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NY Times Highlights The Importance of Sleep in ADHD

Here’s an important article that everyone should read in the New York Times.  The author highlights the fact that in many cases of attention deficit hyperactivity disorder (ADHD), the real deficit may in your child’s sleep.

Expert Interview: Dr. A. Joseph Borelli on Brain Dysfunction and Sleep Apnea

In this teleseminar, I interview Dr. A. Joseph Borelli, who is President and Medical director of MRI at Belfair, in Bluffton, SC. He is a leading expert in brain imaging and has an interest in brain imaging in patients with obstructive sleep apnea. He’s going to show some eye-opening radiologic images of your brain after repeated apneas.

Please fill in your information below to access the free MP3 recording:

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Expert Interview: Dr. Jeff Rouse on TMJ and Sleep Disorders

In this teleseminar, I interview Dr. Jeff Rouse, about the relationship between TMJ disorders and sleep-breathing problems. 

 

Please fill in your information below to access the free MP3 recording, as well as the PDF of his slides:

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*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

What’s the Link Between Erectile Dysfunction And Heart Disease?

Erectile dysfunction (ED) is a common condition that’s usually treated by urologists with medications. In the sleep medicine literature, there are numerous studies showing that many men with ED have undiagnosed obstructive sleep apnea (OSA) and that treating OSA can significantly improve or even cure ED. Here’s one of many papers (PDF). Even in my practice, men oftentimes comment that this is a positive side effect of CPAP. 

Here’s another study that reiterates the known association between ED and cardiovascular disease. There’s no mention of sleep whatsoever. We also know that obstructive sleep apnea is a major risk factor for heart disease. It’s frustrating to know that most of these men will never have their obstructive sleep apnea diagnosed or treated.

I’m not saying that all cases of ED are due to OSA. But even if 50% of patients are improved, wouldn’t it be worthwhile looking into this possibility? Not to mention that once you’re able to sleep better, things can begin looking up again :)

100% Success Rate for Sleep Apnea Surgery?

Maxillo-mandibular advancement (MMA) surgery has been around a long time for obstructive sleep apnea. It has a good track record with high success rates raging from 80-95%. Here’s a study showing that that the success rate was 100%. In Dr. Prinsell’s 50 patients, the apnea hypopnea index (AHI) dropped from 59 to 5, and the apnea index (AI) dropped from 35 to 1. Success was defined as the AHI < 15, AI < 5, and the low oxygen saturation > 80%, and the AHI and AI dropping more than 60%.

MMA surgery is one of the bread and butter procedures for most oral surgeons. However,  different surgeons have different success rates for obstructive sleep apnea. If you’re considering this procedure, ask about results specifically for obstructive sleep apnea.

One thing to note is that just because the AHI dropped significantly doesn’t mean that you’ll always feel dramatically better, or that the results will last for a long time. These are issues that need to be addressed, like with any surgical procedure for obstructive sleep apnea.

Can 50% of All Women Have Obstructive Sleep Apnea?

The most commonly cited figure for obstructive sleep apnea in women is 9%, but a more recent study out of Sweden revealed that 50% of women had an AHI of 5 or more. Of note, sleep apnea in women was statistically related to age, obesity and hypertension, but not daytime sleepiness.

Rates of obstructive sleep apnea differ amongst different studies and different countries, but I’m willing that this is an accurate figure, especially with the obesity epidemic. The real question is, now that we know that this condition is epidemic, is the field of medicine going to do anything to tackle this condition head on, or just continue doing things the same way?

Esophageal Pressure in Children Correlates with Disruptive Behavior

It’s common knowledge that esophageal pressure readings are the gold standard when determining more subtle levels of breathing obstruction, such as what’s found in upper airway resistance syndrome. Here’s an interesting study from the University of Michigan which showed that in children, esophageal pressure readings correlated with a disruptive behavior disorder (Diagnostic and Statistical Manual of Mental Disorders, 4thEdition: attention-deficit/hyperactivity disorder, conduct disorder, or oppositional defiant disorder), and more sleepiness after adenotonsillectomy. However, it did not correlate with the pediatric apnea-hypopnea index, or the respiratory disturbance index. Neither esophageal pressure or the AHI predicted ADHD, cognitive performance, or improvement after surgery.

With such a high prevalence of obstructive sleep apnea in children with ADHD, the addition of esophageal pressure readings may be useful in children when there’s suspicion of an underlying sleep-breathing disorder.

