Chicago Sleep Apnea Treatment: CPAP, BIPAP, Surgery And Oral Appliance Therapy Memory Problems Linked To Stopping CPAP Treatment

    GURNEE, IL, October 02, 2009 /24-7PressRelease/ -- Sleep apnea can have numerous adverse effects on health including cardiovascular problems, endocrine problems and neurologic deficits. Studies have shown resolution of these problems with CPAP use. All current studies have shown that if if the apnea is resolved with CPAP, oral appliances or surgery, the results are similar.

CPAP is considered the gold standard for sleep apnea treatment while oral appliances are a first line treatment for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea when patients do not tolerate CPAP. Surgery is a first line treatment for children with large tonsils and adenoids but otherwise has not been as effective as oral appliances and is not considered a first line treatment.

Recent studies have shown that 60% of patients abandon CPAP use and that most patients prefer oral appliances to CPAP. A recent article in the Journal of Sleep and Respiration Sept 17,2009 describes treatment as "adherence is notoriously low, and holidays from treatment are common." This is a serious problem because the study also showed significant declines in performance after acute withdrawal of CPAP. It showed patients experienced "declines in cognitive performance that would need considerable reallocation of resources to function at the same cognitive levels as with PAP treatment." (abstract is included below for convenience)

Patient studies have shown that the majority of patients offered a choice prefer oral appliance therapy to CPAP when offered a choice and compliance rates are much higher. Patients interested in learning more about comfortable and effective oral appliance therapy for sleep apnea can find more information at http://www.ihatecpap.com/oral_appliance.html While oral appliance therapy is preferred over CPAP there are still non-compliant patients who surgery may be the best option. The most successful surgeries are bimaxillary advancements and tongue reductions. Most patients benefit by opening of the nasal airway by correction of deviate septums or turbinate reduction even though this is rarely a cure. UP3 surgery or, uvulopalatalpharyngealplasty is rarely curative and has a high morbidity rate. The majority of patients will still require CPAP or oral appliances. Additional information on surgery for treating sleep apnea is available at http://www.ihatecpap.com/sleep_apnea_surgery.html

Sleep apnea has been implicated in short term memory loss and other neurologic dysfunctions. It is not causative for Alzheimer's or Dementia but untreated apnea does have a negative effect on these disorders. It is vitally important that patients who are using CPAP therapy be carefully followed and if they do not consistently use their PAP machines they should be directed to an expert in Dental Sleep Medicine for evaluation on use of an oral appliance. Patients who are not compliant with CPAP or oral appliances should be considered for surgical intervention.

Patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents and a 300% increase in MVA with serious injuries. It is especially important that anyone involved in transportation, trucking airlines etc be carefully monitored.

Chicagoland Dental Sleep Medicine Associates provides consultation and treatment of sleep apnea and snoring. Dr Ira L Shapira is a Diplomate of the American Board of Dental Sleep Medicine and can be contacted at 1-8-NO-PAP-MASK.

From PubMed.gov
"J Sleep Res. 2009 Sep 17. [Epub ahead of print]Links
Treatment effects on brain activity during a working memory task in obstructive sleep apnea.Aloia MS, Sweet LH, Jerskey BA, Zimmerman M, Todd Arnedt J, Millman RP.
Department of Medicine, National Jewish Medical and Research Center, Denver, CO.

Summary Positive airway pressure (PAP) is the most common form of treatment for obstructive sleep apnea (OSA). Treatment adherence is notoriously low, and holidays from treatment are common. To date, there is no literature on the effects of acute withdrawal from PAP treatment on the brain activity of individuals with OSA. Nine participants with OSA performed a 2-Back verbal working memory paradigm during repeated functional magnetic resonance imaging (FMRI). Counterbalanced FMRI sessions were under conditions of PAP treatment (at least one consecutive week) or non-treatment (for two consecutive nights). Treatment effects on 2-Back-related brain activity were significant, with greater deactivation in the right posterior insula and overactivation in the right inferior parietal lobule. The observed responses to PAP treatment withdrawal were more extreme in all regions of interest, such that 2-Back-related activity increased and 2-Back-related deactivation decreased further relative to the 0-Back control task. The withdrawal of PAP treatment in effectively treated individuals with OSA might result in the need to reallocate resources in order to perform at the same cognitive level.

PMID: 19765205 [PubMed - as supplied by publisher]

Related articles
Working memory in obstructive sleep apnea: construct validity and treatment effects. J Clin Sleep Med. 2007 Oct 15; 3(6):589-94.
[J Clin Sleep Med. 2007]
Brain activation changes before and after PAP treatment in obstructive sleep apnea. Sleep. 2009 Sep 1; 32(9):1161-72.
[Sleep. 2009]
Neural activation patterns during working memory tasks and OSA disease severity: preliminary findings. J Clin Sleep Med. 2009 Feb 15; 5(1):21-7.
[J Clin Sleep Med. 2009]
ReviewPositive airway pressure treatment for obstructive sleep apnea. Chest. 2007 Sep; 132(3):1057-72.
[Chest. 2007]
ReviewA review of neuroimaging in obstructive sleep apnea. J Clin Sleep Med. 2006 Oct 15; 2(4):461-71. "

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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