EIC Social Media Team
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Sinusitis affects about one in eight adults in the US, and this translates into over 30 million annual diagnoses. With a cost of $11 billion per year for managing adult sinusitis, it is no surprise that a large part of this cost comes from antibiotic therapy. In fact, nearly one in five antibiotics prescribed for adults are for sinusitis, making it the fifth most common condition responsible for antibiotic therapy.
Yet a new guide published by The American Academy of Otolaryngology—Head and Neck Surgery has recently made changes for ENT specialists that will affect those figures concerning antibiotic therapy. To better serve those with sinusitis, the guide recommends improved doctor-patient communication as the key to offering other methods besides antibiotics that have similar results.
To further hammer this point home about doctor-patient relations, this updated clinical practice guideline identifies quality improvements, and makes explicit actionable recommendations for clinicians managing adult sinusitis, including a greater focus on patient education and patient preference as part of the larger equation.
Of recent, there has been a trend in getting medical professionals to improve the lack of communication between the practitioner and the patient, and those in the medical field are taking notice. Thus, it isn’t surprising to read about a new guideline on managing adult sinusitis by having better communication. In this essential guide, Richard M. Rosenfeld, MD, MPH, explained, “More than ever before, there is a prominent role for shared decision-making between patients and clinicians when managing adult sinusitis–especially in deciding whether to use antibiotics for acute bacterial sinusitis or to instead try ‘watchful waiting’ to see if a patient can fight the infection on his or her own.”
Besides being more restrained in prescribing antibiotics, Dr. Rosenfeld also emphasized the importance of shared decisions regarding sinusitis symptom relief options such as pain relievers, topical intranasal steroids, and nasal saline irrigation.
Other differences between the 2007 guideline and the 2015 update include:
- more explicit details about the role of alternatives to antibiotics;
- more recommendations for amoxicillin with or without clavulanate when antibiotics are prescribed, while the prior guideline recommended amoxicillin alone;
- more discussion about the management of acute and chronic sinusitis, including other procedures.
This clinical guideline for managing adult sinusitis was updated by a multi-disciplinary panel of experts in otolaryngology-head and neck surgery, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate.
New research has found that patients who have percutaneous coronary intervention (PCI) are at higher risk for obstructive sleep apnea (OSA). PCI, also known as angioplasty, is a procedure used to open blocked coronary arteries and restore blood flow to the heart without open-heart surgery.
One lead researcher, Luciano Drager, MD, PhD, of the University of São Paulo School of Medicine in Brazil, said: “Our findings, in a large, multicenter sample of patients, reinforce the known association between OSA and cardiovascular disease.” He added, “Nearly half of the patients in our study, who were treated with PCI for either myocardial infarctions or angina, had OSA.”
In this study, 1,305 participants had undergone PCI treatment. Most of the patients were male and came from Singapore, China and Hong Kong, India, Myanmar, and Brazil. The researchers performed an overnight sleep study on all subjects. From this test group, nearly half of the participants had moderate OSA and a little over one-fifth of the subjects had severe OSA.
For this group, the researchers administered two screening tools for OSA, and both tests offered highly differing results. From the Epworth Sleepiness Scale, only a quarter of the patients indicated a high risk for OSA. On the other test, the Berlin Questionnaire, only half of the patients were categorized as being at a higher risk for OSA. These tests suggest their unreliability. It is important to note that an estimated 80 percent of men and 93 percent of women with moderate to severe sleep apnea are undiagnosed. With such stakes involved, this study further suggests that there needs to be better tools to diagnose obstructive sleep apnea.
Besides the discrepancies in the screening tools, researchers found more connections between sleep apnea and heart disease problems. This connection has been made before, but this study further confirms this relationship. Dr. Drager added: “Earlier studies have shown strong relationships between sleep apnea and a number of cardiovascular conditions, including high blood pressure, arrhythmia, stroke and heart failure. Our study supports this strong association between OSA and heart disease and also suggests that the methods used to screen for OSA in patients with cardiovascular disease need to be improved.”
