Q: Can Sleep Apnea Cause Birth Defects?

Q:
Dear Dr. Park,

I was wondering if you are aware of any link to birth defects or other issues in babies of mothers with undiagnosed sleep apnea? I have only been diagnosed lately at the age of 47, but my first child who’s 22 was born with a cleft lip, has asthma + is waiting for an operation for a deviated septum. My son, who’s 13, is waiting to see a specialist as his hearing is very bad in one ear, he has a permanent stuffy nose and also has learning problems (border-line dyslexia). When my daughter was born with the cleft lip her orthodontist asked me several times if I could think of any occasion during my pregnancy where there could have been a lack of oxygen to the placenta. At the time I couldn’t, but I didn’t know then that I had sleep apnea.

Many thanks for your time.
Kath (UK)

A:  It’s interesting that you ask that question, as a recent study reported that women with OSA had a much higher incidence of children with neural tube defects. There are a number of other studies linking sleep-breathing problems with perinatal complications. One study revealed that snoring alone during pregnancy was associated with much lower Apgar scores at birth. I’m not aware of any association between sleep apnea during pregnancy and cleft lip or palate problems, but I wouldn’t be surprised if there is a link. We also know that sleep apnea is most likely a major aggravator for pre-eclampsia during pregnancy.
 
I think your family history is a combination of hereditary risk factors as well an pregnancy-related sleep apnea complications. Unfortunately, there’s no easy way of proving cause and effect. The various problems that your children suffer from could be related to hereditary factors, since you already know that you sleep apnea. There are also external environmental factors that may contribute as well, such as bottle-feeding and the child’s diet. Needless to say, oxygen deprivation during pregnancy is not good for the developing baby.

Q: Can Sleep Deprivation Be Harmful For Pregnancy During Medical Residency?

Q: 
Dear Dr. Park,

I will be starting internship in a few months, and will be doing q4 30 hour call for the entire first year. I am worried about the possible detrimental effects to my health (cardiovascular, metabolic, chronic pro-inflammatory state) from not sleeping AT ALL every 4th night for one year. More importantly, do you know of any studies that have been done with pregnant women and sleep deprivation? If I were to become pregnant sometime during residency, is it dangerous for the baby to be on a 30 hour q4 call cycle? Any insight you could provide would be greatly appreciated!
Sincerely,
D, med student

A:  You bring up an interesting question, in light of the fact that new recommendations were released by the Institute of medicine regarding resident work hours (click here to read.) It sounds like you’ll definitely get more sleep than in years past: One of the recommendations is a 5 hour protected sleep shift during overnight shifts. Gone are the days when residents worked 120 to 140 hours every week. I won’t get into the pros and cons of this debate, but it’s safe to say that any degree of long-term sleep deprivation is not good for anyone, male or female. I’m not aware of any studies of intentional sleep deprivation and pregnancy, for obvious reasons.

Depending on the type of residency, some programs or specialties are more conducive to pregnancies than others. Internship is probably not a good time to have a baby, but in the latter years of residency, many women do go through pregnancies with creative scheduling and cooperation with other residents.

Q: Is My Sleep Test Reliable?

Q:  Dr. Park,

Is my sleep study reliable? I was told to sleep on my back only during the test and then were given two different diagnosis by the clinic and the interpreting doctor. Would a repeat of the original study be advisable?
Danielle

A:  Without looking your study results, it’s hard to say if it’s reliable. Most sleep studies are standardized, and there are various ways of determining from the report whether or not there was enough reliable data to analyze. Different doctors may interpret the raw data differently, just as different polysomnographic technologists can interpret tests differently.

Also forcing you to sleep on your back when you normally like to sleep on your side is not natural.

Ultimately, together with your sleep physician, you should re-evaluate your medical condition in light of the sleep study interpretation and decide what to do.

 

Q: How many hours should I sleep?

 

A:  It depends. Assuming that you don’t have any sleep-breathing problems and no other medical issues exist, the general range is about 5-8 hours. Everyone is different, with various sleep requirements. If you do have a sleep-breathing problem, then since your sleep quality is not as good, you’ll need more.

It’s been shown that the bare minimum "core" sleep that one needs is about 5 hours. By 5 hours, you’ll have gotten most of your non-REM deep sleep. Studies have shown that people who sleep less than 5 hours or more than 9 hours have higher rates of depression and heart disease. In short sleepers, this makes sense. But why is sleeping extra long a problem? Sleeping longer than 9 hours means that you’re not sleeping efficiently, for whatever reason. The most common problem will be a sleep-breathing problem, such as obstructive sleep apnea or upper airway resistance syndrome. If you can’t sleep on your back, or feel tired no matter how long you sleep, get evaluated by a sleep specialist.
 

 

Q: What’s a Neti-Pot?

 

A:  A Neti-Pot is an ancient Indian method of nasal and sinus cleansing, where one uses a small tea-pot shaped container to pour salt water into the nose. The saline solution is not very different from other forms of nasal saline recipes that are widely available. There are many different ways of getting salt water into your nose, including bottles that spray, mist or pump saline. Some come in aerosol cans. Another, more aggressive way of irrigating your nose is to use a Water-pik machine which sprays the saline under high pressure. You’ll need to get an inexpensive nasal adaptor if you want to use this device.

The Neti-Pot is similar to all the other methods mentioned above, but is unique in that it uses gravity to pour large volumes of saline into one side of your nose. It’s applied by bending your head over a sink and tilting your nose to one side. The nozzle of the Neti-Pot is placed on the higher nostril and slowly emptied into the nose. The saline goes to the back of the nose, turns around the back of the septum, and comes out the lower, gravity-dependent side. The head is turned to the other direction and the other side is then addressed. There are video demonstrations of this technique on YouTube.

 

Q: Why do I lose my voice all the time?

A: There are many reasons for losing your voice, but one of the most common reasons for chronic voice problems is due to acid reflux. This is not your typical gastro-esophageal reflux (GRED) in that you don’t have to have any heartburn or indigestion. The only thing you may feel is hoarseness, but more often than not, you’ll also have chronic post-nasal drip, throat clearing, cough, a lump sensation, difficulty swallowing, or pain. This is called laryngo-pharyngeal reflux disease, or LPRD.

Initially, try eating dinner much earlier, and avoid alcohol close to bedtime. There are various over-the-counter medications for acid reflux, but they are not designed for this type of reflux. If your problem persists for more than a few weeks, or keeps coming back, it’s probably prudent to see an ear, nose and throat specialist for a proper evaluation.