All Press Releases for October 26, 2008

Even Mild Sleep Apnea Increases Cardiovascular Risk. Snoring Alone Without Apnea Increases Risk of Carotid Atherosclerosis and Stroke 1000%

A study from the Oxford Centre for Respiratory Medicine showed that people with even minimally symptomatic obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease because of impaired endothelial function and increased arterial stiffness.

    GURNEE, IL, October 26, 2008 /24-7PressRelease/ -- Obstructive Sleep apnea is known to cause 6-7 fold increases in heart attacks and strokes. This new study showed that patients who exhibit even minimally symptomatic obstructive sleep apnea (OSA) may be at increased risk for cardiovascular disease because of impaired endothelial function and increased arterial stiffness. Snoring is the number one symptom identifying sleep apnea.

"It was previously known that people with OSA severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people - some of whom may be completely unaware that they even have OSA - are at risk than previously thought," said lead author of the study, Malcolm Kohler, M.D.

The study will be published in the first issue for November of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine. At the American Thoracic Society meeting last year data was presented showed a 300% increase in motor vehicle accidents with severe injuries to one ore more people in mild apnea with no symptoms of daytime sleepiness. Mild Apnea is also known to cause permanent brain damage in adults and developing children.

"Only one out of approximately five subjects with [clinically defined OSA] complains of excessive daytime sleepiness in population studies," according to Geraldo Lorenzi-Filho, M.D., Ph.D. in his editorial in the same issue of the Journal. "It is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system."

Dr. Kohler and colleagues performed a controlled, cross-sectional study to assess differences in endothelial function. The study compared 64 patients who had proven OSA to matched control subjects without OSA. These findings prove that minimally symptomatic OSA is a severe cardiovascular risk factor that was previously underestimated.

"In our study, the augmentation index, a measure of central arterial stiffness that independently predicts cardiovascular events in high-risk populations, was significantly higher in patients with minimally symptomatic OSA compared to matched controls," said Dr. Kohler. "We also found impaired endothelial function as indicated by decreased vascular reactivity of their arteries compared to control subjects without OSA."

The difference in arterial stiffness between OSA patients and control subjects, Dr. Kohler said was "comparable in size to the effect seen after four weeks' continuous positive airway pressure (CPAP) therapy in patients with moderate to severe symptomatic OSA." This means that even patients with mild apnea will benefit from CPAP therapy. The problem with CPAP is that most patients do not continue to use it on a regular basis. Studies have shown that only 23-45 % of patients actually use CPAP and even users average only 4-5 hours a day. It is recommended that CPAP be worn 7 1/2-8 hours nightly.

Dr.Kohler and colleagues from the Oxford Centre for Respiratory Medicine are currently investigating the effects of 6 month CPAP therapy on arterial stiffness and endothelial function as part of an international randomized controlled trial (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular Trial; MOSAIC) which will show the impact of CPAP therapy on cardiovascular risk in patients with minimally symptomatic OSA. The problem with compliance with is still a problem but it has been shown that oral appliances are as effective as CPAP for mild to moderate sleep apnea ant that oral appliances have much higher compliance. Information on oral appliance therapy can be found at

Due to the fact that permanent damage to the brain and cardiovascular system results from untreated apnea this lack of treatment compliance has led an intense effort to improve compliance by improving the design of the machines and the masks. This effort has been only minimally effective. The field of Dental Sleep Medicine has emerged as the best hope for patients who do not tolerate CPAP treatment. The American Academy of Sleep Medicine has endorsed oral appliances as a first line treatment along with CPAP for mild to moderate sleep apnea and as an alternative treatment for severe sleep apnea. This position is also endorsed by the National Sleep Foundation, The American Sleep Apnea Association (AWAKE) and the American Academy of Dental Sleep Medicine. An excellent site for information on Dental Sleep Medicine was developed by Dr Ira L Shapira a Chicago dentist who is a Diplomate of the American Board of Dental Sleep Medicine and a pioneer in the field. He was a charter member of the Sleep Disorder Dental Society, which evolved into the American Academy of Dental Sleep Medicine and is a charter member of DOSA, The Dental Organization for Sleep Apnea. has a find a dentist area to help patients connect with Sleep Apnea Dentists. DR SHAPIRA EMPHASIZES THAT HE DOES NOT HATE CPAP AND THAT IT IS AN EXCELLENT TREATMENT FOR PATIENTS WHO TOLERATE IT AND USE IT THE RECOMMENDED 7-8 HOURS NIGHTLY.

To learn more about the dangers of Sleep Apnea and the treatment alternatives you can use the following resources: ... a_Poll.htm

Dr Ira L Shapira is an author and section editor of Sleep and Health, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical Schools Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

Source: Sleep and Health Journal

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