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.
Showing posts with label sleep apnea treatment. Show all posts
Showing posts with label sleep apnea treatment. Show all posts
Tuesday, December 13, 2016
Oral appliance treatment amazing according to sleep apnea patient
Mike describes how he was diagnosed with sleep apnea. He was less than thrilled with diagnosis and definitely did not want CPAP. He travels a lot and CPAP would be a problem. Besidesmhe definitely did not want CPAP and wanted a Comfortable CPAP Alternative.
He cam to see Dr Shapira and received an oral appliance that he considers amazing therapy. He responded wonderfully to the oral appliance. Everything about the entire experience was wonderful and Dr Shapira's team is amazing.
Watch the Video:
https://www.youtube.com/watch?v=xYjNUxwwIOY
Skleep Apnea Treatment with Oral Appliance is Amazing!
Visit Dr Shapira's website to learn more:
Highland Park: www.ThinkBetterLife.com
Gurnee: www.DelanyDentalCare.com
North Shore www.NorthShoreSleepDentist.com
Hate CPAP? www.IHateCPAP
Hate Headaches? www.IHateHeadaches.org
Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org
https://www.youtube.com/watch?v=xYjNUxwwIOY
Sunday, December 4, 2011
Sleep Apnea Diagnosis Can Make Health And Life Insurance Extremely Expensive. Insurance Agents Have Experienced Problems Insuring Clients
Sleep Apnea Diagnosis Can Make Health And Life Insurance Extremely Expensive. Insurance Agents Have Experienced Problems Insuring Clients Diagnosed With Sleep Apnea.
Patients who are interested in off the grid sleep studies can contact Dr Ira L Shapira, a Gurnee, Il dentist who has been treating Sleep Apnea with oral appliances since the early 1980’s. As a Visiting Assistant Professor at Rush Medical Schools Sleep Center he did research on jaw position and Sleep Apnea.
http://www.delanydentalcare.com/sleep_apnea.html
Monday, May 23, 2011
Can the Brain Learn to Overcome Sleep Apnea?
New research from the University of Toronto shows that the brain might be more plastic than previously suspected, a quality that will help it overcome the damage inflicted by sleep apnea. The study, published in the December 2010 issue of The Journal of Neuroscience, studied the body's ability to lay down an adaptive respiratory memory.
Researchers studied long-term facilitation of breathing in response to repeated apneic and hypopneic events. In response to these types of events, the body lays down a respiratory memory that that strengthens the ability of respiratory motoneurons to trigger contraction of breathing muscles. In particular, the researchers looked at the effect obstructive sleep apnea had on a number of motoneurons in test rats. In studied rats, the breathing interruptions strengthened muscle tone in the tongue and the muscle that supports it from the chin. Interestingly, this stimulation did not affect the nerves controlling the diaphragm.
This research may help find a drug treatment that can support current forms of sleep apnea treatment. However, the treatment may not be successful if it is not coupled with appropriate positioning of the lower jaw, which supports the tongue. This repositioning of the lower jaw can be accomplished with an oral appliance. With support from a new drug treatment, oral appliance therapy may become the frontline treatment for obstructive sleep apnea even for severe cases. However, since this feedback channel does not stimulate the diaphragm, it may not be a good treatment avenue for central sleep apnea.
To learn more about the sleep apnea treatment options available, please contact a local sleep dentist today.
Tuesday, May 3, 2011
Trucking Industry Takes Initiative in Sleep Apnea Diagnosis and Treatment
On a number of occasions, we have discussed the dangers obstructive sleep apnea poses for truck drivers and those who share the highways with them. We have discussed the decision some trucking companies have made to begin screening drivers, the FMCSA's potential rules on sleep apnea, and the challenge these rules present for dental appliance users.
Sleep apnea testing is not yet required for commercial truck drivers. However, a number of trucking companies have established their own sleep apnea testing and treatment plans. These trucking companies have been working with private contractors to identify drivers who are at risk for sleep apnea and get them tested. Once sleep apnea sufferers are identified, they are matched up with appropriate sleep apnea treatment to reduce their risk of daytime sleepiness.
There are a number of motivators behind the trucking companies' actions. Truck accidents are expensive for trucking companies. And, as lawyers have pointed out, once truck companies are aware of a risk, they have a responsibility to prevent it, something that may become the basis for truck accident lawsuits in the future. Even if an apneic trucker is not involved in an accident, the trucking company may face serious expense due to the numerous health conditions that are associated with sleep apnea and will be covered under company health insurance.
As trucking companies move ahead of FMCSA regulations, it is hoped that they move to embrace all sleep apnea treatment options.
To learn more about all the successful sleep apnea treatment options available, please contact a local sleep dentist today.
Monday, March 21, 2011
Share Your Successful Sleep Apnea Treatment Story
Unfortunately for them, about 80% of obstructive sleep apnea sufferers are undiagnosed. This means that they are unaware of their increased risk for dangers of sleep apnea, including their overall sixfold increased risk of "all-cause mortality," death by any cause, from car accidents to heart attacks and stroke. To reduce their risks of these serious health consequences, people need to understand what sleep apnea is and how its seemingly-innocuous symptoms can be a sign of a life-threatening condition.
If you are a current or previous sleep apnea sufferer, you can help those around you who are suffering from undiagnosed sleep apnea by talking to them about your experience. Talk about risk factors and make sure people understand when they should be tested. Talk about your symptoms, and talk about how you got your diagnosis. Talk about the treatment options you tried, the ones that worked and the ones that didn't.
Finally, talk about how much of a difference treatment has made in your life. Most sleep apnea sufferers live under a low-energy cloud. They may suffer from a lack of motivation, may suffer depression or a loss of enjoyment in life's activities. Their personal and professional relationships may suffer. Sometimes their undiagnosed condition may make it seem like there is no hope, but if talk to them about your story, you can show them that there is hope, that there is a way to turn their lives around.
Sleep dentists are dedicated to helping sleep apnea patients learn about their condition and the full range of treatment options available. To get treatment for sleep apnea or to share your successful treatment story, please contact a local sleep dentist today.
Monday, March 14, 2011
Incomplete Resolution of Sleep Apnea Can Be Corrected With Tongue Tapper
I recently had a request from a Dentist about how the Tongue Tapper works. It is something that I add to an oral appliance on occasion when incomplete resolution of sleep apnea is a problem.
Don: Dr.S, In one of the recent AADSM forum discussions you mentioned a tongue tapper to help with tongue reflexes. Can you share how you do that with a MAD? Thank.
Dr Shapira Response:I use a 1 mm ortho spring wire from either the lower or upper appliance with a small composite or acrylic button that very lightly touches the posterior lateral surface of the tongue. If the tongue drops back and touches it elicits a protrusive reflex of the tongue.
