Can Snoring Harm Your Health?

Presented by:Alison S. Kole, MD/MPH

Director, Sleep Disorders Center19 November 2015

Overview• Importance of Healthy Sleep• How sleep apnea affects your health• Who is at risk for sleep apnea• Options for diagnosis and treatment• Preventative strategies

Importance of Healthy Sleep

Importance of Healthy Sleep

• AASM and SRS Consensus Statement1

“Adults should sleep 7 or more hours per night on a regular basis to promote optimal health”

• Official American Thoracic Society Statement2

“Sleep is an essential biological function with major roles in recovery, energy conservation, and survival”

“It is clear that good-quality sleep is critical for good health and overall quality of life”

1. Journal of Clinical Sleep Medicine, Vol 11, No 6, 20152. Am J Respir Crit Care Med Vol 191, Iss 12, 1450-1458, Jun 15, 2015

Sleeping < 7 hours per night1

• Weight gain and obesity

• Diabetes• High blood pressure• Heart disease• Stroke• Depression

• Immune dysfunction• Greater risk of

accidents• Increased risk of

death

Associated with:

1. Journal of Clinical Sleep Medicine, Vol 11, No 6, 2015

Airway Anatomy

Picture reference: http://stopsnoringrx.com/why-do-we-snore/

Airway during Sleep

Picture reference: http://www.dreamstime.com/royalty-free-stock-image-snoring-sleep-apnea-image27809776

Obstructive Sleep Apnea (OSA)3

• Apnea Pause in breath for ≥ 10 seconds

• Hypopnea Flow of breath decreases by 30% of baseline

for ≥ 10 seconds associated with a fall in oxygen saturation by 3%

3. AASM Scoring Manual Version 2.2, 2015

Obstructive Sleep Apnea• Upper airway

closes• Increased

blood pressure

• Increased heart rate

• Oxygen level drops

Picture reference: http://advan.physiology.org/content/32/3/196

Sleep Apnea Severity

Apnea Hypopnea Index (AHI)

Picture reference: http://www.google.com/patents/WO2010107894A1?cl=en

Health Affects of OSA• 26% general US

population has OSA4

• 48% diabetes6

• 35% high blood pressure5

• 30% coronary artery disease5

• 60% stroke5

OSA

Picture reference: http://binghamtontmjandsleep.com/adult-sleep-disorders/risks-and-effects-of-osa-factors/4. Rising prevalence of sleep apnea in U.S. threatens public health. National Healthy Sleep Awareness ProjectMonday, September 29, 2014 5. Sleep Apnea and Cardiovascular Disease. Circulation, 2012, 126: 1495-1510 6. Prevalence of Sleep Apnea in a Population of Adults With Type 2 Diabetes Mellitus. Endocr Pract. 2007;13(4):355-362

Health Affects of OSA

Lily Eunhae Studer, 7/29/15

Health Affects of OSA• Untreated OSA:

2.5x higher risk of accidents7

• Effective treatment cuts this risk by 70%7

Huffington Post 4/7/2014 “Engineer Involved In Fatal

Metro-North Train Derailment Had Undiagnosed Sleep

Apnea” 7. Risk of motor vehicle accidents is higher in people with sleep apnea. American Academy of Sleep MedicineTuesday, March 10, 2015

Risk Factors for OSA

• Personal history • Family and ethnic risk• Post menopausal women

Picture reference: https://utswim.wordpress.com/tag/pulmonary/

Options for DiagnosisPolysomnography

Options for DiagnosisHome Sleep Testing

Picture reference: http://join.sleepgroupsolutions.com/products/watermark-ares/

Options for Treatment

• CPAP (continuous positive airway pressure) therapy

• APAP (auto-positive airway pressure therapy

Picture reference: http://www.schofieldmedical.com/Catalog/Online-Catalog-Product/2076/Prsystem-One-Remstar-Auto

Alternative Therapies

NONSURGICAL SURGICAL

Positional Therapy• Tennis ball T-shirt

Picture: http://www.tennisballtshirt.com/Stop_Snoring_Remedy_%3A_Tennis_Ball_T_Shirt_%3A_Anti_Snore_Cure.html

Zzoma belt

Picture reference: http://www.medicare.ie/zzoma-positional-device-887.html

Night Shift Positional device

Picture reference: Assessment of a Neck-Based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea. J Clin Sleep Med 2014;10(8):863-871. http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29591

Provent

Picture reference: http://www.lunar.com/blog/lunar-designed-ventus-provent-sleep-apnea-therapy-wins-gold-idea/Picture reference: http://www.sleepwa.com.au/mas-and-provent-Therapy

Oral Appliance Therapy

Panthera Herbst

Mouthpieces

Oral Appliance Therapy• Dental Device Titration (MATRx)

Determining who benefits from mouthpieces

Coming January 2016 to SMG Warren Sleep Laboratory!

Surgical Treatment of OSAUvulopalatopharyngoplasty (UPPP)

• removal of upper airway soft tissues including the uvula, soft palate, tonsils, and adenoids

Surgical Treatment of OSAMaxillomandibular advancement (MMA)

• Currently the most effective surgical option for OSAPicture reference: http://www.homesleepclinic.com/desktop/treatment-options.html8. Oral Appliance Treatment for Obstructive Sleep Apnea: An Update. J Clin Sleep Med 2014;10(2):215-227.

Hypoglossal Nerve Stimulation

Picture reference: Upper-Airway Stimulation for Obstructive Sleep Apnea. N Engl J Med 2014; 370:139-149

Preventative strategies• WEIGHT LOSS

Diet, exercise, weight loss surgery• Avoidance of alcohol• Avoidance of prescription sleep aids• Quit smoking!

Picture reference: http://users.rowan.edu/~blondi74/Expert.page.2.html

Comprehensive Sleep Evaluation

Kole

Bakal Kohn (Pediatrics)

Bass BlausteinWilt

Livingston campusFlorham Park campus

Berkeley Heights campusFlorham Park campus

Berkeley Heights campus

Thank You!

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