• Home
• About Dr. Park
  • Dr. Park’s Bio
  • My Mission
• Testimonials
• Articles
• Sleep Apnea Basics
  • Obstructive Sleep Apnea – A Primer
  • Upper Airway Resistance Syndrome
  • Surgery For Snoring & Sleep Apnea
  • Usual and Unusual Ways to Stop Snoring
• Expert Interviews
• Blog
• Press Room
• Resources
• Contact Us

Subscribe: Email RSS 

Why Hypertension Is More Lethal For African Americans

Blacks with high blood pressure were found to be twice as likely to suffer sudden cardiac death compared to other racial groups. A study published in HeartRhythm found that this was the case regardless of other other factors such as age, gender, family history, weight, diabetes or previous history of heart disease. What they don’t mention is that blacks are also at significantly increased risk for having obstructive sleep apnea, which more than doubles one’s chances of having a heart attack or stroke. I wish more studies like this would also control for the presence of obstructive sleep apnea. 

CPAP Can Help With Metabolic Syndrome

We already know that treating obstructive sleep apnea can help you to sleep better, but there’s been conflicting studies showing the benefits of CPAP on high blood pressure, diabetes, or risk of heart disease. However, for the most part, CPAP has been found to be helpful with hypertension, diabetes and cardiovascular risk factors.

Here’s a small study out of India showing that CPAP significantly lowered various markers for metabolic syndrome (high blood pressure, high cholesterol, and insulin resistance). Eighty-six volunteers (87% had metabolic syndrome) with were randomized to be given CPAP or sham CPAP therapy for 3 months. After 3 months, the two group were reversed. People treated with CPAP had an overall drop of 3.9 mm Hg systolic (top number) blood pressure, and 2.5 mm Hg in the diastolic (bottom) number. Total cholesterol went down 13.1 points, and  LDL dropped 9.6 points. Triglycerides also dropped, by 18.7 points. Thirteen percent no longer had metabolic syndrome.

On a side note, this study was funded by Pfizer, which makes many of the popular medications for high cholesterol and high blood pressure. It’s interesting that they would fund a study that would make it less necessary to use their prescription medications. We know that they don’t manufacture CPAP machines, so I wonder why they funded this study. Could they be interested in entering the sleep apnea market?

Lack of Deep Sleep Can Cause High Blood Pressure

Here’s another article which confirms what we already know: That lack of deep sleep can cause high blood pressure. We’ve known for years that sleep fragmentation can increase your adrenaline response at night during sleep, preventing the normal lowering of your blood pressure during sleep. Not having this “dipping” phenomenon is tied to having hypertension during the day.

If you look at this study in light of statistics from the CDC, the implications are frightening: Almost 1/3 of Americans have high blood pressure, and about 70% of these people are on medications, but less than 50% are being adequately controlled. Another 25% have pre-hypertension. Over 70% of people over 65 have hypertension. Take into consideration how sleep deprived we are as a society, and that 90% of people with obstructive sleep apnea are not diagnosed, this should be wake-up call for everyone.

 

Lack of Deep Sleep (From Sleep Apnea) Can Cause High Blood Pressure

If you don’t sleep well or are sleep deprived, you know what that feels like: you’re more likely to be unenergetic, unfocused, unproductive, and unmotivated. Lack of sleep in general is already an epidemic in this country, and there are studies that show that lack of specific stages of sleep can contribute to certain types of symptoms. Sleep deprivation is also tied to an increased risk of hypertension, heart disease, diabetes and early death. Researchers from Harvard have now confirmed that lack of non-REM deep sleep is associated with an increased risk of high blood pressure. Furthermore, people who lacked deep sleep were more likely to have obstructive sleep apnea.

We’ve known for years that people who lack the normal blood pressure “dipping” phenomenon at night are at increased risk for high blood pressure during the day. People with sleep apnea are known to lack this blood pressure dip at night. It’s thought that increased physiologic stress responses from activation of of your sympathetic nervous system may the the cause. As your throat muscles begin to relax in deeper levels sleep, apneas are more likely to occur. 

