Mather Hospital Executive Director Kevin McGeachy holds the Village Cup. Photo by Stuart Vincent
A scene from the 14th annual Village Cup Regatta. Photo by Stuart Vincent
From left, Phyliss Macchio, NP and Dr. Melissa Devlin from Mather’s Palliative Health Program; Mather Executive Director Kevin McGeachy; Ralph Macchio; and Mayor Lauren Sheprow. Photo by Stuart Vincent
Port Jefferson Village Team. Photo by Stuart Vincent
A scene from the 14th annual Village Cup Regatta. Photo by Stuart Vincent
Mather Hospital Team. Photo by Stuart Vincent
A scene from the 14th annual Village Cup Regatta. Photo by Stuart Vincent
Mather Hospital Executive Director Kevin McGeachy accepted the $47,000 Mather check (an equal amount went to the Lustgarten Foundation)
A scene from the 14th annual Village Cup Regatta. Photo by Stuart Vincent
By Heidi Sutton
The 14th annual Village Cup Regatta, a friendly competition between Mather Hospital and the Village of Port Jefferson, set sail on Sept. 9 on the Long Island Sound for two good causes.
The Regatta consists of Yacht Club-skippered sailboat where employees from the Hospital and Village help crew the boats, which race in one of three classes based on boat size.
Presented by the Port Jefferson Yacht Club, the Regatta raises funds for Mather’s Palliative Medicine Program and the Lustgarten Foundation, which funds pancreatic cancer research. This year’s Regatta, which was won by the Mather team, raised $94,000 which was divided equally between the two groups. Mather Hospital’s Executive Director Kevin McGeachy accepted the Village Cup and the check for his team at a celebratory Skipper’s Reception at the Port Jefferson Village Center following the races. Mayor Lauren Sheprow represented the Port Jeff Village team.
Actor, director and local resident Ralph Macchio once again served as Village Cup Regatta Celebrity Ambassador for the event. Macchio has helped to publicize the important work of the two programs funded by the Regatta for the last ten years. His wife, Phyllis, is a nurse practitioner in Mather Hospital’s Palliative Medicine Program.
Starting soon, all newborns in New York state will receive testing for congenital cytomegalovirus. Photo by Farajiibrahim from Wikimedia Commons
Starting later this month or early next month, all children born in New York state will receive testing for congenital cytomegalovirus, an infection that can cause hearing loss and learning deficits.
The state will track children who test positive for this virus, which is related to the virus for chickenpox, herpes and mononucleosis, over the years after their birth to provide early intervention amid the development of any symptoms and to provide a baseline for understanding how the virus may affect the growth and development of other children born with the virus.
Mothers who contract CMV, which is the most common congenital virus and the leading nongenetic cause of deafness in children, for the first time while they are pregnant can transmit the virus to their developing child.
Local doctors suggested that this testing, which other states would likely examine closely, provided a welcome opportunity to gather information about their children, even if the test raised questions or concerns about what the diagnosis means.
“Knowledge is power,” said Dr. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital. “The more you can tell a parent about what’s going on, the more they can make informed decisions.”
To be sure, Nachman anticipated that more parents initially might opt out of having their child’s screen result reported in their newborn record, until pediatricians and obstetricians have had a chance to talk with them.
There will be a “lot more opting out in the beginning” until parents understand what the test means and how it might help in understanding a virus that could affect their children’s health and development, Nachman said.
One in 200 babies
New York State recently received a contract from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to add screening for this virus for a period of a year.
Dr. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital. Photo from Stony Brook Medicine
Parents of babies who test positive will receive referrals to infectious disease specialists across the state for follow-up and evaluation.
The state predicts about one out of every 200 newborns may test positive for the virus, according to the New York State Department of Health website.
Over half of the adults in the U.S. have had CMV, while most people don’t know they’ve had it because they show no symptoms.
Those who develop symptoms have sore throats, fever, fatigue and swollen glands, which are the kind of nonspecific conditions that characterize the body’s response to infections from other viruses.
Opt-out options
While all babies will receive a congenital CMV test, parents can choose to opt out of having their children’s screen result reported in their newborn screen record.
The state urges parents who would like to opt out to do so quickly, as newborn screen reports are complete five to seven days after birth.
