Author: Michael Kelley
40% of Police Officers have Sleep Disorders
In the current issue of JAMA “Journal of the American Medical Association” A large study of Police Officers in the U.S and Canada found 40% of police officers had symptoms of a sleep disorder, including sleep apnea and insomnia. Click here to view Abstract and Full article Officers who screened positive for those disorders were also more likely to be burned out, depressed or have an anxiety disorder. Over the next two years, they committed more administrative errors and safety violations and were more prone to falling asleep at the wheel than sound sleepers. “In general we have this cultural attitude of, sleep is for the weak,” said Dr. Michael Grandner, from the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia. “When you’re in an environment where signs of weakness are particularly discouraged, there may be a social pressure to not address sleep problems or to shrug them off,” added Grandner, author of a commentary published with the new study in the Journal of the American Medical Association. When police officers in particular suffer from sleep problems, he said, it becomes a public health and safety problem. “It’s not just the people with sleep disorders that are affected,” Grandner told Reuters Health. “If they’re impaired, you’re at risk.” Researchers say police departments could do more to make sure that officers with sleep disorders receive appropriate treatment, which may include sleep machines, therapy or changes in work schedules. For the new study, close to 5,000 police officers were surveyed on sleep problems and other health topics. That included Philadelphia officers and Massachusetts state police as well as a broader range of other U.S. and Canadian cops. The officers were on average 38 to 39 years old and most had been in the police force for more than decade. Dr. Charles Czeisler from Brigham and Women’s Hospital in Boston and his colleagues found that 40% of the officers screened positive for at least one sleep disorder. The most common was sleep apnea, which affected a third of cops, followed by moderate or severe insomnia and shift work disorder, which consists of sleepiness and insomnia associated with working at night. DEPRESSION, BURNOUT, ANXIETY Officers with a sleep disorder were more than twice as likely as healthy sleepers to report depression, emotional exhaustion or burnout and anxiety disorders on their original surveys. On follow-up questionnaires sent out over the next two years, they were also 40 to 60% more likely to report making serious administrative errors, falling asleep while driving or committing a fatigue-related error or safety violation during work. Poor sleepers reported more citizen complaints and more often showed uncontrolled anger toward a suspect or citizen. “You have people who are sleep deprived, which means that their ability to make good decisions, to respond effectively, to drive emergency vehicles well … all of those things are impaired,” said Bryan Vila, a criminal justice professor who studies sleep and performance in cops at Washington State University in Spokane but wasn’t involved in the study. The researchers noted that being heavy increases the risk of sleep apnea, and that almost 80% of the officers they surveyed were overweight or obese.
Is early Adenotonsillectomy better for children better than wait and see?
Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS: The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%). CONCLUSIONS: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.). N Engl J Med. 2013 Jun 20;368(25):2366-76. doi: 10.1056/NEJMoa1215881. Epub 2013 May 21. Link to abstract and related material: http://1.usa.gov/13ySICu
OSA is highest risk factor for Bruxism
Several studies have reported that sleep bruxism rarely occurs in isolation. Recently, in an epidemiological study of sleep bruxism and risk factors in the general population, it was found that among the associated sleep symptoms and disorders obstructive sleep apnea (OSA) was the highest risk factor for tooth grinding during sleep. The purpose of this report was to evaluate the effect of continuous positive airway pressure (CPAP) on sleepbruxism in a patient with both severe OSA and sleep tooth grinding. Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night most breathing abnormalities were eliminated and a complete eradication of the tooth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep. Sleep Med. 2002 Nov;3(6):513-5
E-Cigs power increases exposure to chemicals
The higher the power of an e-cigarette, the higher the concentrations of potentially hazardous substances the device produces, including acetaldehyde, acrolein, and formaldehyde. Those are among the findings presented at an international conference of the American Thoracic Society by lead study author Dr. Daniel Sullivan, an internal medicine resident at the University of Texas Southwestern Medical Center. During his previous training at the University of Alabama, Birmingham, Dr. Sullivan and his associates used a variety of methods including liquid chromatography–mass spectrometry and enzyme-linked immunosorbent assay (ELISA) to study components and nicotine formulations typical of e-cigarette users. Under some test conditions, formaldehyde levels were comparable to those seen in traditional tobacco cigarettes, he said in a video interview.
No Significant Difference between in lab PSG and HST: Study Finds
American Thoracic Society International Conference, with the latest research declaring that home testing of sleep apnea followed by initiation of home treatment with an auto-titrating CPAP device reduced costs compared with in-laboratory testing and titration. Furthermore, home testing did not negatively impact clinical outcomes. “While the use of home testing and initiation of CPAP therapy is increasingly common, studies of its cost-effectiveness are scarce,” said lead author Charles W. Atwood, Jr., MD, associate professor of medicine at the University of Pittsburgh School of Medicine and director of the Sleep Disorders Program of the VA Pittsburgh Healthcare System in a NewsWise summary. “In our randomized study, sleep-related costs were substantially lower for patients who underwent home testing and treatment initiation than for those who underwent laboratory testing, and this cost saving was accomplished without sacrificing clinical quality.” According to a news report, the study enrolled 296 subjects, 113 of whom began CPAP at home and 110 of whom began in a laboratory. Assessment with the Functional Outcomes of Sleep Questionnaire, a disease-specific quality of life questionnaire designed to assess the impact of sleep disorders on activities of everyday living and the extent to which these abilities are improved by treatment, showed no significant difference in outcomes between groups. Publication summary: Cost-Effectiveness Of Home Management Of Obstructive Sleep Apnea: The Veterans Sleep Apnea Treatment Trial, [Publication Page: A3672]C.W. Atwood, MD1, S.T. Kuna, MD2, K.C. Little, MS1, S. Hin, MS2, R. Gupta, MS2, I. Gurubhagavatula, MD, MPH2, H. Glick, PhD2 1Pittsburgh, PA/US, 2Philadelphia, PA/US Click Here to access ATS abstracts and presentations The post Home Sleep Testing Gets Boost from Latest Studyappeared first on Sleep Diagnosis and Therapy.
