Losing tongue fat improves sleep apnea
Tongue could be a new target for treating the common sleep disorder
January 10, 2020
Science Daily/University of Pennsylvania School of Medicine
Using magnetic resonance imaging (MRI) to measure the effect of weight loss on the upper airway in obese patients, researchers found that reducing tongue fat is a primary factor in lessening the severity of OSA.
Losing weight is an effective treatment for Obstructive Sleep Apnea (OSA), but why exactly this is the case has remained unclear. Now, researchers in the Perelman School of Medicine at the University of Pennsylvania have discovered that improvements in sleep apnea symptoms appear to be linked to the reduction of fat in one unexpected body part -- the tongue.
Using magnetic resonance imaging (MRI) to measure the effect of weight loss on the upper airway in obese patients, researchers found that reducing tongue fat is a primary factor in lessening the severity of OSA. The findings were published today in the American Journal of Respiratory and Critical Care Medicine.
"Most clinicians, and even experts in the sleep apnea world, have not typically focused on fat in the tongue for treating sleep apnea," said Richard Schwab, MD, chief of Sleep Medicine. "Now that we know tongue fat is a risk factor and that sleep apnea improves when tongue fat is reduced, we have established a unique therapeutic target that we've never had before."
Twenty-two million Americans suffer from sleep apnea, a serious health condition in which breathing repeatedly stops and starts, causing patients to wake up randomly throughout their sleep cycles. The condition, which is usually marked by loud snoring, can increase your risk for high blood pressure and stroke. While obesity is the primary risk factor for developing sleep apnea, there are other causes, such as having large tonsils or a recessed jaw. CPAP (continuous positive airway pressure) machines improves sleep apnea in about 75 percent of patients, studies suggest, but for the other 25 percent -- those who may have trouble tolerating the machine -- alternative treatment options, such as oral appliances or upper airway surgery, are more complicated.
A 2014 study led by Schwab compared obese patients with and without sleep apnea, and found that the participants with the condition had significantly larger tongues and a higher percentage of tongue fat when compared to those without sleep apnea. The researchers next step was to determine if reducing tongue fat would improve symptoms and to further examine cause and effect.
The new study included 67 participants with mild to severe obstructive sleep apnea who were obese -- those with a body mass index greater than 30.0. Through diet or weight loss surgery, the patients lost nearly 10 percent of their body weight, on average, over six months. Overall, the participants' sleep apnea scores improved by 31 percent after the weight loss intervention, as measured by a sleep study.
Before and after the weight loss intervention, the study participants underwent MRI scans to both their pharynx as well as their abdomens. Then, using a statistical analysis, the research team quantified changes between overall weight loss and reductions to the volumes of the upper airway structures to determine which structures led to the improvement in sleep apnea. The team found that a reduction in tongue fat volume was the primary link between weight loss and sleep apnea improvement.
The study also found that weight loss resulted in reduced pterygoid (a jaw muscle that controls chewing) and pharyngeal lateral wall (muscles on the sides of the airway) volumes. Both these changes also improved sleep apnea, but not to the same extent as the reduction in tongue fat.
The authors believe that tongue fat is a potential new therapeutic target for improving sleep apnea. They suggest that future studies could be designed to explore whether certain low-fat diets are better than others in reducing tongue fat and whether cold therapies -- like those used to reduce stomach fat -- might be applied to reducing tongue fat. However, Schwab notes, these types of interventions have not yet been tested.
Schwab's team is also examining new interventions and other risk factors for sleep apnea, including whether some patients who are not obese but who have "fatty" tongues could be predisposed to sleep apnea, but are less likely to be diagnosed.
In a recent related study, Schwab found that ethnicity may also play a role in sleep apnea severity. His research team compared the upper airway anatomy of Chinese and Icelandic patients with sleep apnea, and found that, compared to Icelandic patients of similar age, gender, and symptoms, Chinese patients had smaller airways and soft tissues, but bigger soft palate volume with more bone restrictions. This means that Asian patients may generally be more at risk for severe sleep apnea symptoms. The bottom line, according to Schwab, is that all patients who suffer from snoring or sleepiness should be screened for sleep apnea, whether or not they appear to fall into the typical "high-risk" obese categories.
