Snoring and the Brain, CPAP and Oral Appliances
In the last few days there have been three articles released in the scientific literature that have a direct effect on those suffering with sleep apnea:
Professor Rae, in Australia, published a paper that showed that changes in brain chemistry linked to obstructive sleep apnea could be compared to the changes in brain chemistry of people who have "had a sever stroke or who are dying." She found that this may be due to a lack of oxygen reaching the brain during the apneic (lack of breathing) episodes.
In a second article, Dr. Pepin and colleagues in France reported that people who suffer from excessive daytime sleepiness may continue to be sleepy during the day even when they are treated with CPAP. There was no mention of whether patients treated with oral appliances showed the same problem.
Finally, a study from Korea found that success rates of patients treated with mandibular advancement devices (oral appliances) were actually higher in patients with the worst apnea.
What these articles show is that snoring is (as my wife points out) not the punchline to a bad joke. It is a serious problem that can and must be identified and treated appropriately. CPAP is appropriate and effective therapy but it is not the final word in the treatment of sleep apnea - residual problems do exists that must be addressed and resolution sought.
And, evidence for the efficacy of oral appliance therapy continues to grow. The option for treatment with an oral appliance must be offered to all patients with sleep apnea.
Dr. Barsh
Professor Rae, in Australia, published a paper that showed that changes in brain chemistry linked to obstructive sleep apnea could be compared to the changes in brain chemistry of people who have "had a sever stroke or who are dying." She found that this may be due to a lack of oxygen reaching the brain during the apneic (lack of breathing) episodes.
In a second article, Dr. Pepin and colleagues in France reported that people who suffer from excessive daytime sleepiness may continue to be sleepy during the day even when they are treated with CPAP. There was no mention of whether patients treated with oral appliances showed the same problem.
Finally, a study from Korea found that success rates of patients treated with mandibular advancement devices (oral appliances) were actually higher in patients with the worst apnea.
What these articles show is that snoring is (as my wife points out) not the punchline to a bad joke. It is a serious problem that can and must be identified and treated appropriately. CPAP is appropriate and effective therapy but it is not the final word in the treatment of sleep apnea - residual problems do exists that must be addressed and resolution sought.
And, evidence for the efficacy of oral appliance therapy continues to grow. The option for treatment with an oral appliance must be offered to all patients with sleep apnea.
Dr. Barsh
posted by Dr. Larry Barsh at
7:05 AM
2 Comments:
I would like to see more clinical studies done treating OSA with oral appliances. Patients who are noncompliant with Cpap may have better success with oral devices.
Jim
http://cpapcritic.com
These are very interesting studies. I think each case needs to be analyzed on an individual basis and the attending physician should decide if whether a CPAP machines or oral appliance is most appropriate.
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