimbursement.

If the majority of patients abandon CPAP, what is the best treatment for obstructive sleep apnea.

My opinion, is that oral appliances are the best treatment because a vast majority of patients prefer them to CPAP. Oral appliances are not perfect and do have problems and drawbacks. There is no question that if an oral appliance successfully treats sleep apnea it is a better treatment than a CPAP machine sitting in the closet.

Morbidly obese patients are the patients who will usually find cpap the most effective treatment. Younger thinner healthier patients who do not use CPAP swhould consider oral appliances the best alternative treatment to CPAP.


Expert Rev Neurother. 2010 Aug;10(8):1267-71.
Risk of stroke from sleep apnea in men and women.
Djonlagic I, Malhotra A.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Comment on:

Am J Respir Crit Care Med. 2010 Jul 15;182(2):269-77.
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, and research on the effects of sleep apnea is important to gain insight into how sleep affects health. Untreated OSA has been associated with important health consequences, such as an increased risk for hypertension, cardiovascular disease and diabetes. Previous studies have shown that OSA also represents a risk factor for stroke. The relationship between OSA and stroke is particularly relevant, as stroke is the second leading cause of death globally. The reviewed article presents new data from the Sleep Heart Health Study, a longitudinal cohort study, which shows an association between incident stroke and untreated OSA of varying severity for men and possibly more severe OSA for women. The study is discussed in the context of the current state of knowledge about OSA, in particular its health consequences, and the general limitations in conducting research with OSA patients.

PMID: 20662752 [PubMed - in process]

J Stroke Cerebrovasc Dis. 2010 Jul 24. [Epub ahead of print]
Worse Outcome after Stroke in Patients with Obstructive Sleep Apnea: An Observational Cohort Study.
Mansukhani MP, Bellolio MF, Kolla BP, Enduri S, Somers VK, Stead LG.

Department of Family Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
To evaluate the risk and presence of obstructive sleep apnea (OSA) in patients presenting with acute ischemic stroke, and examine the correlation of OSA with age, sex, ischemic stroke subtype, disability, and death, a prospective cohort study was conducted in all consecutive patients presenting with acute ischemic stroke between June 2007 and March 2008. Exclusion criteria were age <18 years, refusal of consent for the study, and incomplete questionnaire. The Berlin Sleep Questionnaire was used to identify patients at high risk for OSA. A total of 174 patients with acute ischemic stroke were included; 130 (74.7%) had a modified Rankin Scale (mRS) score >/=3 at dismissal, and 11 patients (6.3%) died within 1 month. The Berlin Sleep Questionnaire identified 105 patients (60.4%) at high risk for OSA, along with 7 patients (4%) with a previous diagnosis of OSA. Those with a previous diagnosis of OSA were more likely to die within the first month after stroke (relative risk, 5.3; 95% confidence interval, 1.4-20.1) compared with those without OSA. Patients at high risk for OSA did not demonstrate increased mortality at 30 days (P = 1.0). In multivariate analysis, after adjusting for age and National Institutes of Health Stroke Scale score, previous diagnosis of OSA was an independent predictor of worse functional outcome, that is, worse mRS score at hospital discharge (P = .004). The mRS score was 1.2 points higher (adjusted R(2), 40%) in those with OSA. Our findings suggest that patients considered at high risk for ischemic stroke should be screened for OSA, the prevalence of which may be as high as 60%. Those with definitive diagnosis of OSA before stroke are at increased risk of death within the first month after an acute ischemic stroke.

PMID: 20656506 [PubMed - as supplied by publisher]

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.

Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
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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posted by Dr Shapira at 7:42 PM

CPAP Failure is Common. 60% of Patients Abandon CPAP and Users Average Only 4-5 Hours A Night

The following blog entry is reprint of a JANUARY 2010 press release. I am frequently asked what is the best sleep apnea treatment or what is the best CPAP machine. The best treatment for sleep apnea is not a simple question as it will vary between patients. One thin we no for certain, the best treatment is a treatment that is used. CPAP machines sitting in your closet do not constitute the best treatment. The press release below discusses the fact that the majority of patients do not use their CPAP. CPAP is not the best treatment for those patient. Dr Ira L SHAPIRA (PRESS RELEASE FOLLOWS BELOW)

CPAP is still considered the Gold Standard of treatment even though the majority of patients discontinue use. CPAP failure occurs do to lack of patient compliance not because CPAP is not effective. CPAP is very effective when used all night.

