Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
sleep problems, which plague up to 40% of the elderly, include light sleep, frequent waking, and daytime fatigue. Among older people, there is also a decrease in the deep-sleep stage and an increase in periods of wakefulness during the night.
How is insomnia managed?
Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically, CBT-I is equally or more effective than sleep medications.
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
sleep problems, which plague up to 40% of the elderly, include light sleep, frequent waking, and daytime fatigue. Among older people, there is also a decrease in the deep-sleep stage and an increase in periods of wakefulness during the night.
How is insomnia managed?
Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically, CBT-I is equally or more effective than sleep medications.
Lifestyle modification in epilepsy
Lifestyle Modifications
Lifestyle modifications can include:
Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring.
Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures.
Minimizing emotional stress: Although there is not definitive proof that stress causes seizures, those who maintain healthy stress levels have reported that they believe it reduces their risk.
Frequency of exercise: In addition to a range of health benefits, regular exercise can help reduce risk of seizure. However, you should consult your physician before starting a new exercise routine, as some exercise can, rarely, cause seizures.
Can't sleep peacefully? Do you have Sleep Apnea? No worries, It is a common sleep disorder. You will be completely cured from sleep apnea and snoring by taking proper treatment. Surf here to learn important things about sleep apnea and it types, causes, treatment, etc...
Epilepsy is a common neurological condition, and still largely shrouded by stigmatisation. This presentation explored practical steps to the management of epilepsy, discusses the new classification of epilepsy, and touched on some relevant lifestyle changes.
Practice focusing on orofacial myofunctional therapy and Buteyko breathing retraining.
Orofacial Myofunctional Therapy is the practice of teaching clients neuromuscular techniques to alleviate orofacial disorders.
These disorders include things like:
Tongue thrusts
Lip and tongue sucking
Snoring
Pacifier, thumb uses or nail biting
Orofacial disorders can show up as crazy things like
Restless legs
Silent acid reflux
Sinus infections
Temporomandibular pain
Neck and shoulder pain
Fibromyalgia
Orthodontic relapse
Lifestyle modification in epilepsy
Lifestyle Modifications
Lifestyle modifications can include:
Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring.
Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures.
Minimizing emotional stress: Although there is not definitive proof that stress causes seizures, those who maintain healthy stress levels have reported that they believe it reduces their risk.
Frequency of exercise: In addition to a range of health benefits, regular exercise can help reduce risk of seizure. However, you should consult your physician before starting a new exercise routine, as some exercise can, rarely, cause seizures.
Can't sleep peacefully? Do you have Sleep Apnea? No worries, It is a common sleep disorder. You will be completely cured from sleep apnea and snoring by taking proper treatment. Surf here to learn important things about sleep apnea and it types, causes, treatment, etc...
Epilepsy is a common neurological condition, and still largely shrouded by stigmatisation. This presentation explored practical steps to the management of epilepsy, discusses the new classification of epilepsy, and touched on some relevant lifestyle changes.
Practice focusing on orofacial myofunctional therapy and Buteyko breathing retraining.
Orofacial Myofunctional Therapy is the practice of teaching clients neuromuscular techniques to alleviate orofacial disorders.
These disorders include things like:
Tongue thrusts
Lip and tongue sucking
Snoring
Pacifier, thumb uses or nail biting
Orofacial disorders can show up as crazy things like
Restless legs
Silent acid reflux
Sinus infections
Temporomandibular pain
Neck and shoulder pain
Fibromyalgia
Orthodontic relapse
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Some considerations in treatment planning myofunctional orthodontics based on the patients' psychology as well a dental needs in the context of a multi-service orthodontic practice.
Contact us -
Email- amitsuryawanshi999@gmail.com
Cell phone- +91 9405622455
Face Art International Clinic Landline- +91 7758976097
For International Patients - Dial country code of India (+91)
Visit us at www.faceart-clinic.com for more information.
Tongue thrusting habit & other habits ,its management 2 /certified fixed ort...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Screening Adult Dental Patients for Sleep DisordersKen Luco
The article discusses how a dentist can identify patients with sleep disorder and how he can treat the disorder. Topics discussed include a description of different forms of sleep disorder, their causes and effects on health, guide questions for dentists concerning their patients to determine the presence of sleep disorder, and what a dentist can do to treat a patient diagnosed with sleep disorder. Luco Hybrid OSA Appliance ~ 1st Ever ~ FDA Approved ~ Treatment for Sleep Bruxism | OSA | UARS | Snoring |
We've all heard the term 'fat-burning', but how does it really happen in the body? Fat cells in the body release a hormone that signals to the brain that there is enough energy stored. This triggers your body to burn energy stored as fat
Pulmonologist, Jenny Kim, MD, FCCP of our Sleep Disorders Center partnered with the Livingston Health Department to present, Can’t Sleep? The ABCs of Your ZZZs to the community. During the session, Dr. Kim discussed tips for improving sleep and treatment options for common sleep disorders.
