ALLERGY, RESPIRATORY
Folic Acid Might Offer Allergy Relief
Using Music and Sports to Improve Kids' Asthma
Air Pollution May Raise Blood Pressure
ALTERNATIVE MEDICINE
Pain-Relieving Powers of Acupuncture Unclear
Relaxation Tapes or Mozart Lower Blood Pressure
No Verdict Yet on Grape Seed Extract vs. Breast Cancer
ANIMAL CARE
Separation Anxiety, Canine-Style
Safe Toys for Dogs
Rest Easy. When It Comes to Swine Flu, Your Pet Is Safe
BONES & JOINTS
Cane Use May Cut Progression of Knee Osteoarthritis
Tips to Ease an Aching Back
B Cells Can Act Alone in Autoimmune Diseases
CANCER
Tanning Beds Shown To Raise Cancer Risk, Study Says
Yoga May Bring Calm to Breast Cancer Treatment
Strenuous Daily Workout May Keep Cancer at Bay
CAREGIVING
Falls Are Top Cause of Injury, Death Among Elderly
Study of Everest Climbers Questions Oxygen Use
Study Casts Doubt on Influential Hospital Safety Survey
CIRCULATORY SYSTEM
Laughter Can Boost Heart Health
Drink a Little Wine, Live a Little Longer
Tai Chi and Qigong Offer Many Health Benefits: Review
COSMETIC
Get Sugared!.... Its a sweet choice for hair removal
Study Evaluates Laser Therapies for Hair Removal
Gum Chewing May Cut Craving for Snacks
DENTAL, ORAL
Scientists Find Gene for Tooth Enamel
A Sweet Way to Shield Baby's Teeth
Gummy Bears Join Cavity Fight
DIABETES
Whole Grains Take a Bite Out of Type 2 Diabetes Risk
Laughter May Lower Heart Attack Risk in Diabetics
Chamomile Tea May Ward Off Diabetes Damage
DIET, NUTRITION
'Soda Tax' Wins Health Experts' Support
Memory Loss Help from Brain Supplement Prevagen
Vitamin B12 Key to Aging Brain
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Warmer-Than-Average Temperatures Raise Migraine Risk
Cats Can Trigger Eczema in Some Infants
Topical Drugs May Pollute Waterways
EYE CARE, VISION
Gene-Transfer Proves Safe for Vision Problem
Autistic Children Make Limited Eye Contact
Too Much Sun, Too Few Antioxidants Spell Eye Trouble
FITNESS
Many Cancer Survivors Don't Adopt Healthy Lifestyle
Exercise Helps Reduce Falls in Young and Old
Fall Cleanup Is a Prime Time for Accidents
GASTROINTESTINAL PROBLEMS
Gum Chewing May Speed Colon Surgery Recovery
Peppermint Oil, Fiber Can Fight Irritable Bowel
Bowel Prep Harder on Women Than Men
GENERAL HEALTH
Mind Exercise Might Help Stroke Patients
Week of Historic Senate Hearings on Integrative Medicine May Open New Doors
Simple Exercise Precautions To Help Keep Baby Boomers Fit
HEAD & NECK
Ski Helmets Encouraged for All
Many Children Will Outgrow Headaches
Zen May Thicken Brain, Thwart Pain
HEALTH & TECHNOLOGY
Combating Myths About Seasonal Allergies
The Internet Is Becoming One-Stop Shopping for Health Help
Using Light Therapy to Silence Harmful Brain Activity
HEARING
Summer Sounds Can Lead to Hearing Loss
Noise Hurts Men's Hearing More, Study Shows
HEART & CARDIOVASCULAR
Laughter Can Boost Heart Health
Rheumatoid Arthritis a Threat to the Heart
Boosting Vitamin D Can Do a Heart Good
INFECTIOUS DISEASE
Hand Washing 10 Times a Day May Help Keep Flu Away
The HPV Vaccine: Preventative Medicine or Human Sacrifice?
Swine Flu Is Now a Pandemic Says W.H.O.
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Traffic, Dust Linked to Asthma in Kids
Music of Mozart Soothes the Preemie Baby
3 Home Habits Help Youngsters Stay Slim
MEN'S HEALTH
Could Chinese Herb Be a Natural Viagra?
Physical Activity May Prolong Survival After Colon Cancer
Strenuous Daily Workout May Keep Cancer at Bay
MENTAL HEALTH
Keeping a Healthy Holiday Balance
Teen Internet Addicts More Likely to Self-Harm: Study
Optimism May Boost Immune System
PAIN
Alleviating Rheumatoid Arthritis
Are We Exercising Pain Away? Not So Much.
Acupuncture, Real or Fake, Eases Back Pain
PHYSICAL THERAPY
PREGNANCY
Pregnant Women Exposed To Certain Pollutants Could Lower Childs IQ
Breast-Feeding May Protect a Woman's Heart
Mom's Extra Pregnancy Pounds May Raise Child's Heart Risks
SENIORS
Tai Chi and Qigong Offer Many Health Benefits: Review
The Juice From Beetroots May Boost Stamina
Could Your Cell Phone Help Shield You From Alzheimer's?
SEXUAL HEALTH
SLEEP DISORDERS
Meditation May Help Put Primary Insomnia to Bed
Lose Weight, Sleep Apnea May Improve
Moderate Aerobics May Ease Insomnia Symptoms
WOMEN'S HEALTH
Whole Grains, Bran May Fight Hypertension in Men
Soy May Not Lead to Denser Breasts
Being Active an Hour a Day Puts Brakes on Weight Gain
Add your Article

New Options Offered for Sleep Apnea

By Steven Reinberg
HealthDay Reporter

MONDAY, May 18 (HealthDay News) -- Two new treatments -- one surgical and the other an appliance that adjusts the jaw -- might help people with sleep apnea, which has proven tough to treat.

