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Obstructive Sleep Apnea has been linked in the research to both upper and lower airway inflammation and systemic inflammation. CPAP use may exacerbate these problems. Inflammation in the upper airway (pharyngeal area) plays a role in upper airway collapse (Caples, et al, 2005), and systematic inflammation found in Obstructive Sleep Apnea is tied to cardiovascular morbidity (Bergeron et al., 2005; Boisvert et al., 1998). CPAP may exacerbate these issues; CPAP’s use was found to be associated with the development of Airway Hyperresponsiveness, or AHR (Devouassoux et al., 2007). AHR is found in diseases like asthma or COPD and is characterized by an increased constrictive response, or simply, an increased tendency of the airway to constrict itself in response to environmental or physical stimuli (OByrne & Inman, 2003). CPAPs use has also been linked to inflammatory responses. In a recent study seeking to determine whether CPAP was pro-inflammatory in human subjects, AlAhmari (2012) and his team at the University College Medical School, London, studied both humans (in vivo) and their cells (in vitro). It was found that CPAP results in dose-dependent release of cytokines. Cytokines recruit and activate immune cells, which establish inflammation in the body (Lynch et al, 2003). Conclusion: Obstructive Sleep Apnea is linked to upper and lower airway inflammation as well as systematic inflammation. Upper airway collapse and/or cardiovascular morbidity are connected to these inflammatory responses in the body. CPAP treatment used to treat Obstructive Sleep Apnea may add to these inflammatory responses. CPAP has been tied to Airway Hyperresponsiveness and release of cytokines, which activate immune cells and the body’s inflammatory response.
The ACSDD is proud to announce that we have forged a working relationship with the Arizona Chiropractic Association led by Dr. Alan Immerman. This is an exciting announcement as it further expands the reach of the ACSDD’s multidisciplinary education philosophy. I will be working with Dr. Immerman in inviting chiropractors to connect with dentists and vise versa in the treatment of OSA. Further we will explore cross-lecturing, connecting our websites, joint research, and other projects. As an important aside, we are pleased and honored to have Jeffrey Mersky, DC, as one of our distinguished lecturers at our October 19-20, 2012 conference at the Ritz Carlton in Phoenix, AZ.
According to research presented at the American Stroke Association's International Stroke Conference. Ninety-one percent (51 of 56) of the patients who had a stroke had sleep apnea and were more likely to have silent strokes and white matter lesions that increased risk of disability at hospital discharge. Check out the statement from the American Heart Association here.
What is PCORI? PCORI stands for Patient Centered Outcomes Research Initiative. Put simply, PCORI is a private organization interested in what patients think about current treatment systems within U.S. healthcare and users' experience of that care. According to PCORI's mission, patients and their preferences should be at the center of care. PCORI does not seek to steer patients toward any one option, but instead wants to serve as a trusted source of information for patients and caregivers alike. You can check out the PCORI site here Dr. Joe Selby, the director of PCORI, describes PCORI's focus as one that concentrates on patient engagement and he asserts the value PCORI places on public feedback about systems of care and the care itself. Although central to the Initiative, the definition of "patient centered outcomes research" is in the process of being finalized, following a period of public comment from practitioners and patients across the country. PCORI seeks to work with practitioners and patients to provide patients and their caregivers answers to these questions: “Given my personal characteristics, conditions and preferences, what should I expect will happen to me?” “What are my options and what are the benefits and harms of those options?” “What can I do to improve the outcomes that are most important to me?” “How can the health care system improve my chances of achieving the outcomes I prefer?” Why should you care? Dentists practicing Dental Sleep Medicine are providing a treatment option that has been slowly and surely attracting more and more proponents. The evidence for Dental Sleep Medicine's success and high rates of patient acceptance and subsequent compliance is mounting. PCORI is an organization trying hard to hear patient voices and to create [...]
