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Strong scientific findings presented at AIDS 2010 point to promise ahead and underscore the need to stay the course

Posted by Pacific J Med Sci on July 25, 2010 at 8:26 AM Comments comments (0)

Strong scientific findings presented at AIDS 2010 point to promise ahead and underscore the need to stay the course


HIV epidemic at a crossroads as delegates, buoyed by scientific progress, confront the possibility of stagnant funding for program scale-up


23 July 2010 [Vienna, Austria]–

The biennial meeting of the global AIDS community concluded today with clear evidence of tangible progress in HIV research and programme scale up, yet facing an urgent need for increased resources, the protection of human rights, and broader use of scientifically sound prevention strategies. Delegates and organizers depart Vienna – where the conference opened 18 July under the theme of Rights Here, Right Now -- with a renewed commitment to push for securing universal access to HIV prevention, care, treatment and support.

"International governments say we face a crisis of resources, but that is simply not true: The challenge is not finding money, but changing priorities. When there is a Wall Street emergency or an energy crisis, billions upon billions of dollars are quickly mobilized. People's health deserves a similar financial response and much higher priority," said Dr. Julio Montaner, AIDS 2010 Chair, President of the International AIDS Society and Director of the B.C. Centre for Excellence in HIV/AIDS in Vancouver, Canada. "Billions of people stand in solidarity with us in our drive for universal access. We must rally their support behind Michel Sidibé's Prevention Revolution and Treatment 2.0 initiative and UNAIDS to ensure that world leaders do not turn their backs on their pledge to reach the goal of universal access."

AIDS 2010 drew 19,300 participants from 193 countries. The week-long programme featured 248 sessions covering science, community and leadership. The conference was supported by 770 volunteers from Vienna and elsewhere.

"The legacy of Vienna is the proof that we can scale up treatment and prevention to all those in need," said Dr. Brigitte Schmied, AIDS 2010 Local Co-Chair and President of the Austrian AIDS Society. "Despite the formidable obstacles in our path, we leave here with renewed energy to maintain momentum."


Vienna Declaration

By the close of the conference, more than 12,725 individuals had signed the Vienna Declaration, the official declaration of the XVIII International AIDS Conference. On Thursday, the First Lady of Georgia, H.E. Sandra Elisabeth Roelofs, signed the declaration, adding her voice to the call for more rational and scientifically sound drug policies to strengthen HIV prevention for people who use drugs.


Closing Features Examination of Conference Issues

Rapporteur reports in each of the scientific tracks and programme areas examined the key issues addressed by conference delegates over the past week and will play an important role in evaluating the conference and its impact.


The Closing Session featured a video address by South African Archbishop Desmond Tutu, remarks by Rachel Ong, Chair of the Global Network of People Living with HIV, and Patricia Perez, Chair of the International Steering Committee of the International Community of Women Living with HIV/AIDS. Montaner and Incoming IAS President Elly Katabira, Professor of Medicine at Makerere University in Uganda, presented the first IAS Presidential Award to Jack Whitescarver of the U.S. National Institutes of Health and Katabira gave an inaugural address.


At the conclusion of the Closing Session, representatives of the AIDS 2010 local partners officially transferred the International AIDS Conference globe from Vienna to Washington, DC, which will host the XIX International AIDS Conference in July 2012. Accepting the globe for DC were AIDS 2012 Local Co-Chair Dr. Diane Havlir and representatives of the AIDS 2012 local partners.


Earlier today, delegates heard from three plenary speakers.

HIV and Incarceration: Prisons and Detention

The first of today's plenary presentations featured two speakers. Dmytro Shermebey (Ukraine) of the All-Ukranian Network of PLHA offered a powerful account of his personal fight for survival during a nine-year prison sentence served in a Ukranian jail where he contracted HIV, hepatitis and tuberculosis. He survived because he wanted to prove that prisoners are humans who have a right to life, respect, understanding, help and protection.


