EIC Social Media Team
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Risk factors for obstructive sleep apnea (OSA) and the subsequent development of associated problems with this condition, such as cardiovascular complications have been suspected to vary by sex, but until recently, whether the effects of OSA on heart disease is similar for men and women had not been clearly established. Researchers have discovered that OSA is more dangerous for women than for men in their study.
Published in Circulation in October, the results of the research found that gender does play a role between OSA and cardio vascular disease, and that in women, sleep apnea was associated with higher blood levels of troponin (hs-TnT), a biomarker of heart disorders of which the most important is myocardial infarction (heart attack). Also, increased levels of troponin indicate cardiac muscle cell death because the enzyme is released into the blood upon injury to the heart.
“The finding that sleep apnea is associated with evidence of early heart injury and an elevation in long term risk of heart failure, coronary heart disease, enlargement of the heart muscle, and death in women highlights the importance of sleep apnea screening and treatment for women, a group who often are not routinely screened for sleep apnea,” says co-author Susan Redline, MD, MPH, and associate clinical director at the Division of Sleep and Circadian Disorders at BWH.
The study examined post-menopausal women, who are at a greater risk for sleep apnea and heart disease. The study concluded that older women may be at relatively greater risk of sleep apnea related heart disease compared to men.
The study took participants of an average age of approximately 63 years, of whom 23% were men and 10% women having undiagnosed moderate to severe OSA. Over a 14 year follow up, 46% of men and 32% of women experienced a significant adverse cardiac event, death, or had an enlarged heart. Women with moderate to severe OSA were more than 30% likely to experience these adverse heart problems compared to women without OSA. This relationship was not statistically significant in men, suggesting that factors such as age, obesity, hypertension, and diabetes explained most of the observed heart disease risk in the men studied.
“We hope these results focus attention on the importance of sleep apnea in women, who historically are under-diagnosed in this area,” Redline says. Another aspect of this study that we should pay attention to is that even among women with obstructive sleep apnea who don’t get heart disease or attacks, the condition is associated with changes in the heart, which may lead to worse ramifications.
There are already several home sleep apnea tests available, but some are costly and inconvenient; that could change with the development of a new smart phone app from the University of Washington (UW), according to a news release by Dr. Nathaniel F. Watson, Md, MSc, professor of neurology and co-director of the UW Medicine Sleep Center. The study uses a smartphone to wirelessly test for sleep apnea events in a person’s own bedroom. Unlike other home sleep apnea tests in use today, ApneaApp uses inaudible sound waves emanating from the phone’s speakers to track breathing patterns without needing special equipment or sensors attached to the body.
The clinical study was presented at the MobiSys 2015 conference in May. It’s been appropriately called the ApneaApp, because it can identify signs of sleep apnea as accurately as a polysomnography test, which is 98% accurate. For those of you who don’t know, the polysomnograph is the gold standard among sleep apnea tests, which tests for a disease that affects roughly 1 in 13 Americans. The polysomnograph, however, is much more costly and inconvenient, since it requires an overnight stay in a sleep lab and can cost over thousands of dollars. In contrast to this costly test, this sleep apnea test may prove to be just what the patient and doctors want to improve savings and detection.
“Right now we don’t have enough sleep clinics, sleep laboratories, and sleep specialists in the country to address all the sleep apnea that is out there,” says co-author Dr. Watson. “These initial results are impressive and suggest that ApneaApp has the potential to be a simple, noninvasive way for the average person to identify sleep apnea events at home and hopefully seek treatment.”
To determine if a person is experiencing sleep apnea signs, also called events, ApneaApp adapts an Android smartphone into a sonar system that can track minute changes in a person’s breathing patterns. Sonar works by using an echo. When an animal or machine makes a noise, it sends sound waves into the environment around it, and those waves bounce off nearby objects, reflecting back to the object that made the noise. The phone does the same, but emits inaudible sound waves that bounce off a sleeping person’s body, reflecting back to the phone’s microphone.
The sound waves are too low for adults to hear, so the app easily screens out background noise from people talking, cars, or other common sounds. The UW team developed new algorithms and signal-processing programs, both of which test the boundaries of what smartphones can do.
