Risk factors for sleep apnea during pregnancy

If you are pregnant, snoring, older age and obesity can put you at risk for sleep apnea, according to the National Institutes of Health (NIH). They completed a study that appeared in the American Journal of Obstetrics and Gynecology to look further into this connection and how risky it is for sleep apnea and pregnant women.

What are the risk factors?

An earlier study of first-time pregnancies found that sleep apnea increases a woman’s risk for hypertension and gestational diabetes. However, there are currently no medical guidelines or treatment recommendations available for sleep apnea during pregnancy. NIH’s current study, though, supports a look at treatment options for pregnancy-related sleep apnea. And, based on these results, they are planning a larger study to look deeper into this subject.

Researchers found that almost four percent of more than 3,000 women in early pregnancy and more than eight percent of over 2,500 women in mid-pregnancy had sleep apnea. The risk factors for having this condition included frequent snoring, older maternal age and being overweight as determined by body mass index (BMI).

Each woman’s risk will vary depending on their individual characteristics. However, the researchers in this study created a calculator using maternal age, BMI and snoring frequency to arrive at the woman’s probability of sleep apnea in early and mid-pregnancy.

Treating sleep apnea during pregnancy

Of course one option  available is the use of CPAP therapy. However, it is not currently known if this type of treatment during pregnancy will prevent hypertension, diabetes or other complications of sleep apnea. We can also turn to oral appliance therapy to help improve sleep apnea symptoms and potentially improve the woman’s health and well-being during pregnancy.

What is the role of sleep apnea in COPD?

Chronic obstructive pulmonary disease ( COPD ) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Obstructive sleep apnea (OSA) is a known common comorbidity of COPD. However, the relationship of the combination of OSA and COPD on mortality is not clear. It has been found that OSA occurs in about 10 to 15 percent of patients with COPD. This is often referred to as the overlap syndrome.

What is the connection?

According to the COPD Foundation, sleep-related disorders are most prevalent in adults and are associated with increased mortality and morbidity from obesity, cardiovascular diseases, diabetes and depression. As a result, so many people experience a reduced quality of life and increased health care costs.

Patients with severe COPD commonly exhibit abnormal sleep like insomnia that can contribute to daytime sleepiness and fatigue. Additionally, medications that have been used to treat COPD may affect the patient’s quality of sleep. Due to a nighttime reduction of oxygen levels that are commonly seen in patients with COPD, it can have a profound effect and lead to long-term sequelae, which can produce arrhythmias, myocardial stress and even lower survival rates.

Oral appliances for treatment

Individuals with both conditions have an increased risk of death and more hospitalizations without CPAP treatment, or in our case, oral appliance therapy. Without treatment, it can negatively impact their overall well-being. The use of oral appliance therapy helps to improve breathing for patients.

For patients with COPD, there is a very poor quality of sleep involved. And if they suffer from OSA as well, it can have profound effects. By looking further into OSA among patients with diagnosed COPD, it can potentially help improve treatment and their outlook on life. Recommend a sleep evaluation for patients diagnosed with COPD and try asking questions about daytime sleepiness, snoring, etc.

We owe it to our patients to remain up-to-date on the latest health connections with sleep apnea for improved care.

Sleep disorders common among non-cystic fibrosis bronchiectasis patients, study says

Let’s take a look at another connection with sleep breathing disorders. Adults with non-cystic fibrosis bronchiectasis (NCFB) suffer from sleep disorders stemming from less oxygen in the blood, according to a study.

What is bronchiectasis though? It is a chronic condition characterized by abnormal widening of airways. This can lead to their destruction, a buildup of excess mucus and a decline in lung function.  

Sleep orders, specifically obstructive sleep apnea, affect 45 percent of the world’s population. Of this, about three to seven percent of young men and about 2.5 percent of young women in the Western world have sleep apnea. A risk increases in people with respiratory disorders.

Despite confirmed links between a number of respiratory diseases and sleep disorders, states the study, the relationship between bronchiectasis and sleep disorders have still not been investigated extensively. For this reason, this research team looked to dive into the connection.

What were the results?

It was found that 41 percent of patients had sleep apnea associated with low blood oxygen levels and 71 percent snored. On top of that, 53 percent of patients experienced excessive daytime sleepiness, a percentage higher than the general population.

This study brings to our attention just how important it is to complete further research on various connections with sleep disorders, such as sleep apnea. By conducting further research and expanding our education, we can further provide our patients with even better care.

What conditions have you noticed a link with sleep apnea? Is there adequate research out there?

Recognize sleep and chronic pain as separate disorders

Sleep apnea and chronic pain often co-exist, but it is also important to understand each condition individually for the best treatment options. In the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is mandated that coexisting medical and mental conditions should be independently specified when treating patients. This then raises the question, which came first, pain or sleep disturbance?

Studies suggest that 50 to 70 percent of chronic pain patients suffer from a sleep disturbance and that 89% of patients seeking treatment for chronic pain report at least one complaint related to a disturbed sleep and wake cycle, according to a recent study.

Sleep apnea, restless leg syndrome and periodic limb movements in sleep are the most commonly cited ailments associated with pain. In fact, sleep apnea is diagnosed in 17 percent of headache patients, which exceeds population rates.

It is evident that pain impairs sleep, but there is evidence of a biodirectional relationship between pain and sleep. Increased pain in the daytime is often linked with poor subsequent nighttime sleep and poor sleep is associated with augmented next-day pain.

What is the relationship between pain and sleep?

In patients that suffer from chronic pain, the study states that a self-perpetuating cycle can be set in motion in which joint, myofacial or musculoskeletal disease leads to fatigue. This then leads to decreased exercise and physical deconditioning. Patients then begin to spend more time in bed, which causes their basic circadian cycle to be disrupted.

And as a result, the basic physiologic rhythm of sleep is lost and this lack of movement and sleep begins to lead to more pain and even more sleep loss. Obtaining less than six hours or more than nine hours of sleep can be associated with greater next-day pain. To help improve sleep among these patients it is important to encourage exercise. More strenuous exercise during the day will help to promote better sleep. Just make sure the exercise patients are performing is completed at least three hours before bedtime.

It is important for us as dentists to be on the lookout for signs and symptoms of sleep apnea. This is also the case for chronic pain among our patients–especially when the two are connected. By gaining a better understanding of this link, you can not only identify these conditions, but treat them individually for the best results.