Category Archives: Obstructive Sleep Apnea

Undiagnosed Sleep Apnea Linked to Resistant Hypertension in African Americans

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MedicalResearch.com Interview with:

Dayna A. Johnson PhD Department of Epidemiology Emory University Atlanta, GA

Dr. Johnson

Dayna A. Johnson PhD
Department of Epidemiology
Emory University
Atlanta, GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are several studies that have determined that African Americans have the highest prevalence of hypertension and are the most likely to have uncontrolled hypertension compared to other racial/ethnic groups. We were interested in studying whether sleep apnea contributed to hypertension control among African Americans.

We found that participants with sleep apnea were more likely to have resistant hypertension than those without sleep apnea. In particular, individuals with severe sleep apnea had the highest risk of resistant hypertension. Most of the participants with measured sleep apnea were undiagnosed (96%).  Continue reading →

Tonsillectomy Often Done When Not Indicated (and vice versa!)

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MedicalResearch.com Interview with:

A pair of tonsils after surgical removal Wikipedia image

A pair of tonsils after surgical removal
Wikipedia image

Tom Marshall, MSc, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham, Birmingham, UK

MedicalResearch.com: What is the background for this study?  

Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea).

Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems.

Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.

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Obstructive Sleep Apnea: Short Apneas Linked To Increased Mortality

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MedicalResearch.com Interview with:
"Snoring away" by Doug Ford is licensed under CC BY 2.0Matthew P Butler, PhD
Assistant Professor, Oregon Institute of Occupational Health Sciences
Assistant Professor, Department of Behavioral Neuroscience
Oregon Health & Science University
Portland, OR 97239

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obstructive sleep apnea (OSA) is associated with heart disease and mortality, but how OSA does this is not well understood. We are therefore looking for sub-phenotypes within OSA that will help us predict who is at greatest risk.

Current diagnosis of OSA is made on the basis of the apnea-hypopnea index (AHI – the number of respiratory events per hour of sleep). But the AHI is not a very good predictor of future mortality.

We tested the hypothesis that the duration of events (how long the breathing interruptions are) would predict risk. We found that those with the shortest breathing interruptions had the highest risk of dying, after accounting for other conditions like age, gender, race, and smoking status.  Continue reading →

People With Sleep Apnea At Increased Risk of Gout

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MedicalResearch.com Interview with:

Dr M Blagojevic-Bucknal Senior Lecturer in Statistics Arthritis Research UK Primary Care Centre Research Institute for Primary Care & Health Sciences Keele University Staffordshire UK

Dr. Blagojevic-Bucknal

Dr M Blagojevic-Bucknal
Senior Lecturer in Statistics Arthritis Research UK Primary Care Centre
Research Institute for Primary Care & Health Sciences
Keele University Staffordshire UK 

MedicalResearch.com: What is the background for this study?

Response: Evidence suggests that elevated serum uric acid levels, the cause of gout, are also frequently identified in patients with sleep apnoea However, despite prevalent hyperuricaemia in patients with sleep apnoea, shared risk factors with gout of obesity and alcohol consumption, and research identifying the associations between gout and other co-morbidities, few studies have considered the possibility of an association between sleep apnoea and gout in short and long term.

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Structural Brain Changes in Sleep Apnea Linked to Cognitive Decline

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MedicalResearch.com Interview with:
“Woman sleeping” by Timothy Krause is licensed under CC BY 2.0Nathan E. Cross PhD, first author
School of Psychology.
Sharon L. Naismith, PhD, senior author
Leonard P Ullman Chair in Psychology
Brain and Mind Centre
Neurosleep, NHMRC Centre of Research Excellence
The University of Sydney, Australia 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Between 30 to 50% of the risk for dementia is due to modifiable risk factors such depression, hypertension, physical inactivity, obesity, diabetes and smoking.

In recent years, multiple longitudinal cohort studies have observed a link between sleep apnoea and a greater risk (1.85 to 2.6 times more likely) of developing cognitive decline and dementia.  Furthermore, one study in over 8000 people also indicated that the presence of obstructive sleep apnoea (OSA) in older adults was associated with an earlier age of cognitive decline, and that treatment of OSA may delay the onset of cognitive impairment.

