Control Your Sleep Apnea Blog
January 14, 2013
Snoring & Pregnancy
Pregnant women who snore because of mild sleep-disordered breathing could help their unborn babies a favor by getting treated for their sleep condition, per a new study.
The findings, published in the journal SLEEP, show that fetal movements are higher when a woman with preeclampsia and mild sleep-disordered breathing receives CPAP treatment for the sleep condition, compared with not receiving the treatment. Fetal movements are a positive sign of the fetus's well-being.
The study was conducted in three parts. In the first part, researchers examined the fetal activity in 20 women who were in the third trimester of their pregnancies. In the second part, 20 pregnant women with preeclampsia (moderate to severe high blood pressure and urine protein during pregnancy) and 20 healthy pregnant women had their fetal movement monitored overnight. Researchers found in this second part that the healthy pregnant women had more fetal movements than the women with the preeclampsia -- 689 movements compared to 289.
The third part of the study included 10 women with moderate to severe preeclampsia, whose fetal movement was measured for two nights in a row. The first night, the women did not receive CPAP treatment; the second night, they did.
Researchers learned that the women in the study who had mild sleep-disordered breathing and received the CPAP therapy had higher fetal movement than the women with the sleep condition who didn't receive the treatment.
The findings point to the possibility that a simple, noninvasive therapy for SDB [sleep disordered breathing] may improve fetal well-being, according to the researchers.
January 7, 2013
From MARINE CORPS BASE CAMP LEJEUNE: Sleep apnea: Keeping millions awake at night by LCpl. Joshua W. Grant
Million of Americans suffer from obstructive sleep apnea every year but many people of all ages who have the condition don’t realize because they don’t know the symptoms and it’s often undiagnosed.
At the quarterly retiree town hall meeting at Naval Hospital Camp Lejeune, Navy Lt. Stephanie Fofi, a three-year family medicine resident, gave the retirees much of the information they needed to recognize if they were suffering from sleep apnea.
It is unknown exactly how many people suffer from OSA, but the World Health Organization published the number could be as high as 100 million worldwide, and states less than 25 percent of cases are diagnosed, said Fofi.
Approximately 4 percent of men and 2 percent of women over the age of 35 suffer from sleep apnea but most are unaware it’s the cause of their lethargy. Classified as one or more pauses in breathing during the night, sleep apnea is commonly diagnosed through snoring.
“Snoring doesn’t always mean you have sleep apnea,” said Fofi. “When you sleep, parts of your throat muscles relax and cause a block in the air way which vibrates, causing snoring.”
People shouldn’t be too worried if they snore or think they have sleep apnea because the brain automatically wakes you when your breathing pattern is interrupted, said Fofi.
Fofi added breathing abnormalities can happen up to one hundred times per night causing lasting effects during the day.
“It increases the risk of hypertension, stroke and heart attacks, heart failure and heart arrhythmia,” said Fofi. “Untreated it also causes daytime sleepiness that increases risk for work-related and motor vehicle accidents.”
Despite the symptoms and effects of sleep apnea, there are many treatment methods. Surgery, medications, oral appliances and Continuous Positive Airway Pressure machines all help to rid individuals of sleep apnea.
CPAP machines are a type of head gear worn during sleep that regulates air flow to keep breathing consistent at night.
Fofi said OSA is not always an immediate threat, but without treatment it can cause lasting effects which threaten the health and safety of millions.
December 31, 2012
From a page on the excellent American Sleep Apnea Association website, three common therapies for OSA:
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.
The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping. Visit the Online Directory of Products and Services for additional infomation.
Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes.
December 24, 2012
OSA & Atrial Fibrillation
A clear association exists between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Researchers for years have investigated whether OSA is merely a common coexisting condition among patients with AF or whether it is a true causative factor.
Both conditions are widespread; over 2 million adults in the United States have AF, and at least 1 in 15 has moderate to severe OSA. Thus, it would be expected that several individuals would have both conditions simply as a matter of chance (ie, 1/15th, or 6.7%, of those with AF would also have OSA).
