In Resistant Hypertension, Sleep Apnea Results in Greater Blood Pressure and Treatment Lowers It.

Published on April 6, 2015

A new meta-analysis published in the Journal of Hypertension suggests that untreated sleep apnea may be a major factor in why medications appear to be less effective in reducing high blood pressure in some people. Further, the study shows that CPAP therapy may be the key to helping those with difficult to treat hypertension get their blood pressure under control.

As many as 10 million people in the United States have “resistant hypertension” which either doesn’t respond to or requires multi-drug therapy. Most people with resistant hypertension also have obstructive sleep apnea (OSA). It’s a deadly combination that exponentially increases the risk of death or disability from a stroke or heart attack, but one that researchers say may have a relatively simple solution.

“Our study indicated that the patients with resistant hypertension and the very highest blood pressure experienced the greatest reduction in blood pressure after using CPAP therapy,” says Ulysses Magalang, MD, the study’s principal investigator and director of the Sleep Disorders Center at The Ohio State University Wexner Medical Center, in a release. “This response suggests that untreated sleep apnea may be why these people haven’t seen improvement in their blood pressure despite the concurrent use of three or four medications.”

Previous studies have shown that CPAP therapy offers patients with hypertension a significant, yet modest two to three point reduction in blood pressure. Magalang and the research team found that when they honed in on the specific results for those with resistant hypertension, the benefits of CPAP use looked quite different.
In their study, patients experienced an average reduction of 7.21 millimeters of mercury (mmHg) in ambulatory systolic blood pressure (SBP), and 4.99mmHg in ambulatory diastolic blood pressure (DBP) from baseline after using CPAP therapy. Ambulatory blood pressure (measured over a 24 hour period) is considered a good predictor of future organ damage and cardiovascular problems.

“We know that small changes in blood pressure translate into big benefits in terms of protecting the heart and reducing stroke risk,” says co-author Christopher Valentine, MD, a nephrologist at Ohio State’s Wexner Medical Center. “These findings suggest that physicians may need to be more aggressive with screening for sleep apnea and ensuring CPAP therapy compliance in patients with resistant hypertension.”

Systematic Analysis of Resistant Hypertension and CPAP Use

Despite the fact that millions of people suffer from resistant hypertension, and that its cardiac comorbidities carry a significant public health burden, studies looking at CPAP use and hypertension historically haven’t focused on this difficult to treat population.

“We have a lot of evidence about the benefits of CPAP in people with hypertension and OSA, but ours is the first analysis to systematically review CPAP use in people with difficult to treat hypertension and apnea,” Valentine says. “The results are clinically relevant because the effects that we found are significantly higher than what’s been previously observed in a more general hypertensive population. CPAP use could offer this subset of patients a new chance to reach a healthier blood pressure goal, or even to reduce their medication burden.”

From an initial scan of 157 articles, the researchers narrowed the data from 6 different studies, looking at pre- and post-CPAP blood pressure measurements from more than 300 patients with resistant hypertension. The duration of CPAP use ranged from 3 weeks to 6 months. In addition to measuring ambulatory blood pressure, investigators also looked at CPAP therapy and its impact on nighttime blood pressure—another predictor of future cardiac events.

While the researchers found significant improvement in ambulatory and nocturnal blood pressure measurements after CPAP use in some of the studies, other cuts of the data showed that CPAP therapy delivered about the same nocturnal blood pressure benefit as observed in previous studies.

“More studies are needed to further define CPAP influence on blood pressure, but overall, we think that the longer the CPAP is used during the night, the greater the impact,” Magalan says.

The authors also acknowledge other limitations of their analysis, including small sample size, and potentially confounding factors such as the concomitant use of the antihypertensive medications, obesity, and other life-style factors such as the use of alcohol and smoking.

Sleep Apnea, High Blood Pressure: Shared Genetic Origins?

Magalang and Valentine say their findings also support the idea that resistant hypertension and OSA represent an “extreme phenotype” of those who have OSA, but never develop hypertension. A phenotype describes how an individual’s characteristics are influenced by the interaction of their genes with their environment. The researchers further suggest that resistant hypertension in those with sleep apnea may be caused by a less common gene variant that nonetheless has significant impact.