CPAP failures are common and everyone is left frustrated. Patients feel like failures because they are frequently unaware of the fact that up to 60% of patients fail CPAP. Spouses are upset and worried, their loved ones are not only disturbing their sleep with loud snoring but they are also worried about heart attacks and stokes. Patients with untreated sleep apnea have a 36% decrease in 8 year survival compared to treated patients.

Patients with untreated apnea are more likely to die in their sleep than while exercising . They have slower reaction times than someone who is legally drunk and have a sis-fold increase in motor vehicle accidents. The number one reason for CPAP failures is that patients "Hate CPAP!"

Dr Ira Shapira is a pioneer in the field of Dental Sleep Medicine who did research as a visiting assistant professor at Rush Medical School in Chicago in the 1980's. After treating patients with oral appliances for over 25 years he was very excited when the American Academy of Sleep Medicine changed their parameters of care and determined that oral appliances along with CPAP were a first line standard of care for snoring and mild to moderate apnea treatment. The AASM also said that oral appliances were an alternative to CPAP for severe apnea when patients do not tolerate CPAP.

The National Sleep Foundation the declared that "oral Appliances are a Therapy Whose Time has Come!" in SleepMatters their regular magazine.

Dr Shapira who is a Diplomate of The American Board of Dental Sleep Medicine and a member of the AASM, DOSA and the ADSM realized that even though the appliances were extremely effective many patients were still unaware of oral appliances. While more knowledgable sleep physicians were referring patients for oral appliances most patients were unaware of this option. Studies have shown that patients prefer comfortable oral appliances to CPAP when offered a choice. Dr Shapira created the website http://www.ihatecpap.com because "i HATE CPAP!" was the number one statement he heard from patients over the years when he asked why they wanted an oral appliance.

The website is extremely popular with over 10,000 individual visits a month. Thousands of patients have found out about oral appliances at the area of the site (http://www.ihatecpap.com/oral_appliance.html) on oral appliances which has photos of many appliances.

The I HATE CPAP! website has been so successful that Dr Shapira has now created a new site http://www.ihateheadaches.org that helps patients with migraines, chronic daily headaches, sinus headaches and tension headaches find help thru Neuromuscular Dentistry.

The NHLBI considers Sleep Apnea to be a TMJ disorder and published a report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" In their report they state " About 60-90% of cases appear to experience satisfactory resolution of symptoms with a range of interventions" This is actually better results than almost any drug regiment for treating migraines or chronic daily headaches.

Dr Barry Cooper published a paper in Cranio that describes "overwhelming relief" of TMJ symptoms and headaches after treatment with a neuromuscular dental orthotic. The I HATE Headaches! website offers help to patients tired of living in pain. TMJ disorders are often called "The Great Imposter" because there are so many symptoms such as headaches and migraines that patients do not associate with bite problems or their jaws.

An excellent resource for patients with TMJ disorders or headaches is a story in Sleep and Health Journal "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" which can be found at http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor.
"

# # #

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH. He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA, the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management. He is a former assistant professor at Rush Medical School's Sleep Service where he did research. Dr Shapira is a consultant to sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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posted by Dr Shapira at 7:30 PM

Monday, August 16, 2010

Pregnancy and Snoring

A new study released information also showing that snoring while pregnant can lead to future health issues between both the mother and the baby. By having a sleep apnea evaluation performed by Dr. Ira Shapira in Gurnee Illinois, you can make sure you put a stop to your snoring and sleep apnea so you and your baby get the sleep you need.

The study was performed on 189 healthy women who were observed and surveyed both early in their pregnancy, when they enrolled, and in their third trimester. The results showed that women who snore at least 3 nights per week had 14.3% chance of developing gestational diabetes. Women who did not snore this often only had a 3% chance of developing the disease.

