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A new study recently published in the International Journal of Pediatric Otorhinolaryngology recommends that parents look into whether or not their children are displaying systems consistent with Obstructive Sleep Apnea (OSA). Those symptoms may be the cause of behavioral problems in children. Even if your child has a high IQ, you may still want to examine how well he or she is sleeping.
Research into Behavioral Problems in Children
In the initial study, the researchers examined 147 children, ages 3 to 12, who were scheduled for adenotonsillectomy, a procedure that removes both the tonsils and the adenoids. This procedure is common for those who suffer from OSA, as the condition tends to enlarge the tonsils and adenoids. This stops children from breathing, often several times during the night.
A previous study found that after receiving an adenotonsillectomy, behavioral problems in children—who were struggling in school or at home—decreased. The difference between this study and others is the fact that it focused on children who were doing well from the start.
Regardless of whether or not the children were from low- or high-IQ groups, researchers saw that the children improved at a similar level when their sleep and behavior were evaluated six months after the adenotonsillectomy procedure.
What Behavioral Problems Should You Look into?
The data from these studies is great news for parents with struggling children. They can nail down whether or not their child may have OSA.
Hyperactivity is a prevalent symptom. According to Seockhoon Chung, M.D., Ph.D., and Associate Professor at Asan Medical Center in South Korea, “Children with obstructive sleep apnea are fidgeting and not able to stay on task, because they’re doing anything they can to stay awake.”
This problem is harder to determine in children with a high IQ, because hyperactivity is less apparent. Dr. Chung suggests that, “Even when those behavioral problems are minimal, improvement is still possible.”
Parents may also want to monitor whether or not their children are snoring loudly, or if their breathing is sporadic throughout the night. Children with a high IQ will still benefit from having their OSA treated; improving both their behavior during the day and their brain activity.
When it comes to Obstructive Sleep Apnea (OSA), it can be caused by many factors. Some of those causes are believed to include old age, brain injury or decreased muscle tone. However, does a lack of Vitamin D have an effect on OSA?
The Truth About Vitamin D Deficiency
Hypovitaminosis D, or Vitamin D deficiency, is typically found in people who lack an adequate amount of Vitamin D in their system, and/or do not get enough exposure to sunlight. Other causes include disorders and conditions that prevent the body from getting or properly processing Vitamin D into the body.
This is a serious condition with plenty of symptoms and diagnoses, including:
- Rickets, a childhood disease that impedes growth and deformity of long bones,
- Osteomalacia, a bone-thinning disorder which causes muscle weakness and bone fragility,
- Osteoporosis, a disease which decreased bone strength, leading to broken bones,
- Muscle twitching,
- Light-headedness, and
- Erectile dysfunction.
However, a new study published online in the Annals of the American Thoracic Society finds there is no evidence linking Vitamin D deficiency to OSA.
“Although our study was not designed to figure out why obese people have lower vitamin D levels, our results ultimately suggest that low Vitamin D levels do not cause or worsen OSA,” said senior investigator Ken Kunisaki, MD, MS, Medical Director of the Sleep Apnea Program at the Minneapolis VA and Associate Professor of Medicine at the University of Minnesota. “Therefore, taking additional Vitamin D supplements is not likely to prevent or improve OSA.”
Instead, researchers discovered there is more of a link between obesity and Vitamin D deficiency.
“The link between obesity and Vitamin D deficiency can be explained a number ways, one of which is that obese individuals are less likely to be physically active, thereby limiting their sun exposure,” said Dr. Kunisaki.
In the study, the researchers analyzed 2,827 generally healthy, mostly Caucasian (92.2%), elderly males (average age 76.4 years). The data they received from these participants found that there was no evidence to support a link between Vitamin D deficiency and increased risk of OSA in those without obesity.
What is the connection between sleep apnea and high blood pressure?
The connection between sleep apnea and heart disease is a complicated one. The causal connection is not clear, but we do know that those with sleep apnea today have a high chance of developing hypertension in the future. In fact, people with cardiovascular problems—especially high blood pressure, heart failure, and stroke—have a higher prevalence of sleep apnea.
This fact makes sense because those with obstructive sleep apnea put their bodies under more stress because the condition prevents proper rest to occur on a daily basis. Obstructive sleep apnea (OSA) is when the upper throat closes, and the patient stops breathing numerous times during the night, putting them at risk for developing vascular disease that causes a specific type of treatment-resistant form of high blood pressure.