It’s a hypothesis that will likely be put to the test over the next decade. The researchers who collaborated on the paper all belong to the Sleep Apnea Genetics International Consortium (SAGIC), a partnership of scientists from five continents who are building the first-ever international biomedical database to uncover the genetic causes of sleep apnea. By collecting biological material from thousands of patients with sleep disorders, the group hopes to amass enough data to start identifying underlying genetic causes of different conditions.

“We’re only just now beginning to appreciate the link between sleep apnea and disease,” says Magalang. “We hope that one day we will find common genes shared between people who have uncontrollable blood pressure and sleep apnea, and that will open up a whole new world of interventions and treatment strategies.”

The research was supported by the National Heart, Lung and Blood Institute. Ohio State’s Center for Clinical and Translational Science (CCTS) also provided biomedical informatics support for the study and provides ongoing informatics support for SAGIC.

Sleep Apnea May Reduce Antidepressant Response, Increase Dementia Risk

Published on April 7, 2015

Studies suggest sleep apnea may have a strong influence on antidepressant response and increase the risk for mild cognitive impairment in older patients with major depressive disorder, reports Medscape.

“This shows that clinicians should definitely screen for sleep apnea when patients are presenting with late-life depression,” lead author Lauren Waterman, from the University of Pittsburgh School of Medicine, Pennsylvania, told Medscape Medical News.

Does your dog's snoring keep you awake?

Dogs that snore aren't getting a good night's sleep -- and, chances are, neither are you.

By Stacey Cohen

Stacey Cohen has been a news broadcaster and talk show host for more than 25 years. She has worked with Sally Jesse Raphael, G Gordon Liddy, Martha Stewart, Jane Fonda and many more. She even did play-by-play for the O.J. Simpson trial.

Photo © Tatiana Katsai - Fotolia

For some reason we tolerate our pets' snoring more than we do our spouse's, but it can be the cover-up for an array of issues. Like any problem, if it is something new, it might be worth a trip to the vet to check out. Snoring can have some underlying serious causes.

If your dog is snoring it is some kind of obstruction that is causing the problem. Digging in the dirt, rolling in the grass, even drinking water and eating can introduce foreign objects into your dog’s nasal passage, resulting in snoring. Extra mucus from a cold will also create snoring.

For the most part, snoring caused by nasal obstructions is temporary and should stop when the passage is cleared. There are some other common reasons for snoring:

Dental problems can be a factor. If your dog has bad teeth. It can lead to an abscess. It will go right through the nasal passages. If you don't have your dog’s teeth looked at, dental problems can be a source of infection that goes through your dog’s whole body. Infections can be a host for another set of problems.

Extra pounds

Is your dog carrying a little extra weight? If so, that can be a factor that is causing the snoring. Excess tissue in the throat will cause the obstruction that blocks the airways. As your dog breathes in and out, obesity makes the trachea rings slam shut.

Or it could be a fungus that you may not even be aware of but your dog sure is, such as mold found in hay, grass clippings and similar environments. Left untreated, this fungal disease can cause discomfort, loss of appetite and serious health problems.Any type of upper respiratory problem can cause a blockage, including a temporary inflammation in the nose from a cold or seasonal allergies.

You may have just picked a breed that has this issue through genetics. Because of genetics some breeds may actually have to have a surgery to open up their nasal passages because they are almost completely shut, like a pug or Boston terrier. Brachycephalic breeds -- the breeds with very short noses, such as English/French bulldogs, Boston terriers and pugs -- have a natural tendency to snore.

Is your dog breathing secondhand smoke? Smoke can irritate the nasal passages and make it difficult to breathe. Smoke away from the dog or better yet quit. You both will be healthier.

How can you help your dog breathe more easily? Try giving your dog a pillow. It will elevate the head.

A round bed will encourage a different sleeping position. The round bed will encourage a curled position that allows air passages to expand.

A humidifier can help increase the moisture in the air and help, so the nasal passages won't be so dry.

If your dog is snoring it most likely isn't getting a restful sleep and if it isn't getting good sleep that means you probably aren't either. If the problem persists after trying to change up the sleep environment go back to the vet and see if it is an allergy or if possibly surgery is needed.

6 Things That Are Keeping You Fat.

K. Aleisha Fetters, U.S. News & World Report
MARCH 30, 2015  11:23 AM

You're filling up on healthy foods, exercising daily and still, the scale isn't budging. It's mind-numbingly frustrating. Luckily, it's also fixable. Here are six common things that could be standing between you and your weight-loss goals – plus easy ways to bust through each.


