OBSTRUCTIVE SLEEP APNEA- JUST A MAN’S DISEASE??

Obstructive Sleep Apnea Does Not Discriminate Against Sex or Age. In the European Respiratory Journal, Swedish scientists reported that OSA  is common in both sexes, a disorder that was thought to mainly affect men.  Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography. The authors concluded: “Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate, and 6% severe sleep apnea. Sleep apnoea in females is related to age, obesity and hypertension but not to daytime sleepiness. When searching for sleep apnea in females, females with hypertension or obesity should be investigated.” A apnea-hypopnea index of 30 or more (severe symptoms) affected 14% of the participants aged 55 or more 31% of the women who were obese and at least 50 years of age had severe sleep apnea  And let’s not forget our children. More reports to follow which will show corelations of OSA with children.

 

Autumn Starts September 21st- Sleep Well!

Sleep soundly this fall- don’t sleep with sound.

In denial, many people still ask, “What’s the big deal about snoring?” “Don’t most people snore?”

Snoring is disturbing and is a major cause of spousal alienation. Who can sleep with the sounds of a freight train two feet away from their ear? Spouses of snorers often have to move into separate bed rooms and sales are up of homes with two Master bed rooms.Snoring is, however, the most attention demanding WARNING SIGN of serious sleep dysfunction. 

It is the common denominator in the Sleep Apnea equation. Snoring, like pain, should sound an alert to us that there is something more serious to look for under the surface.

We continue to learn about more illnesses connected to Sleep Apnea–

Cancer

Researchers suggested a correlation between sleep apnea and increased cancer risk of any kind. A Cancer study of 1,240 participants who underwent colonoscopies found that those who slept fewer than six hours a night had a 50 percent spike in risk of colorectal adenomas, which can turn malignant over time. Another 2012 study identified a possible link between sleep and aggressive breast cancers. Ref: 2010 American Cancer Society Other serious ailments known to be tied to Sleep Apnea are:

Obesity, Dementia, Depression, Diabetes Mellitus, High Blood Pressure, Chronic Daytime Fatigue, Motor Vehicle Accidents

With an assortment of health threats like these, all Sleep Apnea related, we need to show more respect to snoring.

CHILDREN AND SLEEP: Consistent Bedtime is as Important as Sleep Quality and Quantity.

 

There are numerous studies on the quality and the quantity of sleep for children. Now there is insight to the regularity of children’s sleep.  It is found that he consistent nature of bedtimes during early childhood is related to cognitive performance. Considering the importance of early child development, this may be an influence for health throughout life.

 

 

 

A study out of the United Kingdom revealed that inconsistent bedtimes for young children result inlower scores on reading, math, and spatial awareness tests administered at age 7, compared to children who went to bed at the same time every night.

 

This research is particularly interesting because it zeroes in on the timing of sleep and the issue of bedtime consistency, apart from sleep quality or quantity. In the study, 11,178 children whose bedtimes were irregular at ages 3, 5, and 7 were tested at age 7.

 

 

 

 

Results

 At age 7, not having a regular bedtime was related to lower cognitive test scores in girls: reading (β: −0.22), maths (β: −0.26) and spatial (β: −0.15), but not for boys. Non-regular bedtimes at age 3 were independently associated, in girls and boys, with lower reading (β: −0.10, −0.20), maths (β: −0.16, −0.11) and spatial (β: −0.13, −0.16) scores. Cumulative relationships were apparent. Girls who never had regular bedtimes at ages 3, 5 and 7 had significantly lower reading (β: −0.36), maths (β: −0.51) and spatial (β: −0.40) scores, while for boys this was the case for those having non-regular bedtimes at any two ages (3, 5 or 7 years): reading (β: −0.28), maths (β: −0.22) and spatial (β: −0.26) scores. In boys having non-regular bedtimes at all three ages (3, 5 and 7 years) were non-significantly related to lower reading, maths and spatial scores.

 

 

 

References
“Time for Bed: associations with cognitive performance in 7 year old children: a longitudinal population based study”
Yvonne Kelly, John Kelly, Amanda Sacker
Department of Epidemiology and Public Health, University College London, London, UK
Published Online First 8 July 2013

 

A VICIOUS CYCLE: Sleep Apnea, Sleepiness, Anxiety, Caffeine and Bruxism

We know there is a correlation between bruxism and sleep apnea, but how does the one contribute to the other?