Ask Dr. Park Anything About Obstructive Sleep Apnea

Please join me on Tuesday, August 7th at 8PM Eastern when I answer YOUR questions about obstructive sleep apnea.

Sorry, but this program has been canceled. Please look for more upcoming Expert Interviews and Ask Dr. Park programs.

Strong Link Between PCOS and Sleep Apnea

Here’s another study linking polycystic ovary syndrome (PCOS) and obstructive sleep apnea. Researchers found that obese women with PCOS had twice the risk of having pre-diabetes compared with women with PCOS but without obstructive sleep apnea. The important figure in this study is the fact that almost one-half (48%) of women with PCOS had obstructive sleep apnea, and even in the control group (obese women without sleep apnea), 36% were found to have obstructive sleep apnea. We know that sleep apnea can wreak havoc on your hormones and also promote weight gain. Based on these figures, it makes sense to routinely screen for obstructive sleep apnea in all women with PCOS.

Moans In The Night

An interesting article in a recent sleep medicine journal describes a rare condition where women moan intensely while sleeping. Contrary to what you may have been thinking, these women were not moaning due to either pain or erotic dreams. These seven women sought treatment at Stanford’s sleep clinic due to a condition which has been coined catathrenia. They were all embarrassed by their condition, as well as having family members who were alarmed by the strange noises. Catathrenia has been classified in the parasomnia category, which are disturbances that occur during sleep-wake transitions, in contrast to sleep-breathing problems such as obstructive sleep apnea. This condition is typically seen in younger, premenopausal women, who are relatively thin.

When these women underwent an overnight sleep study, none were found to have obstructive sleep apnea. However, they all had in common the typical feature of multiple breathing pauses with arousals, leading to inefficient sleep. All these women also had in common smaller jaw sizes and a history of dental extractions for crowding or orthodontic problems. Many also complained of chronic fatigue symptoms as well.

This article caught my attention because of the nature of the cure for this condition. All the women were essentially cured with treatment that’s normally given for people with obstructive sleep apnea. Yet, they didn’t have obstructive sleep apnea. What they really had was upper airway resistance syndrome (UARS). As I’ve described at length in other articles, UARS is a variation/precursor to obstructive sleep apnea, where people have narrowed upper airway anatomy that causes brief obstructions and breathing pauses that are not severe enough to be called obstructive sleep apnea.

To receive a diagnosis of obstructive sleep apnea, you have to stop breathing completely or partially for 10 seconds or more, at least 5 times every hour while you sleep. But if you stop breathing 15 times every hour, but wake up after 2-3 seconds each, then your apnea score is 0 and you’re told you don’t have obstructive sleep apnea. These UARS patients are constantly tired and suffer from various other chronic conditions such as recurrent sinus pain or infections, low blood pressure, cold hands or feet, various gastrointestinal symptoms, anxiety/depression, and almost invariably, prefer not to sleep on their backs.

The lead author of this article (Dr. Guilleminault at Standford University) was the first to describe UARS as well. In his original UARS paper, he treated these constantly tired people with CPAP, or continuous positive airway pressure. This is a device that delivers gentle air pressure through the nose, thereby keeping their breathing passageways open. For the most part, they all did well, but in the long term, they could not continue sleeping with masks and hoses attached to their faces. Most UARS patients, due to heightened sensitivities, are unable to tolerate this device.

In this current study describing catathrenia, many of the patients tried CPAP as well, which worked, but they all refused to use it continuously. Most of the patients subsequently underwent various surgical procedures of the throat, and were reported as being “cured.”

It’s amazing how often I find studies that link common and uncommon medical conditions to sleep-breathing disorders. Knowing that sleep-breathing disorders (obstructive sleep apnea or upper airway resistance syndrome) may be linked to depression, anxiety, cold hands, migraines, irritable bowel syndrome, chronic fatigue syndrome, polycystic ovarian syndrome, obesity, ADHD, TMJ, diabetes, high blood pressure, high cholesterol, heart disease, heart attack and stroke, could a breathing problem during sleep be the common link? I’ve even seen articles linking obstructive sleep apnea to epilepsy, cluster headaches, and even cancer. In my book, Sleep, Interrupted, I propose that the this may be a possibility. It may be a bit of a stretch to say a definite yes, but I’m confident that in 10 to 15 years, the answer to the above question will be more clear. This just goes to show that what we generally take for granted my have an alternate explanation.

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