26th Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring

This course has been coordinated through the University of California, San Francisco Department of Otolaryngology-Head and Neck Surgery and the Penn Center for Sleep Disorders at the University of Pennsylvania. The program is designed to provide a comprehensive review and update on recent advances in sleep apnea and snoring. New approaches and controversies in the management of patients with sleep disordered breathing will be highlighted. Leaders in the field from Pulmonary and Critical Care Medicine, Otolaryngology – Head and Neck Surgery, Dentistry, Oral and Maxillofacial Surgery, Pediatrics, Bariatric Surgery, Neurology and Obesity Research will share their medical and surgical expertise in didactic sessions, case presentations and workshops with the intent to close practice gaps in physician knowledge and competence for diagnosing and managing sleep disordered breathing and complications resulting thereof. Patients with sleep disordered breathing are highly prevalent in every physician’s practice, and complications related to the disease can manifest in a number of ways to the detriment of patient health and well-being. There will be ample opportunity for interaction with participating faculty. An electronic course syllabus, complete with program outline and up-to-date references, will be provided to each participant. Please bring your laptop or tablet if you would like to view the syllabus during the didactic sessions.

TARGET AUDIENCE
This continuing medical education activity is intended for the physician in Sleep Medicine, Otolaryngology-Head and Neck Surgery, Pulmonary Medicine, Oral and Maxillofacial Surgery, Family Practice, Internal Medicine, Pediatrics, Cardiology, Neurology, Psychiatry, Anesthesia, and Geriatrics. Dentists, sleep respiratory therapy technologists, nurses, and other healthcare professionals are also invited to attend this program.

from Sleep Review http://www.sleepreviewmag.com/events/26th-annual-advances-diagnosis-treatment-sleep-apnea-snoring/…

How I Transitioned My Dental Practice to a Dental Sleep Medicine Practice

Four dentists discuss their motivations, challenges, and rewards of treating patients who have obstructive sleep apnea.

Dental sleep medicine is now a viable career path for dentists looking to expand their professional horizons and help a growing number of patients who are experiencing sleep-related health problems.

But the bigger question is how? How can a dentist make the transition? What are some of the pitfalls to avoid? What are the unexpected rewards?

As the following four dental sleep medicine practitioners explain, there’s no single way to make the transition, just the one that works best for you, your practice, and your patients.

Don Johnson, DDS, Idaho

Don Johnson

Don Johnson, DDS, has been practicing dental sleep medicine for the past decade. Photo courtesy of Don Johnson, DDS

Don Johnson, DDS, has been providing dental sleep medicine services for about 10 years at his practice in Coeur d’Alene, Idaho, which includes the Northwest Snoring Center.

“The main reason I started doing sleep dentistry is because sleep apnea kills people,” Johnson says. “All you have to do is open the obituaries and you’ll see a young person who died of ‘natural causes.’ You don’t die of natural causes if you’re 39. More likely it was sleep apnea.”

And to that point, Johnson’s mission is clear: to save lives.

It’s a mission Johnson, who’s practiced general dentistry for 40 years, is quite passionate about. But his passion didn’t supersede preparation.

“You can’t do a weekend course and you’re qualified to practice sleep dentistry. It’s a huge investment in time and equipment,” says Johnson, who emphasizes that learning “everything that you can” about the temporomandibular joint (TMJ) and its disorders is essential.

Johnson not only continued his education formally, but he also found a mentor with whom he spends time with regularly to better comprehend facets such as billing and building a referrer network. “You really have to learn how to work with physicians,” he says. “And you have to get paid, including learning how to bill medically—and hire specialists to help you. If you don’t accept insurance, you’re losing a lot.”

Among

Treating Mild Sleep Apnea Results in Higher Vitality Scores

CPAP can improve energy levels and vitality in people who experience mild sleep apnea—that is, those with an apnea-hypopnea index between 5 and 15 events per hour—according to a new study.

This is the finding from a new study of over 200 patients, published in the journal The Lancet Respiratory Medicine, led by Imperial College London.