Parents have several ways to opt out. They can scan the QR code found on their brochure, which will bring them to the Newborn Screening Program website and opt out portal. They can also remove and fill out the opt-out form in the parent brochure and give it to the hospital to submit with the newborn screen specimen.
Alternatively, parents can email a picture of the completed opt-out form to [email protected] or they can call the program at 518-473-7552 and press option five. Finally, parents can mail the opt-out form to the NYS Newborn Screening Program in Albany.
First steps
Nachman is co-leading one of the 11 units across the state in pediatric infectious disease with Dr. Andrew Handel.
The teams will meet once a month to discuss issues around CMV.
“One of the goals of the project, which is why it’s funded by NICHD is can we identify who is at risk” to develop problems such as hearing loss.
Among the numerous unanswered questions the group hopes to address is whether early treatment would be a way to prevent problems from developing, even among children who test positive but are asymptomatic. Giving medication to all children who test positive comes with its own problems, as the medication for CMV has side effects, said Nachman.
It’s not like “taking a dose of Tylenol, given several times a day for weeks at a time,” said Nachman.
While women who have had CMV prior to pregnancy are unlikely to transmit the virus, Nachman discourages people from intentionally contracting the virus before becoming pregnant.
“We don’t encourage people to go out and get CMV so they’ll be cleared by the time they’re pregnant,” in part because people can develop symptoms, conditions and secondary infections after having the virus.
By monitoring the health of children after their diagnosis, the state hopes to understand more about the virus and its effects.
“We need to follow enough children long enough” to be able to address those medical questions and concerns, Nachman said.
The study might be able to find markers that could predict who might be at risk for hearing loss in the early years of a child’s life, she said.
During hearing screens that could occur every six months, children born with CMV can receive early intervention.
“The sooner we see something, the sooner we can act on it,” Nachman said.
As for developmental issues, children who show even a glimmer of a developmental delay can also receive early intervention.
At this point, Stony Brook has been participating in clinical trials for a vaccine, which, if approved, could be administered to adolescents.
The trials for the vaccine, which could last for 10 years, are still in the early stages of development.
New York Cancer & Blood Specialists (NYCBS), one of the nation’s leading oncology practices, is proud to announce the addition of Jin Guo, MD. She will practice at 1500 Rt 112, Bldg 4, Port Jefferson Station.
“We are proud to welcome Dr. Jin Guo to the NYCBS team,” said Jeff Vacirca, MD, CEO of NYCBS. “We are confident that Dr. Guo’s expertise and compassionate approach will greatly benefit our patients and further enhance our mission to provide exceptional cancer care.”
Dr. Guo’s love for oncology’s scientific and humanistic aspects led her to medicine. “It’s important to understand what makes cancer cells grow and what we can do to fight cancer but building a human connection is equally important,” Dr.Guo said. “I became an oncologist because it requires expertise in both. Oncology is an art and a science.”
After supporting her grandmother through her cancer journey, Dr. Guo pursued the field to deliver the highest quality cancer care to her patients while supporting their families and caregivers. “My philosophy is to not only treat the person behind the cancer but also to encourage and empower my patients to be active participants in their own care through communication, trust, and respect.” Dr. Guo said.
Dr. Guo received her Doctor of Medicine from the University at Buffalo School of Medicine and Biomedical Sciences. She completed her Hematology/Oncology Fellowship with a Master Clinician Track at The University of Texas MD Anderson Cancer Center, renowned for its exceptional cancer care and groundbreaking research. Prior to her fellowship, Dr. Guo served as an Internal Medicine Resident at New York Presbyterian-Weill Cornell Medicine.
To make an appointment with Dr. Guo, please call 631-751-3000. For more information, visit nycancer.com.
Mather Hospital in Port Jefferson recently received the Pain and Addiction Care in the Emergency Department (PACED) designation from the American College of Emergency Physicians. Photo from Mather Hospital
Mather Hospital in Port Jefferson recently received the Pain and Addiction Care in the Emergency Department (PACED) designation from the American College of Emergency Physicians.
PACED is a national accreditation program that seeks to improve pain management and substance use care for patients. Having a PACED designation means that patients in these hospitals will receive the highest level of treatment for pain and addiction, while minimizing the use of opioid medications.