Light touch not brute force similar to how tonsils cause tongue thrusts.
THERE ARE MANY ORAL AND PHARYNGEAL REFLEXES THAT CAN EFFECT BREATHING IN SLEEP. THE TONGUE TAPPER TAKES ADVANTAGE OF ONE OF THESE REFLEXES TO CREATE TONGUE PROTRUSION. ONE OF THE REASONS I LIKE THE TAP 1 APPLIANCE IS THAT IT ELIMINATES OR DECREASES RETRUSIVE TONGUE REFLEXES.
tHE MOSES APPLIANCE IS DESIGNED TO PREVENT RETRUSIVE REFLEXES AS WELL.
Don: Dr.S, In one of the recent AADSM forum discussions you mentioned a tongue tapper to help with tongue reflexes. Can you share how you do that with a MAD? Thank.
Dr Shapira Response:I use a 1 mm ortho spring wire from either the lower or upper appliance with a small composite or acrylic button that very lightly touches the posterior lateral surface of the tongue. If the tongue drops back and touches it elicits a protrusive reflex of the tongue.
Light touch not brute force similar to how tonsils cause tongue thrusts.
THERE ARE MANY ORAL AND PHARYNGEAL REFLEXES THAT CAN EFFECT BREATHING IN SLEEP. THE TONGUE TAPPER TAKES ADVANTAGE OF ONE OF THESE REFLEXES TO CREATE TONGUE PROTRUSION. ONE OF THE REASONS I LIKE THE TAP 1 APPLIANCE IS THAT IT ELIMINATES OR DECREASES RETRUSIVE TONGUE REFLEXES.
tHE MOSES APPLIANCE IS DESIGNED TO PREVENT RETRUSIVE REFLEXES AS WELL.
Saturday, March 5, 2011
Wisconsin Sleep Apnea Treatment: Oral Appliances are a comfortable alternative to CPAP, BiPAP or A-PAP
Treatment of sleep apnea is vital to the health and welfare of patients diagnosed with sleep apnea. CPAP treatment was once the only treatment offered to most patient. This is no longer the case. Dental Sleep Medicine ofers comfortable oral appliances as a comfortable alternative to CPAP.
Most sleep physicians follow the AASM guidline and offer oral appliance therapy as a treatment choice. Some sleep physicians have not kept up with the research and are not aware that recent studies have shown that properly titrated cpap oral appliances can be as effective as cpa.
60% of all patients who try cpap cannot tolerate and discontinue treatment while 90-95% of patients are successful with oral appliance therapy. The majority of patients offered a choice prefer oral appliance therapy to cpap and most insurance companies now cover oral appliance therapy.
Coverage of sleep apnea treatment saves insurance companies money by reducing heart attacks and strokes, hypertension, aiding in diabetes treatment and reducing motor vehicle and work-place accidents.
Employers have found that employees who have had effective sleep apnea treatment have higher output, lower medical expenses, and fewer workplace accidents and worker compensation claims.
Some sleep physicians continue to bad mouth oral appliance out of ignorance or due to bad experiences with untrained dentists providing poor quality treatment in the past.
Many dentists do not understand the importance of follow-up polysomnography in all patients. Failure to follow proper protocols can put patients at risk.
Other physicians have financial intrests in DME companies and are loathe to lose the income sales of cpap and cpap supplies generate.
I provide Dental Sleep Medicine treatment with oral appliances to patiens in Southeast Wisconsin including Lake Geneva, Kenosha, Racine and Milwaukee. I am certified in Dental Sleep Medicine and a Diplomate of the American Board of Dental Sleep Medicine. I am a former Asistant Professor at Rush Medicak Schools sleep center and have over 25 years successfully treating sleep apnea with oral appliances.
Most sleep physicians follow the AASM guidline and offer oral appliance therapy as a treatment choice. Some sleep physicians have not kept up with the research and are not aware that recent studies have shown that properly titrated cpap oral appliances can be as effective as cpa.
60% of all patients who try cpap cannot tolerate and discontinue treatment while 90-95% of patients are successful with oral appliance therapy. The majority of patients offered a choice prefer oral appliance therapy to cpap and most insurance companies now cover oral appliance therapy.
Coverage of sleep apnea treatment saves insurance companies money by reducing heart attacks and strokes, hypertension, aiding in diabetes treatment and reducing motor vehicle and work-place accidents.
Employers have found that employees who have had effective sleep apnea treatment have higher output, lower medical expenses, and fewer workplace accidents and worker compensation claims.
Some sleep physicians continue to bad mouth oral appliance out of ignorance or due to bad experiences with untrained dentists providing poor quality treatment in the past.
Many dentists do not understand the importance of follow-up polysomnography in all patients. Failure to follow proper protocols can put patients at risk.
Other physicians have financial intrests in DME companies and are loathe to lose the income sales of cpap and cpap supplies generate.
I provide Dental Sleep Medicine treatment with oral appliances to patiens in Southeast Wisconsin including Lake Geneva, Kenosha, Racine and Milwaukee. I am certified in Dental Sleep Medicine and a Diplomate of the American Board of Dental Sleep Medicine. I am a former Asistant Professor at Rush Medicak Schools sleep center and have over 25 years successfully treating sleep apnea with oral appliances.
Friday, January 28, 2011
Cardiologists embrace oral appliances as an alternative treatment to CPAP for sleep apnea
Cardiologists have long recognized that sleep apnea is a leading cause of hypertension (high blood pressure), heart attacks and strokes. Cardiologists have referred patients for sleep studies and CPAP therapy for years. Cardiologists have become disillusioned by the poor compliance with CPAP that has been documented in patients with sleep apnea. The majority of patients with mild apnea as well as moderate and severe sleep apnea reject CPAP in large numbers. A recent study showed 60% of patients abandon CPAP therapy.
Cardiologists who are proponents of sleep apnea treatment are referring more and more patients for oral appliance therapy as an alternative to CPAP. They recognize that CPAP therapy is worthless if it is not used. Oral appliances are considered a first line treatment for mild to moderate sleep apnea. Oral appliance therapy is also an alternative to CPAP for severe sleep apnea when patients do not toleratte CPAP.
THE MAJORITY OF PATIENTS DO NOT TOLERATE CPAP!!! MEDICARE IS NO LONGER COVERING CPAP THERAPY FOR PATIENTS WHO DO NOT USE CPAP ON A REGULAR BASIS. MOST PATIENTS DO NOT USE CPAP ON A REGULAR BASIS.
Cardiologists are more comfortable referring patients for CPAP but have come to realize that patients are much more compliant with oral applainces than CPAP.
