Robot May Improve Success of Sleep Apnea Surgery

Image courtesy of Penn Medicine.

Clinical trials are proceeding for a new variation that may improve the success rate of surgical treatment for sleep apnea. In the past, surgical treatment has been sought to help patients who were unable to get good treatment results from CPAP and other methods. However, the most common surgical technique, uvulopalatopharyngoplasty (UPPP), has a widely variable success rate. One explanation for the variation in success is that the base of the tongue is a significant contributor to the obstruction of the airway in some cases and without surgical alteration of the tongue, the airway remains restricted. Unfortunately, tongue surgery is challenging and difficult to accomplish.

Now, though, it is hoped that transoral robotic surgery (TORS) can be used in combination with traditional surgical techniques to improve the success rate of sleep apnea surgery. It is hoped that the TORS technique will overcome the challenges associated with tongue surgery, including the difficulty of performing surgical maneuvers in confined spaces, poor lighting and depth perception when using endoscopic instruments, and the need for external incisions.

Clinical trials have started all across the country. Obstructive sleep apnea patients are evaluated using MRIs and sleep endoscopy to determine whether their tongue is partly responsible for their obstructive sleep apnea. If so, then they are considered a candidate for TORS for sleep apnea.

Although robotic surgery is a worthwhile avenue to explore for improving the surgical technique for the treatment of sleep apnea, it is also important that we utilize all treatment avenues open to us. There are a number of oral appliances that work at least partly by lifting and repositioning the tongue, and these should be tried for patients who seem to have tongue positioning problems prior to seeking surgery.

If you have obstructive sleep apnea, it is important that you find a successful sleep apnea treatment as soon as possible. To learn more about the full range of sleep apnea treatments, please contact a local sleep dentist today.

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.

Is Sleep Apnea to Blame for $25 Million Theft?

A Manhattan travel agent claims that her sleep apnea is to blame for her decision to embezzle $25 million from various clients. She stole $17 million from American Express through fraudulent charges on defunct business travel accounts, then overbilled a defense contractor to the tune of $8 million more. Now, she says, she cannot understand what made her make the decisions she made, but partly attributes her decisions to her undiagnosed sleep apnea. As the woman's lawyer pointed out, this is not a defense. She pleaded guilty to the charges and is prepared to accept her six year sentence and will attempt to make full repayment of the stolen funds. But is it an explanation?

Sleep apnea sufferers show many diverse sleep apnea symptoms which can range from physical symptoms such as tiredness and an increased risk of serious health conditions such as heart attack, stroke, and obesity. In addition, patients experience many psychological side effects, which may include personality changes and cognitive defects. It's possible that this woman experienced a period of questionable judgment in which she thought that the reasons she was taking the money for, such as her business and her novel, would yield enough return to allow her to pay back the stolen money.

Although sleep apnea is not a good defense for any criminal proceedings, it can put you in a wrong state of mind and make you more susceptible to making poor decisions. To put yourself in your right mind, make sure you're getting the sleep you need. To learn more about sleep apnea treatment options, please contact a local sleep dentist today.

Sleep Apnea Discrimination Case Cleared to Proceed in Massachusetts

The Massachusetts Commission Against Discrimination (MCAD) has found probable cause to proceed with an investigation into possible discrimination and retaliation by the Holliston School District against a school psychologist. The school psychologist claimed that his sleep apnea treatment was insufficient to his symptoms and asked for accommodations for his intermittent fatigue. When the school district refused, he asked MCAD to intervene, at which point he says he received disciplinary actions that were retaliatory in nature.

According to the district, the type of accommodation sought by the psychologist was unreasonable. The psychologist had asked for permission to complete paperwork at home on days when he was fatigued, contingent on his immediate supervisor's consent. However, the district did not think this was reasonable because the school psychologist has to be available for crises and should not be gone for "an indeterminate amount of time each day," in the words of the superintendant.

In response, the psychologist took his request to MCAD, which made the preliminary findings that the case justified investigation. At which point, according to the psychologist, some accommodations were granted, but, he says, he also received unjustified disciplinary action based on conflicting reports about a meeting with a student and his grandmother.

Although it is unclear how this case will be resolved, it is clear that sleep apnea can significantly impair your ability to work if you do not receive adequate treatment. If you have been prescribed a treatment that you cannot tolerate or use successfully, you need to seek another treatment before your profession and livelihood suffer.

To learn more about CPAP treatment alternatives, please contact a local sleep dentist today.

Did Sleep Apnea Hurt Fairley in the NFL Draft?