In sleep apnea, the upper airway becomes blocked, and people stop breathing during sleep, usually in 10- to 20-second bouts that can occur 30 or more times an hour. The problem is usually treated with a device that increases air pressure in the throat, keeping the airway open. Called continuous positive airway pressure, or CPAP, the therapy involves wearing a mask attached to a machine.

Though effective, many people find it uncomfortable.

"Whilst continuous positive airway pressure is the gold standard treatment, it does not adequately serve all patients, with some that fail to tolerate treatment and others that simply refuse treatment," said Dr. Neville Patrick Shine, of St. Johns Hospital in Edinburgh, Scotland, and the lead author of a study that tested a surgical treatment for sleep apnea.

The surgery, called transpalatal advancement pharyngoplasty, enlarges the space behind the roof of the mouth.

When the obstruction is significant, "the choice may lie between surgery or no treatment, with the potential attendant cardiovascular and neurocognitive sequelae of sleep apnea," Shine said. "So in this cohort, transpalatal advancement surgery offers a reasonable treatment option."

For the study, Shine and his colleague Dr. Richard Hamilton Lewis, from the Royal Perth Hospital in Perth, Australia, reviewed the medical records of 60 people who had this surgery to treat sleep apnea.

The researchers looked for reductions in sleep disturbances and increases in the amount of oxygen in the individual's blood. With these criteria, the surgery was deemed successful in 38 people. Sleep apnea was cured in 21 people.

"One of the limitations of the procedure is the inability to accurately predict the positive responders to surgery from preoperative characteristics, and all patients undergoing this surgery must be made aware of this fact," Shine said.

"Although this surgery is not a magic bullet treatment for sleep apnea, it does have a role in those patients who have failed conservative treatment, have putative retropalatal disease and are willing to undergo surgery with no absolute guarantee of success," he said.

Dr. Jose W. Ruiz, an assistant professor of otolaryngology at the University of Miami Miller School of Medicine, noted that the surgery is only one of the surgical procedures used to treat sleep apnea.

"Most sleep apnea surgeries have success rates that range from 50 percent up to 70 percent," Ruiz said. "Most of it comes down to selecting the correct patient for the surgery and doing the right surgery. We haven't found the best surgery to do for everyone. That's why we are coming out with new techniques every year."

The ideal candidate for surgery is someone who has tried CPAP therapy but cannot tolerate it, Ruiz said. The success rate of CPAP therapy is very high, more than 90 percent, he noted.

"The problem is that only about 50 percent of the people tolerate it," Ruiz said. "So even though it works really well, most people don't use it." In fact, he said, some people have had surgery to make CPAP therapy more tolerable.

Another new study, though, offers a different alternative to surgery. Its findings are published in the May issue of Archives of Otolaryngology, Head & Neck Surgery, as is Shine's study.

The alternative tested in the study was an appliance called a mandibular advancement device, designed to prevent the airway obstruction of sleep apnea. It does this by moving the lower jaw forward.

A research team led by Dr. Chul Hee Lee, from Seoul National University Bundang Hospital and Seoul National University College of Medicine, evaluated 50 people with sleep apnea who used the device. Based on reductions in shallow or stopped breathing, the device worked in 37 of the participants, including a mix of people with mild, moderate and severe sleep apnea, the researchers found.

"The mandibular advancement device is a simple, non-invasive, easy-to-manufacture and easy-to-use device and showed good treatment outcome in nocturnal respiratory function and sleep quality in Korean patients with obstructive sleep apnea," including those with a severe condition, the researchers wrote. They described it as a "good alternative option" for anyone with obstructive sleep apnea.

However, Dr. Shirin Shafazand, an assistant professor of medicine in the Division of Pulmonary and Critical Care Medicine at the University of Miami Miller School of Medicine, said that devices such as the one tested in the Korean study, are really for people with mild sleep apnea and should be prescribed only after people have undergone sleep studies to determine the severity of their condition.

"It wasn't a surprise that there is improvement," Shafazand said. "But the numbers are too small to know whether people with severe sleep apnea will truly benefit long-term with this device."

She noted that the severity of the condition was reduced in those with severe sleep apnea, but the best result still reduced it only to the level of moderate sleep apnea.

There are a number of devices available that do the same thing, Shafazand said. But, she added, over-the-counter devices don't really work very well.

"The oral appliances that we recommend are to patients who have the sleep studies, so we know their level of severity," Shafazand said. "If their sleep apnea is mild, and they don't want to use continuous positive airway pressure therapy or can't tolerate it, we refer them to a dentist that fits them properly."

However, given the available options, Shafazand said she prefers to start most people on CPAP therapy.

"I always advise patients to try continuous positive airway pressure therapy, especially if it's moderate to severe," Shafazand said. "It's my first-line agent. If they absolutely can't do continuous positive airway pressure therapy, then oral appliances and surgery are alternatives -- but they are not perfect alternatives."

More information

The U.S. National Heart, Lung, and Blood Institute has more on sleep apnea.



SOURCES: Neville Patrick Shine, F.R.C.S., St. Johns Hospital, Edinburgh, Scotland; Shirin Shafazand, M.D., assistant professor, medicine, Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami; Jose W. Ruiz, M.D., assistant professor, otolaryngology, University of Miami Miller School of Medicine, Miami; May 2009, Archives of Otolaryngology, Head & Neck Surgery

Last Updated: May 18, 2009

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