One of the problems with defining the connection between OSA and heart disease is that people with the former condition often have other complicating diseases as well.
When treating people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. This suggests there is a cause-and-effect relationship between hypertension and sleep apnea.
Nancy Kanagy, PhD, a professor in the University of New Mexico (UNM) Department of Cell Biology and Physiology, is researching to understand how the connection occurs.
Insight is on the horizon
Just how sleep apnea heightens blood pressure demands further research, but we do know that up to one in five people may suffer from it. Recently, the National Institutes of Health issued a call for proposals on sleep apnea research on the connection several years ago. Kanagy realized UNM’s experience in conducting vascular studies could provide much needed insight here.
“Most researchers were looking at the sympathetic nervous system,” Kanagy says in a release. “We thought, ‘Why not develop a model to investigate vascular changes and contributions to the elevated blood pressure?”
Kanagy’s discovered a key connection when her team developed a rat model of sleep apnea and discovered that after 14 days of repeated exposure to hypoxia during sleep increases blood pressure, even during waking hours. Hypoxia is a condition when the body or a region of the body is deprived of an adequate supply of oxygen. The researchers found that hypoxia increases production of an artery-constricting peptide called endothelin, and this peptide elevates blood pressure. Further studies are investigating exactly how that happens.
Her team is further investigating how hydrogen sulfide molecules (H2S) play a crucial role in controlling blood pressure. In the study, they found that sleep apnea patients show significantly lower H2S levels compared with normal sleepers. This molecule appears to limit inflammation and open arteries, which leads to relieving the cardiac and vascular systems from constriction.
“Long-term, we are hoping that a better understanding of these mechanisms will lead to new and more effective therapies to treat cardiovascular disease in sleep apnea patients,” Kanagy says.
A new study shows treatment with long-term low-dose azithromycin in combination with the conventional therapy can reduce the recurrence rate of chronic sinusitis symptoms after functional endoscopic sinus surgery, but there was no sufficient evidence to support clinical significance of azithromycin at the investigated dose.
The aim of clinical trial was to evaluate the efficacy of long–term consumption of low–dose azithromycin after a successful endoscopic sinus surgery.
Chronic sinusitis is recognized as a common disease that imposes a huge burden on the healthcare system worldwide. About 37 million Americans suffer from at least one episode of sinusitis each year. Besides the burden on the healthcare system, there is a huge burden on the individual due to missed workdays and reduced productivity that the condition causes. This study is needed because when it comes to conventional therapies, other less invasive surgeries should be considered such as balloon sinuplasty.
Method of Research
Sixty-six patients were randomly divided into intervention and control groups. The subjects received the standard conventional treatment (fluticasone nasal spray plus normal saline solution irrigation) or the conventional treatment plus 250 mg of azithromycin on a daily basis for 3 months. Evaluation was made based on the 22-item Sino-Nasal Outcome Test (SNOT-22) immediately before surgery and 3 months after surgery.
The intervention group showed a significant improvement in SNOT-22 scores after the treatment and a higher percentage change after 3 months of therapy compared to the control group. Also the researchers found a significant correlation between the percentage change of SNOT-22 scores and smoking in the placebo group.
Conclusion in relation to chronic sinusitis
Treatment with long-term low-dose azithromycin in combination with the conventional therapy could statistically reduce the recurrence rate of chronic sinusitis symptoms after functional endoscopic sinus surgery. However, more evidence is needed to support clinically significant conclusion of azithromycin at the investigated dose. Thus a larger scale trial and a longer follow-up period are warranted to evaluate the effectiveness of the therapy.
When you eat better, do you find that you sleep better? There may be a connection between sleep and diet. A new study found that eating more fiber, cutting back on saturated fat, and reducing sugar intake can be associated with deeper, more restorative, and less disrupted sleep.
Results show that greater fiber intake tended to result in more time spent in the stage of deep, slow-wave sleep. In contrast, a higher percentage of energy derived from saturated fat meant lighter slow-wave sleep. More arousals from sleep took place when greater sugar was consumed during waking hours.