Also, patients with AF and those with OSA share several similar demographic and patient-specific features. Hypertension is common in both conditions, both occur more frequently in men, both increase in incidence with older age, and increasing body mass index plays a signifcant role in the development of both AF and OSA in both men and women. It is frequently asserted by researchers that each disorder occurs independently in susceptible patients.
However, numerous studies have established that patients with OSA, particularly those with more severe disease, are significantly more likely to develop AF, and patients with AF have a higher prevalence of OSA than would be explained by random chance. After adjustment for multiple variables commonly observed in both conditions, OSA consistently has been shown to be an independent predictor for both the development of AF and its recurrence after cardioversion. In addition, the hemodynamic and sympathetic consequences of OSA can conceptually explicate the development of AF. As such, it seems clear that OSA is an independent predictor of, and causative factor in, the development of AF.
Among consecutive patients with AF scheduled for electrocardioversion, Gami and colleagues identified OSA in 17% more patients than controls. Similarly, Bitter and colleagues established that the prevalence of OSA was 42.7% among consecutive patients with AF. This prevalence was even higher in a study by Braga and colleagues, who found OSA in 81.6% of patients with AF.
Not only is OSA more commonly observed in patients with AF, but the incidence of AF is considerably higher in those with OSA. It also seems that AF is more likely to develop in those with more severe OSA. In the Sleep Heart Health Study, patients with severe OSA (apnea/hypopnea index [AHI] > 30 events/hr) had a 4-fold increased risk for AF (odds ratio, 4.02; 95% confidence interval, 1.03-15.74).
December 17, 2012
Insomnia & Sleep Apnea
A new study indicates that nighttime awakenings experienced by people with chronic insomnia might be caused by sleep breathing problems.
The Sleep and Human Health Institute (SHHI) in Albuquerque, NM, conducted the study on 20 patients who met diagnostic criteria for an insomnia disorder, denied having any classic symptoms of sleep disordered breathing (ie, loud snoring, apneas), and had no previous sleep testing. Patients in the study reported that awakenings, which cause or contribute to their insomnia, were usually caused by stress, nightmares, trips to the bathroom, racing thoughts, physical discomfort, worries, anxiety, or unknown reasons.
And yet, when diagnostic polysomnography tests were conducted on each of the 20 patients, 478 of 531 (90%) total objective awakenings for these patients were directly preceded by sleep breathing events. Only 10% of awakenings were caused by non-breathing factors (leg jerks, laboratory interaction, or spontaneous). Of the 478 breathing-related awakenings, 30 resulted in an awakening interval greater than 5 minutes, a duration that increases the likelihood of an insomnia episode. All 30 of these extended awakenings were preceded by a breathing event.
December 10, 2012
Patients with OSA have same early cardiovascular damage as diabetics
Patients with obstructive sleep apnea have the same early cardiovascular damage as diabetics, according to research presented at EUROECHO and other Imaging Modalities 2012. The study was presented by Dr Raluca Mincu from Bucharest, Romania.
EUROECHO and other Imaging Modalities 2012 is the annual meeting of the European Association of Cardiovascular Imaging (EACVI), and it took place December 5-8th in Athens, Greece.
The study assessed endothelial and arterial function in 20 patients with moderate to severe OSA (and no diabetes), 20 patients with treated type 2 diabetes mellitus (matched for age, sex and cardiovascular risk factors), and 20 healthy controls (age and sex matched).
In all subjects, arterial function was assessed by intima-media thickness (IMT). Arterial stiffness was measured by young elastic modulus, beta stiffness index, arterial compliance, first systolic peak and second systolic peak. Endothelial function was assessed by flow mediated dilatation (FMD).
All five parameters of arterial stiffness were significantly higher in the OSA and diabetes mellitus groups compared to controls. FMD was lower in these groups, meaning they had poorer endothelial function than controls.