“Receiving PACED accreditation confirms the work we’ve done across several disciplines — medicine, nursing, social work, pain management — to remove the stigmas associated with addiction and to provide the best evidence-based care,” said Adam Wos, MD., Medical Director of the Emergency Department. “This means that our clinicians are focused on approaches that prevent the harms of addiction, and our patients have more resources and fewer barriers to seeking out the care they need.”
Mather is one of 18 Northwell hospitals to received PACED designation. Sandeep Kapoor, MD, assistant vice president of Emergency Medicine Addiction Services, said the designation recognizes Northwell’s determined efforts over the past decade to create a landscape of humanistic and evidence-based approaches in helping people living with substance use disorder (SUD) and pain issues.
“The fact that 18 of our hospitals have received national accreditation recognizes our efforts to humanize the approach to substance use and pain. We are very proud that our model of care is being regarded as an industry standard,” Dr. Kapoor said.
Flu, RSV and COVID-19 are especially tough on those with impaired lung function
By David Dunaief, M.D.
Dr. David Dunaief
Our experiences over the past several years with COVID-19 have increased our awareness of how chronic ailments can make us more vulnerable to the consequences of acute diseases circulating in our communities.
For those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape, the consequences of the flu, RSV and COVID-19 are especially severe.
The good news is that we can do a lot to improve our lung function by exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Studies suggest that everyone will benefit from these simple techniques, not only people with compromised lungs.
Do antioxidants improve asthma?
In a randomized controlled trial, results show that, after 14 days, asthma patients who ate a high-antioxidant diet had greater lung function than those who ate a low-antioxidant diet (2). They also had lower inflammation at 14 weeks. Inflammation was measured using a c-reactive protein (CRP) biomarker. Participants in the low-antioxidant group were over two-times more likely to have an asthma exacerbation.
The good news is that there was only a small difference in behavior between the high- and low-antioxidant groups. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Using carotenoid supplementation in place of antioxidant foods did not affect inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma in a very short period.
Can increasing fiber lower COPD risk?
Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers.
In one study of men, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The “high-fiber” group was still below the American Dietetic Association’s recommended intake of 14 grams per 1,000 calories each day.
In another study, this time with women, participants who consumed at least 2.5 serving of fruit per day, compared to those who consumed less than 0.8 servings per day, experienced a highly significant 37 percent decreased risk of COPD (4).
The highlighted fruits shown to reduce COPD risk in both men and women included apples, bananas, and pears.
What devices can help improve lung function?
An incentive spirometer is a device that helps expand the lungs when you inhale through a tube and cause a ball (or multiple balls) to rise in a tube. This inhalation opens the alveoli and may help you breathe better.
Incentive spirometry has been used for patients with pneumonia, those who have had chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5). A small study showed that those who trained with an incentive spirometer for two weeks increased their lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. Incentive spirometers are inexpensive and easily accessible.
In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gasses, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.
How does exercise help improve lung function?
Exercise can have a direct impact on lung function. In a study involving healthy women aged 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in just 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.
Note that you don’t need special equipment to do aerobic exercise. You can walk up steps or steep hills in your neighborhood, do jumping jacks, or even dance around your living room. Whatever you choose, you want to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. You’ll find that your stamina improves quickly when you do it consistently.
We all should be working to strengthen our lungs. This three-pronged approach of lifestyle modifications — diet, exercise and incentive spirometer — can help.
References:
(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
September is Prostate Cancer Awareness Month. Early detection is key to long-term survival rates of prostate cancer, which is why Stony Brook Medicine’s Department of Urology and Stony Brook Cancer Center offers free Prostate Cancer Screenings throughout the year.
Prostate cancer is the most commonly diagnosed cancer in American men. Approximately 1 in 9 men will be diagnosed with prostate cancer and 1 in 41 men will die of the disease. As you get older, your risk increases.
Men aged 45-75 years, African American men and men with a family history of prostate cancer may benefit from early screenings. In most cases, prostate cancer has no symptoms and is usually detected through a screening.
This month, free screenings will be held at Stony Brook Medicine’s Advanced Specialty Care, 500 Commack Road, Suite 201B, Commack on Sept. 19 from 6 to 7:30 p.m. and at Stony Brook Urology, 24 Research Way, Suite 500, East Setauket on Sept. 20 from 2 to 5 p.m.
Appointments are strongly recommended. Insurance is not required. To make an appointment, call 631-216-9181.