This study emphasis that point that despite sleeping 8 to 9 hours, if you’re not getting quality (deep) sleep, it can can still be detrimental to hour health.

 

Sleep Apnea Causes High Blood Pressure In Children

A new study out of Australia showed that in children with obstructive sleep apnea, their blood pressure levels were higher while awake just before sleep onset and during sleep. Overall, their blood pressure was 10-15 mm Hg higher compared with controls. Blood pressure was elevated, regardless of the severity of sleep apnea. The authors argue that thresholds for mild forms of sleep-disordered breathing needs to be reassessed, and that benign snoring should not be considered benign anymore.

I totally agree with the study authors. Sleep apnea doesn’t begin in middle age—it begins during the early childhood years. Having smaller jaws and more narrow airways predisposes to additional inflammation, causing lymphoid tissues (tonsils and adenoids) to become larger, which causes even more breathing problems. Taking out tonsils and adenoids are usually the first line therapy for most children with sleep apnea, but a significant number of children will have persistent sleep apnea, despite surgery. Since most children undergoing adenotonsillectomy don’t have sleep studies before and after their procedures, we’re probably missing a large number of children with persistent obstructive sleep apnea, despite subjective and clinical improvement in their symptoms.

Addressing these issues early on could potentially prevent many of the complications that may occur later in adulthood. A child that doesn’t sleep well due to breathing problems can manifest with a number of medical conditions, such as ADHD, asthma, developmental delay, bedwetting, ear infections, or even mood disorders. The public health implications are potentially huge.

 

 

 

 

 

 

 

 

 

 

Should Asymptomatic Sleep Apnea Patients Be Treated?

Once in a while, I’ll come across someone with moderate or severe obstructive sleep apnea who feel fine. They deny any sleep problems or any daytime fatigue. In this situation, it’s hard to convince the patient that he or she should use CPAP or oral appliances. Here’s another study that shows why it’s important to treat obstructive sleep apnea, even if you’re not tired: Researchers from Spain showed that treating asymptomatic sleep apnea patients significant lowered their cardiovascular risks by 28%. Furthermore, sleep apnea patients with hypertension had a 50% reduction in cardiovascular events if they used CPAP for at least 4 hours every night.

If the patient is still resistant, I give the following example: If you had high blood pressure or diabetes, you’ll feel fine, right? But if your doctor told you that despite dieting and exercise, your numbers (blood pressure or glucose levels) are still on the high side and medications were recommended, would you consider it?

Do you have obstructive sleep apnea and are completely symptom free? If you’re on some sort of treatment, what motivated you to start treatment? I’d like to know. Please enter your reasons in the text area below.

A Link Between Sleep Apnea and Diabetes Confirmed Again

A Link Between Sleep Apnea and Diabetes Confirmed—Again

It’s almost a given that you’ll see headlines regarding sleep apnea every few days, about how it’s linked with heart disease, diabetes, high blood pressure, weight gain, and sudden death. Unfortunately, it’s gotten to the point where you’re likely to yawns at these findings because you’re so inundated with more interesting medical news and other celebrity media stories. Bare minimum, you might glance at the brief article and think, "that’s interesting," and then go on to the next story. 

 

Recently, there’s been news about the National Transportation and Safety Board making recommendations about mandatory screening for all commercial airline pilots, commercial truck drivers, ship pilots, and transit train operators, in light of many recent events including pilots that fall asleep and miss their destinations due to undiagnosed sleep apnea. Yawn.

 

A recent Johns Hopkins study showed that if you have severe sleep apnea, you have a 46% increased risk of dying compared with those that have mild to moderate sleep apnea. Yawn. We already know this information. Sleep apnea patients have a much higher risk of dying from heart attacks or strokes.

 

A study now shows that your risk of developing diabetes is 2-3 times higher if you have severe sleep apnea and you have daytime sleepiness. We already know that sleep apnea is independently linked to diabetes.

 

I guarantee that many more studies will be released repeating these same findings over and over again, linking or associating one variable to sleep apnea, without flat out saying that one causes the other. 

