Landmark study: Snorers at risk for stroke (Part 2)

by MIKE MARTIN, UPI Science Correspondent

NEW HAVEN, Conn., June 22 (UPI) -- Seeking signs of sleep apnea in patients with a history of transient ischemic attacks -- "mini-strokes" -- may greatly reduce the instance of a full-blown medical catastrophe, according to several top clinical experts responding to a landmark Yale University study linking sleep-related breathing disorders with increased risk of stroke.

"Since sleep-related breathing disorders are treatable, patients with stroke and transient ischemic attacks should be investigated for these conditions," Dr. Vahid Mohsenin, director of the Yale Center for Sleep Disorders and principal investigator of the study, told United Press International from New Haven.

"We see stroke patients all the time who have signs and symptoms of apnea that were not treated," Dr. Michael Coppola, medical director of the sleep lab at Mercy Hospital in Springfield, Mass, told UPI. "As far as I'm concerned, it's a missed opportunity to treat something that is preventable."

"We may not presently be looking carefully enough for sleep apnea in patients with transient ischemic attacks or mini strokes," Dr. Mark Alberts, professor of neurology and director of the stroke program at Northwestern University in Chicago, told UPI. "Dr. Mohsenin's paper will open the eyes of many practicing physicians to look for a history of sleep apnea in order to remove one more cause of stroke."

The "gold standard" in sleep apnea treatment, according to Coppola and Dr. Elliott Schwartz, co-medical director of the Integris Sleep Disorders Center of Oklahoma City, is continuous positive airway pressure, or CPAP.

"You use CPAP if you have a narrowing of airways," Schwartz told UPI. "It functions as an air splint that keeps the airways open with a medical grade air compressor."

Schwartz said two other treatments, laser-assisted uvulaplasty and somnoplasty, are more experimental.

"Our somnoplasty procedure provides for the first time a minimally invasive approach for the treatment of obstructive sleep apnea and habitual snoring," John Schulte, CEO of Somnus Medical Technologies, told UPI from Sunnyvale, Calif. "Somnoplasty uses temperature-controlled radio frequency energy to shrink tissue in the upper airway in an outpatient procedure performed under local anesthesia," Schulte explained. "It has been cleared by the FDA for the treatment of obstructive sleep apnea, habitual snoring and chronic nasal obstruction and there are numerous peer reviewed journal articles demonstrating the safety and efficacy of somnoplasty for these conditions."

Schwartz and Coppola were less certain of somnoplasty's benefits. "Most patients have multiple levels of obstruction," Schwartz told UPI. "Treatments such as somnoplasty only deal with one site of obsruction."

"Somnoplasty is unproven as yet," Dr. Coppola said. "CPAP is far and away the universally state of the art treatment of apnea disorders."

Coppola related his own experience with sufferers of sleep apnea.

"Ten years ago I gave a lecture on sleep apnea here in Springfield," Coppola said. "I told the event organizers to take attendance because we wanted to be able to prove who had attended -- we thought we'd be lucky if we got three. We ended up with over 350 people and had to schedule an additional night. Sleep apnea is a huge problem, and we're still packing auditoriums today, ten years later."