WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER

WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER

By Charles Kravitz, DDS

We know that men are more at risk of developing sleep apnea. But for women who suffer from OSA the risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. The scientists collected data of 20,000 patients with OSA. It was found that a large percent of these patients were later diagnosed with cancer.

HOW OSA INFLUENCES CANCER

The studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.
Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.
 Two of the key hormones that fall out of balance—cortisol and melatonin—are critical for maintaining a healthy immune system (cortisol) and for regulating the body’s circadian system (melatonin). In addition, this neurochemical balance can lead to body-wide (systemic) inflammation.

How does this relate to cancer?
Without a healthy immune system, the body can struggle to fight off the aggressive cellular behaviors that can lead to tumors. 
With an imbalance in circadian rhythms as the result of decreased melatonin, the body produces higher amounts of other substances that are risk factors for cancer (for women, higher estrogen can lead to breast cancer, and for men, higher estrogen can lead to prostate, bowel, lung, and bladder cancer). 

Systemic inflammation causes oxidative stress to the organs. Oxidation is a breakdown of tissues that is the consequence of long-term inflammation; oxidative stress refers to the damage that results from unchecked systemic inflammation, which makes it easier for cancer—an opportunistic disease—to establish itself wherever the body is most vulnerable.
Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen.

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia. Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have. Sources: American Sleep Apnea Association, Centers for Disease Control, Mayo Clinic, National Institutes of Health, National Sleep Foundation, The New York Times, Wisconsin Cohort Study, World Health Organization

“HOW DO I FIND PATIENTS TO TREAT SLEEP APNEA?”

Think about this-

A Sleep Coordinator in a dental practice asked me, “How do I find sleep apnea patients that I can treat?“

Here’s how I answered her, “They will find you.“

 

If you saw the award winning movie “Field of Dreams” you will remember Ray Kinsella (Kevin Costner) being told, “Build a field and they will come.”   He did build a baseball field in a Kansas corn field and sure enough the great legends of the game came to play there.

 

 

After you have been trained and become confident in your screening and treatment skills you’ll be pleasantly surprised at the vast number of sleep apnea patient resources.  Build your field and they will come.

 

 

These are just a few of the sources available to you:

• word gets around that you can help them and new patients will seek you out
• your patient base will produce enough candidates to keep your schedule filled  
• you will be developing a network of healthcare professionals that will send you patients
• patients you have treated will be referring their family and friends

Success in Dental Sleep Medicine, unlike in other ventures, does not have to be long and drawn out. If you focus on all the “little things“ and stay dedicated you will reach your objective in a few months.

 

Studies reveal OSA is prevalent. 

-A  study in Switzerland reported 50% of men and 23% of women had at least moderate OSA.¹

-In 2002, the Sleep Heart Health study found that 24% of men and 9% of women have at least mild OSA.²

-In the Wisconsin Sleep Study Cohort, it was reported that 10% of men and 3% of women age 30 to 49 have at least moderate OSA, while 17% of men and 9% of women age 50 to 70 have at least moderate OSA.

-Over 50% of children diagnosed with ADHD suffer from sleep apnea

-According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). 

-OSA is highly underrecognized, and it is estimated that 82% of men and 93% of women in the United States with OSA are undiagnosed.⁴

 

Is there any better opportunity today in dentistry?

 

Are you ready to build your field of dreams? 

Join Sleep Coordinator Academy https://www.linkedin.com/groups/12468632/?lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3BPS2%2B0cvWS%2FeKvV0ZQRBx3Q%3D%3D

 

Write me with any questions at cskdoc@aol.com.

 

References

1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
2. Young T, Shahar E, Nieto FJ, et al; for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002;162(8):893-900.
3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
4. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706

 

COMORBIDITIES OF SLEEP APNEA

Gastro esophageal reflux disease, GERD, a.k.a. acid reflux is one of the most common comorbidities of sleep apnea. Although very common in senior adults it still occurs frequently in younger people.Poor little GERD was so under-appreciated in our poll.

How it happens:   During the nocturnal cessations of breathing the body will increase its efforts to take in air. Abdominal contractions are exaggerated and increase until breathing resumes.
The contractions squeeze the stomach and force acid up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.

New Tag

Acid reflux

GET C.E. CREDITS WITH A BONUS

Study Club and Dental Society Members:

GET AN EARLY START ON NEXT YEAR’S C.E. CREDITS

It’s November and you probably have your  CE credits locked in for this year.

