Mayo Clinic Finds Sleep Apnea May Be Risk Factor For Sudden Cardiac Death In Study Of 11,000

24/7 Press Release ^ | December 27, 2008 | Dr. Ira L Shapira

[2ndDivisionVet]

Mayo Clinic cardiologist Apoor Gami, M.D., the lead researcher on the study, presented his findings at the American Heart Association's Scientific Sessions 2008 in New Orleans. "Nighttime low oxygen saturation in the blood is an important complication of obstructive sleep apnea," according to Virend Somers, M.D., Ph.D., the study's principal investigator. "Our data showed that an average nighttime oxygen saturation of the blood of 93 percent and lowest nighttime saturation of 78 percent strongly predicted SCD, independent of other well-established risk factors, such as high cholesterol. These findings implicate OSA, a relatively common condition, as a novel risk factor for SCD."

Another study; Int J Cardiol. 2008 Aug 18;128(2):232-9. Epub 2007 Aug 28. Showed that moderate to severe obstructive sleep apnea is linked to left ventricular hypertrophy, left ventricular dilatation or elevated natriuretic peptides in patients without overt cardiovascular disease. Significant changes in NT-pro-BNP values indicate an improvement of cardiac function following effective oral-appliance therapy.

Stroke victims who have obstructive sleep apnea die sooner than stroke victims who do not have sleep apnea or who have central sleep apnea, according to Swedish researchers, who will presented their findings at the American Thoracic Society's 2008 International Conference in Toronto on May 19. The results were independent of age, gender, smoking, body-mass index, hypertension, diabetes, atrial fibrillation, cognitive ability and how dependent patients were on help in their daily lives.

Cardiac disease, cardiac failure as well as increases in high blood pressure, diabetes and decreased quality of life are all associated with obstructive sleep apnea. Many studies have shown improvement with CPAP and studies are now showing similar improvements in outcomes with oral appliances. Information about oral appliance available at www.ihatecpap.com

Sleep apnea is recognized as deadly but until recently patients were offered only treatment with CPAP. This was unfortunate because while CPAP is considered the Gold Standard of treatment most patients are not able to tolerate it. Various studies have shown that only 23-45 % of patients prescribed CPAP actually tolerate it. Many patients are not offered alternatives to CPAP when they have demonstrated CPAP intolerance. Oral appliances have been shown to be a highly effective alternative to CPAP. Surgery is also an alternative to CPAP but has a relatively high morbidity and low success rate for treating sleep apnea. The surgical bi-maxillary advancement procedure is an exception that is highly successful. See the Sleep and Health Journal article comparing Oral appliances to Surgery: http://sleepandhealth.com/modules.php?name=News&file=article&sid=55&tid=22

Chicago dentist, Dr Ira Shapira is a pioneer of dental sleep medicine who formed I HATE CPAP LLC a company dedicated to promoting the dangers of sleep apnea and the role of dental sleep medicine in improving patients lives. Dr Shapira is clear in stating that he does not HATE CPAP which is still the gold standard for treatment. He formed the company and its website www.ihatecpap.com in response to what patients reported. The most common statements he heard from his patients were "i hate the mask" , "I hate The machine", "i hate CPAP!" and that was how the name came about. While some consider it provacative it resonates with patients unable to tolerate CPAP treatment. Thousands of patients who had abandoned CPAP have returned to treatment because they felt an emotional connection to the sentiment.

Most patients offered a choice between oral appliances and CPAP chose the appliances due to increased comfort and ease of use. Compliance, or patients continued use of therapy is much higher with oral appliances than CPAP.

Patients with untreated sleep apnea have a six fold increase in motor vehicle accidents and are also more prone to poor performance and accidents at work. Trucking companies have shown that screening for sleep apnea and insuring treatment have lowered insurance costs and accident rates. Short term memory loss is one of many intellectual defects associated with untreated sleep apnea. The problem is that many patients prescribed CPAP are not offered a choice and if they cannot tolerate treatment with CPAP then go without treatment.

There is an urgent need to help all patients diagnosed with sleep apnea find treatment modalities that work and that the can tolerate and use on a long-term basis. There will be a net reduction in overall medical expenses if all patients who do not tolerate CPAP are offered oral appliances as an alternative. Patients with mild to moderate sleep apnea should be offered oral appliances a a first line treatment along with CPAP according to the new parameters of care of the Academy of Sleep Medicine.