This means that patients use their oral appliances to treat their sleep apnea. Cardiologists know this is vital to their patients health. While CPAP may be more effective for some patients it is a total treatment failure for those patients who do not use their CPAP.
In addition to heart attacks and stroke untreated sleep apnea can also cause short term memory loss, lead to drammatic increases n motor vehicle accidents because patients with untreated sleep apnea have slower reaction times than patients who are legally intoxicated. Untreated sleep apnea can increase severity and speed of onset of Alzheimer's and Dementia, is implicated in up to 80% of ADD and ADHD in children, can increase the severity of metabolic problems from diabetes to obesity.
The National Sleep Foundation has declared that oral appliances are a therapy whose time has come!
The American Academy of Sleep Medicine considers oral appliances to be a first line treatment for mild to moderate sleep apnea.
The American Academy of Dental Sleep Medicine has published reports on the success of treating severe sleep apnea with comfortable oral appliances.
MORBIDLY OBESE PATIENTS SHOULD STILL CONSIDER CPAP AS THE TREATMENT OF CHOICE. A RECENT STUDY SHOWED THAT PROPERLY TITRATED ORAL APPLIANCES ARE EQUALLY EFFECTIVE TO CPAP FOR SLEEP APNEA PATIENTS.
THE UNITED STATES GOVERNMENT HAS ENDORSED ORAL APPLIANCES FOR TREATING SLEEP APNEA BY ACCEPTING DENTAL SLEEP MEDICINE FOR COVERAGE UNDER MEDICARE.
THE NEW MEDICARE POLICY ALSO RECOGNIZES THE DISMAL COMPLIANCE RATES OF CPAP WITH NEW MINIMAL USAGE REQUIREMENT FOR CPAP COVERAGE. THIS NEW POLICY WILL BENEFIT EVERYONE AS MANUFACTURERS AND DME'S WORK TO INCREASE COMPLIANCE WITH CPAP.
Cardiologists who are proponents of sleep apnea treatment are referring more and more patients for oral appliance therapy as an alternative to CPAP. They recognize that CPAP therapy is worthless if it is not used. Oral appliances are considered a first line treatment for mild to moderate sleep apnea. Oral appliance therapy is also an alternative to CPAP for severe sleep apnea when patients do not toleratte CPAP.
THE MAJORITY OF PATIENTS DO NOT TOLERATE CPAP!!! MEDICARE IS NO LONGER COVERING CPAP THERAPY FOR PATIENTS WHO DO NOT USE CPAP ON A REGULAR BASIS. MOST PATIENTS DO NOT USE CPAP ON A REGULAR BASIS.
Cardiologists are more comfortable referring patients for CPAP but have come to realize that patients are much more compliant with oral applainces than CPAP.
This means that patients use their oral appliances to treat their sleep apnea. Cardiologists know this is vital to their patients health. While CPAP may be more effective for some patients it is a total treatment failure for those patients who do not use their CPAP.
In addition to heart attacks and stroke untreated sleep apnea can also cause short term memory loss, lead to drammatic increases n motor vehicle accidents because patients with untreated sleep apnea have slower reaction times than patients who are legally intoxicated. Untreated sleep apnea can increase severity and speed of onset of Alzheimer's and Dementia, is implicated in up to 80% of ADD and ADHD in children, can increase the severity of metabolic problems from diabetes to obesity.
The National Sleep Foundation has declared that oral appliances are a therapy whose time has come!
The American Academy of Sleep Medicine considers oral appliances to be a first line treatment for mild to moderate sleep apnea.
The American Academy of Dental Sleep Medicine has published reports on the success of treating severe sleep apnea with comfortable oral appliances.
MORBIDLY OBESE PATIENTS SHOULD STILL CONSIDER CPAP AS THE TREATMENT OF CHOICE. A RECENT STUDY SHOWED THAT PROPERLY TITRATED ORAL APPLIANCES ARE EQUALLY EFFECTIVE TO CPAP FOR SLEEP APNEA PATIENTS.
THE UNITED STATES GOVERNMENT HAS ENDORSED ORAL APPLIANCES FOR TREATING SLEEP APNEA BY ACCEPTING DENTAL SLEEP MEDICINE FOR COVERAGE UNDER MEDICARE.
THE NEW MEDICARE POLICY ALSO RECOGNIZES THE DISMAL COMPLIANCE RATES OF CPAP WITH NEW MINIMAL USAGE REQUIREMENT FOR CPAP COVERAGE. THIS NEW POLICY WILL BENEFIT EVERYONE AS MANUFACTURERS AND DME'S WORK TO INCREASE COMPLIANCE WITH CPAP.
Which oral appliance works best for treating sleep apnea?.
I usually know what type of oral appliance, CPAP, BiPAP or surgery will best suit my patient with obstructive sleep apnea after a short interview and exam. Success is not only efficacy of the appliance but also compliance which is a complex issue poorly addressed by randomized trials. The way the patient responds to the exam, impressions and bite often give the final clues to which treatment will be most beneficial. (many types of appliances are shown on the I HATE CPAP! site)
I present below a recent study on which appliances are the most effective. I review the information but I would like to make some personal comments about evidence based medicine and how it ignores the clinical knowledge and experience of trained physicians and dentists. Having done thousands of appliances I believe I am very adept at determining which patients will do best with various appliances. Unfortunately, clinical experience is not easy to integrate into randomized controlled studies. In fact, clinical experience and "gut feelings" about patients are ruled out of these studies. Randomized controlled studies work best with a limited number of variables. A problem many patients who try oral appliances have is that there dentist was trained by a manufacturers course and the doctor only has a single tool in his belt or only one appliance he understands and is comfortable using.
I teach a dental sleep medicine course that extensively covers the entire field of dental sleep medicine. I do give dentists who take my course a handful of appliances that are extremely effective for different patient groups. I also know that experience is vital to treating patients and therefore offer unlimited phone follow-up for 6 months with doctors that I train. I review sleep studies and frequently help them thru the diagnostic regimen to pick an appropriate appliance.
My article review follows and I include the PUB MED abstract with additional comments.
A brand new article looked at the effectiveness of various oral appliances. They found 1475 articles comparing efficacy of various appliances. The study showed that 116 of these studies compared an oral appliance to a control. They gave weight to only 14 of these studies that were randomized controlled trials (RCTs). All of the studies concerned MAD or mandibular advancement devices. The study concludes that "The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA."
Eur J Orthod. 2011 Jan 13. [Epub ahead of print]
A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea.
Ahrens A, McGrath C, Hägg U.
Discipline of Dental Public Health.
Abstract
Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.