The importance of this study evaluates whether OSA contributes to the risk of several heart problems in patients who have undergone successful PCI. Dr. Drager’s research concludes that OSA does contribute to the risks of heart disease, especially for those who have had PCI treatment. He has also discovered that screening tools for OSA need to be better developed so that the highly undiagnosed population with obstructive sleep apnea can get early treatment.
also discovered that screening tools for OSA need to be better developed so that the highly undiagnosed population with obstructive sleep apnea can get early treatment.
Heavy snoring and sleep apnea may be linked to a decline in memory and thinking for younger people, according to a new study published in the issue of Neurology®, the medical journal of the American Academy of Neurology. This study also suggests that treating the disorder with a breathing machine may interrupt the decline.
Ricardo Osorio, MD, with the NYU Langone Medical Center in New York and key researcher of the study, said, “Abnormal breathing patterns during sleep such as heavy snoring and sleep apnea are common in the elderly, affecting about 52 percent of men and 26 percent of women.” The medical histories of 2,470 people ages 55 to 90 were reviewed. Researchers categorized patients in two categories: free of memory and thinking problems, in early stages of mild cognitive impairment (MCI), or with Alzheimer’s disease.
The researchers also looked at people with untreated sleep-breathing problems versus those without the problems and also untreated versus treated people with sleep-breathing problems.
The importance of this study shows that those with sleep-breathing problems were diagnosed with MCI, on average, nearly 10 years earlier than those participants who did not have sleep-breathing problems. For example, those who developed MCI or Alzheimer’s disease during the study had developed MCI at an average age of 77, compared to an average age of 90 for those who did not have sleep-breathing problems. Among that group, those who had sleep breathing problems also developed Alzheimer’s disease five years earlier than those who did not have sleep-breathing problems, at an average age of 83 versus 88.
The researchers found that those who were treated for sleep-breathing problems with a continuous positive airway pressure (CPAP) treatment were diagnosed with MCI about 10 years later than those whose problems were not treated, or at age 82 instead of age 72.
“The age of onset of MCI for people whose breathing problems were treated was almost identical to that of people who did not have any breathing problems at all,” Osorio said. “Given that so many older adults have sleep-breathing problems, these results are exciting — we need to examine whether using CPAP could possibly help prevent or delay memory and thinking problems.”
From this study sleep apnea and memory loss appear connected. Osorio said that, although more research is needed, many of the findings point towards the importance and benefits of sleep apnea treatment. One such treatment is CPAP because it may prevent, or at least delay mental decline for those with the sleeping disorder.
A recent study suggests that undiagnosed sleep disorders are common among middle-aged and older adults in the US, especially among certain minorities.
Researchers studied 2,230 ethnically diverse men and women between the ages of 54 and 93 years from six US communities. Using several tests such as the polysomnography, actigraphy and validated questionnaires during a three year period, the researchers found troubled sleeping patterns played a role in health disparities in the US.
The study indicated that black, Chines and Hispanic Americans were more likely to have sleeping problems than whites, including nighttime breathing problems characteristic of sleep apnea.
Results from this study indicate that about one-third of participants had moderate or severe sleep-disordered breathing measured by polysomnography (PSG). There are several screening tests for sleep disorders and the PSG is the gold standard for testing for sleeping disorders. From the other tests, thirty-one percent had fewer than six hours of sleep, while nearly one-quarter suffered from insomnia, and 14 percent had excessive daytime sleepiness.
“As sleep apnea has been implicated as a risk factor for cardiovascular disease, stroke, diabetes, and mortality, our findings highlight the need to consider undiagnosed sleep apnea in middle-aged and older adults, with potential value in developing strategies to screen and improve recognition in groups such as in Chinese and Hispanic populations,” said senior author Dr. Susan Redline, professor of medicine at Harvard Medical School and Division of Sleep Medicine at Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center in Boston.
After adjusting for sex and age, the report revealed blacks to be most likely to have the shortest sleep patterns, less than six hours, and they were more likely than whites to have sleep apnea, poor sleep quality, and daytime sleepiness. Hispanics and Chinese were more likely than whites to have sleep-disordered breathing and short sleep patterns, but Chinese were least likely to report having insomnia.
“Our findings underscore the very high prevalence of undiagnosed sleep disturbances in middle-aged and older adults, and identify racial/ethnic disparities that include differences in short sleep duration, sleep apnea and daytime sleepiness,” said lead author Dr. Xiaoli Chen, research fellow in the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston.