Here’s how to get fast and easy CE credits for next year and score even greater benefits:

Have your Dental Study Club or local Dental Association schedule a speaker for a Dental Sleep Medicine presentation. We will provide a nationally known DSM speaker, all materials, CE credits and most importantly, a valuable introduction to Dental Sleep Medicine.

 Hands-on training

 Presentation Outline

These DSM presentations include:

• analysis of patients’ symptoms and how to screen for them
• scripts for an effective patient interview
• how to motivate the Dental team to commit their patients
• how to get your patients to “own” their disease
• the morphology of the airway
• comorbidities to look out for
• the effects on the systemic organs
• the reimbursement strategy and insurance billing using dental and medical coding.

 

Dentists who attended our DSM presentations have gone on to secure huge rewards for their patients and their practices. Email me at <cskdoc@aol.com> to find an available date for a presentation to your study club or dental society meeting.

WE “FALL BACK” ON SUNDAY, NOV. 6th AND CAN GAIN AN EXTRA HOUR’S SLEEP

Before going to bed Saturday night, set your clocks back one hour.

How are you planing to take advantage of the extra hour? In order to fulfill the essential number of regenerating sleep cycles the average adult needs 7-8 hours.

Do you sleep soundly or sleep with sound?

Instead of “falling back” his fall, dentists have the opportunity to spring forward with Dental Sleep Medicine and help the millions of their Sleep Apnea victims.

Upcoming training seminars by DSM experts are available in the following cities:

Nov 2016

LAS VEGAS, NV –         11/04/2016 – 11/05/2016 Register Now! 
MEMPHIS, TN –             11/04/2016 – 11/05/2016 Register Now! 
OKLAHOMA CITY, OK – 11/11/2016 – 11/12/2016 Register Now! 
WASHINGTON, DC –    11/11/2016 – 11/12/2016 Register Now! 
BOSTON, MA –              11/18/2016 – 11/19/2016 Register Now! 
GREENVILLE, SC –       11/18/2016 – 11/19/2016 Register Now! 
SAN FRANCISCO, CA – 11/18/2016 – 11/19/2016 Register Now! 

Dec 2016

CHICAGO, IL –                12/02/2016 – 12/03/2016 Register Now! 
TAMPA, FL –                   12/02/2016 – 12/03/2016 Register Now! 
DENTAL STAFF BOOT CAMP – 12/02/2016 – 12/03/2016Register Now! 
DALLAS, TX –                  12/09/2016 – 12/10/2016 Register Now! 
NEW YORK CITY, NY –   12/09/2016 – 12/10/2016 Register Now! 
HUNTINGTON BEACH, CA – 12/16/2016 – 12/17/2016 Register Now! 
SALT LAKE CITY, UT –    12/16/2016 – 12/17/2016 Register Now! 
TUCSON, AZ –                  12/16/2016 – 12/17/2016 Register Now! 

The Medical Role of Hygienists in Dental Sleep Medicine

Is there anyone in a better position than the Hygienist to discover the signs and symptoms of Obstructive Sleep Apnea? Your field of operations is right there at the opening of the airway. 

 

You can’t miss the signs.
You can see if a large tongue is blocking the passageway to the pharynx. You can see if the sides of the tongue show a scalloping which is indicative of a forceful gasping for precious air. Is the airway blocked laterally by large fauces or tonsils?  You can’t miss the patient’s Mallampati score.

Do the occlusal surfaces of the posterior teeth show evidence of bruxism? Are the incisal edges of the anterior teeth worn down?
Does your patient have acid reflux? TMJ pain? A severely receded (retrognathic) chin?

And in your interview with your patient do you learn that your patient has daytime sleepiness, often dozes off while watching TV or at the movies, and even worse, feels sleepy while driving?

Were you informed that the patient’s spouse complains about loud snoring?
Do you see an overweight patient with a large diameter neck? 

 

 

Listen to the alert! 
These are some of the more common signs and symptoms of obstructive sleep apnea. They are so easy to see. These warning signs are sitting right there in the hygienist’s field of operations and they are screaming out, “Notice us. We are here to destroy your patient”.  “We can cancel out all the good that you do for this patient.”

 

For a diligent Hygienist to miss these warnings would be to surrender a great opportunity to help patients enjoy a better quality of life and, in fact, to save lives. The rewards to you, your practice, and your patients are considerable-  both emotionally and financially.  

Take action! 