 

I wonder what will it take to significantly elevate sleep apnea awareness in this country? Celebrities with sleep apnea? We already have a few including Rosie and Regis. Politicians with sleep apnea? With the congress being mostly older men, I’m guessing about 1/3 to 1/2 of our leader have at least some degree of sleep apnea.

 

Should All Older People Be On High Blood Pressure Pills?

A recent article published in the British Medical Journal concluded that all older people should be placed routinely on blood pressure lowering pills, regardless of whether or not they have high blood pressure. You can read a summary here.

It’s one thing to conclude that lowering blood pressure even incrementally has potential health benefits, but to say that all older people should be placed routinely on a cocktail of high blood pressure medications is going too far. Also, the fact that the authors have financial interest in what they’re recommending does not support their stance.

What they should be asking is what’s actually causing hypertension. One major cause that’s been proven but virtually ignored by the medical community is the presence of obstructive sleep apnea. It’s safe to say that most seniors will have some degree of obstructed breathing. Despite all that we know about the cause and effect relationship between hypertension and sleep apnea, 90% of people who have it are not diagnosed. Instead, they get treated for their hypertension, diabetes, depression, anxiety, weight gain, heart disease, heart attack and stroke.

 

Read the summary article and let me know your thoughts on this. Has research, in the name of science, gone too far?

 

 

 

Can A Sleep Problem Give You Alzheimer’s?

There’s been a lot of press recently about the side affects that poor sleep quality has on our cognitive functioning not to mention what it means for those who suffer from neurological problems like Alzheimers.

This month, our expert article is contributed by noted neurologist and author of Deadly Sleep, Dr. Mack Jones, who explains the reason why he thinks everyone who has Alzheimers or is at risk for this problem should get tested for a sleep breathing problem like OSA.

——-

 Is it possible that Obstructive Sleep Apnea (OSA) causes Alzheimer’s Disease (AD)? I believe so. As a retired clinical neurologist and former patient with Obstructive Sleep Apnea, I have a special interest in sleep disorders medicine. I am thoroughly convinced of the connection between OSA and AD and will remain so until credible studies prove otherwise. Numerous short term studies have been done on cognition (mental processes) and sleep or the lack thereof, but there are few or no long term studies to determine OSA’s relationship to Alzheimer’s Disease (AD) and/or the other dementias.

Many polysomnograms (PSGs) or in lab sleep tests have been done on patients with AD revealing an incidence of OSA of up to seventy to ninety percent.  The assumption has been that AD causes OSA, or they just happened to coincide, but I contend that OSA is the cause of AD.

There are no studies that either prove or disprove my hypothesis that long standing undiagnosed OSA is a cause of AD, but evidence is accumulating. For example, OSA is a recognized risk for Type 2 Diabetes. In the April 2008 issue of The Archives of Neurology, type 2 Diabetics had an increased risk or developing Mild Cognitive Impairment (MCI)(1) which is the earliest stage of dementia.  Fifty to sixty percent of patients with MCI progress to AD at rate of twelve percent per year.
 
Additionally, OSA is a known risk for the development of high blood pressure.  Like patients with Type 2 diabetes, those with high blood pressure were also found to have an increased risk of developing MCI.(2)  Since the majority of patients with MCI eventually progress to Alzheimer’s Disease at a rate of approximately twelve percent per year, then it’s not a stretch to conclude that OSA is a cause of Alzheimer’s Disease.
 
In 2006 a study in the Proceedings of the National Academy of Sciences showed low brain oxygen (hypoxia) raises Alzheimer’s risk in the mouse brain with a genetic susceptibility.(3) A group of mice with an Alzheimer’s gene were given a maze test in which they all performed normally. They were separated into two groups, one exposed to 16 hours of a reduced oxygen environment (hypoxia) daily for several weeks; the other group in a normal environment.

The maze test was repeated and revealed the hypoxic mice performed poorly, whereas the control groups performance remained normal as before. All the mice were sacrificed and their brains examined under the microscope. Plaques and neurofibrillary tangles typical of Alzheimer’s Disease were present in the hypoxic mouse brain specimens, whereas the controls were normal. According to investigators, the study suggests that preventing brain hypoxia (as occurs in OSA) may reduce the risk of developing Alzheimer’s Disease.
 