"Primary care doctors, and perhaps even dentists, should be asking about snoring and sleepiness in all patients, even those who have a normal body mass index, as, based on our data, they may also be at risk for sleep apnea," Schwab said.
https://www.sciencedaily.com/releases/2020/01/200110101035.htm
Treat insomnia before sleep apnea
August 13, 2019
Science Daily/Flinders University
The 'double whammy' of co-occurring insomnia and obstructive sleep apnea (OSA) is a complex problem best managed with non-drug targeted psych interventions, a new Australian study has found.
By following simple new guidelines, people with the concurrent conditions reported great improvement to both their sleep, and their health -- with about 50% improvement in global insomnia severity and night-time insomnia after six months.
'Co-Morbid Insomnia and Sleep Apnoea' (COMISA) is a little studied and debilitating disorder which can improve by identifying and treating insomnia separately.
The new Australian study of 145 patients aimed to work out better treatments for 'COMISA' patients who, in the past, have shown poor results from using continuous positive airway pressure (CPAP) therapy, compared to patients who do not report symptoms of insomnia.
As a result, the sleep experts are advising people living with both conditions to be treated first with a targeted, 4-10 week program of cognitive and behavioural therapy for insomnia (CBTi) -- before using CPAP machines to reduce the effects of sleep apnoea.
"We found that treating COMISA patients with non-drug CBTi before commencing CPAP significantly improved insomnia symptoms," says lead researcher Dr Alexander Sweetman, from the Adelaide Institute for Sleep Health at Flinders University.
"Importantly, we also found increased use of CPAP therapy by about one hour per night in patients treated with CBTi and CPAP therapy, compared to a group receiving treatment with CPAP alone."
OSA patients -- who comprise around 10% of the general population -- suffer from frequent airway narrowing events during sleep which leads to a poor quality of sleep and reduced daytime functioning.
About one-third of OSA patients also report clinically significant insomnia symptoms, including long-term difficulties falling asleep at the start of the night, or long awakenings during the night.
The study found the new routine resulted in CBTi patients increasing acceptance of CPAP devices by 87% and increased long-term CPAP use by one hour each night over the first four months.
At six months, combined CBTi and CPAP therapy led to significant improvements of:
· 52% in global insomnia severity, compared to 35% in the control group,
· 48% in night-time insomnia complaints, compared to 34%
· 30% in dysfunctional sleep-related cognitions (compared to 10%).
Heart disease, obesity and depression have been connected to insomnia and sleep apnea, so getting the best therapies are important to health and wellbeing for millions of people around the world, says co-author Professor Doug McEvoy.
"Long-term cardio-metabolic benefits for patients with COMISA is an important consideration, independent of those debilitating symptoms which can be relieved with the right treatment," Professor McEvoy says.
"This latest study suggests that sleep physicians and clinics should screen for insomnia symptoms and, if present, treat the insomnia with CBTi to improve subsequent acceptance and use of CPAP therapy. This will improve outcomes for both disorders."
https://www.sciencedaily.com/releases/2019/08/190813101936.htm
Common sleep myths compromise good sleep and health
April 16, 2019
Science Daily/NYU Langone Health / NYU School of Medicine
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.
These are, in fact, among the most widely held myths about sleeping that not only shape poor habits, but may also pose a significant public health threat, according to a new study publishing online in Sleep Health on April 16.
Researchers from NYU School of Medicine reviewed more than 8,000 websites to identify the 20 most common assumptions about sleep. With a team of sleep medicine experts, they ranked them based on whether each could be dispelled as a myth or supported by scientific evidence, and on the harm that the myth could cause.
"Sleep is a vital part of life that affects our productivity, mood, and general health and well-being," says study lead investigator, Rebecca Robbins, PhD, a postdoctoral research fellow in the Department of Population Health at NYU Langone Health. "Dispelling myths about sleep promotes healthier sleep habits which, in turn, promote overall better health."
The claim by some people that they can get by on five hours of sleep was among the top myths researchers were able to dispel based on scientific evidence. They say this myth also poses the most serious risk to health from long-term sleep deficits. To avoid the effects of this falsehood and others identified in this study, such as the value of taking naps when you routinely have difficulty sleeping overnight, Robbins and her colleagues suggest creating a consistent sleep schedule and spending more time, at least seven hours, asleep.
Another common myth relates to snoring. And while Robbins says snoring can be harmless, it can also be a sign of sleep apnea, a potentially serious sleep disorder in which breathing starts and stops over the course of the night. The authors encourage patients not to dismiss loud snoring, but rather to see a doctor since this sleep behavior may lead to heart stoppages or other illnesses.
