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Is Sleep Apnoea Hereditary?
Here's a very interesting article written by Doctor Steven Park of why sleep apnoea can be hereditary. It sure is, depending on the reasons why a person has sleep apnoea. How do I know? Simple...... Hope2Sleep sells comfort products regularly to different sufferers in the same family (in a few cases, 3 generations). Look out for your precious family members, as we're more likely to see the signs than they are!
Dr Park's book he mentions can be bought here in the UK at http://www.hope2sleep.co.uk/products/16
Does Everyone in Your Family Have Sleep Apnea?
More and more often, I'm coming across entire family members that are on CPAP for sleep apnea, or undergoing various other treatments for this condition. If one parent has sleep apnea, your children have an increased risk of developing sleep apnea, but if both parents have it, then it's safe to assume that your children will have it too, given that fact that they inherit your facial anatomy.
As I describe in my book, "Sleep Interrupted", all modern humans are on a continuum, where we're all susceptible to breathing problems at night. Only the end extreme is called obstructive sleep apnea. Since sleep apnea is caused by narrow facial structures, young children and even infants can have it too. Many of the various childhood maladies, such as frequent colds, ear infections, bedwetting, night terrors, and even ADHD are probably related to poor breathing and inefficient sleep, aggravating inflammation in the upper airways. There's even speculation that the rate of autism increased after doctors recommended placing infants on their backs during sleep. It's not surprising then, that parents of autistic children are found to have a higher rate of obstructive sleep apnea.
Most young children are treated with tonsillectomy and adenoidectomy for their sleep apnea, and many children do very well. However, about 1/3 who undergo tonsillectomy don't improve significantly. These are the children that probably have smaller jaws. Smaller jaws leads to more reflux and inflammation, leading to enlarged tonsils, causing more frequent obstructions. In these children, rapid palatal expansion was found to be equivalent to tonsillectomy. If you combine both procedures, the results were additive.
Some young children are able to tolerate CPAP, but for most, this is not a practical option. One advantage that children have over adults is the malleability of their jaws. Orthodontics can not only help to straighten teeth, but to expand the jaws as well. Traditional orthodontic dentists tend to remove teeth to make more room for the other teeth, but that ends up making the jaws even smaller. Forward thinking orthodontists make more room for the teeth by enlarging the jaws, both in the front to back and side to side dimensions. The earlier you start, the better the long-term results. Many dentists are beginning treatment as soon as the permanent teeth have come in.
Dr Steven Park
http://doctorstevenpark.com/does-everyone-in-your-family-have-sleep...
Views: 2529
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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Worldwide people of Asian decent are predicted to have the same rate of apnea. This same community also has the lowest rate of obesity. How would you explain this phenomenon TF?
http://www.ncbi.nlm.nih.gov/pubmed/20815189
Sleep. 2010 Aug 1;33(8):1075-80.
Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea.
Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, Cistulli PA.
Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, NSW, Australia.
Abstract
STUDY OBJECTIVES: To explore differences in craniofacial structures and obesity between Caucasian and Chinese patients with obstructive sleep apnea (OSA).
DESIGN: Inter-ethnic comparison study.
SETTING: Two sleep disorder clinics in Australia and Hong Kong.
PATIENTS: 150 patients with OSA (74 Caucasian, 76 Chinese).
INTERVENTIONS: Anthropometry, cephalometry, and polysomnography were performed and compared. Subgroup analyses after matching for: (1) body mass index (BMI); (2) OSA severity.
MEASUREMENTS AND RESULTS: The mean age and BMI were similar between the ethnic groups. Chinese patients had more severe OSA (AHI 35.3 vs 25.2 events/h, P = 0.005). They also had more craniofacial bony restriction, including a shorter cranial base (63.6 +/- 3.3 vs 77.5 +/- 6.7 mm, P < 0.001), maxilla (50.7 +/- 3.7 vs 58.8 +/- 4.3 mm, P < 0.001) and mandible length (65.4 +/- 4.2 vs 77.9 +/- 9.4 mm, P < 0.001). These findings remained after correction for differences in body height. Similar results were shown in the BMI-matched analysis (n = 66). When matched for OSA severity (n = 52), Chinese patients had more craniofacial bony restriction, but Caucasian patients were more overweight (BMI 30.7 vs 28.4 kg/m2, P = 0.03) and had a larger neck circumference (40.8 vs 39.1 cm, P = 0.004); however, the ratios of BMI to the mandible or maxilla size were similar.