Some WTC 911 responders are suffering from PTSD and cognitive disorders many years after 911. Researchers are trying to determine why as they continue monitoring patients.
Photo courtesy of Stony Brook WTC Health and Wellness Program
Twenty-two years after the September 11 World Trade Center attacks, responders who have suffered physical and cognitive illnesses resulting from exposures continue to be monitored by healthcare providers. Ongoing studies by investigators at the Stony Brook WTC Health and Wellness Program reveal that assessments of this patient population’s mental health and cognitive status remain on the forefront of research as we move further away from that fateful day of 9/11.
Benjamin Luft, MD, Director and Principal Investigator of the Stony Brook WTC Health and Wellness Program, and the Edmund D. Pellegrino Professor of Medicine at the Renaissance School of Medicine at Stony Brook University, and his colleagues study all aspects of responders’ health status. The program monitors approximately 13,000 WTC responders.
Previous research has shown that some responders may be experiencing cognitive difficulties earlier in life than the general population, and that PTSD, which remains one of their most common ailments, may be associated with cognitive problems and/or physical illnesses.
A compilation of new research published over the past yearsuggeststhe need to delve further into investigating the brain status of responders and their cognitive problems.
A study in the Journal of Geriatric Psychiatry and Neurology assessed more than 700 responders, many with chronic PTSD, and the relationship between having cortical atrophy and behavioral impairments. They found that individuals with PTSD start to experience more mental health symptoms as a secondary symptom to cognitive impairments. Specifically, responders with an increased risk of cortical atrophy showed behavioral impairment in motivation, mood, disinhibition, empathy and psychosis.
Published in Molecular Neurobiology, another study revealed that there are associations between WTC exposure duration and inflammation in the brains of responders among 99 responders who participated from 2017 to 2019, with the average age being only 56 years. Neuroinflammation was evident both in the hippocampus, a part of the brain that helps to regulate emotions and memory, and throughout much of the cerebral white matter.
A paper published in Psychological Medicine highlights research that may reveal a better way tounderstand responders’ PTSD symptoms, as opposed to self-reporting or screening. This work found that by using an AI program that reads the words of responders can predict their current PTSD and even the future trajectory of the illness.
Moreover, WTC investigators are developing AI programs to identify and predict psychological symptoms from facial expressions and tone of voice. AI analyzes video recordings of WTC responders. Importantly, when these methods are fully developed, they may be able to offer objective diagnostic tests for PTSD and other mental disorders.
Many responders to date have experienced mild cognitive impairment in comparison to non-responders their age.
A study that measured a key aspect of brain chemistry — proteins or biomarkers often associated with dementia and Alzheimer’s Disease — may provide specific evidence that responders need to be monitored for earlier onset dementia.
Published in the Alzheimer’s Association’s Diagnosis, Assessment and Disease Monitoring, this study illustrates that among approximately 1,000 responders —average age at 56.6 years, and some who have dementia — associations exist between WTC exposures and the prevalence of neurodegenerative proteins in their brains.
Lead author Sean Clouston, PhD, Professor in the Program of Public Health, and the Department of Family, Population, and Preventive Medicine, and colleagues found that 58 percent of responders with dementia had at least one elevated biomarker and nearly 3.5 percent had elevations in all biomarkers. The overall cohort had an increased risk of dementia associated with plasma biomarkers indicative of neurodegenerative disease.
Another core member of the Stony Brook research team, Pei-Fen Kean, PhD, Professor in the Department of Applied Mathematics and Statistics, is involved in several ongoing multi-omics research projects to help explicate pathophysiology of these disorders on molecular level and identify novel blood-based biomarkers. For example, a study in the Translational Psychiatry identified the metabolomic-proteomic signatures associated with PTSD to enhance understanding of the biological pathways implicated in PTSD.
As the collaborative work of the research teams affiliated with the Stony Brook WTC Health and Wellness Program moves forward, they will use previous findings and new methods to build their work to best assess the mental and physical health conditions of responders.
These images reveal the striking similarities between real candy and edible products containing THC. Photos from the Suffolk County Department of Health Services
Children are getting into their parents’ supplies of edible marijuana, leading to an increase in illnesses and emergency room visits.
Stony Brook Pediatric Hospital treated 14 children in 2022 and 13 in 2021 — up from about one or two a year before 2020.