“Right now phones have sensing capabilities that we don’t fully appreciate,” says co-author Shyam Gollakota, assistant professor of computer science and engineering and director of the UW Networks and Mobile Systems lab. “If you can recalibrate the sensors that most phones already have, you can use them to achieve really amazing things.”
In the clinical study, 37 patients were tested using the sleep apnea test with the smart app at Harborview Medical Center. Researchers used a Samsung Galaxy S4 smartphone placed at the corner of the beds during their overnight sleep study. Nearly 300 hours of testing were done, and the app tracked various respiratory paterns including central apnea, obstructive apnea, and hypopnea with between 95% and 99% accuracy, compared to the use of polysomnography. This new app of course needs further testing at other research clinics, but once they are further tested, many of us look forward to testing this app for ourselves and passing on the savings to our patients.
Anyone who’s had a sinus infections will attest to the misery they suffer during allergy season. So it should come as no surprise that those who are hardest hit want—even need—relief now and thus they call their doctor complaining of the pain. Yet the nation’s ear, nose and throat doctors say that is not a good idea for most cases.
Most people who get sinusitis feel better within a week–your doctor will assure you of this–because many of those infections are caused by viruses. So even if you did get antibiotics, they are not going to help. Truth be told, this is how it is. You can only blow to your heart’s content and resist antibiotics for a typical sinus infection.
But should you be more sure about whether you’ve got a viral or bacterial sinus infection? Today, ENTs (Ear, Nose and Throat specialist) are becoming more and more involved with patients on figuring out what’s causing the infection, partly because patients should learn how antibiotics don’t work and can even harm the patient. And part of getting the patients to understand this is by their self-diagnosing the infection.
“For the first time we’ve really made it crystal clear how to self-diagnose your own bacterial sinus infections without going to the doctor, with a high degree of accuracy,” says Dr. Richard Rosenfeld, lead author of the practice guidelines published Wednesday by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
How can you tell if it’s bacterial or viral?
It’s rather simple: If you’ve been ill for fewer than 10 days and your symptoms remain the same, it’s most likely viral. If your symptom become worse within 10 days or if they get worse in that 10 days after having improved a bit, bacteria could be to blame. The premise here for waiting it out in the DIY approach is that it’s OK to wait and see what happens, rather than rushing off for antibiotics.
Even if it is bacterial, antibiotics help very little Rossefeld says, and adds that “most of what’s going on is your body fighting off the infection yourself with maybe a little boost from antibiotics.”
So what can I do for some relief?
ENTs highly approve of nasal saline washes, as well as over-the-counter pain medications. The saline washes out mucus and reduces stuffiness, and refreshes and –re-invigorates the membranes, Rosenfeld says.
Steroid nose sprays may help with inflammation, the guidelines say, especially for people with chronic sinusitis, which lasts more than three months.
Chronic sinusitis shouldn’t be diagnosed just on symptoms, the guidelines say. A doctor needs to document inflammation of the nose and sinuses, which is usually done by inspecting the nose with special scopes.
You can diagnose acute sinusitis from the comfort of your home remember, but not chronic sinusitis. For that you need a doctor.
That nasal passage infections have been an important area of research for ENT specialists is no secret. Research in morphology and bacteria have recently yielded some crucial research in infections that originate in the nasal passage ways. Some animals are physically shaped by their environment in whole, not just in part. For example, earthworms are entirely slender so that they can weave in and out of narrow spaces in the ground. Evolution plays a key role in such benefits. But does that hold for all things big and microscopic? Interestingly, bacteria come in two shapes: there’s the spherical bacterium (coccus) and the stick-shaped (bacillus)?
Biologists and morphologists wonder if there’s a reason behind why one is spherical and the other slender-shaped. After analyzing pathogenic bacteria living in the nasopharynx, the upper part of the nose, questions of shape have been answered. These bacteria have changed over time, evolving from bacillus to coccus. In an article published in the journal PLOS Genetics, Professor Frédéric Veyrier, of INRS-Institut Armand-Frappier Research Centre, along with his colleagues, demonstrated that the change may have occurred to allow bacteria to pass through the defenses of their host’s immune system.
