Risks of Sleep Apnea

This article discusses the basics of sleep apnea and talks about when it is appropriate to see a medical professional.

Are you having trouble sleeping and don’t even know it? Do you wake up in the middle of the night for no reason? You may have a sleeping disorder and you don’t even know it. Most people with a sleeping disorder suffer from obstructive sleep apnea.

What is obstructive sleep apnea?

Sleep apnea is a sleeping disorder where breathing stops and starts. Obstructive sleep apnea is the same thing as sleep apnea, but it is caused by your throat muscles relaxing while you are asleep.

How do I know if I have sleep apnea?

Sometimes you may not know if you have a sleeping disorder or not, mostly because you are asleep when it is occurring, but there are some signs that you should take note of that may give you a clue on whether or not you have a sleeping disorder. Some signs of sleep apnea include excessive daytime tiredness, loud snoring, periods of stopped breathing during sleep witnessed by another person, morning headaches, attention problems, and waking up with a dry mouth and throat, and suddenly waking up short of breath. If you experience any of these symptoms you should seek help from a physician.

What causes sleep apnea?

Obstructive sleep apnea is when the muscles in the back of your throat that support your tonsils, side walls of the throat, soft palette, and uvula; relax and cause your airway to narrow or close. Because you are unable to breathe the oxygen levels in your blood begin to lower. Your brain notices a change in these levels and wakes you from sleep, even though you may not notice being woken up. Because this sleeping disorder may go on for long periods of time without being noticed, people with sleep apnea do not get the rest they need because they cannot reach full rest potential.

Who is at risk for sleep apnea?

There are several risk factors that may lead to sleep apnea. Some of these risk factors include use of alcohol, smoking, race, gender, nasal congestion, neck circumference, age and excess weight. Some of these risk factors can be prevented and some cannot, for example men are at a higher risk than women to get sleep apnea.

What do I do if I have sleep apnea?

First of all there are a couple of diagnostic tests that you can do to see if you have sleep apnea. One of them is a nocturnal polysomnography, this includes being hooked up to heart monitors and other machines that can see your breathing patterns while you sleep. This is typically done in a lab setting. Then there are take home tests similar to the nocturnal polysomnography that can also detect heart rate and breathing patterns.

As far as treatment there is a variety of options that you may choose from. There are various types of therapies and devices that you can wear while you sleep, sometimes surgery is necessary and sometimes there are only lifestyles changes to make.

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Sleep apnea can also impact children

This article discusses how sleep apnea can impact children and when a child should be evaluated by a professional for sleep apnea.

When we think of a sleeping child, the picture that often comes to mind is of a cherubic face relaxed into a smile, with an air of complete peace about her. This, unfortunately, is not the case for many children (and their parents) whose nights are interrupted by a sleep disorder.

It is generally accepted that from time to time in a child’s life there will be periods when a restful night’s sleep is not a given. For a child with a sleep disorder, those nights can become the norm rather than an occasional occurrence. One type of sleep disorder, obstructive sleep apnea syndrome, is more common in children than one might think and can lead to a whole host of issues during the day for a child who is affected by this condition.

There has been plenty of information made available about obstructive sleep apnea in adults over the last 20 years or so, but rarely have we heard about children being affected with the disorder. About 2 percent of children have sleep apnea, which may not seem like a lot, but to put it into context, of the approximately 16,000 children (birth to age 18) in Livingston County, 320 could possibly have this disorder.

Children who are most at risk for this disorder are those with Down syndrome, cerebral palsy, skull and face abnormalities or those who are overweight.

In a report published in the August 2012 issue of Pediatrics, the American Academy of Pediatricians (AAP) recommends that any child who snores on a regular basis be evaluated for sleep apnea. Symptoms of this sleep disorder can include:

• Frequent snoring
• Problems breathing during the night
• Sleepiness during the day
• Difficulty paying attention
• Behavior problems

In order to make a diagnosis of sleep apnea, usually an overnight sleep study called a polysomnogram will be performed. Sensors are attached to the sleeping child to monitor breathing, oxygen levels and brain waves. This information can help the doctors determine whether sleep apnea is present.

If left untreated, complications that can arise from sleep apnea include cardiovascular problems, poor growth and developmental delays. Treatment often begins with the removal of the child’s tonsils and adenoids, as they are commonly enlarged in these children. This is an effective treatment and will often be all that is required for the child to be symptom free.

A second line of treatment is for the child to use a CPAP machine at night. This is a mask that delivers steady air pressure through the nose, keeping the airways open and allowing for more regular breathing. For children who are overweight, weight loss can improve the symptoms but a CPAP may be necessary until the excess weight is lost.

Getting proper sleep is imperative for a child to grow and develop as best they can. Any sleep disorder that interrupts or decreases the quality of their sleep is a problem worth tackling right away. Quiet nights and happy, thriving kids are things every parent hopes for as they navigate the joys and worries of raising children.