It has been observed that a third of bruxism patients also suffer from sleep disorders like sleep apnea, restless legs syndrome, etc. Bruxism may be the effect or the cause of many types of sleep disorders including obstructive sleep apnea, snoring, daytime lethargy.

The effects of stress, anxiety and caffeine ingestion come into play here. Studies link high anxiety levels to bruxism, and the symptoms of sleep apnea itself may cause anxiety. Additionally, the daytime sleepiness caused by apnea may lead to high levels of caffeine consumption which, in turn, is linked to a high risk of bruxism. This is the vicious cycle.

The relationship between sleep bruxism and sleep apnea can be attributed to an arousal response. When an apnea event ends, various oral phenomena may occur: snoring, gasping, choking, grunting and teeth grinding. Immediately after the apnea episode, a physiological compensation occurs. The jaw will open and close, thus dilating the upper airway in order to facilitate normal breathing.  The patient then pushes the tongue forward to move away from the air tract and forces it against the teeth.

Research has shown that increase of teeth grinding is directly proportional to the increase of frequency of apnea episodes.The results of these studies suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.

WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.

What is essential?
Beyond the obvious FMX, charting of existing and needed dental and periodontal conditions, and an oral cancer screening,there are many other evaluations which are directly related to our services and are within our range of authority and responsibility. 
The Comprehensive Exam should also include measurement of vitals such as blood pressure, etc., sleep dysfunction screening such as the Epworth Sleepiness Scale, and a careful discussion of any notable items (alerts) in the patient’s med history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right. If I were still practicing today I would certainly perform these and a nutritional analysis.

  TMJ exam, facial muscle palpation,Mallampati classification  (correlates tongue size to pharyngeal size) and an oxygen saturation test will provide critical information.  Any dentist/hygienist/team will chose how extensive they wish their dental exams to be and what should be included.

Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, our conscience, and our dental license.

And is this “nearly always accepted by patients with huge value and appreciation”? YES, it is, where the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices. The really successful ones.

Do you want to do more?
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver.
It is reported that 34% of the population has SA symptoms. One of the next three patients that walk thru your doors is a Sleep Apnea victim. Are you able to help them?
Does your New Patient Exam include a screening for Sleep Apnea?

Interested? Then check this out: http://sleepgroupsolutions.com/2.0/

WHAT ARE YOU MISSING IN YOUR NEW PATIENT EXAM THAT CAN HURT YOU?

Dentists are in the first line of discovery and defense of many systemic diseases. 
We are often the first ones to discover diabetes, sleep apnea and oral cancer.

The three serious conditions listed above are all too frequently under-diagnosed. 
New tools and techniques are now available for dental professionals to be able 
to do far more as comprehensive caregivers for their patients.
An interdisciplinary approach, enabling conferencing and sharing of information 
between patients' full medical teams will provide the most reliable diagnosis 
and optimal treatment.

Oral Cancer Screening
-Oral cancer is the most prevalent form of cancer. 
-It can form in any part of the mouth or throat.
-Most oral cancers begin in the tongue and in the floor of the mouth. 
-Anyone can get oral cancer, but the risk is higher if you are male, over age 40, 
use tobacco or alcohol or have a history of head or neck cancer. 
-The methods in use for oral cancer screening have been cumbersome and costly. 
-Dentists now have an easy to use and economical system for oral cancer 
screening and are calling this a "game changer".
   - "Oral ID" has an impressive record of evidence-based testing, is sought after 
because of its non invasive ease of usage, and its very affordable cost.

Sleep Apnea Screening
-Patients are realizing how a blockage of oxygen to the brain, caused by 
nocturnal apnoeic events, can influence systemic damage. 
-Sleep Apnea is connected to strokes, cardiac arrest, diabetes and dementia. 
-The public asks their dentists for help- most dentists are unprepared. 
-Less than 1% of practicing dentists are trained and qualified to screen and treat 
the over 40 million victims of Sleep Apnea.
-One of the next three patients that walk thru your doors is a Sleep Apnea victim. 
      -Are you prepared to help them? 

