ALLERGY, RESPIRATORY
Air Pollution May Raise Blood Pressure
Air Quality Better in Northeast, Midwest
Overweight Moms More Likely to Have Asthmatic Kids
ALTERNATIVE MEDICINE
New Insights Show Ginseng Fights Inflammation
No Verdict Yet on Grape Seed Extract vs. Breast Cancer
Animals Respond to Acupuncture's Healing Touch
ANIMAL CARE
Animals Respond to Acupuncture's Healing Touch
Separation Anxiety, Canine-Style
Beware of Dog Bites
BONES & JOINTS
Using a Balloon to Repair a Broken Back
Heart Failure Raises Risk of Fractures
For All Their Plusses, Pets Pose a Risk for Falls, Too
CANCER
Where You Live May Affect Your Cancer Diagnosis
Well Water Might Raise Bladder Cancer Risk
Broccoli May Help Battle Breast Cancer
CAREGIVING
Study of Everest Climbers Questions Oxygen Use
Caregiving May Lengthen Life
Hispanic Children More Likely to Have Hearing Loss
CIRCULATORY SYSTEM
Potassium-Rich Foods May Cut Stroke, Heart Disease Risk
An Apple a Day May Help Keep Heart Disease Away
Migraines in Pregnancy Boost Vascular Risks
COSMETIC
What to Do If You Have Unsightly Veins
New Genetic Links to Baldness Discovered
Wrinkle Fillers Need Better Label Warnings: FDA Panel
DENTAL, ORAL
Biological Product Shows Promise Against Gum Disease
Study Links Osteoporosis Drugs to Jaw Trouble
An Oral Approach to Heart Disease
DIABETES
Out-of-Control Blood Sugar May Affect Memory
Exercise Protects Black Women From Type 2 Diabetes
Older Diabetics With Depression Face Higher Death Rate
DIET, NUTRITION
DASH Diet Has Extra Benefits for Women's Health
Potassium-Rich Foods May Cut Stroke, Heart Disease Risk
Trans-Fat Ban In New York City Is Proving successful
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Preparing for a Chlorine Gas Disaster
Researchers ID Genetic Markers for Esophageal Cancer
Hypertension May Hit Black Males Earlier
EYE CARE, VISION
Impotence Drugs Don't Harm Vision: Study
Blood Sugar Control Helps Diabetics Preserve Sight
Eye Test Could Spot Diabetes Vision Trouble Early
FITNESS
Strenuous Daily Workout May Keep Cancer at Bay
Tai Chi and Qigong Offer Many Health Benefits: Review
Exercise in Adolescence May Cut Risk of Deadly Brain Tumor
GASTROINTESTINAL PROBLEMS
Gum Chewing May Speed Colon Surgery Recovery
New Guidelines Issued for Management of IBS
Olive Oil May Protect Against Bowel Disease
GENERAL HEALTH
Proven Strategies for Avoiding Colds and the Flu
Living With Less TV, More Sweat Boosts Weight Loss
Whole Grains, Bran May Fight Hypertension in Men
HEAD & NECK
Many Children Will Outgrow Headaches
Zen May Thicken Brain, Thwart Pain
Ski Helmets Encouraged for All
HEALTH & TECHNOLOGY
E-Mailing Your Way to Healthier Habits
Magnet Therapy May Ease Hard-to-Treat Depression
'Comfort Dogs' Come to Emotional Rescue
HEARING
Summer Sounds Can Lead to Hearing Loss
Noise Hurts Men's Hearing More, Study Shows
HEART & CARDIOVASCULAR
Women Who Run May Benefit From Extra Folic Acid
Review Confirms Links Between Diet, Heart Health
Laughter Can Boost Heart Health
INFECTIOUS DISEASE
Swine Flu Loves a Crowd
Poor Restroom Cleaning Causes Cruise-Ship Sickness
Chinese 'Devil Dung' Plant Could Be a Swine Flu Fighter
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
St. John's Wort Doesn't Work for ADHD
Don't Leave Your Kids In The Car !
Too Many Infants Short on Vitamin D
MEN'S HEALTH
Lots of Sex May Prevent Erectile Dysfunction
Soy Linked to Low Sperm Count
Exercise May Prevent Prostate Cancer: Study Shows
MENTAL HEALTH
17 Ways to Create the Perfect Workday
Optimism May Boost Immune System
Music Soothes Anxiety as Well as Massage Does
PAIN
'Cell Phone Elbow' -- A New Ill for the Wired Age
Tai Chi May Help Ease Fibromyalgia
Alleviating Rheumatoid Arthritis
PHYSICAL THERAPY
PREGNANCY
Breast-Feeding May Protect a Woman's Heart
Prenatal Stress May Boost Baby's Asthma Risk
Before Conceiving, Take Folic Acid for One Full Year
SENIORS
As You Age, Better Health Means Better Sex
Living Alone Increases Odds of Developing Dementia
Memory Loss Help from Brain Supplement Prevagen
SEXUAL HEALTH
SLEEP DISORDERS
Better Sleep, Grades Seem to Go Up
Exercising Throat Muscles May Relieve Sleep Apnea
Lose Weight, Sleep Apnea May Improve
WOMEN'S HEALTH
How Much Fish to Eat While Pregnant?
Iodine in Prenatal Vitamins Varies Widely
Simple Carbs Pose Heart Risk for Women
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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