This study reveals important insights into how sleep disorders such as OSA may impact the brain in older adults, as it is associated with widespread structural alterations in diverse brain regions. We found that reduced blood oxygen levels during sleep are related to reduced thickness of the brain’s cortex in both the left and right temporal areas – regions that are important in memory and are early sites of injury in Alzheimer’s disease. Indeed, reduced thickness in these regions was associated with poorer ability to learn new information, thereby being the first to link this structural change to memory decline. Continue reading →

CPAP Improved Sexual Quality of Life for Women

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MedicalResearch.com Interview with:

“The new CPAP machine” by Bryan Alexander is licensed under CC BY 2.0

One CPAP model
Image by Bryan Alexander

Sebastian M. Jara, MD
Resident Physician & Research Fellow
Department of Otolaryngology – Head & Neck Surgery
University of Washington Affiliated Hospitals 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Sleep apnea is a common disorder associated with numerous health consequences and reduced quality of life. There is growing evidence that sleep apnea also affects sexual quality of life and that treatment for sleep apnea, with CPAP (continuous positive airway pressure), may improve sexual quality of life. The goal of this study was to evaluate the impact of long-term CPAP therapy on sexual quality of life in a group of men and women with sleep apnea.

Our study included 182 men and women with newly diagnosed obstructive sleep apnea, each of whom were prescribed a CPAP. Subjects completed a quality of life survey, which included questions on sexual quality of life, at their initial clinic visits and again one year later. Changes in sexual quality of scores over time were then compared between CPAP users and non-users.

Among the subjects, 72 used a CPAP nightly and 110 did not. When looking at all subjects, an overall improvement in sexual quality of life was observed in subjects that used their CPAP compared to subjects that did not, after accounting for several factors that can also affect sexual quality of life. When subgroup analysis was performed, a large improvement in sexual quality of life was noticed for women in the study. In contrast, men in the study experienced little-to-no improvement in sexual quality of life.

MedicalResearch.com: What should readers take away from your report?

Response: These findings add to a large body of evidence that CPAP improves overall health and quality of life, in both men and women with sleep apnea. Because sleep apnea is more common men, there are fewer studies, especially those assessing sexual dysfunction, in women. However, there’s growing recognition that women, too, are affected and can benefit from CPAP use. Our findings demonstrate that improved sexual quality of life is one of the many health benefits that comes with CPAP treatment for women.While this study showed no improvements in sexual quality of life for men, CPAP has been shown to have numerous other health benefits in men and use should still be encouraged. Our hope is that the findings of this study will help motivate patients of both sexes who sleep poorly to seek evaluation for sleep apnea as treatment can have a wide-range of health benefits, including improved sexual quality of life. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: In future studies, it will be important to study more comprehensive measures of sexual quality of life in sleep apnea patients. This will include both a more extensive assessment of sexual quality of life in patients themselves and effects on their bed partners. Additionally, it will be important to test the effects of other sleep apnea treatments, such as surgery. Although CPAP is the first-line treatment for sleep apnea, it can be cumbersome to wear and might adversely affect intimacy and sexual quality of life compared to other treatments. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: This study was funded by the National Institutes of Health. The authors of this study otherwise have no other funding, financial relationships, or conflicts of interest to disclose. 

Citation:

Jara SM, Hopp ML, Weaver EM. Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep ApneaFollow-up Study of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online May 24, 2018. doi:10.1001/jamaoto.2018.0485

 

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Sleep Apnea Increases Amyloid Load In Brain, A Hallmark of Alzheimer’s Disease

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MedicalResearch.com Interview with:

Ricardo S Osorio MD Center for Brain Health Department of Psychiatry Center of Excellence on Brain Aging NYU Langone Medical Center New York, NY 10016, USA

Dr. Osorio

Ricardo S Osorio MD
Center for Brain Health
Department of Psychiatry
Center of Excellence on Brain Aging
NYU Langone Medical Center
New York, NY 10016, USA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a study that was performed in a group of healthy normal elderly from the community that volunteered for studies on memory and aging.

The main findings were that sleep apnea was very common, in almost all cases undiagnosed, and that it was associated with a longitudinal increase in amyloid burden which is considered one of the hallmark lesions of Alzheimer’s disease

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Women With Severe Hot Flashes At Higher Risk of Obstructive Sleep Apnea

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MedicalResearch.com Interview with:
Stephanie S. Faubion, MD, FACP, NCMP, IF
Director, Executive and International Medicine
Director, Office of Women’s Health
Associate Professor of Medicine
Division of General Internal Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was used for this study investigating the association between vasomotor symptoms (hot flashes and night sweats) and risk for obstructive sleep apnea, a common and underdiagnosed sleep disorder in women which is associated with increased cardiovascular risk.

We found that Women who had severe or very severe hot flashes or night sweats were more likely to be at increased risk for obstructive sleep apnea.  This association held even after adjusting for age, body mass index, smoking and hypertension, such that the odds of women having intermediate /high risk for obstructive sleep apnea were 1.87 times higher for those with severe/very severe hot flashes/night sweats compared to those with less severe symptoms.  We decided to analyze the group of women with normal body mass index, and indeed, this finding was still significant in the lean group of women.