The study authors also found sufficient evidence in published studies that, despite beliefs to the contrary, drinking alcoholic beverages before bed is indeed unhealthy for sleep. According to experts, alcohol reduces the body's ability to achieve deep sleep, which people need to function properly.
"Sleep is important to health, and there needs to be greater effort to inform the public regarding this important public health issue," says study senior investigator Girardin Jean Louis, PhD, a professor in the departments of Population Health and Psychiatry at NYU Langone. "For example, by discussing sleep habits with their patients, doctors can help prevent sleep myths from increasing risks for heart disease, obesity, and diabetes."
The researchers acknowledge that some myths still cause disagreement among sleep experts. For instance, although sleeping in on weekends does disrupt the natural circadian rhythm, for people in certain professions, such as shift workers, it may be better for them to sleep in than to get fewer hours of sleep overall. These discrepancies, they say, suggest that further research needs to be done.
https://www.sciencedaily.com/releases/2019/04/190416081414.htm
Synthetic cannabis-like drug reduces sleep apnea
November 28, 2017
Science Daily/Northwestern University
A synthetic cannabis-like drug in a pill was safe and effective in treating obstructive sleep apnea in the first large multi-site study of a drug for apnea funded by the National Institutes of Health. The study was conducted at Northwestern Medicine and the University of Illinois at Chicago (UIC).
There is currently no drug treatment for sleep apnea, a sleep breathing disorder affecting about 30 million individuals in the United States. In sleep apnea, breathing is interrupted, and these pauses can last from a few seconds to minutes and may occur 30 times or more an hour. Untreated apnea raises the risk of heart disease, diabetes, sleepiness, cognitive impairment and a motor vehicle accident.
Participants in the trial had reduced apnea and decreased subjective sleepiness.
The common treatment for sleep apnea is a CPAP (Continuous Positive Airway Pressure) device that delivers air (acting like an air splint) to prevent collapse of the airway and breathing pauses. But adherence to the device can be challenging for many patients, some who simply stop using it.
"There is a tremendous need for effective, new treatments in obstructive sleep apnea," said co-lead study author David W. Carley, the Katherine M. Minnich Endowed Professor Emeritus of Biobehavioral Health Sciences, Medicine and Bioengineering at UIC.
Researchers investigated the effect of dronabinol, a synthetic version of the molecule Delta-9 THC (tetrahydrocannabinol), which is in cannabis, on sleep apnea in a Phase 2 trial. The trial was the largest and longest randomized, controlled trial to test a drug treatment for sleep apnea.
Dronabinol was approved by the Food and Drug Administration more than 25 years ago to treat nausea and vomiting in chemotherapy patients.
Drug targets the brain in new approach
The drug treatment was a new approach in that it targeted the brain rather than the physical problem of collapsing airways. This reflects the new belief that sleep apnea is not just a physical problem but may be caused by multiple factors. One of those is poor regulation of the upper airway muscles by the brain, said co-lead author Dr. Phyllis Zee.
Zee is the Benjamin and Virginia T. Boshes Professor of Neurology at Northwestern University Feinberg School of Medicine and director of the Northwestern Medicine Sleep Disorders Center.
"The CPAP device targets the physical problem but not the cause," Zee said. "The drug targets the brain and nerves that regulate the upper airway muscles. It alters the neurotransmitters from the brain that communicate with the muscles. Better understanding of this will help us develop more effective and personalized treatments for sleep apnea."
While CPAP is highly effective, some patients simply refuse to use the machine. Even people who want to use it often only stick with it for about four hours a night, on average, Carley said.
"So the best they can get is a roughly 50 percent improvement in their apnea," Carley said. "When people take a pill to treat apnea, they are treated for the entire night."
The final version of the paper will be published Dec. 5 in the journal SLEEP.
How the study worked
In the study, 73 adult patients with moderate or severe sleep apnea were divided into three groups. One group was given a low dose of the drug, a second group received a higher dose and the third, a placebo. Participants took the drug once daily before bed for six weeks.
Six weeks of treatment by the highest dose of dronabinol (10 milligrams) was associated with a lower frequency of apneas or hypopneas (overly shallow breathing) during sleep, decreased subjective sleepiness and greater overall treatment satisfaction compared to the placebo group. The severity of their disorder was reduced by 33 percent compared to complete compliance with the mechanical treatment, although complete compliance for the night is rare.