1. Sleep Apnea Prepared by: dr. Mohamad Ghazi 1
2. Outline: • Sleep Apnea definition • Epidemiology • Types of Sleep Apnea • Risk factors for Obstructive sleep apnea • Diagnosis • OSA can increase the risk of ? • Treatment Options for Sleep Apnea • Conclusion 2
3. Sleep Apnea is defined as the stopping of airflow during sleep and preventing air from entering the lungs caused by an obstruction.(1) What is Sleep Apnea? 1.British Snoring & Sleep Apnoea Association . 2. Orthodontics - Current Principles and Techniques - Graber 5th edition - 2011 Just as allergic disease significantly affects quality of life, obstructive sleep apnea, if it is untreated, may affect adversely the ability of adults and children to function adequately at work and at school.(2) 3
4. 4
5. Is Sleep Apnea Significant Health Issue ? 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. (3) 3.American Sleep Apnea Association 4.Young et al 1993 5.Young et al 2002 15. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130: 576-84. EPIDEMIOLOGY: OSA present in 25-58% of Male and 10-37% of Female. (4)(5) According to a report by American Academy of Pediatrics, depends on the population studied, the prevalence of OSAS is in the range of 1% to 5% (15) 5
6. Types of Sleep Apnea: Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly. 6
7. Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. A) Obstructive sleep apnea. Note continued chest and abdominal effort in the absence of airflow. B) Central sleep apnea. Note absence of chest and abdominal effort, as well as absence of airflow 7
8. You have a higher risk for obstructive sleep apnea if you are: Overweight ??? (Most Important Factor) 5.Young et al 2002 6.National Institutes of Health 14.Malhotra et al 2002 • About 70% of those with OSA are obese (14) • Higher BMI associated with higher prevalence – BMI>30: 26% with AHI>15, 60% with AHI>5 – BMI>40: 33% with AHI>15, 98% with AHI>5 Obese people have extrinsic narrowing of the area surrounding collapsible region of the pharynx and regional soft tissue enlargement. Increased fat deposits posteriolateral to oropharyngeal airspace at level of soft palate, in the soft palate, and in submental area. Risk factors for Obstructive sleep apnea(6) 8
9. • Sex : Male are more likely than Female to have sleep apnea. • Age : the risk increases as you get older. • A family history of sleep apnea.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
4. SLEEP DISORDERS…
• Insomnia: 32 million (unreliable estimate)
• Sleep Apnea: estimated 18 million Americans
(NHLBI)
• Obstructive sleep apnea: 12 million Americans
Narcolepsy: 200,000 Americans (NHLBI
estimate); 50,000 diagnosed.
• Chronic Fatigue Syndrome: 500,000 Americans
(CDC/NIAID)
•
2011 Health Grades Inc.
5. Obstructive Sleep Apnea…
A Common Problem:
• Estimated prevalence: 40 MILLION Americans
who are undiagnosed (1 in 6)
• 50-90% diagnosed are referred for a sleep
evaluation.
Most do not follow through.
Myers et al, JAMA, 2013
6. CENTRAL SLEEP APNEA…
• The sleeper whose problem is central sleep
apnea periodically does not breathe at all, or
breathes so shallowly that oxygen intake is
ineffectual. The brain just seems to shut
down. In either type of sleep
apnea, obstructive or CENTRAL, the lack of
oxygen usually causes the patient to wake, at
least briefly. (Hypopneas)
7. Risk Factors…
• Male gender
• Age
• Obesity
• Neck Circumference > 17.5 inches in men
16 inches in women
• Smoking
• Craniofacial structures
• Smoking
• Family History
8. Risk Factors…
• High blood pressure.
• High blood pressure in lungs.
• Abnormal heart rhythm, heart
failure, coronary artery disease (CAD), or
stroke.
• Depression.
• Diabetes.
9. Symptoms of OSA in Children…
Restless Sleep
Headaches
Obesity
Large Tonsils
Noisy Breathing
Allergic Shiners
Runny Nose
Frequent Upper
Airway Infections
Earaches
Bedwetting
10. Symptoms of Sleep Apnea in Adults
and Children…
Daytime Symptoms:
• Excessive Daytime Sleepiness
• Depression / Anxiety / ADHD
• Morning Headache
• Dry, Irritated Throat & Raspy Voice
• Social and Workplace Issues
• Short Attention Span, Hot Temper, Impulsive,
Memory Problems
11. Symptoms of Sleep Apnea in Adults
and Children…
Nighttime Symptoms:
• Snoring
• Witnessed Breathing Pauses
• Frequent Awakenings
• Frequent episodes of Bedwetting
• Insomnia
12. Screening
Questionnaire…
•
•
•
•
•
Do you snore?