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Obstructive Sleep Apnea May Accelerate Alzheimer’s Disease

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MedicalResearch.com Interview with:

O. Michael Bubu, M.D., M.P.H., C.P.H Wheaton College

Dr. Bubu

O. Michael Bubu, M.D., M.P.H., C.P.H
Wheaton College

MedicalResearch.com: What is the background for this study?

  • Obstructive Sleep Apnea (OSA) and Alzheimer’s disease (AD) are both chronic disease conditions that are highly prevalent, cause significant morbidity and mortality to those afflicted, and have an enormous socio-economic impact. Recent human and animal studies describe associations between Sleep Disordered Breathing (SDB) and Alzheimer’s Disease (AD). However, whether OSA accelerates longitudinal increases in amyloid (Aβ) burden in MCI patients is presently unclear.
  • In this study, we examined the effect of Obstructive Sleep Apnea (OSA) on longitudinal changes in brain amyloid deposition, and Alzheimer’s disease (AD) Cerebrospinal fluid (CSF) biomarkers including CSF beta-amyloid 42 peptide (Aβ-42), CSF TAU protein, CSF phosphorylated TAU protein (PTAU) in Cognitive Normal (CN), Mild Cognitive Impairment (MCI) and AD elderly. Brain amyloid (Aβ) burden, CSF Abeta42 and tau proteins are biomarkers (measurable substances whose presence are indicative) of AD-associated pathologic changes in the brain.
  • Data from 1639 subjects (516 CN, 798 MCI and 325 AD, mean ages = 74.4 ± 5.8; 73.4 ± 7.4 and 75.1 ± 7.8 respectively), in the Alzheimer’s disease Neuroimaging Initiative (ADNI) database was used. OSA was self-reported and participants were labeled OSA positive, or OSA negative (mean ages = 72.3 ± 7.1; and 73.9 ± 7.3 respectively). Statistical analyses were conductedto examine whether OSA positive compared to OSA negative participants experienced significant differences in the rate of change of AD biomarkers over time (mean = 2.52 ± 0.51 years) in each group (CN, MCI and AD). Both OSA positives and negatives were similar in age, APOE e4 status, and history of cardiovascular disease. The final models controlled for sex, body mass index (BMI), and Continuous Pulmonary Airway Pressure (CPAP) use.

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Drug-Induced Sleep Endoscopy With Cardiorespiratory Monitoring For OSA

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MedicalResearch.com Interview with:

Dr. Simone Baiardi MD Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna

Dr. Simone Baiardi

Dr. Simone Baiardi MD
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum
University of Bologna

MedicalResearch.com: What is the background for this study?

Response: Drug-induced sleep endoscopy (DISE) is an useful tool for studying the upper airway dynamic in patients with obstructive sleep apnea syndrome (OSAS), and it’s crucial for the therapeutic choice (especially for non ventilatory treatment, such as surgery). The main limits of DISE are the lack of standardization of procedure and the low inter-observer reliability among non-experienced ENT surgeons.

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Obstructive Sleep Apnea More Common In Obese Adolescents With Enlarged Tonsils

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MedicalResearch.com Interview with:

Ron B. Mitchell, MD Professor and Vice Chairman, Department of Otolaryngology, Head and Neck Surgery William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas Dallas, TX 75207

Dr. Ron Mitchell

Ron B. Mitchell, MD
Professor and Vice Chairman,
Department of Otolaryngology, Head and Neck Surgery
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children’s Medical Center Dallas
Dallas, TX 75207

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obstructive Sleep Apnea (OSA) has not been widely studies in adolescents. This is one of a few studies that was targeted at 12-17 year olds who were referred for a sleep study for possible OSA. The study included 224 adolescents (53% male). aged 12 to 17 years. The mean BMI was 33.4 and most were either Hispanic or African American (85.3%). A total of 148 (66.1%) were obese. Most adolescents referred for a sleep study (68%), had  Obstructive Sleep Apnea. Normal-weight adolescents were least likely to have OSA at 48%, while obese children were most likely at 77%. Severe OSA was most likely in obese males with tonsillar hypertrophy.

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Obstructive Sleep Apnea: Task Force Finds Insufficient Evidence To Screen All Adults

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MedicalResearch.com Interview with:

Dr. Alex Krist, MD MPH Task Force member Associate Professor Fairfax Family Medicine Residency Co-director, Ambulatory Care Outcomes Research Network Virginia Commonwealth University

Dr. Alex Krist

Dr. Alex Krist, MD MPH
Task Force member
Associate Professor
Fairfax Family Medicine Residency
Co-director, Ambulatory Care Outcomes Research Network
Virginia Commonwealth University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea.

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Study Finds CPAP Improved Quality of Life But Did Not Reduce Cardiovascular Risk

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MedicalResearch.com Interview with:
Prof. Craig Anderson, PhD
Professor of Stroke Medicine and Clinical Neuroscience
Medicine, The George Institute for Global Health
University of Sydney

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wished to prove whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP ) can modify the risk of cardiovascular disease. The is a lot of association data from epidemiological and clinical studies but no large scale international clinical trials assessing the effects of CPAP on the prevention of serious cardiovascular events like heart attack and stroke.