PMID: 21239397 [PubMed - as supplied by publisher]
The article states " These findings highlight the absence of a universal definition of treatment success." The definition of success should be the elimination of all obstructive apneas, hypopneas and RERA's or respiratory related arousals and/or UARS upper airway resistance syndrome. Ideally snoring should also be resolved. Success should also consider central apneas that are not treated by appliances. If there are substantial episodes of central apnea other alternatives may need to be considered.
Positional treatment and oral appliance therapy are frequently used together if incomplete results are obtained with just an oral appliance. It is important to remember that even patial therapy with an oral appliance is far superior to no therapy in patients who reject CPAP. The physician/dentist should try to eliminate all sleep disordered breating.
Allergies and nasal congestion can be addresses with nasal breathing strips, medication, correction of deviated septums or reduction of turbinates.
Irrigation with a Netti Pot utilizing saline or black tea and saline can reduce mucous congestion. I have seen several patients who clain great relief from NAET, I do not understand or endorse this therapy but I have seen many patients who claim significant relief.
The bottom line, it is essential to control all apneic episodes. Untreated sleep apnea is dangerous and can be fatal. Heart disease, hear attacks, strokes, hypertension, short term memory loss, increased risk of motor vehicl accidents, earlier and more severe onset of dementia and/or Alzheimers are just the tip of the iceberg for possible negative consequences related to sleep apnea.
My advice: See a sleeep apnea dentist with experience and/or a mentor who is trained in multiple oral appliances. I am a Diplomate of the American Academy of Dental Sleep Medicine. There are many dentists who are well trained but have not received Diplomate status. Choosing a Diplomate in dental sleep medicine does insure a wide range of experience but is only one of many considerations.
I present below a recent study on which appliances are the most effective. I review the information but I would like to make some personal comments about evidence based medicine and how it ignores the clinical knowledge and experience of trained physicians and dentists. Having done thousands of appliances I believe I am very adept at determining which patients will do best with various appliances. Unfortunately, clinical experience is not easy to integrate into randomized controlled studies. In fact, clinical experience and "gut feelings" about patients are ruled out of these studies. Randomized controlled studies work best with a limited number of variables. A problem many patients who try oral appliances have is that there dentist was trained by a manufacturers course and the doctor only has a single tool in his belt or only one appliance he understands and is comfortable using.
I teach a dental sleep medicine course that extensively covers the entire field of dental sleep medicine. I do give dentists who take my course a handful of appliances that are extremely effective for different patient groups. I also know that experience is vital to treating patients and therefore offer unlimited phone follow-up for 6 months with doctors that I train. I review sleep studies and frequently help them thru the diagnostic regimen to pick an appropriate appliance.
My article review follows and I include the PUB MED abstract with additional comments.
A brand new article looked at the effectiveness of various oral appliances. They found 1475 articles comparing efficacy of various appliances. The study showed that 116 of these studies compared an oral appliance to a control. They gave weight to only 14 of these studies that were randomized controlled trials (RCTs). All of the studies concerned MAD or mandibular advancement devices. The study concludes that "The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA."
Eur J Orthod. 2011 Jan 13. [Epub ahead of print]
A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea.
Ahrens A, McGrath C, Hägg U.
Discipline of Dental Public Health.
Abstract
Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.
PMID: 21239397 [PubMed - as supplied by publisher]
The article states " These findings highlight the absence of a universal definition of treatment success." The definition of success should be the elimination of all obstructive apneas, hypopneas and RERA's or respiratory related arousals and/or UARS upper airway resistance syndrome. Ideally snoring should also be resolved. Success should also consider central apneas that are not treated by appliances. If there are substantial episodes of central apnea other alternatives may need to be considered.
Positional treatment and oral appliance therapy are frequently used together if incomplete results are obtained with just an oral appliance. It is important to remember that even patial therapy with an oral appliance is far superior to no therapy in patients who reject CPAP. The physician/dentist should try to eliminate all sleep disordered breating.
Allergies and nasal congestion can be addresses with nasal breathing strips, medication, correction of deviated septums or reduction of turbinates.
Irrigation with a Netti Pot utilizing saline or black tea and saline can reduce mucous congestion. I have seen several patients who clain great relief from NAET, I do not understand or endorse this therapy but I have seen many patients who claim significant relief.
The bottom line, it is essential to control all apneic episodes. Untreated sleep apnea is dangerous and can be fatal. Heart disease, hear attacks, strokes, hypertension, short term memory loss, increased risk of motor vehicl accidents, earlier and more severe onset of dementia and/or Alzheimers are just the tip of the iceberg for possible negative consequences related to sleep apnea.
My advice: See a sleeep apnea dentist with experience and/or a mentor who is trained in multiple oral appliances. I am a Diplomate of the American Academy of Dental Sleep Medicine. There are many dentists who are well trained but have not received Diplomate status. Choosing a Diplomate in dental sleep medicine does insure a wide range of experience but is only one of many considerations.
SLEEP APNEA IN CHILDREN IS FREQUENTLY TREATED WITH REMOVAL OF TONSILS AND/ OR ADENOIDS. ORTHOPEDIC APPLIANCES AND SLEEP APPLIANCES ALSO HAVE A ROLE.
Dawn: My 5yo daughter had T&A sx at 22mos which seemed to help her osa up until about 8months ago. She is now going to start using a cpap for severe osa. I now know she will need orthodontic and/or maxillofacial close monitoring. I am wondering if any of thes oral applianced are used with children this young also, and if there is anyone in the northern ******** area who is best trained for this.
Dr Shapira: Dear Dawn,
There is an excellent Sleep Apnea Dentist in your area Dr *********** I just talked to him and he would be happy to work with you and your daughter. If there are any questions during treatment we can discuss it as treatment pprogresses.
There would actully be two appliances involved a nightime appliance and a daytime appliance. This will allow the widening of the maxilla while using an appliance to prevent apnea...Dr ******* has a great deal of experience in treating sleep apnea.
This will not only treat the sleep apnea but begin treating the underlying orthopedic problem. You child will still need orthodontics (probably) in the future but the early orthopedic therapy will make future orthodontics easier.
MORE ON THIS TOPIC: SLEEP APNEA IN CHILDREN IS FREQUENTLY TREATED WITH REMOVAL OF TONSILS AND/ OR ADENOIDS. ORTHOPEDIC APPLIANCES AND SLEEP APPLIANCES ALSO HAVE A ROLE IN TREATING CHILDHOOD SLEEP APNEA TREATMENT.
There is a question whether tonsilectomy and adenoidectomy should occur before of after widening of the maxilla. Widening the maxilla will improve the airway and possibly lower post-op complications. If T&A is done prior to widening studies have shown that it does not correct the development orthopedic problems. All patients should be reevaluated for sleep apnea and for maxillary expansion.
