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BRUXISM & OBSTRUCTIVE SLEEP APNEA

L. Wayne Halstrom, DDS, D.ABDSM

Diplomate, American Board of Dental Sleep Medicine

Adjunct Professor – Respiratory Therapy & Sleep Science, Thompson Rivers University

 

Obstructive Sleep Apnea (OSA) is a condition that has received an unprecedented level of attention over the past decade.  The health implications of OSA are life altering and life threatening.  A growing body of research is linking OSA to heart attack, stroke, and other associated health risks.

Recent research has demonstrated that sleep bruxism or clenching may occur as a mechanism to prevent airway collapse.[1]

Bruxism has been classified by the American Academy of Sleep Medicine as a “sleep related movement disorder”.  Sleep apnea induced bruxism can have significant implications for standard dental procedures.  When major dental restorative procedures are contemplated, the identification of bruxing patients who suffer from OSA becomes an even more compelling objective.

The following CT scans of a sleep apnea patient’s airway response to clenching are very revealing. Top Figure – the resting airway, Middle Figure – the airway in a simulated sleep apnea event (Mueller maneuver), Bottom Figure – the very same airway during clenching.  As the airway is collapsing during sleep the brain initiates clenching and grinding as a subconscious mechanical technique to open the airway and improve breathing.

This “reflex action” may go a long way to explain the often puzzling bruxism we see in children.  If a child has large and extended tonsils that block the airway it is quite natural to expect that the child will resort to clenching, grinding and tongue thrusting to relieve the blockage.

Dentistry’s typical protocol to address bruxism is the fabrication of a night guard. However, research conducted at the University of Montreal indicates that night guards have the potential to increase existing sleep apnea by a factor of 50% for half of the OSA patients.[2] For patients with moderate sleep apnea, increasing their sleep apnea by such a factor could lead them to a level of “severe” sleep apnea, thus potentially placing the life of the patient at risk.

According to a survey conducted by the Public Health Agency of Canada over 1 in 4 (26%) adults reported symptoms and risk factors that are associated with a high risk of having or developing obstructive sleep apnea.

With simple screening techniques we are able to uncover patients who may suffer from OSA. Loud snoring is the earliest sign of a blocked airway. You may be surprised at how often questions about snoring will lead to the next questions “do you stop breathing at night?”, and “are you sleepy during the day”.  A yes answer to any of these questions is a good indication for further assessment.

Validated questionnaires may be used to assist in the identification of potential sleep apnea patients.  An example of these is the STOP Questionnaire.[3] This questionnaire uses the following four simple questions, with two or more positive answers returning a “high risk” result.

  • Snoring: Do you snore loudly (loud enough to be heard through closed doors)?
  • Do you often feel tired, fatigued or sleepy during the daytime?
  • Has anyone observed you stop breathing during your sleep?
  • Do you have or are you being treated for high blood pressure?

In February of 2006 the American Academy of Sleep Medicine issued a position paper on the efficacy of Oral Appliance Therapy that recommended “Oral appliances are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP”.  Recommendations also included the requirement of “serious training” for dentists undertaking oral appliance therapy for their patients.

This message is reinforced within a Position Paper published in the September 2012 issue of the Canadian Respiratory Journal. “Oral Appliances (OAs) offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine.”[4]

Dentists who embrace the various guidelines and protocols may serve as a valuable resource in the treatment of obstructive sleep apnea for the medical profession.

 


[1] Simmons JH, Prehn R, Airway protection: the missing link

between nocturnal bruxism and obstructive sleep apnea.

Sleep 32(abstract suppl):A218, 2009.

Simmons JH, Prehn R, Nocturnal bruxism as a protective

mechanism against obstructive breathing during sleep. Sleep

31(abstract suppl):A199, 2008.

Prehn R, Simmons JH, Prevalence of sleep-disordered

breathing (SDB) in patients with temporal mandibular joint

disease (TMD). Sleep 34(abstract suppl):A125, 2011.

[2] Aggravation of Respiratory Disturbances by the use of an Occlusal Splint in Apneic Patients: A Pilot Study – Yves Gagnon DM/Pierre Mayer, MD/Florence Morisson, DMD, PhD/Pierre H. Rom-pre, MSc/Gilles J. Lavigne, DMD, MSc, PhD.