UN Special Rapporteur on Torture, Manfred Nowak, said there is an urgent need for a comprehensive reform of the criminal justice and prison system to ensure an adequate response to the HIV/AIDS epidemic and detainees' human rights. The prevalence of HIV/AIDS and TB in prisons and the measures authorities take to deal with it, impact – and often violate – detainees' human rights. It is often forgotten that while prisoners are denied their right to liberty, they have not abrogated their other rights, such as the right to health or the right to freedom from cruel and unusual punishment. For several reasons, prisons are characterized by particularly high HIV prevalence and are conducive to the spread of the epidemic. The transmission of HIV largely is due to risk behaviour and the failure of states to provide harm reduction measures. Evidence-based interventions, such as voluntary HIV testing and counselling and the provision of condoms, needles, syringes and opioid substitution therapy, would provide effective means to contain the spread of HIV. However, locked up behind prison walls, the fate of detainees is largely forgotten by society. The mere fact that about 30 million detainees enter and leave prisons every year highlights that prisoners' health is a pressing public health issue.


Care and Support: Integral to Comprehensive Care

Elizabeth Gwyther (South Africa) of the Hospice and Palliative Care Association of South Africa called for the integration of HIV treatment, care and support programmes to ensure comprehensive HIV care to meet the needs of PLHIV. Gwyther described the experience of PLHIV beginning at the time they present to health care providers, often because of an opportunistic infection, highlighting the complex interventions and continuity of care they need to maintain their health and mitigate HIV's impact on their socio-economic status. She noted that palliative and supportive care should not be reserved for end-of-life care because it plays an important role in promoting health restoration. Gwyther also spoke about the experiences of community care workers who work on the front-line of the community response to HIV, saying that many are undervalued and do not receive the recognition they deserve. In addition to a policy for integrated HIV care, she called for governments and donors to provide accessible funding to support the community-led response to HIV/AIDS.


Hepatitis C: Cure and Control, Right Now

Dr. David Thomas (United States) of the Johns Hopkins School of Medicine said HIV and HCV co-infection is a serious and common problem, particularly among people who acquired HIV through drug use, and causes liver disease that is not sufficiently controlled by antiretroviral therapy. HIV/HCV co-infected persons die at a much higher rate than people with only one of the two infections, and liver failure is now the second leading cause of death among PLHIV on antiretroviral therapy.


While there are major challenges in addressing hepatitis C, HCV infection is curable and major improvements in treatment are expected within the year. Thomas called for scale-up of hepatitis C testing, particularly among PLHIV, and new ways to integrate HCV treatment with comprehensive HIV health and wellness services. Major challenges to an effective scale-up exist as HCV screening is uncommon and engaging people who use drugs in traditional medical care can be difficult.


Visit for complete programme information and comprehensive online coverage.

AIDS treatment must include more than drugs

Posted by Pacific J Med Sci on July 25, 2010 at 8:20 AM Comments comments (0)

AIDS treatment must include more than drugs



FREELANCEJULY 25, 2010 2:02 AM


At last week's International AIDS Conference in Vienna, many excellent solutions will be discussed about how to combat the pandemic, from treating people with anti-retroviral drugs once they are diagnosed (Vancouver's Seek and Treat Program) to ways we can better stop the transmission of the virus from mother to foetus. We already possess the knowledge to effectively prevent, treat, and manage this disease; however, there is still a massive gap between the treatments we have and their availability for those who need them.


What good are ARVs if there isn't a health-care worker to test the patient, dispense the medications and follow up with them? What good are ARVs if adequate diagnostics are not available? What if you don't have access to adequate nutrition? (An HIV-positive person needs 1,500 calories per day minimum, versus 1,200 calories if you are HIV-negative. Proper nutrition is the most important "drug" for a person who is HIV positive.) What if the medications needed to treat the many other diseases that can kill people, whether they have HIV or not, are not available? What are the effects on a population's health if the people do not have access to clean water with which to take their drugs? How do you dispense information on prevention, along with the condoms people need to protect themselves, without a skilled primary health-care worker? The number of new infections still vastly exceeds the number of new patients receiving treatment, so prevention is crucial to containing the disease.


There is only one proven way to collectively confront the AIDS pandemic and the other common preventable or treatable diseases that kill tens of millions of people per year: invest in primary health care. This is the best way to implement an integrated program that enables us to manage a patient's overall health needs -- from prevention to treatment. As Michel Sidibe, executive director of UNAIDS said, "AIDS isolation must end."


There is also a natural convergence between addressing the AIDS pandemic and improving maternal and child health (a commitment to the latter was just made at the G8 Summit in Ontario). Quite simply, if you can provide good obstetrical care for a pregnant woman, it means there is access to basic surgical capabilities, trained health-care workers, basic medications, electrical power, access to proper nutrition, and clean water. These are the same assets that are needed to prevent HIV infections and treat those who are HIV-positive. An enormous added benefit is that with these capabilities, 80 per cent of the problems in an emergency room can also be treated.