Respiratory infections are the number three cause of death worldwide. So understanding how these bacteria, or pathogens, make it into the upper respiratory passage way is critical. These pathogens are highly evolved, some so well that bacteria like Neisseria meningitidis and Moraxella catharralis can sometimes cause severe infections in humans. Genetic analysis of the ancestors of these bacteria pinpointed a key gene: yacF. The absence of this gene makes it possible for the shape of these bacteria to evolve. The N. meningitidis and M. catharralis found today in humans are spherical and missing the yacF gene.
The bacteria’s changing from stick-shaped to spherical has allowed the composition of certain molecules on their surface to transform. These molecules, peptidoglycans, play a vital role in how the immune system recognizes bacteria.
“We have long believed that the shape of bacteria was a fixed variable,” noted Professor Veyrier. “We even use it as a way to classify bacteria. Some mystery remains as to how the various species regulate their shape. This research demonstrates that the environment in which the bacteria evolve has an impact on their morphology. These are exciting results because we were able to identify the same change in two different species–and therefore its impact could be a key aspect in the specific way these pathogens are adapting to the human nasopharynx.”
By deepening our understanding of the evolution of bacteria, researchers believe they’ll be able to create new tactics that will prevent severe infections, even those related to sinus infections. This research about bacteria evolving over time could lead to preventing and treating such nasal passage infections that attack more than your head and sinuses, but your entire body.
Anyone with chronic sinus trouble will tell you how it causes problems with breathing and sleep. Anyone can also tell you that much research has been done about improving sinus problems. But what about those with both sleep apnea and sinus problems? In a recent study, published in the JAMA Otolaryngology — Head & Neck Surgery, researchers have found that surgery may help those with chronic sinus problems so that they can breathe easier, better, and even improve the lives of those with the sleep-related condition called obstructive sleep apnea.
In the study, researchers found 15% of people with chronic sinus problems also had the sleep disorder obstructive sleep apnea (OSA). And those who had surgery for clearing the sinuses reported a better quality of life and improved sleep, regardless of whether or not they had a sleep disorder. Of course, this is not surprising for sinusitis treatment. Improved quality of life is the purpose of many surgeries for sinusitis. However, what’s important about this new study is that patients with both sinusitis and OSA have a substantially reduced quality of life, but those with both conditions had dramatic improvements in quality of life following surgery.
OSA is a condition that causes people to stop breathing hundreds of times during sleep throughout the night. For those with OSA, the tongue and other structures might relax too much, blocking the airway and preventing breathing. There are several signs of OSA. Here are the most common ones: Snoring, choking and gasping for air, and daytime fatigue.
Dr. Jordan Josephson, an ENT specialist at Lenox Hill Hospital in New York City, says, “Sinus and nasal problems often are part of the problem leading to snoring and sleep apnea, and are often overlooked and left untreated.” Josephson was not involved in the current study, but was a reviewer of it. He added that patients with sinus problems and nasal breathing problems “should all be evaluated for snoring and sleep apnea.”
For the study, researchers studied 400 patients who underwent surgery for chronic sinus problems. They then checked the outcomes of those with both chronic sinus problems and OSA. Of this group, sixty had OSA, and following surgery these patients had improved psychologically and with their sleep problems.
The link between OSA and chronic sinus problems is still inconclusive, but might much evidence suggests how air passages through the nose and airways and how sleep affects the body’s ability to manage infection have a lot to do with both conditions.
Peter Fotinakes, a neurologist and sleep disorders specialist at St. Joseph Hospital in Orange, Calif., has one theory for the two conditions overlapping, “When we’re asleep, we prefer to breathe through our noses.” He further added, “When we can’t, we open our mouth to breathe, and when you open your mouth, it sets your tongue free.” That freed-up tongue, he said, can fall back into the airway, blocking it.
Does this mean anyone with a chronic stuffy nose and fatigue should go straight for sinus surgery? Of course, not. Patients should try noninvasive measures first, such as medication before surgery. But many patients have experienced tremendous benefits in both disease severity and overall quality of life after sinus surgery. Seeing an board-certified ENT specialist is in your best interest if you’re looking for solutions to your chronic sinusitis and you suspect a sleeping disorder.
No one likes the prospects of surgery, but the good news is that newer surgical techniques can be performed on an outpatient basis without general anesthesia with minimal discomfort and most patients can go back to work the next day. This is welcome news for those suffering from both chronic sinus problems and sleep apnea.
