Thursday, June 30, 2011

Exercise Alone Can Reduce Sleep Apnea

According to a recent study, exercise alone can make a significant positive impact on sleep apnea. Currently, behavioral therapy for sleep apnea approaches stress exercise along with diet and other behavioral changes as part of a combination therapy for treating obstructive sleep apnea.

The study showed that when patients began an exercise program that combined brisk walking with weight training, they cut their sleep apnea by 25%. They were assessed using a polysomnography. Study participants went from 32 apneic events per hour to 25 apneic events.

The population used for the study were 43 sedentary adults. Researchers noted that the increase in exercise and decline in sleep apnea events occurred without any corresponding weight loss, and that, typically, a 10% weight loss (e.g. 20 pounds in a 200-pound individual) would be necessary to achieve the same results.

The study showed that people who are suffering from sleep apnea can see positive benefit simply from starting an exercise program, independent of weight loss. However, researchers noted that people should not see a moderate exercise program as an alternative to other forms of sleep apnea treatment, such as CPAP or oral appliance therapy. Instead, people should talk to their doctors about an appropriate level of exercise at the same time they discuss their sleep apnea.

If you are suffering from sleep apnea and would like to learn more about your treatment alternatives, please contact a local sleep dentist today.

Sleep Apnea May Increase Risk of Adverse Pregnancy Outcomes

Research presented at the American Academy of Sleep Medicine's 2011 conference earlier this week suggest that women with sleep apnea are at the highest risk of having an adverse outcome to a pregnancy. However, researchers noted that their data was not able to distinguish whether obstructive sleep apnea or obesity was the primary risk factor contributing to adverse outcomes, which were led by gestational diabetes and preterm birth.

Gestational diabetes has been independently associated with maternal obesity. Preterm birth has also been independently associated with preterm birth, neonatal delivery, and low birth weight. In the population considered for this study, 87% of the women who had obstructive sleep apnea during pregnancy were also obese, making it a significant confounding factor.

Many women who do not normally suffer from obstructive sleep apnea may acquire it during pregnancy as a result of weight gain. It can become especially pronounced during the third trimester, when women's weight gain is at its greatest. Women who suspect they may suffer from sleep apnea prior to pregnancy are encouraged to be evaluated and receive sleep apnea treatment to lessen the potential impact of sleep apnea on their pregnancy.

If you would like to learn more about sleep apnea treatment options, please contact a local sleep dentist today.

Get Tested for Sleep Apnea When Awake

New Research suggests that you may not have to get a sleep test to determine whether you suffer from obstructive sleep apnea. Instead, an analysis of your waking breathing may be able to determine your risk, and whether you are likely to suffer from mild, moderate, or severe sleep apnea.

The preliminary research was reported at the 2011 SLEEP conference, but suggests that several audible features of daytime breathing were significantly different between OSA and non-OSA subjects. Using just two of the most significant sound features, researchers stated they were able to predict the presence or absence of OSA with an 84% accuracy.

Researchers explained that the reason these breathing features were so significant was that OSA sufferers tend to have a narrower and more collapsible pharynx with more negative pharyngeal pressure. This gives greater resistance when a person breathes through his or her nose, creating distinctive sound features.

Subjects were asked to breathe through their nose normally for five breaths, then breathe through their nose at maximum volume for five breaths. They repeated the normal and maximum breathing through their mouth with a nose clip in place. This was done in upright and supine positions. Sounds were recorded using a microphone attached to the patients' neck, then analyzed using digital techniques. Finally, subjects were given a full night polysomnogram to determine whether they actually suffered from obstructive sleep apnea and their degree of apnea.

If this actually does prove to be a successful test for obstructive sleep apnea, it can save millions of dollars, not to mention the inconvenience associated with polysomnography.

However, if you suspect you might be suffering from obstructive sleep apnea, it is crucial that you not wait for new testing methods, but instead get tested and begin treatment today to protect your health and your life from this potentially deadly condition. To learn more, please contact a local sleep dentist today.

Friday, June 24, 2011

How Corticosteroids Treat Childhood OSA

Although the largest portion of obstructive sleep apnea sufferers are adult males age 50 or over, childhood obstructive sleep apnea (OSA) is a serious problem. Childhood sleep apnea can result in behavior problems, school difficulties, and serious health consequences for its victims. Unfortunately, treatment of the condition can be difficult, and the preferred first line of treatment, surgery, is not as effective as doctors would like. Some studies estimate the effectiveness of surgical treatment to be as low as 50%. When you add in the risk of surgical complications, it seems that a nonsurgical treatment option may be a better front-line treatment.

