Sleep related breathing problems-What you need to know

Mon, 08/06/2007 - 4:46am — Health Dimensions

The following is a transcript of an interview Dr Schiesser and Dr Lazar performed on the radio with Dr Terry Jacobs, sleep Specialist:

Dr. Amy Lazar: Welcome back everyone to Health Dimensions. This is Dr. Amy Lazar, your co-host and we are bringing back on Dr. Teresa Jacobs who specializes in the diagnosis and treatment of sleep disorders, advanced training in pulmonary medicine and sleep medicine and practices at Creekside Medicine in Bellevue. Again, you can go to www.creeksidemedicine.com. Welcome back, Dr. Jacobs.
 
Dr. Teresa Jacobs: Good morning, Amy.
 
Dr. Lazar: You were mentioning before we took the break about sleep testing and the process of overnight sleep studies. Could you please go into that a little bit more and mention how children do with this testing.
 
Dr. Jacobs: Well the sleep testing for adults and children is pretty much the same. We are monitoring the same information to learn about the consistency and quality of the sleep, how frequently it is being interrupted and by what the breathing is doing, what the heart's response to the sleep is and movement and muscle tension in the legs. There is a lot of wires, none of which that go through the skin.
 
So, there is nothing painful about the test. It is just a little awkward and uncomfortable. My daughter had a sleep study a few years ago and actually was kind of fascinated by it and had no trouble falling asleep so that we could learn what we needed to learn which was that she had sleep apnea, a breathing problem where her breathing stopped.
 
Dr. Michael Schiesser: Well I want to bring on Dr. Jan Zemplenyi. This is Dr. Michael Schiesser and Dr. Zemplenyi is the President and Director of the Bellewood Center for Aesthetic Surgery. In addition to being a Board certified otolaryngologist with an expertise in snoring, he is a cosmetic and reconstructive surgeon. So, Dr. Zemplenyi, are you there? Are you there?
 
Dr. Jan Zemplenyi: Good morning everyone.
 
Dr. Lazar: Good morning.
 
Dr. Zemplenyi: Hi. I apologize for my alarm malfunction.
 
Dr. Schiesser: I had anxiety dreams all night about not being here. It looks like I dropped Dr. Jacobs so you are only guy right now. This morning was fraught with technical difficulties which is going to be humorous and I appreciate everybody listening in here. So, Dr. Zemplenyi what can you tell us about sleep related breathing problems?
 
Dr. Zemplenyi: Well, I think that speaking as an otolaryngologist, we see a lot of patients who have had their spouses essentially make them come in because after all if you spend all of your night listening to your husband or wife snoring away it can be very, very frustrating and patients are very grateful to have somebody evaluate them for snoring and explain to them that there is something that can be done for this very vexing problem.
 
As an otolaryngologist, I analyze not only the patient's symptoms, listen to what the difficulties are that are being created by this very often social difficulties. We look at the anatomy and try to figure out whether it is the nose, the throat area which we call the soft palate or the base of the tongue which is the area lower down which is causing the obstruction. The vibrations of the soft palette are thought to be the main cause of the snoring sounds.
 
Dr. Schiesser: Is snoring--I mean, obviously snoring is a problem for people who are snoring and the people who are trying to sleep in the same house with the snorer. What other problems can be associated with snoring?
 
Dr. Zemplenyi: Well, snoring, as you know, is seen always, that is to say very significant snoring in patients who have sleep apnea. So, we are very concerned about the possibility that obstructive sleep apnea may be present and so it's a standard of care to work up the patients for the possibility of sleep apnea by referring them for an evaluation with an overnight sleep study.
 
Dr. Schiesser: Dr. Jacobs was telling us a little bit about sleep studies. Is it your experience that that's important useful beneficial for patients who are snoring? How many patients who are snoring actually have any problems that are more important than that?
 
Dr. Zemplenyi: Well, many, many patients who snore turn out to be of such that they actually have sleep apnea, so it's very, very important to work them out.
 