Our study in nearly 3000 adults with prior heart attack or stroke and moderate to severe obstructive sleep apnea showed that CPAP treatment did not prevent recurrent cardiovascular events or major cardiovascular risk factors. However CPAP did improve wearers’ sense of wellbeing, mood and work productivity.

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Study Raises Concerns About Sales of Secondhand CPAP Devices

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MedicalResearch.com Interview with:

Ken Kunisaki, MD, MS Associate Professor of Medicine Minneapolis Veterans Affairs Health Care System and University of Minnesota

Dr. Kunisaki

Ken Kunisaki, MD, MS
Associate Professor of Medicine
Minneapolis Veterans Affairs Health Care System and University of Minnesota and

Roxanne Prichard, PhD Associate Professor of Psychology and Neuroscience University of St. Thomas

Dr. Prichard

Roxanne Prichard, PhD
Associate Professor of Psychology and Neuroscience
University of St. Thomas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: CPAP devices, or continuous positive airway pressure devices, are used to treat obstructive sleep apnea, a common condition that causes people to intermittently stop breathing during their sleep. This leads to poor sleep quality and often results in symptoms like excessive sleepiness in the daytime. In the United States, CPAP devices are classified by the Food and Drug Administration as Class II medical devices with possible risks; their sale requires a medical prescription. We were aware of online advertisements for secondhand, used CPAP machines, but we have not seen publications that have analyzed this practice.

Once a week, our research team monitored online advertisements for secondhand CPAP devices on Craigslist.org in 18 U.S. cities and areas over a one-month period. During that time, we found 270 advertisements, most of which did not describe who previously had used the device or why it was being sold. Only 5 of the advertisements mentioned anything about the legal requirements of a prescription and 61 percent of the devices included a used mask without information about its age or how it was cleaned.

CPAP devices create air pressure and attach to a nose or face mask that delivers that pressure to a patient’s airway, thereby keeping him or her breathing during sleep. The amount of air pressure delivered by the devices is adjusted for each patient and usually is determined by a medical exam that includes an overnight stay in a laboratory. Our study found that most of the Craigslist advertisements failed to mention the devices’ pressure settings—settings that were prescribed for the original owners.

The average price for a CPAP device listed on Craigslist was $291, much less than the $600 to $2,000 cost of a new device.

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Truck Drivers With Sleep Apnea Who Don’t Use Their CPAP Have More Preventable Crashes

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MedicalResearch.com Interview with:

Stefanos N. Kales, MD, MPH, FACP, FACOEM Associate Professor, Harvard Medical School & Harvard TH Chan School of Public Health Director, Occupational Medicine Residency Division Chief OEM, Cambridge Health Alliance

Dr. Stefanos Kales

Stefanos N. Kales, MD, MPH, FACP, FACOEM 
Associate Professor, Harvard Medical School &
Harvard TH Chan School of Public Health
Director, Occupational Medicine Residency
Division Chief OEM, Cambridge Health Alliance

MedicalResearch: What is the background for this study?

Dr. Kales: Up to 20% of all large truck crashes are due to drowsy or fatigued driving, which would account for almost 9,000 fatalities and up to 220,000 serious injuries. OSA is the most common medical cause of excessive daytime sleepiness or fatigue, and has been linked with negative impacts on attention, working memory, vigilance, and executive functioning. Past studies primarily of passenger car drivers have linked untreated OSA with a several-fold increased risk of motor vehicle accidents. They have also shown that effective treatment with CPAP reduces this risk close to that of unaffected drivers.

Although commercial truck drivers undergo a biennial examination to determine their medical fitness to safely operate a vehicle, there are currently no mandatory standards for OSA screening or diagnosis, in part because there have been no large-scale studies evaluating the crash risk of commercial drivers diagnosed with OSA.

Our study examined the results of the first large-scale employer program to screen, diagnose, and monitor OSA treatment adherence in the U.S. trucking industry  Continue reading →

Vitamin D Level Likely Has No Impact on Sleep Apnea

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Ken M. Kunisaki , MD Associate Professor of Medicine Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota

Dr. Kunisaki

MedicalResearch.com Interview with:
Ken M. Kunisaki , MD
Associate Professor of Medicine
Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Minnesota 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kunisaki : Obstructive sleep apnea (OSA) is a very common condition that is the result of recurrent complete or partial closure of the upper airway during sleep.  OSA leads to poor sleep quality and excessive daytime sleepiness.