The research was conducted at 11 National Health Service (NHS) sleep centers across the United Kingdom, including the Royal Brompton & Harefield NHS Foundation Trust. Although previous trials have found a CPAP machine to improve symptoms of moderate to severe cases, the researchers say the significance of this study is it is the first large trial to find that mild cases of OSA can also be treated with this technology.

Lead author Mary Morrell, PhD, professor of Sleep and Respiratory Physiology at the National Heart and Lung Institute at Imperial, says in a release, “We are seeing increasing cases of sleep apnea, and in a wide range of patients. Although the condition was previously thought to mainly affect overweight men, we now know it also strikes post-menopausal women, the elderly, and even children.”

Morrell, who is also honorary researcher at the Royal Brompton Hospital, says, “Around 60% of all cases of sleep apnea are classed as mild, but until now we didn’t know whether a CPAP would be helpful to these patients.”

In the study, 115 patients were asked to use the CPAP for three months, while 118 received were given advice on improving sleep and avoiding anything that can exacerbate the condition, such as drinking alcohol before bed.

The research revealed those who used the CPAP machine had an improvement of 10 points on a vitality scale, compared to those who received standard care. The vitality scale assesses a range of factors such as sleep quality, energy levels, and daytime sleepiness. The researchers also saw improvements in a number of additional factors among the patients who used the CPAP, including fatigue, depression, and social and emotional functioning.

The researchers have not yet conducted an economic analysis of the cost to the NHS

AASM Issues Position Statement on Chronic Opioid Therapy and Sleep

Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine (AASM).

In addition to understanding the risks of opioid addiction and abuse, it is important for health care providers to be aware that chronic opioid use is associated with changes in sleep architecture and an increased risk of respiratory depression during sleep.

“This statement increases awareness among health care providers of the important adverse events that can occur in patients on chronic opioid therapy,” says co-author R. Nisha Aurora, MD, associate professor of medicine at Rutgers Robert Wood Johnson Medical School in New Jersey, in a release. “The paper also highlights the need for providers to recognize and diagnose sleep-related breathing disorders that are frequently seen with chronic opioid use.”

The position statement was developed by the AASM board of directors and is published in the Nov 15 issue of the Journal of Clinical Sleep Medicine.

Patients who have chronic pain often experience fatigue and disturbed sleep. Studies have shown that chronic opioid therapy has the potential to further disrupt sleep by reducing sleep efficiency, slow wave sleep, and rapid eye movement sleep. Another adverse effect of opioid use is respiratory depression, which can increase the risk of sleep-related breathing disorders such as sleep-related hypoventilation, central sleep apnea and obstructive sleep apnea.

Medical providers who care for patients on chronic opioid therapy need to be aware of the signs of disrupted sleep, such as snoring and excessive daytime sleepiness, in order to provide their patients with high quality care.

“Because of the complex relationship between pain, sleep, daytime functioning, and opioid therapy, a strong collaboration between pain specialists, sleep physicians, and primary care providers is needed to optimize patient benefit and minimize complications when opioids are part of chronic therapy,” says Aurora.

While opioid therapy can contribute to sleep disruption and sleep disorders, it can be an effective treatment for patients with restless legs syndrome (RLS), a sleep disorder associated

I’m A CPAP Dropout: Why Many Lose Sleep Over Apnea Treatment

When doctors told Frances Faulkenburg she had sleep apnea, she was more than ready for relief from her tired-all-the-time existence. She used to fall asleep at red lights while behind the wheel. At night, she’d wake up gasping for air, heart pounding. Her husband told her she snored.

But Faulkenburg, 47, couldn’t tolerate the CPAP machine her doctor prescribed.

“I just could not get used to the face mask covering both my nose and mouth,” said Faulkenburg, who lives in Oviedo, Fla.

“It was claustrophobic.”

CPAP, or continuous positive airway pressure, is often one of the first solutions doctors suggest for sleep apnea. With this disorder, a person’s breathing stops and starts so frequently during the night that it can lead to or exacerbate health problems. The National Sleep Foundation estimates that more than 18 million American adults have sleep apnea.