Dr. Candice Foy, a pediatric hospitalist at Stony Brook Children’s Hospital. Photo from Stony Brook Medicine/Jeanne Neville
“In the last two years, we’ve seen very high numbers,” said Dr. Candice Foy, a pediatric hospitalist at Stony Brook Children’s Hospital.
The accidental consumption of marijuana among children has increased throughout the country. A study published in the journal “Pediatrics” indicates that calls to poison control centers for children five and under for the consumption of edibles containing tetrahydrocannabinol, or THC — the main ingredient in the cannabis plant — rose to 3,054 in 2021 from 207 in 2017, with over 95 percent of the children finding gummies in their homes.
Amid an increase in adult use of edible gummies containing marijuana, children of a wide range of ages have mistaken them for candy, leading to symptoms that trigger medical concerns from their parents.
Children with THC in their system can have low blood pressure, high heart rates, lethargy and sleep for prolonged periods, Foy said.
One child required a machine to help breathe.
Dr. Jennifer Goebel, emergency room doctor at Huntington Hospital, said the hospital recently saw children who were dizzy and not acting appropriately.
When pediatric patients accidentally consume pot edibles, doctors also need to consider what else they might have in their system, Goebel added.
Dr. Jennifer Goebel, emergency room doctor at Huntington Hospital. File photo from Northwell Health
Significant exposure can “lead to severe hyperactive behaviors, slowed breathing and even coma,” Dr. Gregson Pigott, Suffolk County Health Commissioner, explained in an email.
The health effects of marijuana can last 24 to 36 hours in children. The response may vary based on the amount ingested, the size of the child and metabolic factors, Pigott added.
Unlike naloxone, which health care providers can administer to counteract the effect of narcotics, doctors don’t have the same resources available with accidental marijuana ingestion.
Doctors opt for supportive care. A nauseous child could receive anti-nausea medication, while a child sleeping and not eating or drinking can receive intravenous fluids.
Typically, doctors observe children who consume marijuana for several hours, often releasing them to return home once the symptoms subside.
Hospitals are required to call child protective services during such an incident. Investigators usually find that such consumption is incidental, as parents sometimes leave their edibles in the wrong location.
“A lot of times, CPS will go in there” and, after checking the home, “will close the investigation,” Foy said.
Doctors and local officials urged people who consume such edibles themselves either not to keep them in the house or to put them in places far from other candy or food, such as in an inaccessible spot in the back of a closet.
Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services. File photo
“The Department’s Office of Public Information has issued warnings about keeping edible gummies out of the reach of children through its social media channels,” Pigott explained in an email. “In addition, the New York State Office of Addiction Services and Supports and our partners in prevention promote safe keeping of all THC products, including edibles, out of reach and in secure child safe storage,” such as a lock box.
Goebel cautioned that children are adept at getting to products that appeal to them, mainly if the packaging makes them look like candy.
Many of the pot-related medical issues are “accidental,” Goebel said.
Hospitals have seen a range of children with marijuana symptoms, from as young as one year old to 11, with the vast majority falling between two and four years old, Foy said.
“I don’t think it’s something that a lot of people think about the same way they think about protecting their children from bleach and other chemicals commonly found” in the home, she said. It’s important to “get the message out” and ensure “people are talking about this.”
The Suffolk County Department of Health Services Office of Health Education offers curriculum and teacher training to public and private schools at no cost. The lessons address behaviors that lead to morbidity and mortality in the young, including intentional and unintentional injuries, such as injury caused by children ingesting edible gummies or other edible-infused products, Pigott wrote.
“During parent workshops, we show the similarity between real food items and the THC-containing items that look like the food item to highlight how deceptive and easy it is to mistakenly ingest cannabis-laden products,” he added.
The U.S. Food and Drug Administration has approved a new COVID-19 booster, which will protect against the virus’s circulating strain.
With hospitalizations and cases rising in Suffolk County and nationwide, single booster shots from Pfizer-BioNTech and Moderna should be available soon.
Local doctors recommended that people at the highest risk consider getting the shot.
That includes those with other medical issues, such as a 45-year-old smoker or a 65-year-old with diabetes.
Health care providers generally believe people who recently had COVID have at least three months of protection, although no definitive rule exists.
“If you had it in August, you probably don’t need to get a booster now,” said Dr. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital. “If you had it in January and you’re high risk, you should get it now.”