Annually, 50,000 women around the world die during pregnancy from complications associated with AIDS. Most of these deaths are entirely preventable. In order to save these women's lives, along with the 380,000 pregnant women and 8.8 million children who die every year from entirely preventable or treatable causes, the international community must redouble their efforts to invest in primary health care.


This is not glamorous, but it works. If we strengthen this often-neglected area in health care, then we can provide maternal care, infant care, HIV programs, tuberculosis programs and much more. Access to primary care is truly the common path that will dramatically reduce the annual death toll of so many people who die needlessly in the developing world. The international community must stop focusing on specific diseases and instead take a broader, public-health view.

Vienna's AIDS conference offers an ideal opportunity to break down the silos, cast a spotlight on what works, and invest in the primary health-care systems that low-income countries need to improve the overall health and welfare of their people, whether they are HIV-positive or not.


Dr. Keith Martin is a physician and Member of Parliament. He is the founder of the Canadian Physician Overseas program and of the Centres for International Health and Development initiative. In June 2009, he chaired the drafting committee at the pre-G8 meeting in Rome on international health. This committee drafted a plan of action to decrease maternal mortality, which was given to the G8 leaders in L'Aquila.


© Copyright (c) The Edmonton Journal


Exploiting The Body's Own Ability To Fight A Heart Attack

Posted by Pacific J Med Sci on February 26, 2010 at 3:09 PM Comments comments (0)

Exploiting The Body's Own Ability To Fight A Heart Attack


26 Feb 2010


Scientists trying to find a way to better help patients protect themselves against harm from a heart attack are taking their cues from cardiac patients.


The work has its roots in a perplexing curiosity that physicians have long observed in their patients: When faced with a heart attack, people who have had a previous one oftentimes fare better than patients who have never had one. Scientists have been working for 25 years to understand one reason why - a process known as ischemic preconditioning, where a temporary restriction of blood flow somehow strengthens cardiac tissues down the road.


In the latest research, published online Feb. 25 in the journal Circulation Research, a group led by Paul Brookes, Ph.D., and graduate student Andrew Wojtovich at the University of Rochester Medical Center have developed new methods in the effort to track down one of the key molecular agents involved. That molecule, known as the mitochondrial ATP-sensitive potassium channel, or mKATP, is central to ischemic preconditioning, but it has proven elusive for scientists seeking to isolate and describe it.


The Rochester team has created a new way - faster, less expensive, and easier than current methods - to measure the activity of mKATP. The team has also identified a molecule, known as PIP2, that can restore the channel's activity even once it has stopped working properly. The new work is expected to provide new clues about how the channel, which is thought to be central to our heart health, is regulated in the heart. The ultimate goal of ischemic preconditioning, of course, is not to condition the heart by purposely causing a lack of blood flow to it. Rather, scientists like Brookes hope to use their knowledge to develop a new medication or treatment to help all patients better resist heart damage should it occur.


"Preconditioning has been shown to be effective in a variety of models in the laboratory, but it hasn't made it to the clinic yet," said Brookes, associate professor of Anesthesiology and of Pharmacology and Physiology. "One would want to design a drug to get the benefit of ischemic preconditioning without actually impeding blood flow in any way."


Physicians like cardiologist Eugene Storozynsky, M.D., Ph.D., see the phenomenon of ischemic preconditioning play out in their patients. He says that it's not uncommon for a middle-aged heart attack patient who has had symptoms of heart disease to fare much better than a younger person with no history of heart disease who suddenly has a heart attack. "The person with chronic heart disease who presents with a new heart attack does not appear nearly as disabled as the younger, healthier person with no history of heart disease, even though they present to the hospital with nearly identical blockages in their heart arteries," said Storozynsky, a heart failure expert who was not involved in the study.


"Of course, the ultimate goal for patients is to prevent heart disease wherever possible," added Storozynsky, assistant professor of Medicine in the Cardiology Division. "People need to make sure they eat a balanced, low-fat, reduced-salt diet, exercise regularly, and control their blood pressure - these actions will cut down one's risk for having a heart attack dramatically."