December 3, 2012
Women & OSA
Women suffering from sleep apnea have, on the whole, a higher degree of brain damage than men with the disorder, per a study conducted by researchers at the UCLA School of Nursing, reported in the December issue of the peer-reviewed journal SLEEP.
Obstructive sleep apnea left untreated can lead to high blood pressure, stroke, heart failure, diabetes, depression and other serious health problems.
Some 10 years ago, this UCLA research team was the first to show that men with obstructive sleep apnea have damage to their brain cells.
For this latest, multi-year study, "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea," the researchers looked at patients who were diagnosed with obstructive sleep apnea at the UCLA Sleep Laboratory. They compared the nerve fibers in these patients' brains — known as white matter — to fibers of individuals without sleep problems and focused on unearthing the difference in brain damage between men and women with sleep apnea.
Specifically, the study found that women were impacted in the cingulum bundle and the anterior cingulate cortex, areas in the front of the brain involved in decision-making and mood regulation. The women with sleep apnea also showed higher levels of depression and anxiety symptoms, the researchers reported.
November 26, 2012
Better Sleep After Shedding Pounds
Losing weight leads to better sleep, according to a new Johns Hopkins study.
The improvement in problems such as fatigue, insomnia, sleep apnea, and restlessness occurs whether the patient sheds pounds through diet and exercise or through dietary changes alone, the researchers noted.
“We found that improvement in sleep quality was significantly associated with overall weight loss, especially belly fat,” says Kerry Stewart, professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine.
Dr. Stewart is the senior author of the study, which was presented November 6 at the American Heart Association Scientific Sessions by lead author Soohyun Nam, now at the Yale University School of Nursing.
The study included 77 overweight or obese people with either type 2 diabetes or pre-diabetes. The participants were randomly split into two groups. One group went on a weight-loss diet and had supervised exercise training, while the other only had the diet. A total of 55 participants completed the six-month study.
The participants filled out a survey at the beginning and end of the study to identify sleep problems, including sleep apnea, daytime fatigue, insomnia, restless sleep, excessive sleep or sleepiness, and use of sedatives to aid sleep. Body mass index and abdominal fat were also measured at the start and end of the study.
Both groups lost about 15 pounds, on average. They also lost about the same amount of belly fat, about 15%.
Although the participants indicated a variety of sleep problems, no issue stood out as being the most common, so the researchers analyzed a composite score, which reflects overall sleep health. What they found was that both groups improved their overall sleep score by about 20% with no differences between the groups.
November 19, 2012
Vets & OSA
An increasing concern in the medical community is that a growing number of veterans are suffering from obstructive sleep apnea (OSA).
According to the U.S. Department of Veterans Affairs (VA), one out of every five war veterans has been diagnosed with OSA -- compared with only five out of 100 civilians in the general population. And between 2008 and 2010, the number of veterans who received medical benefits related to sleep apnea grew by 61%, from 39,145 cases in 2008 to 63,118 cases in 2010.
Why do war veterans suffer from sleep apnea more than non-war veterans and civilians? Some VA physicians thinik it's due to the high number of repeat deployments to Iraq and Afghanistan -- soldiers are being exposed to higher levels of dust, smoke, stress and violence.
But what is at the center of this connection between war, OSA and other related conditions, such as daytime sleepiness, memory loss, a decrease in work productivity, obesity, heart disease, diabetes, and hypertension? Researchers at the Wayne State University School of Medicine are beginning to study this in depth.
Since the mid-2000s, WSU researchers have been studying 145 American immigrants who left Iraq before the 1991 Gulf War and 205 who fled Iraq after the Gulf War began.
All of these immigrant lived in the Detroit area at the time, and were asked about "socio-demographics, pre-migration trauma, how they rated their current health, physician-diagnosed and physician-treated OSA and any somatic and psychosomatic disorders.
The study's lead investigator, Bengt Arnetz, M.D., Ph.D., M.P.H., School of Medicine professor of occupational and environmental health and deputy director of the Institute of Environmental Health Sciences at Wayne State, indicated:
"It may be the stress of war that leads to fractured sleep, and that no one had explored this possible link before, although basic research suggests it as plausible."
