Well
An Academic Research Center of Excellence
September - October
2008
Wellness Mondays for Employees • September 8, 15, 22 & 29, 9:00 a.m.-3:00 p.m. • October 6, 13 & 27, 9:00 a.m.-3:00 p.m. 320 Bayer Learning Center Wellness Wednesdays • September 24, 1:00-3:00 p.m. • October 8 & 29, 1:00-3:00 p.m. 320 Bayer Learning Center Blood Pressure Screening • September 24, 10:00 a.m.-noon • October 8 & 29, 10:00 a.m.-noon 3rd Floor, Duquesne Union
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Tobacco Cessation Program The Center for Pharmacy Care offers a five-week program. Any employee or student interested in joining a group to quit tobacco should call X5874. Dates will be determined after sign-up. Center for Pharmacy Care Services The Center offers the following complimentary screenings and services Mondays and Wednesdays by appointment: osteoporosis screening/bone density, body composition analysis, facial skin analysis, cholesterol screening, medication therapy management, and health care coaching. Please call 412-396-5874 for an appointment.
Sleep Apnea:
What’s Waking You Up At Night?
A
pnea is derived from the Greek word apnoia meaning “without breath”. Although there are three different types of sleep apnea, each causes the patient to stop breathing repeatedly during the night. Sleep apnea affects approximately 12 million Americans and is more common in African Americans, Hispanics and Pacific Islanders than in Caucasians. The most common form of this condition is obstructive sleep apnea (OSA). It is caused by excessive relaxation of the muscles in the back of the throat resulting in narrowing of the airway and a temporary cessation of breathing (see Figure 1). This interruption of breathing lowers oxygen levels and alerts the brain of breathing difficulties. The patient is forced to awaken in order to reopen the airway. A second and less common form of this disorder is termed central sleep apnea. It also awakens the patient from sleep, but occurs because the brain fails to transmit signals to muscles that are used in breathing. The third and final form is a combination of the two and is referred to as complex sleep apnea.
Risk Factors Wellness Mondays/Wednesdays
aware
Sleep apnea can occur in all age groups and affects both males and females. Certain risk factors (see Table) can make a person more predisposed to the condition. Central sleep apnea is usually related to an underlying condition such as brain tumor, whereas obstructive sleep apnea generally has more modifiable risk factors. Patients with OSA may not be overweight, but excess weight or a neck circumference greater than 17.5 inches can result in airway obstruction and make an individual more prone to sleep apnea. Gender and age also play a role in sleep apnea. Men are twice as likely as women to suffer from OSA as are adults over the age of 65. Some lifestyle choices may also increase the risk for OSA. Smoking increases inflammation and fluid retention in the upper airway and makes a person more susceptible to the condition. Some additional risk factors for OSA include the use of alcohol and sedatives as well as hypertension and a naturally narrow throat.
Courtesy of the American Sleep Apnea Association
Figure 1: Normal and Obstructed Airways From: ASAA http://www.sleepapnea.org/info/media/pressimage.html (accessed 19 August 2008)
Symptoms and Diagnosis Obstructive and central sleep apnea share common symptoms, often making it difficult to differentiate between the two forms of this condition. One of the most common symptoms is loud, chronic snoring. While this is more prominent in OSA, it can be seen in either type. Two other frequent complaints are choking or gasping for air while asleep and increased daytime sleepiness, even after a full night of sleep. Some people who suffer from sleep apnea may notice other symptoms such as dry mouth or sore throat upon awakening, morning headache, irritability and mood swings, loss of memory or concentration, and difficulty staying asleep. An individual who recognizes several of these symptoms should consult their physician. Diagnosis of the disorder may require completion of a sleep study. During this evaluation, a patient’s stage of sleep is monitored by brain waves and eye and chin movement. Additionally, the patient’s heart rate, breathing patterns, blood levels of oxygen and carbon dioxide, and leg movements are recorded. Early and accurate diagnosis of sleep apnea can result in appropriate treatment and reduction of complications.