Fortunately, one alternative sleep apnea treatment is the use of nasal corticosteroids. The most commonly studied steroid is fluticasone, which has shown reasonable success. In one study, children receiving nasal steroids saw a reduction of arousals due to apneic events of 3.5/hr. In addition, less than half of children treated with nasal steroids went on to have surgery, compared to three-quarters of children treated with placebo.

In the most recent study, researchers looked at the mechanism that allows the corticosteroid to treat sleep apnea. They found that corticosteroids significantly decreased the amount of cytokine IL-6, which has been associated with cardiovascular risk and death. Although the study is brief and involved only a small number of children, it does point to an important treatment option for childhood OSA sufferers.

If your child is having trouble in school or suffers from behavior problems, you should consider the possibility of childhood obesity among other potential causes. To learn more about how to get the best treatment for childhood sleep apnea, please contact a local sleep dentist today.

Monday, June 20, 2011

Researchers Recommend Sleep Apnea Screening before Bariatric Surgery

People who are classified as morbidly obese often seek bariatric surgery to reduce their risks of serious health outcomes such as heart disease and cardiovascular-related death. Unfortunately, morbidly obese people are also at an elevated risk for obstructive sleep apnea, and obstructive sleep apnea sufferers are an increased risk for many surgical complications, including anesthesia-related death. In order to increase the safety and effectiveness of bariatric surgery, one team of researchers from the American Society of Metabolic and Bariatric Surgery recommends that all bariatric surgery candidates be assessed for sleep apnea prior to undergoing surgery.

This recommendation is strengthened by a recent study that showed 86% of bariatric surgery candidates evaluated actually suffered from obstructive sleep apnea. The results showed that 18% had mild, 17% had moderate, and 51% had severe obstructive sleep apnea. Studies have shown that sleep apnea sufferers may have 2-3 times the risk of serious complications compared to non-sufferers. Since bariatric surgery already has a mortality risk of up to 0.6%, anything that can be done to reduce the risk of complications seems to be consistent with the ideal of best practices.

However, many bariatric surgeons (and patients) are resistant to the idea of using a sleep study prior to bariatric surgery. A sleep study conducted as an on-site polysomnography can be inconvenient, time-consuming, and expensive. Instead, they tend to rely on questionnaires, such as the STOP-BANG screening tool when considering whether to refer patients to a full sleep study. Although these screening tools are useful, they are only part of the solution.

If you are considering any serious surgery, you should talk to your doctor about sleep apnea and sleep apnea treatment. If you are looking for a comfortable sleep apnea treatment and alternative to CPAP, please contact a local sleep dentist today.

Wednesday, June 15, 2011

Adherence to CPAP Improves Quality of Life, Oral Appliances are as Effective as CPAP but show Higher Compliance.

A recent study in Sleep and Breathing Journal,"Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients"showed significant improvement in patients who used CPAP for 6 months.

A more careful look at the study also shows the major problem with CPAP.

This study looked at 50 patients, 41 men and 9 women who were "compliant" with CPAP usage. This means that they wore CPAP an average of 4-5 hours/night. It is well established that 7-7.5 hours/night is ideal CPAP usage. Standardized tests showed subjective improvement in quality of life but a large group of patients still reported "excessive fatigue" (54.5%), and "decreased energy" (55.3%).

The real danger to using CPAP for 4-5 hours a night is the risk of cardiovascular events including heart attack and stroke. Patients with untreated sleep apnea have an enormous and dangerous increased risk of myocardial infarction and cerebral vascular accidents in the early morning hours, usually between 3 and 5 AM. Patient who wear CPAP for only 4-5 hours are no longer utilizing it during the hours of greatest risk!

The danger of unacceptably low CPAP use (4-5 hours /night) was well documented by an article in Sleep (2011 Jan 1;34(1):105-10.) "Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited."

The article concludes "Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI." Clearly stating 4-5 hour compliance is a poor measure of success.

Compare this information to a recent article in Chest (2011 Jun 2) "Efficacy of An Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure For the Treatment of Obstructive Sleep Apnea Syndrome." Where they found high effectiveness of Oral Appliances. Oral Appliances are utilized by most patients for the entire night.

Sleep Breath. 2011 Jun 11. [Epub ahead of print]
Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients.
Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas CI, Behrakis P.

