Snoring Obstructive Sleep Apnea and Treatment Animation
Snoring and sleep apnea.In normal breathing, air enters the nostrils and goes through the throat and the tracheato the lungs. In people who snore this airway is partiallyobstructed by excess tissue of the throat, such as large tonsils, large soft palate ortongue. Another common cause of obstruction is the dropping of the tongue into the throatdue to over relaxation of tongue muscles during sleep. Air currents competing throughnarrow spaces in the throat cause the soft palate essentially a piece of soft tissuehanging in the throat to vibrate. This vibration is the source of the noise we hear when someoneis snoring.
Sleep apnea happens when the airway is completelyobstructed, no air can go through and the person stops breathing. This cessation ofbreathing triggers the brain to respond by waking up the person just enough to take abreath. This repeats itself again and again during the course of the night and may resultin sleep deprivation. Snoring and mild sleep apnea may be treatedwith a mandibular advancement device. This device is designed to move the lower jaw andthe tongue slightly forward and thus making the space in the back of the throat larger.
2015 Atrial Fibrillation Patient Conference Managing AF Risk Factors Panel
Wilber: Well thank you. This is really,I think, a topic that I look forward to talking to people about and I think more and moreit's assuming increasing importance in how we take care of patients. We're going to tryto do a broad overview. We're going to focus specifically on diabetes, sleep apnea andexercise as 00:00:30 potential risk factors and how they can be modified in our care ofpatients with atrial fibrillation, but we'll try to give your broad overview of some ofthe other topics as well. So although I'm going to mostly talk about obesity today andatrial fibrillation, we'll talk about a couple of other things as well.
There are a variety of risk factors for atrialfibrillation and this was initially, I think, mostly of interest to epidemiologists, peoplewho study how disease, what the prevalence of it is, and how it comes to pass. I thinknow we've really begun to understand that central role, not only in sort of understandingthe disease but really in treating it, and if we don't consider these as we treat patientsthen I think our outcomes are not nearly as good as they might be otherwise. This is the traditional list and I think thereare probably even a few more. I've starred a few of them where I think that the evidencenow is becoming very clear that these are
potentially modifiable and that's really whatI want you to take home today. These aren't static risk factors that cause something andthen there's nothing you can do about it but treat the consequences, but in fact by intervening,both early and late, you have a chance to modify the disease and improve outcomes. What that means for you as patients is thatyou have to participate in your care and that's really something I want to emphasize; andif you're not invited to do so, then you must insist on doing it. Because I think your outcomesfor atrial fibrillation really depend on how you address each of these risk factors asthey apply to you individually.
Just to briefly talk about hypertension; wewon't spend a lot of time. It's certainly important; it's one of the most common riskfactors associated with atrial fibrillation. Somewhere between 60% and 80% of patientswho have atrial fibrillation in large populations studies have at least hypertension as a riskfactor, and by itself may account for the 20% to 25% of the overall risk of new onsetatrial fibrillation. There's some evidence that systolic bloodpressure probably plays a more important role than diastolic blood pressure, but there'sno clear threshold value. When you look in large population studies, each increment insystolic blood pressure is associated with
the increasing risk of atrial fibrillation.There's no sort of magic number necessarily that if you get below, your risk of atrialfibrillation goes away. It's probably reasonable and what I like to use as a therapeutic targetis somewhere around below 13080. What that means is that that's even below the sort oftraditional guidelines for treatment of hypertension, but it's very clear that even mild elevationsof blood pressure within the range of what we would call normal can still confer afibrisk. There's no clear superiority of one drug overanother although the control of atrial fibrillation certainly can improve the symptoms and thefrequency with which you have atrial fibrillation.
It's not clear that any single drug is absolutelybetter. There's some evidence that ACE inhibitors and ARBs, which are drugs that many of youmay be on to treat your hypertension, may be particularly beneficial, particularly whenyou have relatively advanced hypertension with end organ involvement like thickeningof the heart muscle, the left ventricular hypertrophy, as we call it. But there's also evidence that uncontrolledhypertension as you start antiarrhythmic drug treatment and after catheter ablation, ifyou enter into that with poorly controlled blood pressure, in fact, you have much pooreroutcomes than if your blood pressure is controlled.
2015 Atrial Fibrillation Patient Conference Overview of Afib John D Day MD FHRS
Twenty years ago â€” at the time I was on call and still doing my cardiology training â€” I was at Stanford University at the time, and it was the middle of the night. And typically, when you're on call, you hope to make it through the night without your pager going off. But in the middle of the night my pager went off. And I looked at it and the telephone number was from my father. You don't ever want to get those calls in the middle of the night. And as I called my father, he shared with me that my grandmother, Grandma Day as we called her, we had just found her down on the floor unconscious. They had taken her to the
and she had had a massive stroke and was diagnosed with atrial fibrillation. She had never been in atrial fibrillation before. She was in excellent health, other than a little bit of arthritis and high blood pressure. She was currently serving on the city council, she was very active in politics, the community, and service. But one little stroke, actually it was a big stroke from atrial fibrillation, changed everything. She didn't ever make it; two days later she passed away. Since that experience, it's changed the way I've approached things. I always knew I wanted to go into cardiology,
but atrial fibrillation was something that I knew that there was something we had to do about this, something to try to change this so that other people didn't have to go through the same thing. And so as I'm talking with you today and sharing with you some of these thoughts and new ways of looking at things, there are better ways that perhaps we don't have to experience this. Or, if we do have atrial fibrillation, that it can be reversed. And so let me take you on a journey as we go through ways atrial fibrillation can either beprevented or reversed. But before we get there, first of all I want to disclose, as Mellanie had mentioned, and thanks to
Mellanie for inviting me here, I have performed more than 4,000 atrial fibrillation ablation procedures. I'vebeen doing this for the last 16 years since it began. But the thing that I've learned about all of this is that how we live, our lifestyles, our daytoday choices, have every bit as much to do as to whether or not we can overcome our atrial fibrillation as any hightech, whizbang procedure that we could perform. So what is atrial fibrillationé And it doesn't look like it's going toplay here. There we go, fantastic.
Atrial fibrillation represents total electrical chaos of the upper chambers of the heart, as you can see here. Also, over time as people have atrial fibrillation you will see areas of scarring that develop. This electrical chaos results in the upper chambers of the heart not being able to beat properly. When that happens, strokes can form, blood clots can form. And then if that blood clot happens to make its way out of the heart and to the brain, that's a stroke. Also, when the upper chambers of the heart are quivering and beating at very rapid rates,
it can cause lower chambers of the heartto beat very fast, as well. If you've ever taken your pulse through an episode of atrial fibrillation, you'll typically note that it's very fast and veryirregular. What symptoms can this causeé Atrial fibrillation cancause a lot of symptoms. Probably the number one symptom that I hear isfatigue, quot;I'm tired. I just don't have the energy that I used to have.quot; Number twowould be shortness of breath, especially if trying to do something: walkingupstairs, trying to move. You just don't have the stamina that you once had. Othercommon symptoms of atrial fibrillation