Defensive tackle Nick Fairley from Auburn was expected to be one of the top picks in the NFL draft this week. The heart and soul of the defense of last year's national champs, Fairley was expected to be picked up no later than number 8 by the Tennessee Titans, who were desperately in need of some defensive juice after last season's poor showing. However, some insiders expressed concern about his sleep apnea. Although he issued a press release showing that he was getting treatment for his sleep apnea using CPAP, he was passed over.

Perhaps officials with the Tennessee Titans were not convinced that Fairley's CPAP treatment would work. Perhaps they know that more than half of all sleep apnea sufferers give up CPAP treatment within the first year. Perhaps they might have been better persuaded by treatment using oral appliance therapy, which treats mild to moderate sleep apnea and has a much higher compliance rate than CPAP.

We will see how well Fairley's CPAP treatment works, and we wish him good luck in his career with the Detroit Lions.

If you have been diagnosed with sleep apnea and want to learn about treatment options that are more comfortable and therefore more likely to be complied with, please contact a local sleep dentist today.

Research Out of Spain Shows Sleep Apnea More Than Doubles Stroke Risk

According to research presented by researchers at the School of Medicine and the University of Navarra Hospital, people with serious sleep apnea are more than twice as likely to suffer an ischemic stroke than non-sleep apnea sufferers. The study is based on observations of 394 subjects over the age of 70 for six years. At the end of the study, 20 of the subjects had suffered a stroke.

An ischemic stroke--the most common form of stroke--is caused by an obstruction in the blood vessels, such as a blood clot or plaque that breaks off from a thicker blood vessel. This reinforces the results of another study showing that sleep apnea contributes to the prevalence of coronary artery disease and that sleep apnea sufferers are more likely to have soft arterial plaques that have a greater tendency to break off and cause blood vessel obstructions, including acute cardiac events and strokes.

This research again affirms the need for effective sleep apnea treatment. If you have been diagnosed with sleep apnea, your life is in danger, and every day you go untreated, this danger increases. To learn more about all sleep apnea treatment alternatives, please contact a local sleep dentist today.

Newly Diagnosed With Heart Failure? Have a Sleep Test To Diagnose Sleep Apnea and Increase Your Survival Rate

A recent study "Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure" (see abstract below) in the American Journal of Critical Care Medicine showed better outcomes and higher survival rates when patients are tested for sleep apnea and then treated.

This study was among older patients on Medicare.

Medicare now covers oral appliances as well as CPAP.

The problem with CPAP therapy is that most patients do not tolerate it. When heart failure is a issue Dental Sleep Medicine and oral appliances can be a life saver.


Am J Respir Crit Care Med. 2011 Feb 15;183(4):539-46. Epub 2010 Jul 23.
Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure.

Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT.

Sleepcare Diagnostics, Cincinnati, OH 45040, USA. javaheri@snorenomore.com
Abstract

RATIONALE: Previous studies have demonstrated a high prevalence of sleep apnea (SA) in patients with chronic heart failure (HF), which is associated with higher rates of morbidity, mortality, and health care use.

OBJECTIVES: To investigate the reported incidence, treatment, outcomes, and economic cost of SA in new-onset HF in a large U.S. database.

METHODS: This retrospective cohort study used the 2003 to 2005 Medicare Standard Analytical Files and included subjects with newly diagnosed HF from the first quarter of 2004, without prior diagnosis of SA, stratified by testing, diagnosis, and treatment status.

MEASUREMENTS AND MAIN RESULTS: Among a study population of 30,719 incident subjects with HF, only 1,263 (4%) were clinically suspected to have SA. Of these, 553 (2% of the total cohort) received SA testing, and 545 received treatment. After adjustment for age, sex, and comorbidities, subjects with HF who were tested, diagnosed, and treated for SA had a better 2-year survival rate compared with subjects with HF who were not tested (hazard ratio, 0.33 [95% confidence interval, 0.21-0.51], P < 0.0001). Similarly, among subjects who were tested and diagnosed, those who were treated had a better 2-year survival rate than those who were not treated (hazard ratio, 0.49 [95% confidence interval, 0.29-0.84], P = 0.009).

CONCLUSIONS: In Medicare beneficiaries with HF, comorbid SA is most often not tested and consequently subjects are underdiagnosed and not treated. Meanwhile, in the few subjects in whom a diagnosis of SA is established and treatment is executed, survival improves significantly. These results support the importance of SA testing and treatment for patients newly diagnosed with HF.

PMID: 20656940 [PubMed - indexed for MEDLINE]

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