I try to communicate with patients every day that fixing sleep apnea adds extra useful years to your life. JR

J Clin Neurophysiol. 2006 Feb;23(1):21-38.

Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack.

Grigg-Damberger M.

Pediatric Sleep Services, University Hospital Sleep Disorders Center, and Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA. mgriggd@salud.unm.edu

Abstract

Neurologists need to recognize, diagnose, and treat obstructive sleep apnea (OSA) in patients with stroke or transient ischemic attack (TIA). Increasing medical evidence suggests that OSA is an independent risk factor for stroke and TIA. Stroke (or TIA) is more likely a cause, rather than a consequence, of OSA because PSG studies have shown: 1) apneas in stroke are typically obstructive, not central or Cheyne-Stokes in type; 2) apneas are just as frequent and severe in patients with either TIA or stroke; 3) OSA severity is not influenced by the acuteness or location of the stroke; 4) untreated OSA patients have more strokes, stroke morbidity, and mortality than those who are treated. OSA alone can induce hypertension, especially in younger men. A causal relationship has recently been demonstrated between OSA and hypertension. A distinctive feature of OSA-induced hypertension is loss of the normal nighttime fall in blood pressure ("nondippers"). Data from the Sleep Heart Health Study showed a dose-response association between OSA severity and the presence of hypertension 4 years later. Hypertension or ischemic heart disease usually develops in untreated patients with OSA over time without particular worsening of OSA. Studies have shown sleep itself is not a risk factor for stroke because most stroke and TIAs begin between 6 am and noon, while the individual is awake. However, OSA promptly be considered in stroke beginning during sleep because 88% of strokes that develop during sleep occur in "nondippers." Premature death in OSA patients is most often cardiovascular, but occurs while the patients are awake. The risk of myocardial infarction is increased 20-fold in untreated OSA. Treating OSA patients with continuous positive airway pressure can prevent or improve hypertension, reduce abnormal elevations of inflammatory cytokines and adhesion molecules, reduce excessive sympathetic tone, avoid increased vascular oxidative stress, reverse coagulation abnormalities, and reduce leptin levels. If all this can be achieved by a polysomnogram, then this test should become part of a neurologist's armamentarium for stroke and TIA.

PMID: 16514349 [PubMed - indexed for MEDLINE]

At-Home Sleep Testing Equal to Overnight in a Sleep Lab in Treatment Results

At-Home Sleep Testing Equal to Overnight in a Sleep Lab in Treatment Results ...and CPAP outcomes are equivalent

ATS 2010, NEW ORLEANS—Patients with suspected obstructive sleep apnea (OSA)

may no longer have to spend an expensive and uncomfortable night at a sleep center to

monitor their sleep-disordered breathing. According to new research, those who

performed sleep testing in their home with portable monitors showed similar

improvements after three months of treatment with continuous positive airway pressure

(CPAP) in daytime function as compared to patients who underwent overnight testing in

a sleep center.

Furthermore, patient adherence to CPAP over the first three months of treatment was

similar in patients with OSA who received home versus in-lab testing.

http://www.thoracic.org/newsroom/press-releases/conference/articles/2010/sleep-testing-at-home.pdf

Is the outcome of home sleep testing worse than the lab? No!

Chest. 2010 Feb 19. [Epub ahead of print]

Outcomes of home - based diagnosis and treatment of Obstructive Sleep Apnea.

Skomro RP, Gjevre J, Reid J, McNab B, Ghosh S, Stiles M, Jokic R, Ward HA, Cotton D.

1 University of Saskatchewan, Saskatoon, SK., Canada.

Abstract

INTRODUCTION: Home diagnosis and therapy of OSA may improve access to testing and CPAP treatment. We compared subjective sleepiness, sleep quality, quality of life, blood pressure and CPAP adherence after four weeks of CPAP therapy in subjects diagnosed and treated at home and in those evaluated in the sleep laboratory.

Conclusions: Compared with the home-based protocol, diagnosis and treatment of OSA in the sleep laboratory does not lead to superior four-week outcomes in sleepiness scores, sleep quality, quality of life, blood pressure, and CPAP adherence.

PMID: 20173052 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/20173052

Floppy Eyelids Increase the risk of Sleep Apnea

Floppy Eyelids and Sleep Apnea - Your optometrist can save your life...

When physicians see a patient with floppy eyelid syndrome, they should also screen for obstructive sleep apnea-hypopnea syndrome, new research has shown.

In a small study, those with the condition -- characterized by rubbery upper eyelids -- had a 12.5-fold increased risk of obstructive sleep apnea, Daniel G. Ezra, MD, of Moorfields Eye Hospital in London, and colleagues reported in the April issue of Ophthalmology.

http://www.medpagetoday.com/Pulmonology/SleepDisorders/19372

Sleep Apnea Tied to Increased Risk of Stroke - Adds 10 years

Sleep Apnea Tied to Increased Risk of Stroke

Even Mild Sleep Apnea Puts Men in Danger

"Our findings provide compelling evidence that obstructive sleep apnea is a risk factor for stroke, especially in men, " noted Redline. "Overall, the increased risk of stroke in men with sleep apnea is comparable to adding 10 years to a man’s age. Importantly, we found that increased stroke risk in men occurs even with relatively mild levels of sleep apnea. "

http://www.nih.gov/news/health/apr2010/nhlbi-08.htm

Gret news!

I am now in network with Kelsey Seybold and Humana!

JR

FOR KIDS: Making light of sleep
Teens are prone to sleep problems, but a little sunshine could help
By Susan Gaidos Web edition : 1:10 pm

Maybe this has happened to you: In the middle of class, while you pretended to be paying attention to the teacher’s lecture, your eyelids started to droop. You began having second thoughts about staying up late on Facebook the night before.

Don’t be too hard on yourself. Your computer screen may be to blame. And your clock may be too. Not the clock on your nightstand, but the one in your head. All mammals have a clock located inside their brains. Similar to your bedside alarm clock, your internal clock runs on a 24-hour cycle. This cycle, called a circadian rhythm, helps regulate when you wake, when you eat and when you sleep.

Somewhere around puberty, something happens in the timing of the biological clock. The clock pushes forward, so adolescents and teens are unable to fall asleep as early as they used to. When your mother tells you it’s time for bed, your body may be pushing you to stay up for several hours more. And the light coming from your computer screen or TV could be pushing you to stay up even later.



http://www.sciencenews.org/view/generic/id/56802/title/FOR_KIDS_Making_light_of_sleep