Brookes' team also discovered that mKATP is inhibited by fluoxetine, whose brand name is Prozac. It's the latest in a list of medications that have been shown in the laboratory to impede ischemic preconditioning, Brookes said. Others include painkillers known as cox-2 inhibitors, as well as beta-blockers that are used frequently to treat high blood pressure and heart problems. Because medications like anti-depressants and beta-blockers are used so widely in patients who have had heart problems, scientists should take a close look at their possible effects on ischemic preconditioning, Brookes said, noting that the drugs have not been linked to any cardiac difficulties in people. The new findings came about through a collaboration of several research groups at Rochester that allowed the team to address a problem that has dogged scientists for years. Brookes and a few other scientists had worked on mKATP, which shuttles potassium into and out of the mitochondria, for many years, but the laboratory work involved was so finicky that some other teams have not been able to reproduce the results, leading some scientists to question whether the channel truly exists.


Keith Nehrke, Ph.D., assistant professor in the Nephrology Division of the Department of Medicine, proposed a new way to measure the channel's activity. The new method involves measuring the movement of the element thallium into and out of mitochondria, as a surrogate for potassium. The new method is much faster and less expensive and should be much easier to reproduce by other scientists, Brookes said. He and Nehrke recently received funding from the National Institutes of Health to use the new method in the tiny roundworm known as C. elegans to identify the mKATP channel.


Then a retreat of the Department of Pharmacology and Physiology, where Wojtovich is a graduate student, connected the group with other researchers who are experts on potassium channels - Daniel A. Gray, M.D., of the Department of Medicine and Coeli Lopes, Ph.D., of the Aab Cardiovascular Research Institute.


In addition to Brookes, Wojtovich, Nehrke, Gray and Lopes, authors of the paper include former medical resident Marcin K. Karcz, M.D., now with Unity Health System; and technical associate David M. Williams. The work was funded by the National Heart Lung and Blood Institute, the National Institute of General Medical Sciences, and the American Heart Association.

Source: Tom Rickey

University of Rochester Medical Center


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Main News Category: Cardiovascular / Cardiology

Also Appears In: Hypertension, Nutrition / Diet, Heart Disease,

What Is Obstructive Sleep Apnea (OSA)?

Posted by Pacific J Med Sci on February 9, 2010 at 3:00 PM Comments comments (0)

Medical News Today: 09 Feb 2010

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What Is Obstructive Sleep Apnea (OSA)?

Written by Stephanie Brunner (B.A.)


Obstructive sleep apnea (OSA) is a condition which causes interruptions in breathing during sleep. It is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep as the throat muscles intermittently relax and block the airway. In obstructive sleep apnea, breathing is interrupted by a physical block to airflow, despite the effort to breathe. The most noticeable sign of obstructive sleep apnea is snoring. However, not everyone who has OSA snores. According to Medilexicon's medical dictionary, Obstructive Sleep Apnea (OSA) is:

"a disorder, first described in 1965, characterized by recurrent interruptions of breathing during sleep due to temporary obstruction of the airway by lax, excessively bulky, or malformed pharyngeal tissues (soft palate, uvula, and sometimes tonsils), with resultant hypoxemia and chronic lethargy. Sleep in the supine position predisposes apnic episodes."


People with OSA may experience repeated episodes of apnea during the night. The lack of oxygen causes a person to come out of deep sleep into a lighter stage of sleep in order to restore their normal breathing. Once they fall back into deep sleep further episodes of apnea can occur. The repeated interruptions to sleep that are caused by OSA can lead to the person feeling very tired during the day. A person with OSA will usually have no memory of any episodes of breathlessness.

OSA is a relatively common condition that affects men more than women. The condition is most common in people aged 40 or over, although it can affect people of all ages, including children. It is also especially common in people who are overweight.


OSA is a serious condition:

A person suffering from the condition can experience a lack of proper sleep. As a result, their risk of being involved in a life-threatening accident, such as a car crash, is increased. The lack of sleep causes impairment in judgment and reaction time. Also, there is some evidence suggesting that people with OSA are at greater risk of developing high blood pressure (hypertension), which can lead to a heart attack or stroke. Obstructive sleep apnea treatment may involve using a device to keep the airway open or undergoing a procedure to remove tissue from the nose, mouth or throat.


