Here are some highlights from Days 2 and 3 of our sleep apnea and snoring course:
Gary Foster, PhD, a long-time faculty member at Temple University and more recently the C0-Chief Scientific Officer at Weight Watchers, showed new studies evaluating the benefits of weight loss in improving moderate to severe obstructive sleep apnea, providing evidence that is more relevant than early studies that were done mainly in people without sleep apnea or mild sleep apnea. Interestingly, the benefit for sleep apnea seems to hold up well, even in patients who regain some of their lost weight. A study published just last year suggested that weight loss may be more beneficial than CPAP alone in obese patients with sleep apnea, although the combination seems to improve blood pressure more than weight loss alone. The bottom line is that weight loss can be very helpful in obese patients, with a 10% weight loss improving many health conditions (especially diabetes) and obstructive sleep apnea. The exciting thing is that there are more behavioral programs and medication options that can make a difference and help someone achieve weight loss.
Neil Freedman, MD discussed the evidence related to CPAP and echoed the conclusions of other speakers: patients who have excessive sleepiness specifically are those that have the highest health risks related to sleep apnea and may be the patients who achieve the most benefit from CPAP. This has been fascinating to see the studies come out, as historically physicians have always considered health effects and sleep quality effects to be separate.
Peter Cistulli, MBBS of the University of Sydney gave an excellent talk about oral appliances, including mandibular repositioning appliances. Jamison Spencer, DMD followed this by speaking about the relationship between snoring or sleep apnea and temporomandibular dysfunction, tooth grinding (bruxism) or clenching, and other temporomandibular joint (TMJ) abnormalities. While tooth clenching and grinding are considered by many to be reasons not to use an oral appliance in treatment of snoring or sleep apnea, he showed some small studies that some patients can actually have improvement of tooth clenching or grinding with oral appliances.
Ron Mitchell, MD of UT Southwestern spoke about tonsillectomy and adenoidectomy (T&A) in children with sleep disordered breathing. There is growing evidence that many children with sleep problems have behavior changes that are similar to those seen in attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). In those children, these can improve substantially after T&A; this is not new. What was new to me was the research that is now showing the depressive symptoms can improve even more; this has been shown in adults, but I had not seen the studies in children before. Another interesting study was an evaluation of medical costs in the 2 years before and after T&A; this showed that there was a 37% reduction in medical costs after T&A, especially in drug costs and outpatient office visits, suggesting a reduction in infections.
Richard Schwab, MD of the University of Pennsylvania discussed his work with magnetic resonance imaging and showed some data that will be presented at the American Thoracic Society meeting in a few months. This indicated that obese patients with sleep apnea who lost weight (at least 10% of their body weight) decreased the volume of the tongue and the lateral pharyngeal walls. We still have a long way to go to understand exactly how weight gain and weight loss worsen or improve snoring and sleep apnea, respectively, and his team’s work will be leading the way.
These highlights from the course do not reflect the important discussions of surgical treatments and outcomes that the course includes, but these posts simply reflect the fact that I already follow the latest publications related to sleep surgery.