Tag: <span>Sleep Apnea Treatment</span>

sleep apnoea

Newsletter September 2021

Dear Colleague

 

I have been asked to share my process and contacts when managing patients with snoring and/ or mild OSA. Please note this is my personal approach but is driven by the research literature. I would always urge that, if there are any symptoms of OSA, that a sleep study should be done before any of these treatment options. We now have a number of ENTs, dieticians and dentists who are accredited by the South African Society for Sleep and Health (SASSH) as having passed the short Course on OSA. They thus know more than the average professional about OSA.

CPAP: Patients with moderate to severe OSA should all have a trial of CPAP. However, patients with mild OSA may also find that nasal CPAP is their best option, particularly if the AHI is higher in REM sleep, they have significant desaturations or comorbidities that make even mild OSA significant.

If not CPAP then there are various local obstructive factors which may be tackled and I go through each one with the patient and refer according to findings. Sometimes more than one option has to be used:

Nasal obstruction: If patients have a blocked nose (particularly up on the highveld in winter) then I start with steroid sprays. If there appears to be any permanent obstruction, or any other reason for possible obstruction at any level within the pharynx then an ENT opinion with airway assessment would be recommended. Remember to ask about tonsils and adenoids – if they remain again send to the ENT for assessment and possible removal. If you would prefer to send to an ENT that is accredited by SASSH regarding OSA please drop me an email with your area and I can let you know.

Oral appliances: These are a viable option to treat mild to moderate OSA and can work very well.The literature confirms that they tend to drop the AHI by up to 50% (only the custom fit devices). If your patient is not sure whether they will be able to tolerate one they can buy a cheap one from a pharmacy and then if it appears to be working – get a custom one made for them. They require assessment and fitting by a dentist or an ENT.

Here are some dentists / ENTs to try:

Dr Clyde Keevy (Johannesburg) OSA accredited by SASSH https://www.keevydentistry.co.za

Dr Gerald Kaplan (Johannesburg) https://prosthodontist.co.za SDSdental is a company that supplies the OrthoApnea device and works with a number of dentists and ENTs around the country http://sdsdental.co.za/preferredPartners

Dr Dawie Schlebusch works in the Eastern Cape but can let you know if there is a dentist close to you that can help your patient. www.nu-smile.co.za Referrals: 064 166 1710

Dr Alison Bentley referral@drbentleyinc.com MBBCh (Wits) PhD Appointments: 011 356 6457 Pr:1493604 074 236 3087 alison.bentley@drbentleyinc.com

Positional therapy: I always report on the percentage of apneas that occur in the supine position if significant. Keeping these patients lying on their sides while sleeping can often reduce the AHI to normal levels. An option for treatment is to place a small ball (either in a small pocket or using a practice golf ball) on the back of pyjamas or t-shirt. Alternatively, a pillow can be used to keep them lying on their side. Here is a pillow made locally.

Weight: An increase in weight (particularly in men) is crucial for the development of OSA. A visit to a dietician and gym may reduce the AHI. It is important that the dietician knows about OSA and the changes that occur in the metabolic system with OSA

I hope this list helps you manage the patient with mild OSA. If you are interested in learning more about OSA I would recommend, if you haven’t already done so, that you attend the short course on OSA including treatment options that I run for the South African Society for Sleep and Health. It runs over zoom on Monday evenings from the 18th October 2021. As mentioned above there is an accreditation option with MCQs for each session. If you are interested, please send an email to sasleepsoc@gmail.com or me for more details.

Regards and thanks for the ongoing referrals

Alison

cpap treatment

Letters from Dr Bentley: June 2020

Dear Colleague

What strange times we are living in. I hope this newsletter finds you well. When the COVID pandemic hit I was quite sure that obstructive sleep apnea had no place in the discussions. I may have been wrong. Please find some interesting information about the relationship between OSA and COVID infection.

1. What do I do about using my CPAP machine during the pandemic?

Keep using it but be aware of the increased aerolisization caused by CPAP which is more severe than that from coughing or sneezing and it goes on all night. So there is an increased risk of cross infection if you are COVID positive and using a CPAP machine. Thus extra hygiene and cleaning measures may be required.

2. Should I rather not use my CPAP machine then?

That is not a good option. Quite apart from the obvious increase in cardiovascular morbidity that comes with untreated OSA, OSA may be another risk factor for increased severity of COVID. In a sample of diabetic patients with severe COVID illness, treated obstructive sleep apnea (OR 2.80 [1.46, 5.38]) was independently associated with an increased risk of death on day 7 – reason unclear (Cariou et al 2020). It is also unclear whether untreated OSA carries an increased risk of death from COVID infection. Patients with the highest mortality risk of COVID – men, over 50 years old, with hypertension, obesity and diabetes, sound very much like the classical patient with OSA. They already score 4 factors on the STOP-BANG questionnaire (a score of 5 or more would be 80% predictive of OSA) (Nagappa et al PLoS One 2015).

3. Why would OSA increase the risk for mortality in severe COVID infection?

Severe COVID infection is characterised by a cytokine storm and systemic inflammation. Patients with OSA, particularly if they also have metabolic dysfunction, have a higher level of pro-inflammatory cytokines as well as increased endothelial dysfunction and systemic inflammation (Bonsignore et al Eur Respir Rev 2013). The prevalence of OSA in patients with factors linked to an increased severity of COVID disease – hypertension and diabetes – ranges from 30-60% – higher than the proposed 10-20% national prevalence of OSA (Benjafield et al Lancet Respir Med. 2019).

Thus there is an urgency for all patients with OSA to be diagnosed and treated. Diagnostic studies and CPAP titrations are done at home therefore not increasing the exposure risk to COVID in hospitals or excess person contact. Screening of possible patients with possible OSA using the STOP-BANG questionnaire is recommended.I hope this information is useful in your daily practice.

Sincerely

Dr Alison Bentley – Sleep Clinician

cpap treatment

Letters from Dr Bentley: The Impact of Nasal CPAP Treatment

Welcome all to 2020 and I hope this year goes well for you. This is our first newsletter for the year where I try and give some new information on obstructive sleep apnea which I hope will help you in your management of these patients.

Here is a summary of a recent meta-analysis of the impact of CPAP treatment on various symptoms and comorbid disorders. It is an official review by the American Academy of Sleep Medicine and the full reference is listed at the bottom of the page in case you would like to find it and study it in more detail.

Read more

sleep apnoea

Letters from Dr Bentley: Interesting Information about Obstructive Sleep Apnea

Dear Colleague

Welcome to our short newsletter which gives you some (hopefully) interesting information about obstructive sleep apnea.

It can be quite challenging to decide which patients to screen for obstructive sleep apnea (OSA) as the perceived prevalence is quite low. This is incorrect – the prevalence in the adult population ranges between 10 and 24% increasing to 49% in people over 65 years. Read more

sleep apnoea

Newsletter September 2021

Dear Colleague   I have been asked to share my process and contacts when managing patients with snoring and/ or mild OSA. …

Home based Sleep Studies vs In Hospital Sleep Studies for Sleep Apnea detection

Sleep Apnea is one of the most common sleep disorders with 25% of adults worldwide and 50% of cardiovascular disease patients …

I Wake Up Exhausted- Should I Worry About Sleep Apnea?

Sleep Apnea is one of the most common sleep disorders with 25% of adults worldwide and 50% of cardiovascular disease patients …