What are the signs and symptoms of sleep apnea?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Signs and symptoms of obstructive sleep apnea include: Abrupt awakenings accompanied by shortness of breath, Awakening with a dry mouth or sore throat, Difficulty staying asleep (insomnia), Excessive daytime sleepiness (hypersomnia), Forgetfulness, Frequent heartburn or Gastroesophageal reflux disease, Frequent urination at night, Gasping, snorting, Heavy night sweats, Loud snoring (with periods of silence followed by gasps), Mood changes such as irritability, anxiety and depression, Morning headache, Noisy breathing, Observed episodes of breathing cessation during sleep, Trouble concentrating, Unexplained daytime sleepiness


Consult a medical professional if you experience, or if your partner observes the following:

Snoring loud enough to disturb your sleep or that of others, Shortness of breath that awakens you from sleep, Intermittent pauses in your breathing during sleep, Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving a vehicle, People with OSA may have no memory of their sleep being interrupted. Over time, the repeated interruptions to sleep will lead to the symptoms of sleep deprivation. These include: depression, feeling excessively sleepy during the day, headaches particularly in the morning, irritability and short temper, lack of interest in sex, poor memory and concentration in men, impotence. Some people with OSA may also find that they wake up frequently during the night in order to urinate. Many people do not consider snoring as a sign of something potentially serious. In addition, not everyone who has sleep apnea snores. Typically, snoring is loudest when sleeping on the back. It quiets when turning on the side. Seek medical advice about any sleep problem that leads to chronic fatigue, sleepiness and irritability.


What causes obstructive sleep apnea? Obstructive sleep apnea occurs when the muscles in the back of the throat relax too much to allow normal breathing. These muscles support the tongue, tonsils and soft palate (a muscle at the back of the throat used in speech). Once the muscles relax, the airway in the throat can narrow or become totally blocked. This interrupts the oxygen supply to the body which triggers the brain to interrupt deep sleep so that the airway can be reopened and normal breathing is restored. This awakening is usually so brief that the person does not remember it. The person awakens with a temporary shortness of breath that corrects itself quickly, within one or two deep breaths. The person makes a snorting, choking or gasping sound. All night long, this pattern can repeat itself five to 30 times or more each hour. These disruptions impair the ability to reach the deep, restful phases of sleep. Most adults require at least eight hours of sleep to function at their best and half of that time should be spent in the deepest phase of sleep.

Obstructive sleep apnea in children, unlike adults, is often caused by obstructive tonsils and adenoids and may sometimes be cured with tonsillectomy and adenoidectomy.


What are the risk factors of obstructive sleep apnea? A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Anyone can develop obstructive sleep apnea. However, there are certain risk factors: Obesity - the more obese a person is, the higher the risk. More than half of those with obstructive sleep apnea are overweight. Fat deposits around the upper airway may obstruct breathing. However, thin people can also develop the disorder.


A family history of sleep apnea - People with family members with sleep apnea, may be at increased risk.

A narrowed airway - People who have a naturally narrow throat. Tonsils or adenoids may become enlarged, blocking the airway. Age - Being 40 years of age or over.

Being black, Hispanic or a Pacific Islander - Among people under age 35, obstructive sleep apnea is more common in blacks, Hispanics and Pacific Islanders.

Being male - In general, men are twice as likely to have sleep apnea. The reasons why are unknown.

Being older - Sleep apnea occurs two to three times more often in adults older than 65.

Chronic nasal congestion - Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.

Diabetes - Obstructive sleep apnea is three times more common in people who have diabetes.

Having a large neck - The size of the neck may indicate whether or not there is an increased risk of obstructive sleep apnea. This is because a thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women is associated with an increased risk of obstructive sleep apnea.

Having an unusual inner-neck structure - Such as an unusually narrow airway or unusually large tonsils or tongue or having a lower jaw that is set back further than normal.

High blood pressure (hypertension) - Obstructive sleep apnea is relatively common in people with hypertension.

Menopause - A woman's risk appears to increase after menopause. The changes in hormone levels that occur during the menopause may cause the throat muscles to relax.

Smoking: Smokers are nearly three times more likely to have obstructive sleep apnea.

Taking medicines that have a sedative effect - Such a sleeping pills or tranquillizers.

Taking the anti-impotence medicine sildenafil (Viagra) - There is some evidence to suggest that sildenafil can cause the throat muscles to relax.

Use of alcohol, sedatives or tranquilizers: These substances relax the muscles in the throat.


What are the complications of obstructive sleep apnea?

Sleep apnea is considered a serious medical condition. Complications may include:

Cardiovascular problems: Many people with obstructive sleep apnea (OSA) develop high blood pressure (hypertension). This also increases the risk of developing a cardiovascular disease such as a stroke or heart attack. This can lead to sudden death from a cardiac event. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. The more severe the obstructive sleep apnea, the greater the risk of high blood pressure. Patients with sleep apnea are much more likely to develop abnormal heart rhythms such as atrial fibrillation.

