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A Possible Reason for Low Sperm Counts

Here’s an interesting article from 2004 showing how sperm counts in men living in Western industrialized countries are rapidly declining. In 1950, the average sperm count was 100 million sperm pr mL. in 1970, 75 million and in 1990, 50 million. Anything under 20 million is considered infertile. 

We know that untreated obstructive sleep apnea can suppress reproductive hormones. External artificial hormones such as the xenoestrogens that mimic estrogen can also aggravated this problem. I’ve written extensively in the past about fertility issues in women in the past and how undiagnosed  sleep-breathing problems can be a major aggravating factor. No wonder there are so many couples having trouble conceiving. 

Ask Dr. Park: Cutting Edge Surgical Options for Sleep Apnea

Please join me on Tuesday, February 22nd at 8 PM Eastern for my next Ask Dr. Park Teleseminar. This month, I’m going to do a presentation on the latest in surgical treatment options for obstructive sleep apnea. 

Registration details will be made available about one week prior to the event.

How Infections Can Raise Stroke Risk In Children

Here’s an article showing that children who suffer from stoke had some sort of infection in the days leading up the event. Researchers from UCSF found that 29% of children who suffered a stroke had an infection within 2 days of the stroke, whereas only 1% had infections in the control group.

It’s likely that if you already have narrowed breathing passageways, any additional inflammation and swelling will cause even more narrowing, leading to more severe episodes of snoring or apneas. We know that obstructive sleep apnea can significantly increase your risk of stroke. Furthermore, blood in patients with obstructive sleep apnea is found to be much thicker and more prone to clotting. 

I’m willing to bet that these children already had some sort of sleep-breathing problem, and the infection tipped them over the edge. Oftentimes, you’ll see large tonsils or adenoids, dental crowding, a high arched hard palate, nasal congestion, and an inability to sleep on their backs. Parents of these children are more likely to snore in this scenario.

Fortunately, this condition is rare (5/100,000), but the consequences can be devastating. This is why it’s important to pick up and address any underlying sleep-breathing issues before complications arise.

High Blood Pressure In Children Predicts Heart Disease In Parents

You may be thinking that I mixed up the words in the title. Yes, I did mean to say that children who have high blood pressure or high cholesterol have higher chances that their parents have diabetes or heart disease later on in life. Researchers found that 26 years after screening these children for health problems, 47% of parents of these same kids had suffered a heart attack, stroke, or underwent a procedure to unclog blocked arteries. Thirty-seven percent of parents developed diabetes.

Again, there’s not one mention of the likelihood that there’s any chance of obstructive sleep apnea. 

Can Reflux Medications Help Asthma Symptoms?

Here’s a classic example of a study with negative results which is not surprising. Researchers gave acid reducing medications (lansoprazole) to children with steroid dependent asthma. About 300 children were randomized to receive either the medication or a placebo. They found no significant differences between the two groups in terms of asthma symptoms. If you look at all the studies that link asthma to obstructive sleep apnea, and reflux to obstructive sleep apnea, it makes more sense that the two (asthma and reflux) are connected by obstructive sleep apnea. 

It’s been shown that apneas create conditions in the esophagus and throat which can cause your stomach juices to reach your throat. Furthermore, pepsin and bile have been found in lung and sinus washings. What this means is that your stomach juices are still coming up into your throat, especially if you have obstructive sleep apnea. However, what’s coming up is just less acidic juices, but still includes bile, digestive enzymes, and bacteria. We know that proton pump inhibitors and H2 blockers such as cimetidine don’t really do anything to prevent reflux into the throat. 

My hypothesis is supported by studies that show that pro-motility agents such as domperidone and clarithromycin can help lower asthma symptoms. There are also numerous studies showing that treating obstructive sleep apnea can help with symptoms of asthma and reflux. 

I’m Now Board Certified In Sleep!

I’m happy to tell all my readers that I just found out that I passed the sleep medicine board exam that I took last October. It was both challenging and rewarding, as I had just changed over to academia, and I was working full time. I’ve debated for years whether or not to take this exam, since obstructive sleep apnea is a very small fraction of the content of the test. However, by taking this test, I feel more well-rounded and more confident that I can better help people with obstructive sleep apnea and upper airway resistance syndrome. 

