Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

June 21, 2017

The Sleepless, Hungry Brain

Filed under: Blog — Tags: , , , , , — Riley Forbes @ 5:23 am

Your brain is not static. It is an ever-changing web neuronal connections, like wires, called synapses. When we imagine the brain, we imagine this sleek, complex circuitry. What science understands, but rarely portrays, is that it is messy. Synapses are removed and created, dysfunctional neurons are often destroyed. The brain has a clean-up crew. Part of that involves the astrocytes. These cells prowl the brain, pruning unnecessary or damaged synapses.

A recent study has investigated the relationship between the activity of these cells, and sleep deprivation. The authors demonstrate that losing one night’s sleep will result in a further 2% astrocyte activity, and the chronically sleep deprived a further 7.5% activity. Furthermore, other maintenance and disposal cells are more active after chronic sleep deprivation.

Increased activity in such cells has been linked to neurodegenerative disorders, such as Alzheimer’s disease. This is another item in the long list of reasons to value sleep. Further research is needed to clarify the effects of sleep disrupting disorders like obstructive sleep apnoea, and periodic leg movement disorder, but the way the wind is blowing, it appears these could play a similar role to deprivation in terms of neurodegeneration.

Bellesi, M., de Vivo, L., Chini, M., Gilli, F., Tononi, G. and Cirelli, C. (2017). Sleep Loss Promotes Astrocytic Phagocytosis and Microglial Activation in Mouse Cerebral Cortex. The Journal of Neuroscience, 37(21), pp.5263-5273.

June 19, 2017

Have you watched yourself snore?? It may help…

Filed under: Blog — Tags: , , , , , — Phil Teuwen @ 7:40 am

Have you been told that you snore or stop breathing in your sleep? Have you been shown that you do this? If you have watched a video of yourself snoring or stopping breathing in your sleep, that video may actually be a helpful tool for you.

Aloia et al. from the National Jewish Heath in Denver recently released some preliminary findings at the Associated Professional Sleep Societies. They are currently performing a randomised controlled trial. The trial consists of patients with an average age of 50 years old,  who have recently been diagnosed with Obstructive Sleep Apnoea (OSA). These patients were split into three groups:

  • Those that watched a video of themselves snoring and gasping for air
  • Those that watched a video of others snoring and gasping for air
  • Those who watched no video

All patients received routine CPAP education.

What they found was that those that watched video of themselves used CPAP for a mean of 6.5hrs per night, those that watched someone else used it for 4.1hrs and those who didn’t watch anyone had 3.5 hrs of usage per night. This usage was measured over the first 90 days of therapy.

These findings are quite interesting, and in future (with more data) video may become an important tool in CPAP education.

 

View the original article here:

http://www.mdedge.com/chestphysician/article/140357/sleep-medicine/personalized-snoring-video-boosts-cpap-adherence

May 29, 2017

March 27, 2017

MATRx and Mandibular Advancement Splints; changes to sleep studies coming?

Filed under: Blog — Tags: , , , , — Phil Teuwen @ 3:47 am

Mandibular Advancement Splints are a common treatment for Obstructive Sleep Apnoea (OSA). These look much like the mouthguards that your favourite football stars wear on the weekend. These work by having two plates, these plates (or mouth guards) sit over your teeth (top and bottom) and connect help keep your lower jaw forward. It is thought that by stabilising and/or protruding the lower jaw forward, the MAS devices prevent the soft tissue of the upper airway from collapsing and thus treating OSA.

MAS – the pro’s:

  • Patient compliance is generally pretty good. The devices are easy to wear and can be a comfortable sleep therapy

MAS – the con’s:

  • These don’t always work for every patient, i.e. the efficacy of therapy is lower than other OSA treatment
  • Can have side effects on the jaw, bite and dentition

MAS – the summery:

  • What these devices may lose in efficacy they may gain in compliance
  • Its hard to know if the MAS will work prior to having the device made, can be a $2000 treatment that may or may not treat OSA
  • A fully fitted MAS device can cost a similar amount to CPAP (CPAP = gold standard treatment for OSA

 

MATRx

 

Recently Sutherland et al tested a device called MATRx at the Royal North Shore Hospital in Sydney. What this device does, is it allows a MAS to be adjusted remotely, i.e. by a sleep technician while a patient is asleep in the sleep unit. They found that by adjusting the device overnight during a sleep study, they could actually give a good indication of whether or not the MAS would be suitable or not.

 

Why is this important? Well, if a disposable MAS could be made cheaply and used during a sleep study, we could potentially identify those patients who may be suitable for a MAS device. More importantly, we could identify those who are NOT suitable candidates for MAS. These patients otherwise need to pay for the device up front, then have a sleep study to see if it works. Hopefully, in time, patients may be able to have a trial device made, and have the sleep study to assess its effectiveness before having to spend the money to have the device made.

 

Go here for the original article: http://www.aasmnet.org/JCSM/ViewAbstract.aspx?pid=30965

March 23, 2017

Obesity, Sleep Apnoea, and Heart Surgery

Filed under: Blog — Tags: , , , , , , , , — Mark Russell-Pavier @ 1:25 am

A study recently published in Chest investigated obesity, sleep disordered breathing and complications after cardiac surgery. Atrial fibrillation, the complication being investigated, is an abnormal heart rhythm characterised by rapid and irregular beating; a disruption in the electrical system of your heart.

The study took large group of 190 people. Each person had done a sleep study, and then had cardiac surgery within three years. The investigation aimed to use that data to determine whether sleep apnoea is a risk factor for post-cardiac surgery atrial fibrillation. Whilst the study concluded that there was no association between the two, the methodology may be flawed.

The study took the AHI of the patients, and adjusted it for obesity, and then compared that to atrial fibrillation numbers. By doing this they may have eliminated a great deal of the variation in AHI, thereby making it difficult to form a statistical association. Perhaps a better way of investigating the relationship would be to split the group of patients into three; one with sleep apnoea and no obesity, one with obesity, and one with sleep apnoea and obesity. The difference between the three groups might have investigated the relationship more conclusively.

Kaw, Roop et al. “Obesity As An Effect Modifier In Sleep Disordered Breathing And Post-Cardiac Surgery Atrial Fibrillation”. Chest (2017): n. pag. Web. 23 Mar. 2017.

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