[3] STOP Questionnaire – A Tool to Screen Patients for Obstructive Sleep Apnea, Anesthesiology 2008; 108:812–21

Frances Chung, F.R.C.P.C.,* Balaji Yegneswaran, M.B.B.S.,† Pu Liao, M.D.,‡ Sharon A. Chung, Ph.D.,§

Santhira Vairavanathan, M.B.B.S., Sazzadul Islam, M.Sc., Ali Khajehdehi, M.D.,† Colin M. Shapiro, F.R.C.P.C.

[4] Position paper by Canadian dental sleep medicine professionals on the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances

L Gauthier, F Almeida, J-P Arcache, C Ashton-McGregor, D Coté, HS Driver, KA Ferguson, GJ Lavigne, P Martin, J-F Masse, F Morisson, J Pancer, CH Samuels, M Schachter, F Sériès, GE Sullivan

 

INTERVIEW

Dr. Halstrom – Radio Interview

Snoring / Sleep Apnea & The Silencer®

 

The following questions and answers have been prepared as a general guide to assist dental practitioners during radio or television interviews.  These represent the thoughts and opinions of Silencer Products International Ltd. The individual dentist is encouraged to seek additional and independent scientific and market information.

 

Could you tell us a little bit about The Silencer and its inventor Dr. Wayne Halstrom?

 

Well, Dr. Halstrom came from a family of legendary snorers.  His uncles all snored, mother, father and so on and so forth.  It has always been a blamed nuisance to anyone of the family who ever had to put up with one of these people, particularly as they got older.

 

His background is in the health field.  He and I are dentists by profession, specializing in the treatment of snoring and sleep apnea.  What got him really deeply interested in this area was his own snoring.  In his late 50’s he developed the much more serious condition of sleep apnea.  Sleep apnea is a robber of rest and restoration of the body as we sleep.  Dr. Halstrom hit a freeway abutment at 60-mph sound asleep.  That got his attention.

 

Definitely a wake up call there?

 

That was a wake up call he could hardly refuse to take notice of. His medical doctor said to him, “ there is something more wrong with you than just being tired and over worked.”

 

His quest for diagnosis and treatment ultimately lead to his invention of The Silencer.

 

How big of a problem is snoring and sleep apnea, how many people for example snore, do we have a number?

 

Yes we do, a great deal of research has been done on snoring and sleep apnea over the last twenty years.  The National Sleep Foundation tells us that:

•           59% of adults report snoring.

•           24% say they snore every, or almost every night.

 

Recent estimates indicate that 38 million people suffer from obstructive sleep apnea in the US, and as we age things tend to get worse.

 


Why is that?

 

Well, a combination of things.  First, as we get older, we tend to put on a little extra weight and we lose muscle tone in various places.  The extra weight crowds the breathing channel causing the snoring action to occur.   The sound of snoring is caused by the flapping of tissue in the upper airway.  This flapping is due to the loss of muscle tone in the upper airway, allowing the tissue to flap more easily.  It gets to be a vicious circle of life.  Snoring and sleep apnea can often be an inherited tenancy as well.

 

As the weight comes and then the relaxation of the tissue occurs we may put on more weight and we get into a vicious circle.  That circle being this.  If you are overweight and not sleeping well when you wake up in the morning are you a good candidate to put on your running shoes and go out for a lifestyle changing run?   It is not very likely.  You go to work, spend all day doing what you have to do to put bread on the table, you come home to a family all wanting your attention, worn out and tired.  Are you then a candidate to do good lifestyle things again?  It is not likely.

 

We need to interrupt that vicious circle by treating this condition.

 

The lifestyle choices of smoking and drinking, do they factor in at all?

 

Absolutely, particularly drinking from the standpoint that alcohol is a relaxant drug.  A stimulant at first but then later in the alcohol cycle it becomes a relaxant.  So, therefore anything that will cause the muscles of the upper airways to relax will tend to allow them to collapse more easily.

 

Smoking acts as an irritant, causing the tissues in the airway to swell.  We recommend firstly, to people who are looking for a treatment for snoring and sleep apnea is that they stop smoking and do not drink particularly at night before bedtime and do not eat late.  Those things will help, but often it is not enough to do the trick.