Are you sleepy during the daytime?
Do you have headaches or sore throats in the AM?
Has anyone witnessed apneas or respiratory gasps?
Do you not get ‘enough sleep’ despite adequate time
in bed?
• If they answer any affirmatively, use the “EPWORTH
SLEEPINESS SCALE” TO ASSES SEVERITY. We give this
to everyone!
13. Is It a COLD or an ALLERGY?
• Cold:
• Runny nose and sneezing last 1-3 days; if cold symptoms persist for more
than a week, see a doctor - you may have complications such
• as bronchitis or sinusitis
•
• Sore throat and / or coughing
•
• General malaise -fever, muscle aches, chills, sweats, loss of
appetite, fatigue -which indicate an infection
•
• Burning sensation in nose, often accompanied by nasal/sinus tenderness
•
• Mucus can become yellow, green, thick, foul-smelling or bloody
14. • Allergy:
• Persistent watering of nose and eyes lasts anywhere from a few
weeks to several months, depending on the allergen
• Itchiness of the nose, eyes and roof of the mouth or back of throat
• General feeling of well-being, except for areas experiencing allergic
symptoms; appetite usually is not diminished
• In most cases, sinuses are not painful or tender
• Mucus is watery and clear
15. We Cannot See Adenoids and Septums
But We CAN See Tonsils and Tongues
Large Adenoids
Deviated Septum
Large tonsils
Wide tongue/Long Uvula
16. Medical Conditions /Sinusitis…
•
•
•
•
Diabetes
Gastro esophageal reflux disease
Nasal polyps or septal deviation
Disorders of the immune system
(fungal infections are especially risky)
• Oral or intravenous steroid treatment
• Hypothyroidism -- causes congestion that often
clears up when the condition is treated
• Cystic fibrosis -- a genetic disorder in which the
mucus is very thick and builds up
18. DISEASES…
Type II Diabetes
• Almost 50% of type 2 diabetes patients have sleep
apnea;1 among obese type 2 diabetes patients, the
prevalence of sleep apnea has been estimated at 86%.
AM J RESPIR CRIT CARE MED.2010 Mar 1;181(5):507-13. doi: 10.1164/rccm.200909-1423OC.
Epub 2009 Dec 17.
• 76% Congestive Heart Failure
Javaheri S. Sleep-related breathing disorders in heart failure. In: Heart Failure, A Companion
to Braunwald’s Heart Disease, edited by Douglas L. Mann. WB Saunders, Philadelphia 2010;
471-487
• 70% Stroke/TIA
http://sleepdisorders.about.com/od/sleepandgeneralhealth/f/Sleep_Apnea_Stroke_Risk.htm
Mar 4, 2013 ...
22. Determine Etiological Factors which would
prevent the success of a therapy program
BY BEING PART OF A team!
1. Deviated Septum
2. Enlarged Turbinates
3. Polyps
4. Enlarged Adenoids and / or Tonsils
5. Allergic Rhinitis and / or Sinusitis
6. Vaulted -Narrow Palatal Arch Formation
REFER! Ask Questions
30. CARDIOVASCULAR
LINKS…
• 5.7 million people in the US have heart failure
{American Heart Association Statistics}
• 76% of Heart Failure Patients have SDB
• Heart Failure is the MOST expensive disorder to treat
• Obstructive Sleep Apnea is noted in 49% of atrial
fibrillation patients and 30% of cardiovascular
patients
• OSA presents in 70% of heart attack patients
31. Mortality Links…
• SDB is associated with a 3-fold
increase in mortality risk
• Severe sleep apnea raises
premature death risk by 46%
32. Mood Disorder and Apnea…
• 54.1% of Bipolar patients were found to
be at risk for OSA
• Sleep apnea associated with major depression
(2.4% in men, 5.4% in women)
• Treatment of OSA ameliorates symptoms
in the short and long term
Soreca, Bipolar Disord, 2012
Wheaton, Sleep, 2012
Scjwartz, J Clin Sleep Med, 2007
33. Restless Legs Syndrome and
Periodic Limb Movements…
• Periodic Leg Movements (PLMD)
• Restless Legs Syndrome (RLS)
Movement disorder (Rest increases
symptoms)
• Sensory Motor Syndrome
34. Cardiovascular Risk and RLS…
• 2 times greater risk of heart and
cardiovascular disease
• Women with RLS for 3 years are at greater
risk for heart disease
• Older Men with RLS are 67% times more
likely to have a stroke than those without
Li,RCircuLlatioSn,2013
35. Are pregnant women at
risk for sleep apnea?
