ALLERGY, RESPIRATORY
Obesity May Raise Kids' Allergy Risk
Air Quality Better in Northeast, Midwest
Molecule in Skin May Link Eczema and Asthma
ALTERNATIVE MEDICINE
Alternative Treatments May Boost IVF Success
Acupuncture May Help Restore Lost Sense of Smell
Tai Chi: An Ideal Exercise for Many People with Diabetes
ANIMAL CARE
Animals Respond to Acupuncture's Healing Touch
Beware of Dog Bites
'Comfort Dogs' Come to Emotional Rescue
BONES & JOINTS
Many Americans Fall Short on Their Vitamin D
Living Near Major Road May Boost Rheumatoid Arthritis Risk
Frankincense Provides Relief for Osteoarthritis
CANCER
Study Cites Gains in Gall Bladder Cancer Treatment
Yoga Eases Sleep Problems Among Cancer Survivors
Papaya Could Be a Cancer Fighter
CAREGIVING
Older Caregivers Prone to Worse Sleep Patterns
Tiniest Babies Carry Biggest Costs
Stressed Health Care Workers Battle 'Compassion Fatigue'
CIRCULATORY SYSTEM
An Apple a Day May Help Keep Heart Disease Away
Exercise May Blunt Salt's Effect on Hypertension
Night Shift Work Hard on the Heart
COSMETIC
Health Tip: After Liposuction
With Psoriasis, the Internet May Offer Hope
Science May Banish Bad Hair Days
DENTAL, ORAL
Biological Product Shows Promise Against Gum Disease
Gum Disease May Reactivate AIDS Virus
Amino Acid May Be Key to Strong Teeth
DIABETES
Red-Grape Compound May Improve Diabetes
Whole Grains Take a Bite Out of Type 2 Diabetes Risk
Americans Consuming More Sugary Beverages
DIET, NUTRITION
'Organic' May Not Mean Healthier
Cinnamon Breaks Up Brain Plaques, May Hold Key to Fighting Alzheimer’s
Fatty Acid in Olive Oil Wards Off Hunger
DISABILITIES
Could Your Cell Phone Help Shield You From Alzheimer's?
Review Finds Marijuana May Help MS Patients
ENVIRONMENTAL HEALTH
Hurricane Threats: Time to Batten Down the Hatches
Warmer-Than-Average Temperatures Raise Migraine Risk
Genetics, Environment Shape Sexual Behavior
EYE CARE, VISION
Blood Sugar Control Helps Diabetics Preserve Sight
Omega-3 Foods May Lower Eye Disease Risk
Glaucoma Associated With Reading Impairments in Elderly
FITNESS
Brisk Walk Can Help Leave Common Cold Behind
Women Who Run May Benefit From Extra Folic Acid
Maximize Your Run
GASTROINTESTINAL PROBLEMS
Japanese Herbals May Ease Gastro Woes
New Guidelines Issued for Management of IBS
Intestinal Bacteria Trigger Immune Response
GENERAL HEALTH
Healthy Living Adds Years to Life
Should the FDA Regulate Tobacco?
Pay Attention to Signs That Say You're Too Fatigued to Drive
HEAD & NECK
Ski Helmets Encouraged for All
Zen May Thicken Brain, Thwart Pain
Many Children Will Outgrow Headaches
HEALTH & TECHNOLOGY
The Internet Is Becoming One-Stop Shopping for Health Help
'Cell Phone Elbow' -- A New Ill for the Wired Age
Combating Myths About Seasonal Allergies
HEARING
Summer Sounds Can Lead to Hearing Loss
Noise Hurts Men's Hearing More, Study Shows
HEART & CARDIOVASCULAR
Omega-3, Some Omega-6 Fatty Acids Boost Cardiovascular Health
Vitamin B3 May Help Repair Brain After a Stroke
Low Vitamin D Levels Linked to Heart Disease
INFECTIOUS DISEASE
Viral Infection Might Trigger High Blood Pressure
Dry Weather Boosts Odds of Flu Outbreaks
Swine Flu Now Reported in All 50 States
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Most Depressed Teens Don't Get Treatment
Eating Fish, Breast-Feeding Boost Infant Development
Backpack Safety Should Be on Back-to-School Lists
MEN'S HEALTH
Noise Hurts Men's Hearing More, Study Shows
The Dark Side of Vegetarianism
Strenuous Daily Workout May Keep Cancer at Bay
MENTAL HEALTH
Heal Your Life® Tips for Living Well
Common Social Groups and Race, Seem to Help People Relate
The Unmedicated Mind
PAIN
Acupuncture, Real or Fake, Eases Back Pain
'Cell Phone Elbow' -- A New Ill for the Wired Age
Tai Chi May Help Ease Fibromyalgia
PHYSICAL THERAPY
PREGNANCY
Heart Defects in Newborns Linked to Antidepressants
Before Conceiving, Take Folic Acid for One Full Year
Music of Mozart Soothes the Preemie Baby
SENIORS
Keeping Mentally Active Seems To Keep The Brain Active
Exercise Benefits Even the Oldest Old
Martial Arts Training May Save Seniors' Hips
SEXUAL HEALTH
SLEEP DISORDERS
Better Sleep, Grades Seem to Go Up
Exercising Throat Muscles May Relieve Sleep Apnea
Daylight Savings: Not a Bright Time for All
WOMEN'S HEALTH
Supportive Weigh-In Program Keeps Pounds Off
Caffeine in Pregnancy Associated With Low Birth Weight Risk
Sleeping Could Help Women Lose The Baby Fat
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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