The results of the study are published in the October 2012 issue of Psychosomatic Medicine in the article "Obstructive Sleep Apnea, Post-Traumatic Stress Disorder, and Health in Immigrants." The research showed that those who left Iraq after the war began and suffered from mental disorders such as PTSD and depression and self-rated their physical health as worse than their actual health were 43 times more likely than pre-Gulf War immigrants to report OSA and later develop major chronic health issues, such as cardiovascular disease.
November 12, 2012
The Cost of OSA
Researchers at Universitas Bergensis recently reported that sleep problems such as insomnia and sleep apnea are costing billions in terms of making people less productive at work and leading to serious accidents.
According to the research, about 10% of the population in the United States suffer from insomnia. Insomnia can cause people to lose hours of sleep, wake up intermittently throughout the night, and make them feel tired and restless in the morning.
The researchers stated that sleep apnea effects 4-5% of the population. Those who have sleep apnea cannot breathe for up to 50 seconds at varying intervals throughout the night, which can be difficult for the heart and makes a person sleep uncomfortably. Also, individuals with sleep apnea have been known to have an elevated risk for cardiovascular disease like hypertension and stroke.
Apart from sleep apnea, loss of sleep can cause car accidents, per the study Drugs used to help sedate drivers could cause them to feel not as rested during the day. Sleep medication is often just a short-term solution, with individuals losing deep sleep over a longer period of time.
A recent study conducted in the United States found that annual workplace losses due to insomnia amounted to $63.2 billion. From this amount, 33% was related to absence from work and 67% was associated with a loss of productivity at work.
Sleep issues also relate to other chronic diseases. According to the U.S. Centers for Disease Control and Prevention (CDC), insufficient sleep can lead to a variety of chronic diseases that can cause premature death and illness.
For one, researchers have discovered that lack of sleep is correlated with an elevated risk for the development of Type 2 diabetes. Levels of Hemoglobin A1c, a biomarker for blood sugar, can become affected by the amount of sleep and quality of sleep. As such, improving sleep duration and quality could be related to boosting blood sugar control for people with Type 2 diabetes.
Secondly, obesity has been found to be linked to short sleep duration. Studies have found that extra weight is related to short sleep duration for people of all ages, but especially children. As such, sleep for children is important in helping to shape their brain development and the part of the brain that manages appetite and energy expenditure.
Finally, sleep is connected to depression and recent studies have shown that symptoms of depression may be reduced if sleep apnea has been correctly treated.
November 5, 2012
Findings presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, show that asking someone whether they've been elbowed by a partner for snoring or stopping breathing while sleeping is a sign of... sleep apnea.
The findings are based on 124 people who were tested at a sleep disorders lab. They were asked whether they've ever been elbowed or poked due to their snoring, or elbowed or poked because they'd stopped breathing during sleep. Then, they were tested for OSA.
Researchers recorded participants' scores on the apnea–hypopnea index (AHI), which is a measure of the severity of a person's sleep apnea and is determined by how many times a person has a sleep apnea "event" per hour. According to the American Sleep Apnea Association, having an AHI between 5 and 15 (meaning there were 5 to 15 events in an hour) indicates mild sleep apnea; an AHI of 15 to 30 is moderate sleep apnea; and an AHI of 30 or higher is severe sleep apnea.
The researchers discovered that a person is nearly four times more likely have an AHI score greater than 5 (indicating at least mild sleep apnea) if they said that they've been woken up by a partner for their snoring.
And the likelihood of a person having an AHI score greater than 5 was more than 6 times higher if a person indicated that they'd been woken up by a partner for having an apneic spell (when a person stops breathing during sleep).
October 29, 2012
25% of Israeli Men May Suffer from OSA
One-quarter of the Israeli men assessed in a recent study suffered from sleep apnea, according to Israel's Medical Institute for Road Safety.