 

I understand that Snoring and Sleep Apnea can have an adverse effect on high blood pressure, how so?

 

It can be a contributing factor to hypertension.  As the body is struggling to breathe the chest wall is working harder.  As a result you tend to get high blood pressure as a next step from that particular event.

 

You mentioned a couple of times Sleep Apnea.  Please define what it is and how it differs from another sleep disorder we hear about, narcolepsy?

 

Narcolepsy is a central nervous system disorder.  It is characterized by sudden and deep sleep.  You just fall asleep.

 

You just nodding off uncontrollably?

 

You just short right out. It is a central nervous system oriented condition.

 

Apnea itself is defined as cessation of ventilation of breathing for a period of longer than ten seconds.  If you were to hold your breath as we were talking, for longer than ten seconds, you have had an apnea event.  If that happens while you are sleeping, you have what we refer to as sleep apnea.  This event can happen hundreds of times a night in patients that have been observed, this cessation can exist for as long as 93 seconds.

 

What are the consequences of that happening?

 

What you have is the brain being starved for oxygen.  Crowding of the airway with all of this tissue and the tongue creates the obstruction event of sleep apnea that robs the brain of oxygen.  I liken it to putting 3 large men in a phone booth; there just is not enough room.  When that blockage occurs breathing ceases for longer than 10 seconds that is classically what we call sleep apnea.

 

For those folks who sleep with a sleep partner who wakes up gasping or does not even wake up but they find them gasping at night for air, this can be frightening.  What is happening is a temporary period of affixiation caused by the upper airway being blocked.  There is no air passing through to the body therefore it is not receiving the oxygen that it requires.  What will then happen is the blood oxygen goes down and like a hydraulic system, the blood carbon dioxide level goes up.  The brain then says. “I need to have air, come on stupid breath.” Then, you will take a big gasp of air and the cycle repeats itself.  As this repeats itself hundreds of times a night it robs the person of the opportunity to get down into the normal sleep cycles.  Unless you get into deep sleep, REM sleep, you can not get enough restoration time.  Your body simply does not get the rest it needs.

 

So, you wake up feeling tired?

 

You wake up feeling tired and tend to be sleepy during the day.  You wake up with headaches and a raspy dry throat because of all of the gasping of air in and out.  It can be a very uncomfortable place to be.

 

 

What happens when someone wakes up snoring?

 

You really do not wake yourself up snoring.  The reason you wake up is the lack of oxygen and the increase of carbon dioxide in the blood.  The arousal is caused by the body’s fight for oxygen.

 

What exactly causes people to snore?  What is making that snoring noise?

 

There is a little piece of tissue that hangs down the back of the throat the soft palate, called the uvula.  It along with some of the other tissues in what we call the lateral pharyngeal area, the breathing tube, all contribute to the noise.

 

Think of the breathing tube as a two-inch piece of polyvinyl pipe.  Hanging into this pipe is a little flap. Extending and narrowing the pipe are some other pieces of material.  What happens, as the materials collapse into the pipe, is that the air is being pulled in and pushed out under pressure and around obstructions.  As the air passes over and around the obstructions in its path the materials start to flap and make motion.  It is the combination of the sucking of the air and the motion of those particular tissues that cause snoring.

 

For any of you who have taken a garden hose with a small amount of water flowing through it and gradually closed it with your fingers you will find that flow that was unimpeded did not make any noise.  If you choke that off you will find that you will get noise from the water being restricted.  That same analogy applies to the snoring sound.

 

How is medicine traditionally responded to the snoring problem?   What solutions have they offered?

 

It is amazing; we have been snoring since the beginning of time.  It had always been thought of as being more of a joke than anything else.  However, since the 1960’s medical science has developed the diagnostic tools and therapeutic options currently available for sleep apnea sufferers.  We now understand that snoring, particularly heavy snoring, can be the first and most obvious marker for the more serious health condition of sleep apnea.  We discovered that snoring is not a joking condition at all.  We have always felt sorry for the snoree, not the snorer.  What we are realizing now is that the snorer, particularly the one who stops breathing, needs medical attention.  They need assistance to stop this problem.  It is now clearly not good enough to say, “don’t worry about it George, Mabel will kick you and you will roll over.”

