Sleep Apnea Research at OSU

Occasionally I stop by the web page of the Center for Clinical and Translational Science at Ohio State University--mainly to ponder "what does translational mean." Believe it or not, it's getting ARRA (stimulus) money--over $1.6 million for some new computer grid--and I also ponder how that will do one thing to improve the economy. Although I still haven't answered those questions, I did note some interesting research on sleep apnea, which if successful, looks a whole lot easier than wearing one of those awful masks in order to have a good night and safe night's sleep.

"Dr. Magalang, an Associate Professor in the Divison of Pulmonary, Allergy, Critical Care, and Sleep Medicine, along with his research team will examine the effects of mandibular advancement devices [MAD] treatment on insulin sensitivity, blood pressure, psychologic well-being, and quality of life in patients with OSA who are unable to tolerate Continuous Positive Airway Pressure (CPAP) therapy.

Sleep apnea affects more than 20 million Americans and occurs when the area behind the tongue and soft palate becomes obstructed repeatedly, causing a person to stop breathing numerous times during sleep. It can range from mild to severe and the condition has been associated with an increased risk for stroke, hypertension, heart disease, depression, and diabetes.

The most common treatment for OSA patients is CPAP, delivered by a machine through a specially designed mask that prevents the throat from collapsing during sleep. While CPAP is a highly effective treatment for sleep apnea, it is estimated that at best, only 50% of patients tolerate and continue to use the machine long term.

Thus, Dr. Magalang and his team have proposed a study to better understand the effects of MAD for the treatment of sleep apnea. MAD is a dental device that is worn by the patient only during sleep and protrudes the lower jaw forward, preventing the airway from collapsing.

“There is a need for alternative therapy for sleep apnea,” says Magalang. “MAD has been used in the past to treat OSA, but the health outcomes as a result of this treatment have not really been evaluated. Some patients just cannot tolerate CPAP and we need to know the health outcomes of these alternative therapies.”

Dr. Magalang hopes that by providing evidence for the effects of MAD therapy on selected health outcomes, practitioners will consider this form of treatment when the patient is unable to tolerate CPAP.

“There is good evidence that the hypoxic stress, caused by the repetitive dipping of the oxygen levels in sleep apnea, is associated with insulin resistance, a marker for the development of diabetes and also an important risk factor for heart disease,” he said. “We need to know whether MAD treatment improves insulin resistance.”

Over the course of 3 months, the study will examine 40 randomized subjects who have reported that they cannot tolerate CPAP. The research team also includes: Dr. Allen Firestone, Department of Orthodontics; Dr. Dara Schuster, Divison of Endocrinology; and Dr. Sharla Wells-DiGregorio, Department of Psychiatry."

My husband says that when I lost 20 lbs I stopped snoring. Do thin people snore?

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Women who snore

Yes, we do. Maybe not as loud as the guys, maybe we don't rock the house or scare the dog, but we snore. Especially if we are fat. Today I was reading "Menopause not always to blame for sleep problems in midlife women" in the May 2 issue of JAMA (I'm not caught up, sorry). Lynne Lamberg reports that sleep complaints from midlife women (and we all have them) may not just be menopause. They may be more subjective than objective, too, because sleep lab studies show that postmenopausal women had better sleep overall than premenopausal women! Just a guess here, but I'm betting Lynne hasn't reached the hot flash, soak-the-bedsheets, wake-up-dripping stage of life yet. Here are some of the other causes

job stress

care responsibilities for aging parents

ill spouse

bed partner's snoring (I think it's funny that you have an "ill spouse," but the person you sleep with is a "bed partner." But I digress

obstructive sleep apnea (OSA)

restless leg syndrome (RLS)

Women with sleep apnea (and you know who you are, dear readers) "commonly present with insomnia, depression, fatigue, and hypothyroidism, and they are more likely to have higher body mass indexes (BMIs)" than men who have the same condition. The article then proceeds to discussing the medical profession's cop-out--encourage the woman with OSA to use CPAP (continuous positive airway pressure). It only requires 6 hours of use nightly to restore sleepiness to normal levels--but it does nothing for the sex life, so many women refuse to use it.

Restless leg syndrome (feels like bugs crawling) also is aggrevated by higher BMI and by smoking. It too can cause depression, drowsy driving, impaired concentration, anxiety and all that other stuff we mid-lifers get. Again, the medical profession recommends a medication that affects the brain center.

So after reading the article, I asked my husband a simple question: "Do you think I snore as much as I used to?" He didn't hesitate to think. "No."

I wasn't enormous--I was just at the tipping edge of my range on the BMI scale, but I did lose the 20 pounds I didn't need (see my TT about food triggers). The reason I asked wasn't just this article. I had noticed I wasn't waking up as much at night and was wondering what was different. I didn't connect it with the weight loss. This is not medical advice, but if you ask your doctor about your sleep problems, I'm guessing you'll be told to lose weight. I'd at least pass on the CPAP or the meds and try 10-20 lbs to see if that helps.