The average age of those tested was only 28, and other research literature on the subject shows that some 5% of adults in this age group suffer from severe sleep apnea.
Of the 204 men who completed all the tests in the Israeli study, 50 were found to suffer moderate to severe sleep apnea. All the subjects were men in the process of obtaining a license to drive a public vehicle, truck or ambulance.
The findings, which were published this month in the Journal of Occupational and Environmental Medicine, also described a questionnaire that was included about the license applicants' sleep habits as well as results from home apnea-testing kits.
Applicants found to suffer from sleep apnea can still get a license to drive a public vehicle if the problem is mild or improves with treatment, indicated Joseph Ribak, the director of the medical institute.
"When the case is severe, the driver will be given a therapeutic mask to wear at night, and he must present the institute with a printout from the equipment that shows he is using it," said Ribak. "When breathing parameters decline to an acceptable level, he can receive his public vehicle license."
In Israel, not all candidates for public vehicles or truck licenses are required to undergo testing - only those whose doctors report to the institute that they suffer from breathing problems that require treatment.
The study is set to be expanded to 180 more men in the process of obtaining their public vehicle or truck license. The goal of the expanded study is to formulate a short questionnaire based on risk factors identified in the research group, so as to identify other drivers who may need treatment.
October 22, 2012
OSA & Blood Pressure Drop
In men with obstructive sleep apnea and preexisting systemic hypertension or type 2 diabetes, positive airway pressure (PAP) is associated with a significant and sustained reduction in both systolic and diastolic blood pressure, per research published in the Oct. 15 issue of the Journal of Clinical Sleep Medicine.
To assess the effectiveness of PAP treatment on clinical BP and diabetes control measures, Bharati Prasad, M.D., of the University of Illinois at Chicago and colleagues conducted a retrospective cohort study involving 221 male veterans with a new diagnosis of OSA who initiated PAP treatment.
The researchers identified sustained independent effects of OSA treatment on systolic and diastolic BP, after adjustment for potential confounders, at 3-6 months and 9-12 months after treatment. OSA treatment was not associated with changes in diabetes control measures.
"OSA treatment lowers blood pressure in a clinical population of men with hypertension. This study extends the known efficacy to real-world effectiveness of OSA management on hypertension," the authors penned. "Prospective effectiveness research examining changes in cardiovascular outcomes with treatment interventions for OSA is necessary to confirm these findings, to identify traits associated with a positive therapeutic response, and to inform clinical practice."
October 15, 2012
Taking Sleeping Remedies Without Advice Increases Health Risks
Research from the Royal Pharmaceutical Society indicates that 51% of people with insomnia have diagnosed themselves with the condition and bought sleeping remedies without seeking advice from a health professional first. This could potentially make their health at risk as insomnia is often the result of an underlying physical or mental health problem.
When questioned, some 30% of individuals with insomnia admitted they had taken sleeping remedies for longer than a month without getting advice, including 14% who had taken them for more than 6 months. A further 18% could not recall how long they had taken the remedy.
The study indicated that there's a risk of over-using sleeping remedies. The research postulated that they can be effective for short-term treatment of mild insomnia but perhaps should not be taken for long periods without advice because they can hide a serious health problem, which could get worse if it remains untreated.
October 8, 2012
Sleep Apnea & Truckers: Lack of Disclosure Leads to Driver Fatigue
A recent study looked at a troubling cause of driver fatigue: failing to report symptoms of sleep apnea because truckers are worried about losing their jobs. While truck drivers face strict hours-of-service rules and other trucking safety regulations to allow them the appropriate amount of rest, those measures are meaningless if drivers are not actually getting adequate sleep during their down time.
The study, authored by the sleep lab of the University of Basel in Switzerland, which is dedicated to respiratory medicine advocacy, discovered that truck and bus drivers with sleep apnea who participated in a controlled study radically underreported their level of daytime sleepiness when compared to other participants. The reason, according to the lead author is that commercial drivers are playing down their levels of sleepiness for fear of losing their jobs.