Potential risk factors for SDB in pregnancy:
•
•
•
•
•
•
Nasal congestion and gestational rhinitis (1)
Increased Mallampati scores (2)
Reduction in size of upper airway (3,4)
Weight gain
Reduction in FRC (5) and airway collapsibility (6)
Vacuum effect related to increased ventilator drive (7)
•
•
•
•
•
•
•
1-Young T. J All Clin Immunol 1997; 99: S757-62.
2- Pilkington S. Br J Anesth 1995; 74:638-42
3- Iczi B. ERJ 2006; 27:321-7
4- Iczi B. AJRCCM 2003; 167:137-40
5- Crapo R. Clin Obstet Gynecol 1995; 39:3-16
6- White DP. AJRCCM 2005; 172:1363-70
7- Edwards N. Thorax 2002; 57:555-8
36. Consequences of Apnea for
Pregnant Women…
• Pregnancy associated with lower residual
volume and lower functional residual
capacity (FRC)
• Lower oxygen reserve because of lower
FRC and higher oxygen consumption
37. Preeclampsia…
PEC is an important cause of:
•
•
•
•
•
Infant prematurity
Neonatal morbidity
Maternal morbidity and mortality
Maternal ICU admissions
Precursor of cardiovascular disease
38. Consequences of Apnea on Fetus:
• Concern for fetal wellbeing with recurrent
desaturations and possible hypoventilation
(Data from high altitude residents strongly
suggests risk of growth restriction and
PEC with chronic hypoxia)
(Doctors in Denver are very aware of the risks!)
39. Gestational Diabetes…
Diabetes occurring during pregnancy
• 30-50% of women with GDM end up
developing DM later in life
• GDM is cause for infant morbidity
• Other complications
40. Reflux - Another Issue…
• In a study presented at the 70th Annual
Scientific Meeting of the American College of
Gastroenterology, 81 patients with
documented sleep complaints at least three
nights per week underwent polysomnographic
sleep evaluations. 26 percent had acid reflux.
Of those who suffered with reflux, 94 percent
of the recorded reflux events were associated
with arousal from sleep or awakening.
53. Sleep Study…
•
•
•
•
Typical result…
Time in bed: 9 hours 47 minutes
Time asleep: 6 hours 46 minutes
AWAKE: 3 hours due to Arousals
( I did one just to find out what happens. I do not have
OSA, but I did not sleep well!)
55. Tonsillectomy/Adenoidectomy…
• Chronic or recurrent tonsil infections—Tonsillectomy
may reduce the number, but will not completely
eliminate, these infections.
• Peri-tonsillar abscess (pocket of infection spreading
outside the tonsil)
• Enlarged tonsils causing obstruction of the
throat
• Adenoids blocking the
nasal airway
58. Somnoplasty…
• Radio-frequency generator is used to cause
internal scarring and shrinkage of the soft
palate and uvula
• Local Anesthetic
• Outpatient
• Success: LOW
62. Issues with Medications…
• Benzodiazepines, hypnotics, narcotics
may relax the airway more in patients
who have sleep apnea.
• Narcotics can contribute to central sleep
apnea.
64. CPAP…
• CPAP is still considered the
“Gold Standard” by most physicians.
Compliance: Low
65. Myofunctional Therapy with
a TEAM APPROACH
Helps to minimize snoring by training the
tongue to rest in a normal posture
Changes head and neck posture which
opens the airway
Allows for better nasal breathing (noses
are ‘use them or lose them’)
Changes sleep behavior with better sleep
rejuvenation
Changes facial esthetics
CHANGES LIVES!
66. APP for Patient’s Monitoring
Their OWN Snoring…
SNORELAB.COM
for IPHONES
Snoreclock.com
for DROIDS
67. SNORELAB.COM…
• This woman snored so loudly that her whole
family wore ear plugs to sleep!
• She started the exercise program and went to
Seattle to care for her elderly mother.
• She has sent a “SNORE REPORT” every day!
74. Summary…
• Successful treatment of snoring and
sleep apnea is totally dependent
upon an accurate diagnosis of the
region of obstruction and treatment
that is directed at the ETIOLOGY!
75. Sleep…
“[Sleep is] the golden chain that ties
health and our bodies together.”
Thomas Dekker (1572-1632)