1. You Aren't Tracking What You Eat

"Most of the time, when someone comes into my office saying they aren't losing weight, the problem is that they are eating a lot more than they think they are," says Holly Herrington, a registered dietitian and clinical nutritionist with the Center for Lifestyle Medicine at Northwestern Medical Faculty Foundation. "Almost every single person underestimates how much they are eating." You can blame oversized restaurant portions, mindless munching and "health halos" for that, she says.

After all, French fries and ice cream aren't the only things that are calorie-packed. So are healthy foods, including olive oil, avocado and nuts. For instance, 1 cup of almonds contains about 750 calories. If you're snacking on them (a great idea), but without measuring and tracking those calories (a bad idea), you could easily end up gaining weight, Herrington says.

She recommends tracking everything you eat, at least for a couple months, with apps like My FitnessPal, which will help you learn proper portion sizes and how your favorite health foods measure up calorie-wise. In one American Journal of Preventive Medicine study, people who kept daily food records lost double the weight of those who didn't track their food intake.

2. You're Not Sleeping Enough

A bad night's sleep can wreck your weight-loss efforts through a two-pronged approach. For one, it makes you hungry and likely to overeat. "When you don't get enough sleep, your levels of cortisol and also ghrelin, a hormone that increases the sensation of hunger, rise," explains board-certified internist Dr. Patricia Salber.

For example, in one University of Chicago study, healthy young men who got just four hours of sleep two nights in a row (compared to their usual seven to nine hours) reported a 24 percent increase in appetite, along with cravings for candy, cookies, chips, bread and pasta. They also experienced an 18 percent decrease in leptin, which promotes fullness, and a 28 percent increase in the hunger-hormone ghrelin.

Second of all, not getting enough sleep could make your body store what you do eat as fat. For instance, a 2011 study in the American Journal of Clinical Nutrition found that just one night's bad sleep caused healthy men's resting energy expenditure – the number of calories they burned by simply being alive – to drop by 5 percent. The number of calories they burned after each meal also dropped by 20 percent.

"Sleep deprivation and sleep apnea may affect blood sugar levels and increase insulin resistance," says endocrinologist Dr. Michael Bergman, clinical professor of medicine at the NYU Langone Medical Center. "Sleep disorders, namely obstructive sleep apnea, [have] been associated with the development of Type 2 diabetes."

If clean-sleep habits – such as keeping your bedtimes consistent and not playing on electric devices in the hour before bed – don't help you get eight solid hours a night, talk to your doctor about how you can sleep better and longer, he says.

3. You're Eating the Same Number of Calories You Did on Day One of Your Diet

Oh, the weight-loss plateau: At the beginning of your diet, you were losing weight and feeling great. But now, you're doing the exact same thing, but with zero results. That might be the problem. "As you lose weight, your caloric needs will change," Herrington says. "The smaller you get, the fewer calories your body needs, so the fewer calories you'll need to eat to continue losing weight."

If your weight-loss results have plateaued for one to two months, she recommends gradually cutting back on calories. Start by eating 100 fewer calories a day and see how the scale shifts in a couple weeks' time. Don't cut back too much, though. Most women shouldn't eat any fewer than 1,200 calories a day and men shouldn't eat any fewer that 1,700 a day. Meanwhile, you should never feel famished or low on energy, she says.

4. You're Constantly Stressed

Acute stress – say from a looming work deadline or relationship drama – can cause your appetite to go MIA. But if the stress keeps up and becomes chronic, too-high levels of the stress hormone cortisol can increase your appetite, particularly for high-carbohydrate foods, according to Salber.

"When stressed, people seek to comfort themselves and relieve the tension," she says. "All too often, that means turning to sugar or starchy foods." High-carb foods can cause a quick spike in blood sugar and feel-good serotonin levels. But both crash quickly, and put you in a vicious cycle of stress and overeating.

Meanwhile, by stimulating the production of insulin, cortisol also increases your body's tendency to store calories as visceral fat. A type of fat that hangs out in the abdominal cavity and likes to hug your vital organs, visceral fat is associated with the development of insulin resistance and, in some cases, diabetes, Salber says.

If you can't remember the last time you weren't stressed, consider visiting your doctor or a therapist to help you manage your stress levels and get healthy. Mental health issues, including stress, are no different than physical health issues, she says. They deserve professional help.