Real marijuana not the same as apnea drug
Can a person simply ingest or smoke marijuana and get the same benefits for sleep apnea?
No, said Zee. "Different types of cannabis have different ingredients," she noted. "The active ingredient may not be exactly the same as what's indicated for sleep apnea."
"Cannabis contains dozens of active ingredients, but we tested just purified delta-9 THC," added Carley.
Larger scale clinical trials are needed to clarify the best approach to cannabinoid therapy in obstructive sleep apnea, the authors said.
UIC has licensed intellectual property related to the experimental drug treatment used in the study to the pharmaceutical company RespireRx.
Researchers have attempted to identify drugs to treat sleep apnea for nearly 35 years, but to no avail, Carley said.
Carley developed the idea that dronabinol might be useful in treating sleep apnea more than 15 years ago. He and colleagues tested the concept in an animal model of apnea, publishing their findings in the journal SLEEP in 2002 and launched a subsequent pilot study in humans in 2007. Those encouraging findings from the small-scale pilot study formed the basis for this multi-center clinical trial led by Carley and Zee.
"By providing a path toward the first viable obstructive sleep apnea drug, our studies could have a major impact on clinical practice," he said.
https://www.sciencedaily.com/releases/2017/11/171128230117.htm
Ecstasy use may lead to sleep apnea: Illegal 'club drug' poisons neurons involved in control of breathing during sleep
December 3, 2009
Science Daily/Johns Hopkins Medical Institutions
Repeated use of the drug popularly known as "ecstasy" significantly raises the risk of developing sleep apnea in otherwise healthy young adults with no other known risk factors for the sleep disturbance, a new study by Johns Hopkins scientists suggests. The finding is the latest highlighting the potential dangers of the amphetamine-style chemical, currently used illegally by millions of people in the United States.
The Johns Hopkins scientists note that sleep apnea itself can lead to an assortment of health problems, including a decline in cognitive function, an increased risk of diabetes, and an increased risk of death from heart disease.
"We know that abusing drugs can have numerous harmful effects. Our findings show yet another reason not to use ecstasy," according to lead researcher Una D. McCann, M.D.
Users claim the drug enhances intimacy, diminishes anxiety, and facilitates some forms of psychotherapy.
The team led by McCann, professor in the Department of Psychiatry at the Johns Hopkins University School of Medicine, previously linked ecstasy, or methylenedioxymethamphetamine (MDMA), to a variety of neurological problems, including subtle cognitive deficits, impulsive behavior, and altered brain wave patterns during sleep. These problems are thought to arise from the drug's targeted toxic effects on neurons that produce the hormone serotonin. Studies in animals and people have shown that MDMA use shortens the filament-like ends of these nerve cells, preventing them from making normal connections with other neurons.
Because these cells regulate multiple aspects of sleep, McCann's team recruited 71 sleep study volunteers, all MDMA users, by advertising for "club drug users" in newspapers and fliers. All had typically used other recreational drugs as well. They also recruited 62 participants who had similar patterns of illegal drug use but had never taken MDMA. The MDMA users had taken the drug at least 25 times in the past, a number previously shown to have lasting effects on serotonin neurons. All of the volunteers were otherwise physically and mentally healthy and had abstained from drug use for at least two weeks prior to the study.
To evaluate the participants' breathing patterns during sleep, each volunteer spent a few nights at a sleep research center. From "lights out" at 11:00 p.m. to "lights on" at 7:00 a.m., study volunteers slept while hooked up to a variety of devices to measure breathing, including airflow monitors at their noses and mouths and bands around their chests and abdomens to measure expansion.
The researchers diagnosed sleep apnea by counting the rate of incidences of shallow or suppressed breathing, with mild apnea requiring five to 14 of these incidences, moderate apnea requiring 15 to 29, and severe apnea requiring 30 or more.
Results published in the Dec. 2, 2009, issue of Neurology, the medical journal of the American Academy of Neurology, showed that rates of mild apnea were similar between the two groups, with 15 MDMA users and 13 other volunteers affected. However, while 8 MDMA users had the moderate form of apnea and 1 had the severe form, none of the other volunteers had either of these more serious forms. Results showed that the more participants had used MDMA in the past, the more severe their apnea was likely to be.