 

People who suffer from significant sleep apnea run a 2.8 X risk factor for stroke and a 2.5 X risk factor for heart disease.  It is not a joke at all.

 

Now that we realize and understand the implications and complications medical science has come forward and there are some treatments for this.

 

Positive lifestyle changes will assist any treatment option, however with lifestyle changes on their own there is a low probability of success for many sleep apnea patients.

 

The Gold Standard of treatment for sleep apnea is a device called CPAP which provides Continuous Positive Airway Pressure, in effect acting to splint the airway open with a column of air.  This is a life saving piece of equipment.  The therapy is particularly well suited to the more moderate or severe sleep apnea patients.

 

The American Academy of Sleep Medicine practice parameters now recommend oral appliances as a first line  treatment for snoring and mild to moderate sleep apnea.  The Silencer falls into this category.  Oral Appliances are regulated by the FDA and are considered a medical device.  The Silencer obtained 510K approval (K954530) in November of 1995.

 

The surgical alternative is an attempt to cure snoring or sleep apnea by eliminating some of the tissues that are contributing to the airway blockage.  Generally speaking I believe that it is a good idea to try the noninvasive and reversible treatment options before considering surgery.

 

How does The Silencer work?

 

The Silencer makes room by positioning the lower jaw forward thereby moving the tongue forward and bringing tone to the airway  Thus making room back there for the uvula and the other tissues.

 

How do you accomplish that?

 

The Silencer looks a lot like an upper and lower mouth guard or night guard.  The movement of the jaw however is controlled by a titanium precision attachment that lies in the appliance behind the front teeth.  It simply moves the lower jaw forward, and or open, a prescribed amount that will then move the tongue forward and by so doing will pull the tissues out of the way and can eliminate the problem.

 

Does that in anyway obstruct your regular breathing? Does it take some getting used to?

 

There is plenty of room for normal breathing while wearing the appliance.  There is an adjustment period, and some patients will salivate a little more until they get used to it.

 

Is there any danger of the device itself obstructing the breathing passage?  Can you swallow it at night?  Or get it caught in the airway?

 

No, that can’t happen at all.  It uses the natural teeth to be retained.

 

OBSTRUCTIVE SLEEP APNEAAND THE WORKFORCE  Obstructive Sleep Apnea (OSA) is a medical condition that has not so silently crept up on our population.  It has always been there, but has remained below the radar screen of both the profession of Medicine and the health care community.  It is only for about the last twenty years that there has been available the technology to quantify the health implications of lowered blood oxygen levels during sleep.  It is only in the last ten years that the specter of the health risks and costs of OSA to the health care system, as well as to the business community, have become obvious. The overall goal of a “human resources” division of an employer is to encourage, assist and sustain a healthy, happy, productive, stable and retainable workforce.  There is a weevil gnawing away at the underpinning of this goal.  It is Sleep Disordered Breathing (SDB) The following paper is intended to summarize and quantify the health care concerns, costs and strategies to bring the relevant issues into focus.  It is our objective to turn this focus into action. This article will outline and identify some well established motherhood statements about this condition as well as detail items from specific papers that comment upon areas of interest and concern.   Wayne Halstrom B.A., D.D.S., Dip.A.B.D.S.M.                                     F.A.D.I., F.P.F.A., F.A.C.D., F.I.C.D.                     Diplomate American Board of Dental Sleep MedicineDental Director – Vancouver Institute of Sleep Medicine  
OBSTRUCTIVE SLEEP DISORDERED BREATHING There is no condition of the human that is made better by lowered blood oxygen levels.  There are a number of conditions of the human that are made much worse by this condition.  Sleep Disordered Breathing (SDB) is related to a multitude of health risks and is present in 24% of men and 9% of women.  SDB presents as a spectrum of health issues ranging from Snoring, to Upper Airway Resistance Syndrome and Obstructive Sleep Apnea (OSA).  Obstructive Sleep Apnea (OSA) has Cardiovascular and Cerebrovascular implications.  It negatively impacts Diabetic patients, Asthma sufferers and many other conditions.  When considering the costs of patient management and care over time, failure to address the presence of OSA poses serious risk to both morbidity and mortality.  Heart disease – a 2.5x risk factor;