5. You're Using Artificial Sweeteners

Artificial sweeteners, whether you stir them into your coffee, get them from diet sodas or spoon them from your yogurt container, are an easy way to cut calories and sugar in the short term, but they could harm your long-term weight-loss efforts. Case in point: Research from the University of Texas found that over the course of 9.5 years, the average two-a-day diet-soda drinker puts on five times more belly fat than do people who abstain.

That could be because your brain responds to artificial sweeteners by telling you to eat more sweet stuff, according to the Harvard School of Public Health. Meanwhile, they may also throw off the balance of healthy bacteria in the gut, Salber says.

A 2014 study from the Israel-based Weizmann Institute of Science's immunology department found a significant correlation between the consumption of artificial sweeteners, gut bacterial configuration and a tendency to develop glucose intolerance, which contributes to the development of obesity and Type 2 diabetes.

Eliminate any artificial sweeteners in your diet and replace them with sweeteners that also contain vitamins and minerals, such as honey and maple syrup. Just make sure to count their calories.

6. You Have a Medical Condition

While rare, underlying health conditions can make weight-loss difficult to achieve on your own. For instance, Cushing's disease, marked by excess cortisol levels, and polycystic ovary syndrome, a common endocrine disorder in women, can both contribute to glucose disorders, Bergman says.

Meanwhile, hypothyroidism, a condition in which the thyroid gland doesn't produce enough hormones, can also contribute to weight-management issues. About half of thyroid disorder cases in America are undiagnosed, according to the American Association of Clinical Endocrinologists.

If you aren't losing weight, but feel like you are following your body's caloric needs and are exercising between two and five hours a week, Herrington recommends talking to your doctor about your weight-loss concerns. He or she may be able to run some simple tests to make sure a health condition isn't behind your frustrations. If something is amiss, treating it will do more than help you lose weight.

Obesity In Children Linked to Lack of Sleep and Breathing Problems

March 7, 2015

A child’s difficulty to sleep and breathing problems can influence the risk of your child from getting obese. The recent research study published in The Journal of Pediatrics revealed that these two conditions may double the risk for obesity of a child as he reaches the age of 15. The lead researcher, Prof. Karen Bonuck, indicated that sleep and breathing problems are correctable conditions, but when not treated accordingly can increase the risk of the child to become obese.

Sleep disordered breathing

Sleep disordered breathing is considered to be a risk factor to child obesity. The condition includes sleep apnea and snoring. Parents of children in the study were asked to provide information involving their child’s sleep duration and sleep disordered breathing symptoms since birth until the child reaches the age of 6 years. Data on body mass index(BMI) were also obtained. The study showed that those with a higher BMI and with severe sleep disordered breathing symptoms are at the greatest risk of getting obese. Their chance to become obese as they reach the age of 7 to 15 years old is twice as much as those who are symptomatic with sleep disordered breathing condition. A study made in Hong Kong revealed that children with an excess weight tend to have a breathing problem because it causes the narrowing or congestion of the child’s airway while sleeping. Children with sleep disorders also tend to have enlarged tissues at the back of their throat, increasing their chance to getting obese later on.

Sleep duration symptoms

Children with a shorter sleep duration at the age of five or six have about 60 to 100 percent of getting obese upon reaching the age of 15. This finding, however, is interestingly not consistent among children of other age group. Short sleep duration in children refers to sleep that is less than 90% than the other children of their age. Parents are advised to help their children get enough sleep at an ideal duration, considering that about 25 to 50 percent of preschoolers suffer from lack of sufficient sleep.

In a research study published in Pediatrics that was conducted by the University of Chicago researchers, the sleeping patterns of about 308 children between the age of 4 and 10 were tracked down using a special wrist device. These children were categorized with normal, overweight and obese according to their respective body mass index. The study revealed that obese children in the group have variable sleep patterns and they tend to have short duration sleep as the other children. They were also identified to have the unhealthiest blood profile during blood extraction.

Additional findings of the researchers show that those children having the tendency to become obese are more protected when they get adequate sleep. Additional observation was added by Dr. Phyllis Zee, a sleep researcher, where he agreed there is a correlating link between sleep and obesity, but also signifies that the variability of sleep-wake timing in children can also be a contributing factor in regulating weight.