Known risk factors for sleep apnea include older age, obesity, and other medical conditions. However, McCann says, of the 24 ecstasy users who had sleep apnea, 22 were age 31 or younger, and none had any known serious medical problems.
"Our subjects were otherwise healthy young adults, so this is a very surprising finding," she says.
Though the researchers suspect that the cause for the MDMA users' sleep apnea centers on affected serotonin neurons, the exact mechanism remains a mystery. McCann explains that these neurons appear to help sense blood oxygen levels, control airway opening and generate breathing rhythms. Any of these pathways could be separately influenced by ecstasy use, she says. The researchers are currently working to tease apart which pathway is at play in MDMA users.
https://www.sciencedaily.com/releases/2009/12/091202162332.htm
Absentmindedness points to earlier warning signs of silent strokes among people at risk
February 6, 2019
Science Daily/Baycrest Centre for Geriatric Care
Adults who notice that they frequently lose their train of thought or often become sidetracked may in fact be displaying earlier symptoms of cerebral small vessel disease, otherwise known as a 'silent stroke,' suggests a recent study.
Researchers uncovered that individuals with damage to the brain's white matter, caused by silent strokes, reported poor attentiveness and being distracted more frequently on day-to-day tasks, according to a recently published paper in the journal Neurobiology of Aging. Despite these complaints, about half of the people with identified white matter damage scored within the normal range on formal laboratory assessments of attention and executive function (a person's ability to plan, stay organized and maintain focus on overall goals).
"Our results indicate that in many cases of people who were at a higher risk of silent stroke and had one, they saw a notable difference in their ability to stay focused, even before symptoms became detectable through a neuropsychological test," says Ayan Dey, lead author on the paper and a graduate student at Baycrest's Rotman Research Institute (RRI) and the University of Toronto. "If a person feels this may be the case, concerns should be brought to a doctor, especially if the person has a health condition or lifestyle that puts them at a higher risk of stroke or heart disease."
Cerebral small vessel disease is one of the most common neurological disorders of aging. This type of stroke and changes in the brain's blood flow (vascular changes) are connected to the development of vascular dementia and a higher risk of Alzheimer's disease and other dementias.
The strokes are "silent" since they don't cause lasting major changes seen with an overt stroke, such as affecting a person's ability to speak or paralysis. Despite a lack of obvious symptoms, cerebral small vessel disease causes damage to the brain's white matter (responsible for communication among regions), which can cause memory and cognitive issues over time.
Typically, this type of stroke is uncovered incidentally through MRI scans or once the brain damage has worsened, says Dey.
"There are no effective treatments for Alzheimer's disease, but brain vascular changes can be prevented or reduced through smoking cessation, exercise, diet and stress management, as well as keeping one's blood pressure, diabetes and cholesterol under control," says Dr. Brian Levine, senior author on the paper, RRI senior scientist and professor of Psychology and Neurology at the University of Toronto. "With the right diagnosis, these interventions and lifestyle changes give older adults who are at risk for cognitive decline some options for maintaining brain health."
The study looked at results from 54 adults (between the ages of 55 to 80), who also possessed at least one risk factor for a stroke, such as high blood pressure, high cholesterol, diabetes, sleep apnea, a history of smoking, past mini strokes and advanced age above 75.
Research participants had their brains scanned by MRI and scientists analyzed brain tissue damage, specifically in relation to white matter, to determine injuries caused by cerebral small vessel disease. They also took part in a number of neurocognitive tests and questionnaires that assessed their attention and executive function.
Following up on this study, researchers will analyze functional brain imaging and electrical brain activity from participants to look at the differences in brain networks. They hope to uncover why some people are still able to perform well on cognitive assessments, despite damage to the brain.
"The question that remains is whether overcoming these changes in the brain is a natural ability some people have or if this is something that can be built up over time," says Dey. "If it's something that can be developed, is it something we can train?"
https://www.sciencedaily.com/releases/2019/02/190206091417.htm
Sleep, Alzheimer's link explained
July 10, 2017
Science Daily/Washington University in St. Louis
Disrupting just one night of sleep in healthy, middle-aged adults causes an increase in a brain protein associated with Alzheimer's disease, research shows. Further, a week of poor sleep leads to an increase in another brain protein that has been linked to brain damage in Alzheimer's and other neurological diseases.