Sleep Laboratory, Henry Dunant Hospital, Athens, Greece.

The aim of the study was to asses quality of life and symptoms of obstructive sleep apnea syndrome (OSAS) patients after adhering to 6 months of continuous positive airway pressure (CPAP) treatment.

A group of 50 patients (41 men and 9 women) were diagnosed by polysomnography and treated with CPAP therapy for 6 months. Their symptoms and health-related quality of life were assessed by administering a validated and translated version of the sleep apnea quality of life index (SAQLI). Sleepiness was measured using the Epworth Sleepiness Scale (ESS) and through electronic monitoring of CPAP usage per night of sleep.

Mean CPAP usage was 4.5 ± 0.5 h per night. Comparisons between quality of life indexes before and after CPAP treatment showed an improvement in the total SAQLI score (3.8 ± 0.9 vs. 5.8 ± 0.8 after CPAP, p < 0.01), in daily functioning (4.2 ± 1.4 vs. 6.0 ± 0.9, p < 0.01), social interactions (4.8 ± 1.3 vs.6.3 ± 0.7, p < 0.01), emotional functioning (4.4 ± 1.4 vs. 5.7 ± 1.0, p < 0.01), symptoms (1.6 ± 0.8 vs. 5.8 ± 1.2, p < 0.01), and in the ESS (13.7 ± 6.5 vs. 3.9 ± 3.8, p < 0.01). Regarding the patients' symptoms, improvement was noticed for "sleepiness while watching a spectacle" (96%), "reading" (95%), "carrying on a conversation" (95%), "driving" (92.9%), "restless sleep" (87.8%), and "urinating more than once per night" (84.8%). Smaller improvements were observed for the reported "dry mouth-throat upon awakening" (36.1%),"excessive fatigue" (54.5%), and "decreased energy" (55.3%).

We conclude that OSAS patients who adhere to nighttime CPAP therapy show significant improvement of their quality of life, daytime sleepiness, and other symptoms after 6 months of treatment with CPAP. The article explains mathematically the problems of considering 4-5 hours as "success. "The more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0-5, respectively). The required nightly percentage use rises as one reduces the AHI target to < 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP). By using these definitions most CPAP usage of 4-5 hours a night is actually only partial treatment leaving the patient at risk.

Sleep. 2011 Jan 1;34(1):105-10.
Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited.
Ravesloot MJ, de Vries N.

Sint Lucas Andreas Ziekenhuis, Department of Otolaryngology/Head Neck Surgery, Amsterdam, the Netherlands.

Various treatment methods exist to treat obstructive sleep apnea (OSA); continuous positive airway pressure (CPAP) is considered the gold standard. It is however a clinical reality that the use of CPAP is often cumbersome. CPAP treatment is considered compliant when used ≥ 4 h per night as an average over all nights observed. Surgery, on the other hand, is regarded as successful when the apnea hypopnea index (AHI) drops at least 50% and is reduced below 20/h postoperatively in patients whose preoperative AHI was > 20/h. The effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned.

The aim of the study was to compare non optimal use of optimal therapy (CPAP) with the continuous effect (100%) of often non optimal therapy (surgery).

Using mathematical function formulas, the effect on the AHI of various treatment modalities and their respective compliance and success criteria were calculated.

The more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0-5, respectively). The required nightly percentage use rises as one reduces the AHI target to < 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP).

Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.

[PubMed - indexed for MEDLINE]
PMCID: PMC3001787
[Available on 2011/7/1]

Chest. 2011 Jun 2. [Epub ahead of print]
Efficacy of An Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure For the Treatment of Obstructive Sleep Apnea Syndrome.
Holley AB, Lettieri CJ, Shah AA.

Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center.

We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, and provide a comparison to CPAP.

Retrospective analysis of patients prescribed an aOA. Results of overnight, PSG with aOA titration were evaluated and compared to CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.

A total of 497 patients were prescribed an aOA during the specified time period. The aOA reduced the mean AHI to 8.4±11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI<5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score (ESS) by 2.71 (95% CI: 2.3-3.2; p<0.001) at follow-up. CPAP improved the AHI by - 3.43 (95% CI: 1.88-4.99; p<0.001) when compared to an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (-5.88 (95% CI: -8.95 - -2.82; p<0.001)). However, 70.1% of all patients achieved an AHI < 5using CPAP, compared to 51.6% for the aOA (p<0.001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.

In comparison to past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, while CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.