A previous study suggested that OSA is more common in the winter, but there were no vitamin D measurements in that study, which seemed potentially relevant since many people have lower vitamin D levels in the winter, due to less sunlight exposure in the winter.  Several studies have also shown that people with low vitamin D levels have worse muscle function.  Since muscles are partially responsible for keeping the upper airway open during sleep, we wondered whether people with low vitamin D levels might have weaker upper airway muscles and therefore be more prone to having OSA.

In our study, we found that indeed, persons with OSA had lower vitamin D levels than those without OSA, but this was explained by obesity.  In other words, the low vitamin D levels seen in OSA patients is likely just a marker of obesity and not likely related to the presence or absence of OSA.
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Both CPAP and Mandibular Advancement Devices Improve Blood Pressure in Sleep Apnea

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Prof. Malcolm Kohler, MD Chair Respiratory Medicine Clinical Director Department of Pulmonology University Hospital of Zurich Zurich Switzerland

Dr. Kohler

MedicalResearch.com Interview with:
Prof. Malcolm Kohler, MD
Chair Respiratory Medicine
Clinical Director Department of Pulmonology
University Hospital of Zurich
Zurich Switzerland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kohler: CPAP and Mandibular Advancement Devices (MADs) have been shown to reduce symptoms of obstructive sleep apnea (eg sleepiness, see Bratton et al. Lancet Respir Med 2015). Whether this is also true for both treatments re blood pressure was not answerable from individual studies. Our metanalysis shows that both treatments have similar positive effects on blood pressure, the treatment effect of CPAP seems to be larger in patients with higher number of hours of nightly usage of CPAP.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kohler: Both treatments are effective not only in reducing symptoms of obstructive sleep apnea but also in reducing blood pressure. Mandibular Advancement Devices are to be considered as an alternative treatment to the more widely used CPAP, especially in patients who fail to adapt to CPAP treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kohler: The effects of other OSA treatment approaches (eg weight loss) on blood pressure and other clinically relevant outcomes should be evaluated in metanalyses.

Citation:

Dr. Malcolm Kohler (2015). Both CPAP and Mandibular Advancement Devices Improve Blood Pressure in Sleep Apnea 

Surgical Treatment An Option For Patients With Recalcitrant Sleep Apnea

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Dr-Soroush-Zaghi.jpg

Dr. Soroush Zaghi

MedicalResearch.com Interview with:
Soroush Zaghi, MD
Department of Head and Neck Surgery
David Geffen School of Medicine at UCLA
University of California, Los Angeles

MedicalResearch: What is the central message for clinicians and surgeons from your results?

Dr. Zaghi: Multiple studies from different practitioners and institutions agree that Maxillomandibular Advancement (MMA) is a highly effective surgical option for patients with obstructive sleep apnea who cannot tolerate positive pressure therapy and have not found success with other surgical procedures.

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Cost-Effective Clinical Pathway Determined Hospitalized Patients’ Risk of Sleep Apnea

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Sunil Sharma, M.D Associate professor of pulmonary medicine Sidney Kimmel Medical College at Thomas Jefferson UniversityMedicalResearch.com Interview with:
Sunil Sharma, M.D
Associate professor of pulmonary medicine
Sidney Kimmel Medical College at Thomas Jefferson University

Medical Research: What is the background for this study? What are the main findings?

Dr. Sharma: Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant cardiovascular implications. In this condition the patient may repeatedly quit breathing during sleep, sometimes hundreds of times, leading to loss of oxygen and frequent arousals throughout the night. OSA has been associated with high blood pressure, congestive heart failure, coronary artery disease, arrhythmias and stroke, among other conditions. While overall awareness is improving, the condition is under-recognized in hospitalized patients. Due to multiple co-morbid conditions these patients may be at higher risk for complications. Recent studies have also shown that early recognition of OSA in hospitalized patients may reduce readmission rates. In our study, we used a simple and cost-effective clinical pathway to determine high-risk patients. Of the 149 patient’s determined to be high risk by our protocol, 128 (87%) were confirmed with the diagnosis by a polysomnography (gold standard test). Furthermore, data derived from a simple and cost-effective oxygen measuring device (pulse-oximeter) was found to co-relate well with the polysomnography.  Continue reading →

Custom Oral Appliance Reduced Sleep Apnea and Restless Legs

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Marie Marklund, DDS senior lecturer Department of Odontology, Faculty of Medicine Umeå University SwedenMedicalResearch.com Interview with:
Marie Marklund, DDS senior lecturer
Department of Odontology, Faculty of Medicine
Umeå University
Sweden

MedicalResearch: What is the background for this study? What are the main findings?

Response: Snoring and obstructive sleep apnea are common in the population and these disorders continuously increase because of the ongoing obesity epidemic in many countries. Today, 34% of men and 17% of women in the US suffer from obstructive sleep apnea of all severities. Symptoms include daytime sleepiness, poor sleep quality, headache, insomnia and restless legs. In the longer term, a more severe sleep apnea is associated with serious consequences, such as hypertension, stroke, cancer, traffic accidents and early death.

