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It’s more than just snoring
Sleep disorders affect millions of Americans

As featured in MDupdate, a Pitt County Memorial Hospital Publication, June 2005:

By Daniel Lee, MD
Medical Director, Sleep Center, Pitt County Memorial Hospital

Adequate, restful sleep is necessary for both physical and mental health. Studies have shown, for example, that sleep is essential to maintain normal functioning of the immune system and the nervous system. In addition, adequate sleep is necessary for learning and for normal, healthy cell growth. Advances in this science have shown that conditions that interrupt sleep are more than an irritation leading to daytime fatigue. They may also be risk factors for life-threatening diseases such as hypertension and diabetes.

Sleep disorders are common, and their treatment has advanced significantly in recent years. Today, many of these conditions—common and otherwise—
can be addressed successfully through appropriate diagnostic and therapeutic measures.

The state-of-the-art Sleep Center at Pitt County Memorial Hospital is one of the largest facilities accredited by the American Academy of Sleep Medicine and the first of its kind in North Carolina. The Sleep Center provides a full scope of services to care for all of the 88 different kinds of sleep disorders that occur among pediatric and adult populations.

Obstructive sleep apnea
OSA is by far the most common sleep disorder encountered in our sleep center and it affects some 18 million Americans every night. Several large, cross-sectional studies have demonstrated that sleep apnea is an independent risk factor for hypertension. Research has also shown that treatment with the nasal continuous positive airway pressure (CPAP) machine leads to reduction in diastolic blood pressure. A recent sleep/heart health study showed that sleep apnea also increases the glucose levels in the body, leading to insulin resistant diabetes. Apneas have also been implicated as a risk factor for pulmonary hypertension, irregular heartbeat, heart failure and stroke.

Patients with sleep apnea often present with excessive daytime sleepiness, unrefreshing sleep, snoring, frequent night time urination, ankle swelling, morning headaches and memory problems. Patients are counseled and evaluated at our center for various treatment options including Uvulopalatopharyngoplasty (UPPP) surgery, laser-assisted uvulopalatoplasty (LAUP) surgery, radio frequency somnoplasty, snore guard, non-invasive nasal CPAP and nasal bilevel device.

Compliance with recommended use of CPAP is essential for dealing with sleep apnea. Our approach, which involves extensive patient education, has enabled us to achieve a 92 percent compliance rate compared to a national rate of 64 percent. The American Sleep Disorder Association Accreditation Committee calls the PCMH Sleep Center, “a model center for the nation.”

Restless leg syndrome
RLS is the most common movement disorder encountered in any clinical practice. Patients often complain about the “creeping crawling sensation” in their legs in the evening interfering with their ability to achieve and maintain sleep. The sensation can be alleviated only with movement. Our sleep center physicians, along with an international team of sleep physicians has conducted leading edge research to tackle this disabling condition, and we have published five studies in peer-reviewed journals on the treatment of restless leg syndrome over the last year. These findings were presented to the American Academy of Neurology, American Sleep Society and European Neurological Society. Our center has also played a pivotal role in the development and research of Ropinirole, the first treatment approved by the FDA for restless leg syndrome.

Pediatric sleep disorders
Sleep related breathing disorders are common in the pediatric population and have a profound effect on a youngster’s health and cognitive development. Daytime symptoms are frequently misinterpreted as attention deficit disorder or laziness. Sequela attributed to sleep apnea range from school failure to headache, hypertension and heart disease.

Parasomnias such as sleep walking, sleep terrors, and confusional arousals can easily be differentiated from sleep related epileptic seizure by sleep histories and sleep studies. Children may also suffer from restless leg syndrome. These problems can be diagnosed with sleep studies and treated effectively. The child’s quality of life often improves remarkably with appropriate therapy. Because our center is accustomed to dealing with children and families, we are able to make the sleep study a positive experience for all.

Bibliography
Erin Read, Craig Whaley, J.J. Lin, Daniel McKenny, Daniel Lee, Ronald Perkin. Hypopnea in pediatric patients with obesity hypertension. Pediatric Nephrology (2004) 19:1014-1020

Arthur Walter, William Ondo, Daniel Lee, Kapil Sethi. Ropinrole is effective in the treatment of restless leg syndrome: A 12-week double blind, randomized, parallel group; placebo controlled study. Movement Disorders (2004) 19: Issue 12:1313-1423.

Lyle Victor. Treatment of obstructive sleep apnea. AAFP (2004) Vol. 69 No3. Punjabi NM, Shahar E, Redline S et al. Sleep disorder breathing, glucose intolerance and insulin resistance: the Sleep Heart Healthy Study. American Journal of Epidemiology 2004. Sept 15: (160) 6:52-30.

 
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