Researchers have found that it takes remarkably little to make a difference in sleep patterns. “Our main finding was that diet quality influenced sleep quality,” said principal investigator Marie-Pierre St-Onge, PhD, assistant professor in the department of medicine and Institute of Human Nutrition at New York’s Columbia University Medical Center. “It was most surprising that a single day of greater fat intake and lower fiber could influence sleep parameters.”
“This study emphasizes the fact that diet and sleep are interwoven in the fabric of a healthy lifestyle,” said Dr. Nathaniel Watson, President of the American Academy of Sleep Medicine. “For optimal health it is important to make lifestyle choices that promote healthy sleep, such as eating a nutritious diet and exercising regularly.”
The study also found that after eating fixed meals prepared by a nutritionist, which were lower in saturated fat and higher in protein than self-selected meals, participants feel asleep faster. It took participants an average of 29 minutes to fall asleep after consuming foods and beverages of their choice, as opposed to 17 minutes to fall asleep after eating controlled meals.
“The finding that diet can influence sleep has tremendous health implications, given the increasing recognition of the role of sleep in the development of chronic disorders such as hypertension, diabetes and cardiovascular disease,” said St-Onge.
Twenty-six adults took place in the randomized, cross-over study, evenly divided between men and women. The adults had a normal weight and an average age of 35 years. Participants spent 9 hours in bed from 10 p.m. to 7 a.m. for 5 nights in a sleep lab, sleeping for 7 hours and 35 minutes on average per night. Objective sleep data were gathered nightly by polysomnography, a diagnostic tool in sleep medicine. Sleep data were analyzed from night 3, after 3 days of controlled feeding, and night 5, after one day of when study subjects consumed food of their choice. Study results are published in the January issue of the Journal of Clinical Sleep Medicine.
The study suggests that dietary suggestions and changes might help improve sleep in people with poor sleep quality. However, additional studies are needed to assess and confirm this relationship.
In our noses are about six million smell receptors and about four hundred different types. How these receptors are spread out varies according to each person, and because of this variance, to each his or her own sense of smell. Yes, we each have a unique smelling nose. Published in the Proceedings of the National Academy of Sciences (PNAS), Weizmann Institute researchers discovered how to identify an individual’s sense of smell, which they’re calling an “olfactory fingerprint.”
The importance of this study is that each one’s smell fingerprint may lead to many medical improvements from early diagnosis of degenerative brain disorders to a non-invasive test for matching donor organs.
The method to this madness is based on how similar or different two odors are from one another. In the first stage of the experiment, scientists asked the volunteers to rate 28 different smells according to 54 different descriptive words, like “lemony,” or “masculine.” Dr. Lavi Secundo led the study, along with Drs. Kobi Snitz and Kineret Weissler, all members of the lab of Prof. Noam Sobel of the Weizmann Institute’s Neurobiology Department. They developed a multidimensional mathematical formula that allows patients to identify how similar any two odors are to one another in the human sense of smell. This formula does not require the subjects to agree on the use and validity of any one given verbal descriptor; so the fingerprint is odor dependent but descriptor and language independent.
The next stage of the research suggested that our olfactory fingerprint may tie in with another system of ours in which we all differ – the immune system. They found, for example, that an immune antigen called HLA, today used to assess matches for organ donation, is correlated with certain olfactory fingerprints. This part of the study was conducted together with Drs. Ron Loewenthal, and Nancy Agmon-Levin, and Prof. Yehuda Shoenfeld, all of Sheba Medical Center.
So might this work for millions of patients? The researchers say that their figures prove that 28 odors alone could be used to “fingerprint” two million people, and that it would only take 34 odors to identify seven billion individuals on the planet.
But this smell fingerprinting could lead beyond identifying individuals, because it could be developed into methods for the early detection of diseases like Parkinson’s and Alzheimer‘s, and it could lead to non-invasive methods for screening donor matches.
A new study proves that your taste buds may predict post-surgery results for sinusitis surgery patients, according to a Penn study.
Taste buds pickup what is called biomarkers, that is, the existence of a certain biological state or condition, such as bitter or salt. The researchers from Penn Medicine and the Monell Chemical Senses Center reported their findings in International Forum of Allergy & Rhinology.
It might sound strange but the team discovered that a genetic biomarker—the receptor for bitter taste—could better predict post-surgery results for patients who underwent surgery for chronic sinusitis. Remember that this seasonal-related condition afflicts around 37 million Americans each year. The condition reduces daily productivity in lost worktime, and is associated with a lower quality of life. In the US, sinus infections cost more than $13 billion in lost productivity each year.