Diabetes Mellitus 
The oral manifestations of diabetes include:  
-Periodontal Disease, Xerostomia, tenderness, pain and burning sensation 
of tongue, secondary enlargement of parotid glands with sialosis. 
-Increased caries prevalence in adults. 
-Increased risk of infection- reasons unknown, but macrophage metabolism 
altered with inhibition of phagocytosis. 
-Peripheral neuropathy and poor peripheral circulation, 
-Oral mucosal diseases including Candidal infections, lichen planus and 
recurrent aphthous stomatitis. 
-Delayed healing of wounds due to microangiopathy and ultilization of protein 
for energy may retard the repair of tissues. 
-Increased prevalence of dry sockets. 
-Immunological deficiency: -A high sugar medium decreases 
production of antibodies.
 Blood pressure and other "vitals" 
Imagine administering a mandibular block, having your patient go into 
cardiac arrest, and realizing that no one in your office has taken that patient's 
blood pressure today.
 Enough said about that!

Are you providing a Comprehensive Exam?

Come to Rochester, NY and learn to become a “Sleep Medicine Dentist”, with Dr. Hnat-16 CE

Come with the family to Rochester, NY, August 23-24 (Friday and Saturday) at the DoubleTree by Hilton Hotel. Enjoy the weekend sightseeing, dining and learning Sleep Medicine.

This course is designed to provide you with the knowledge to confidently return to your practice and immediately begin implementing new screening, and treatment protocols. It includes Medical billing protocol and codes.

Dr. Michael Hnat, the seminar leader. is one of the most respected instructors in Dental Sleep Medicine.

ROCHESTER
The East End is a residential neighborhood in Downtown Rochester but also the main nightlife district. The Eastman Theatre, the Rochester Philharmonic and the Eastman School of Music are in the East End, along with the Little Theatre, an independent film theatre and many clubs, bars and high-end restaurants.

The High Falls are one of three voluminous waterfalls on the Genesee River

Read the 2-day course outline and register here:  http://sleepgroupsolutions.com/2.0/modules/piCal/index.php?action=View&event_id=0000002905

Study Shows Large Percentage of Surgical Patients With Undiagnosed Obstructive Sleep Apnea

Preoperatively, surgeons were not aware of the ongoing study and did not identify 90% of the patients who had severe OSA. Anesthesiologists did not diagnose 53% of these patients.

Singh M, Liao P, Kobah S, Wijeysundera DN, Shapiro C, Chung F

Br J Anaesth. 2013;110:629-636

Study Summary
The goal of this study was to better understand how many patients arriving to the operating room have undiagnosed obstructive sleep apnea (OSA). A better way to identify these patients ahead of time would be useful for tailoring the anesthetic as well as postoperative care and monitoring.

Singh and colleagues asked almost 6000 patients who were seen in a preoperative clinic in Toronto to enroll in this study, and 1085 agreed. After dropouts, 819 patients completed the study. Of the 819 patients, 111 patients had pre-existing OSA. The remaining 708 patients were screened for OSA.

First, patients answered the screening STOP-BANG questionnaire:

• Do you snore loudly (loud enough to be heard through closed doors)?

• Do you often feel tired, fatigued, or sleepy during the daytime?

• Has anyone observed you stop breathing during your sleep?

• Do you have or are you being treated for high blood pressure?

• Is your body mass index > 35 kg/m2?

• Is your age over 50 years old?

• Is your neck circumference > 40 cm?

• Are you male?

A person is deemed to be at high risk for OSA if he or she answers yes to 5 or more of the 8 questions.

The patients also underwent a sleep study (polysomnography) to measure the number of abnormal respiratory events (apnea or hypopnea) per hour of sleep. More than 30 of these events per hour is diagnostic for severe sleep apnea, as is an apnea/hypopnea index (AHI) score > 30.

Among the 708 study patients with no pre-existing diagnosis of OSA, 31% had no OSA, 31% had mild OSA (AHI: 5-15), 21% had moderate OSA (AHI: 15-30), and 17% had severe OSA (AHI > 30).

Preoperatively, surgeons were not aware of the ongoing study and did not identify 90% of the patients who had severe OSA. Anesthesiologists did not diagnose 53% of these patients. Overall, one third of patients with sleep study-identified OSA had only 1 or no cardinal symptoms of OSA. This indicates that these asymptomatic, “silent” patients are not going to be identified purely by history obtained by the physician.

More than 60% of the sleep study-identified patients with moderate and severe sleep apnea reported at least 2 symptoms suggestive of the diagnosis. These symptoms were daytime sleepiness (most common), witnessed apnea, and snoring. Singh and colleagues suggest that, had patients been screened before their surgeries with the STOP-BANG questionnaire, most cases of undiagnosed moderate and severe OSA would have been identified.

