SNORING AND OBSTRUCTIVE SLEEP APNEA
Snoring and Obstructive Sleep Apnea (OSA) are serious medical conditions.
Either can prevent a good night's sleep of the affected person and/or the sleep partner. Lack of a good rest can result in day time sleepiness, fatigue, a less productive day, irritability, tension between the sleep partners, increased risk of an automobile accident and similar issues.
OSA (and sometimes snoring) causes the person to periodically stop breathing. With obstructive sleep apnea, muscles of the soft palate at the base of the tongue and the uvula relax, obstructing the airway, making breathing labored and noisy. Each time breathing stops, oxygen in the blood falls and the heart must work harder to circulate blood. This may account for deaths during sleep of people who went to bed in apparent good health.
Fifty percent of the people who snore have OSA. This lowers the percent of oxygen in the blood. These changes increase the risk of: damage to the heart and blood vessels, hypertension, heart attack, sudden death, stroke, morning headaches,diabetes, weight gain, erectile dysfunction, impotence, and decreased desire for sex.
Obstructive Sleep Apnea
Ways of treating Obstructive Sleep Apnea
1. Oral Appliance Therapy
An oral appliance can reposition the mandible more forward, opening the airway.
Research shows the oral appliance has a high percent of success in treating snoring, and mild to moderate OSA. As a result of these findings, an increasing number of physicians are now prescribing the oral appliance as the first line of treatment for snoring and mild to moderate OSA.
An increasing number of physicians are also prescribing the oral appliance before surgery for patients intolerant to positive airway pressure (PAP) devices diagnosed with severe OSA.
The oral appliance is small, easy to wear, and easy to travel. Most users can drink, talk, and kiss while wearing it. It can easily fit under the pillow for a time, and is easily returned to the mouth when desired. Approximately 80% to 90% of patients will wear the oral appliance every night. In order for the oral appliance to be effective to treat your obstructive sleep apnea, it must be properly customize and precision fit for each patient
2. CPAP (continuous positive air pressure)
Nasal CPAP is a machine that delivers pressurized air through a hose that is hooked to a nose mask that you wear when you sleep. The flow of air keeps your upper airway open to help prevent apnea. Despite its effectiveness in restoring normal breathing, the rate of compliance with the nasal CPAP therapy is less than 50%.
In severe obstructive sleep apnea cases, your physician may recommend removal of throat tissues to enlarge your airway opening.
Whether or not you have OSA it is best confirmed by a diagnostic polysomnographic study. We are happy to provide the names of sleep medicine physicians as well as sleep labs that we work with, upon request.
Please call for an appointment for a complimentary consultation. We can help you know if an oral appliance can be fitted for your teeth. We can also answer your questions concerning oral appliances and obstructive sleep apnea.
WE LOOK FORWARD TO SERVING YOU
June 12, 2009
Letter to the Editor • Red Rock News
Gastroesophageal reflux disease was discussed in your June 10 HEALTH WISE column. Thank you to Red Rock News and the sponsors for the excellent article. We are always interested in learning more about our health.
The article describes GERD as heartburn or acid reflux disease. It states that "approximately 50 million American adults experience symptoms on a frequent basis."
The article says "...77 percent of people experience nighttime heartburn..." Your readers may want to know more about this. At night during obstructive sleep apnea the throat closes and breathing stops. The chest wall tries hard to expand to breathe. This produces a strong negative pressure inside the chest, which in turn can produce a flow of stomach acid into the esophagus.
Successful treatment of the obstructive sleep apnea often eliminates or reduces the GERD. I would encourage your readers suffering from nighttime GERD to seek advice from their physician. Treatment for OSA can be as simple as wearing an oral appliance or using a positive airway pressure machine.
William P. Smith, Jr., D.D.S.
Download pdf's of these information articles by Dr. Smith
Sleep Apnea Affects Children as Well as Adults
Effect of Obstructive Sleep Apnea on Frequency of Stroke in Patients With Atrial Fibrillation
Lee A. Surkin, MD, FACC, FCCP, FASNC
President: Carolina Clinic for Health and Wellness, Founder of American Academy of Cardiovascular Sleep Medicine
The following is an abstract from the American Journal of Cardiology (Volume 115, Issue 4, Pages 461–465) by Dmitry M. Yaranov, MD, Athanasios Smyrlis, MD, Natalia Usatii, MD, Amber Butler, BS, Joann R. Petrini, PhD, MPH, Jose Mendez, MD, Mark K. Warshofsky, MD
Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation (AF). The aim of this study was to investigate the impact of OSA on stroke rate in patients with AF. Patients with AF and new diagnoses of OSA were identified from retrospective chart review. Those with histories of stroke at the time of the sleep study were excluded. The primary outcome was the incidence of stroke, determined by a physician investigator blinded to the results of polysomnography. Subgroup analysis was performed among different CHADS2 and CHA2DS2-VASc scores. Of 5,138 patients screened for OSA, 402 (7.7%) had AF and 332 (6.4%) met the inclusion criteria. Among the study population, the occurrence of first-time stroke was 22.9%. Ischemic stroke was more common in patients with OSA compared with patients without (25.4% vs 8.2% respectively, p = 0.006). After controlling for age, male gender, and coronary artery disease, the association between OSA and stroke remained statistically significant, with an adjusted odds ratio of 3.65 (95% confidence interval 1.252 to 10.623). A positive dose effect of the apnea-hypopnea index on the rate of stroke was observed (p = 0.0045). Subgroup analysis showed significantly higher rates of stroke in patients with CHADS2 scores of 0 and CHA2DS2-VASc scores of 0 and 1 and co-morbid OSA. In conclusion, OSA in patients with AF is an independent predictor of stroke. This association may have important clinical implications in ischemic stroke risk stratification.