Daytime fatigue: People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work or even when driving. Children and young people with sleep apnea may do poorly in school, have reduced mental development or have behavior problems. Treatment of sleep apnea can improve these symptoms, restoring alertness and improving quality of life.

Sleeping while Driving: Experiencing significant daytime sleepiness will have an adverse impact on driving ability. One study calculated that people with severe untreated OSA are 15 times more likely to be involved in a car accident. You should avoid driving until symptoms of OSA respond to treatment.

Complications with medications and surgery: Obstructive sleep apnea is a concern with certain medications and general anesthesia. People with the condition may be more likely to experience complications after major surgery. This is because they are prone to breathing problems, especially when sedated and lying on their backs. Inform your doctor before having surgery. Undiagnosed sleep apnea is especially risky in this situation. Use of analgesics and sedatives in these patients postoperatively should be minimized or avoided.

Partners or family: Loud snoring can keep those around from getting good rest. This can be eventually disruptive in relationships.

People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night.


How is obstructive sleep apnea diagnosed?

If experiencing the symptoms of excessive daytime sleepiness a useful first step may be to ask a partner, friend, or relative to observe you when you are asleep. They may be able to spot episodes of breathlessness that could help to confirm a diagnosis of obstructive sleep apnea (OSA).

Physical examination and tests: A physical examination and a number of tests, including a blood pressure test, may be carried out. This is in order to rule out other conditions that could explain tiredness, such as an under-active thyroid gland. An evaluation may be made based on the signs and symptoms or there may be referral to a sleep disorder center. A sleep specialist can help decide whether there is need for further evaluation. The evaluation may involve overnight monitoring of breathing and other body functions during sleep. This can sometimes be done in sleep centers which are specialist clinics or hospital departments that help treat people with sleep disorders.

Nocturnal polysomnography: During this test, the patient is hooked up to equipment that monitors the heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while sleeping.

Oximetry: This screening method involves using a small machine that monitors and records blood oxygen level while sleeping. A simple sleeve fits painlessly over one finger to collect the information overnight at home. The results of this test will often show drops in blood oxygen level during apneas and subsequent rises with awakenings. However, oximetry does not detect all cases of sleep apnea.

Portable cardiorespiratory testing: Under certain circumstances, the patient may be provided with at-home tests to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.

The patient may also be referred to an ear, nose and throat doctor (otolaryngologist) to rule out any anatomic blockage in the nose or throat.

The severity of OSA is judged on how many episodes of apneas are experienced over the course of an hour. The number of episodes determines mild, moderate, and severe OSA: Mild OSA - between 5 to 14 episodes an hour; Moderate OSA - between 15 to 30 episodes an hour; Severe OSA - more than 30 episodes an hour.


What is the treatment for obstructive sleep apnea? Lifestyle changes may be recommended for milder cases of obstructive sleep apnea, such as losing weight or quitting smoking. If these measures do not improve the signs and symptoms or if the apnea is moderate to severe, a number of other treatments are available:


Therapies: Positive airway pressure. For moderate to severe sleep apnea, a machine that delivers air pressure through a mask placed over the nose while sleeping may be recommended. The most common type is called continuous positive airway pressure (CPAP). With this treatment, the pressure of the air breathed is continuous. The compressed air prevents the airway in the throat from closing. This prevents apnea and snoring. CPAP is the most commonly used method of treating sleep apnea. However, some people find it awkward and uncomfortable. Most people learn to adjust the mask to obtain a comfortable and secure fit. Some people also benefit from using a humidifier along with their CPAP system. Do not stop using the CPAP machine. Check with your doctor to see what adjustments can be made to improve its comfort. Also, after weight changes, your doctor may need to adjust the pressure settings. Mouthpiece (oral device) or Inter-oral devices (IODs). Wearing a mouthpiece designed to keep the throat open is another option. Oral appliances are a successful alternative for some patients. Some are designed to open the throat by bringing the jaw forward. This can sometimes relieve snoring and mild obstructive sleep apnea. Others hold the tongue in a different position. Advice from a dentist experienced in dental sleep medicine appliances is required for the fitting and follow-up therapy.


