park spreecast 2015

Sleep & Breathing:The 2 Keys to Optimal Health

Steven Y. Park, MDOtorhinolaryngology & Sleep Medicine

Assistant Professor Albert Einstein College of Medicine Department of Otorhinolaryngology

Montefiore Medical Center Bronx, NY

Disclosures

Klinorynchy

Anterior Migration of Foramen Magnum

Laryngeal Descent

Laryngeal Descent

3 Dental Concepts

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Corruccini

Weston Price

Weston Price

Weston Price

Weston Price

Attractive?

Attractive?

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Cover Comp 9 4/2/08

SleepInterrupted.com

Endorsed by New York Times best-selling authors:

Dr. Christiane Northrup Dr. Dean Ornish Dr. Mark Liponis Mary Shomon

Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome

Apnea Hypopnea Index (AHI) > 5

Apnea: > 90% obstruction

> 10 seconds

Hypopnea: > 30% obstruction + 4% desaturation

or arousal

Respiratory Event Related Arousal

(RERA)

isr Intensive Scoring Review

40

The nasal pressure excursions drop by more than 50% for at least 90% of the event’s duration.

The event lasts more than 10 seconds.

There is no oxygen desaturation. There is an arousal at the end of the event.

The event meets the criteria for 4.B. but not 4.A. It is a hypopnea only if your center uses 4.B. If you use 4.A., it is a RERA.

Respiratory Disturbance Index (RDI)

(Apneas + Hypopneas + RERAs) / hour

Inspiratory Flow Limitation (IFL)

Upper Airway Resistance Syndrome

(UARS)

Upper Airway Resistance Syndrome

(UARS)

Unexplained Illnesses” by Martin L. Pall, 2007

UARS & OSAS

OSAS UARS “Normal”

Why Are Things Getting Worse?

Myers, G. S. (1971). Effect of sodium fluoride and sodium pyruvate on palatal development in vitro. Anatomical Record. Part a: Discoveries in Molecular, Cellular, and Evolutionary Biology, 171(1), 39–52. doi:10.1002/ar.1091710104

Laryngeal Descent

SIDS

Prematurity and OSA riskX

Awaken HR Variability

Obst. Events Arousals Sleep

DurationNREMSleep

Sleep Efficiency

+25%

Preterm Prone

Preterm Supine

3 mo Prone

+6%-40%

Multi-hit Theory

Tonsils

http://www.atsjournals.org/doi/full/10.1164/rccm.200201-050OC#.VEVHykvjlVL

Harper, R. M., Kumar, R., Ogren, J. A., & Macey, P. M. (2013). Sleep-disordered breathing: effects on brain structure and function. Respiratory Physiology & Neurobiology, 188(3), 383–391. doi:10.1016/j.resp.2013.04.021

7 Procedures That Can Cause OSA

Nasal Surgery

Any Surgery that Forces Supine Sleep

Sleep Hygiene

iPad

Circadian Rhythm

Age Hours Of Sleep Needed

Newborns (1-2 mo) 14-18 hours

Infants (3-11 mo) 13-16 hours

Toddlers (1-3 yrs) 12-14 hours

Preschool (3-5 yrs) 11-13 hours

Children (5-12 yrs) 10-11 hours

Teens (13-17 yrs) 9-10 hours

Adults (18 and up) 7-9 hours

Eating in bed

Eating in bed

7 Procedures That Can Cause OSA

7 Procedures That Can Cause OSA

Migraine

Genes

Red Wine

Weather

Chocolate

Genes

Red Wine

Chocolate

“Success”

Tonsillectomy

Nasal Surgery

Orofacial Myo

Dental

Tonsillectomy

Tonsillectomy

Dental

Dental

Basic Principles

All humans are susceptibleRedefine aging

New health paradigm

Practical TipsDon’t eat within 3-4 hours of bedtime

Don’t drink alcohol within 3-4 hours of bedtimeOptimize nasal breathing

Sleep positionHead position

Migraine triggersRelaxation / breathing techniques

Enlarge the airway

Practical Tips

Treat the patient, not the numbersPractice evidence-based medicine, but always treat

the patient first

Practical Tips

It’s all in the patient’s history — listen to their stories

Practical Tips

Practice what you preach

Questions?

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