Gestational diabetes is a form of diabetes that develops in 1% to 3% of pregnant women, and it affects their ability to process sugar. The results of having gestational diabetes include an increased risk of complications and health problems with the baby at birth.

Doctors believe that pregnant women develop serious snoring problems and sleep apnea because the increased weight gained by the pregnant body can lead to airway resistance. An experienced sleep dentist can help determine what the best sleep apnea treatment is for you.

If you or your sleep partner is pregnant and snoring at least 3 times per week, you should contact sleep apnea dentist Dr. Ira Shapira in Gurnee, Illinois to schedule a sleep evaluation.

posted by Lynn at 6:19 AM

Friday, August 13, 2010

THE BEST SLEEP APNEA TREATMENT: CPAP vs ORAL APPLIANCES. A QUESTION OF COMPLIANCE AND EFFECTIVENESS.

This is a reprint from a recent press release. The time where CPAP is considered the only treatment is already behind the curve. Current realities show that compliance issues favor oral appliances over CPAP for 60% of patients who abandon CPAP use. What is the best treatment for sleep apnea? Is CPAP the best treatment for sleep apnea or are oral appliances the best treatment for sleep apnea. Compliance is the real issue for what is the best treatment.

THE BEST SLEEP APNEA TREATMENT: CPAP vs ORAL APPLIANCES. A QUESTION OF COMPLIANCE AND EFFECTIVENESS. Young thinner healthier patients are often better served with oral appliances due to comfort.

CPAP is considered the Gold Standard for sleep apnea treatment but poor compliance issues with CPAP often make Oral Appliances the best sleep apnea treatment. For Morbidly Obese patients CPAP is Best

FOR IMMEDIATE RELEASE
(Free-Press-Release.com) August 13, 2010 -- What is the best sleep apnea treatment? It is not CPAP according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be it is poor treatment if it is not used. Oral Appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for morbidly obese patients and those with severe sleep apnea.

Oral appliances are the "Best Sleep Apnea Treatment" because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and Dental Sleep Medicine is http://www.ihatecpap.com

Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis.

CPAP is the "BEST TREATMENT" for the 25% of patients who love their CPAP, and use it all night, every night.

Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.

Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance elminates apnea based on a sleep study it is equivlant to CPAP. The issue of compliance almost always favors oral appliances but objective monitor for appliance use are not yet available.

The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.

Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to "NO TREATMENT" .

CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.

There are patients who are severe and/or morbidly obese and the "Best Treatment" is actually combination treatment of an Oral Appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.

The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from Airway Management.

Cleanliness is of major importance with both CPAP and Oral Appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease.

Information on oral appliances is available at http://www.ihatecpap.com

Dr Shapira is a Diplomate of the American Board of Dental Sleep Medicine and offers Oral Appliances to Chicago area patients at his offices in Gurnee, Skokie and Schaumburg. Call today 1-8-NO-PAP-MASK

More information can be found online at http://HTTP://WWW.IHATECPAP.COM

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posted by Dr Shapira at 9:01 PM

Blog on problems with sleep apnea treatment.

Dr Shapira: Dear Angie: I understand your concerns about your sleep apnea treatment. I have been treating sleep apnea with oral appliances since 1982 and have been an Asst Professor at Rush Medical School and teach courses to Dentists learning about sleep apnea. I do not know if you are a good candidate for oral appliance therapy without an exam and review of your sleep study.

Oral appliances are very successful in treating mild to moderate sleep apnea and are frequently successful with severe sleep apnea. It is possible to have bite changes and/or tooth movement but it is rarely a serious problem.

Weekend courses are limiting especially because many are from appliance manufacturers primarily wanting to sell their appliance. Having multiple appliances is essential to treat different types of problems. I always do a full year of follow-up with doctors who take my course because a weekend course is insufficient.

Sleep Apnea is a TMJ disorder according to the NHLBI (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf)

The AASM and AADSM recommend that dentists treating sleep apnea should be knowledable in treating TMJ disorders. It is a relatively small percentage of patients who experience problems usually from to rapid of an advancement of the mandible or poor appliance design.