Dr Shapira: Dear Dawn,
There is an excellent Sleep Apnea Dentist in your area Dr *********** I just talked to him and he would be happy to work with you and your daughter. If there are any questions during treatment we can discuss it as treatment pprogresses.
There would actully be two appliances involved a nightime appliance and a daytime appliance. This will allow the widening of the maxilla while using an appliance to prevent apnea...Dr ******* has a great deal of experience in treating sleep apnea.
This will not only treat the sleep apnea but begin treating the underlying orthopedic problem. You child will still need orthodontics (probably) in the future but the early orthopedic therapy will make future orthodontics easier.
MORE ON THIS TOPIC: SLEEP APNEA IN CHILDREN IS FREQUENTLY TREATED WITH REMOVAL OF TONSILS AND/ OR ADENOIDS. ORTHOPEDIC APPLIANCES AND SLEEP APPLIANCES ALSO HAVE A ROLE IN TREATING CHILDHOOD SLEEP APNEA TREATMENT.
There is a question whether tonsilectomy and adenoidectomy should occur before of after widening of the maxilla. Widening the maxilla will improve the airway and possibly lower post-op complications. If T&A is done prior to widening studies have shown that it does not correct the development orthopedic problems. All patients should be reevaluated for sleep apnea and for maxillary expansion.
Friday, November 12, 2010
Specific Areas of Brain Damage Associated with Sleep Apnea
Italian researchers have identified several regions in the brain that suffer damage as a result of obstructive sleep apnea. They also found that these regions responded to treatment with significant structural recovery.
The researchers matched 17 sleep apnea sufferers with 15 age-matched healthy individuals. All subjects underwent a sleep study, took cognitive tests, and underwent magnetic resonance imaging. Then the sleep apnea sufferers began treatment. Three months later, the tests were repeated.
Initially, the sleep apnea sufferers showed impairment in most cognitive areas, as well as their mood. Many reported sleepiness. They also showed focal reductions in brain matter in the enthorhinal cortex, the left posterior parietal cortex, and the right superior frontal gyrus. The Enthorhinal cortex plays an important role in memory, especially biographical memory. The posterior parietal cortex controls voluntary movements. The superior frontal gyrus has been shown to be involved in self-awareness, mood, laughter, spatial cognition, and working memory. Identifying these damaged regions provides important insight into the mechanisms of sleep apnea's dangers. It shows, too, that there are other potential risks that cannot objectively be measured. With sleep apnea, you may be at risk for losing important parts of your identity and self-awareness.
Fortunately, the researchers also found that treatment of sleep apnea could reverse the damage suffered in these specific regions of the brain. Although the researchers used CPAP as the treatment method, it is likely that other adequate treatment methods like oral appliance therapy could lead to similar reverses.
If you are a sleep apnea sufferer, don't put your life and your personality at risk, get treatment today. To learn more about sleep apnea treatment options, please contact a local sleep dentist today.
Monday, November 8, 2010
Did use of headgear cause sleep apnea problem?
Robert: As a kid, I had to wear head gear to pull my lower jaw back to help correct a slight under bite. Could this adjustment of my mouth/jaw be a factor in my sleep apena.
Dr Shapira response: It is quite possible that the headgear made you more likely to have sleep apnea. What is probably more important was the opportunity to increase your airway during ortho tx.
Orthodontics can ce a complete of partial sleep apnea cure or a major complicating factor.
When orthodontic widening is done at a young age it widens the palate and the floor of the nose. It is recommended that pediatric patients with sleep apnea should have obstructive tonsils and adenoids removed. It is also recommended that a followup sleep study always be done to evaluate residual disease. The majority of patients may benefit from maxillary widening as well.
Some top researchers are recommending that orthodontic widening precede T & A removal to lessen surgical complications and risks.
Treatment of sleep apnea with an oral appliance advances the mandible at night but those changes can become permenant. CPAP tend to act like a Headgear causing backward movement of the maxilla and upper teeth.
All parents contemplating orthodontics for their children should work with growth and development orthodontists who understandf airway and sleep apnea. The outmoded practice of removing permenant bicuspid can produce an orthopedic position more prone to sleep apnea.
Dr Shapira response: It is quite possible that the headgear made you more likely to have sleep apnea. What is probably more important was the opportunity to increase your airway during ortho tx.
Orthodontics can ce a complete of partial sleep apnea cure or a major complicating factor.
When orthodontic widening is done at a young age it widens the palate and the floor of the nose. It is recommended that pediatric patients with sleep apnea should have obstructive tonsils and adenoids removed. It is also recommended that a followup sleep study always be done to evaluate residual disease. The majority of patients may benefit from maxillary widening as well.
Some top researchers are recommending that orthodontic widening precede T & A removal to lessen surgical complications and risks.
Treatment of sleep apnea with an oral appliance advances the mandible at night but those changes can become permenant. CPAP tend to act like a Headgear causing backward movement of the maxilla and upper teeth.
All parents contemplating orthodontics for their children should work with growth and development orthodontists who understandf airway and sleep apnea. The outmoded practice of removing permenant bicuspid can produce an orthopedic position more prone to sleep apnea.
Saturday, November 6, 2010
CPAP USE CAUSES SIGNIFICANT CHANGES IN POSITION OF BONES OF FACE AND TEETH. THESE CHANGES MAY CAUSE TMJ DISORDERS OR SMASHED FACES.
A new study in Chest shows significant changes in bone and teeth positio secondary to CPAP use. The changes are retropositioning of the upper maxillary teeth and the bones of the face. Smashed Face Syndrome resulting from long term CPAP use could have negative consequences of a cosmetic and physiologic nature.
It is important to note that treatment of sleep apnea is essential and that CPAP and Oral Appliances the only First Line treatments can cause changes. These changes should not be considered a reason to discontinue life-saving treatment with either modality.
The changes that occur with Oral Appliance treatment are not the same as changes that occur with CPAP use. There are ominous problems that could be associated with the CPAP specific changes. These changes could cause worsening of Sleep Apnea if CPAP use is discontinued and even lead to an addiction to CPAP. I have discussed problems with "CPAP Addiction" with Dr Alex Golbin a prominent sleep physician and pioneer of the field of Sleep Medicine.
The change that occured with use of CPAP include "Significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity" These findings were visible on cephalometric radiographs but were not reported by patients. All of these changes have the potential to cause TMJ problems, tension headaches and migraines. The changes CPAP cause will lead to retropositioning of the mandible. The changes caused by oral appliances are anterior positioning of the mandible. Studies have shown that these changes do not adversly affect the TM Joints (TMJ). In fact these are the same changes that take place when treating TMJ disorders with a neuromuscular orthotic. Part of the effect of neuromuscular treatment of headaches and migraines (see www.ihateheadaches.org) is thought to be do to improvements in airway and quality of sleep.