Become a member of the LinkedIn discussion group RDH SLEEP SOLUTIONS and enter the discussion to learn to incorporate Dental Sleep Medicine into your practice.  

https://www.linkedin.com/groups/12016156

 

SLEEP GROUP SOLUTIONS presents “Treating Snoring and Sleep Apnea in the Dental Office” to Broward County Dental Association (Florida)

Monday November 21st, 2016, 6 PM

Call BCDA 850-628-7939 for reservations

John Nadeau, VP of SGS, presents this Intro to Dental Sleep Medicine, including Medical Billing for Dentists

You can join the battle to combat this serious disease– Sleep Apnea..

Get trained and prepared to help the 40 million victims of sleep apnea.

 Many of them are already your patients.

Be a shining light and stand out as a doctor who literally saves lives.

DO WE HAVE TOO MANY DENTAL HYGIENISTS?

A Hygienist/Staffing Specialist in Cleveland/Akron, Ohio posed this question on LinkedIn to the American Dental Education Association:   “…why are schools graduating so many Dental Hygienists in a field that is very saturated, with little chance of job opportunities for these new Dental Hygiene grads? “

I am also interested in hearing the answer. Here in south Florida there is a plethora of well trained, dedicated Hygienists who are working part-time for Staffing Agencies, or as clinical assistants, and in other industries, because there are not enough opportunities in dental offices. My colleagues in Philadelphia and southern California tell me the situation is similar there.

Do you find this to be the case in YOUR area?

From The Bureau of Labor Statistics:
Job prospects are expected to be favorable in most areas, but will vary by geographical location. Because graduates are permitted to practice only in the State in which they are licensed, hygienists wishing to practice in areas that have an abundance of dental hygiene programs may experience strong competition for jobs.

Projection data from the National Employment Matrix Occupation:
Dental hygienists

174,100 2008
237,000 2018
36% increase

Do you feel that expanding the legal functions of Hygienists, and relaxing their areas of “direct supervision” will alleviate this problem?

★★ Learn from the Stars ★★

                                                                                                                                                                                                                                                                       Dr. Damian Blum, a renown trainer and a star in Dental Sleep Medicine, will present a comprehensive “A to Z” introduction course to dentists and their teams in Hollywood, Florida.

You can join the battle to combat this serious disease– Sleep Apnea..

Get trained and prepared to help the 40 million victims of sleep apnea. Many of them are already your patients.

Be a shining light and stand out as a doctor who literally saves lives.

Register with code: DBK916 and receive huge ($1130.) savings on tuition:

Only 655. with 2 auxiliaries at no charge.

(Available only by responding with this code.)

Review the course outline and register here:

http://join.sleepgroupsolutions.com/seminars/fort-lauderdale-fl/

 

 

ARE YOU A SMOKER?

Are you a smoker? If so, the chances are that you have obstructive sleep apnea. Smokers are three times more likely to have obstructive sleep apnea (OSA) than are people who have never smoked.

The Correlation

Smoking may irritate the tissues in your nose and throat and cause inflammation and fluid retention in your upper airway. This swelling causes a blockage which restricts air flow.

Both smoking and OSA are deadly conditions that, in combination, will wreak havoc to your quality of life and can severely shorten your life span.

Smoking and Sleep Apnea:  1+1 = 1000

Both sleep apnea and smoking can cause all sorts of cardiovascular and respiratory health problems. OSA can lead to stroke and heart disease while smoking increases one’s chance of contracting mouth, throat and lung cancer. Studies have even shown that sleep apnea victims who smoke, generally have heightened triglyceride levels and lowered HDL levels.

The Studies

The average person loses 1.2 minutes of sleep for every cigarette they smoke, due to nicotine’s stimulating and subsequent withdrawal effects, according to a  University of Florida study in 2011.

Men’s Health reported, “People who smoke within two hours of bedtime struggle to fall asleep because the nicotine disrupts their natural sleep-wake cycle, and withdrawal symptoms set in before the morning alarm goes off, often leaving smokers feeling even more restless and agitated.”

Patients who suffer from untreated sleep apnea are rarely able to reach the cycles of deep sleep where dreaming occurs. With treatment, patients begin to dream again and it takes time to get used to it.  Vivid dreaming is a common occurrence in those who are in the process of quitting smoking and have begun sleep apnea treatment.

Conclusion

A 20012 report in Chin Med concludes: “Smoking may act as a risk factor for OSA and join with OSA in a common pathway to increase the risk of systematic injury. OSA, in turn, may be a predisposing factor for smoking. Thus, smoking cessation is recommended when considering treatment for OSA, and treating OSA may be a necessary precondition for successful smoking cessation.”

Resources

American Journal of Respiratory and Critical Care Medicine.

Johns Hopkins University 2008 

University of Florida

Men’s Health

Chin Med

Mayo Clinic

WebMD