Continuous positive airway pressure is a highly effective treatment for sleep apnea patients. Adherence problems, for instance from nasal stuffiness and claustrophobia reduces its effectiveness. An oral appliance holds the lower jaw forwards during sleep in order to reduce snoring and sleep apneas. This therapy has primarily been suggested for snorers and patients with mild and moderate sleep apnea. No previous placebo-controlled study has, however, evaluated this specific group of patients. Results from more severe sleep apnea patients have shown a good effect on sleep apneas. The effect of oral appliances on daytime symptoms is unclear. Symptomatic improvement is an important outcome for milder sleep apnea patients.

The primary aims of the present study were to study the effects on daytime sleepiness and quality of life of a custom-made, adjustable oral appliance in patients with daytime sleepiness and snoring or mild to moderate sleep apnea, i.e. the primary target group for this type of therapy. Secondary aims included the effects on sleep apnea, snoring and various other symptoms of sleep disordered breathing such as headaches and restless legs. We found that oral appliance therapy was effective in reducing sleep apneas, snoring and symptoms of restless legs. The apnea-hypopnea index was normal (<5) in 49% of patients using the active appliance and in 11% using placebo, with a numbers needed to treat of three. Daytime sleepiness and quality of life did not differ during active treatment and the placebo intervention. The patients experienced reduced headaches with active treatment, but the results did not differ from placebo. It was concluded, that a custom-made, adjustable oral appliance reduces obstructive sleep apneas, snoring and possibly restless legs. The efficacy on daytime sleepiness and quality of life was weak and did not differ from placebo in this group of patients. Continue reading →

CPAP For Sleep Apnea May Decrease Atrial Fibrillation Recurrence

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Dr. Larry Chinitz MD Professor of Medicine and Director, Cardiac Electrophysiology NYU Langone Medical CenterMedicalResearch.com Interview with:
Dr. Larry Chinitz MD
Professor of Medicine and Director, Cardiac Electrophysiology
NYU Langone Medical Center

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Chinitz: The treatment algorithms proposed currently for maintenance of sinus rhythm in patients with atrial fibrillation focus on use of anti-arrhythmic drugs and catheter ablation. Data available to evaluate the effect of modification of known adverse clinical factors on atrial fibrillation recurrence is scant.

Obstructive sleep apnea in a known factor associated with both new onset atrial fibrillation as well as its recurrence after catheter ablation. Through a meta-analysis of available data we found that use of continuous positive airway pressure in patients with sleep apnea was associated with a 42% relative risk reduction in recurrence of atrial fibrillation. This effect was similar across patient groups irrespective of whether they were medically managed or with catheter ablation.
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Too Much Time Spent Sitting, TV Viewing May Increase Sleep Problems

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Matthew Buman PhD Asst Professor SNHP Exercise & Wellness Arizona State UniversityMedicalResearch.com Interview with:
Matthew Buman PhD Asst Professor
SNHP Exercise & Wellness
Arizona State University

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Buman: A lack of physical activity is a known risk factor for insomnia, poor sleep, and obstructive sleep apnea. In addition to physical activity, sedentary behavior has emerged as an important behavior. Sedentary behavior is not just the lack of physical activity, but actually refers to the time someone spend sitting. This behavior has been shown to, independent of physical activity, be related to many poor health outcomes including cardiovascular disease, diabetes, and even premature death. This is the first study to examine whether there is a relationship between excess sitting and insomnia, poor sleep, and risk for obstructive sleep apnea.

We found, after adjusting for physical activity and body weight (among other confounding factors), that total daily sitting was associated with poor sleep quality but not other sleep metrics or OSA risk. However, we also examined sitting while watching television and found a significant relationship between this type of sitting and a host of sleep quality metrics as well as risk for OSA. In a subsequent analysis we found that despite the independent relationship between sitting while watching television with OSA risk, those that were physically active were protected from this negative impact.

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Sleep Apnea Increases Stroke Risk in Atrial Fibrillation Patients

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Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health NetworkMedicalResearch.com Interview with:
Dmitry Yaranov, MD
Danbury Hospital
Western Connecticut Health Network

Medical Research: What is the background for this study? What are the main findings?

Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification. Continue reading →

Polysomnography Remains Standard For Pediatric Obstructive Sleep Apnea Diagnosis

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Ron B. Mitchell, MD Professor of Otolaryngology and Pediatrics William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas ENT Clinic Dallas, TX 75207MedicalResearch.com Interview with:
Ron B. Mitchell, MD
Professor of Otolaryngology and Pediatrics
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children’s Medical Center Dallas
ENT Clinic Dallas, TX 75207

Medical Research: What is the background for this study? What are the main findings?

