Surgery Has No Clear Benefit For Sleep Apnea

Surgery should not be the first treatment for a patient who suffers from obstructive sleep apnea - when the upper airway during sleep collapse - after a article in the British Medical Journal (BMJ) , the theme of this week .


Obstructive sleep apnea, a common disease that causes loud snoring. Sometimes the people with this disease can be completely breathing for a short time during his or her sleep. Affected are mostly middle-aged, overweight men, and can be reached by car crashes and reduces health related to the quality of life, the authors explain.


Although the guidelines recommend CPAP (continuous positive airway pressure), combined with weight control and management of alcohol, upper airway surgery is becoming increasingly popular as the first line of treatment.


Dr. Adam Elshaug, University of Adelaide, Australia, and the team conducted an investigation. It analyses the latest evidence of the upper airway surgery. The results showed that the evidence for the benefits of the operation is unclear.


One of seven randomized trials showed that the operation had a very limited effect on the symptoms. Even where the quality of life showed some improvements, hardly showed that this improvement lasted longer than one or two years.


A review of 48 studies showed that 62% of patients who undergo surgery for obstructive sleep apnea had suffered lasting negative effects, including difficulty swallowing, voice changes, smell and taste disorders and dry throat.


The researchers explain that weight loss and other lifestyle changes are recommended in combination with CPAP. However, they are difficult to reach. The surgical 'cure' may be attractive because CPAP therapy, the patient must compliance with the instructions - CPAP, the benefits for the patients seem to be inconclusive.


Nevertheless, as the evidence of a clear benefit from the operation is missing, and the risk of adverse effects (surgery), guidelines recommend CPAP as the first line of treatment.


The authors write that surgery for obstructive sleep apnea should be carried out within controlled clinical trials. Information about the inconsistent results of the surgery, and the possible side effects, should be used for the patient.


"Upper airway surgery should not for the first-line treatment of obstructive sleep apnoea in adults"

Adam G Elshaug, John R Moss, Janet E Hiller, J Guy Maddern

BMJ , 2008; 336:44-5 doi: 10.1136/bmj.39381.509213.AE

http://www.bmj.com


Written by - Christian Nordqvist

Copyright: Medical News Today

not be reproduced without the permission of Medical News Today

Restless Legs Linked To Increased Stroke And Heart Disease Risk

A new US study has found that people with restless legs syndrome (RLS) have double the risk of stroke and heart disease compared to people without
RLS.


The study is the work of Dr. John Winkelman W, of the Harvard Medical School in Boston, Massachusetts, and colleagues, and is in the 1st
January 2008 issue of the journal Neurology .


Winkelman and colleagues also found that most people with severe and frequent symptoms of RLS ran the highest risk for stroke and heart -
disease.

Gr�te its kind, the 3433 study included community-based participants in the average age of 68 the Sleep Heart Health Study, a multi-center cohort
study conducted by the National Heart Lung and Blood Institute (NHLBI) to cardiovascular and other consequences of sleep-disordered breathing.


The researchers used information that the participants on detailed questionnaires to ascertain who had RLS and had a diagnosis for angina pectoris,
heart attack, stroke or heart failure by a doctor. Reports of treatments such as coronary revascularization were also included.


This helped the researchers determine the presence of coronary artery disease (CAD) and total cardiovascular disease (CVD), which also reports
CAD and stroke, or heart failure .


A diagnosis of RLS was four diagnostic criteria, and if the symptoms occurred at least five times a month and has been associated with
least moderate distress.


The results showed that:

• 6.8 percent of women and 3.3 percent of male participants had RLS.
  
  
• people with RLS were more than 2 times more likely to heart disease, or cerebrovascular disease (odds ratio 2.05 for the war and for CAD 2.07
  For CVD).
  
  
• This figure was unchanged after adjusting for age, sex, race, body mass index (BMI), diabetes, high blood pressure, high blood pressure medications,
  HDL / LDL cholesterol, and smoking status.
  
  
• The relationship between RLS and heart disease and stroke was greater in people who reported symptoms of RLS at least 16 times per month.
  
  
• The relationship between RLS and heart disease and stroke was also greater in people who reported severe as opposed to "m�ig bothersome
  symptoms. < br>
  
  The authors concluded that:
  
  
  "-Restless Legs Syndrome (RLS) is far with coronary heart disease and cardiovascular diseases. This association seems more in the
  gr�erer frequency and severity of RLS symptoms. "
  
  
  Winkelman, said that although their research results do not show that RLS causes cardiovascular and cerebrovascular disease, there was strong evidence to suggest a number
  The way they it can do.
  
  
  "In particular, most people with RLS have more than 200 to 300 periodic leg movements of sleep per night and leg movements that are used in conjunction with
  Acute significant increases in the two Blood pressure and heart rate, which may be on the long-term, produce cardiovascular or cerebrovascular diseases, "
  Winkelman said.
  
