Author: Michael Kelley

  A ResMed-led analysis published in The Lancet Respiratory Medicine (July 2019) estimates that more than 936 million people have obstructive sleep apnea. As summarized in news-medical.net and elsewhere, the estimate from the multinational analysis by ResMed and 12 sleep researchers is nearly 10 times greater than the World Health Organization’s 2007 estimate of more than 100 million.   “More than 85 percent of sleep apnea patients are undiagnosed, meaning hundreds of millions repeatedly suffocate instead of getting healthy, restful sleep each night,” said Carlos M. Nunez, M.D., study coauthor and ResMed’s chief medical officer. “This raises their risk of workplace and roadway accidents, and can contribute to other significant health problems, such as hypertension, cardiovascular disease, or even poor glucose control for diabetic patients. We know the risks, and now we know the size of the problem is nearly 10 times greater than previously thought. Addressing it starts with screening patients we know to be high-risk.” Education for clinicians and patients alike can help get more people diagnosed, but Nunez contends that educational component should include a conversation about what constitutes good sleep. “For instance, some believe snoring may simply be a normal feature of how some people sleep, when in fact it’s one of the most important signs for the risk of having sleep apnea,” Nunez said. “With a global prevalence that approaches 1 billion people, patients and physicians need to consider the risks and ask the questions that may ultimately help them sleep and live better. This is no longer a problem that can be treated lightly or ignored.” Source: Medical News

ORLANDO, FL – The actual National Football League (NFL) Pro Bowl game is famously uncompetitive. Instead of scoring touchdowns, the main goal among players is largely to stay uninjured.   Retired players who arrive for related festivities are also focusing on their health, but unlike their active gridiron colleagues, they face a variety of ailments. Thanks to the Pro Player Health Alliance (PPHA), an arm of the American Sleep & Breathing Academy (ASBA), retired players have a convenient opportunity to be screened for obstructive sleep apnea (OSA), a disorder that often goes untreated for far too long.  Ronald Rosenbaum, DMD, PA, owner of Cosmetic, Restorative & Preventive Dentistry, Pembroke Pines, Fla., returned to this year’s Pro Bowl in Orlando, Fla., once again to educate players about the dangers of OSA. Thanks to relationships built between ASBA president David Gergen and the NFL Players’ Association (NFLPA), dentists are now a mainstay at the Pro Bowl’s health screening events, and OSA awareness continues to grow.  “There were even more players coming through this year than last,” says Rosenbaum, who has a sleep side of the business called Sleep With a Smile Inc., which has allowed him to perfect his sleep medicine craft. “Dave Gergen put on a great event. There was quite a long line of players who were waiting to see us, because a lot of these guys are suffering from sleep apnea on a daily basis, and they don’t even know they have it.”  Unfortunately, the same grit that gets players to the epicenter of America’s most popular game can also delay their OSA treatment. Taught to push through exhaustion and ignore physical frailties, players may think they can deal with the effects of OSA. Rosenbaum sees the mindset, but believes it can be overcome through diligent education.   “It can sometimes be difficult with the players,” Rosenbaum says. “Education is the big thing. That’s not just with NFL players; that’s everyone. We help them understand that if they’re not using the CPAP machine they still need a treatment of some sort to facilitate proper breathing. That’s an opportunity to talk about oral appliances and continuing to educate.”   Rosenbaum has worked with Sleep Group Solutions (SGS) and Rani Ben-David, SGS’ president and founder, to hone his craft. Part of that training includes use of a pharyngometer to measure the airway. “The pharyngometer sets us apart from a lot of the practices,” Rosenbaum explains. “The oral appliance has been around for years, but with the pharyngometer I’m able to have patients or players basically breathe into a tube so I can reposition the lower jaw into different positions and see how we can change the airway and how the appliance can make a difference.”  Once players are getting treatment, Rosenbaum sees the gratitude because, “It changes how they sleep and feel.” Beyond the health screening, Rosenbaum confirms that The Pro Bowl is indeed a fun event. While the football side was “pretty much rained out this year,” he did get to spend time with the players and get to know them.  “My staff and I are a lively bunch, so we tend to be the area [at the screening] that the groups gather around,” he says. “We try to keep it light and entertaining while getting impressions taken right there and then. Not everyone is a fan of dentists, so we have to keep these guys calm and make sure they understand what we’re doing. We had great hospitality and Dave and his team again helped to put on an excellent event for the second year in a row.”  Education and Acceptance Among physicians, acceptance of oral appliances has not always been high, but Rosenbaum reports that respect levels are “getting there.” He bases the assessment on reactions he gets to presentations, where some physicians begin to understand the power of oral appliances.  By the end of the presentation, they are “surprised” and curious about the device’s potential. “I believe that dental sleep medicine is gaining traction with the medical community,” Rosenbaum says. “I have had positive responses in my trials and in approaching the medical community. A lot of these physicians will have CPAP failures and think that is basically that. They don’t realize there is another option and that a dentist can make this available to patients. I keep going back to the ‘education’ word because it’s what we have been trying to do for a few years now.”  As for the Pro Bowl in 2020, Rosenbaum and Gergen are hopeful that awareness will be even stronger, with even more physicians and players embracing the benefits of oral appliances. Rosenbaum hints that pediatric treatment could even be more prevalent next year.  He explains: “I’d like to talk with Dave Gergen about possibly treating the children of some of these NFL players, or even their grandchildren. This whole problem starts at a young age. A child snores, grinds teeth, sucks on a thumb, and it all causes constriction of the pallet and jaws, and the child becomes more susceptible to sleep apnea.”    

In an attempt to turn their stores into “health service hubs,” the two largest pharmacy chains in the U.S. (Walgreens and CVS) are remodeling stores to resemble doctors’ offices. According to an Associated Press article by M. Spencer Green, CVS opened three such concept stores in Houston late last year. Called HealthHUBs, the stores “dedicate much less space to typical drugstore products like greeting cards and seasonal items. Instead, these stores offer more health products like sleep apnea masks and devote space to services aimed at helping customers manage chronic conditions.” In addition to the sleep apnea masks, walkers are also sold at the redesigned stores. “CVS’ walk-in clinics, MinuteClinics, now offer more services, including a lab for blood testing and health screenings,” writes Green. “Nurse practitioners can screen patients for diabetic retinopathy, or vision loss associated with diabetes, as well as sleep apnea. The HealthHUBs also include a dietitian who can counsel patients in stores or connect them with Noom, an online weight-loss service.” Even in the world of groceries, officials at Kroger are reportedly pursuing the health care market. According to Bloomberg via Beckers Hospital Review, Kroger CEO Rodney McMullen said: “Healthcare is an area where we see a lot of opportunity. We’re talking to several potential partners at the moment.” Bloomberg reports that Kroger has already “partnered with pharmacy Walgreens for a pilot program that allows customers to order groceries online and pick them up at Walgreens locations. Kroger also operates a specialty pharmacy business that posted strong sales in 2018.” —————————————————————— An Associated Press (AP) article A Walgreens and CVS drugstore are seen on adjacent corners at an intersection in Calumet City, Ill. CVS Health and Walgreens are remodeling some of their drugstores to look more like doctor’s offices. The two largest pharmacy chains in the U.S. have both opened redesigned stores that dedicate more space to health services and less space to staple products like greeting cards. As people shop online more, CVS and Walgreens are trying to give people reasons to keep coming into their drugstores. While their redesigns are just tests at this point, they could become models for future stores. Here’s a look at CVS and Walgreens’ new stores. CVS’ HealthHUBs CVS opened three concept stores, called HealthHUBs, in the Houston, Texas area in December. These locations dedicate much less space to typical drugstore products like greeting cards and seasonal items. Instead, these stores offer more health products like sleep apnea masks and devote space to services aimed at helping customers manage chronic conditions. Medical products CVS’ new concept stores, called HealthHUBs, offer more health services than its typical drugstores. Care concierge Each HealthHUB staffs a “care concierge” to help guide customers through the new health services and provides more care coordination between the pharmacy, the clinic and the other services. iPads are also stationed for people to browse health and wellness apps and shop on CVS’ website.  

