Q&A With Dr. Jim Shaffer & Editor-In-Chief Dr. Jim Palermo
‘Twas the night before Christmas and all through the house, not a creature was stirring…except for Dad’s relentless snoring which threatened to scare Santa and his reindeer away…”
TWENTY YEARS AGO, snoring was usually considered nothing more than a social nuisance. An audible harbinger of the inevitable aging process. Or perhaps the consequence of a few too many night time libations.
Today, thanks to the popular media and the medical literature, disruptive snoring and its associated grunts, gasps and silent pauses often signals a serious problem. Obstructive sleep apnea (OSA) now looms in epidemic proportions throughout the United States.
It is estimated that up to 24 percent of men and 9 percent of women in America have undiagnosed sleep apnea. That’s between 12 and 20 million Americans, or a prevalence of more than 6.5 percent which makes sleep apnea as prevalent as asthma or diabetes.
Furthermore, it is estimated that there are 17 million untreated individuals accounting for 23 billion in health care costs. The public health consequences of this not-so-silent nocturnal scourge are far reaching.
Space Coast Medicine.com is delighted to welcome Dr. Jim Shaffer, pulmonologist, intensive care specialist and board certified expert in sleep disorders, to address the frequently asked questions related to OSA.
SPACECOASTMEDICINE.COM: What exactly is Obstructive Sleep Apnea and why does it pose health risks?
Dr. Shaffer: Sleep apnea is a condition that affects breathing during sleep. The word “apnea” derives from a Greek word meaning “want of breath”. There are three types of apnea: Obstructive, Central and Mixed. Of these, obstructive is the most common. Individuals themselves are rarely aware of the problem thus it is often a vigilant or frustrated bed partner whose concern results in further evaluation. The severity of the condition is quantified by the number of obstructive events per hour of sleep, with greater than five considered abnormal.
The repeated interruption in airflow creates two major problems: 1) Sleep is interrupted. The repeated interruption of sleep results in less than refreshing sleep which causes one of the most common symptoms of OSA: Excessive daytime sleepiness. 2) Airflow obstruction poses a stress upon the heart and lungs. This ultimately leads to higher rates of hypertension, stroke, cardiac arrhythmias and even sudden death.
SPACECOASTMEDICINE.COM: Who is at risk for OSA?
Dr. Shaffer: There are five major risk factors for OSA: 1) Obesity; 2) Gender, with men being affected up to six times more than women until women complete menopause after which the rates are similar; 3) Use of tobacco products; 4) Alcohol use near bedtime with its effect depending upon the quantity and proximity to bedtime; and 5) Genetics. There is definitive evidence that OSA clusters in families.
SPACECOASTMEDICINE.COM: Do children get OSA?
Dr. Shaffer: Approximately one to three percent of children aged two to six suffer from sleep apnea. While sleep apnea in this population is most often created by adenoidal or tonsilar hypertrophy, the rising incidence of childhood obesity clearly mirrors the rising prevalence of OSA in this young population.
SPACECOASTMEDICINE.COM: What are the signs and symptoms and who should get checked?
Dr. Shaffer: Classic features include daytime sleepiness or fatigue in an individual who exhibits disruptive snoring. Other common findings are irritability, poor concentration, morning headache and frequent night time urination.
Basically, individuals with obesity, hypertension, diabetes or those who exhibit events suggesting apnea should discuss the possibility of OSA with their physician.
Approximately one to three percent of children aged two to six suffer from sleep apnea.
SPACECOASTMEDICINE.COM: How is OSA diagnosed?
Dr. Shaffer: Technician attended polysomnography remains the gold standard for diagnosing sleep apnea. A polysomnogram, referred to as a sleep study, should be conducted in a center that is accredited by the American Academy of Sleep Medicine. This insures that specific quality standards are upheld and that the staff tending to the patient are properly trained, licensed and experienced. This allows for collection of accurate data which will be used to determine necessary treatment. A polysomnogram is usually conducted at night.
Patients typically arrive two hours before bedtime so that multiple wires can be fixed to various body parts to allow measurements of brain waves, breathing patterns, leg movements, heart rhythm and blood oxygen. Despite all of the wires, most individuals sleep reasonably well. During the night, technicians observe multiple parameters in real time. From these observations, the sleep specialist can determine the severity of sleep apnea and prescribe appropriate treatment.
SPACECOASTMEDICINE.COM: What is the treatment?
Dr. Shaffer: Continuous Positive Airway Pressure (CPAP) is currently the most effective treatment for patients requiring treatment. The CPAP device itself is about the size of a shoebox and sits at the bedside. It generates a specific amount of pressure that is customized to each patient and delivered through a mask, which the patient wears over some combination of his nose and mouth. Basically, the pressurized mask acts like a stent to prop the airway open during sleep. The vast majority of patients feel an immediate sense of improvement after just one night’s use.
Other standard treatments include weight reduction when indicated, alcohol avoidance four to six hours prior to bedtime and smoking cessation. For some patients, an oral appliance that is fitted by a properly trained dentist is indicated. Finally, surgery to remove the uvula, part of the soft palate and some times tonsils is a viable option for some patients who meet certain clinical criteria.
ABOUT THE AUTHOR
Dr. Jim Shaffer is a native of Youngstown, Ohio. He graduated cum laude from Malone College in 1988 and completed his medical training at The Ohio State University College of Medicine. He completed residencies and board certifications in Internal Medicine and Pediatrics followed by fellowships in Pulmonary, Critical Care and Sleep Disorders at The Ohio State University Medical Center. He also attained a Masters in Health Administration at the University of Florida in May 2005.
Upon completion of his training in July 2000, Dr. Shaffer joined a large multispecialty group in Melbourne, Florida where he developed a successful traditional combined Pulmonary and Critical Care practice. In 2003, Dr. Shaffer focused his career efforts on developing critical care services at both the local and national level when he joined Health First to lead a clinical and cultural transition in the critical care service areas.
Dr. Shaffer currently serves as the founding Medical Director of VitalWatch, the nation’s first eICU to be implemented in the southeast United States. He also maintains a sleep disorders practice where he treats a variety of conditions including sleep disordered breathing, narcolepsy, insomnia and circadian rhythm disorders.
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