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Sleep Apnoea Forum Bringing Help + Support to the Patient
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: 2513
Replies to This Discussion
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Permalink Reply by Tigers Fan on
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Nature or nurture?
Until they find an OSA gene, I'm plumping for nurture! A family is very likely to pass on life-style traits and, as we know, life-style is a great indicator for OSA. Change a family's tendency to fatty food, lack of ecercise, too much alcohol, too many cigarettes de dah and I'll put money on the OSA chain being broken.
I've absolutely no evidence to support this except the folk in waiting rooms of sleep clinics.
TF
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Permalink Reply by Kath Hope on
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I totally agree with you TF, along with the hereditary factor from the bone structure of the jaw. My own sleep apnoea comes from a large tongue base, large soft palate, receding jaw and upper airways problem - none of which are from life-style traits (as far as I'm aware). Oh, and by the way, I had a childhood full of tonsillitis and when my GP decided it was time to take them out, he discovered nature had beat us to it, as they'd disappeared (not sure of the medical term for it). There's no 'Hope' for me of ever being cured is there? LOL
My own mother snored for England and definitely had apnoeas, but she died of a heart attack at the age of 49. I'll guarantee she had sleep apnoea. My sister is in the process of being checked out as it seems she's probably got it too.
Tigers Fan said:Nature or nurture?
Until they find an OSA gene, I'm plumping for nurture! A family is very likely to pass on life-style traits and, as we know, life-style is a great indicator for OSA. Change a family's tendency to fatty food, lack of ecercise, too much alcohol, too many cigarettes de dah and I'll put money on the OSA chain being broken.
I've absolutely no evidence to support this except the folk in waiting rooms of sleep clinics.
TF
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Permalink Reply by RockRpsgt on
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I do not agree that just by changing lifestyle traits and habits that one or one's whole family can break the apnea chain. Many factors have to be looked at when confronting apnea.I do agree that lifestyle and habits play a large part. i just do not believe them to be bulk of the problem. Anatomy, tongue, and neck size are just as big of factors as weight. Maybe even bigger. All three of these things can be accreditted to genes and heredity. Neck size(The #2factor) can be attributed to aging regardless of weight or anatomy.
We are also forgetting that all of the above mentioned contributers for apnea are just that. Apnea is caused my muscle atonia. Muscle atonia is safety mechanism that has been brought on by millions of years of evolution. This MAJOR characteristic of sleep keeps our subconscience from acting out our dreams while we sleep. It does this by diminshing our muscle tone to the point of paralysis during REM sleep. I do not believe this chain will be broken without serious side effects.
Tigers Fan said:Nature or nurture?
Until they find an OSA gene, I'm plumping for nurture! A family is very likely to pass on life-style traits and, as we know, life-style is a great indicator for OSA. Change a family's tendency to fatty food, lack of ecercise, too much alcohol, too many cigarettes de dah and I'll put money on the OSA chain being broken.
I've absolutely no evidence to support this except the folk in waiting rooms of sleep clinics.
TF
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How come a common outcome for bariatric surgery in OSA sufferers is 1. weight loss 2. no longer diabetic type 2 and 3. no longer suffer OSA?
How come so many sufferers are fat and don't exercise much or at all?
How come so many sufferers smoke and drink a lot - see 2. above?
No-one is saying it's the whole amswer - just a very large proportion of it.
TF
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Tigers Fan said:How come a common outcome for bariatric surgery in OSA sufferers is 1. weight loss 2. no longer diabetic type 2 and 3. no longer suffer OSA?
Test those same people in within 2 to six years and you will find a huge reocurrence in apnea. The same goes for children who undergo toncillectomies and adnoid removals. In my 4 years as a tech I have only known of 2 people to get off of PAP due to weight loss or surgery. Check the statistics I believe you will be surprised.
How come so many sufferers are fat and don't exercise much or at all?
Obesity is a factor. I did not say it was not. Fat people have large necks which as I said is the #2 factor for apnea. If your neck is over 16" most likely you will have apnea.
How come so many sufferers smoke and drink a lot - see 2. above? Smoking increases your risk for everything. I do not see any more smokers than I do non-smokers. In hippie-liberal Colorado quite the opposite.
No-one is saying it's the whole amswer - just a very large proportion of it.
I agree weight and lifestyle play a huge part. Anatomy and muscle atonia play the largest though.
TF
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We are talking chicken and egg here TF. Which came first obesity? or apnea? I believe for most they came at the same time.
For most men apnea begins in the late teens to early 20s when we first fill out. Despite most active men keeping a decent BMI the added bulk we receive during this time will cause apneas or SBDs. As we begin to fill out the size of our mouths and airways become a huge factor as our o2 needs go up. The AHI might only be 1-5 but it is enough to begin the cycle. These 1-5 events cause irregularities in our o2. The o2 problems will eventually cause our heart to increase it's productivity to compensate for the irregularities. (We all know what happens when we have a limp in one leg and compensate with another.) Our body does not understand o2 deprivation. It requires what it requires all of the time.
