April 15, 2014 by Steven Park
It’s now official: The train engineer from last year’s deadly train derailment was found to have severe obstructive sleep apnea, where he stopped breathing 65 times per hour. To date, there’s no conclusive proof that the crash was a direct result of his untreated sleep apnea, since he was also taking a sedating antihistamine and had changed shift hours two weeks prior. However, federal transportation officials are convinced that driver fatigue may have played a role in crash that killed four and injured 70 people.
In an article about this incident, a transportation union official was quoted as saying the crash was a “tragic accident,” and that “there isn’t enough awareness of sleep apnea within the transportation industry.” This is an interesting comment, in light of the fact that recently, the National Transportation Safety Board (NTSB), Federal Motor Carrier Safety Administration (FMCSA), American Trucking Association (ATA), Federal Aviation Administration (FAA), and even Congress have worked tirelessly to bring more awareness about sleep apnea to the public.
Congress just passed a law (H.R. 3095) requiring investigation, data collection and gathering expert opinion into screening requirements for sleep apnea in various transportation industries. The FAA recently announced that they will be more vigilant about screening for OSA, especially in severely overweight pilots. In this press release, the FAA noted that there are almost 5000 pilots with OSA on treatment that have been issued special issuance certificates. Interestingly, the NTSB database reports 34 accidents, 32 of which were fatal, involving people who had sleep apnea and 294 incidents involving another type of sleep disorder.
Around 170,000 individuals are injured in trucking accidents each year. About 5,000 semi-trucks per year are involved in fatal traffic accidents in the United States. In a study conducted by the University of Pennsylvania and sponsored by the FMCSA and the American Trucking Association, almost one-third (28%) of commercial truck drivers were found to have OSA.
Given that the incidence of obstructive sleep apnea is so high in these industries, perhaps there should be universal screening. What do you think? Is it invading privacy to force mandatory sleep apnea testing, or does public safety take priority over individual rights?
April 7, 2014 by Steven Park
During college, one of the most influential coursers that I took was called “Paradigms of Health and Disease.” It was taught by my advisor in the biophysics department. This course looked at how we define what is is to be healthy or sick, and compare and contrast our definitions with other cultures and societies. One important concept that stuck with me from this course is that no disease can ever be truly “cured.” We as physicians can help to alleviate the severity of disease, but we can never completely eradicate conditions like cancer, Alzheimer’s disease, or asthma. The same concept also applies to obstructive sleep apnea.
March 16, 2014 by Steven Park
I just saw a patient 5 weeks after major tongue and soft palate surgery for obstructive sleep apnea, and as expected more often than not, his sleep quality was significantly improved. He did not suffer from brain fog anymore, and was able to think clearly again, something he was not able to do for more than 30 years. He was very happy with the results. As he was leaving the exam room, he wanted to show me something. He took off his shoes, and then his socks, and asked me what I thought.
I was a bit confused by his request, but then I remembered that he showed me his feet many months prior to his procedures. Compared to his right foot at that time, his left foot was more dusky, red and scaly, and not too healthy looking. He had peripheral neuropathy with pain, burring and numbness, for which he was being treated by another doctor. On the post-operative visit, his left foot looked much healthier. He also noted proudly that although he still had some numbness, his burning and pain were completely gone.
Peripheral neuropathy is a common condition seen usually in diabetics, but can also occur in non-diabetics. I wasn’t surprised by his result, but it was a bit unexpected. It not something that’s routinely described as a potential benefit of treating obstructive sleep apnea. We know that sleep apnea causes a stress response that clamps down on blood vessels of the distant extremities.
I did a quick literature search of the connection between obstructive sleep apnea and peripheral neuropathy and found a handful of studies. One report found that patients with obstructive sleep apnea without any symptoms in the feet had objective measures of diminished nerve function, which improved significantly after CPAP therapy. Another paper described resolution of peripheral neuropathy pain (but not numbness) in a non-diabetic after CPAP.
Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.
If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?
March 5, 2014 by Steven Park
February 26, 2014 by Steven Park
I haven’t talked a great deal about sleep deprivation, so when I came across this article on Medscape, I thought the overview of the various epidemiologic findings related to sleeping less than 6 hours was worth reviewing:
“Sleep deprivation has a profound impact on multiple disease states. For example, if you sleep less than 6 hours, epidemiologic studies show the following:
• Stroke is increased by a factor of 4 times.
• Obesity is increased by an increase in ghrelin, which is a hunger hormone.
• Diabetes is increased because sleep deprivation increases insulin resistance.
• Memory loss is accelerated. Epidemiologic studies show that there is not only permanent cognitive loss but also evidence of early brain deterioration.
• Osteoporosis is increased, at least in an animal model, with changes in bone mineral density. Even changes in bone marrow are evident within 3 months of a study in a rat model.
• Cardiac disease is increased. There is a 48% increase in early cardiac death, as well as increased cardiac-related mortality.
• A 4-fold overall increase in mortality.
