May 8, 2013
About 3% of teens in this country were found to experience extreme fatigue lasting 3 or more months not relieved by rest. This short article in US News & World Report highlights the importance of a small segment of teens who are severely debilitated. The vast majority go untreated. It’s also likely that many will sleep excessively long hours and still not feel refreshed.
I wonder how many of these teens have an untreated sleep-breathing disorder such as obstructive sleep apnea or upper airway resistance syndrome. It’s not too common to have teenagers’ fatigue explained by their poor sleep habits, hormonal changes, or just “being a teenager,” when in fact the source of their problem may be an undiagnosed sleep-related breathing disorder. For example, even a simple viral infection or allergy attack can enlarge lymphoid tissues in the throat, nose and tongue (palatine tonsils, adenoids and lingual tonsils), leading to more frequent partial to total obstructions and arousals. This can prevent quality deep sleep, leading to chronic, prolonged unrelenting fatigue.
What you’ll see that that these teens will oftentimes prefer to sleep on their sides or stomachs, and have a parent that snores heavily (obstructive sleep apnea).
Do you have a teen that’s overly fatigued, no matter how long they sleep?
March 7, 2013
Here’s a study which reports that 29% of children with ADHD go on to have ADHD as adults. I’ve written extensively about how a significant portion of kids with ADHD have undiagnosed obstructive sleep apnea. In fact, in one study, taking out tonsils and adenoids cured 50% of children with ADHD. Clearly, not all ADHD is related to a sleep-breathing problem, but even if it’s due to sleep apnea in 50%, or 25%, or even 10%, wouldn’t it be worthwhile to at least screen for it?
January 26, 2013
Researchers found that the earlier a woman undergoes surgical removal of her ovaries, the more likely that there will be signs of early cognitive decline. These women had significantly higher rates of decline in memory, global cognition, and neuritic plaques. This study supports other findings that associate early surgical menopause to higher rates of heart disease, heart attack, stroke, cognitive decline, as well at all cause mortality (death from any reason). Typical for most studies of this type, no conclusions or reasons for the findings are made, except to say that it’s only an association.
My take on this study is that taking out a woman’s ovaries, whether or not there’s hormone replacement therapy, will cause a sudden decline in natural progesterone, which has a protective effect on the woman’s upper airway. Progesterone is an upper airway stimulant, tightening your throat muscles, helping to protect the upper airway from collapsing. Progesterone goes up significantly during pregnancy, which partially helps to protect the airway despite significant weight gain. It also drops just before a women’s monthly periods, and gradually drops slowly throughout menopause.
Having more relaxed muscles in the throat can definitely lead to more frequent obstructions and arousals. If your breathing pause is over ten seconds, it’s called an apnea. Lesser rates of airflow obstructions are called hypopneas. You’ll need at least 5 apneas and/or hypopneas to say that you have obstructive sleep apnea. However, you can stop breathing 25 times every hour and not officially have obstructive sleep apnea on a sleep study. Regardless of your score, it’s important to treat the breathing problems to improve your deep sleep quality. Lack of continuous, deep sleep (in addition to lack of oxygen to your brain) has been shown the cause memory problems, focus and attention issues, as well as many other common conditions.
For those of you who underwent surgical menopause at an early age, did you suffer any memory problems?
January 2, 2013
Preeclampsia is a potentially dangerous condition during pregnancy that can lead to life-threatening high blood pressure, kidney failure, and fetal growth delay. Dr. Colin Sullivan (the inventor of the CPAP machine) has published a series of studies on the beneficial effects of using CPAP to control preeclampsia. In his latest study, he and his colleagues showed that fetal movements were significantly lower in mothers with preeclampsia compares to controls. Using CPAP at relatively low pressures significantly increased the number of fetal movements. Over the course of the night, women not on CPAP had progressively lower fetal movements, whereas those on CPAP had progressively increased fetal movements.
Just like in their previous studies, many of these women had only mild obstructive sleep apnea. Some did not have sleep apnea at all. However, the vast majority had what’s called inspiratory flow limitation, where there is partial obstruction to inhalation, but not meeting the criteria for an apneas (10 second pauses and/or lowered oxygen levels).
It’s likely that they are treating is upper airway resistance syndrome, with multiple partial obstructions and arousals that don’t present as classic obstructive sleep apnea.
It’s disappointing that despite this important information about pre-eclampsia, there’s been no significant movement to look for sleep-related breathing disorders in preeclamptic women.
If you ever had preeclampsia during pregnancy, did your doctor ever ask about your snoring or sleep quality?
November 8, 2012
Here’s an article that I wrote which was published this week on KevinMD, one of the most popular online physician blog sites. It’s called “Why Speech is the Achilles’ Heel of the Human Race.
Whether you like it or hate it, please leave a comment below.
November 2, 2012
Click here to purchase MP3 recording ($17).
PDF of slides (free).
October 4, 2012
I’ve written about the many dangers of untreated obstructive sleep apnea for adults and children, but what happens if you’re pregnant and have obstructive sleep apnea? A recent study showed that it can be very dangerous:
- Babies born to mothers with obstructive sleep apnea are more likely to be admitted to the neonatal ICU (46 vs. 18%)
- Mothers with sleep apnea had double the rate of c-sections compared with those that didn’t have sleep apnea (65 vs. 33%)
- 42% of those with sleep apnea had pre-eclampsia, compared with 17% that didn’t have sleep apnea.
- About 15% of pregnant women had obstructive sleep apnea. They were more likely to be obese and had high blood pressure
Additionally, this study didn’t include women with upper airway resistance syndrome, where they may not formally meet the official definition of obstructive sleep apnea (5 to 15 apneas and hypopneas per hour). You can stop breathing 20 to 30 times per hour and still not officially have sleep apnea.
Based on all these statistics, wouldn’t it make sense to routinely screen for obstructive sleep apnea if you’re pregnant, especially if you’re overweight? This study didn’t show that treating obstructive sleep apnea will lower complication rates, but it’s highly likely that that may be possible.
August 8, 2012
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.
August 7, 2012
On this Expert Interview program, Dr. Derek Mahony, a world renowned orthodontist from Australia, gives a special talk on:
Nasal Airway, Snoring/OSA & Malocclusion in Children
Please fill in the form below to receive the MP3 recording and PDF of the slides for free:
July 24, 2012
Sorry, but this program has been canceled. Please look for more upcoming Expert Interviews and Ask Dr. Park programs.