Dentists routinely explain to their patients that oral appliances can change bites and move teeth as part of their informed consent for treatment.
The responsibility for informing patients of negative orthopedic changes from CPAP falls on the prescribing physicians and on CPAP manufacturers. The FDA should make device manufcturers include information on this subject in their materials.
Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.
Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. htsuda@dent.kyushu-u.ac.jp
Abstract
BACKGROUND: Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.
METHODS: Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.
RESULTS: Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.
CONCLUSION: The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.
PMID: 20616213 [PubMed - indexed for MEDLINE]
It is important to note that treatment of sleep apnea is essential and that CPAP and Oral Appliances the only First Line treatments can cause changes. These changes should not be considered a reason to discontinue life-saving treatment with either modality.
The changes that occur with Oral Appliance treatment are not the same as changes that occur with CPAP use. There are ominous problems that could be associated with the CPAP specific changes. These changes could cause worsening of Sleep Apnea if CPAP use is discontinued and even lead to an addiction to CPAP. I have discussed problems with "CPAP Addiction" with Dr Alex Golbin a prominent sleep physician and pioneer of the field of Sleep Medicine.
The change that occured with use of CPAP include "Significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity" These findings were visible on cephalometric radiographs but were not reported by patients. All of these changes have the potential to cause TMJ problems, tension headaches and migraines. The changes CPAP cause will lead to retropositioning of the mandible. The changes caused by oral appliances are anterior positioning of the mandible. Studies have shown that these changes do not adversly affect the TM Joints (TMJ). In fact these are the same changes that take place when treating TMJ disorders with a neuromuscular orthotic. Part of the effect of neuromuscular treatment of headaches and migraines (see www.ihateheadaches.org) is thought to be do to improvements in airway and quality of sleep.
Dentists routinely explain to their patients that oral appliances can change bites and move teeth as part of their informed consent for treatment.
The responsibility for informing patients of negative orthopedic changes from CPAP falls on the prescribing physicians and on CPAP manufacturers. The FDA should make device manufcturers include information on this subject in their materials.
Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.
Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. htsuda@dent.kyushu-u.ac.jp
Abstract
BACKGROUND: Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.
METHODS: Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.
RESULTS: Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.
CONCLUSION: The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.
PMID: 20616213 [PubMed - indexed for MEDLINE]
Monday, March 15, 2010
I HATE CPAP FAN
Hey very nice blog!!….I’m an instant fan, I have bookmarked you and I’ll be checking back on a regular….See ya
Wednesday, February 17, 2010
SWEDISH EPIDEMIOLOGY: OBSTRUCTIVE SLEEP APNEA INCREASE CARDIOVASCULAR MORBIDITY AND MORTALITY
Obstructive sleep apnea increases cardiovascular morbidity and mortality according to Swedish article. This increase suggests that OSA is an increased (additive) risk above and beyond established risk factors of obesity, hypertension, smoking and hyperlipidemia. (see PubMed Abstract below).
A second article (see PubMed abstract below) published in the Journal of Cardiology 2010 Jan;55(1):92-98 concluded that Sleep Apnea Syndrom increased nocturnal blood pressure even in patients without hypertension. Patients with severe apnea demomstrated more sever elevations in nocturnal blood pressure.
A Japanese study (Heart Vessels. 2010 Jan;25(1):63-9) showed effectiveness of CPAP in treating arrythmias. Sleep apnea treatment with oral appliances and dental sleep medicine should show identical results based on other studies comparing treatment outcomes. This study showed " The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients." Again I expect that apnea treated with oral appliances would have similar outcomes to CPAP use. This study again relates cardiac disorders to obstructive sleep apnea.
Another review article (Curr Opin Pulm Med. 2009 Aug 2) "Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment." reviews recent articles on Sleep disordered breathing and Heart Failure. The article's summary (see PubMed abstract below) say "The relationship between CHF (congestive heart failure) and SDB (sleep disordered breathing) is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined. The effects of each conition worsens the other. Treatment that eliminates sleep disordered breathing should result in positive effects on cardiac symptoms. The article also discusses patients with central sleep apnea associated with Cheyne-Stokes breathing. Unfortunately CPAP and Oral appliances are not effective for central sleep apnea but adaptive servo-ventilation shows encouraging results. "Small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking" in regards to aaptive servo-ventilation.
A key point from all of these studies is that sleep apnea is a dangerous condition with multiple associated morbidities and with treatment improvement in morbidities and mortality is seen. While CPAP is extremely effective studies show it is rejected by the majority of patients. Dental Sleep Medicine and oral appliances provide needed alternatives to CPAP. Oral appliances are a first line treatment for mild to moderate sleep apnea. Patients with severe apnea who do not tolerate CPAP will benefit from an oral appliances. Patients with central sleep apnea may want to consider sero-ventilation.
Anadolu Kardiyol Derg. 2010 Feb;10(1):75-80.
Cardiovascular consequences of sleep apnea: I -Epidemiology.
Turgut Celen Y, Peker Y.
Sleep Medicine Unit, Department of Neurology and Rehabilitation Medicine, Skaraborg Hospital, Skövde, Sweden. yuksel.peker@lungall.gu.se.
Obstructive sleep apnea (OSA) is common in general population. There is an accumulating research evidence for an independent relationship between OSA and cardiovascular morbidity and mortality. This relationship is stronger in clinical cohorts compared with the general population, which suggests that concomitant OSA in subjects with traditionally recognized risk factors such as obesity, hypertension, smoking, and hyperlipidemia may provide an additive risk factor for the cardiovascular consequences. In the current article, the clinic-and population-based epidemiologic data will be reviewed in this context.
PMID: 20150011 [PubMed - in process]
J Cardiol. 2010 Jan;55(1):92-98. Epub 2009 Nov 22.
Relationship between sleep apnea syndrome and sleep blood pressure in patients without hypertension.
Sekizuka H, Kida K, Akashi YJ, Yoneyama K, Osada N, Omiya K, Miyake F.
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki-city, Kanagawa-prefecture 216-8511, Japan.