A good night's sleep refreshes body and mind, but a poor night's sleep can do just the opposite. A study from Washington University School of Medicine in St. Louis, Radboud University Medical Centre in the Netherlands, and Stanford University has shown that disrupting just one night of sleep in healthy, middle-aged adults causes an increase in amyloid beta, a brain protein associated with Alzheimer's disease. And a week of tossing and turning leads to an increase in another brain protein, tau, which has been linked to brain damage in Alzheimer's and other neurological diseases.
"We showed that poor sleep is associated with higher levels of two Alzheimer's-associated proteins," said David M. Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor, head of the Department of Neurology and the study's senior author. "We think that perhaps chronic poor sleep during middle age may increase the risk of Alzheimer's later in life."
These findings, published July 10 in the journal Brain, may help explain why poor sleep has been associated with the development of dementias such as Alzheimer's.
More than 5 million Americans are living with Alzheimer's disease, which is characterized by gradual memory loss and cognitive decline. The brains of people with Alzheimer's are dotted with plaques of amyloid beta protein and tangles of tau protein, which together cause brain tissue to atrophy and die. There are no therapies that have been proven to prevent, slow or reverse the course of the disease.
Previous studies by Holtzman, co-first author Yo-El Ju, MD, an assistant professor of neurology, and others have shown that poor sleep increases the risk of cognitive problems. People with sleep apnea, for example, a condition in which people repeatedly stop breathing at night, are at risk for developing mild cognitive impairment an average of 10 years earlier than people without the sleep disorder. Mild cognitive impairment is an early warning sign for Alzheimer's disease.
But it wasn't clear how poor sleep damages the brain. To find out, the researchers -- Holtzman; Ju; co-first author and graduate student Sharon Ooms of Radboud; Jurgen Claassen, MD, PhD, of Radboud; Emmanuel Mignot, MD, PhD, of Stanford; and colleagues -- studied 17 healthy adults ages 35 to 65 with no sleep problems or cognitive impairments. Each participant wore an activity monitor on the wrist for up to two weeks that measured how much time they spent sleeping each night.
After five or more successive nights of wearing the monitor, each participant came to the School of Medicine to spend a night in a specially designed sleep room. The room is dark, soundproof, climate-controlled and just big enough for one; a perfect place for sleeping, even as the participants wore headphones over the ears and electrodes on the scalp to monitor brain waves.
Half the participants were randomly assigned to have their sleep disrupted during the night they spent in the sleep room. Every time their brain signals settled into the slow-wave pattern characteristic of deep, dreamless sleep, the researchers sent a series of beeps through the headphones, gradually getting louder, until the participants' slow-wave patterns dissipated and they entered shallower sleep.
The next morning, the participants who had been beeped out of slow-wave sleep reported feeling tired and unrefreshed, even though they had slept just as long as usual and rarely recalled being awakened during the night. Each underwent a spinal tap so the researchers could measure the levels of amyloid beta and tau in the fluid surrounding the brain and spinal cord.
A month or more later, the process was repeated, except that those who had their sleep disrupted the first time were allowed to sleep through the night undisturbed, and those who had slept uninterrupted the first time were disturbed by beeps when they began to enter slow-wave sleep.
The researchers compared each participant's amyloid beta and tau levels after the disrupted night to the levels after the uninterrupted night, and found a 10 percent increase in amyloid beta levels after a single night of interrupted sleep, but no corresponding increase in tau levels. However, participants whose activity monitors showed they had slept poorly at home for the week before the spinal tap showed a spike in levels of tau.
"We were not surprised to find that tau levels didn't budge after just one night of disrupted sleep while amyloid levels did, because amyloid levels normally change more quickly than tau levels," Ju said. "But we could see, when the participants had several bad nights in a row at home, that their tau levels had risen."
Slow-wave sleep is the deep sleep that people need to wake up feeling rested. Sleep apnea disrupts slow-wave sleep, so people with the disorder often wake up feeling unrefreshed, even after a full eight hours of shut-eye.
Slow-wave sleep is also the time when neurons rest and the brain clears away the molecular byproducts of mental activity that accumulate during the day, when the brain is busily thinking and working.
Ju thinks it is unlikely that a single night or even a week of poor sleep, miserable though it may be, has much effect on overall risk of developing Alzheimer's disease. Amyloid beta and tau levels probably go back down the next time the person has a good night's sleep, she said.