The study found people sensitive to a certain bitter compound reported breathing more easily through their nose, having fewer subsequent infections, and sleeping with ease six months after surgery than those less sensitive to the bitter compound.
Bitter taste receptors are proteins that are found in taste cells of the tongue, where they protect against the ingestion of toxic plant and bacterial products. The collaborative Penn Medicine/Monell team had earlier identified these cells lining the passages of the nose and sinuses and contributing to the natural defenses against certain bacteria.
For the study, patients were asked to taste a specific bitter chemical and report their sensations. Those more sensitive to the bitter chemical than those who were not proved to better fight off certain types of respiratory infections. This specific genetic difference correlates to how much one group is able to combat infection following surgery. Thus, the study suggests those more sensitive to certain bitter tastes fight off upper respiratory infections better, and if they do get sick enough to require surgery, they improve more than people with less sensitive systems.
The researchers warn that there is still much research to do because of the diverse functions of taste receptors, but for now, once an easy test kit is produced, ENT specialists will be better able inform and chose a treatment for their patients.
This is welcome news for otolaryngologists who can correlate surgical outcomes to bitter taste tests in order to forecast postoperative complications and results, and thus choose the best sinusitis surgery options.
Other Penn authors are Douglas Farquhar; James N. Palmer, MD; David W. Kennedy, MD; Laurel Doghramji, RN; Shane A. Morris; David Owens; and Robert J. Lee, PhD.
Other authors are Corrine Mansfield, Anna Lysenko; Beverly J. Cowart PhD; and Danielle R. Reed, PhD, all from the Monell Chemical Senses Center in Philadelphia.
Did you know Obstructive Sleep Apnea (OSA) affects more than 8 million men and 4 million women in the US? Yes: and it’s twice as common in men as in women. 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. “Apnea” is Greek for “without breath.” 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.
There are different levels of OSA, each with an ideal treatment. For mild OSA, sometimes a CPAP (continuous positive airway pressure) is all you’ll need. But for those with a more severe case, a surgical procedure known as maxillomandibular advancement (MMA) has proven to benefit the patient, according to a study published online by JAMA Otolaryngology-Head & Neck Surgery.
Maxillomandibular advancement surgery is an invasive yet often highly effective surgical procedure for the treatment of OSA, especially for those who have difficulty with the CPAP. In this procedure, the surgeon moves the upper (maxilla) and lower (mandible) jaws forward in order to enlarge the airway in both the palate and tongue regions. Compared to other single procedures, this one has been known to provide the greatest improvement in treating OSA. Still to help shape the patients’ selections and to counsel patients regarding their chances of achieving a significant improvement with MMA, an assessment of preoperative factors associated with postoperative outcomes should be considered case-by-case.
Soroush Zaghi, MD, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues conducted a thorough post-analysis of 45 studies with individual data for 518 patients/interventions. In the studies patients had undergone MMA as treatment for OSA. Among them 74 % had undergone prior surgery for OSA. The researchers analyzed three key indicators for OSA severity: the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and measures of the severity of OSA after MMA.
They found that MMA is associated with substantial improvements to AHI and RDI. They further found that those with less severe measures of OSA experienced a smaller magnitude of change in AHI or RDI postoperatively, but they had the highest chance of achieving a surgical success and/or cure. The average reduction for AHI and RDI outcomes was 80 percent and 65 percent, respectively. Patients with high residual RDI and AHI scores (despite prior surgical procedures) were highly likely to benefit from management of OSA by means of MMA.
“Maxillomandibular advancement surgery is a highly effective treatment for OSA,” the researchers write. “Those patients with the most severe measures of OSA tend to benefit to the greatest degree.” Future studies will provide further telling insights about how this procedure may help optimize patients living with obstructive sleep apnea.
Of course, there are caveats with every invasive surgical procedure, and because of this, patients need to have direct, sensible, and honest conversations with their doctors. If you suffer from mild to severe OSA and want to know what options are available to help–even cure in some cases–your condition, perhaps you should talk to an experienced ENT specialist who understands the risks and benefits of maxillomandibular advancement surgery.