Since 2007, scientists announced plans for a Human Microbiome Project to catalog the micro-organisms living in our body, and because of this project, a new body of research has had a profound influence on how such organisms affect our health. From this growing research, one study has found a possible link between throat microbes and schizophrenia, and this link could explain the etiology, that is, the causes, behind this neuropsychiatric disorder, and thus pave a way for new treatments.
In this peer-review study conducted at George Washington University in Washington, DC, and published in the journal PeerJ, researchers looked at the levels of fungi, bacteria and virus microbes in the oropharynx region of the throat. The reason for choosing this region, according to the head author Eduardo Castro-Nallar, is that the oropharynx region appears to contain different levels of oral bacteria in people with schizophrenia compared to people who don’t have the disorder. “Specifically, our analyses revealed an association between microbes such as lactic acid bacteria and schizophrenics,” he says.
A growing number of studies have demonstrated that the microbiome—the ecological community of viruses, bacteria and fungi found living on and within the human body—has recently been conntected to brain development, behavior and cognition.
Several studies published in Medical News Today and the New York Times have reported on how gut microbiome can reduce cognitive functioning and affect psychological moods and states such as anxiety and depression.
New research on our body’s microbiome—especially how it affects cognitive development and moods—is becoming more and more exciting in medicine. The link between throat bacteria and schizophrenia is one clear example of what’s happening with connecting the microbiome to health issues. Hopefully, more of this research will lead to improved sinusitis and some forms of sleep apnea.
This new study examined the complete microbiome by looking at viruses, bacteria and fungi present in 16 individuals with schizophrenia and 16 control participants. The researchers reported significant differences between the microbiome of schizophrenia patients and those of the control participants. The control participants were richer in microbe species but less even in their distribution than the participants with schizophrenia.
What this means is that evidence of the fungal species Candida dubliniensis was more evident in participants with schizophrenia, and the researchers suggested that this fungus may be connected with immune response problems. One lead researcher mentioned the importance of further and wider studies though.
“Our results suggesting a link between microbiome diversity and schizophrenia require replication and expansion to a broader number of individuals for further validation,” reports Keith Crandall, director of the Computational Biology Institute at George Washington University. He further explained, “But the results are quite intriguing and suggest potential applications of biomarkers for diagnosis of schizophrenia and important metabolic pathways associated with the disease.”
The researchers concluded that their findings were extremely important to understanding not only schizophrenia but also how our microbiome in the body affects cognitive development and other behavioral issues. Yet more research with diverse samples, such as in the gut microbiome, will be able to shed more light on the potential links between schizophrenia and these microbes.
Obstructive sleep apnea (OSA) is a potential health risk for millions of Americans, and several studies point to one possible reason behind the disorder: a “fat” tongue. In one study, obese people with OSA were more likely to have an overweight base of the tongue.
“This is the first study to show that fat deposits are increased in the tongue of obese patients with obstructive sleep apnea,” study senior author Dr. Richard Schwab, co-director of the Sleep Center at the University of Pennsylvania Medical Center, said in a news release from Sleep, and published the findings last year.
Let’s remember, obstructive sleep apnea is a common sleep-related disorder where breathing is characterized by stops and starts in breathing, and these starts and stops may occur over 400 times in one night, causing the sufferer to wake up several times in one night. The hallmarks of this condition include chronic loud snoring, with periodic gasps or choking, along with daytime drowsiness because of poor sleep.
Should you see someone’s breathing stop and start continuously, throughout the night, you are likely observing some sort of sleep apnea. Apnea means “suspension in breathing.” Such stops and starts during sleep cause fatigue the next day. And the effects go beyond fatigue. Studies suggest those pauses in breathing stress the nervous system, boosting blood pressure and inflammation in the arteries.
Obese people tend to be at higher risk for obstructive sleep apnea because of the fat deposited in and around the breathing passageway, and Schwab’s team say the new findings may help explain the link between obesity and the breathing disorder.
The study included 90 obese adults with sleep apnea and 90 obese adults without the disorder.
The participants who had OSA had significantly larger tongues and a higher percentage of tongue fat than those without the disorder, the researchers found. Those with sleep apnea had fat concentrated at the base of the tongue. Too much fat at the base of a tongue may prevent muscles that attach the tongue to bone from positioning the tongue away from the breathing airway during sleep. While the study found an association between tongue fat content and sleep apnea, it could not prove cause and effect.
