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Ask Dr. Park: Sleep 2010 Boston

In this Ask Dr. Park Teleseminar, I’ll be reporting from this year’s national SLEEP 2012 meeting, held in Boston. I’ll be bringing you the latest in research and innovations in sleep apnea treatment, as well as to answer your questions. 

 

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High Blood Pressure In Pregnancy Raises Child’s Heart Risk

Having high blood pressure during pregnancy (also called preeclampsia) was found to increase the offspring’s risk of having high blood pressure in childhood and young adulthood. This study published in Pediatrics analyzed 18 studies and looked at cardiovascular risk factors in people exposed to high blood pressure during pregnancy. Those that were exposed had a systolic blood pressure that was 2.39 mm Hg higher compared to those whose mothers had healthy pregnancies. The diastolic pressure was 1.35 mm Hg higher. They calculated  that over time, these figures would increase one’s risk for dying from heart disease by 8% and from stroke by 12%.

What’s my take on this study? It’s not surprising, since many women with preeclampsia have sleep-breathing problems such as obstructive sleep apnea and upper airway resistance syndrome. It’s been shown that treating with CPAP can lower blood pressure in women with preeclampsia. Despite this knowledge , sleep apnea is almost never considered when treating preeclamptic women in the US. Having hypoxia and physiologic stress from the mother’s poor sleep quality can be detrimental to the developing fetus. Since the offspring will also inherit the mother’s upper airway anatomy, it’s not surprising that the child will be predisposed to the consequences of obstructive sleep apnea, such as high blood pressure, diabetes, heart attack and stroke. It’s also likely that environmental and dietary factors during pregnancy  may carry over into the household which can also affect the child’s diet.

The Missing Link Between Gum Disease and Heart Disease

It’s medical dogma that having gum disease can cause heart disease. The most common explanation is that bacteria from your mouth can spread through the bloodstream and infect your heart valves (called endocarditis). The problem with this explanation is that endocarditis is a tiny fraction of people who have heart disease. Just because there’s an association, it doesn’t mean that one causes the other.

The American Heart Association recently reviewed 537 articles on this subject and published a review, stating that there’s no scientific evidence that gum disease causes heart disease, heart attacks, or stroke. Past studies were mainly observational, and not based on prospective studies. They also state that there’s no evidence that treating periodontal disease can prevent heart disease.

What’s the missing link? You guessed it: Obstructive sleep apnea. We know that obstructive sleep apnea can cause reflux and inflammation in the mouth. Mouth breathing due to craniofacial narrowing and inflammation also dries out saliva, which helps to protect your mouth from pathogens. If you’re missing teeth, then your mouth gets smaller, narrowing your airway even further. We also know that obstructive sleep apnea significant increases your risk of heart disease, heart attack, stroke, and death.

So it makes sense that if you treat sleep apnea, you’ll have less gum disease, and less heart disease. Obviously a prospective, randomized, placebo-controlled, double-blinded study is needed to prove this point.

Read AJ Jacobs’ Drop Dead Healthy: One Man’s Humble Quest for Bodily Perfection

AJ Jacobs, a senior editor for Esquire Magazine, interviewed me last year while working on his latest book project, Drop Dead Healthy: One Man’s Humble Quest for Bodily Perfection. The book is now out and was favorably reviewed by the New York Times. We talked extensively about his snoring and sleep apnea, and he underwent the entire diagnosis and treatment protocol, including CPAP. I just read sections of his book (including parts with me in it) and it’s hilarious! 

If you’re not already familiar with Mr. Jacobs, he’s also the author of The Know-It-All: One Man’s Humble Quest to Become the Smartest Person in the World and The Year of Living Biblically: One Man’s Humble Quest to Follow the Bible as Literally as Possible. His current book, Drop Dead Healthy, is already #31 on Amazon’s best-seller list. 

His book was endorsed by Dr. Mehmet Oz, and Timothy Ferriss (author of The 4-Hour Body). I strongly recommend that you read Mr. Jacobs’ book. But don’t stay up too late reading it—sleep deprivation can lead to premature aging.

My Quote in More Magazine About Alcohol and Sleep

Look for my quote in More Magazine about the effects of alcohol on sleep (under #3).

Listen To My Interview About Snoring With Dr. Sosenko

Dr. Lydia Sosenko, a dentist specializing in sleep-breathing disorders in Illinois, interviews me for this 34 minute segment on snoring. You can listen to it or download it here. We talk about about the many dangers of snoring, how it’s a “dealbreaker” in many relationships, why sleep tests are very important, how common undiagnosed apnea really is, and much more!

Can Snoring As A Baby Predict Behavior Problems?

Here’s a new study which reinforces what I’ve been saying about sleep-breathing problems and children: That it’s a major undiagnosed cause of developmental and behavior problems in childhood. Researchers from Albert Einstein College of medicine followed over 11,000 children over a 6 year period. Parents were asked about snoring in sleep surveys from 6 months on, and at 7 years, they filled out a behavioral assessment. Not too surprisingly, children who snored as early as 6 months of age had a 50% increased risk of developing behavior problems by age 7 compared to controls. 

We know that children who are sleep deprived become paradoxically hyperactive. In contrast, adults get sleepy (there are always exceptions to this observation). This study supports another study which I mentioned in the past showing that in children with ADHD who undergo tonsillectomy, about 50% can be cured for their ADHD condition. It’s no wonder that stimulants like Ritalin can help to calm a hyperactive child. 

It’s important to note that I’m not saying all cases of ADHD are due to sleep-breathing disorders. However, it’s been estimated that a significant number of children (25 to 50%) with an ADHD diagnosis could have a treatable sleep-breathing problem. With these numbers in mind, wouldn’t it make sense to routinely screen for obstructive sleep apnea or a sleep-breathing problem before being given an ADHD diagnosis?

 

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.

Expert Interview: Dr. Shelby Harris on Sleep Hygiene

This month, we’re privileged to have with us Dr. Shelby Harris, who answers your most pressing questions about sleep hygiene. Dr. Harris has been quoted numerous times in the New York Times, The Wall Street Journal, The Huffington Post, and the New Yorker. She has also appeared on the Today Show, World News with Diane Sawyer, Good Morning America Health, ABC7-NY’s Eyewittness News and ABC’s Primetime: Live.

 

 

Some of the topics and questions she covers are:

• “If I sleep in on the weekend, does it make up for the lost sleep over the week?”
• “I’m so tired when I’m on the couch at night, but when I hit the pillow, my mind starts racing and I can’t fall asleep. Why?”
• The importance of scheduling in time for sleep as well as wind-down time beforehand
• Proper timing of exercise to help with better sleep
• Misuse of alcohol as a sleep aid
• Smoking – effects on sleep
• Caffeine – how/when to use it and when not to
• And lots more

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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.

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? 

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