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TOPIC TITLE: What is sleep apnea?
Created On 1/24/05 12:08 AM
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P. S. Ledereich, MD

Posts: 43
Joined: Jan 2005

1/24/05 12:08 AM
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During sleep, just like during the daytime, you need to continue to breath.
You breath to keep your oxygen level steady in your blood stream, in order
for you to live, and keep your brain functioning. (See how beautiful and
magnificent Hashem's creations are?)

Unfortunately, sometime people stop breathing while they sleep.

The most common form of this is "obstructive" sleep apnea. This happens when a
person is asleep, and tries to breath. Unfortunately, because the muscles in the
throat are "floppy", the throat collapses upon itself. The person "chokes" himself,
until the person wakes up a little (has a microarousal), and regains muscle tone.
They start breathing again. An "apnea" is a cessation of breathing at least 10 - 15
seconds. A "hypopnea" is where the breathing slows down, but does not actually stop.
A "central" apnea, is where the throat does not collapse on itself, but the brain stops
sending signals to the diaphram and chest wall respiratory muscles, and they simply
stop moving, causing the breathing to stop.

This is considered in adults to be normal up to 5 times per hour. If this happens
more than 5 times an hour, it is considered that the person has obstructive sleep apnea.
5-20 is considered milk, 20-40 time per hour moderate, and greater than 40 is considered
severe (although I have seen patients stop breathing around 90 times per hour - that is
about every 45 seconds!)

A number of things go wrong when this happens:
1) the oxygen in the blood drops
2) that puts a strain on the persons heart and lungs and brain
3) people can have their blood "thicken" in order to compensate for the
low oxygen levels
4) pulmonary hypertension can develop (high blood pressure within the lungs)
5) they snore loudly
6) they are excessively tired during the day.
7) Patients have a 3x the rate of heart attacks and 5x the rates of strokes than the general population.
8) the average age of death is 62 (considering that the average age at death is well
into the 70's, many years of life are lost).

80% of the people with obstructive sleep apnea are overweight. It can be treated succesfully
with weight loss, which includes eating properly and exercise. Obviously, people who smoke
should quit. While attempting the weight loss, a CPAP or BiPAP mask can be used to
help the person keep on breathing. Avoiding alcohol will also help. For more mild
cases, position therapy can be helpful (for example, sleeping only on your sides, not on your back).

If the simple/conservative treatments do not work, then you may consider wearing a dental
appliance nightly to help with the apnea or surgery. The best surgery would be one that is
tailored to the patients anatomy (not one size fits all).

In general, it is advisable to reduce "cardiac" and "cardiovascular" risk factors, including
avoiding fatty foods, not smoking, drinking in moderation, treating blood pressure and
cholesterol abnormalities.

In a recent study of patients with sleep apnea who needed to undergo surgery, their
level of C-reactive protein (CRP) was tested before and after surgery. CRP is a measure
of inflammation of the arteries, and can be a predictor of risk for a person to
(chas vsholom) undergo a cardiac event. The patients all had high CRP before the surgery, and
afterwards, their CRP decreased significantly.

I have done extensive research in patients with obstructive sleep apnea. My finding noted that
patients with sleep apnea DIED of heart attacks 3x than the general population, and DIED of strokes
5x than the general population. The average age of death was 62 (compared to 78 for the general population).
Patients died in car accidents (perhaps they were so sleepy, they lost control of the car).
This was a large patient population of 279 patients, and I followed them at 5, 10, 15 and 20 years
after diagnosis over time. Please note, that I can not tell you whether a patient died of sleep apnea,
because many of the patients were overweight, smoked, had diabetes, high blood pressure, etc, so
these confounding factors are difficult to tease out in a group of only 279 patients. What is important to
understand from my studay is that patients with sleep apnea should consider themselves at risk for cardiac and cardiovascular events, and need to reduce their risk factors as much as possible.

Sleep apnea is best diagnosed with an all night sleep test in a sleep laboratory. There is current
research on alternative testing, including the "snap" test, and overnight testing in the home (non monitored)
setting. Sleep apnea can not be diagnosed from history and physical examination, although one can
suspect it with the history of loud snoring, apneas noted by the patients bedpartner, excessive daytime
sleepiness, obesity, or even with a crowded pharynx (oro-pharyngeal disproportion).

Treatment can be as simple as losing weight, changing your sleep postion, wearing a "breathing" mask
called a CPAP or BiPAP that helps the patient breath at night, or even wearing a dental appliance. For
patients who fail or can not tolerate conservative medical therapy, surgery can be considered.

If you think you or someone you know has sleep apnea, you should have it checked out, as treatment
is readily available.

Ushmartem meod es nafshoseichem. Be well!

P. S. Ledereich, MD
Family Ear Nose and Throat Care
1033 Clifton Avenue, Suite 204
Clifton, NJ 07013
Telephone: 973 470 8266
144 Route 59
Suffern, NY 10901
Telephone: 845 357 8302

Edited: 1/30/05 at 11:09 PM by P. S. Ledereich, MD

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