  
  He also said that the study was supported by the fact that the data were collected from its own Information from questionnaires and clinical interview with a trained medical professional
  .
  
  
  RLS is a neurological disorder where you the irresistible urge to move your legs, often accompanied by uncomfortable feelings such as creeping,
  itching pulling, tugging and gnawing. Symptoms are often worse, if you, for example, when you lie down, and better if your legs
  .
  
  
  One of the gr �ten complaints from RLS patients is difficult and there asleep. too many RLS patients have periodic limb movements of sleep
  (PLMS), where the legs jerk every 20 or 30 seconds, on and off all night while sleep. This means that sleep deprivation can be serious health consequences,
  relationships, work, and the general quality of life.
  
  
  According to the RLS Foundation, up to 10 percent of Americans have the syndrome.
  
  
  "Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study."
  < br> Winkelman, John W., Shahar, Eyal, Sharief, Imran, Gottlieb, Daniel J.
  
  neurology 2008 70: 35-42
  
  Published 1 . online in January 2008.
  
  
  Click here for Abstract.
  
  
  Click here for more information on RLS (the RLS Foundation, US).
  
  
  Sources: journal articles, American Academy of Neurology press release, Sleep Heart Health Study website, RLS Foundation.
  
  
  Written by: Catharine Paddock
  
  
  Copyright: Medical News Today
  
  not be reproduced without the permission of Medical News Today
  

Undiagnosed Obstructive Sleep Apnea Patients Have Altered Cardiovascular Responses During Exercise Recovery

People with untreated obstructive sleep apnea (OSA) have changed cardiovascular reactions during the convalescence of maximum exercise. These results indicate an imbalance in the autonomous control of heart rate during the recovery, and may be an early sign of the clinical progression of OSA.


The study, by Trent A. Hargens, PhD, Virginia Tech, which are about 44 people: 14 overweight with OSA (OSA), 16 overweight without OSA (No-OSA), and 14 normal weight without OSA (Control). All were aged between 18 and 26 The subjects, the maximum ramping load testing on a cycle ergometer with five minutes of active recreation. Lab measurements include heart rate, blood pressure, respiration and oxygen consumption exchange ratio.


According to the results, in the OSA patients, the heart rate recovery was significantly weakened compared to the no-OSA and groups throughout recovery. No differences were found in heart rate and blood pressure response to exercise in each group.


"We believe that our study is the first study to show blunted post-exercise heart rate recovery in small seemingly healthy young men who are latently obstructive sleep apnea. Mechanistic studies by other investigators indicate that out that this response is a function of impaired vagal reactivation following vigorous exercise is a marker, specifically the autonomic dysfunction of sleep, "said William G. Herbert, Ph.D., co-author of the study. "In view of these results were observed in young men, follow-up confirmation with large cohorts May support use of this marker for the identification of men at risk of early sleep and for the monitoring of therapy in the treatment, which is already common for this, but under-diagnosed disorder. "


OSA is a sleep-breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue on the back of the throat collapses and blocks the airway. This holds in the air from the lungs. It is estimated that four percent of men and two percent of women have OSA, and millions more remain undiagnostiziert.


On average, most adults need between seven and eight hours of sleep per night to feel alert and well rested.


The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good sleep:


- Follow a consistent bedtime routine.

- Establishing a relaxed setting before bedtime.

- Get a full night sleep every night.

- Avoid foods or drinks, which contain caffeine, and all the medicines, has a stimulant before bedtime.

- You do not go to bed hungry, but do not eat a large meal before bedtime either.

- Avoid any rigorous exercise within six hours after your bedtime.

- Make your bedroom quiet, dark and a little cool.

- Get up at the same time every morning.


First introduced as a treatment option for sleep apnea in 1981, continuous positive airway pressure (CPAP) is the most common and effective treatment for OSA. CPAP provides a steady stream of compressed air to patients through a mask, that while they sleep. This airflow keeps the airway open, which prevent the pauses in breathing characterize sleep apnea and restoring normal oxygen.


CPAP Central, a Web site created by the AASM, provides the public with comprehensive, accurate and reliable information on CPAP. CPAP Central includes expanded information about OSA and CPAP, including OSA is diagnosed, the function of CPAP, the benefits of CPAP and an overview of what to expect when the top CPAP, the position of experts on CPAP and tools for success . CPAP center also offers an interactive slide set that educates the public about the warning signs of OSA.


More information on OSA is available from the AASM on www.SleepEducation.com/Disorder.aspx?id=7


SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the AASM and the Sleep Research Society.


SleepEducation.com, a patient education Web site, by the AASM, offers information on various sleep disorders, the forms of treatment available, recent news on the subject of sleep, sleep disorders studies, which were carried out, and a list of sleep.