A CPAP machine blows a stream of air into the back of the throat to let people breathe easier. It prevents muscles in the back of the throat from narrowing, which can constrict the airway, causing snoring or disturbed sleep.

Yet Faulkenburg quit using her CPAP and went back to feeling sleepy and tired all the time.

Many people have a negative reaction to the machines and are tempted to do the same. The big whoosh of air in your throat. The restrictive mask on your face. It can be a lot to adjust to. Studies suggest that from one-third to more than 50% of patients either stop using their CPAP machine or never bother to fill their prescription. They quit for a variety of reasons, but mostly because the device can be cumbersome and uncomfortable. Sometimes, they quit because of confusing or stringent health insurance restrictions.

But the health effects of untreated sleep apnea can be serious. People struggle with anxiety, tiredness and low productivity. There’s even an increased risk of high blood pressure, heart attack and stroke.

Mary Mertens, a respiratory therapist at the Cleveland Clinic, helps patients work through problems with their CPAP machine. Patients often complain that the volume

New TV Show Is Looking for Britain’s Loudest Snorers Whose Long-suffering Partners Have Had Enough

The Sun reports that an ad for the unnamed show—which is being produced by Firecracker Films—read: “Is your partner’s snoring ruining your life?”

“Firecracker Films is making an exciting new show for a major terrestrial broadcaster and we’re looking for some of Britain’s biggest and loudest snorers.

“We want to hear from fed-up partners who’ve simply had enough.”

from Sleep Review http://www.sleepreviewmag.com/2019/10/new-tv-show-is-looking-for-britains-loudest-snorers-whose-long-suffering-partners-have-had-enough/…

Researchers ID Sleep-disordered Phenotypes in Infants

New research has examined the impact of an infant’s sleep duration and sleep disruption due to sleep-disordered breathing (SDB) on cognitive and language development at two years of age. A separate study has identified 4 distinct types of SDB that occur in infants, along with unique risk factors associated with each.

The findings, published in two papers in the August 2018 issue of Sleep Medicine, will help doctors better predict which children are at risk for sleep disorders and intervene early with treatment.

Piush Mandhane, MD, PhD, FRCPC, an associate professor of pediatrics in the University of Alberta’s (U of A) Faculty of Medicine & Dentistry, and leader of the CHILD Study’s Edmonton site, led both studies.

“Short sleep duration and symptoms of SDB ranging from snoring to sleep apnea have been associated with multiple health, learning, and behavioral problems in children,” says Mandhane in a release. “In the CHILD Study, we were interested to find out if limited sleep time and sleep disruption affected cognitive and language development in preschool children.”

Importance of Total and Nighttime Sleep

In the first study, CHILD researchers found that infants who regularly sleep less than 12 hours total over any given 24-hour period have poorer cognitive and language development at 2 years of age than infants who get more sleep. They also found that nighttime sleep had a greater impact on cognitive and language development compared to daytime sleep, and a short nighttime sleep was associated with a 10.1-point decrease in cognitive development using a standardized test of mental and motor development.

“A drop of 10 points represents nearly a full standard deviation on the cognitive scale,” Mandhane explains. “It’s quite a substantial difference.”

The researchers further found that children with persistent SDB had lower language scores, but no differences in cognitive development compared to children with no SDB. There are a few possible explanations for this finding, according to the study first-author Lisa Smithson, a postdoctoral researcher at the U of A.

“One theory is that language acquisition is more sensitive to sleep disruption than cognitive development. Alternatively, the link

Italian Researcher Says Sleep-Breathing Screenings Should Be Required for Truckers

A survey of 905 Italian truck drivers has shown that approximately half have at least one sleep-related breathing problem that potentially can cause drivers to fall asleep at the wheel.

In a presentation at the European Respiratory Society International Congress entitled”Obstructive sleep apnoea screening the truck driver population,” Luca Roberti, president of Apnoici Italiani (the Italian Sleep Apnoea Patient Association), called for it to be made compulsory for European haulage companies to test drivers for sleep-related breathing problems.