As it relates to gastrointestinal disease, there is an increased risk for colon cancer, and at least 1 epidemiologic study shows an association between sleep deprivation (or lack of sleep) and an increase in the likelihood of precancerous (adenomatous) polyps.”
The author also summarized the results of this finding that sleep deprived mice had higher rates of tumor growth.
More and more studies are linking sleep deprivation and obstructive sleep apnea with numerous medical conditions, including cancer.
If you sleep less than 6 hours, something else to sleep on…
February 19, 2014 by Steven Park
It’s been a general consensus amongst physicians that chronic pain can disrupt sleep, leading to insomnia and frequent awakenings during the night. In the sleep research field, it’s been long known that poor sleep quality or quantity can lower your pain thresholds, meaning that you’ll feel pain a lot earlier. Regardless of what causes what, it’s a vicious cycle.
Here’s a study that only confirms this link: Nonrestorative sleep was found to be a strong predictor of widespread pain in adults over 50. This has enormous implications as people age and go on to develop aches and pains that are commonly found with arthritis.
Anecdotally, I’ve had a handful of patients with severe rheumatoid arthritis who stated that the pain went away completely after starting CPAP for newly diagnosed obstructive sleep apnea. One patient tried a number of different biologics that are often prescribed for severe rheumatoid arthritis, but only CPAP helped. This is not surprising, since sleep apnea causes generalized systemic inflammation, in addition to aggravating any already existing pain.
Statistically, it can be argued that the majority of people over 65 will have at least some degree of obstructive sleep apnea. If this is the case, it’s not surprising that as sleep apnea worsens, arthritis can also worsen.
If you have rheumatoid arthritis, what is the quality of your sleep?
February 12, 2014 by Steven Park
Insomnia is treated by sleep specialists as a completely different condition from obstructive sleep apnea. Similar to how sleep problem is now considered a “co-morbid” condition to depression and various other medical conditions, insomnia is now beginning to be considered a “co-morbid” condition alongside obstructive sleep apnea. I’ve interviewed Dr. Barry Krakow in the past on upper airway resistance syndrome and complex insomnia (click here for the interviews; search for Krakow). Here’s a must-read interview that was just published in Sleep Review Magazine. The magazine interviews Dr. Krakow on complex insomnia and how everyone with severe insomnia should also be considered for a possible sleep-breathing disorder.
February 6, 2014 by Steven Park
There’s been a rash of studies on the numerous health consequences of pre-term deliveries. Here’s a study showing that babies born before 37 weeks had significantly higher rates of developing asthma. The more preterm, the higher the risk. Since it was a large-scale epidemiological study combining 42 similar studies, with over 1.5 million total births, it didn’t go too much into possible mechanisms.
Underdevelopment of the lungs is a common potential explanation, but here’s another possible mechanism: Preterm delivery can raise your risk for obstructive sleep apnea. This study found that very premature delivery and maternal smoking raised the risk of developing obstructive sleep apnea by 2.2 time normal.
We know that obstructive sleep apnea can predispose your stomach juices to come up into the throat, mainly due to vacuum forces in the throat. If you accept the possibility that stomach juices can reach the throat, then it can easily reach the lungs or even the ears. Here’s one study showing that children with chronic lung diseases had much higher rates of pepsin (a stomach enzyme) in lung washings.
There’s a reason why 40 weeks is needed for full-term delivery. Not having enough time to fully develop the airway and jaw structures can lead to narrowed upper airways which can predispose to obstructive sleep apnea, asthma, reflux, and a variety of other future health problems.
If your child was delivered pre-term, does he or she have asthma?
February 3, 2014 by Steven Park
I’m willing to bet that many of you reading this blog stayed up last night watching TV or surfing the net, going to bed much later than your normal bedtime. Some of you never sleep for more than 6 hours. Life can oftentimes prevent optimal sleep times, such as having a new baby, work obligations, or staying up to watch the Grammy or Academy awards.
I’ve written in the past about the enormous medical consequences of poor sleep quality or quantity. But here’s another good reason to regularly get at least 7 hours of sleep: Our country’s gross domestic product. The New York Times printed a revealing article about the negative impact of sleep deprivation on our country’s economy. One telling statistic mentioned is that the number or people who sleep less than 6 hours rose 22% from 1975 to 2006.
If you listen to the topic of conversations during work or amongst friends, being tired or having problems with sleep are very common. Not getting the 7 to 8 hours of sleep is almost normal in this day and age. This is not including people who have medical sleep conditions such as obstructive sleep apnea. In one month in 2008, 29% of workers had fallen asleep or felt sleepy at work. One Australian study estimated the cost of sleepiness on the country’s gross domestic product at 0.8%. If you include medical complications of poor sleep, car accidents and industrial accidents, this figure is sure to be much higher.
This is why companies that values quality sleep can be much more productive and fosters more creativity (think Google’s sleep pods).
What’s your reason for not getting enough sleep? Is it under your control, or do your personal or work situations prevent you from getting a good night’s sleep?
January 27, 2014 by Steven Park