Surgery or other procedures: The goal of surgery is to remove excess tissue from the nose or throat that may be vibrating and causing the snoring. The excess tissue may be blocking the upper air passages and causing sleep apnea. Surgical options may include:

Surgical removal of tissue: Uvulopalatopharyngoplasty (UPPP) is a procedure in which the tissue from the rear of the mouth and top of the throat is removed. The tonsils and adenoids are commonly removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.

Jaw correction: This procedure is called maxillomandibular advancement. The upper and lower parts of the jaw are moved forward from the rest of the facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require an oral surgeon and an orthodontist

Surgical opening in the neck: This form of surgery may be needed if other treatments have failed and the patient has severe, life-threatening sleep apnea. In this procedure, called a tracheostomy, an opening in the neck is made. A metal or plastic tube is inserted for breathing. The opening is kept covered during the day. But at night it is uncovered to allow air to pass in and out of the lungs, bypassing the blocked air passage in the throat.

Implants: The Pillar procedure is a minimally invasive treatment. It involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild to moderate obstructive sleep apnea.

Removing tissues in the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that are sometimes use to treat snoring. However, these procedures are not recommended for treating obstructive sleep apnea.


Other types of surgery: They may help reduce snoring and sleep apnea by clearing or enlarging air passages. Nasal surgery to remove polyps or straighten a crooked partition between the nostrils (deviated nasal septum). Surgery to remove enlarged tonsils or adenoids


Stimulants: If symptoms of daytime sleepiness are particularly severe, a short-term dose of a medicine known as a stimulant may be recommended. Stimulants work by increasing the activity within the nervous system in order to make the patient feel more alert and awake. A medicine called modafanil may be recommended. Side effects of modfanil can include dizziness and blurred vision. In rare situations, modafanil can cause depression and make people think suicidal thoughts. The long-term use of stimulants is not recommended because they can become addictive.


Alternative treatments: Treatment is offered by speech therapists to strengthen the muscle tone and neural pathways involved in breathing.

Breathing exercises, such as those used in Yoga, the Buteyko method, or didgeridoo playing can be effective. There are muscles which act to tension and open the airway during each inspiration. Exercises can, in some cases, restore sufficient function to these muscles to prevent or reduce apnea.


Positional treatments: Many people benefit from sleeping at a 30 degree elevation of the upper body. It helps prevent the gravitational collapse of the airway. A 30 degree elevation of the upper body can be achieved by sleeping in a recliner, an adjustable bed, or a bed wedge placed under the mattress. This approach can easily be used in combination with other treatments and may be particularly effective in very obese people. Lateral positions (sleeping on a side) as opposed to supine positions (sleeping on the back), are also recommended.


Lifestyle changes: Some cases of mild to moderate OSA can be successfully treated by making changes to lifestyle. These include: Avoiding alcohol during the evening, Losing weight, Quitting smoking. Sleeping on the side, rather than on the back, may also help to relieve symptoms of OSA. Avoid medications such as tranquilizers and sleeping pills. These relax the muscles in the back of the throat, interfering with breathing. Keep nasal passages open at night. If there is congestion, use a saline nasal spray to help keep the nasal passages open. Get medical advice about using nasal decongestants or antihistamines, because, unlike saline sprays, these medications are generally recommended only for short-term use.


Written by Stephanie Brunner (B.A.)

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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Brain chemical serotonin may play a role in SIDS: U. S. study

Posted by Pacific J Med Sci on February 3, 2010 at 10:29 AM Comments comments (0)

Brain chemical serotonin may play role in SIDS: U.S. study



FEBRUARY 2, 2010


After two decades of work and in a finding that could help explain why some babies die mysteriously in their sleep, a Boston doctor and her collaborators believe they have evidence that abnormally low level of a chemical in the brain that helps control breathing during sleep plays a role in causing sudden infant death syndrome (SIDS).


Dr. Hannah Kinney, a Children's Hospital Boston neuropathologist, says she has never been satisfied with the idea that normal babies sometimes die, that SIDS is a mystery, a "bolt out of the blue."

"I found that unacceptable," she said. Now, in a study published this week in the Journal of the American Medical Association, Kinney and her colleagues are linking SIDS with low production of serotonin deep in the brainstem.


Serotonin helps regulate breathing, heart rate and blood pressure during sleep.

The finding may one day lead to a test to screen babies at birth for a serotonin brainstem defect — the same way infants are now screened for hypothyroidism and other diseases — and, ultimately, treatments that would correct the hormone deficiency. "It adds one further piece of evidence that SIDS is a biological disorder," says Dr. Ernest Cutz, a senior staff pathologist and senior associate scientist at the Hospital for Sick Children in Toronto.