Complications Untreated sleep apnea can lead to a variety of complications. One bothersome complaint continued on back
Sleep apnea: What’s Waking You Up At Night? is daytime fatigue resulting from frequent awakenings during the night. The fatigue can be so severe as to disrupt a patient’s normal activities at work, school, and home. Some patients may find themselves falling asleep while driving, thus endangering their lives and those of others. A person with sleep apnea may snore loudly and continually awaken throughout the night. This may cause the spouse to become sleep deprived as well. There are other serious complications associated with untreated sleep apnea. The risk for high blood pressure is increased two to three times in patients with sleep apnea. Sudden drops in blood oxygen levels produce a strain on the cardiovascular system and can result in sudden death in patients with underlying heart disease. Furthermore, sleep apnea increases the risk of stroke regardless of whether the patient is hypertensive. Another concern is the increased potential for complications following surgery, especially if sleep apnea had not been previously diagnosed. This occurs because these patients are more prone to breathing problems when sedated and lying on their back.
Treatment The first step in managing sleep apnea is to institute a few lifestyles changes: • If overweight, attempt to lose weight. Even slight weight loss can decrease constriction in the throat and lead to easier breathing. • Avoid alcoholic beverages and smoking because both can aggravate the problem.
• Change sleeping position to side or abdomen. Sleeping on the back further blocks the airway and should be avoided. • Keep nasal passages open during sleep by using a saline nasal spray. • Consider medications to improve wakefulness during the day. Modafanil (Provigil) and armodafinil (Nuvigil) are the only pharmaceutical treatments currently FDA approved for OSA; however they do not directly affect the cause of the disorder or its progression. Some patients believe medications such as tranquilizers and sleeping pills might improve their condition, but, in reality, these drugs actually relax muscles of the throat and further interfere with proper breathing. More severe cases of OSA may require additional therapies. The preferred method of treating severe OSA is the use of a continuous positive airway pressure (CPAP) machine (see Figure 2). This device uses a mask to deliver air at a pressure greater than that of the surrounding room. It keeps the upper airway passages open and prevents sleep apnea and snoring. If CPAP is not effective, a bi-level positive airway pressure (BiPAP) apparatus can be used because it provides more pressure upon inhalation and less during exhalation. Although not as effective as CPAP, oral appliances may be beneficial and are considered more user-friendly. These appliances, usually obtained from a dentist, help maintain an open airway by
aware
A publication of: Mylan School of Pharmacy Center for Pharmacy Care Pharmaceutical Information Center (PIC)
Additional information on newsletter topics: Pharmaceutical Information Center 412-396-4600 pic@duq.edu Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417
Figure 2: Continuous Positive Airway Pressure (CPAP) From: Mayo Clinic http://www.mayoclinic.com/print/sleep-apnea/DS00148/ METHOD=print&DSECTION=all (accessed 19 August 2008)
pushing the lower jaw forward and preventing the tongue from falling back and obstructing air flow. Surgery is considered an option when other treatments have proven ineffective. Central and complex sleep apnea are treated similarly to OSA. In addition, underlying medical problems must be addressed and managed. Supplemental oxygen may also be required in these types of sleep apnea. Sleep apnea is an increasingly recognized disorder that, when severe, can produce significant complications. Early recognition and treatment are critical in reducing the risk of these problems.
Risk Factors for Sleep Apnea
Well
© Mayo Foundation for Medical Education and Research. All rights reserved.
Obstructive Sleep Apnea Central Sleep Apnea Age >65
Male sex
Male sex
Brain tumor
Excessive weight
Heart condition
Neck circumference >17.5 inches
Stroke
Family history of sleep apnea Hypertension Naturally narrow airway Use of alcohol, sedatives or tranquilizers Smoking
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Newsletter Contributors
For more information regarding sleep apnea, please visit the following Web sites:
John G. Lech, Pharm.D. Ashley M. Bartell, Pharm.D. Candidate Alaina E. Fairley, Pharm.D. Candidate
• http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html
• http://www.mayoclinic.com/print/sleep-apnea/DS00148/METHOD=print&DSECTION=all • http://www.sleepapnea.org/index.html 321806 9/08