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SLEEP DISORDER & CPAP ARTICLES
CLOSING THE GAP
Sleep Review Magazine Article
Issue: July-August 2005
by John D. Zoidis, MD
Recent studies tighten the link between OSA and hypertension, which are leading to more targeted therapies.OSA affects approximately 4% of middle-aged adults and up to 50% of elderly persons. Of the approximately 75,000 patients seen annually in sleep disorder centers, roughly 75% are diagnosed with OSA.3 Projections of the prevalence of OSA in the United States range from 7 to 18 million people.
OSA is a potentially life-threatening condition characterized by repeated collapse of the upper airway during sleep, cessation of breathing, and clinical associations with a variety of disease states, including hypertension. The spectrum and severity of clinical presentations of OSA are extremely variable.
Apnea and hypopnea cause temporary elevations in blood pressure in association with blood-oxygen desaturation, arousal, and sympathetic activation, and may cause elevated blood pressure during the daytime and, ultimately, sustained hypertension.1,4 Epidemiologic data support a link between obesity and hypertension as well as between OSA and hypertension. For example, untreated OSA predisposes to an increased risk of new hypertension, and treatment of OSA lowers blood pressure, even during the daytime. To read the full article, click here.
UNDERSTANDING CHILDREN'S SLEEP
Sleep Review Magazine Article
Issue: March-April 2005
by Regina Patrick
Sleep requirements for children can be as simple as allowing them to follow their natural instincts. “Is my baby having trouble settling down to sleep because his body naturally wants to go to sleep at a later time than the bedtime I have set for him or is he just being stubborn?” “Is my child waking up early in the morning because he is just naturally a ‘short sleeper’ or does he have insomnia?” “Is my teen sleeping too long or are his long periods of sleep normal?”
Just what is normal and what is abnormal is often difficult to tell when it comes to a child’s sleep. “Normal” is affected by several factors. One factor is a child’s age. What is normal at one age becomes abnormal at another age (awakening every 3 hours at night is normal in infancy but abnormal in a teen). A second factor is parental perception of a child’s sleep behavior. Parents who find their children’s sleep behavior problematic (frequent nocturnal awakenings) will be more likely to perceive them as having a sleep problem. A third factor is culture. Each culture has a unique effect on moderating sleep behavior so that the prevalence of certain sleep behaviors differs from culture to culture. Each culture interprets sleep behavior in different ways as to what is considered “normal sleep.” An example of one’s culture moderating a child’s sleep behavior was demonstrated in a 1999 study by Latz et al.1 They found that a child’s nocturnal awakenings were a problem for Japanese parents who slept with their children while stressful sleep problems, bedtime struggles, and a child’s nocturnal awakenings were problems for American parents who slept with their children. Since both American and Japanese parents had the same behavior (they coslept with their children), the research concluded that a factor that could explain the difference in the type of sleep problems a child manifested would be the child’s culture. In an attempt to limit the confusion caused by these factors and truly learn what is normal in pediatric sleep needs, scientists have heavily relied on questionnaires, polysomnography, and actigraphy. Through these means, an increasingly clearer idea about pediatric sleep needs is developing and myths are being overturned. To read full article, click here.
CPAP MAY HELP HEADACHES
Sleep Review Magazine Article
Issue: September-October 2005
by Lawrence T. Chien, MD, FAAP, FAAN, ABSM, and Anne P.Y. Chien, MSN, APN, NP-C
Two patients suffering from migraine and OSA were successfully treated with nasal CPAP.Current therapies for patients with migrane headaches include avoiding triggers such as ingestion of cheese and chocolate, and avoiding allergic factors. Stress and not eating may also bring on migraine attacks. Hormonal factors during a woman’s menstrual cycle certainly may affect migraine occurrence as well. Sleep hygiene has been proven to help children and adolescents to reduce mean duration and frequency of migraine attacks as reported by Bruni et al.1
Patients with cluster headaches seen in the emergency department are often treated with low flow oxygen. In patients with OSA and migraine headaches, there is associated hypoxia and hypercarbia. Hypercarbia has been known to be a strong cerebral vascular dilator and worsen any headaches by increasing brain volume. This article reports on two patients with remarkable improvement of migraine frequency and severity after nasal CPAP treatment was administered for their sleep apnea. To read full article, click here.
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