One answer to this condition is a common surgical procedure to reduce the large or over-sized tongue called base tongue reduction. But this may be avoided if the sufferer of OSA due to a large base tongue loses weight.
However, the researchers believe future studies should assess whether removing tongue fat through weight loss, upper airway exercises or surgery could help treat sleep apnea.
“Tongue size is one of the physical features that should be evaluated by a physician when screening obese patients to determine their risk for obstructive sleep apnea,” American Academy of Sleep Medicine President Dr. Timothy Morgenthaler added in the news release.
“Effective identification and treatment of sleep apnea is essential to optimally manage other conditions associated with this chronic disease, including high blood pressure, heart disease, type 2 diabetes, stroke and depression,” he said.
The National Sleep Foundation has reported that we in the US are in the middle of a 50-year decline in sleep time. One study found that 90% of Americans use their gadgets within the last hour before bedtime at least a few nights a week. They also found that the average college student loses 46 minutes of sleep every night because of answering phone calls or checking messages. All of these disruptions add up to our risking losing much-needed sleep which will prevent our brain from doing its job. When we lose sleep, we lose a lot more than rest: Many sleep specialists believe sleep deprivation leads to less efficient learning, higher emotional states, increased anxiety, and a less effective brain.
One of the reasons for our lack of sleep is due to our staying connected whether due to work or for personal reasons. Some may feel our wireless routine is expected, even normal, and that there’s little to fear since staying connected is so seamless to nearly every aspect of our lives. Unfortunately, staying connected at certain times is harmful to sleep rhythms. Recent studies discuss how anxiety may emerge because of our need to be connected.
For now, let’s skip the psychological reasons for why we feel anxiety when we feel the need to write—or read—one more email. Instead, let’s look at how staying connected to our mobile devices physically affect sleep. Sometimes that seemingly harmless email verification or update does more harm than you’d think at certain times of the day. Those anxious about staying connected are more likely to use their technology right up until bedtime. Staying connected causes neurological disruptions because the blue wavelength light from LED-based devices (phones, tablets, computers) triggers the release of cortisol in the brain, a chemical that makes us more alert while inhibiting the production of melatonin, the chemical that helps us fall asleep. This is why The National Sleep Foundation advises powering down our mobile devices—especially at least one hour prior to bedtime.
The Mayo Clinic recommends keeping your screen at least 14 inches from your face and dimming the brightness to reduce the blue light if you must read an hour prior to bedtime. Doing this should increase the natural melatonin released so you can fall asleep. Another study, by researchers at Harvard Medical School, found that those who read a paper book fell asleep ten minutes sooner than those who read an e-book. Those reading an e-book experienced 90 minutes of delayed melatonin onset — and had half the amount of melatonin released. They also experienced less rapid eye movement during sleep. These effects were further complicated by anxious people because they had more cortisol in their system. Anxious people, in general, tend to have shorter attention spans and switch tasks every 3-5 minutes. Both behaviors are known to spike stress and cortisol levels, thus creating a vicious cycle. Although anxiety may be a psychological underlying cause for checking emails or texts and such every ten minutes, what’s suggested here is that for more sleep power down your mobile devices at least one hour before bedtime to get a good night’s rest.
Antibiotics have been a wonder drug since their beginning. You can’t overstate penicillin’s impact on medicine and society, especially its role in treating bacterial infections, preventing the spread of disease and minimizing serious complications of disease.
But sometimes too much of a good thing does more harm than good. For example, what happens when antibiotics are overprescribed? They should be used for serious bacterial infections, but now, due to overprescriptions, have become less effective, even ineffective, because certain strains of bacteria have become resistant to newer and stronger antibiotics.
Some main reasons for this trend in antibiotics losing their effectiveness is due to overuse and misuse by doctors and hospitals. Both play a role in ensuring best practices of such drugs. Granted that bacteria develop resistance to any drug is normal and expected. But also the way drugs are used affects how quickly and to what extent drug resistance occurs.
If you didn’t know, a bacterium becomes more resistant to a drug when it has changed in some way that either protects itself from the drug or neutralizes that drug. And any bacterium that survives an antibiotic treatment strengthens itself and can multiply and then pass its resistant properties on. In short, bacteria become stronger and more resistant to treatment.