  • Atrial fibrillation
  • Systemic arterial hypertension
  • Ischemic heart failure
  • Cardiac arrhythmias are present in 50% of OSA patients

Cerebrovascular disease;

  • Stroke – a 2.8x risk factor
  • Intracranial pressure is the major cause of headaches
  • 55% of male patients with a stroke were chronic snorers
  • 35% of strokes occurred during sleep

Diabetes;

  • 36% of diabetics have OSA
  • males are twice a likely to suffer from the combination

In many chronic conditions, the cost associated with performance-based work loss, which has been called “presenteeism”, greatly exceeds the combined costs of absenteeism and medical treatment.   Considering the above noted physical repercussions from OSA, how does this relate to the work force and the cost of OSA and its link to health care costs?  Dr. Meyer H. Kryger of the St. Boniface General Hospital in WinnipegManitoba published some defining research on the subject of health care costs for OSA patients.[1]  His findings were that the OSA population used twice the health care resources in the last ten years before diagnosis than did the control group. This work has been largely ignored by Health Canada since in many jurisdictions in Canada there still remains a reluctance to provide either diagnosis of or treatment for OSA.  It therefore becomes the task of the private sector to deal with, for the public good and their own corporate reasons, the issues that are forthcoming for employees who suffer from OSA. Three of the largest non-natural disasters in history were caused by inattentiveness, in part due to sleep disordered breathing, of key supervisory personnel.

  • Exon Valdez
  • Three Mile Island
  • Bophal Chemical plant

Beyond these incredible facts and figures is the issue of the costs to the employer of pharmaceutical products, damage to equipment, increased insurance premiums and material as well as danger to other workers. One of the principle causes of increased employer spending has been, and is destined to continue to be, related to pharmacology and drug costs in the treatment of hypertension, high blood pressure and depression.  Of immediate and quantifiable note can be the savings in Pharmaceutical costs for treated OSA patients.  Treatment of underlying OSA conditions can offer a financial benefit as such treatment will be a buffer against the use of pharmaceutical products. We advocate for a comprehensive screening for all employees.  The referenced newspaper coverage (Schedule 10) attests to the fact that had the employer, whose driver was involved in the tragic accident, screened for sleepiness in their drivers and had the driver been treated for a probable underlying OSA condition, the RCMP constable killed in this accident might have been alive today. This is but one of many such stories that have reached the media.  As noted in the Schnieder National Inc. (SNI) paper (Schedule 9), and on the same pathway,CSA is willing to participate with employers, at no cost, to provide material and assistance to create SDB screening programs.  In addition CSA is willing to place into the facility of major employers a diagnostic and treatment facility to ensure access to appropriate measures to identify SDB and treat susceptible employees. Obstructive Sleep Apnea Screening = Identification Consultation = Informed/Consenting employees 

Treatment = Results

 

  • reduced morbidity
  • reduced mortality
  • reduced overall health care costs
  • reduced pharmacology costs
  • increased work performance
  • increased employee retention

The following summary and quotations represent a comprehensive literature review performed in support of this presentation.  Most statements should be of concern to employers. The papers referenced have been included for information purposes and are attached as Schedules 1 – 10.Summaries of comments and statements from these papers are a follows:

Schedule 1: THE CONSEQUENCES OF SLEEP DISORDERED BREATHING            Thorax – 1995            Kathlene A. Ferguson and John A. Fleetham            Respiratory Division, Department of Medicine, VancouverHospital and Health Science Centre, Vancouver, BC. –          Sleep disordered breathing is common and may affect up to 24% of men and 9% of women.-          Systemic hypertension occurs in 40-60% of patients with OSA-          Blood pressure is higher in the morning than in the evening in patients with OSA-          Several studies have shown that 22-30% of patients with systemic hypertension have OSA.-          Long term treatment of OSA reduces systemic blood pressure independently of any weight changes.-          The increased intracranial pressure is probably the major contributing cause of the nocturnal and morning headaches present in some patients with SDB.-          Intellectual deterioration, personality, and behavioral changes are well recognized features of SDB.-          Psychological testing in patients with SDB has demonstrated significant deficits in thinking, perception, memory and the ability to learn.-          Treatment of sleep disordered breathing may improve psychological status and result in less anxiety and depression.-          Of 50 patients with severe OSA, 44% were reported to have either diminished sexual interest or performance. Schedule 2: THE IMPACT OF OBSTRUCIVE SLEEP APNEA AND DAY TIME SLEEPINESS ON WORK LIMITATIONC.F. Ryan, J. A. Fleetham et alDepartment of Medicine and Division of Respiratory Medicine, University of B.C., Vancouver, B.C.  – 2007 –          We have demonstrated a clear relationship between excessive sleepiness and decreased work productivity in a population referred for suspected sleep-disordered breathing.-          Screening for sleepiness and sleep-disordered breathing in the workplace has the potential to identify a reversible cause of low work productivity.-          There is a gradual increase in work limitations with severity of subjective sleepiness.-          The study showed a deleterious effect of OSA on time management and work output.-          Snorers and OSA patients showed difficulties with concentration, learning of new tasks and performing new tasks.-          Snoring patients showed far more work impairment than nonsnorers.-          There is a robust relationship between subjective sleepiness and work limitations.-          Patients may have occult depression associated with work limitations.-          Screening for SDB in the workplace has the potential for decreased “presenteeism” and improvement of work productivity.-          Sleep fragmentation leads to:

  • Poor quality of sleep
  • Excessive daytime sleepiness
  • Reduced vigilance
  • Microsleeps
  • Neurochemical dysfunction
  • OSA has an adverse effect on productivity


Schedule 3: MEDLINE PLUS 10/28/2007 –          20 Million people in the USA have diabetes.-          18 Million people in the USA suffer from OSA-          36% of diabetics suffer from OSA.-          There is a relationship between OSA, glucose intolerance and insulin resistance.OSA is related to a multitude of health risks, including heart disease, high blood pressure, depression, sexual dysfunction and an increase in car accidents Schedule 4: PUBMED – NATIONAL LIBRARY OF MEDICINE (SLEEP 2004)Department of Respiratory and sleep Medicine, St George Hospital , The University of New South Wales, Sydney, Australia. – Oral appliance therapy for OSA over 4 weeks results in a reduction in blood pressure , similar to that reported with continuous positive airway pressure (CPAP) therapy. PUBMED – NATIONAL LIBRARY OF MEDICINE (Int J. Prothodontics  – 2006) –          These data suggest that effective oral appliance therapy for OSA patients with Hypertension can lead to a substantial reduction in daytime blood pressure. AMERICANACADEMY OF SLEEP MEDICINE            Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005 – Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. 
Schedule 5: THE AGE – November 19, 2002 –          Patients with OSA show a dramatic early loss of grey matter.-          OSA patients suffer disordered wiring in brain regions that control muscles of the airway.-          Healthy men’s brains were between two and 18% larger in the areas that control breathing.-          OSA patients often display other traits that suggest subtle brain damage, including problems with memory, thought and motor skills.-          The repeated oxygen loss from OSA may damage other brain structures that regulate memory and thinking.-          38% of OSA patients reported a history of stuttering or speech impairment.-          75% of the American population stutters. Schedule 6: NATIONAL SLEEP FOUNDATION – 09/10/2007 –          65% of Americans are overweight or obese.-          A 10% decrease in weight can lead to a significant clinical improvement in the severity of OSA..-          1 in 3 American children born in 2000 will develop diabetes-          A build up of “sleep debt” over a matter of days can impair metabolism and disrupt hormone levels.-          Glucose tolerance tests showed short sleepers were experiencing hormonal changes that could affect their function, body weight and impair long term health.-          To keep blood sugar levels normal, short sleepers needed to make 30% more Insulin.-          We tend to eat when we are actually sleepy, because our bodies confuse fatigue as a sign of hunger.
Schedule 7: CHEST – NOV, 8, 2007Sleep apnea and the Commercial Motor Vehicle Operator –          Medical research has shown that OSA is a significant cause of motor vehicle crashes (resulting in a twofold to seven fold increase in risk) and increases the possibility of an individual having significant health problems such as hypertension, stroke, ischemic heart disease, and mood disorders.-          USA Federal Motor Carrier Safety Regulations state:

  • “the driver must have no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.”