“Considering that drivers are in charge of transport vehicles weighing several tons, companies have a great moral and civic responsibility to ensure their employees are safe to drive and are not at risk of suddenly falling asleep at the wheel. This would also be in line with European Union legislation that regulates the renewal of drivers’ licenses for people suffering from obstructive sleep apnea,” he said.

The European Union Directive 2014/85/EU, created to limit accidents arising from OSA, requires drivers with moderate or severe OSA to seek medical advice before their licenses can be issued or renewed; drivers may be advised not to drive until confirmation of a diagnosis and steps are taken to control the condition. One of the main risk factors for OSA is being overweight.

Roberti and colleagues conducted their study in 2018 after being asked by an Italian truck driver cooperative, Federtrasporti, to carry out a health survey of truck drivers. On 44 days between March and December, volunteer expert patients, doctors, and nurses questioned drivers at truck dealerships, 50 companies that were part of Federtrasporti, at driver training days and at a truck driver show.

They measured height, weight, and waist circumference, took details of medical conditions, such as diabetes, and of lifestyle factors, such as whether the drivers smoked or took drugs. They asked about their length of time as a haulier, distances covered, whether they drove national or international routes, and the types of goods they transported. Their questions about sleep included:

  • do you sometimes stop breathing and have sleep apnea at night?
  • do you snore?
  • do you wake up needing to urinate urgently?
  • are

Oventus Medical: The War on Snoring, Spousal Homicide and the Mouth Guard that Caught Alan Moss’ Eye

The Health Kick Podcast with Tim Boreham chats with Chris Hart, founder, managing director and CEO of Oventus Medical.

The company’s key focus is its range of medical devices that improve comfort during sleeping for patients suffering from various ailments including sleep apnoea and snoring, as well as secondary effects such as tooth decay and gum disease.

from Sleep Review http://www.sleepreviewmag.com/2019/09/oventus-medical-the-war-on-snoring/…

Philips Consumer Sleep Products Suite Aims to “Address 80% of All Sleep Issues”

Revealed at the CES tradeshow in January 2019, Philips expanded SmartSleep suite of consumer-facing sleep solutions is now available in the United States. The products address sleep issues such as difficulty falling asleep, snoring, and simply not getting enough quality sleep. By expanding its suite of consumer sleep solutions, Philips states that its aim is to ultimately address 80% of all sleep issues globally.

“Everyone sleeps, but unfortunately sleep doesn’t come easily for everyone. There are a host of issues that impact sleep—from trouble falling asleep to snoring to chronic conditions like sleep apnea,” says Mark Michels, business leader, Healthy Sleep Solutions at Philips, in a release. “Using our nearly 40 years of deep clinical expertise in sleep technology, we continue to enhance the solutions available for people who experience common issues that negatively impact the quality of their sleep. Our suite of solutions aims to provide consumers with access to clinically backed innovations that will help them get a better night’s sleep to achieve more productive days ahead, while also increasing awareness to the importance of sleep health. All of this comes with the hope of positively impacting the consumer and clinical sleep industries alike.”

Philips SmartSleep suite of solutions is comprised of a mix of existing and new solutions, which aim to make better sleep accessible to everyone:

  • SmartSleep Analyzer: It provides personalized analysis of users’ sleep based on an online questionnaire to identify sleep challenges and recommend sleep solutions personalized to the user. This triage tool was developed in collaboration with sleep physicians, specialists, and researchers to identify the most common sleep challenges, helping to support Philips strategy to amplify awareness around the role sleep plays in consumers’ health and wellbeing.
  • SmartSleep Snoring Relief Band: This wearable device is a personalized solution for positional snoring. Derived from clinical technology, a small, discreet positional monitor detects when the wearer begins to shift to their back and delivers adaptive vibrations that prompt them to sleep on their side.
  • SmartSleep Better Sleep Program: Rooted in the principals of cognitive behavioral therapy for insomnia (CBT-I), the SmartSleep Better Sleep Program combines