"The main concern is people who have chronic sleep problems," Ju said. "I think that may lead to chronically elevated amyloid levels, which animal studies have shown lead to increased risk of amyloid plaques and Alzheimer's."
Ju emphasized that her study was not designed to determine whether sleeping more or sleeping better reduce risk of Alzheimer's but, she said, neither can hurt.
"Many, many Americans are chronically sleep-deprived, and it negatively affects their health in many ways," Ju said. "At this point, we can't say whether improving sleep will reduce your risk of developing Alzheimer's. All we can really say is that bad sleep increases levels of some proteins that are associated with Alzheimer's disease. But a good night's sleep is something you want to be striving for anyway."
https://www.sciencedaily.com/releases/2017/07/170710161442.htm
Mediterranean diet and exercise can reduce sleep apnea symptoms
November 28, 2011
Science Daily/European Lung Foundation
Eating a Mediterranean diet combined with physical activity can help to improve some of the symptoms of sleep apnea, according to new research. The study, which is published online in the European Respiratory Journal, looked at the impact a Mediterranean diet can have on obese people with sleep apnea, compared to those on a prudent diet.
Obstructive sleep apnea syndrome (OSAS) causes frequent pauses of breathing to occur during sleep, which disrupts a person's normal sleeping pattern. It is one of the most prevalent sleep-related breathing disorders with approximately 2-4% of the adult population experiencing the condition. This percentage increases up to 20-40% with obesity, and weight loss is often an essential part of the recommended treatment plan.
The researchers, from the University of Crete in Greece, examined 40 obese patients suffering from OSAS. Twenty patients were given a prudent diet to follow, while the other 20 followed a Mediterranean diet. Both groups were also encouraged to increase their physical activity, mainly involving walking for at least 30 minutes each day.
In both groups, the patients also received continuous positive airway pressure (CPAP) therapy which involves wearing a mask that generates an air stream, keeping the upper airway open during sleep.
The researchers monitored the patients during a sleep study, known as polysomnography. This involved monitoring several markers for OSAS, including electrical activity in the brain, eye movements and snoring. The patients were examined at the start of the study and again 6 months later.
The results showed that people following the Mediterranean diet had a reduced number of disturbances, known as apneas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night.
The findings also revealed that people following the Mediterranean diet also showed a greater adherence to the calorie restricted diet, an increase in physical activity and a greater decrease in abdominal fat.
The results of this small sample did show an improvement during one stage of sleep for people with sleep apnea, however it did not show an overall improvement in severity of the condition. The authors suggest that further studies in a larger sample are required to fully understand the benefits of this diet.
Christopher Papandreou, lead author for the research, said: "This is the first study examining the impact of the Mediterranean diet in combination with physical activity on OSAS via changes in the human body. Our results showed that the number of disturbances during REM sleep was reduced more in the Mediterranean diet group than the other group. Recent reports have related an increase in disturbances during REM sleep with the risk of developing significant systemic consequences like diabetes type II. However, its clinical significance remains unclear. Finally, more studies are needed to examine the effect of the above diet on this sleep-related breathing disorder taking into account its anti-inflammatory and antioxidant properties."
http://www.sciencedaily.com/releases/2011/11/111102093043.htm
High risk of sleep apnea in young veterans with PTSD
May 19, 2015
Science Daily/American Academy of Sleep Medicine
The probability of having a high risk of obstructive sleep apnea increased with increasing severity of post-traumatic stress disorder symptoms (PTSD), a new study of young US veterans shows. The study involved 195 Iraq and Afghanistan veterans who visited a Veterans' Affairs outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity.
The study involved 195 Iraq and Afghanistan veterans who visited a VA outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity. Every clinically significant increase in PTSD symptom severity was associated with a 40 percent increase in the probability of screening as high risk for sleep apnea.
"The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated," said co-principal investigator Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine. "This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety."
The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep disease afflicting at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. The AASM and other partners in the National Healthy Sleep Awareness Project, which is funded by the Centers for Disease Control and Prevention, urge anyone with symptoms of sleep apnea to visit http://www.stopsnoringpledge.org to pledge to "Stop the Snore" by talking to a doctor.
The study idea was initiated by Tonya Masino, MD, who was the first to recognize that a surprising number of younger veterans who were coming to the clinic for PTSD treatment also were presenting with sleep apnea symptoms. Study results are published in the May 15 issue of the Journal of Clinical Sleep Medicine.
