park spreecast 2015
TRANSCRIPT
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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
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Disclosures
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Klinorynchy
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Anterior Migration of Foramen Magnum
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Laryngeal Descent
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Laryngeal Descent
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3 Dental Concepts
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Corruccini
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Weston Price
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Weston Price
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Weston Price
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Weston Price
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Attractive?
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Attractive?
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?
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?
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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
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Obstructive Sleep Apnea Syndrome
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Obstructive Sleep Apnea Syndrome
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Apnea Hypopnea Index (AHI) > 5
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Apnea: > 90% obstruction
> 10 seconds
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Hypopnea: > 30% obstruction + 4% desaturation
or arousal
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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.
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Respiratory Disturbance Index (RDI)
(Apneas + Hypopneas + RERAs) / hour
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Inspiratory Flow Limitation (IFL)
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Upper Airway Resistance Syndrome
(UARS)
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Upper Airway Resistance Syndrome
(UARS)
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Unexplained Illnesses” by Martin L. Pall, 2007
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UARS & OSAS
OSAS UARS “Normal”
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Why Are Things Getting Worse?
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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
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Laryngeal Descent
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SIDS
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Prematurity and OSA riskX
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Awaken HR Variability
Obst. Events Arousals Sleep
DurationNREMSleep
Sleep Efficiency
+25%
Preterm Prone
Preterm Supine
3 mo Prone
+6%-40%
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Multi-hit Theory
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Tonsils
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http://www.atsjournals.org/doi/full/10.1164/rccm.200201-050OC#.VEVHykvjlVL
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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
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7 Procedures That Can Cause OSA
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Nasal Surgery
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Any Surgery that Forces Supine Sleep
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Sleep Hygiene
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iPad
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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
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Eating in bed
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Eating in bed
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7 Procedures That Can Cause OSA
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7 Procedures That Can Cause OSA
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Migraine
Genes
Red Wine
Weather
Chocolate
Genes
Red Wine
Chocolate
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“Success”
Tonsillectomy
Nasal Surgery
Orofacial Myo
Dental
Tonsillectomy
Tonsillectomy
Dental
Dental
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Basic Principles
All humans are susceptibleRedefine aging
New health paradigm
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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
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Practical Tips
Treat the patient, not the numbersPractice evidence-based medicine, but always treat
the patient first
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Practical Tips
It’s all in the patient’s history — listen to their stories
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Practical Tips
Practice what you preach
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Questions?
doctorstevenpark.com