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Study Claims Sleep Apnea Worsens during Winter Months

Countless Americans suffer from sleep apnea, a dangerous sleep disorder that causes sufferers to stop breathing numerous times throughout the night. Most people suffering from the condition must cope with frequent waking, daytime fatigue and snoring. Now, a recent study out of Brazil suggests these symptoms may worsen when the mercury drops.

More Severe During the Winter

According to research conducted at Universidade Federal do Rio Grande do Sul, weather changes can have a very real impact on the way patients experience sleep apnea. Over the course of a decade, researchers tested 7,500 patients for at least one night to see how many times each stopped breathing. Ultimately, they found that subjects who were tested during the coldest months of the year experienced more nighttime disturbances (18) than those who were tested during the warmer months (15).

Additionally, the study found that, while only 28 percent of subjects were found to have severe sleep apnea during the warm season, 34 percent suffered from severe sleep apnea during the colder parts of the year.

Although researchers weren’t able to determine why cold weather might make the sleep disorder worse, they theorized that wood burning might irritate the condition, as might heating units which can dry the air and dehydrate the sinuses.

Seeking Treatment

Regardless of the season, sleep apnea remains a serious condition that can drastically reduce the quality of a sufferer’s life. The condition has also been linked to numerous health problems, including obesity and dementia. Normally, people find 100 percent relief when they receive CPAP treatments; however, many people suffer unknowingly with the sleep disorder for years before they get help.

In the end, only a sleep physician can diagnose a patient with sleep apnea. Typically, patients are expected to sleep overnight at a sleep clinic; however, these days, more and more physicians are using at-home sleep testing equipment that allows patients to be tested while in the comfort of their own beds.

Down Syndrome Treatment Trial

Rivastigmine Study in Adolescents With Down Syndrome (DS Riv)

This study is currently recruiting participants.

Verified March 2012 by Duke University

First Received on March 8, 2010.   Last Updated on March 20, 2012   History of Changes

Sponsor:	Duke University
Collaborator:	Taishoff Family Foundation
Information provided by (Responsible Party):	Duke University
ClinicalTrials.gov Identifier:	NCT01084135

  Purpose

The purpose of this study is to determine if short term use of rivastigmine can improve functional abilities (for example, language, memory, and executive function) in adolescents with Down syndrome.

Condition	Intervention	Phase
Down Syndrome	Drug: Rivastigmine Other: Liquid Placebo	Phase 1 Phase 2

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	A 20-Week Double-Blind Placebo Controlled Clinical Trial to Evaluate the Safety and Efficacy of Rivastigmine in Children (Ages 10-18) With Down Syndrome

Resource links provided by NLM:

Genetics Home Reference related topics: 17q21.31 microdeletion syndrome tetrasomy 18p

MedlinePlus related topics: Down Syndrome

Drug Information available for: Rivastigmine Rivastigmine tartrate

U.S. FDA Resources 

Further study details as provided by Duke University:

Primary Outcome Measures:

• Vineland Adaptive Behavior Scales, Second Edition (Survey Interview Form) [ Time Frame: Baseline & Study termination (Week 20) ] [ Designated as safety issue: No ]
  Indirect (parent report) measure of adaptive function

Secondary Outcome Measures:

• Behavior Rating Inventory of Executive Function-Preschool (Brief-P) [ Time Frame: Baseline and Final (Week 20) visit ] [ Designated as safety issue: No ]
  Indirect measure of executive function

Estimated Enrollment:	40
Study Start Date:	November 2009
Estimated Study Completion Date:	May 2013
Estimated Primary Completion Date:	February 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Rivastigmine- Liquid form At the baseline visit (week 0), the subject will begin rivastigmine treatment at a dose of 0.75 mg bid. This dose will be continued for two weeks and then increased to 1.5 mg bid for an additional eight weeks. At the week 10 safety visit, the dose will be increased to 4.5 mg/day (3.0 mg and 1.5 mg) for an additional 10 weeks. If a subject is unable to tolerate a particular dose, the dose will be lowered to the previously tolerated dose, down to a minimum of 0.75 mg bid. If the subject is unable to tolerate the 0.75 mg bid dose he/she will be dismissed from the study.	Drug: Rivastigmine At the baseline visit (week 0), the subject will begin rivastigmine treatment at a dose of 0.75 mg bid. This dose will be continued for two weeks and then increased to 1.5 mg bid for an additional eight weeks. At the week 10 safety visit, the dose will be increased to 4.5 mg/day (3.0 mg and 1.5 mg) for an additional 10 weeks. Subjects receiving placebo will maintain the same schedule. If a subject is unable to tolerate a particular dose, the dose will be lowered to the previously tolerated dose,down to a minimum of 0.75 mg bid. If the subject is unable to tolerate the 0.75 mg bid dose he/she will be dismissed from the study. Other Name: Rivastigmine-Excelon
Placebo Comparator: Liquid placebo Subjects receiving placebo will maintain matched titration volume increase as treatment arm. The placebo will be matched to liquid rivastigmine in consistency and taste.	Other: Liquid Placebo Subjects receiving placebo will maintain matched titration volume increase as treatment arm. The placebo will be matched to liquid rivastigmine in consistency and taste.