CONCLUSIONS: Craniofacial factors and obesity contribute differentially to OSA in Caucasian and Chinese patients. For the same degree of OSA severity, Caucasians were more overweight, whereas Chinese exhibited more craniofacial bony restriction.
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Permalink Reply by Tigers Fan on
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Hi Rock
From the evidence you present, you seem to be extrapolating "worldwide" and "predicted" from a single Australian study of 150 people with undefined populations (other than ethnicity) and unmentioned controls. She'll be right, mate!
Have you been to China, Japan, Korea, Singapore, Hong Kong lately? Then you'll have seen how the young folk of those nations are roughly the same size as Westeners now that they are being fed adequately - and even over-fed, same as a lot of us. Their parents in Hong Kong and elsewhere are tiny by comparison - possibly the first generation Asian immigrants in Australia also fall into this category - and may have more craniofacial bony restriction. Do their children? I know their children have a great deal of obesity. With only one child per couple permitted in China, the tendency to over-feed these 'Little Emporers' is wide-spread.
You are of one opinion and I'm of another - we've made that abundently clear. There is no definitive evidence to spoil the argument. I'm moving on now.
TF
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Actually I agreed with you. I was just trying to show you that there was another side to it. What do I know though it's not like I do this for a living.
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I believe Kath's thread title suggests 'another side' to the argument. "Is sleep apnoea hereditary?"seems to ask the question quite succinctly.
Elsewhere, you inform us that you work as an RPSGT or Sleep Tech for short.
I take my car to a mechanic so he can fix it. He's not qualified to do anything else, no matter how good he thinks he is at Formula One racing track design.
TF
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Permalink Reply by carol murphy on
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Wow a debate ..... Nature or Nurture?
Tigers Fan you state that the OSA chain will be broken when the life style and family tendancy to diet lacking exercise and alcohol and cigarettes are stopped how do you explain a new born baby having OSA and still having it 3 years later obviously none of the traits you mentioned were in the equation ???
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LMAO;) Just as being a PAP user does not make anyone an expert on sleep. It was just a debate TF. Don't take it so personally.
Tigers Fan said:I believe Kath's thread title suggests 'another side' to the argument. "Is sleep apnoea hereditary?"seems to ask the question quite succinctly.
Elsewhere, you inform us that you work as an RPSGT or Sleep Tech for short.
I take my car to a mechanic so he can fix it. He's not qualified to do anything else, no matter how good he thinks he is at Formula One racing track design.
TF
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What about the 160ilb man that walks into the lab with severe apnea?
It is societies fault that the majority still believes that OSA is just a problem of weight. It has just been in the last 50 years that we have started to monitor weight issues on the whole. OSA was discovered shortly after this process began. People have been snoring since the dawn of man. In the 1500s a snorer was chained in the center of town so that everyone could here how evil they were. OSA awareness is on the rise. This is quite different than the prevelence of OSA being on the rise. OSA existed long before it was discovered. I f you do not believe me read some Dickens.
carol murphy said:Wow a debate ..... Nature or Nurture?
Tigers Fan you state that the OSA chain will be broken when the life style and family tendancy to diet lacking exercise and alcohol and cigarettes are stopped how do you explain a new born baby having OSA and still having it 3 years later obviously none of the traits you mentioned were in the equation ???
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Hi Carol
I do not state that the chain will be broken, I said I'd put money on it. Statistically, I believe I'd have a very good chance of winning. Clerarly, I'd lose in umpteen specific cases - but overall, I believe I'd be a winner. My bet is that more OSA is related to obesity and lifestyle reasons than to hereditary reasons.
Hi Rock
I'm unable to comment on what society believes about OSA, I'm not privy to god-like information and I challenge your claimed access.
You refrain from patronising, I'll refrain from taking it personally.
LMAO means?
TF
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I am a bit fuzzy about the exact details, but around the mid to late 90s, research was being done in Edinburgh on family links. The Edinburgh Royal sleep clinic was recruiting volunteers from amongst their OSA patients. Think they were doing sleep testing on siblings, not sure if they were also checking other relatives. At the time I wasn't able to take part, so didn't note the details too well.
Did anyone on the forum take part and does anyone know what was the outcome of the study ?
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Permalink Reply by Kath Hope on
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Wow, this is very interesting and I'd love to know the outcome of the research if anyone else does!
Lisa said:
I am a bit fuzzy about the exact details, but around the mid to late 90s, research was being done in Edinburgh on family links. The Edinburgh Royal sleep clinic was recruiting volunteers from amongst their OSA patients. Think they were doing sleep testing on siblings, not sure if they were also checking other relatives. At the time I wasn't able to take part, so didn't note the details too well.