Institute of Medicine (IOM). (2006). Sleep Disorders and Sleep Deprivation. Washington, D.C.: National Academies Press Although the report was published in 2006, Sleep Disorders and Sleep Deprivation is a report of which the dental sleep medicine practitioner should be acutely aware. The report is available in hard copy and the PDF version is free to download from www.NAP.edu. Just search for the report by its title. What does the Institute of Medicine say? The IOM's Sleep Disorders and Sleep Deprivation describes sleep loss and sleep disorders as “among the most common yet frequently overlooked and readily treatable health problems” (p. 56). The 425 page report recognizes the shortage of practitioners trained to identify and treat sleep breathing disorders, as well as the lack of funding by organizations such as the National Institutes of Health (NIH) and others to address what the literature is showing to be a continuum of diseases with increasing prevalence in the United States. Sadly, this lengthy examination of what the IOM calls an “unmet health problem” does not sufficiently explore the role and importance of the dental practitioner in identification and management of sleep breathing disorders. In their discussion of treatment options, the authors of the IOM report understand the research to demonstrate that patients are most effectively treated with CPAP and weight loss, but, they admit, “the problem is that many patients are non-compliant” (p. 75). Dental appliances are called “less effective,” indicated only when a dental problem is “etiologically related” (p.303) and are given only a passing mention (exactly twice throughout the whole report). In its detailed recommendations, the IOM asserts the importance of support by the NIH, academe, and private foundations to develop an adequate workforce to address [...]
The Dental Sleep Medicine field continues to expand rapidly as increasing numbers of Dentists are becoming involved in the collaborative effort required to identify and manage sleep breathing disorders. As the field grows, so too does the complexity of each practitioner's needs. The ACSDD is proud of its innovative continuing education and certification programs grounded in evidence-based clinical practice and current scientific research. However, as more of our member dentists expand their scope of practice to include Dental Sleep Medicine, we want to ensure that that our members are aware of not only what the research says but also what's happening policy-wise on a national and international level. The ACSDD's latest blog initiative, Good Science, is designed to keep our members up-to-date on the latest in Dental Sleep Medicine, specifically regarding the clinical research and scholarship dictating national and international healthcare policy that ultimately affects the Dental Sleep Medicine scope of practice. We recognize the need for quality research and education in Dental Sleep Medicine as well as an understanding of the national and international healthcare policy from which the research derives. This is why we are very excited about Good Science and its value to our members.
BioRESEARCH Associates, Inc., and the Academy of Clinical Sleep Disorders Disciplines: Furthering the Art and Science of Dental Sleep Medicine, Temporomandibular Joint Disorder (TMD), and Craniofacial Pain by Finding Synergies The Academy of Clinical Sleep Disorders Disciplines (ACSDD) and BioRESEARCH Associates, Inc., are pleased to announce their relationship. The synergistic effort of these two organizations marks an important milestone in the continuing development and growth of the field of Dental Sleep Medicine, TMD, and Pain. Bio-RESEARCH Associates, Inc., develops and produces objective diagnostic aids for the TM Joint, craniofacial muscles, occlusion, jaw movement and position. Joint Vibration AnalysisTM is used by dentists treating OSA and snoring to ensure they don’t exacerbate a subclinical TMJ issue with their snoring appliance. Additionally, BioRESEARCH serves healthcare practitioners across the United States in both private and academic institutions and boasts a growing global network. The ACSDD brings to the BioRESEARCH dental network its multidisciplinary Academy model, world-class on-line training curriculum in Sleep, TMD, and Pain, its on-line Fellows and Diplomate certification processes, outstanding biannual conference series, and unbeatable member services. Mr. Nate Krey, Domestic Sales Director for BioRESEARCH Associates, Inc., said, “This is an excellent opportunity for BioRESEARCH to partner with an organization that values objective diagnostics in craniofacial physiology. Members may differ on their choice of treatment, but they all understand that a thorough diagnosis must come before treatment.” Greg Kamyszek, Executive Vice President of BioRESEARCH, said, “Our partnering with the ACSDD will benefit our clients worldwide. With solid distribution in Brazil, Russia, India, and China, we have clients and universities worldwide that will benefit from the ACSDD Fellow and Diplomate highly rigorous credentialing programs.” ACSDD Founder and Executive Director, Dr. Michael J. Krahe, states, “The ACSDD desires [...]