Detailed Description:

This 24 week, double-blind, placebo controlled trial will be completed at the Clinical Research Unit of Duke University Medical Center and at the Kennedy Krieger Institute (KKI). Sixteen evaluable subjects will be enrolled at Duke and 24 evaluable subjects will be enrolled at KKI. The study consists of four visits, a screening visit (-4 weeks), a baseline visit (week 0); a safety visit at week 10, and a final/termination visit at week 20.

The specific aims of this study are to: a) investigate efficacy of rivastigmine tartrate treatment; b) build upon our open-label treatment results of overall function and language improvement in adolescents with Down syndrome (DS) in a double-blind, placebo-controlled clinical trial; and c) investigate other specific cognitive domains that may selectively respond to rivastigmine tartrate treatment.

  Eligibility

Ages Eligible for Study:	10 Years to 17 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

1. Correct VERBAL responses for 7/9 of the Expressive One Word Picture Vocabulary Test items.
2. Subject able to put at least 2-3 words together in conversational speech.
3. Subject's speech is understandable to the examiner for the majority of the time.
4. Subjects are in good health and medically stable

Exclusion Criteria:

1. Subject uses sign language as a primary means of communication
2. Subject has a medical history that contraindicate the use of rivastigmine (For example, patients with active seizure disorders, asthma, celiac disease, heart disease or heart rhythm disorders).

  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01084135

Contacts

Contact: Jane Ann McKillop, MS, CGC	919-668-4576	janeann.mckillop@duke.edu
Contact: Blythe Crissman, MS, CGC	919-681-1976	criss004@mc.duke.edu

Locations

United States, Maryland
Kennedy Krieger Institute	Recruiting
Baltimore, Maryland, United States, 21205
Contact: Cathleen Weadon, BA     410-923-9140     weadon@kennedykrieger.org
Principal Investigator: George Capone, MD

Sponsors and Collaborators

Duke University

Taishoff Family Foundation

Investigators

Principal Investigator:

Priya Kishnani, MD

Duke University

  More Information

No publications provided

Responsible Party:	Duke University
ClinicalTrials.gov Identifier:	NCT01084135     History of Changes
Other Study ID Numbers:	Pro00013682
Study First Received:	March 8, 2010
Last Updated:	March 20, 2012
Health Authority:	United States: Institutional Review Board

Keywords provided by Duke University:

Clinical trial Down syndrome adolescents cognitive rivastigmine

Additional relevant MeSH terms:

Down Syndrome Mental Retardation Neurobehavioral Manifestations Neurologic Manifestations Nervous System Diseases Abnormalities, Multiple Congenital Abnormalities Chromosome Disorders Genetic Diseases, Inborn Rivastigmine Cholinesterase Inhibitors

Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Cholinergic Agents Neurotransmitter Agents Physiological Effects of Drugs Neuroprotective Agents Protective Agents Central Nervous System Agents Therapeutic Uses

ClinicalTrials.gov processed this record on May 24, 2012

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Just What's Inside Those Breasts?

Just What's Inside Those Breasts?

May 16, 2012

When writer Florence Williams was nursing her
second child, she read a research study about
toxins found in human breast milk. She decided
to test her own breast milk and shipped a
sample to a lab in Germany. What came back surprised her.

Trace amounts of pesticides, dioxin and a jet
fuel ingredient — as well as high to average
levels of flame retardants — were all found in
her breast milk. How could something like this
happen?

"It turns out that our breasts are almost like
sponges, the way they can soak up some of these chemicals, especially the ones that are fat­
loving — the ones [that] tend to accumulate in fat tissue," Williams tells Fresh Air's Terry Gross.
"Unfortunately, the breast is also masterful at converting these molecules into food in the way of
breast milk."

Learning that breasts soak up lots of chemicals made Williams wonder just what else was going on
with breasts. A lot, as it turns out. In her new book, Breasts: A Natural and Unnatural History,
Williams offers her take on — among other things — why breasts are getting bigger and
developing earlier, why tumors seem to gravitate toward the breast, and how toxins from the
environment may be affecting hormones and breast development.

She says many of those toxins, including the flame retardants found in her breast milk, may come
from ordinary household items like couches and electronics, which often contain flame retardants.
Some animal studies have shown that certain types of flame retardants interact with hormone...

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Another CPAP Alternative in the News - EPAP / Provent

April 9, 2012, 4:59 PM

Treating Sleep Apnea Without the Mask

By ANAHAD O’CONNOR

Joseph A. Golish, M.D.A new C.P.A.P. device has two small plugs that create just enough air pressure to keep the airways open at night.

About 28 million Americans have sleep apnea, which causes repeated awakenings and pauses in breathing during the night, sometimes resulting in loud snoring and gasps for air. For decades, the standard treatment has been “continuous positive airway pressure.” A mask worn at night pushes air into the nasal passages, enabling easier breathing. C.P.A.P. reduces and in some cases completely prevents episodes ofapnea....

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