Studies Show that People with Sleep Apnea have a High Risk of Death

A study in the August 1 issue of the journal Sleep shows that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea, and this risk increases when sleep apnea is untreated. Results show that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index. When 126 participants who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis, the hazard ratio for all-cause mortality related to severe sleep apnea rose to 4.3.

"We found that both men and women with sleep apnea in the general population - not patients - mostly undiagnosed and untreated, had poorer survival compared with persons without sleep apnea, given equa! l BMI, a ge and sex," said principal investigator and lead author Terry Young, PhD, professor of epidemiology at the University of Wisconsin-Madison.

According to Young, most previous studies of sleep apnea and mortality have involved patients referred for a clinical sleep diagnostic evaluation; the mortality risk for sleep apnea in the general population has not been previously reported.

The study was an 18-year follow-up of 1,522 participants in the ongoing Wisconsin Sleep Cohort Study, which was established in 1988 and involved a random sample of men and women from the community who were between the ages of 30 and 60 when the study began. After spending one night at the University of Wisconsin General Clinical Research Center for assessment by polysomnography, participants were categorized by apnea-hypopnea index (AHI), which is the average number of breathing pauses (apneas) and reductions (hypopneas) per hour of sleep. Sixty-three individuals (about four percent) had severe sleep apnea at baseline with an AHI of 30 or more and a range of 30 to 97 apneas and hypopneas per hour. About 76 percent of the study group (1,157 individuals) had no sleep apnea with an AHI of less than five.

For the follow-up study, state and national death records were reviewed up to 3/1/08, to identify participants who had died and to note the causes of death listed on the death certificates. Eighty deaths were recorded, including 37 deaths attributed to cancer and 25 deaths attributed to cardiovascular disease and stroke.

About 19 percent of participants with severe sleep apnea died (12 deaths), compared with about four percent of participants with no sleep apnea (46 deaths). Although participants with mild sleep apnea (AHI of five to 14) or moderate sleep apnea (AHI of 15 to 29) had a mortality risk that was 50 percent greater than those with no sleep apnea, the results did not achieve statistical significance.

Hazard ratios for all-cause mortality remained high after further adjustments! for oth er factors such as smoking, alcohol use, sleep duration and total cholesterol. Severe sleep apnea was associated with increased mortality whether or not participants experienced daytime sleepiness.

About 42 percent of deaths in people with severe sleep apnea (5 of 12 deaths) were attributed to cardiovascular disease or stroke, compared with 26 percent of deaths in people with no sleep apnea (12 of 46 deaths). When the 126 participants who reported regular CPAP use were removed from the analysis, the hazard ratio for cardiovascular mortality soared from 2.9 to 5.2 for people with severe sleep apnea. The results suggest that regular CPAP use may protect sleep apnea patients against cardiovascular death.

"I was surprised by how much the risks increased when we excluded people who reported treatment with CPAP," Young said. "Our findings suggest - but cannot prove - that people diagnosed with sleep apnea should be treated, and if CPAP is the prescribed treatment, regular use may prevent premature death."

Statistical adjustments show that high blood pressure, cardiovascular disease, stroke and diabetes may play a role in the association between sleep apnea and mortality, but the specific mechanisms by which sleep apnea contributes to mortality remain unclear.

The study was supported by grants from the National Institutes of Health.
According to the American Academy of Sleep Medicine, obstructive sleep apnea (OSA) involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

The most common treatment for OSA is CPAP therapy, which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels.



To learn more about this or you have any questions please feel free to visit our website at www.howardcountydentist.com. Call us at(410)-442-2800 or email us at info@howardcountydentist.com

Got Bloody Gums?

OK, this isn’t as fun and sexy to talk about as cosmetic dentistry but it’s time to sound the alarm on one of the most common diseases around. It’s GUM DISEASE folks and 75% of Americans have some stage of it.

Sadly, most people think that it’s normal when gums bleed. Well it’s not! If you washed your hands and they started to bleed, wouldn’t you get a little worried? Of course you would, yet most people don’t get worried about bleeding gums because no one is telling them it is serious gum disease that could be deadly! Well I am moved to start broadcasting this message far and wide and I’m also ready to do some serious intellectual battling with anyone that tells you something different.

The New England Journal of Medicine has reported that inflammation like you find in gum disease causes the liver to produce C - reactive protein which is a better indicator of future heart attack and stroke than cholesterol. Think of all the fuss we’ve heard about cholesterol over the years and now imagine a heightened concern that actually causes people to return to the dentist. It now should be standard protocol for physicians to send their stroke and heart risk patients straight to the dentist to get their gum disease under control as their first line of defense.

And there’s more. Did you know that dentists play a role in identifying the 5 million Americans with undiagnosed diabetes? This is because diabetics are more susceptible to gum disease and that can cause their mortality rate to rise by a factor of 7.5. Patients that don’t respond to our best efforts to get their hygiene under control may have undiagnosed diabetes. Patient with diabetes must keep their gum health pristine to increase their chances of survival.

And there’s still more! University of Southern California researchers have reported that gum disease inflammation can quadruple the risk of developing Alzheimer’s Disease and that treating the inflammation could help stave off the disease.
Still more. The Journal of Periodontology (oral gums and bone) showed that pregnant women with high levels of bacteria in their mouth are at high risk for delivering preterm low-weight babies. Doctors believe that the bacterium from the mouth travels to the uterus and interferes with the pregnancy.

And finally…we have always known that gum infections of the mouth can spread to other parts of the body like the heart and even the brain! The news about gum disease and its connection to our overall health continues to come up again and again in research and medicine. It’s time to get deadly serious about the disease that most of the planet still does not take seriously.

Here’s the good news! In our office we have the systems and technology to get gum disease under control 98% of the time without specialist surgery.

To learn more about this or you have any questions please feel free to visit our website at www.howardcountydentist.com. Call us at(410)-442-2800 or email us at info@howardcountydentist.com

Taking Care of Your Oral Health Is Important

Please check out our website at www.howardcountydentist.com or call our office at (410) 442-2800.