The results suggest that different kinds of sleep problems may contribute to health disparities among US adults. According to Dr. Chen and her colleagues, this is the first study that has linked sleep apnea, short sleep, and poor sleep, as well as subjective measures of insomnia and daytime sleepiness, to varying minorities in the U.S. population.
For those suffering with the disorder sleep apnea, an important device has entered the market to reduce this sleeping disorder. By implementing Inspire® Upper Airway Stimulation (UAS) therapy, researchers have significantly improved patients with obstructive sleep apnea (OSA), according to a recent study published in the New England Journal of Medicine. From this study, they found that patients with OSA could reduce their daytime sleepiness and reduce the severity of their condition by 70%.
Called the Stimulation Therapy for Apnea Reduction (STAR Trial), researchers from 22 medical centers in the US and Europe evaluated the effectiveness of upper airway stimulation for sleep apnea.
Let’s remember that OSA affects more than 8 million men and 4 million women in the US, and is twice as common in men. Characterized by repeated episodes of upper airways collapsing during sleep, this condition causes the sufferer to stop breathing on and off many times during sleep, sometimes for a minute or longer. And half of these suffers are overweight. If you have repeated episodes of sleep apnea can lead to daytime fatigue, and put you at risk for heart attack, stroke, high blood pressure and even death.
In this study, all patients had surgery to implant the device. This is how it works: During sleep, the device stimulates the nerve of the tongue, which enlarges and stabilizes the airways so that the patient can control his or her breathing.
One of the greatest advantages of this device is that it senses breathing patterns and then delivers mild stimulation to a patient’s airway muscles to keep the airway open during sleep. Patients also have a “controller” to turn on the device at night during sleep.
Using such sleep-disorder stimulation systems improved sleep apnea episodes by 68 to 70 percent, the research claims. Kathy Gaberson, one participant of the study, said, “My short-term memory has improved significantly, and the surgery has made a huge difference in my quality of life.” She later added, “My apnea episodes went from 23 times an hour to just two.”
In Gaberson’s case, improvements can be dramatic. While other treatments for OSA include weight loss, upper airway surgeries, oral appliances, and continuous positive airway pressure (CPAP).
Whether your general physician suggests the STAR therapy or CPAP or other surgeries, you should consult an ENT specialist for a second opinion.
Have you heard of sleep apnea?
Sleep apnea is a disorder that constantly interrupts your sleep. Often, people wake up nearly breathless because such interruptions disrupt your body’s circadian rhythms, thus preventing you from getting enough sleep.
Many people think this disorder is very rare. However, the American Sleep Apnea Association claims that sleep disorders affect more than 18 million Americans. To further this serious problem, the actual numbers are hard to detect because sleep apnea is often undetected. This sleeping disorder affects both adults and children. Not getting the sleep you need has been a hot topic in the news lately. There are many complications with sleep disorders and you should know that all of them are destructive to your health. As much as we like to think we can get by on less and less sleep, this condition, or any sleep disorder, is highly detrimental to our overall health. Chronic tiredness is just the tip of the iceberg. When you often feel tired, you might be suffering from some form of sleep disorder, and if left untreated, it may diminish your quality life.
How might you know if you’re suffering from a sleep disorder?
The clearest sign is snoring. People with sleep apnea snore loudly and often. The loud snoring is caused by the muscles in their throat as they relax and then block their airways.
I’m just a heavy snorer!
If your snoring constantly wakens you, then you’ll obviously not get a smooth, uninterrupted sleep. Such a night leaves you feeling groggy all day. Left like this overtime, your condition will affect your performance at work or school, or your emotional and intellectual states, and it can even diminish your personal relationships with your partner and/or children.
Sleep apnea can also cause many serious health problems, including high blood pressure, depression, headaches, weight gain, diabetes, heart disease, stroke memory loss, and even impotence.
So is there any good news here?
Yes. Sleep apnea treatment exists. You can regain deep sleep again and feel better. As you might imagine, a good night’s sleep is integral to your overall well-being.
Consultation and Treatment
If these symptoms above sound like you, getting your sleep apnea under control is easier than you might think. You should talk to a doctor if you think you or your partner is suffering from sleep apnea. Each case is unique, but it’s worth taking the time to build a comprehensive approach to your case.
