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

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

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

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

Yeah, I've got one, and it solved the rain-out problem with the Resmed mask - it's just that the air volume inside the actual business end of the Breeze nasal pillow mask is so small that even the lowest humidifier setting results in rain-out at the mask. But then, I do keep my bedroom pretty cool at night, so perhaps someone else, in a different part of the country, wouldn't have this particular issue with the mask. In any case, it's worth it even so.

I get good service from a company that specializes in sleep disorders here in Los Angeles: Home Respiratory Care Sleep Solutions on Westwood Blvd. (310-441-4640) They are great.

I have a dental appliance. As noted above it holds your jaw forward and prevents snoring for many users. It’s worked well for me for about 15 years. I used to go camping and didn’t want to be tied to the power grid with CPAP.

The insurance companies I’ve dealt with don’t seem to like it. Mine (Blue Cross) never paid a cent for any of the several I’ve owned over the years. Also, I was turned down for health insurance at another company when they found I used the appliance rather than CPAP.

It is easier on trips or when the power is out. You CPAP users might want to consider one as a back up. It isn’t perfect, in some cases it can push your teeth around and it tends to keep your mouth open, leading to drooling and dry mouth.

I’m thinking of getting CPAP and rotate use of the two methods.

The APAPs (Automatic Positive Airway Pressure) seem to be getting good reviews, as they sense apnea conditions and adjust the pressure accordingly, so don’t need to be titrated during a $3,500 sleep study session. May want to ask the doctor about that. http://www.cpap.com/ has good prices.

not to mention it must have been hotter ‘n hell too for ya

don’t know why i never knew u were in Biloxi (?)

my eldest daughter and I drobe down to NOLA last week after visiting Jackson

My best friend experienced Sudden Cardiac Arrest 3 Sundays ago while giving dog agility training. He was going to demonstrate the technique with his Shepherd and as he bent down to release her leash he blacked out and hit the dirt stone dead. God was with him that day and not only was a nurse taking the class, his wife was sitting with a retired doctor. The nurse started mouth to mouth and the doctor started chest compression but that's not all that was in his favor. The fire department was in another building collecting toys for kids and they had a difib on the truck and brought him back with no apparent damage.

He had a double bypass the following day and will now get the implanted defib. I had never heard of the portable device until a few days ago and I found out today that at least two members of our Church have them. (combo defib and pacemaker).

On a side note my heart problem was marked by severe crushing jaw pain. I required a triple bypass in 2004.

Thanks. I will definitely look into it. When I got mine there was only CPAP & BiPAP. And I hated the sleep study, that has been the main thing stopping me from going back.

Looking at your link, I’m guessing APAP is the same as auto-adjusting CPAP. Prices look real good.

Thanks for the suggestions. (”You husband might try the Puritan Bennett Breeze nasal pillow system, He might also take a look at the Resmed Ultra Mirage II if he prefers nasal masks.”)

We’ll look into those. He just took the kind the doctor suggested.

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