park spreecast 2015
TRANSCRIPT
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
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
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?
doctorstevenpark.com