New research suggests that men who have the sleep disorder obstructive sleep apnea (OSA) appear to be at higher risk for depression. Remember, depression afflicts over 34 million Americans. Understanding how some sleep problems are often a symptom and a cause of depression will help anyone better understand the causes of their depression; and thus get the necessary treatment.
In this recent study of 2,000 Australian men between 35 and 83 years of age, researchers discovered those who are unusually sleepy during the day were 10% more likely to be depressed than those who were not (University of Adelaide and the Adelaide Institute for Sleep Health, 2015). After taking into account other risk factors, this relationship was tested, resulting in a strong connection between sleep apnea and depression.
To begin, these men had never been diagnosed with severe obstructive sleep apnea coming into this study, yet the researchers diagnosed 857 of them for this condition. The study found that those with the condition were a little over 2 times more likely to be depressed than those not having the sleep disorder, according to the researcher Carol Lang.
Sleep apnea is a serious sleeping disorder that has been long believed to affect depression. This recent research makes a clearer connection between the two conditions. Researchers found that some of the men suffered from both severe sleep apnea and excessive daytime sleepiness. These men were 4 times more likely to be depressed compared to those with no sleep issues. Men having both undiagnosed severe sleep apnea and excessive daytime sleepiness were at an even greater risk of depression. Their risk of depression was up to five times greater, according to this study.
The researchers evaluated all of the men twice for depression, with the second test occurring five years later. This time frame allowed the researchers to see a link between a recent diagnosis of depression and sleep apnea. This research established a clear link: That men having sleep apnea during the study were nearly 3 times more likely to become depressed during those five years.
Although the nature of the study precludes “our drawing any conclusion to cause and effect,” Lang said, she noted that the relationship between apnea and depression was strong.
This study’s aim did not allow researchers to determine whether sleep problems increase men’s risks of depression. The reverse could be true, or even other factors could contribute to both depression and sleep disorders.
The nature of the link between sleep and depression is still not clear; however, the results do provide ENT specialists with more information to accurately diagnose treatments. The take-away from this study is that doctors should consider patients diagnosed with depression should also consider testing for obstructive sleep apnea, even if they don’t appear sleepy.
Scientists have shown that those with breathing problems—and especially sleep apnea—are at a greater risk for certain heart diseases. Sleep apnea is one of the most common, and under-diagnosed, sleep disorders in the United States today. A major symptom of sleep apnea is persistent snoring, because snoring signals that the airways are being blocked in some way. While snoring is an unpleasant reminder that the person is not getting the proper sleep he or she needs, it doesn’t stop there. Many are ashamed of going to a doctor for snoring, and others are simply unaware that this is a small sign of a much larger dilemma. Many snoring cases contribute to the number of people diagnosed with sleep apnea in the US each year. Researchers have also looked at the various ways that breathing problems persist beyond sleep, particularly how breathing and sleep apnea can lead to heart disease. .
Recently researchers have found some evidence of how breathing problems and sleep apnea affect heart disease and stroke, but exactly what creates this link has eluded scientists so far. Researchers at the University of California’s San Diego School of Medicine conducted a study involving nearly 40 volunteers, with half of them having moderate to heavy sleep apnea, and the other half with mild to no sleep apnea symptoms. For all of the volunteers, the team of researchers did a full diagnostic of their sleep patterns and overall health, eliminating other sleep disorders that could corrupt the results of the study. They had all the volunteers ride on stationary exercise bikes for a long duration – to exhaustion – while at times slowly increasing the resistance of the exercise bikes in order to simulate someone riding a bicycle up a steep hill. The results of this study were startling.
The researchers measured what is called the VO2 max: a measurement of the maximum amount of oxygen the body can absorb through breathing during strenuous exercise. They measured and compared the results of those with moderate to heavy sleep apnea to those without sleep apnea of the same age, gender, and body mass index. From the comparison, they learned that those with sleep apnea had, on average, a 14% lower VO2 max than the control subjects. This deviance increased when the subjects with sleep apnea had a higher rate of breathing – for 10 seconds or more – per each hour of sleep. This shows that breathing problems persist beyond sleep for those suffering from sleep apnea, and that these results may be early indicators of the link between sleep apnea and heart disease and stroke. Since most who have sleep apnea are not diagnosed until serious complications arise and are often obese, thus already at a higher risk for complications later in life, it is imperative that people know if they have sleep apnea. The sooner you discover you have this treatable disorder, the sooner you can be on the road to recovery.