Individuals who suffer from sleep apnea wake up frequently because of breathing disruptions, and the resulting sleep loss can lead to daytime headaches and drowsiness. When a fatigued driver is hauling tons of freight behind a powerful semi tractor, the margin for error is very narrow and the risks to other drivers are signifcant.
October 1, 2012
Snoring Without OSA Not Risky
A new study by researchers from Australia and published in the journal Sleep indicates that objectively measured snoring, without more serious sleep apnea, doesn't increase mortality or cardiovascular disease.
Previous studies from the same team of researchers had established that sleep apnea increases mortality risk but until now, it was not clear if snoring by itself increases the risk of cardiovascular disease.
The project conducted by the Woolcock Institute of Medical Research has revealed that people who snore for most part of the night were at no higher risk of death over the next 17 years, when compared to those people who snored only during 12% or less of the night or did not snore at all.
For the study, the researchers studied a sample of 380 people, consisting of members from both genders from the highly influential Busselton Health Study from Western Australian. The participants of the study underwent investigation with a home sleep apnea and snoring monitoring device in 1990.
The current analysis helps establish the accuracy of some clinic or hospital-based studies which claim that there are long-term risks of snoring alone, and this might increase the risk of stroke.
The authors mentioned that the public needs to be aware of the potential impact of snoring on their health and quality of life. There are effective treatments available and it is important to carry on a detailed medical assessment in order to find the best treatments.
September 24, 2012
OSA & Surgical Weight Loss
Obese patients with obstructive sleep apnea (OSA) who lose significant weight through surgery may still not be cured of their sleep disorder, study findings from the Baker IDI Heart and Diabetes Institute (Melbourne, Australia) indicate.
The research team found that despite bariatric surgery for weight loss resulting in a significantly greater mean weight loss among obese patients with OSA than conventional therapy, this did not necessarily translate into a significantly greater reduction in OSA severity.
"Our study did confirm that weight loss is associated with an improvement in AHI [apnea-hypopnea index], but we found great variability in the individual effect," the researchers explain in JAMA.
"The pattern of improvement in AHI suggests that much of the benefit is associated with mild-to-moderate weight loss, with limited additional benefit with further weight loss."
The researchers compared bariatric surgery and a conventional weight loss program using very low-calorie diets in 60 obese (body mass index >35 and <55 kg/m3) people who had been diagnosed with OSA (AHI of at least 20 events per hour) in the previous 6 months.
Two years later, surgery patients had lost a significant 22.7 kg more than conventional weight loss patients, at an average of 27.8 versus 5.1 kg.
This weight loss was associated with an improvement in AHI in both groups, decreasing by an average 25.5 events/hour among surgery patients and 14.0 events/hour among conventional weight loss patients.
The two groups did not differ with regard to continuous positive airway pressure (CPAP) therapy adherence or mean pressure delivered.
September 17, 2012
Half of Women May Have OSA
Some 50% of the 400 women given overnight sleep tests in a new Swedish study turned out to have mild-to-severe sleep apnea.
In the random population sample of adult women who answered a questionnaire and were monitored while sleeping, half experienced at least five episodes an hour when they stopped breathing for longer than ten (10) seconds, which is the minimum definition of sleep apnea.
Among women with hypertension or who were obese, which are two risk factors for sleep apnea, the numbers were even higher, reaching 80-84% of women.
Sleep apnea is linked to a higher risk of stroke, heart attack and early death. One recent study also found that women who have sleep apnea are more likely to develop memory problems and dementia.
The researchers in Sweden chose 400 women between the ages of 20 and 70 from a larger population sample of 10,000, and asked them to sleep overnight at home with sensors attached to their bodies. The sensors measured heart rate, eye and leg movements, blood oxygen levels, air flow and brain waves.
Each apnea event was defined by at a least a 10-second pause in breathing accompanied by a drop in blood oxygen levels.