In general, antibiotics are only for bacterial infections, not viral ones. For example, we use antibiotics for strep throat, caused by the bacterium Streptococcus pyogenes, but it’s not the right treatment for sore throats caused by viruses such as a severe flu, because the flu originates from a virus.
If you take an antibiotic for a viral infection, the antibiotic attacks the good and bad bacteria in your body. The good bacteria can then promote antibiotic-resistant properties in harmless bacteria and that can be shared with other bacteria.
Yet many people with severe sinus ailments—like facial pain, fever and nasal congestion—want immediate relief and often wonder why their doctors don’t prescribe antibiotics right away. As mentioned in the last blog, patients and doctors need to bide their time wisely, and that means even if you’re really sick with a high fever, it’s still okay to wait out the use of antibiotics. Research shows that there’s not any greater benefit with antibiotics.
The American Academy of Otolaryngology—Head and Neck Surgery Foundation recommends “watchful waiting” for people with sinusitis before they resort to antibiotics. This is not a new guideline and has always been part of best practices for ENT specialists.
For those acute sufferers, the guideline applies to acute sinusitis, even when symptoms last 10 days or more. In addition to this time, seven more days for a total of 17 days should pass before antibiotic therapy should begin. We understand that such a wait is dreadfully painful, but in the long run, it’s essential to keeping the good bacteria strong and the bad bacteria weak by your body’s natural immune system when suffering from acute sinusitis. Remember, your body needs to keep a certain balance and part of it is its good and bad bacteria.
We’ve known for some years that antibiotics don’t help most bronchitis cases and other respiratory problems, like sinusitis. In fact, taking antibiotics isn’t as effective for treating bacterial sinusitis as is widely believed. The American Academy of Otolaryngology—Head and Neck Surgery Foundation says antibiotics fare only slightly better than waiting for the infection to go away on its own. This scant improvement is most likely not worth taking antibiotics. Yet over-prescribing antibiotics persists—even when they don’t help and can even hurt — a study says.
A new study published last month in the American Journal of Managed Care reports that particularly with urgent care, primary care and emergency departments, clinicians seldom follow evidence-based care guidelines for the treatment of common sinusitis. The study criticizes several clinical practices such as over-prescribing antibiotics and over-ordering CT scans.
From the report, only 29 percent of adult acute sinusitis encounters followed accepted clinical guidelines for the prescription of antibiotics, according to the Kaiser Permanente study. And they found the ordering of CT scans more likely in emergency room visits, resulting in expensive imaging tests.
Sinusitis strikes nearly 31 million Americans per year, according to the American Academy of Family Physicians, costing around $3 billion because of tests and procedures, outpatient and emergency department visits, and medication. It is one of the most prescribed conditions for which antibiotics are used, but national clinical guidelines state that antibiotics should only be used when it lasts more than seven days.
Providers may be going against what is suggested by current guidelines, the researchers suggest, resulting in unacceptable standards of care. From the study, antibiotics were prescribed in 89.2 percent of the 152,774 EHR encounters. Nearly 50 percent of these encounters were with patients having symptoms for fewer than seven days.
Granted, each recorded visit entails a different set of symptoms with unique circumstances, especially for those presenting the most urgent and severe symptoms. But from the study, over 75% of the cases took place at the primary care providers’ offices. This number is much too high, considering that most patients were given antibiotics when they had only exhibited symptoms for less than 7 days. We understand the importance of immediate relief, but it’s the long-term harm that should be overriding our decisions.
Despite the frequency of acute sinusitis cases, treatment and prescription habits have not been closely monitored. “A clear understanding of current practices requires awareness of how acute sinusitis is treated in different acute care settings,” say the researchers, from Kaiser Permanente’s large, integrated Southern California system.
This study points to how we as healthcare providers need to better understand and coordinate acute care services in order to achieve the triple crown of health care: that is, improving the patient-care experience, the overall population’s health, and reducing healthcare costs.
The age-old problem of over-prescribing antibiotics may be partly due to the difficulty in differentiating bacterial sinusitis infections from the more common viral ones. To help clinicians identify patients who are likely to benefit from antibiotics for acute sinusitis, the most pragmatic and evidence-based approach is to focus on the patient’s length of symptoms.