Talk:Sleep apnea/Archive2

From Wikipedia, the free encyclopedia

Amazing. People delete screening information on the sleep apnea page and do not replace it. Hello? Not to worry, will do and post it shortly.


I think I may have merged them.```` Posted unsigned: 17:51, August 12, 2006 User:DrSculerati

Merged what? --Jclerman 01:43, 13 August 2006 (UTC)

It has been suggested that Obstructive sleep apnea following pharyngeal flap surgery be merged into this article or section. (Discuss) I did a lot of writing and editingand put in the issue of pharyngeal flap surgery into the main article. DrSculerati


Contents

[edit] Connections between sleep apnea and stroke

Relatively recently, there was a big media focus here in Sweden on the connection between sleep apnea (in the media first portrayed by/present as snoring) and such things as stroke and heart attacks/heart failure. A few quick googlings seem to support this claim, but I do not feel comfortable in my knowledge, or rather lack there of, to try to write this into the article, especially since I don't have any academic/scientific references.--kissekatt 03:07, 24 September 2005 (UTC)


I'll see what I can do. This is important info that might be relevant to may who look at this page. Thanks for the tip. MrSandman 13:30, 24 September 2005 (UTC)

Yale University study:

Obstructive sleep apnea as a risk factor for stroke and death.

"Conclusion: The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension."

hschultz 19 September 2006


Has anybody heard of pillar procedure ? Or has anybody undergone this procedure ? Please post the pluses and minuses of this procedure. Thanks.

The pillar procedure is where they take 3 inserts and insert them into the posterior soft palate, resulting in a stiffening effect, with the goal of lessening the vibration/possible collapse that occurs. The problem with the pillar procedure, as with all surgical interventions for OSA, is the results are variable and unpredictable. I would venture to say that the pillar procedure is only a viable option in either primary snoring, or very mild OSA (overall AHI < 5-10). Surgical intervention for treatment of OSA is limited to a few situations. These include:

   a) mild OSA (overal AHI < 5-10) and even then, the results are variable, but you can usually predict about a 50% reduction in events.  So someone that had an overall AHI                     
           of 5-10 would go to 2.5-5.
   b) enlarged tonsils.  If a person has large tonsils (3-4+) and significant OSA, then T&A is usually the first treatment choice.  You still need to repeat the PSG after the 
           surgery (after adequate time for healing has been had) to ensure resolution of the OSA.
   c) If a patient is intolerant of CPAP (i.e. they need 20+ cm pressure), then surgery (e.g. UPPP) may help clear some space.  This will not cure the OSA, but rather clear
           enough space so that they may be able to adequately control their OSA on a lower pressure requirement (i.e. 12cm vs 20+cm.)  thus making CPAP more tolerable P a
           for the patient who can't handle the higher pressures.

Often times people go to surgery with the thought it will get rid of their OSA. In the select, rare, patient population this happens. But more often than not, the patient has the surgery (which has inherant risks, complications, and pain) and still ends up on the one thing they were trying to avoid in the first place: CPAP.--Sleep3r 14:58, 19 July 2006 (UTC)


[edit] Intro

The intro paragraph seems pretty bad to me, but I'm not an expert. It says "these episodes commonly last 10 seconds or more". Aren't the episodes defined to last ten seconds or more (i.e. an apnea is a cessation in breathing for more than 10 seconds)? Also, "in the morning people will not be aware of the disturbances in their sleep". Shouldn't this be "may not be aware", given that patients with sleep apnea frequently have problems with insomnia, and that they are often asked if they awaken short of breath? Finally, "Most people with sleep apnea will have a combination of both types" (OSA and CSA). Since CSA is rare, shouldn't it be some people? I've tried to fix this up. –Joke 02:41, 24 January 2006 (UTC)

From a previous comment, above:
See prevalence of different apneas in: http://ajrccm.atsjournals.org/cgi/content-nw/full/157/1/144/T1Jclerman 06:12, 28 September 2005 (UTC)
For men aged 65 to 100 the prevalence is very common, nearly the same as for obstructive apnea.Jclerman 06:12, 28 September 2005 (UTC)
For more reliable information search PubMed (MEDLINE, Entrez). Jclerman 06:12, 28 September 2005 (UTC)

Ok, fair enough. But most people aren't 65-100. Overall in that study, OSA is eight times as prevalent as CSA. –Joke 04:25, 24 January 2006 (UTC)

[edit] See also

This article has "See also" links to bruxism and an entry that reads like an ad for a home test for bruxism. The link to bruxism is warranted as another sleep-time disorder, but the second is too indirect. Is this a candidate for deletion?

Nope. See: Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure.

Oksenberg A, Arons E.

Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, P.O. Box 3, Raanana, Israel. psycot3@post.tau.ac.il

Several studies have reported that sleep bruxism rarely occurs in isolation. Recently, in an epidemiological study of sleep bruxism and risk factors in the general population, it was found that among the associated sleep symptoms and disorders obstructive sleep apnea (OSA) was the highest risk factor for tooth grinding during sleep.

Sleep Med. 2002 Nov;3(6):513-5.

[edit] Side effects ...

..(of oral appliances) "are common, but rarely is the patient aware of them." This sounds off. Any takers? Sfahey 04:20, 27 March 2006 (UTC)


[edit] Co-Morbidities with Sleep Apnea

Personal story: I was diagnosed with OSA in 1995, and have been using a CPAP or BiPAP ever since. The CPAP/BiPAP is only a treatment, not a cure. It's no substitute to an unobstructed night's sleep.

Although I was diagnosed with sleep apnea at age 28, I believe I had OSA in my early childhood. Its effects were minimized in high school - the only time in my life where I was near an ideal weight. Even at 19, and only 10-20 pounds overweight, I believe I had OSA even then, looking back at the symptoms I had back then (including very high blood pressure).