Chronic kidney disease (CKD) is commonly associated with type 2 diabetes. Both these diseases are more commonly found in overweight and obese individuals, and another disorder that is common to them is obstructive sleep apnea (OSA). OSA is a blockage of the air passageways during sleep, which causes the individual to stop breathing periodically during their time asleep, causing their body to slightly wake up each time as it pushes the passageway open again. For individuals who are overweight or obese, their extra weight sometimes pushes against their air passageways and can block the lungs from properly breathing while they sleep. Because of this condition among those with CKD, type 2 diabetes and obstructive sleep apnea, researchers wonder if the statistical connection is more than just a coincidence. Scientists from the American Society of Nephrology (ASN) have looked at the possible connections between obstructive sleep apnea and kidney disease in their correlation to type 2 diabetes, looking at sleep apnea as a factor of accelerated renal function decline. Renal function is the most common indication of the state of the kidneys, because it shows how well they function in separating the toxins out from the body and pushing the waste to the proper areas of the body for elimination.
What is currently known is that type 2 diabetes can contribute to the development of chronic kidney disease. Researchers started with this information, along with knowing that CKD patients usually also suffer from obstructive sleep apnea. They analyzed information from over 50 patients with type 2 diabetes and CKD who had performed a specific questionnaire to determine whether or not they also had obstructive sleep apnea. The results showed that over 60% of these patients did have sleep apnea, and those who did have OSA had a significantly lower level of kidney function than those whom it was determined did not have sleep apnea. From the research team’s study, it seems that sleep apnea and kidney disease do have potential links, because obstructive sleep apnea does indeed accelerate kidney function decline in diabetic patients who also have non-dialysis CKD. Not enough evidence was present to determine if this is also the case for those with CKD who do need dialysis. What this study shows, however, is that OSA may lead to accelerated loss of renal function in the kidneys, which leads to chronic kidney disorder progression faster than those without sleep apnea.
Researchers out of the University of Calgary, Canada, released a study that shows it may be possible to treat depression and Obstructive Sleep Apnea (OSA) with the same treatment. Certain devices that are normally used for treating OSA have been found to also alleviate symptoms of depression, according to the study. These machines, the continuous positive airway pressure (CPAP) and the mandibular advancement devices (MADs), help patients during sleep by keeping them breathing properly and avoiding those moment where OSA blocks the airways and stops the person from breathing for a moment; this moment can last a few seconds before the body “awakes” just enough to push through the blockage to start the breathing process again.
The researchers studied 22 randomized clinical volunteers, each diagnosed with sleep apnea and showing signs of depressive symptoms. Of those who were using the CPAP and MAD devices to help with their sleep apnea, each person showed signs of improving their depressive symptoms, according to the questionnaires filled out before, throughout, and after the trial period. Those who did not treat their sleep apnea, or who were treating it with methods besides the CPAP or MAD device, did not show many signs of improvement in their depressive symptoms. This data was cross-referenced with the known literature on sleep apnea treatment and depression, as there seems to be a connection between people with OSA and the depression a majority of them report to experience. One thing the researchers knowingly could not take into consideration with this kind of study was how much non-OSA treatments help with depressive symptoms, like depression medications and therapy, when used in conjunction with the OSA treatments. More studies are needed to learn the connections of these different types of treatments.
The results of this study further affirms that there are benefits to the CPAP and MAD devices that are greater than only helping the person breathe normally throughout the night. The depressive symptoms which seem to be strongly connected to sleep apnea, and the inability to sleep properly throughout the night, are alleviated due to a person being able to both breathe all throughout the night and being able to achieve uninterrupted sleep for several hours at a time. And, the study further revealed, the worse a person’s depression is before the treatment, the more improvement the treatment is on their depressive symptoms. As the main author of this Canadian study says, “This systematic review summarizes the available literature on OSA treatment,” further adding that this could be a novel way to treat depression and Obstructive Sleep Apnea together. “Our results,” he said, “illustrate that the greatest benefit of CPAP treatment on depressive symptoms may occur in populations with worse depression scores at baseline.”