WORKSAFE BC SEPTEMBER 20, 2005 –          According to WSBC, in the five years from 2000 through to 2004, there were 21,700 time loss claims, including 116 fatalities and 533 serious injuries, resulting in more that 650,000 productive work days lost.  These injuries and fatalities cost the BC trucking industry $101 Million in workers’ compensations costs alone.-          “The trucking industry and this province cannot afford the continuing human and financial cost of these injuries and fatalities.” American Academy of sleep Medicine – Spring 2000       Life Insurance Risk Assessment in Patients with OSA –          The diagnosis of obstructive sleep-disordered breathing is now considered by the insurance industry to be a significant risk for mortality in this assessment and may be used to determine insurability.–          Current evidence suggest that patients who are compliant with proven effective therapy for sleep apnea should be expected to have little or no risk of excess mortality due to sleep apnea.-          Life insurance carriers should not assess excessive risk of mortality based on sleep-disordered breathing if the sleep disordered breathing is effectively treated.   Schedule 8: DAMION LEGER – The cost of sleep-related accidents: A report for the National Commission on Sleep Disorders Research.  Sleep – 1994            Unite de Sommeil de l’Hotel-Dieu, Paris, France             Sleep Research Center, Stanford University, Palo Alto, Ca, USA This report, prepared for the National Commission on Sleep Disorders Research explores the economic implications of sleepiness in relation to accidents. –          52% of all work place accidents in 1988 were sleep related.-          Chronic sleep disorders affect 60 – 80% of all shift workers.-          When people with sleep disorders are asked about driving and accidents, their answers indicate that the frequency with which they fall asleep while driving could be between 30 and 93%.  Schedule 9: Mark B. Berger, MD FCCP, Wendy Sullivan, RN, Ross Owen, MPA and Charlotte Wu,  MS Precision Pulmonary  Diagnostics Inc., Schneider National, Inc., and Definity Health Corp. Houston, Texas USA.             This study deals with the health care and community risk factors resulting from OSA conditions in the employee group of a large US trucking firm. –          Only 10% of adults with SDB have been diagnosed.-          Only 10% of primary care physicians inquire about SDB related symptoms.-          A witnessed apnea event by a bed partner is nearly 100% accurate in predicting a diagnosis of SDB.-          It is estimated that Commercial truck drivers have an SDB rate of 28%.-          SDB affected drivers have from 2-15 times more frequent MVAs, as compared to unaffected drivers.-          In 348 drivers who suffered from SDB, CPAP therapy resulted in a 47.8% reduction in per member per month health care spending.-          There was a drop of 73% in preventable accidents in a sub group of 225 full time CPAP treated drivers.-          The average cost per large truck crash involving a fatality was $3.5 Million and in cases of injury, $217,000.-          Risk of SDB and comorbitities are evident in 1 out of 3 drivers.-          After intervention, SDB patients had 25% as many hospital visits and spent 50% of the health care dollars when compared with a similar period prior to intervention.-          The employer enjoyed a 129% greater employee retention rate following corporate intervention for SDB.-          Appropriate treatment for SDB can ameliorate co-morbities of

  • Cardiovascular disease
  • Hypertension
  • Diabetes
  • Obesity


Schedule 10: ALBERTA TRUCKING– 2006            L. Wayne Halstrom, B.A., D.D.S. –          Industry must take the initiative to work with regulatory authorities to produce and environment conducive to “bringing in” the sleepy driver. Canada.com – Truck driver who killed Mountie found guilty. –          “A truck driver who killed and RCMP constable when his truck slammed into the Mounties’ cruiser has been found guilty of dangerous driving  causing death.”

Judges Comments

–          “Smith had past episodes of falling asleep at the wheel or “driving on auto-pilot”.-          “I am satisfied beyond a reasonable doubt that Mr. Smith was aware of the risk, or ought to have been” Conclusion: HAD THE EMPLOYER READ THE ALBERTA TRUCKER IN 20-06 AND ACTED ON THE RECOMMENDATIONS THIS RCMP CONSTABLE MIGHT BE ALIVE TODAY!!!!!                                                       &THE CAREER AND LIFE OF MR. SMITH WOULD NOT BE IN TATTERS!

 


[1] Obstructive Sleep Apnea Patients Use More Health Care Resources Ten Years Prior to DiagnosisJohn Ronald1, Kenneth Delaive1, Les Roos2, Jure Manfreda2,3 and Meir H. Kryger1