Study suggests hypoxia is the main cause of BP rise in sleep apnea

Patients who had previously used continuous positive airway pressure (CPAP) for the treatment of sleep apnea, found that it helped to eliminate their morning blood pressure elevations. It also substantially reduced hypoxia. In a recent study in the American Journal of Respiratory and Critical Care Medicine, relative to treatment with supplemental air, pure oxygen was associated with a 6.6 mm Hg decrease in systolic and 4.6 mm Hg decrease in diastolic pressure.

What is the connection?

Obstructive sleep apnea has been known as a risk factor for hypertension and cardiovascular disease. However, it was not clear if that risk was associated with recurrent arousal or intermittent hypoxia, according to the study.

Understanding that supplemental oxygen reduced intermittent hypoxia but had only a minor effect on markers of arousal, makes a strong case for intermittent hypoxia being the dominant cause of daytime BP increases in patients with sleep apnea.

This study shows us that by blunting the dips in oxygen levels, the use of oxygen can have a positive effect on a person’s BP. We can start to look at patients with sleep apnea who have experienced high blood pressure that is not adequately treated with hypertension medication. According to this study, that specific group of patients should benefit from the use of oxygen therapy.

Oxygen improves BP

In this double-blinded study, CPAP was withdrawn for 14 nights during each treatment arm. During this time, participants received supplemental oxygen or regular air overnight through a face mask. The primary outcome was the change in home morning BP following the withdrawal of CPAP. Secondary outcomes included oxygen desaturation index, apnea hypopnea index, and subjective and objective sleepiness.

The use of supplemental oxygen significantly improved measures of intermittent hypoxia. There was also a significant reduction in heart rate rises index. While additional studies are needed to determine the best candidates for supplemental oxygen therapy, it is important to note these findings.

We, as dentists, can continue to treat sleep apnea patients with oral appliance therapy, but we should be mindful to other treatment options and what a sleep physician suggests for the best outcomes.

Teenagers are not getting enough sleep

 

When we think about teenagers, we often think that they sleep too much. However, in reality, this is not the case at all. Teenagers are actually not getting enough sleep, which can negatively impact their health and wellbeing–they struggle to get the recommended eight to nine hours per night.

According to the Centers for Disease Control and Prevention, about one-third of American adults don’t get the recommended seven hours of sleep per night. This might be because of their jobs or hectic schedules, including working long shifts and then having to take their kids to school every day of the week. To add to that, about 50 to 70 million Americans suffer from a chronic sleep disorder, such as sleep apnea, according to a study by the  Institute of Medicine (US) Committee on Sleep Medicine and Research.

The benefits of sleep for our patients

There is an abundance of research out there that suggests sleep helps us perform a range of vital functions including:

  • Restoring damaged tissues.
  • Boosting learning.
  • Improving memory.
  • Flushing toxins from the brain.

Sleep can also help our patients to remain motivated throughout the day, while also remaining safe behind the wheel of a car. Too little sleep can also have serious consequences on our patients’ health, such as an increased risk for obesity, diabetes and cardiovascular disease.

A lack of sleep for teenagers

In the journal Pediatrics, a recent study highlighted the importance of sleep for teenagers. With such busy lives, teenagers often struggle to meet the recommended eight to nine hours of sleep a night. More than 800 teens participated in this study and only 2.2 percent got enough sleep. And less than half of participants achieved desirable rates of sleep efficiency, which is the percentage of total time in bed that they are actually asleep.

As a result, teens that missed out on key amounts of sleep were more likely to be obese and scored higher on several other risk factors for cardiovascular disease, such as high blood pressure. For teens who were able to sleep for longer and better quality, tended to have less fat around their waists, lower systolic BP and higher levels of “good” cholesterol. These were all signs of cardiovascular health.

We need to be on the lookout for various signs and symptoms in our teenage patients so we can take preventive steps. By understanding how sleep apnea can negatively affect their health, we can better care for our patients.

ADHD can exacerbate sleep apnea symptoms

Our patients should not have a problem sleeping–it should be a simple solution. When it’s nighttime and you get tired, going to bed should be the least of our patients’ worries. However, when attention deficit disorder (ADD or ADHD) is in the picture, it can be even more difficult. Sleep apnea and other sleep disorders and ADHD have a significant connection.

Patients with ADHD are more prone to sleep problems than anyone, and they often go undiagnosed. Sleep apnea, restless leg syndrome and even delayed sleep phase syndrome exacerbate ADHD symptoms. And, other times, patients might even be misdiagnosed with ADHD when they really have a sleep disorder.

Tips to help patients sleep

Sleep apnea can often mimic ADHD symptoms, which can cause inattentiveness and restlessness in those who do not have ADHD. At the same time, sleep apnea can also worsen symptoms in patients who do have ADHD.

Before we dive into some tips to share with your patients, let’s look at primary and behavioral sleep problems. Primary sleep disorders are physical conditions that disrupt sleep. This would include sleep apnea. For behaviorally based sleep problems, it is linked to ADHD and are common in children who cannot make the transition to bedtime without commotion that ends up disrupting sleep.

If the sleep condition is related to behavior, try to encourage your patients to do the following:

  • Remove all screens from the bedroom. If they remain, try to turn off all screens at least two hours before bedtime.
  • Go to bed at the same time every night.
  • Get up at the same time every morning.
  • Don’t do work in your bed. Avoid working in your bedroom.
  • Exercise regularly.
  • Reduce alcohol and caffeine intake.
  • Review ADHD medications with their doctor.
  • Establish a “winding down” routine before bedtime.

These tips can potentially help patients with ADHD and sleep apnea, but the use of an oral appliance will significantly improve sleep as well. What other tips do you have for your patients that have worked?

Patients who snore might suffer from nerve and muscle damage in palate

According to Umeå University in Sweden, people who snore might have extensive tissue damage in the nerves and muscles of the soft palate. As a result, this can create problems for patients when swallowing. It can also contribute to the development of sleep apnea. Treatment options often include early intervention to stop snoring, which can have benefits in healing or preventing the development of sleep apnea.

Development of sleep apnea remains unclear

It is still unclear why some people develop sleep apnea. Some factors that might contribute are obesity, a small throat, neurological diseases and hormonal disorders. However, even if the patient doesn’t have any of those factors they might have sleep apnea. Rresearch has also shown that tissue damage in the soft palate is also an important contributor to the development of sleep apnea and disturbances in swallowing function. Farhan Shah, PhD, a student at the department of integrative medical biology at Umeå University, says that the nerve muscle injuries appear to contribute to the collapse of the upper airway during sleep. The nerve and muscle damage might be the result of recurrent snoring vibrations that the tissues are exposed to.

His dissertation looked at eight patients who snore and 14 with both snoring and sleep apnea compared to 18 non-snoring people. The patients were studied overnight. Tissue samples from their soft palate were also analyzed to detect muscle and nerve lesions. Results showed that snorers and sleep apnea patients had extensive damage to both nerves and muscles. This is related to the degree of swallowing disorders and severity of sleep apnea.

Research is needed on muscle damage

This is good information for us to know, but there is still so more to observe and research. This knowledge can help us to gain a better understanding of the various connections.

This research is also a step in the right direction and we need to look at treatment of sleep apnea. Will treatment help to prevent nerve and muscle damage? Could it prevent or cure further deterioration in patients who snore and/or have sleep apnea?