Reported in the June 27th issue of Neuroscience Letters, sleep apnea patients have shrunken brain structures called “mammillary bodies” involved in memory according to Rajesh Kumar, PhD and colleagues from the University of California at Los Angles (UCLA).  High resolution MRI brain scans revealed mammillary bodies to be twenty percent smaller in patients with sleep apnea than in normals.  “These findings are important because patients suffering from memory loss from other symptoms, such as alcoholism or Alzheimer’s Disease, also show shrunken mammillary bodies,” Dr. Kumar said in a press release.
 
A recent study form San Diego showed that Sleep Disordered Breathing, including OSA, is and important risk factor for cognitive impairment in older women. (4)

Neuroimaging studies have been performed on patients with OSA including CT, MRI. PET and SPECT scans, revealing a variety of defects, but none has displayed anything quiet as dramatic as in a study published in SLEEP July7, 2008, by Dr. Paul M. Macey et al. (5)  The report reveals results of a new MRI technology called DTI (Diffusion Tensor Imaging). It is an extremely sensitive method of determining damaged nerve fibers (axons). This new imaging technique reveals multiple areas of brain damage in OSA patients not known to exist until now. DTI revealed various sized color-coded yellow-orange patches of brain damage scattered throughout the brains of a group of forty-one men and women subjects with OSA. Their ages ranged from thirty-eight to fifty two years old and they had not yet been treated. The areas of nerve fiber injury were wide-spread, located in critical regions of brain including prefrontal, temporal and parietal lobes. The cerebellum and brainstem were equally involved. This is the first report of DTI imaging of a group with OSA to my knowledge. The findings have far-reaching implications.

One can anticipate finding even more areas of damage in an older population as studies are done. What problems result from each one of these areas of brain damage?  It is possible that they are responsible for difficulties with cognition, mood, behavior, memory, heart regulation, high blood pressure, breathing control, fear, anxiety and other emotional disorders including depression? Those findings are yet to be reported. Could this brain damage eventually accumulate enough to cause Alzheimer’s Disease and/or the other dementias? 

The structural changes likely represent accumulated damage over sustained periods of time.  Are they permanent or do they improve or disappear with treatment?  No one knows yet, but my guess is they may improve to some degree or even resolve with treatment, but we will have to wait and see.
 
The implications of these findings are profound. Early treatment of OSA could potentially prevent the development of Alzheimer’s Disease. Now is the time to wake up the public and our snoozing medical community and put an end to this disease.

References:

1. José A. Luchsinger, M.D. et al, Relation of Diabetes to Mild Cognitive Impairment, Arch Neurol. 2007; 64 (4):570-575.
2. Christine Reitz, M.D. PhD, et.al. Hypertension and the Risk of Mild Cognitive Impairment:, Arch Neurol. 2007; 64(12):1734-1740.
3. Xiulian Sun, et al, Hypoxia Facilitates Alzheimer’s Disease Pathogenesis By Up Regulating BACE1 Gene Expression. PNAS (Proceedings of the National Academy of
Sciences) 2006 | vol.103 | no. 49 |18727-18732
4. Adam P. Spira, et al, Disordered Breathing and Cognition in Older Women: Journal of the American Geriatrics Society. Volume 56, issue 1, January 2008, 45-50.
5. Paul M. Macey, et al, “Brain Structural Changes in Obstructive Sleep Apnea," SLEEP vol.32, Number July 7, 2008, 913-1056.

——-
After surviving his four year ordeal in search for a cure of his own sleep apnea, Dr. Mack Jones, a clinical neurologist, felt a need to pass on to others what he learned first-hand as a patient, so that you might avoid the pitfalls he encountered and possibly save your own life or the lives of your loved ones. Dr. Jones in his book, Deadly Sleep, expected publication date, June of 2009, discusses how this common sleep disorder is a likely cause of Alzheimer’s and possibly a host of other life threatening neurological diseases that may have been plaguing us for hundreds if not thousands of years. He can be contacted via e-mail by clicking here.
 

Next Page »

Copyright © 2012 Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring · Design by Fervent