In patients with sleep apnea, perioperative pulmonary complications after orthopaedic and general surgery are significantly more frequent vs matched samples without sleep apnea, according to new research.

Stavros Memtsoudis, MD, with the Weill Medical College of Cornell University, in New York, NY, and colleagues reported their findings in Anesthesia & Analgesia.

Sleep apnea increased the risk for perioperative tracheal intubation and mechanical ventilation by 5-fold after orthopaedic surgery and doubled the risk after general surgical procedures, the researchers report.

References
1.  Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081-1093.

2.  Giarda M, Brucoli M, Arcuri F, Braghiroli A, Valletti PA, Benech A. Proposal of a presurgical algorithm for patients affected by obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2012;70:2433-2439.

3.  Seet E, Chung F. Management of sleep apnea in adults – functional algorithms for the perioperative period: Continuing Professional Development. Can J Anaesth. 2010;57:849-864.

Anesthesiologists worry that such patients will be at higher recovery risk, especially when discharged home on opioids for pain. These patients may also have a higher incidence of difficult intubation, postoperative complications including delirium, increased admissions to the intensive care unit, and longer hospital stays.

Almost one fifth of surgical patients have previously undiagnosed severe OSA. These patients were only diagnosed because they agreed to be enrolled in this study. As the investigators commented, the disparity between a high prevalence of undiagnosed OSA in the population and the low level of recognition and diagnosis at the time of preoperative consultation by surgeons and anesthesiologists is important.

It should be possible to reduce the proportion of undiagnosed severe OSA by implementing a formal screening tool as part of the routine preoperative anesthesia assessment. The results of screening can be used to determine whether a formal sleep study is indicated. In addition to the American Society of Anesthesiologists[1] practice guidelines, functional algorithms have been published that recommend preoperative screening.[2,3] This information has value beyond the benefits to anesthesia care. After being diagnosed with OSA, the patient can be referred to an internist or sleep physician to receive proper long-term treatment after the operation.

Source of information: MedScape

Study Sleep Medicine with Dr.Slabach in San Antonio June 7-8 (Special 50% Rate)

. Learn to become a Sleep Medicine Dentist, with 16 CE credits.

SEMINAR SPECIAL: $495 + 3 FREE staff

River Walk                                        The Alamo

  

This course is designed to provide you with the knowledge to confidently return to your practice and immediately begin implementing new screening and treatment protocols.

In this 2 day seminar Dr. Dawne Sabach explains how Dentists can benefit their patients and themselves by being “The Sleep Dentist”.

Getting Into Dental Sleep Medicine is Exciting!

After the Seminar Dr. Sabach will continue to Mentor you, giving you the confidence to be a Sleep Medicine Doctor.

Read the 2-day course outline and register here:

http://sleepgroupsolutions.com/2.0/modules/piCal/index.php?smode=Daily&action=View&event_id=0000001419

Dr. Dawne Slabach has a clinical practice focused on Sleep-Disordered Breathing, TMJ disorders and orthodontics. Her passion for treating patients comes from her own personal experiences with all three areas of treatment. Dr. Slabach received her B.S. in Biochemistry in 1984 and her Doctor of Dental Surgery in 1988, both from the Ohio State University. She is a Diplomate in the Academy of Sleep Disorders Disciplines, Distinguished Fellow in the American Academy of Craniofacial Pain and a Certified Assistant Instructor for the International Association of Orthodontics. She is also a member of the American Academy of Dental Sleep Medicine and an assistant instructor for Rondeau Seminars. She has been practicing and teaching Dental Sleep Medicine for the past 8 years.

 

 

Obstructive Sleep Apnea is just a Men’s Disease?

Obstructive Sleep Apnea Does Not Discriminate Against Sex or Age.

In the European Respiratory Journal, Swedish scientists reported that OSA  is common in both sexes, a disorder that was thought to mainly affect men.

 

 Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.

 

The authors concluded:
“Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate, and 6% severe sleep apnea. Sleep apnoea in females is related to age, obesity and hypertension but not to daytime sleepiness. When searching for sleep apnea in females, females with hypertension or obesity should be investigated.”

 

• A apnea-hypopnea index of 30 or more (severe symptoms) affected 14% of the participants aged 55 or more
  
• 31% of the women who were obese and at least 50 years of age had severe sleep apnea