Nachman added that no study has indicated the age at which patients should get a booster shot.
People should consult their physicians to determine how their underlying health can affect the decision to get an updated vaccine.
“That gets back to the doctor-patient relationship,” Nachman said.
People who are 70 years old and planning a cruise that stops in several ports might want to get a shot at least two weeks before they travel because “the last thing you want happening is to be hospitalized in a foreign country,” Nachman said.
Nachman suggested that this vaccine, like the others that people have taken, won’t prevent illnesses but will keep people from shedding the virus and can reduce the symptoms and duration of an infection.
The FDA approval of the current vaccine is welcome news because it is a “good match” for the current strain, Nachman indicated.
It’s difficult to predict how much protection the current vaccine will provide for whatever strain might be circulating in February.
When a higher percentage of the population receives the vaccine, the likelihood of new variants declines, she added.
Getting a good night's rest helps keep your mind and body healthy.
METRO image
Sleep apnea may increase your risks of cardiovascular disease and cancer
By David Dunaief, M.D.
Dr. David Dunaief
Our physical and mental wellbeing depends on getting quality, restful sleep; however, many of us struggle to achieve this. For those with obstructive sleep apnea (OSA), quality sleep is particularly elusive.
Sleep apnea is an abnormal pause in breathing that occurs at least five times an hour while sleeping. It can have an array of causes, the most common of which is airway obstruction. Some estimates suggest that about 30 million people suffer from sleep apnea in the United States (1).
OSA diagnoses are classified as either mild, moderate or severe. It’s estimated that roughly 80 percent of moderate and severe OSA sufferers are undiagnosed.
After family history, most risk factors for OSA are modifiable. They include chronic nasal congestion, excess weight or obesity, alcohol use and smoking (2).
Symptoms of OSA include daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration, and morning headaches. While these are significant quality of life issues, OSA is also associated with an array of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.
Fortunately, we have an arsenal of treatment options, including continuous positive airway pressure (CPAP) devices; oral appliances; lifestyle modifications, such as diet, exercise, smoking cessation and reduced alcohol intake; and some medications.
How does sleep apnea affect cardiovascular disease risk?
In an observational study of 1,116 women over a six-year duration, the risk of cardiovascular mortality increased in a linear fashion with the severity of OSA (3). For those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; for those in the severe group, this risk jumped considerably to 250 percent. However, the good news is that treating patients with CPAP considerably decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients.
Another observational study of 1,500 men with a 10-year follow-up showed similar risks of cardiovascular disease with sleep apnea and benefits from CPAP treatment (4). The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in curbing these occurrences.
In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.
Does OSA increase your risk of cancer?
In sleep apnea patients under age 65, a study showed an increased risk of cancer (6). The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk of cancer. The authors believe that intermittent low levels of oxygen, caused by the many frequent short bouts of breathing cessation, may be responsible for the development of tumors and their subsequent growth.
Does OSA affect male sexual function?
Erectile dysfunction (ED) may also be associated with OSA and, like other outcomes, CPAP may decrease this incidence. This was demonstrated in a small study involving 92 men with ED (7). The surprising aspects of this study were that, at baseline, the participants were overweight, not obese, on average and were only 45 years old.
In those with mild OSA, the CPAP had a beneficial effect in over half of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.
An array of other studies on the association between OSA and ED have varying results, depending on the age and existing health challenges of the participants. Some study authors have postulated that other underlying health problems may be the cause in some patient populations.
Can diet help address OSA?
For some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or it may be used in combination with CPAP to improve results.
In a small study of those with moderate-to-severe OSA levels, a low-energy diet showed positive results. A low-energy diet implies a low-calorie approach, such as a diet that is plant-based and nutrient-rich. It makes sense, since this can help with weight loss. In the study, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (8). The results endured for at least one year.
If you think you are suffering from sleep apnea, you should be evaluated at a sleep lab and then follow up with your doctor. Don’t let obstructive sleep apnea cause severe complications, possibly robbing you of more than sleep. There are many effective treatments.
References:
(1) sleepapnea.org. (2) JAMA. 2004;291(16):2013. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) Am J Respir Crit Care Med. 2012 Nov. 15. (7) Sleep. 2012;35:A0574. (8) BMJ. 2011;342:d3017.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
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