For those of you who didn’t know, until 2007, the board exam was administered by the American Board of Sleep Medicine. After 2007, it stopped giving the exam and a new board was created under the auspices of the American Board of Medical Specialties, an umbrella organization that covers most major medical specialties. Five specialties joined to co-sponsor this board: neurology & psychiatry, family practice, internal medicine, pediatrics and otolaryngology (ENT). Each member board administers the same sleep medicine exam test to their own candidates, but only after general certification is obtained. Beginning in 2007, this test was given every two years—2011 was the last year in which candidates could take the exam without doing a one year fellowship, as long as you demonstrated that you’ve seen a minimum number of sleep patients and interpreted a certain number of polysomnograms.

Sleep Apnea & Sudden Hearing Loss: Is There A Connection?

I’ve been saying all along that people with sudden sensorineural hearing loss have higher rates of sleep-breathing problems. Almost 100% of the time, whenever I see someone with sudden hearing loss that’s not explained by a brain tumor, the upper airway looks exactly like someone who has obstructive sleep apnea. These people typically can’t or prefer not to sleep on their backs. Many will also snore, and have parents that snore heavily.

A recent article published in the Archives of Otolaryngology – Head & Neck Surgery found that people with sudden sensorineural hearing loss were more likely to have obstructive sleep apnea. The authors combed  through insurance records and found that, after adjusting for various confounding factors, male patients with this type of hearing loss were 1.4 times more likely to have prior OSA than controls. This was statistically significant. The fact that women didn’t have this finding could be explained by the fact that the overall numbers of people with sudden sensorineural hearing loss is very small, and men have a much higher rate of obstructive sleep apnea than women. Just like all other medical journal articles, it concludes by saying this doesn’t prove that sleep apnea causes sudden sensorineural hearing loss, and that further studies are needed.

The authors’ explanation is that plaque buildup in blood vessels that reach the inner ears can clog up and create blockages. I’ve written in the past that people with OSA have much thicker blood, which can also clot more easily. Untreated obstructive sleep apnea causes massive inflammation in blood vessels and the brain, which can lead to a variety of medical ailments.

If you’ve ever suffered from sudden sensorineural hearing loss, can you sleep on your back at all? 

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?

Ask Dr. Park Anything About Obstructive Sleep Apnea (12/13/11)

In this Ask Dr. Park Teleseminar, I answer the following questions:

• Do people with sleep apnea really die 20 years earlier?

• How effective is home sleep testing? Is it covered by insurance?

• How does sleep apnea lead to serious conditions like heart disease?

• Would fixing a deviated septum help with sleep apnea?

• Tell me more about Provent therapy for sleep apnea.

• If one is successful with CPAP, is surgery an option?

• How successful is the Pillar Implant for sleep apnea?

• What ‘s the difference between hypoglossal nerve stimulation therapy vs. a tongue stabilizer device such as the AveoTSD?

• Are you aware of data in the US regarding OSA and traffic accidents?

• What are the risks to patients whose doctors have untreated OSA?

• What’s the difference between snoring and obstructive sleep apnea?

• Are surgical procedures for UARS covered by insurance?

• Why don’t sleep labs recommend oral appliances as an option?

And much more….

 

Please click here to purchase the MP3 recording ($17).

Ask Dr. Park About Sleep About Sleep Apnea (11/8/11)

For this month’s Ask Dr. Park teleseminar, I answer the following questions:

1. Does sleeping with your head propped up help with sleep apnea?

2. Why is UARS so hard to define?

3. What do you think about all the latest publicity about thyroidectomy in helping with sleep apnea?

4. Can using tape over the mouth help with sleep apnea?

5. As we age how can we gauge whether we have sleep-related breathing issues, or circadian rhythm problems?

6. What if you are using a cpap machine and STILL wake up about every 2-3 hours?

7. How low should one seek to lower the AHI and the AI?

8. Is there a place for hyperbaric oxygen in the treatment of OSA?

9. Does a dental positioning device work for mild sleep apnea?

10. How does the future look for sleep apnea patients£ Will something replace CPAP as the gold standard?

11. Is there a clear distinction between central and obstructive sleep apnea? What are the alternatives if your apnea is primarily classified central?

12. If patient’s airway is examined with camera inserted through nose while patient is sitting upright and airway is found to be clear, is this enough to indicate airway would also be clear if patient was lying down? Should patients be checked in both positions?

And many more questions from the live audience.

Click here to purchase the MP3 recording ($17).

 

 

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