The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) considers sleep apnea to be a TMJ Disorder. There were two articles published in Cranio by Shimshak et al that showed a 200-300% increase across all medical fields in patients carrying a diagnosis of TMJ disorders. This is vital information for those hoping to rectify problems with our current healthcare system. Their report CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS NHLBI WORKSHOP was based on research by the National Heart, Lung and Blood Institute (NHLBI) , NHLBI Division of Heart and Vascular Diseases (DHVD) and the NHLBI National Center on Sleep Disorders Research (NCSDR)

The entire report can be reviewed at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf

Patients interested in learning more about oral appliances used to treat obstructive sleep apnea will find information at: http://www.ihatecpap.com/oral_appliance.html

Additional information about TMJ disorders cn be found in Sleep and Health Journal at: http://sleepandhealth.com/modules.php?name=News&file=article&sid=237&tid=22 or at www.ihateheadaches.org

Organizations involved in treating sleep apnea include The American Academy of Dental Sleep Medicine, DOSA the Dental Organization for Sleep Apnea, The American Academy of Cranifacial Pain, ICCMO the International College for CranioMandibular Orthopedics.

The American Academy of Sleep Medicine states that doctors treating sleep apnea with oral appliances should be well versed in all aspects of dentistry especially in treating TMJ disorders

About Sleep and Health Journal

Dr Ira L Shapira is an author and section editor of Sleep and Health, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates

[2ndDivisionVet]

I've been using CPAP since the early 1990's. I can't even take a nap without it. During Hurricane Katrina (Biloxi, MS - not NOLA) with no electricity, I was in bad shape.

[SatinDoll]

I glad you posted this article. I didn’t know about appliances that can replace CPAP. My mother used one for years and my father used one for a short time before putting it aside. He hates it and refuses to use it, so I’ll look into the appliance.

Sorry to hear about your difficulties during Hurricane Katrina. Hope things are doing better for you now.

[2ndDivisionVet]

Fell asleep at the wheel and had a pretty bad car accident between diagnosis and getting that CPAP (still using that same machine today) but luckily wasn’t hurt. Didn’t help the front end of my Dodge minivan, though.
Only lost my business in Katrina, and moved here to Fort Worth and doing okay.

[Old_Grouch]

My husband fell asleep at the wheel (luckily I was in the car and screamed and he woke up and we stayed on the road.) But that led to diagnosing his sleep apnea, and he has worn his Bi-pap machine every night since, must be three or four years now. He has to be the most faithful CPAP wearer there is. He dislikes it, the cold air blows on his arm or some other discomfort bothers him but he won’t stop wearing it. And he gets good sleep now. This article is interesting but it sounds like an infomercial for the oral devices. But it is good to know that there is an alternative for those who can’t tolerate the CPAP.

[2ndDivisionVet]

I don’t get that some people won’t use CPAP. It was hard to get used to the first week or so, but going on about 15 years, I’m so used to it, and my wife has one, too. The alternative is death, so what’s a little irritation.

[GulfWar1Vet]

I have sleep apnea and I have the CPAP as well. I don’t mind my machine, although at times, the mask gets “leaky” and the air escapes. But a little adjustment and it’s fine.

Water and electricity. I need them both, or I will be in major trouble.

[raybbr]

ping

[Misterioso]

I’ve used CPAP for five or six years and don’t go anywhere without it. A leak here, a whistle there, but it keeps the peace in our bed by stopping the snoring. I know it helps me sleep longer.

[Islander7]

I have seen nothing in this study that has not been known for at least 30 years.

(I managed the sleep lab at GCCH in Biloxi from the time it opened in 1985 until 1991. Provided home care to sleep patients from 1992 until Katrina took my business.)

[joe fonebone]

same here...i always keep a deep cycle marine battery fully charged and an inverter in the house...if the electricity goes down, you can use your cpap for up to 7 days, depending on how old the battery is....

[Joiseydude]

I've used a CPAP machine since '94. I was driving a 35,000 pound truck down the highway and I nodded out, I woke up with the truck climbing the concrete divider. Luckily there was no damage to the truck or myself.