BACKGROUND AND PURPOSE: Ambulatory blood pressure monitoring (ABPM) provides an accurate assessment of blood pressure (BP) and shows non-dipper BP pattern in many sleep apnea syndrome (SAS) patients with hypertension (HTN); however, little information is available on the relationship between the severity of SAS and circadian BP changes in SAS patients without HTN. This study investigated whether SAS patients without HTN would have different BP courses in the severity of SAS. METHODS AND SUBJECTS: Seventy-four consecutive outpatients without HTN [systolic BP (BPs) at clinic <140mmHg and/or diastolic BP (BPd) at clinic <90mmHg], who received no antihypertensives, underwent overnight polysomnography (PSG) and ABPM. The apnea-hypopnea index (AHI) was calculated from the PSG results; patients were stratified into the following 4 groups based on their AHI: non-SAS, mild-, moderate-, or severe-SAS. RESULTS: The diurnal BPs and BPd showed no differences in the severity of SAS; however, the sleep BPs, lowest BPs, and pre-awake BPs were significantly higher in the severe-SAS group than the non-SAS group (p=0.02, p=0.04, and p=0.006, respectively). The sleep BPd and pre-awake BPd were significantly higher in the severe-SAS than the non-SAS (p=0.01 and p=0.0003, respectively) and mild-SAS (p=0.01 and p=0.008, respectively) groups. CONCLUSIONS: The results of this study suggested that SAS affected nocturnal BP elevation even in SAS patients without HTN. The diurnal BP showed no difference in the severity of SAS; however, the severe-SAS group revealed significant nocturnal BP elevation. Copyright © 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
PMID: 20122554 [PubMed - as supplied by publisher]
Heart Vessels. 2010 Jan;25(1):63-9. Epub 2010 Jan 21.
Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients.
Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M, Koyama J, Yamazaki K, Ikeda U.
Division of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
The purpose of this study was to determine the relationship between obstructive sleep apnea (OSA) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of OSA-associated arrhythmias. The study population comprised 1394 Japanese subjects (1086 men and 308 women) who were divided into four groups on the basis of polysomnography (PSG) analysis as follows: the no sleep apnea (N-SA) group (n = 44, apnea-hypopnea index [AHI] < 5), the mild OSA (Mi-OSA) group (n = 197, 5 < AHI < 15), the moderate OSA (Mo) group (n = 368, 15 < AHI < 30), and severe OSA (SOSA) group (n = 785, AHI < 30). The following baseline characteristics were significantly associated with OSA: age (P < 0.001), gender (P < 0.001), body mass index (P < 0.001), hypertension (P < 0.001), diabetes (P = 0.009), and hyperlipidemia (P = 0.013). In the OSA group, PSG revealed the predominance of paroxysmal atrial fibrillation (PAF) (P = 0.051), premature atrial complex short run (P < 0.005), premature ventricular complex (PVC, P = 0.004), sinus bradycardia (P = 0.036), and sinus pause (arrest >2 s, P < 0.001) during the PSG recording. A total of 316 patients from the group underwent CPAP titration and were then re-evaluated. Continuous positive airway pressure therapy significantly reduced the occurrences of PAF (P < 0.001), PVC (P = 0.016), sinus bradycardia (P = 0.001), and sinus pause (P = 0.004). The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients.
PMID: 20091401 [PubMed - in process]
Curr Opin Pulm Med. 2009 Aug 26. [Epub ahead of print]
Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment.
Kee K, Naughton MT.
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
PURPOSE OF REVIEW: This review examines the recently published articles pertaining to sleep-disordered breathing (SDB) and heart failure. RECENT FINDINGS: The recent findings can be classified into pulmonary, upper airway and treatment trials. Pulmonary complications of heart failure include loss of surfactant, increased pulmonary dry weight and reduced lung volume, which are likely to increase plant gain and thus predispose to central sleep apnea with Cheyne-Stokes respiration. Upper airway narrowing in normal individuals has been shown to occur with lower limb compression and the supine body position, thus suggesting that rostral fluid shifts may narrow the upper airway and aggravate obstructive sleep apnea. Extrapolating this to congestive heart failure (CHF), it is possible that CHF fluid status may impact upon obstructive sleep apnea severity. Following the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnoea and Heart Failure trial, further SDB intervention studies have been reported using adaptive servo-ventilation. Although encouraging, small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking. SUMMARY: The relationship between CHF and SDB is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined.
PMID: 19713849 [PubMed - as supplied by publisher]
Anonymous has left a new comment on your post "SWEDISH EPIDEMIOLOGY: OBSTRUCTIVE SLEEP APNEA INC...":
Nice post and this enter helped me alot in my college assignement. Say thank you you on your information.
Dr Shapira: I get dozens of thank you's from high school and college students who use my site as a research source. I take pride in supplying the highest quality information. I recently spoke at Integrate Chicago a course on integrative medicine for medical stuents and many who attended my lectures had spent a considerable amount of time doing research on treatment of sleep apnea. The general response was that it was one of the best sites on the internet if you were looking for alternative treatments for sleep apnea.
Dr Shapira
A second article (see PubMed abstract below) published in the Journal of Cardiology 2010 Jan;55(1):92-98 concluded that Sleep Apnea Syndrom increased nocturnal blood pressure even in patients without hypertension. Patients with severe apnea demomstrated more sever elevations in nocturnal blood pressure.
A Japanese study (Heart Vessels. 2010 Jan;25(1):63-9) showed effectiveness of CPAP in treating arrythmias. Sleep apnea treatment with oral appliances and dental sleep medicine should show identical results based on other studies comparing treatment outcomes. This study showed " The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients." Again I expect that apnea treated with oral appliances would have similar outcomes to CPAP use. This study again relates cardiac disorders to obstructive sleep apnea.
Another review article (Curr Opin Pulm Med. 2009 Aug 2) "Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment." reviews recent articles on Sleep disordered breathing and Heart Failure. The article's summary (see PubMed abstract below) say "The relationship between CHF (congestive heart failure) and SDB (sleep disordered breathing) is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined. The effects of each conition worsens the other. Treatment that eliminates sleep disordered breathing should result in positive effects on cardiac symptoms. The article also discusses patients with central sleep apnea associated with Cheyne-Stokes breathing. Unfortunately CPAP and Oral appliances are not effective for central sleep apnea but adaptive servo-ventilation shows encouraging results. "Small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking" in regards to aaptive servo-ventilation.
A key point from all of these studies is that sleep apnea is a dangerous condition with multiple associated morbidities and with treatment improvement in morbidities and mortality is seen. While CPAP is extremely effective studies show it is rejected by the majority of patients. Dental Sleep Medicine and oral appliances provide needed alternatives to CPAP. Oral appliances are a first line treatment for mild to moderate sleep apnea. Patients with severe apnea who do not tolerate CPAP will benefit from an oral appliances. Patients with central sleep apnea may want to consider sero-ventilation.
Anadolu Kardiyol Derg. 2010 Feb;10(1):75-80.
Cardiovascular consequences of sleep apnea: I -Epidemiology.
Turgut Celen Y, Peker Y.
Sleep Medicine Unit, Department of Neurology and Rehabilitation Medicine, Skaraborg Hospital, Skövde, Sweden. yuksel.peker@lungall.gu.se.
