Poor Quality Sleep Contributes to High Blood Pressure

Obstructive sleep apnea (OSA) is known to cause all sorts of health problems beyond sleepiness. Medical problems include increased risk of stroke, heart attack, peripheral vascular disease, high blood pressure, etc. However, what researchers have recently found is that even if you do not have obstructive sleep apnea, if a person does not have enough "deep sleep" per night resulting in poor quality sleep, that also can increase risk of hypertension.

Researchers collected data on 784 men over the age of 65 who didn't have high blood pressure initially and followed them over the next 3 years. At home sleep studies were obtained initially and at follow-up to look at their sleep patterns as well as their blood pressure.

What they found was that individuals with poor quality sleep, reflected by reduced slow wave sleep (deep sleep), puts individuals at significantly increased risk of developing high blood pressure, and that this effect appeared to be independent of obstructive sleep apnea.

Read a CNN report here.

Reference:
Decreased Slow Wave Sleep Increases Risk of Developing Hypertension in Elderly Men. HYPERTENSION AHA.111.174409. Published online before print August 29, 2011,

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Sleep Apnea Can Turn Your Child Into a School Bully

Image courtesy of Grant Cochrane / FreeDigitalPhotos.net

This statement is supported by a published study indicating that poor sleep, whatever the cause, can be a factor leading a child to bully or display other aggressive behaviors. Among 341 kids who were evaluated, 23% had conduct problems. Of these kids with conduct issues compared to those without, a significant number had symptoms suggestive of a sleep disorder indicated by sleepiness scoring as well as snoring.
It is already known that the prefrontal cortex governs social behavior which is also influenced by sleep. As such, poor sleep can deleteriously influence the brain leading to behavior problems.

Of course, there are other factors that can contribute to sleep problems as well as bullying... such as an unstable family as well as too much technological stimulation (cell phone, internet, television, etc).

As such, as with most things, more study is needed.

But here's my two cents... Applying some common sense here, ask anybody who has pulled an all-nighter whether they are grouchy the next day and I bet you most will say "of course, no duh"!

Well, here's a study that supports that! (No duh!)

All kidding aside, if a child is having behavior issues, it may behoove the parents to see if obstructive sleep apnea is present which would lead to poor sleep quality. At least for kids, obstructive sleep apnea can be addressed surgically by removing the tonsils and adenoids leading to markedly improved sleep quality (and hopefully improved behavior as well!).

Reference:
Aggressive behavior, bullying, snoring, and sleepiness in schoolchildren. Sleep Med. 2011 May 25. [Epub ahead of print]

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Sleep Endoscopy for Obstructive Sleep Apnea and Snoring

A new webpage has been created describing a procedure called "sleep endoscopy" or "sedated endoscopy."

This procedure is performed on patients with obstructive sleep apnea (OSA) or severe snoring in order to determine where the source of their problem is anatomically located.

This special exam is needed in patients where such anatomic determination is not able to be made in the clinic while they are awake. As such, an anesthesiologist would put the patient to sleep using IV medications and when snoring or obstructive events happen, endoscopy is performed.

Areas that will be specifically examined during sleep endoscopy include:

• Behind the palate
• Uvula
• Back of Tongue
• Walls of the Throat
• Epiglottis
• Voicebox

Each of these areas may experience collapse during sleep causing obstructive or snoring symptoms.

Why is this information helpful? Well... once it is apparent where and what is the culprit causing a given patient's problems, surgical treatment can be geared more specifically and directly to the area of concern seen during sedated endoscopy.

Read more here!

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New Video on Uvula Excision for Snoring (and Other Problems)

Our office has created a new video on how a uvulectomy (or uvula excision) is performed to treat not only snoring, but chronic cough, throat-clearing, and even gagging due to an extremely long uvula.

Though the procedure can be performed awake without sedation in adult patients without a severe gag reflex, for those with a bad gag reflex, it must be performed under general anesthesia as shown in this video.

For more info on this procedure, click here.

Check it out here!

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Clinical Guidelines For Tonsillectomy in Children Published

This month, the American Academy of Otolaryngology-Head & Neck Surgery published clinical guidelines for tonsillectomy in kids. No big surprises in the guidelines, but everything is nicely summarized in one document.

In summary:
• Strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.
• Strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy.
• Recommendations for:

1. watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years
2. assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance; PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis); or history of peritonsillar abscess
3. asking caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy
4. counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing
5. counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management
6. advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain
7. clinicians who perform tonsillectomy should determine their rate of primary and secondary post-tonsillectomy hemorrhage at least annually.

References:
Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology– Head and Neck Surgery 144(1S) S1–S30

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Pacemaker To Cure Obstructive Sleep Apnea (OSA)?

The Huffington Post on Dec 27, 2010 published a story about a potential new treatment whose goal is  obstructive sleep apnea cure (OSA) cure using a pacemaker made by Inspire Medical... for the tongue. The New York Times also published a similar story more recently about the same device on 1/8/2014.

The device works by stimulating the nerve going to the tongue (hypoglossal nerve) to contract with every breath a person takes while sleeping.

Why would this help? In some patients with severe obstructive sleep apnea, the tongue falls backward against the throat's back wall (tongue prolapse) causing airway obstruction. By stimulating the tongue's nerve, the tongue is stimulated to move forward when a patient takes a breath preventing obstruction.

Of course, this treatment works ONLY if the obstruction is due to tongue prolapse.

There are other treatments that also accomplish the same thing including:

• Base of tongue coblation/reduction
• Geniohyoid advancement
• Repose procedure
• Oral appliance

At least in our office, we only offer the base of tongue reduction to address tongue prolapse that may lead to obstructive sleep apnea.

This pacemaker for the tongue is currently experimental and not available for the general public yet.

Sources:
Sleep Apnea: Experiments Test If Implant Can Block Sleep Problem. Huffington Post 12/27/10

For Sleep Apnea Patients, a Possible Alternative to Masks. NYT 1/8/14

Reference:
Upper-Airway Stimulation for Obstructive Sleep Apnea. New England Journal of Medicine. January 9, 2014DOI: 10.1056/NEJMoa1308659

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New Non-Addictive Sleep Drug to Help People Sleep!!!

It was with great interest that I read a recent report that a new drug, Silenor, was approved by the FDA this month (March 18, 2010) to help people who have trouble sleeping. Although there are already prescription medications to help with sleep (Ambien and Lunesta being the most common ones), Silenor is very interesting in that there was no suggestion of any addictive properties or withdrawal with this medication in over 1000 patients during clinical trials.

In fact, Silenor has not been designated as a controlled substance by the U.S. Drug Enforcement Administration (DEA) because of its demonstrated lack of abuse potential. Ambien and Lunesta are both considered as controlled substances.

Silenor binds with high affinity to the histamine H1 receptor... the same receptor that over-the-counter benadryl attaches to resulting in a side-effect of drowsiness. BUT, Silenor attaches to this receptor 14X more strongly compared to benadryl.

Silenor is made by Somaxon Pharmaceuticals (SOMX).

Read more here.

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