Sleep apnea may predict mortality risk

It appears that the duration of abnormal breathing events may be a better predictor of mortality risk in both women and men. Patients with sleep apnea who have short interruptions in breathing while they sleep are at a higher risk for death than those with longer interruptions. This new information was found in a study published in the American Journal of Respiratory and Critical Care Medicine.

By understanding this new information, it can help dentists and physicians better prevent long-term mortality associated with obstructive sleep apnea. For those who have a sleep apnea diagnosis, it is linked to high blood pressure, heart disease and, now, an increased risk of dying.

Apnea-hypopnea index for severity

Sleep specialists refer to the apnea-hypopnea index (AHI) to determine the severity of sleep apnea. The severity of the AHI measurement can be linked to mortality and heart disease. However, AHI remains a coarse measurement of sleep apnea severity and is not a good risk predictor for women–AHI is largely based on data from men.

In this new study, not only does it matter how many breathing interruptions occur, but also how long each one lasts. Patients with the shortest apneas were 31 percent more likely to die during the study’s decade of follow-up with participants. This was true for both male and females.

Treating sleep apnea

The most common treatment for sleep apnea is a continuous positive airway pressure machine. However, many patients find that wearing a mask during sleep is uncomfortable. When this is the case, they choose not to use it, which can worsen sleep apnea symptoms.

Even if a patient only has mild or moderate sleep apnea, it is important for both men and women to undergo treatment. Short breathing interruptions require further attention and commitment to treatment.

Breathing through your nose may improve memory.

I recently read an article in the magazine Sleep Review and it was very interesting. In this article, it stated that breathing through your nose may actually improve memory. That really is great to hear and understand. This is based on a study published in The Journal of Neuroscience. In this study, researchers examined the effect of respiration on consolidation of episodic odor memory.

How memory works with sleep

Both female and male participants encoded odors. This was followed by a one hour awake resting consolidation phase where they either breathed solely through their nose or mouth. Immediately after this phase, memory for odors was tested. Recognition memory saw a significant increase during nasal respiration compared with mouth respiration.

From this we see the first evidence that respiration directly impacts consolidation of episodic events. It also supports the idea that core cognitive functions are modulated by the respiratory cycle–adding to the influence of respiration on human perception and cognition.

While the study did not look at brain activity, it did suggest that nose breathing may facilitate communication between sensory and memory networks. This is because memories are replayed and strengthened during consolidation.

Encourage your patients to take deep breaths through their nose to help improve their memory. This can also help their stress levels. It is an all around good idea for their health and well-being.

Treating sleep apnea: The role of dentists, primary care physicians

Obesity is a global epidemic well rooted in the U.S. and Western cultures. With recognition of the magnitude of this epidemic, it is important to promote obesity prevention by all health professions and disciplines. This will help to prevent further health complications, such as diabetes, heart disease and obstructive sleep apnea, as well as other sleep-related breathing disorders (SRBD).

When a person struggles to breathe during sleep, or stops breathing, additional stress is placed on the heart, leading to health risks. To further improve the health of our patients, dentists should work with primary care physicians (PCP). Here is why.

Screening for sleep apnea

Dentists and primary care physicians are the first line of detection and treatment for their patients. As a dentist, you see your patients more frequently than physicians. This is especially true when patients adhere to the recommended cleaning every six months. PCPs  often see their patients more frequently than physician specialists, such as cardiologists, neurologists, pulmonologists, etc.

Both dentists and PCPs have the opportunity to discuss a variety of concerns that affect their patients’ quality of life, well-being and potential health risks. A large number of patients with undetected and untreated sleep disorders pass through dental and PCP offices each day. For this reason, it is important to complete advanced training and continuing education courses. This will help you to better understand how best to embed practical assessments and referrals into routine care.

Dentists and PCPs should work with a referral system. This links the patient with a proper specialist for diagnosis, as well as treatment. They can also educate and consult the patient about healthy lifestyle choices to reduce risk factors associated with obesity and SRBD.

Evidence-based treatment of sleep apnea

After a diagnosis is made, the medical sleep specialist can recommend treatment. Possible treatment might include weight loss, positional therapy, continuous positive airway pressure (CPAP), oral appliance therapy or surgery. Combination therapy is also common to provide individualized treatment for the patient. This often includes CPAP with oral appliance therapy. When a dentist receives proper training and credentialing, they can effectively treat patients using oral appliance therapy.

Patients should receive ongoing reinforcement for healthy behaviors during routine office visits. This is regardless of the treatment or health professional overseeing treatment. 

Relationship between obese youth and sleep apnea

There is an increasing prevalence of children and adolescents with obesity causing a global health concern. While the effect of obesity on cardiovascular function has been investigated, little remains known about how it impacts obstructive sleep apnea in youth with obesity.

In a recent study from the American Journal of Cardiology, researchers looked at the influence of OSA on cardiovascular functional parameters in obese youth. The study looked at 44 obese patients and 44 age- and gender-matched control subjects. Every patient underwent polysomnography and cardiovascular assessment.

The study found that patients with obesity had:

  • Higher left ventricular (LV) mass/height 2.7,
  • Preserved LV systolic parameters.
  • Differences in LV diastolic parameters.
  • Increased PWV and systolic blood pressure at rest compared with control group.

For youth with obesity, 32 percent had obstructive sleep apnea. However, there was no correlation between obesity and the apnea-hypopnea index (AHI). The LV mass/height 2.7 significantly correlated with body mass index z-score whereas PWV correlated with AHI. The body mass index z-score for patients with obesity was an independent predictor for LV mass/height 2.7 and AHI was an independent predictor for higher PWV.

From this study we understand that both obesity and OSA influence cardiovascular performance in youth with obesity. And while obesity is associated with increased LV mass and reduced LV diastolic function, obstructive sleep apnea is associated with changes in arterial stiffness.

Add this to the list for reasons to not only treat sleep apnea, but also offer lifestyle change suggestions for children and adolescents to further prevent complications.