Did anyone on the forum take part and does anyone know what was the outcome of the study ?
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Firstly, when I started this discussion I said here's why Dr. Park's thinks sleep apnoea 'can' be hereditary. I never implied that it's always hereditary, and I certainly believe that it's a mixture of both hereditary and life-style factors. However, like Rock said "which came first - the chicken or the egg?" A big issue that's very common is the fact that normally (and bear in mind I'm not saying 'always') people find it much easier to lose weight once they're being successfully treated for sleep apnoea and their sleep deprivation improves. I hear stories all the time of people who ate and drank for energy, thereby piling on the lbs.
One of the hospitals told me that in the early days, most people getting diagnosed had weight problems, but more and more they're getting very slim patients, and children also. Their take on this is that sleep apnoea was never suspected in people who weren't on the heavier side, and as we all know, it's very rarely one of the first things the medics suspect in people. They were also of the opinion that the reason the heavier patients were discovered first is due to the other related 'conditions' they'd developed and the fact that they were naturally less healthy as a rule than the slimmer patients. Thankfully, now there's more awareness, this is improving. My own GP always used to ask me if I was sleeping well, and I assured him that I was asleep when my head hit the pillow and slept like a log. Little did I know.......... Whilst some sleep apnoea sufferers are aware of waking up, I never was!
I remember once reading on the web about under-achieving icelandic school children being tested in droves for sleep problems, and there was talk at the time of having all children tested, although I'm not sure if that materialised.
In summing up, I firmly believe that sleep apnoea is hereditary, and dare I say, in most cases I believe it is (runs and hides.......... :D) and that the undiagnosed sufferers pile on the weight for energy. However, lifestyle is also a big factor too, so for example, someone comfort eating for reasons other than needing more energy, has a high chance of going on to develop sleep apnoea - same with someone who drinks too much alcohol close to bedtime etc.
Sounds very similar to the difference in type 1 and type 2 Diabetes - I think I'm correct in saying that one's often caused through lifestyle and the other's hereditary. Correct me if I'm wrong!
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Permalink Reply by Julie on
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Without getting too technical here, the nurses at the sleep clinic in Edinburgh have told me that they get all sorts of people through their doors who have been diagnosed with sleep apnoea, overweight, thin, tall, small and from her experience as a nurse at the sleep clinic it can't be pinned down to any one factor.
Julie
RockHinkleRpsgt said:It does not have to be either or TF.
"In my world, some people have 'structural reasons' for having OSA and these may or may not be hereditary AND lots of people have OSA because they are fat."
Structural or anatomy reasons would be hereditary or genetic in most cases. I also believe that lots of people are obese because they have OSA. Have you never wondered why so many people that diet fail? OSA causes hormonal imbalances that promote weight gain.
http://www.ncbi.nlm.nih.gov/pubmed/14711066
Obesity and obstructive sleep apnea.
Gami AS, Caples SM, Somers VK.
Department of Medicine, Mayo Medical School, Rochester, MN, USA.
Abstract
There is a very high prevalence of OSA in obese individuals and a high prevalence of obesity in patients with OSA. The pathophysiology of OSA is intimately linked to obesity. Anatomic and functional considerations of the pharyngeal airway, the CNS, central obesity, and leptin likely interact in the development of OSA in obese individuals. OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. The diagnosis of OSA requires the clinician's awareness of its potential to cause a spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms in patients who may be unaware that their sleep is disturbed. Symptoms and examination findings help predict which obese individuals have OSA, and polysomnography is the gold standard by which to make the diagnosis and assess the effects of treatment. Numerous disease states are associated with both OSA and obesity, and it is becoming clear that the relationships are mediated by complex interrelated mechanisms. Common diseases and disease mechanisms in OSA and obesity suggest that conditions related to obesity may be better managed if patients, particularly those who are morbidly obese, are evaluated and treated for previously undiagnosed OSA. OSA is cured in only specific cases with craniofacial or upper airway surgery, and the general application of UVP is not efficacious. OSA also can be cured with sufficient lifestyle-mediated or surgical weight loss; however, in the absence of long-term weight maintenance, OSA returns with weight gain. Although not curative, nasal CPAP is the initial treatment of choice for most patients because of its noninvasive approach and technical efficacy. It is limited, however, by patient acceptance and long-term compliance. Advances in mask comfort and use of humidified air should increase its acceptance. Future management strategies include newer generations of positive airway devices that automatically titrate pressures (which are not yet recommended by expert organizations) and multidisciplinary approaches to managing the care of patients with OSA.
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