Snoring can harm your health by disrupting sleep. Obstructive sleep apnea causes pauses in breathing during sleep and is associated with increased risks of heart disease, stroke, diabetes and accidents. Risk factors include obesity, family history and post-menopausal status. Diagnosis involves sleep tests. Treatment options include CPAP machines, oral appliances, and surgeries like UPPP. Lifestyle changes like weight loss and avoiding alcohol can also help. Regular healthy sleep of 7 hours or more per night promotes optimal health and well-being.

1. Can Snoring Harm Your Health?
Presented by:
Alison S. Kole, MD/MPH
Director, Sleep Disorders
Center
19 November 2015

2. Overview
• Importance of Healthy Sleep
• How sleep apnea affects your health
• Who is at risk for sleep apnea
• Options for diagnosis and treatment
• Preventative strategies

3. Importance of Healthy Sleep

4. Importance of Healthy Sleep
• AASM and SRS Consensus Statement1
 “Adults should sleep 7 or more hours per night
on a regular basis to promote optimal health”
• Official American Thoracic Society Statement2
 “Sleep is an essential biological function with
major roles in recovery, energy conservation,
and survival”
 “It is clear that good-quality sleep is critical for
good health and overall quality of life”
1. Journal of Clinical Sleep Medicine, Vol 11, No 6, 2015
2. Am J Respir Crit Care Med Vol 191, Iss 12, 1450-1458, Jun 15, 2015

5. Sleeping < 7 hours per night1
• Weight gain and
obesity
• Diabetes
• High blood pressure
• Heart disease
• Stroke
• Depression
• Immune dysfunction
• Greater risk of
accidents
• Increased risk of
death
Associated with:
1. Journal of Clinical Sleep Medicine, Vol 11, No 6, 2015

7. Airway Anatomy
Picture reference: http://stopsnoringrx.com/why-do-we-snore/

8. Airway during Sleep
Picture reference: http://www.dreamstime.com/royalty-free-stock-image-snoring-sleep-apnea-image27809776

9. Obstructive Sleep Apnea (OSA)3
• Apnea
 Pause in breath for ≥ 10 seconds
• Hypopnea
 Flow of breath decreases by 30% of baseline
for ≥ 10 seconds associated with a fall in
oxygen saturation by 3%
3. AASM Scoring Manual Version 2.2, 2015

10. Obstructive Sleep Apnea
• Upper airway
closes
• Increased
blood
pressure
• Increased
heart rate
• Oxygen level
drops
Picture reference: http://advan.physiology.org/content/32/3/196

11. Sleep Apnea Severity
Apnea Hypopnea Index (AHI)
Picture reference: http://www.google.com/patents/WO2010107894A1?cl=en

12. Health Affects of OSA
• 26% general US
population has
OSA4
• 48% diabetes6
• 35% high blood
pressure5
• 30% coronary artery
disease5
• 60% stroke5
OSA
Picture reference: http://binghamtontmjandsleep.com/adult-sleep-disorders/risks-and-effects-of-osa-factors/
4. Rising prevalence of sleep apnea in U.S. threatens public health. National Healthy Sleep Awareness Project
Monday, September 29, 2014
5. Sleep Apnea and Cardiovascular Disease. Circulation, 2012, 126: 1495-1510
6. Prevalence of Sleep Apnea in a Population of Adults With Type 2 Diabetes Mellitus. Endocr Pract. 2007;13(4):355-362

13. Health Affects of OSA
Lily Eunhae Studer, 7/29/15

14. Health Affects of OSA
• Untreated OSA:
2.5x higher risk of
accidents7
• Effective
treatment cuts
this risk by 70%7
Huffington Post 4/7/2014
“Engineer Involved In Fatal
Metro-North Train Derailment
Had Undiagnosed Sleep
Apnea”
7. Risk of motor vehicle accidents is higher in people with sleep apnea. American Academy of Sleep Medicine
Tuesday, March 10, 2015

15. Risk Factors for OSA
• Personal history
• Family and ethnic risk
• Post menopausal women
Picture reference: https://utswim.wordpress.com/tag/pulmonary/

16. Options for Diagnosis
Polysomnography

17. Options for Diagnosis
Home Sleep Testing
Picture reference: http://join.sleepgroupsolutions.com/products/watermark-ares/

18. Options for Treatment
• CPAP (continuous
positive airway
pressure) therapy
• APAP (auto-
positive airway
pressure therapy
Picture reference: http://www.schofieldmedical.com/Catalog/Online-Catalog-Product/2076/Prsystem-One-Remstar-Auto

19. Alternative Therapies
NONSURGICAL SURGICAL

20. Positional Therapy
• Tennis ball T-shirt
Picture: http://www.tennisballtshirt.com/Stop_Snoring_Remedy_%3A_Tennis_Ball_T_Shirt_%3A_Anti_Snore_Cure.html

21. Zzoma belt
Picture reference: http://www.medicare.ie/zzoma-positional-device-887.html

22. Night Shift Positional device
Picture reference: Assessment of a Neck-Based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea.
J Clin Sleep Med 2014;10(8):863-871. http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29591

23. Provent
Picture reference: http://www.lunar.com/blog/lunar-designed-ventus-provent-sleep-apnea-therapy-wins-gold-idea/
Picture reference: http://www.sleepwa.com.au/mas-and-provent-Therapy

24. Oral Appliance Therapy
Panthera Herbst
Mouthpieces

25. Oral Appliance Therapy
• Dental Device Titration (MATRx)
 Determining who benefits from mouthpieces
Coming January 2016 to SMG Warren Sleep Laboratory!

26. Surgical Treatment of OSA
Uvulopalatopharyngoplasty (UPPP)
• removal of upper airway soft tissues
including the uvula, soft palate, tonsils,
and adenoids

27. Surgical Treatment of OSA
Maxillomandibular advancement (MMA)
• Currently the most effective surgical
option for OSA
Picture reference: http://www.homesleepclinic.com/desktop/treatment-options.html
8. Oral Appliance Treatment for Obstructive Sleep Apnea: An Update. J Clin Sleep Med 2014;10(2):215-227.

28. Hypoglossal Nerve Stimulation
Picture reference: Upper-Airway Stimulation for Obstructive Sleep Apnea. N Engl J Med 2014; 370:139-149

29. Preventative strategies
• WEIGHT LOSS
 Diet, exercise, weight loss surgery
• Avoidance of alcohol
• Avoidance of prescription sleep aids
• Quit smoking!
Picture reference: http://users.rowan.edu/~blondi74/Expert.page.2.html

30. Comprehensive Sleep Evaluation
Kole
Bakal Kohn (Pediatrics)
Bass BlausteinWilt
Livingston campus
Florham Park campus
Berkeley Heights campus
Florham Park campus
Berkeley Heights campus

31. Thank You!
I mustache you a question…