Dr. Schiesser: I specialize in sleep disorders, so this is almost a rhetorical question here...
 
Dr. Zemplenyi: Right.
 
Dr. Schiesser: But sleep apnea, so what? If somebody's been diagnosed, what's the significance there, as far as treatment? Do they really need to be treated?
 
Dr. Zemplenyi: Yes, sir. Because that sleep apnea, as opposed to just very significant social snoring, sleep apnea is a condition that then is associated with very significant potential other problems, such as increased cardiac heart disease. It's a risk factor for such a condition. It's also often associated with other significant medical conditions, such as acid washing up from the stomach into the esophagus and throat, called gastro-esophageal reflux.
 
It's also associated with just the fact that people are hyper somnolent, which means that they are very, very sleepy during the day and don't function appropriately; can fall asleep while driving, can fall asleep on the job, don't concentrate very well, sometimes suffer from headaches. So, there is just a very, very large amount of potential symptoms that the patient can be suffering from.
 
Dr. Lazar: Dr. Zemplenyi, this is Dr. Lazar, and I have a quick question for you here, related to that...
 
Dr. Zemplenyi: Hello.
 
Dr. Lazar: In directing to children. A lot of behavioral issues, people don't realize, in children and adolescents, can be related to poor sleep. Can you comment on what you would be evaluating in children and adolescents?
 
Dr. Zemplenyi: Yes. In children, we very often see that the main cause of their symptoms is a very large tonsil and adenoid. So, in children, we tend to recommend an adenotonsilectomy to resolve the problem. About 90 percent of the time or more, there is a dramatic resolution that we see.
 
Dr. Lazar: Is it a common, also, fact that it's not necessarily true that children that are overweight have sleep issues?
 
Dr. Schiesser: Yes. And if a child is overweight and does not have very large adenotonsils, then a sleep evaluation is definitely something that should be performed, especially when suggested by all the other symptoms that are being reported by the parents. But if that person has enlarged adenoid and enlarged tonsil, and especially the tonsil, then an adenotonsilectomy is recommended, and very often will very significantly resolve, or if not resolve, at least help to resolve the problem.
 
Dr. Schiesser: If you're just tuning in, you're listening to Health Dimensions on KPTK 1090 in Seattle. I'm going to try to bring Dr. Jacobs back on the line. And it's possible I could drop you, Dr. Zemplenyi, but let's just see how it goes. Dr. Jacobs, are you still there?
 
Dr. Jacobs: Yeah, I'm back.
 
Dr. Schiesser: Well, it looks like, contrary to popular belief, I can talk with one caller at a time, at least with my current level of skill. And that's fine, because we got you back on the line. And I want to hear just any final thoughts that you have about the importance of sleep testing in individuals who may or may not have sleep apnea due to sleep-related breathing problems. Do you have any other comments that you have been hoping to make this morning about that?
 
Dr. Jacobs: Well, probably the most important thing to remember is that sleep breathing problems are not always obvious.
 
And so if there's a suggestion based on the presence of snoring or the presence of daytime symptoms that suggest that the sleep is not of good quality--somebody getting enough sleep, but not feeling rested--an overnight sleep study will answer a lot of questions, because of all the things it measures to try and help clear that up so that people can feel better and be healthy, because of all the risks associated with these untreated sleep disorders.
 
Dr. Schiesser: And again, the risks, if people aren't treated, are what?
 
Dr. Jacobs: The common risks of untreated sleep disorder breathing are poor functioning during the day, with sleepiness and fatigue, which can translate to problems with driving and safety issues. But the increased risk of stroke and heart attack, in sleep apnea that's untreated for a long period time. And the problems that come with just being sleepy all day long in your daytime relationships, and other medical conditions, where sleep is considered restorative and helpful.
 
Dr. Schiesser: Well, Dr. Jacobs, I want to thank you for coming on our show today. You're listening to Health Dimensions, I'm Dr. Michael Schiesser, on Seattle's Progressive Talk AM 1090. I'm here with Dr. Lazar, and we'll talk more about sleep-related breathing problems after the break...