"The forensic community, they still look at these as suspicious deaths. I think it strengthens the argument that this is a natural disease, that there's something intrinsically wrong with the baby." Low serotonin alone may not lead to SIDS, he said. But if "biologically vulnerable" babies are exposed to risks, such as being put to sleep face down, "this may then trigger SIDS." Sudden infant death syndrome is the leading cause of death in the first year of a child's life; every week in Canada, three babies die of SIDS. In medical terms, SIDS is defined as the sudden and unexpected death of an infant in whom a complete autopsy and death scene investigation fails to reveal the cause of death.


Typically, an apparently perfectly healthy baby is found dead after having been put to sleep.

"It's devastating," says Dr. Michael Rieder, a professor of pediatrics at the University of Western Ontario in London. "Whether you have six kids or one child, a death is a devastating blow. But especially when people are having babies late, and often not many of them . . . it's really a huge blow for otherwise healthy babies to be suddenly found dead."


Rates of SIDS have fallen by half since the 1990s, when "Back to Sleep" awareness campaigns urged parents to put babies to sleep on their backs, and not their tummies. But the campaigns didn't abolish it; the rates have plateaued over the last decade, and SIDS remains the leading cause of post-neonatal infant death, affecting about one in every 2,000 live births. About 20 years ago, Kinney and her colleagues started working on the idea that SIDS was a problem in the brainstem, that some kind of defect prevented babies from responding to "challenges" or stressors during sleep, such as low oxygen, or re-breathing their own breath if babies are sleeping face down. Their hypothesis was that certain babies may not be able to detect high carbon dioxide or low oxygen during sleep, and don't wake up or turn over.


The researchers systematically searched the regions of the brainstem involved in breathing, heart rate, blood pressure and arousal during sleep. They looked at a slew of neurotransmitters systems, and the one with the most significant changes was in the serotonin system. Serotonin is best known for its role in regulating mood; it's the brain chemical targetted by Prozac and drugs like it. It's also found in the brain circuits that govern breathing, sleep and arousal from sleep.


Three years ago, Kinney and her group found abnormalities in the receptors for serotonin in the brainstem, but it wasn't clear whether the problem was too much, or too little serotonin. In the new study, the group measured the levels of serotonin, as well as an enzyme that makes serotonin, in tissue samples taken during autopsies of 35 infants who died from SIDS, provided by research partners at the San Diego County medical examiner's office in California. Levels of serotonin, and the enzyme that makes it, were, on average, lower in the SIDS babies compared to babies who died of other causes.


"There's something about sleep that unmasks the defect," Kinney says. A blood test to detect low serotonin levels in newborns "would be the ultimate goal", she said, "something that was readily accessible that pediatricians could do in their office. I think we're decades from that. (But) it's what we work at." In the meantime, the study strengthens messages about safe sleeping positions.

"You're told to put the baby on his back, but that doesn't make sense. What difference would that make? Our research says that if you have a baby who has a defect in circuits in serotonin, you put this baby face down, and it's in soft bedding, and it starts to re-breathe carbon dioxide around its face, or drops its oxygen around its face, a normal baby would respond to that challenge and stir and rouse and wake up, and that would protect its airway," Kinney says. "A baby who has a defect in the serotonin system who is in the face-down or prone position, wouldn't do that, and would go on to die."


Quick tips:

How to keep babies safe when sleeping:

- Always place a baby on his or her back for every sleep — at night time and nap time

- Infants should sleep in a crib for the first year of life

- Provide the baby with a smoke-free environment — both before and after birth.

Mothers who smoke during pregnancy increase their baby's risk of SIDS. Passive exposure to tobacco smoke in the environment is also associated with an increased risk of SIDS

- Use a crib that is empty of all toys and bedding (except a fitted sheet) and meets current safety regulations. Cribs should be free of quilts, comforters, bumper pads, pillows and pillow-like items. Dressing infants in sleepers eliminates the need for any covers over the baby, other than a thin blanket.

- Have a baby sleep in a crib next to a parent's bed for the first six months

- Breastfeeding may give some protection against SIDS

- Sleeping with an infant on a sofa is associated with a particularly high risk of sudden unexpected death in infancy


Sources: Public Health Agency of Canada; Canadian Paediatric Society

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