Dr. Mitchell: The “gold standard” for the diagnosis of and quantification of obstructive sleep apnea (OSA) is polysomnography (PSG or a ‘sleep study’). However, the majorities of T&A procedures are done without PSG and are based on a clinical diagnosis. This is because PSG is expensive, requires overnight observation and is often unavailable. It is important to diagnose and quantify OSA as it allows for surgical planning and predicts the need and type of treatment after surgery.

We used data from the Childhood Adenotonsillectomy (CHAT) study; a large multicenter
trial (RCT), to look at the ability of clinical parameters to predict the severity of obstructive sleep apnea in children scheduled for a T&A.

The main findings of the study are that certain clinical parameters such as obesity and African American race as well as high scores on certain validated questionnaires (such as the pediatric sleep questionnaire- PSQ) are associated, but cannot predict OSA severity. PSG remains the only way to measure objectively the severity of OSA.

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Sleep Apnea Predicts Atrial Fibrillation after CABG

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MedicalResearch.comInterview with:
Amro Qaddoura BHSc
Research Student of Adrian Baranchuk, MD
Department of Medicine, Queen’s University, Kingston, Ontario, Canada

MedicalResearch: What is the background for this study? What are the main findings?

Response: This publication was a letter to the editor in response to comments on our recent systematic review and meta-analysis that showed obstructive sleep apnea to be a strong predictor of atrial fibrillation after coronary artery bypass grafting (CABG). See the details in another interview: https://medicalresearch.com/heart-disease/sleep_apnea_increases_risk_of_atrial_fibrillation_after_bypass_surgery/8369/

The letter to the editor included an analysis not included in the initial publication, which provided more evidence that obstructive sleep apnea is a predictor of atrial fibrillation after CABG surgery.

As well, it elucidated the reasoning behind one of the analyses that we chose to conduct.

MedicalResearch: What should clinicians and patients take away from your report?

Response:  Healthcare specialists of multiple disciplines should equip themselves with the necessary tools and knowledge to be able to screen and diagnose obstructive sleep apnea.

For patients, it provides further incentive to report any sleep disturbances or snoring to their healthcare providers so that the patients can be optimally cared for and managed.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response:  Only one study that we are aware of investigated the association between severe obstructive sleep apnea and atrial fibrillation after CABG surgery. This provides an impetus to explore this association further.

As well, although the evidence to date indicates that obstructive sleep apnea is a risk factor for atrial fibrillation after CABG surgery, larger high-quality studies may help to confirm the findings of our review.

Citation:

Obstructive Sleep Apnea is a Risk Factor for Post Coronary Artery Bypass Graft Atrial Fibrillation
Qaddoura, Amro et al.
Canadian Journal of Cardiology , Volume 30 , Issue 12 , 1516 – 1522

 

CPAP May Improve Depression In Patients With Sleep Apnea

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Dr. Marcus Povitz MD Department of Community Health Sciences University of Calgary, Calgary, Alberta, Canada Adjunct Professor and Clinical Fellow Western University Department of Medicine, Western University, London, Ontario, CanadaMedicalResearch.com Interview with:
Dr. Marcus Povitz MD
Department of Community Health Sciences
University of Calgary, Calgary, Alberta, Canada
Adjunct Professor and Clinical Fellow
Western University Department of Medicine,
Western University, London, Ontario, Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Povitz: Both depression and obstructive sleep apnea are important causes of illness and have overlapping symptoms. Both feature poor quality sleep, difficulty with concentration and memory as well as daytime sleepiness or fatigue. Previous research showed that depression is common in individuals with sleep apnea, but studies investigating the effect of treating sleep apnea on depressive symptoms have had conflicting results. Our study combined the results of all randomized controlled trials of participants who were treated for sleep apnea with CPAP or mandibular advancement devices where symptoms of depression were measured both before and after treatment. We found that in studies of individuals without a lot of symptoms of depression there was still a small improvement in these symptoms after treatment with CPAP or mandibular advancement device. In 2 studies of individuals with more symptoms of depression there was a large improvement in symptoms of depression.

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Snoring During Twenties May Be Predictive of Sleep Apnea in Forties

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MedicalResearch.com Interview with:
Dr. Swati Gulati, MD Internal Medicine
John H. Stroger Hospital of Cook County
Chicago, IL

Medical Research: What are the main findings of the study?

Dr. Gulati: We conducted an observational study by providing questionnaire about the onset and progression of sleep apnea symptoms to patients seen in our sleep clinic for CPAP set up. In our cohort, mean age at the onset of snoring was 28 years and the mean age at diagnosis was 52 years. There was a lag of almost 23 years between the onset of snoring and the diagnosis of sleep apnea. The snoring started in mid twenties (Phase I) and patients noticed poor concentration and headaches in mid thirties (Phase II). Later, patients developed cardiopulmonary symptoms in mid forties to the time of diagnosis (Phase III).