The ill effects of air pollution may literally be causing some people to lose sleep, according to new research published online in the Annals of the American Thoracic Society. In “The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis,” Martha E. Billings, MD, MSc, and co-authors report a link between obstructive sleep apnea and increases in two of the most common air pollutants: fine particulate pollution, known as PM2.5, and nitrogen dioxide (NO2), a traffic-related pollutant. “Prior studies have shown that air pollution impacts lung and heart health, but only a few studies have looked at how air pollution might affect sleep,” said Dr. Billings, lead study author and associate professor of medicine at the University of Washington. “It seemed likely that air pollution was detrimental to sleep, given that air pollution causes upper airway irritation, swelling and congestion, and may also affect the parts of the brain and central nervous system that control breathing patterns and sleep.” Researchers analyzed data from 1,974 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who also enrolled in both MESA’s Sleep and Air Pollution studies. Using air pollution measurements gathered from hundreds of MESA Air and Environmental Protection Agency monitoring sites in six U.S. cities, plus local environment features and sophisticated statistical tools, the research team was able to estimate air pollution exposures at each participant’s home. The study found a participant’s odds of having sleep apnea increased by: 60 percent for each 5 micrograms per cubic meter (μg/m3) increase in yearly PM5 exposure. 39 percent for each 10 parts per billion increase in yearly NO2 Source: American Thoracic Society

With the Super Bowl coming up on Feb 3, 2019, the New York Times tackled the problem of obesity in retired National Football League (NFL) players. The Jan 17 NY Times article by reporter Ken Belson points out that linemen, in particular, “have higher rates of hypertension, obesity and sleep apnea, which can lead to chronic fatigue, poor diet and even death.” American Sleep and Breathing Academy (ASBA) Diplomate Anthony Scianni, D.M.D., is relied on as an expert in the article that specifically mentions a “mouthpiece” as a successful alternative to CPAP. Belson writes: Former linemen have big necks, and as they age their throat tissue becomes flabby, so their tongues can block their airways, said Anthony Scianni, a dentist who runs the Center for Dental Sleep Medicine, which works with former N.F.L. players. The lack of oxygen, Scianni said, stimulates the body to produce more sugars, which can cause Type 2 diabetes and lead to overeating and other problems. Belson outlines the case of Derek Kennard, a 12-year pro who played offensive line, as a primary beneficiary of sleep apnea treatment. Kennard has worked closely with the ASBA to lower his AHI from 72 to 2, eventually losing 145 pounds thanks to extra energy from better sleep. “After his brother died in 2009, Kennard, who is 6-foot-3 and whose weight peaked at 465 pounds, sought help,” Belson writes. “He was tested for sleep apnea and was told he woke 77 times per hour. One episode of not breathing lasted 1 minute 32 seconds. Because he flips in bed as he sleeps, Kennard had trouble wearing the mask of a CPAP machine, which delivers continuous positive airway pressure and is the standard treatment for sleep apnea. He switched to a mouthpiece that kept his airways open. He now wakes just twice an hour, and sleeps about seven hours a night. His weight fell to about 350 pounds, and he stopped taking painkillers.” Roy Green, a 13-year NFL veteran who played primarily as a wide receiver, Kennard, and David Gergen, CEO of the ASBA, have spread the word about OSA through the ASBA-affiliated Pro Player Health Alliance, holding free public awareness events in cities across the United States. Prior to his work with the ASBA and the NFL, Scianni had made his mark in traditional restorative dentistry with a successful private practice (Renaissance Smiles) in Colts Neck, NJ. Twenty-four months after joining the ASBA, he has been elected to the ASBA board, appointed interim vice president, and is one of the rising stars in dental sleep medicine. “The effects of concussions on retired NFL players have been in the spotlight for years now,” said Gergen. “The fact that the New York Times is highlighting obesity-related sleep apnea shows that our message is getting through. The NY Times is relying on an ASBA Board Member [Scianni] because his work with retired NFL players, and other patients, is showing real results. Those ‘mouthpieces,’ a.k.a. oral appliances, are helping former players improve their health. CPAP is not the only valid treatment for sleep apnea, and the NY Times is validating what we’ve been saying for a long time.” Click Here to read The NFL’s Obesity Scourge by Ken Belson.