Women who had an average of five or more of these events during each hour of sleep were considered to have sleep apnea.
The study, which was funded by the Swedish Heart Lung Foundation, found that apnea became more common in the older age groups.
Among women aged 20-44, some 25% had sleep apnea, compared to 56% of women aged 45-54 and 75% of women aged 55-70.
Young said these numbers are higher than her own estimate, but that's likely because she used a more strict definition of sleep apnea than Franklin's group.
Severe sleep apnea, which involves more than 30 breathing disruptions per hour, was far less common.
Just 4.6% of women 45-54 and 14% of women 55-70 had severe cases. Among women of all ages with hypertension, 14% had severe sleep apnea, and among women who were obese, 19% had severe apnea.
September 10, 2012
New Sleep Apnea Study
According to a new study, people with sleep apnea could be twice as likely to die of cancer as those who sleep soundly. The findings: OSA sufferers with the highest oxygen deprivation were at the greatest risk. The sleep disorder is already linked to obesity, heart disease, diabetes, daytime fatigue and high blood pressure.
Spanish researchers studied more than 5,600 patients from seven sleep clinics, looking at the duration for which oxygen in a person’s blood dropped below 90% at night – a measure called the hypoxemia index. The patients, none of whom had a cancer diagnosis when the study began, were followed for a period of seven years.
Researchers found that the greater the extent of hypoxemia, or oxygen depletion, the more likely a person would be to receive a cancer diagnosis during the study period. Dr Miguel Angel Martinez-Garcia, of La Fe University and Polytechnic Hospital in Valencia, Spain, indicated that the cancer risk increased with the time spent without oxygen.
Severely affected sufferers who spent more than 14% of their sleep with levels of oxygen saturation below 90% had twice the risk of fatal cancer than those without sleep apnea.
The findings were revealed September 6th, 2012 at the European Respiratory Society Congress in Vienna.
September 3, 2012
OSA & Poverty
On August 28, 2012, this illuminating article ran in the Huffington Post: "Sleep Apnea and Poverty: How Socioeconomics Impacts Proper Diagnosis And Treatment." The authors are Dr. Susan Redline and Dr. Michelle Williams.
Here's a clip, and the whole article is here--
A wide range of serious health problems disproportionately afflict individuals from economically disadvantaged backgrounds. These conditions, which reduce quality of life and shorten lifespan, include heart disease, stroke, diabetes, asthma, and cancer. Other health problems commonly associated with poverty are obesity, pregnancy complications, increased infant mortality, HIV/AIDS and dental disease. The U.S. Department of Health and Human Service's "Healthy People 2020," which sets 10-year national objectives for improving the health of the nation, has prioritized the need to close the gap in these "health disparities." There are numerous potential targets for improving the health of low-income people, such as improving nutrition and access to health care. In addition, accumulating research points to a need to improve sleep as means for improving alertness and daily functioning, as well as for reducing the risk of developing chronic diseases such as diabetes and heart disease.
August 27, 2012
Parkinson's & Sleep
Patients with Parkinson's disease performed markedly better on a test of working memory after a night's sleep, and sleep disorders can interfere with that benefit, researchers have shown in an article published last week in the journal Brain.
While the conventional symptoms of Parkinson's disease include tremors and slow movements, Parkinson's can also affect someone's memory, including "working memory." Working memory is the ability to temporarily store and manipulate information, rather than simply repeat it. The use of working memory is essential in planning, problem solving and independent living.
The findings highlight the importance of addressing sleep disorders in the care of patients with Parkinson's, and intimate that working memory capacity in patients with Parkinson's potentially can be improved with training. The results also have implications for the biology of sleep and memory.
The performance boost from sleep was linked with the amount of slow wave sleep, or the deepest stage of sleep. Several studies have reported that slow wave sleep is important for synaptic plasticity, the ability of brain cells to reorganize and make new connections.