The evolution of simple snoring into apneic episodes occurred around 40 years of age after which there was a rapid progression of disease marked by development of Excessive daytime sleepiness (EDS), dyspnea and morning headaches. We also found that patients who had started snoring earlier or at a very young age had a more severe disease as documented by apnea-hypopnea index (AHI).

In the literature, most of the natural history studies have looked at the progression of sleep apnea after diagnosis with a shorter follow up period ranging from 6 to 10 years.   Through our study, we have aimed to determine the natural history of disease progression from simple snoring until the time of diagnosis.

Medical Research: What was most surprising about the results?

Dr. Gulati: We were surprised to find out that the symptoms of snoring started in the mid twenties and progressed over 2 decades before diagnosis. It was also surprising that the duration of snoring and change in weight were better predictors of obstructive sleep apnea (OSA)  severity than the patient characteristics at the time of diagnosis, such as age and BMI. In our study, weight gain per year was the strongest predictor of severity of sleep apnea and it made the BMI at the time of diagnosis insignificant. Surprisingly, we found no association between gender and AHI.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gulati: Based on our study, snoring in these patients starts at an early age and not necessarily in the middle age. Evolution of simple snoring into sleep apnea and symptomatic manifestations takes at least a decade on average.

Significant symptoms of sleep apnea were ignored for at least 20 years by the patients or their physicians. This should provide ample time opportunity for physicians to screen patients for sleep disordered breathing. Timely screening and diagnosis of obstructive sleep apnea will lead to early initiation of treatment and will slow its progression.

 

Medical Research: What recommendations you have for future research as a result of this study?

Dr. Gulati: Since our study population consisted of patients with severe OSA, these findings should be tested on a sample of patient that includes mild to moderate OSA. Randomized controlled trials should be done to see if screening for snoring in young adults and initiation of early treatment can prevent the development of OSA and associated mortality.

 

CHEST abstract:

Progression of Symptoms of Obstructive Sleep Apnea  and Their Association With Its Severity at Diagnosis?
Swati Gulati; Aiman Tulaimat
Chest. 2014;146(4_MeetingAbstracts):946A. doi:10.1378/chest.1992430

 

 

 

 

CHEST 2014: Obstructive Sleep Apnea Linked To Cognitive Difficulties in Postmenopausal Women

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Chitra Lal, MD. Assistant Professor Medical University of South CarolinaMedicalResearch.com Interview with:
Chitra Lal, MD. Assistant Professor
Medical University of South Carolina

 

 

Medical Research: What are the main findings of the study?

Dr. Lal: We studied the prevalence of cognitive problems in early postmenopausal women (age 45-60 years) with obstructive sleep apnea syndrome (OSAS+) and without obstructive sleep apnea syndrome (OSAS-) using a questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI).

We found that the mean MCFSI scores after adjusting for depression were significantly higher in obstructive sleep apnea syndrome+ then the OSAS- group, indicating more self-reported cognitive difficulty in OSAS+ women

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Sleep Apnea Increases Risk of Atrial Fibrillation After Bypass Surgery

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Adrian Baranchuk MD FACC FRCPC Associate Professor of Medicine Director, EP Training Program Queen's University Kingston, Ontario, CanadaMedicalResearch.com Interview with:
Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen’s University
Kingston, Ontario, Canada

Medical Research: What are the main findings of the study?

Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.

We also found that the risk increases in patients with more severe obstructive sleep apnea.

This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
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Sleep Apnea Predisposes To Impaired Brain Blood Flow With Physical Activity

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Paul M. Macey, Ph.D. Assistant Professor in Residence Associate Dean for Information Technology and Innovations, Chief Innovation Officer UCLA School of Nursing and Brain Research InstituteMedicalResearch.com Interview with:
Paul M. Macey, Ph.D.
Assistant Professor in Residence
Associate Dean for Information Technology and Innovations,
Chief Innovation Officer UCLA School of Nursing and Brain Research Institute

Medical Research: What are the main findings of the study?

Dr. Macey: People with sleep apnea are less able to control the blood flowing to their brain, in particular when they grip tightly, or have their foot put in cold water. We measured changes in blood flowing through the brain using an MRI scanner while people gripped hard, had their foot placed in cold water, and breathed out hard into a tube with a very small hole in it. These activities all lead to more blood flowing to the brain in healthy people, which probably helps protect the cells from being starved of blood and oxygen. However, people with sleep apnea send less blood that the healthy participants during the gripped and cold foot activities.

A further important finding is that women with sleep apnea are worse off than men. The female patients showed much weaker blood flow than the males, even accounting for normal differences between men and women.
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