Other researches were also focusing on the resulting interrupted or disordered activity of the body’s metabolism and endocrine system caused by the lack of sleep. This is especially significant among children whose body are still growing. Another relation to sleep and obesity are the changes in the levels  of two hormones named leptin and gherlin, which are responsible for appetite and hunger regulation. The body often misinterprets sleep cravings as a hunger that causes an increase in the activities of these hormones that makes a child overeat.

The Drowsy Driving Epidemic [Infographic]

February 11, 2015 | Daniel R. Rosen


The Cost & Consequences of 168 Million Sleep-Deprived Drivers

There are countless driving hazards every time we get behind the wheel of a vehicle. But one of the most common can also be the most deadly: driving while drowsy.

While texting and driving and drinking and driving are widespread and deadly problems, drowsy driving is even more pervasive in the U.S. More than a third of Americans fell asleep behind the wheel of a car last year, and there are 42 drowsy drivers for every one drunk driver on the road.

Drowsy driving accounts for hundreds of thousands of auto accidents, injuries and deaths, as well as billions of dollars in monetary losses every year. Driving while sleep deprived can even cause impairment that rivals driving under the influence of drugs or alcohol.

The infographic below explores the costs and consequences of drowsy driving across the U.S.


Source: Law Offices of Daniel R. Rosen.

Israeli Researchers Develop Groundbreaking Approach To Evaluate Sleep Disorders.

Mon, Mar 16th, 2015

Ben-Gurion University of the Negev (BGU) researchers have developed a groundbreaking approach to determine sleep quality using their new breath sound analysis (BSA). This is less expensive and invasive than current polysomnography (PSG) technology, according to a new study published on PLOS Online.

“One of the main goals of sleep medicine today is to improve early diagnosis and treatment of the ’flood” of subjects presenting with sleep disorders,” says Prof. Yaniv Zigel Ph.D., head of the Biomedical Signal Processing Research Lab in BGU’s Department of Biomedical Engineering.

“We’ve developed a non-contact ‘breathing sound analysis’ algorithm that provides a reliable estimation of whole-night sleep evaluation for detection of sleep quality, snoring severity and Obstructive Sleep Apnea (OSA). It has the potential to reduce the cost and management of sleep disorders compared to PSG, the current standard of treatment, and could be used at home.”

PSG requires a full night sleep center stay and subjects are connected to numerous electrodes and sensors that are attached to the patient to acquire signals and data from electroencephalography (EEG), electrooculography (EOG), electromyography (EMG), and electrocardiography (ECG) tests. The data is processed and visually examined or mathematically transformed manually in order to reveal insights about sleep/wake states and many aspects of physiology. “This procedure is time-consuming, tedious and costly due to complexity and the need for technical expertise; the market is begging for a better solution,” says Eliran Dafna who conducted this study as part of his Ph.D. research.

In the study, the researchers measured whole-night breathing sounds from 150 patients using both ambient microphones and PSG simultaneously at a sleep laboratory. The system was trained on 80 subjects and a validation study was blindly performed on the additional 70 subjects. A set of acoustic features quantifying breathing patterns was developed to distinguish between sleep and wake segments. Sleep quality parameters were calculated based on the sleep/wake classifications and compared with PSG for validity.

When comparing sleep quality parameters, there were only minor average differences in the measurements between PSG and BSA. Measuring 150,000 individual time segments (epochs), the BSA epoch-by-epoch accuracy rate for the validation study was 83.3 percent with 92.2 percent sensitivity measuring sleep as sleep.

“The results showed that sleep/wake activity and sleep quality parameters can be reliably estimated solely using breathing sound analysis,” says Prof. Ariel Tarasiuk of BGU’s Department of Physiology and head of the Sleep-Wake Disorders Unit, at Soroka University Medical Center. “This study highlights the potential of this innovative approach to measure sleep in research and clinical circumstances. Clearly, the transition of this technology to at-home sleep evaluation depends on third party reimbursements for the use of home study equipment.”

The Biomedical Signal Processing Research Laboratory was established in 2007 by Prof. Yaniv Zigel. The lab’s team are experts in physiological signal processing and pattern recognition.

The for the Study and Diagnosis of Sleep Disorders was established in 1994 by Prof. Ariel Tarasiuk. The unit’s team of experts evaluate sleep disorders in children and adults and operates in conjunction with specialists in respiratory diseases, neurology, ENT, and gastrointestinal diseases.