Sleep apnea, the disruption of sleep caused by obstruction of the airway, interfered with sleep's effects on memory. Patients in the study who showed signs of sleep apnea, if it was severe enough to lower their blood oxygen levels for more than five minutes, did not see a working memory test boost.
In this research study, participants took a "digit span test," in which they had to repeat a list of numbers forward and backward. The test was conducted in an escalating fashion: the list grows incrementally until someone makes a mistake. Participants took the digit span test eight times during a 48-hour period, four during the first day and four during the second. In between, they slept. Repeating numbers in the original order is a test of short-term memory, while repeating the numbers in reverse order is a test of working memory.
54 study participants had Parkinson's disease, and 10 had dementia with Lewy bodies: a more advanced condition, where patients may have hallucinations or fluctuating cognition as well as motor symptoms. Those who had dementia with Lewy bodies saw no working memory boost from the night's rest. As expected, their baseline level of performance was lower than the Parkinson's group.
Participants with Parkinson's who were taking dopamine-enhancing medications saw their performance on the digit span test move up between the fourth and fifth test. On average, they could remember one more number backwards. The ability to repeat numbers backward improved, even though the ability to repeat numbers forward did not.
Patients had to be taking dopamine-enhancing medications to see the most performance benefit from sleep. Patients not taking dopamine medications, even though they had generally had Parkinson's for less time, did not receive as much of a performance benefit. This may reflect a role for dopamine, an important neurotransmitter, in memory.
August 20, 2012
OSA & Migraines
Patients who wake with headaches are three times more likely than the general population to be heavy snorers or to experience obstructive sleep apnea (OSA). [SOURCE: Smith H, Comella C, Hogl B. Sleep Medicine. New York: Cambridge University Press. 2008. pg 165-166.]
Patients with migraines tend to report longer-lasting, more severe headaches. These also, along with cluster headaches, can be caused by the hypoxemia and hypercapnia that occurs from obstructed airways during sleep.
Myriad sleep disorders can cause headaches. These include bruxism, parasomnias, insomnia, REM sleep disorders and sleep-phase related disorders. Bruxism is a sleep disorder in which the headache pain is a result of an increase in temporomandibular joint stress and muscle contraction.
Physicians will typically order a test for OSA if the patient is waking with headaches. When migraine headaches are not controlled well with medication, there exists the possibility of a comorbid sleep disorder.
Migraine sufferers are typically advised to practice good sleep hygiene, as it will improve the frequency and duration of their headaches. [SOURCE: Principles and Practice of Sleep Medicine. Fourth Edition. Philadelphia: Elsevier Saunders, 2005. pg 879-888.]
Migraine headaches occur more often during REM sleep, so the conventional wisdom is to avoid the urge to sleep late which promotes REM sleep. Other migraine triggers during sleep include sleep deprivation, alcohol, stress and trauma.
August 13, 2012
Bariatric Surgery & OSA
A Rhode Island Hospital researcher has found that the majority of bariatric surgery patients being treated for obesity have clinically significant obstructive sleep apnea (OSA), but report fewer symptoms than other sleep disorders patients. The study by Katherine M. Sharkey, M.D., Ph.D., of Rhode Island Hospital is published in the journal Sleep and Breathing.
OSA can be caused by many factors, including obesity. In fact, obese patients have a high prevalence of this sleep disorder, and ultimately are at a higher risk for numerous negative health outcomes including congestive heart failure, coronary artery disease, hypertension and stroke, as well as post-operative respiratory complications and increased perioperative morbidity and mortality following bariatric surgery.
The study identified 269 patients who had sleep evaluations prior to bariatric surgery. Some 60% of the study sample had moderate or severe OSA that had not been diagnosed prior to the patients’ evaluation in anticipation of bariatric surgery. Despite the high prevalence of sleep apnea, the bariatric patients reported significantly fewer symptoms than typical OSA patients.
“The lack of symptoms of sleep apnea in this population means that we must be even more vigilant in identifying sleep apnea prior to bariatric surgery in order to reduce the risk of complications,” Dr. Sharkey said.