Christy: Hello Angie I understand your concerns. I am forwarding this email to Dr. Shapira. He has been successfully treating sleep apnea and TMJ disorders over 25 years. He can best address your concerns.
I hope you are able to find a dental sleep specialist in your area but if not we would be happy to have you come to our office to be treated. We see many people for all around the country with similar problems.
Keep Smiling
Christy

Angie: Your reply is appreciated, but I did find this one on my own a while ago. I just didn't know how legitimate he is in including clenching and TMJ problems into his appliance. That concern comes from me going to xxxxxxxxx to another dentist (Dr. xxxxxxx) and it was a waste of my time because, although he claims to help with apnea and snoring, his appliance will not. He seems to be a regular dentist who took a couple of weekend seminars in Chicago and now tries to claim he can treat apnea. That's where my mistrust comes from.
Also, I'm hearing from the forums that these appliances eventually cause teeth problems and pain, so now I'm really confused. Any thoughts?


ANGiE: I am TIRED of clicking all over the internet and getting bounced around... can someone PLEASE narrow my search!

I live in XXXXXXXXXXX,XX and I've been to dentist in xxxxxxxx... can't help me. I have TMJ, clench teeth all day and I really do HATE my CPAP machine. I am MISERABLE in every way and tired ALL the time!

Please, help me focus on where to look. It will cost a LOT to get the appliance, drive to either St. Louis or Kansas City (how many times back 'n forth?) or stay overnight to get all work done... I feel SO hopeless. Can you make this less complicated?

posted by Dr Shapira at 9:46 AM

Wednesday, August 11, 2010

Some Truckers Being Tested for Sleep Apnea

Trucking companies have a fairly high number of overweight people driving trucks (partly due to the sedentary nature of the job), and with more people becoming aware of the dangers of sleep apnea, some trucking companies are beginning to screen drivers for sleep apnea.

Since sleep apnea develops in seriously overweight people, trucking companies are beginning to treat drivers that may be suffering from the sleep problem. People who suffer from sleep apnea often suffer from sleep apnea symptoms like being tired during the day and not being able to make it through the day without a nap.

This can be dangerous for people whose occupation involves driving a multi-ton commercial truck. Drivers are federally regulated and are not supposed to drive more than 11 hours without a 10 hour break (for the most part), but this might not be enough for victims of sleep apnea.

Trucking companies believe that by identifying drivers with sleep apnea and treating the problem, they may be able to cut down on truck accidents. If a driver is falling asleep at the wheel because they are suffering from sleep apnea at night, it poses a serious danger on the road.

If you would like to find out if you or your sleeping partner is suffering from sleep apnea, please contact sleep apnea dentist, Dr. Ira Shapira in Gurnee Illinois to schedule a complete sleep apnea evaluation.

posted by Lynn at 6:25 AM

Monday, August 2, 2010

Tired Drivers Due to Sleep Apnea

According to an article just published today by Reuters Health, people who suffer from sleep apnea are likely to be less alert while driving and may be more vulnerable to the effects of alcohol than those who don’t suffer from this breathing disorder. Untreated sleep apnea can be very dangerous and a serious health risk.

Sleep apnea occurs when you stop breathing while sleeping. People with sleep apnea may stop breathing for several seconds several hundred times a night. Obstructive sleep apnea (OSA) affects millions of Americans and is characterized by a temporary collapse of the tissues in the back of the throat during sleep, causing you to stop breathing for brief periods of time. Untreated sleep apnea may lead to:

• High blood pressure
• Heart attack
• Depression
• Anxiety
• Diabetes
• Fatigue
• Stroke
• Mood swings
• Memory problems

According to statistics, OSA may be a factor in as many as 1,400 traffic fatalities annually in the United States. The study found that drivers suffering from sleep apnea had more difficulty staying in their lane and were more likely to crash during a simulated virtual road trip than drivers without OSA.

If you live in the Gurnee, Illinois area and feel you or your partner may suffer from sleep apnea, Dr. Ira Shapira, sleep apnea specialist, will meet with you and perform a complete evaluation. There are many viable sleep apnea treatment options available today, and Dr. Shapira can certainly help you just as he has helped thousands of others suffering from this dangerous disorder.

posted by Lynn at 7:16 AM