Over the years, I have also been diagnosed with narcolepsy-type problems, restless legs syndrome (gone since CPAP), high blood pressure (treatable with the CPAP if I sleep well enough), asthma, hypogonadism, enlarged prostate, fibromyalgia and, now, it's also suspected that I also have ADHD (inattentive type), which has yet to be tested and confirmed. It has also aggravated my weight. Since I have low energy, my body tends to eat to make up for lost energy. When I have sugar and caffeine, my ADHD symptoms are reduced, finally giving me a chance to focus, but this also causes weight gain. I had lost 130 pounds at one point, but the OSA never went away, and it never reduced. I honestly believe that, if I can conquer OSA once and for all, all of my other health problems will slowly go away.

This leads me to my point. The article, although good, doesn't list or link to other co-morbid conditions. I'd like to see a Co-Morbitities section added to the article. --Bmeloche 05:21, 28 March 2006 (UTC)



Would like to see discussion on use of supplemental oxygen, difficulties adjusting to sleep machines, further discussion of Central and Mixed Sleep Apnea, sleep architecture, and sleep stages. Thanks for doing this. Already this is one of the better sources of info on Sleep Apnea easily available on the net.

[edit] Inappropriate link to bruxism-related commercial product

As noted previously on this talk page, there's a periodically reappearing link to a Wikipedia page for BiteStrip, a commercial product for diagnosing bruxism. Bruxism is another sleep disorder and not apnea. Linking to Bitestrip seems doubly inappropriate -- it's not just unrelated but it's unrelated and commercial. I deleted the link then thought better of it, reverting my deletion and posting this comment. I did not want to be rude. Perhaps someone can explain why this link should be included -- otherwise I recommend deleting it.--A. B. 19:21, 24 May 2006 (UTC)

Thanks for pointing this out.. I never noticed it. I went ahead and deleted it.. this way you don't feel bad.

The link to the product, as well as the link to bruxism was not relevant to this article. MrSandman 20:50, 24 May 2006 (UTC)

Try using PubMed and search on Bruxism and sleep apnea. See:

Sleep Med. 2002 Nov;3(6):513-5.

"Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night most breathing abnormalities were eliminated and a complete eradication of the tooth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep."

and

Singapore Med J. 2002 Nov;43(11):554-6. Related Articles, Links


Habitual snoring and sleep bruxism in a paediatric outpatient population in Hong Kong.

Ng DK, Kwok KL, Poon G, Chau KW.

Department of Paediatrics, Kwong Wah Hospital, Waterloo Road, Hong Kong, SAR China. dkkng@ha.org.hk

OBJECTIVE: To determine the prevalence of habitual snoring and sleep bruxism in children attending the out-patient clinics of a paediatric department. METHODOLOGY: A cross-sectional survey of parents was conducted with questionnaire administered by paediatric nurses. Parents were recruited when they brought their children to the out-patient clinics. Sex and age were recorded. Presence and absence of habitual snoring and sleep bruxism were noted. Types of diseases that brought the children to the out-patient clinics were also noted. RESULTS: Twenty-nine of the 200 recruited children were noted to have habitual snoring (14.5%, 95% C.I. 10%-20%). The mean age of these habitual snorers was 6.2 +/- 3.1 years. For habitual snorers, male to female ratio was 1.4 to 1. Sixteen of these 28 children accepted a sleep polysomnographic examination. Eleven children were found to have snoring during the night of study. Two were found to have obstructive sleep apnoea syndrome. Sleep bruxism was found in 17 children (8.5%, 95% C.I.5%-13%). Sleep bruxism was closely related to habitual snoring as 16 out of the 17 children with sleep bruxism were also habitual snorers (p < 0.0001). CONCLUSION: Habitual snoring and sleep bruxism were commonly found in children attending paediatric clinics. Paediatricians should be aware of these problems and be prepared to deal with them. Habitual snoring and sleep bruxism were closely related. Further studies into this relationship is needed.

hschultz 19 September 2006

[edit] Deaths

Why was the reference to Jerry Garcia removed? It was noted on his page that he died of a heart attack as a result of sleep apnea. Wouldn't it be useful to note other famous people that have died as a result of a complication caused by sleep apnea? --Ddspell 03:38, 7 June 2006 (UTC)

Thousands of people die of heart attacks and other illnesses related to sleep apnea each year. I don't see how listing famous people is helpful, and frankly, this page is too long already. A list with one persons name is not a list.. and does not warrant a new category. If you want to provide statistics referring to mortality secondary or primary to OSA.. then that would be great. MrSandman 13:47, 7 June 2006 (UTC)

[edit] Merge w/ post-op obstructive apnea?

Support. This is a no-brainer. Sfahey 19:30, 4 August 2006 (UTC)

[edit] Tagged "central apnea" section for cleanup

I hope that didn't seem rude to tag this section. This article contains lots of excellent information, but this section in particular seems to need the wording tweaked. I've seen bad articles tagged with Cleanup, and this section (and article) are certainly not that, but I think could be much better with wordsmithing. Quintote 01:38, 3 September 2006 (UTC)


== Complex Sleep Apnea section modifications

I have modified this section for two reasons. The text was far to explicit for a relatively poorly documented manifestation of sleep disordered breathing; especially one lacking any long-term studies on consequences. The second deletion was to the extensive "adaptive servo ventilation references". This is a new therapy which has not been tested in these patients in a longitudinal trial; accordingly, the therapy has not been demonstrated as substantially different to existing therapies in terms of meaningful outcomes. It also seemed to be somewhat commercial. Sleepydadpro 08:14, 17 October 2006 (UTC)