Obstructive sleep apnea (OSA) is common in general population. There is an accumulating research evidence for an independent relationship between OSA and cardiovascular morbidity and mortality. This relationship is stronger in clinical cohorts compared with the general population, which suggests that concomitant OSA in subjects with traditionally recognized risk factors such as obesity, hypertension, smoking, and hyperlipidemia may provide an additive risk factor for the cardiovascular consequences. In the current article, the clinic-and population-based epidemiologic data will be reviewed in this context.
PMID: 20150011 [PubMed - in process]
J Cardiol. 2010 Jan;55(1):92-98. Epub 2009 Nov 22.
Relationship between sleep apnea syndrome and sleep blood pressure in patients without hypertension.
Sekizuka H, Kida K, Akashi YJ, Yoneyama K, Osada N, Omiya K, Miyake F.
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki-city, Kanagawa-prefecture 216-8511, Japan.
BACKGROUND AND PURPOSE: Ambulatory blood pressure monitoring (ABPM) provides an accurate assessment of blood pressure (BP) and shows non-dipper BP pattern in many sleep apnea syndrome (SAS) patients with hypertension (HTN); however, little information is available on the relationship between the severity of SAS and circadian BP changes in SAS patients without HTN. This study investigated whether SAS patients without HTN would have different BP courses in the severity of SAS. METHODS AND SUBJECTS: Seventy-four consecutive outpatients without HTN [systolic BP (BPs) at clinic <140mmHg and/or diastolic BP (BPd) at clinic <90mmHg], who received no antihypertensives, underwent overnight polysomnography (PSG) and ABPM. The apnea-hypopnea index (AHI) was calculated from the PSG results; patients were stratified into the following 4 groups based on their AHI: non-SAS, mild-, moderate-, or severe-SAS. RESULTS: The diurnal BPs and BPd showed no differences in the severity of SAS; however, the sleep BPs, lowest BPs, and pre-awake BPs were significantly higher in the severe-SAS group than the non-SAS group (p=0.02, p=0.04, and p=0.006, respectively). The sleep BPd and pre-awake BPd were significantly higher in the severe-SAS than the non-SAS (p=0.01 and p=0.0003, respectively) and mild-SAS (p=0.01 and p=0.008, respectively) groups. CONCLUSIONS: The results of this study suggested that SAS affected nocturnal BP elevation even in SAS patients without HTN. The diurnal BP showed no difference in the severity of SAS; however, the severe-SAS group revealed significant nocturnal BP elevation. Copyright © 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
PMID: 20122554 [PubMed - as supplied by publisher]
Heart Vessels. 2010 Jan;25(1):63-9. Epub 2010 Jan 21.
Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients.
Abe H, Takahashi M, Yaegashi H, Eda S, Tsunemoto H, Kamikozawa M, Koyama J, Yamazaki K, Ikeda U.
Division of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
The purpose of this study was to determine the relationship between obstructive sleep apnea (OSA) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of OSA-associated arrhythmias. The study population comprised 1394 Japanese subjects (1086 men and 308 women) who were divided into four groups on the basis of polysomnography (PSG) analysis as follows: the no sleep apnea (N-SA) group (n = 44, apnea-hypopnea index [AHI] < 5), the mild OSA (Mi-OSA) group (n = 197, 5 < AHI < 15), the moderate OSA (Mo) group (n = 368, 15 < AHI < 30), and severe OSA (SOSA) group (n = 785, AHI < 30). The following baseline characteristics were significantly associated with OSA: age (P < 0.001), gender (P < 0.001), body mass index (P < 0.001), hypertension (P < 0.001), diabetes (P = 0.009), and hyperlipidemia (P = 0.013). In the OSA group, PSG revealed the predominance of paroxysmal atrial fibrillation (PAF) (P = 0.051), premature atrial complex short run (P < 0.005), premature ventricular complex (PVC, P = 0.004), sinus bradycardia (P = 0.036), and sinus pause (arrest >2 s, P < 0.001) during the PSG recording. A total of 316 patients from the group underwent CPAP titration and were then re-evaluated. Continuous positive airway pressure therapy significantly reduced the occurrences of PAF (P < 0.001), PVC (P = 0.016), sinus bradycardia (P = 0.001), and sinus pause (P = 0.004). The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients.
PMID: 20091401 [PubMed - in process]
Curr Opin Pulm Med. 2009 Aug 26. [Epub ahead of print]
Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment.
Kee K, Naughton MT.
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
PURPOSE OF REVIEW: This review examines the recently published articles pertaining to sleep-disordered breathing (SDB) and heart failure. RECENT FINDINGS: The recent findings can be classified into pulmonary, upper airway and treatment trials. Pulmonary complications of heart failure include loss of surfactant, increased pulmonary dry weight and reduced lung volume, which are likely to increase plant gain and thus predispose to central sleep apnea with Cheyne-Stokes respiration. Upper airway narrowing in normal individuals has been shown to occur with lower limb compression and the supine body position, thus suggesting that rostral fluid shifts may narrow the upper airway and aggravate obstructive sleep apnea. Extrapolating this to congestive heart failure (CHF), it is possible that CHF fluid status may impact upon obstructive sleep apnea severity. Following the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnoea and Heart Failure trial, further SDB intervention studies have been reported using adaptive servo-ventilation. Although encouraging, small, short-term studies are discussed, however long-term randomized trials with objective cardiac outcomes are still lacking. SUMMARY: The relationship between CHF and SDB is likely to be bidirectional, CHF impacting on SDB severity and vice versa. Identification of SDB in the CHF population appears to be important as it is probably associated with greater mortality, but whether SDB intervention significantly influences CHF survival still remains to be determined.
PMID: 19713849 [PubMed - as supplied by publisher]
Anonymous has left a new comment on your post "SWEDISH EPIDEMIOLOGY: OBSTRUCTIVE SLEEP APNEA INC...":
Nice post and this enter helped me alot in my college assignement. Say thank you you on your information.
Dr Shapira: I get dozens of thank you's from high school and college students who use my site as a research source. I take pride in supplying the highest quality information. I recently spoke at Integrate Chicago a course on integrative medicine for medical stuents and many who attended my lectures had spent a considerable amount of time doing research on treatment of sleep apnea. The general response was that it was one of the best sites on the internet if you were looking for alternative treatments for sleep apnea.
Dr Shapira
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Australian scientists have developed a new method for detecting sleep apnea. Traditionally, the diagnosis of sleep apnea required an overni...
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Patient describes 5 years of sleep apnea treatment with oral appliance. He initially used the CPAP machine but found it made him uncomfortab...
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Mike describes how he was diagnosed with sleep apnea. He was less than thrilled with diagnosis and definitely did not want CPAP. He travels...