Soon after that I had a sleep study done and found out that I had sleep apnea.

I started with the mask, but as others have mentioned I got annoyed with the air leakage around the edges of the mask. I changed over to a Adams Circuit and nasal pillows. That solved the problem with the air leakage.

[libertylover]

What do you know about the “appliances”. I had (still have?) one from 10-12 years ago which would thrust my lower jaw forward and keep it there. The problem, not counting the slobbering, was that every morning when I woke up my teeth hurt, kinda like when you’re a kid and you’ve got a tooth about to fall out, execpt this was all of my teeth. I figured this couldn’t be good for my teeth.

And I’ve had my brush with Sudden Cardiac Death. On Nov. 25th I was playing golf, feeling a little tired but not overly so, standing over a putt on the 16th hole. I got dizzy and lightheaded and tunnel-vision set it. I had opened the door to SCD and stepped in. My implanted defibrillator jerked my back out.

I’m going to talk to my doctor about another sleep study.

[notsofastmyfriend]

I was diagnosed with sleep apnea in the late 90’s, and gave CPAP a go for about 6 months. Couldn’t stand it.

My doctor recommended the U3P surgery and septoplasty since I wasn’t overweight and had an obviously large uvula and deviated septum. Had the surgery and it was a great success, really changed my life (it even eliminated the wall-shaking snoring!).

Fast forward a few years and I now find myself snoring again. I think I’ll look into the appliance. Thanks for posting!

[mvpel]

He dislikes it, the cold air blows on his arm or some other discomfort bothers him but he won’t stop wearing it. And he gets good sleep now.

The most striking thing about going on a CPAP was that my dreams were so long that they got boring. I spent what seemed like five minutes in one dream standing by a lamppost at an intersection, watching the traffic go by while waiting for someone to meet me there.

It was a godsend that I got it when I did, because not long afterward I was laid off, and had to take a job at the far end of a 2- to 2 1/2-hour commute, getting out of bed at around 5:00am and getting home around 7:00pm. Without the CPAP I would have been an absolute wreck by now, two months into it.

You husband might try the Puritan Bennett Breeze nasal pillow system. My mom gave me one of her spares, and it made all the difference between a moderately-annoying hassle that I put up with for the sake of a good night's sleep with my nasal mask, to something that I could almost forget about while wearing. The one minor drawback during the winter is that the humidifier on my CPAP, even at the lowest setting, leads to considerable condensation inside the hoses due to the comparatively low airflow rate.

He might also take a look at the Resmed Ultra Mirage II if he prefers nasal masks, as it has a very good, very quiet exhaust system that directs the exhaust air along the incoming hose, which you can turn upward, rather than directing the air onto his arm or into your face.

[antisocial]

Bookmark

[Joiseydude]

The one minor drawback during the winter is that the humidifier on my CPAP, even at the lowest setting, leads to considerable condensation inside the hoses due to the comparatively low airflow rate.

Had the same problem with even a high flow rate. They sell thermal tube coverings to prevent the condensation inside the tubing.

Scroll down the page a bit and you'll see the listings for different lengths of thermal tube coverings.

[tajgirvan]

Check with your insurance companies...you can get replacements such as hoses and filters quarterly for your machines, as well as masks that readily adjust to your face.
There’s alot of difference with equipment....you owe it to yourself

saltnlemons

[tajgirvan]

Great post! Resmed and Respironics have similiar equipment
The Ultra Mirage series is very good!

saltnlemons

[The Great RJ]

I too have been using a CPAP for 12 years and it has likely saved my life. Before my sleep apnea was controlled with CPAP, I had a near miss accident when I fell asleep while driving and frequently could not remember where I was driving.

[Islander7]

I never dealt with appliances. There was a dentist in the area who had that market. The local sleep doctors were in a constant battle with him because he would prescribe them without any sleep study to verify the need or effectiveness. Of course that was 15 years ago.

I dealt with CPAP, BiPAP and NIPPV. There is a place for appliances, but testing is essential. If you haven't had a sleep study, get one. If you have and it has been over 5 years, time for a followup. You may find that CPAP is more comfortable and effective. Appliances in addition to CPAP can be every effective in some cases.

As always, rely on the expertise of a physician trained in sleep disorders.

American Academy of Sleep Medicine