Is the transportation industry over regulated around Sleep issues?
According to federal officials, drowsy driving is a leading cause of highway fatalities and crashes. For this month alone, driver fatigue has been blamed in deadly accidents in Madison County, Ohio, Austin, Texas, and Marseilles, Illinois. It is estimated that over 30,000 people have died on the highways annually in the U.S. from crashes that involve large trucks. The NYT reported that despite the emphasis of following rules on truckers needing to get ample rest before a work shift and by taking breaks to ensure that drowsy sleeping does not happen, commercial truck operators, for one, resisted following the rules as they argued that Washington cannot regulate one’s sleep. Last year, federal rules have reduced the number of maximum workweek hours for truck drivers from 82 to 70. Drivers who have logged the maximum number are required to rest for 34 hours before starting another workweek. Moreover, it has been declared that drivers should not drive more than 11 hours a day and should have a 30-minute break in their work schedules. Complete article
OSA the NFL and Athletic Performance
Is your sleep restless? Is your loud snoring keeping your family up? Do you wake up tired and drag your feet through the day? You may have Sleep Apnea! Athletes’ work very hard at being fit, often falsely believing that they could never have something like Sleep Apnea, commonly thought to be a fat, old man’s disease! However, the statistics tell a different story. There have been many cases of athlete’s succumbing to Sleep Apnea. One famous example being famed football player Reggie White, nicknamed “The Minister of Defense”. Reggie died in his sleep at the age of 43 while not wearing his CPAP, which was sitting unused on his nightstand. A study investigating Sleep Apnea in Football players found that overall, 14% of professional football players suffer from Sleep Apnea, nearly 5 times higher than similarly aged adults in the general population. Interestingly 85% of the afflicted players were Offensive and Defensive lineman. (George CFP, et al. N Engl J Med. 2003). Another study conducted by Dr. Mair, University of North Carolina at Chapel Hill in 2006 found that, “The traits that make professional soldiers formidable on the battlefield, including increased BMI from upper-body muscular hypertrophy, and large, muscular necks, can leave them gasping for breath as they sleep.” Dr. Emsellem, director for Sleep and Wake Disorders in Chevy Chase, Maryland says “The physical characteristics associated with optimal performance in certain sports can also predispose athletes to sleep apnea”. Christopher Winter, M.D., medical director of the Martha Jefferson Hospital sleep medicine center in Charlottesville, Virginia says “There are athletes everywhere who have sleep apnea”, “Not only does the apnea affect their athletic performance, but it is extremely hard on their cardiovascular systems as well.” Sleep is recovery time for the human body, during the day, an athlete may be very hard on his or her body, if their sleep is disrupted by untreated Sleep Apnea the body isn’t able to fully heal itself. So, not only is the patient suffocating in their sleep, their body is slowly degrading because it never has a chance to heal. CPAP and Oral Appliances are two effective and conservative ways to manage Snoring and Sleep Apnea. So, how does an athlete know if he or she is at risk? “There are a lot of symptoms of sleep apnea to look for, but ultimately, it’s in the hands of a medical profession to diagnose Sleep Apnea. The truth is that anyone can suffer from Sleep Apnea, regardless of level of fitness or BMI. However, certain groups seem to be at higher risk. It appears that for certain sports, professional and semi-professional athletes that work to elite levels are in this high-risk group. If you would like to read more visit reggiewhitefoundation.org John Viviano DDS D ABDSM
Breaking News: S8262 has been removed by Medicare and will not be covered under private medical insurance for TMJ-TMD splints as of 06-20-15
S8262 Code for Mandibular Orthopedic Repositioning Device used for TMD appliance Discontinued. S8262 has been removed by Medicare and will not be covered under private medical insurance for TMJ-TMD splints as of 06-20-2015. D8210 Quick Splint Reimbursement for most insurance companies $295.00 – $345.00 D7880 The only code for TMJ-TMD splints Reimbursement for most insurance companies $1,200 – $1,800 Reimbursement is around half of the allowable ——————————————————- This code has been in the “temporary” code set of the HCPCS 1 coding manual. The Center for Medicaid and Medicare Services (CMS) reserves the right to revise codes without notice and has decided to retire the temporary code with short notice. The quarterly HCPCS coding update file has been released on CMS’s website. One of the “discontinued” codes included in the update is S8262, standing for “Mandibular Orthopedic Repositioning Device. The discontinue date is at the end of the this month on June 30th, 2015. Click here to access the HCPCS update The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as “hick picks”) is a set of health care procedure codes based on the American Medical Association’s Current Procedural Terminology (CPT).