A new study offers some surprising answers to offering chronic sinusitis treatment. According to the study, those with this condition may find great relief in quality of life with nasal sprays and other nonsurgical treatments. For those with chronic sinusitis, this is great news because surgery may not be the best way to treat this infection. The general rule is: the less invasive treatment is the best response to most conditions.
Chronic sinusitis treatments can include nasal sprays and antihistamines may be as effective as surgery in helping some patients achieve a better quality of life, the small study found.
The study was funded by the U.S. National Institutes of Health and published online Oct. 29 in the journal JAMA Otolaryngology-Head & Neck Surgery. Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said, “Chronic sinusitis is the number one cause for chronic fatigue and is closely associated with snoring and sleep apnea.
Thirty-eight patients with chronic sinus infections were given medical therapy rather than having surgery. “Patients who have relatively minimally reduced productivity at work and minimally reduced quality of life from their underlying chronic sinusitis can avoid getting worse by continuing with medical
therapy,” said lead researcher Dr. Luke Rudmik, a clinical associate professor of endoscopic sinus and skull base surgery at the University of Calgary in Canada.
The decision to choose medical therapy versus surgery for chronic sinusitis should be based on patient preference, and the decision for each treatment should involve an honest conversation between the doctor and patient so that the patient understands the expected outcomes and potential risks.
Surgery, however, can be a good option too for people with severe sinus infections. Surgery is just an aide to the necessary long-term medical plan that is required to improve the quality of these patients’ lives. Surgery can be minimally invasive, performed with local anesthesia. During surgery, the doctor uses probes and a laser to remove tissue and bone and polyps that have developed during the infection and are narrowing the nasal passages.
With newer surgical techniques, these procedures allow most patients to be free of black-and-blue marks, with most going home the same day. After surgery, patients still need their medical treatment because the procedure doesn’t stop the running nose. The best chronic sinusitis treatment is designed for each patient.
The best news here is that traditional treatments, alternative treatments, and surgical techniques that have failed patients in the past have been renewed and improved so that for them new medical and surgical treatments may offer significant improvements for their quality of life.
A new study has found a less invasive therapy to reduce both snoring and mild obstructive sleep apnea (OSA) in adult patients, according to a recently published article in The Laryngoscope, a peer reviewed medical journal of the American Laryngological, Rhinological and Otological Society. This could serve as a preliminary Snoreplasty review.
Obstructive sleep apnea (OSA) is a potential health risk for millions of Americans, and several studies point to one possible reason behind the disorder. The National Sleep Foundation estimates that over 18 million Americans suffer from OSA, and that it is underdiagnosed. So this study may bring welcome relief to millions of these sufferers.
In the study researchers assessed the safety and effectiveness of TranQuill™ Sling (a suture or thread used in surgery that is knotless) in snoreplasty (surgery procedure) for the treatment of snoring and mild OSA in adult subjects. The TranQuill Sling Snoreplasty (QSS) is a procedure where the suture is inserted into the soft palate tissues for the treatment of snoring and/or mild obstructive sleep apnea. Soft palate tissues are tissues in the back of the roof of the mouth.
The research explored the effectiveness of TranQuill’s Sling, which was approved by the US Food and Drug Administration (FDA). Effectiveness includes the safety, performance, and effectiveness for the Surgical Specialties Inc., as a therapy for snoring and/or mild obstructive sleep apnea. The Sling is used in all types of surgery that involved deep tissues in the body, but this is possibly a new use.
From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS and subjects with mild OSA. Outcomes were assessed comparing the results of quality-of-life questionnaires, bed partner-assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up.
All 20 subjects had local anesthesia in the examination chair. The subjects’ throats were anesthetized with benzocaine spray followed by a minor numbing of the soft palate. The TranQuill suture was inserted into the soft palate tissues following a preset pattern.
The researchers concluded that TranQuill Sling Snoreplasty™ is a safe therapy that improves snoring symptoms in most adults with mild snoring or mild OSA. Just keep in mind much further clinical trials are needed to identify patients likely to respond to the therapy and that this holds great promise for those millions of OSA and snoring sufferers who could benefit from a minimally invasive procedure and greater relief.
Another advantage of this procedure is that, like the Pillar Procedure™, it can be performed in the comfort of the doctor’s office and with a local anesthesia; so most likely there will be very slight recovery time, again like the Pillar Procedure™. For a Snoreplasty review, this looks very positive so far.