Ninety-three percent of study participants were men, and their mean age was 33 years. Sleep apnea risk was evaluated using the Berlin Questionnaire, and PTSD was assessed using the PTSD Checklist Stressor Specific Version (PCL-S) questionnaire. Analyses controlled for potential confounders such as older age, smoking status, and use of central nervous system depressants.
According to the authors, younger veterans with PTSD are rarely screened for sleep apnea and frequently remain undiagnosed. They noted that the mechanism underlying the relationship between sleep apnea and PTSD in military veterans is unclear. However, potential factors that may connect the two disorders include disturbed sleep in combat, prolonged sleep deprivation, sleep fragmentation and hyperarousal due to the physical and psychological stressors of combat, the chronic stress from PTSD, or the sleep disturbances caused by OSA. Longitudinal studies are needed to examine the temporal relationship between sleep apnea and PTSD.
The study was led by Norman and co-principal investigator Abigail Angkaw, PhD. The lead author of the study is Peter Colvonen, PhD.
According to the National Center for PTSD of the U.S. Department of Veterans Affairs, PTSD symptoms such as nightmares or flashbacks usually start soon after a traumatic event, but they may not appear until months or years later. Symptoms that last longer than four weeks, cause great distress or interfere with daily life may be a sign of PTSD. To get help for PTSD, veterans can call the Veterans Crisis Line at 1-800-273-8255 and press 1, text 838255, contact a local VA Medical Center, or use the online PTSD program locator on the VA website.
http://www.sciencedaily.com/releases/2015/05/150519182243.htm
Older women with breathing problems during sleep experience decline in ability to perform daily tasks
November 12, 2014
Science Daily/Johns Hopkins Bloomberg School of Public Health
Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study.
The findings are notable given the aging of the population -- an estimated 3.7 million Americans will turn 65 in 2015, and by 2030, 19 percent of the U.S. population will be 65 or older -- and the fact that sleep-disordered breathing is treatable. Older adults are as much as four times as likely as middle-aged individuals to have problems with breathing during sleep.
Sleep-disordered breathing involves repeated interruptions or decreases in breathing during sleep, which often leads to fragmented sleep and hypoxemia, or low blood oxygen levels.
Doctors rate the severity of sleep-disordered breathing with the apnea-hypopnea index (AHI), which reflects the number of breathing interruptions (apneas) and the number of significant decreases in breathing (hypopneas) per hour of sleep.
The researchers say they believe it is the low blood-oxygen levels caused by sleep-disordered breathing that cause the trouble with daily tasks, and not sleep fragmentation, which is also increased by sleep-disordered breathing.
http://www.sciencedaily.com/releases/2014/11/141112134748.htm
Half of pregnant women who have hypertension and snore unknowingly have a sleep disorder
June 2, 2014
Science Daily/University of Michigan Health System
A substantial proportion of hypertensive pregnant women have obstructive sleep apnea, and many may not be aware. We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies," says the lead author. “Our findings show that a substantial proportion of hypertensive pregnant women have obstructive sleep apnea and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes.”
"We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies," says lead author Louise O'Brien, Ph.D., M.S., associate professor at U-M's Sleep Disorders Center in the Department of Neurology and adjunct associate professor in the Department of Obstetrics & Gynecology at the U-M Medical School.
"Our findings show that a substantial proportion of hypertensive pregnant women have obstructive sleep apnea and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes."
Habitual snoring – snoring three or more nights a week – is the hallmark symptom of obstructive sleep apnea, which has been shown to increase in frequency during pregnancy. and affects up to one-third of women by the third trimester.
O'Brien's previous studies have found that snoring during pregnancy may influence delivery and baby's health, with a higher risk for C-sections and delivering smaller babies. Women who begin snoring during pregnancy are also at a strong risk for high blood pressure and preeclampsia, O'Brien's research has shown.
"Hypertensive pregnant women who report snoring should be evaluated for obstructive sleep apnea since sleep apnea can be treated during pregnancy," says O'Brien, who is also a member of the Institute for Healthcare Policy and Innovation.
"Prompt recognition, evaluation, and management will not only improve health benefits for both moms and babies but may also help cut the high healthcare expenses of operative deliveries, taking care of babies who are admitted to the NICU and other associated health risks."
http://www.sciencedaily.com/releases/2014/06/140602102009.htm