The New Yorker cast a folksy eye on sleep in its Dec 10 issue. The article by Zoe Heller, entitled Why We Sleep and Why We Often Can’t, discusses the still persistent belief that high achievers should take a measure of pride in disregarding slumber. Breaking down the misconception is happening, but perhaps slower than expected. Heller brings up the case of Arianna Huffington, founder of the Huffington Post and author of The Sleep Revolution. Huffington was not always a believer in the power of sleep, instead opting to burn the candle at both ends—often to the extreme. “These days, she retires at an eminently sensible hour each night, takes a hot bath with Epsom salts, drinks a cup of lavender or chamomile tea, and, just before getting into bed, writes a list of the things she is grateful for,” writes Heller. “As a consequence of her sleep-hygiene regimen, not only has her quality of life improved but her business has done fabulously, too. Sleep isn’t the enemy of success and ambition, she’s discovered, it’s the royal road to the corner office. ‘Sleep your way to the top!’ she jauntily enjoins us.” And yet, not everyone can so readily retire to a genteel night routine. Heller explores the why and why not of obtaining proper sleep in the 21 st century. Click Here to read the article in its entirety:

Harvard Women’s Health Watch, a division of Harvard Medical School’s publishing division, is encouraging readers to go beyond over the counter (OTC) sleep aids. In a Dec 2018 article (Drugstore sleep aids may bring more risks than benefits), editors caution that many common pharmacy remedies do not offer the best solutions. The article, geared toward the non professional consumer market, cites a 2017 recommendation from the American Academy of Sleep Medicine (AASM) that encourages people to not treat chronic insomnia, “with common over-the-counter antihistamine and analgesic sleep aids as well as herbal and nutritional substances, such as valerian and melatonin, because there is not enough evidence that they are effective or safe.” According to the article, which does not mention oral appliances or CPAP, risks include short-term problems such as daytime sleepiness, grogginess, and falls. “In addition, most sleep aids fall into a category of drugs known as anticholinergics, which have been linked to dementia and Alzheimer’s disease among heavy, long-term users,” says Dr. Suzanne Bertisch, an assistant professor of medicine at Harvard Medical School. In addition to discouraging antihistamine-based products, Harvard Women’s Health Watch encourages caution when it comes to so-called natural remedies such as melatonin. “Unfortunately, melatonin is generally not very effective in helping to treat chronic insomnia,” says Dr. Bertisch. “It may be useful in some cases to help shift your body’s natural clock if you are jet-lagged, or in people who have circadian rhythm issues that are causing their sleep disturbances. But people who take melatonin on their own often take it incorrectly, minimizing any of the potential benefits it could produce.” Click Here to read the article in its entirety.

How did David Gergen, a nationally respected dental lab technician, manage to find former National Football League (NFL) players interested in helping him spread awareness about dental sleep medicine? The short answer is they eventually found him. Prior to his current roles as CEO of the American Sleep & Breathing Academy (ASBA) and president of the Pro Player Health Alliance (PPHA), Gergen coached high school football at an elite level, eventually winning a state and national championship. The achievement attracted attention from NFL officials who asked him to run a coaching clinic with former NFL players. Players such as Brian Davis, an all pro defensive back with the Washington Redskins and the Minnesota Vikings, and offensive lineman Derek Kennard, who played with the Dallas Cowboys and Arizona Cardinals, received instruction from Gergen on how to coach the fundamentals for youth players. A bond of friendship developed between Gergen and Kennard, so much so that Gergen eventually confronted Kennard who frequently had low energy during the coaching clinic. “Derek had big raccoon circles under his eyes and he would lean and close his eyes during breaks,” Gergen says. “I said to him, ‘Derek, either you have the worst sleep apnea that I have seen in a long time, or you’ve been out drinking for about a hundred days straight.’” Alcohol was not the problem, and the 6-foot 3-inch, 300-pound lineman explained that he simply could not wear a CPAP mask. As it turned out, Kennard had never heard about oral appliances as a treatment for CPAP. What happened next would help hundreds of retired NFL players, while also helping to spread sleep apnea awareness among Americans who take notice when their football heroes speak about medical problems. The ASBA got the remarkable story from Gergen during a chat in late 2018. ASBA: What happened after you told Derek Kennard about oral appliances? David Gergen: I took him to a friend’s dental office, and we took his bite impressions and I got him a rush from my lab on the oral appliance. We placed a Herbst device and I left on vacation. ASBA: What was Kennard’s reaction? Gergen: After a couple of days, I got a call from Derek at about 2:30 a.m. and I figured the oral appliance was not working. I decided to answer the phone and DK said, ‘David, my brother died tonight from sleep apnea.’ He died with a CPAP machine next to his bed. Derek said, ‘We have to do something because so many of my brothers from around the NFL are suffering from this. Without you telling me about this treatment, I would not have known.’ That was the first time Derek had the idea to launch the Pro Player Health Alliance (PPHA), and we did. After Derek and I met and talked, we reached out to Mike Haynes [member of the Super Bowl Champion Los Angeles Raiders and an inductee to the Pro Football Hall of Fame] and he also said, ‘Let’s do it.’ ASBA: What happened next? Gergen: We spoke with the Living Heart Foundation, which does NFL screenings. Dr. Roberts who heads the foundation was thrilled and said, ‘Yes!’ We gave him my background and he also said, ‘Let’s do it.’ ASBA: Where did the money come for this endeavor? Gergen: There was no money coming in for us, and the NFLPA [NFL Players’ Association] did not even know about us, so I had to fund it all. It’s a worthy cause and I was glad to pay for it. We went to a couple of screenings with Dr. Roberts and things were going well. We were finding out that many of these guys had sleep apnea. We were telling them they had it, but we were not yet doing anything to help them, because the screenings were not set up for treatment. I said, ‘This is great we’re telling them, but we’re not yet doing anything to help them.’ ASBA: How did you manage to get the NFLPA interested? Gergen: Mike Haynes eventually said, ‘David, we must go talk with the NFLPA and the NFL Alumni, and maybe we can get some funding.’ We met with the alumni and we talked with Bart Oates [10-year pro who won two super bowls as a center] about doing this. He thought it was great, but at the time could not get the funding. We reached out to the NFLPA and Andre Collins [an outside linebacker who played ten seasons in the NFL and is currently the director of Retired Players for the NFLPA] in particular. After meeting with Andre, he said, ‘Let’s take it slow and see how it works out, and we’ll go from there.’ It went well for a while, and then I got a call from Dr. Roberts and he basically said, ‘We really can’t do this because we don’t have the funding, and the medical doctors did not like the fact that we were treating NFL guys with oral appliances. The MDs strongly recommended a course of CPAP instead. ASBA: What was the result of this negativity? Gergen: The program stalled, but then my laboratory got a call from the NFL Commissioner’s office, and they said, ‘We have a player who has been in a rough situation. One of the teams did not treat him properly and we need you to step in and help him.’ He was an all pro with the Bears and we tested him at the Super Bowl and he came back with an AHI score of 50. Thirty were obstructive and 20 were central. He looked terrible too, and had not been getting any sleep. Initially we put him on auto PAP and then we got a call from the physician in Florida where he lived, and he wanted to also do an oral appliance to keep his pressure down. We treated him with combination therapy. The player actually called and thanked me for the treatment. ASBA: What was happening (if anything) with the NFLPA? Gergen: Well, I am persistent, and right about that time, we got a call back from Andre Collins, and he heard about what we did [with the Bears player] and he wanted to resuscitate the program. From that day forward, we have been working with the NFLPA and our program continues to grow. ASBA: Why has it grown? Gergen: It is exciting to work with the NFL and its retired players. Football is the number one game in America, and it adds that level of fun. And we have such a high success rate with the former players that Andre Collins at the NFLPA is very pleased with the sleep apnea program and how it has flourished. And that is where we are at today. ASBA: How many retired players have you tested and treated? Gergen: We have tested and treated about 1,200 NFL guys. We have a recent screening in Dallas on Nov 17 at Baylor Hospital. Dr. Harry Sugg and Dr. Ed Hobbes were the participating dentists, and both are diplomates of the ASBA.     Don’t Miss the 2019 Conference ASBA Annual Sleep and Wellness Conference 2019 April 12, 2019 @ 9:00 am – April 13, 2019 @ 5:00 pm Pointe Hilton Squaw Peak, 7677 N 16th St Phoenix, AZ 85020 United States + Google Map The 6th Annual Sleep and Wellness Conference is the 2nd Largest Dental Sleep Medicine meeting in the U.S. With over 600 attendees expected for the 2019 meeting, its rapid growth is due to a commitment to growing the practice management side of dental sleep medicine for its members and the industry. Visit Sleep-Conference.com to learn more.