Eventually this process will cause blood pressure problems and our heart will begin to tire. This is when apnea becomes dangerous as our brain becomes alert to the problem. Our brain will begin to cause arousals as it feels that it is safer to interrupt sleep than to allow the apneas to continue. It is the arousal that truly effects the way we feel and act as sleep is an immuno and memory function. As our sleep is interrupted so is our healing and memory process. The interruption cause cortisol and leptin imbalances. Leptin is a hormone that communicates to our brain that we have enough stored nutrients. Without it we crave carbs causing us to gain weight and adding to the cycle.
A lifestyle change could not have stopped the above process. Regardless of your BMI being over 6' can put you at risk for apnea.
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I'll give you another scenerio TF;
Lisa is a remarkable yet small 6 year old girl. Blessed in many ways and excelling in the 1st grade. Socially and academically all who know this bright little girl have high hopes for her. Unbeknownst to anyone Lisa has a slight SBD caused by enlarged toncills and adnoids. This problem causes flow limitation in Lisa's sleep. This flow limitation may or may not cause snoring. if so it would most likely not be noticed unless one were looking for it.
Lisa will eventually suffer from the same sleep interruptions as the above mentioned man. These interruptions will not only affect her healing and memory process, but her growth and mental development. By the end of the 3rd grade lisa is 30ilbs overweight with behavioral problems.
Could her problem have been helped with a simple lifestyle change? No because it was genetic. Regardless of weight loss or surgery statitistics show that Lisa will develop apnea as an adult due to this same genetic problem.
Solution: Perform the surgery on the child and educate her to monitor for the rest of her life.
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Hi Rock
I suspect we are both swapping half stories here!
I said:
How come a common outcome for bariatric surgery in OSA sufferers is 1. weight loss 2. no longer diabetic type 2 and 3. no longer suffer OSA?
and you replied:
Test those same people in within 2 to six years and you will find a huge reocurrence in apnea. The same goes for children who undergo toncillectomies and adnoid removals. In my 4 years as a tech I have only known of 2 people to get off of PAP due to weight loss or surgery. Check the statistics I believe you will be surprised.
What you haven't said is whether or not those same people with recurrence of apnoea reverted to their old life styles - grew fat and unfit again - or whether the apnoeas reoccurred for other reasons.
What I know is of two people underwent the stapled stomach bariatric surgery rather than bypass, lost weight rtapidly, lost type 2 diabetes, came off CPAP and have stayed that way - but not for four years yet.
From CPAP forums, I gather that people with OSA and who are not obese/fat consider themselves very unlucky. I also note that most members are fat. There are endless studies linking obesity and OSA. Obesity can run down generations because o0f life style. I am not aware of statistics showing causes of OSA to be genetic.
I guess my end argument is that if you have OSA and are fat, there is a good chance of losing OSA if you reduce weight significantly, whether or not your parents had it.
UK obesity rates are following those in US - ever upward - and so are our OSA rates. The rate of increase in rate both there and here - the acceleration - exceed the increase in population rates. The difference can only be due to life style and not hereditary - mathematical fact.
TF
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In your scenerio only the obese and unhealthy would be treated. This would be a travisty as apnea will eventually get effect us all regardless of our health.
RockHinkleRpsgt said:
Tigers Fan said:How come a common outcome for bariatric surgery in OSA sufferers is 1. weight loss 2. no longer diabetic type 2 and 3. no longer suffer OSA?
Test those same people in within 2 to six years and you will find a huge reocurrence in apnea. The same goes for children who undergo toncillectomies and adnoid removals. In my 4 years as a tech I have only known of 2 people to get off of PAP due to weight loss or surgery. Check the statistics I believe you will be surprised.
How come so many sufferers are fat and don't exercise much or at all?
Obesity is a factor. I did not say it was not. Fat people have large necks which as I said is the #2 factor for apnea. If your neck is over 16" most likely you will have apnea.
How come so many sufferers smoke and drink a lot - see 2. above? Smoking increases your risk for everything. I do not see any more smokers than I do non-smokers. In hippie-liberal Colorado quite the opposite.
No-one is saying it's the whole amswer - just a very large proportion of it.
I agree weight and lifestyle play a huge part. Anatomy and muscle atonia play the largest though.
TF
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gGreat discussion TF! This is one of my favorite sleep topics. I have argued it from both sides knowing that there can be no winner to the debate.
For some reason my PC is not letting me cut and past. type in Pubmed in your search engine. This is a medical database. Search OSA and anatomy or OSA and genetics. You will find what you are looking for.
All I am saying is that if your mouth and jaw are not big enough no amount of weight loss or life change will help.
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A matter of degree
I live in a "both ...and" world and not in an "either ....or" world. 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.
If people with 'structural reasons' are fat and lose weight, they still have structural reasons.
If people have OSA and do not have structural reasons, losing weight may well solve the OSA problem. I don't know what proportion of people fall into this category, just that a hell of a lot do.
OSA is increasing faster than population therefore a cause other than hereditary process is at work. Obesity is at the top of the list.
Harder does not mean hard, it means a movement toward the hard end of the scale, by an unspecified degree. Softer does not mean soft, it means a movement in the other direction. Obesity is the cause of a lot of OSA does not mean it causes all OSA, it means it causes a lot of it, again, an unspecified degree. Because fat people have OSA does not preclude thin people from having it.
I'm still going for life style being the major cause of OSA - because OSA is growing faster than the population.
TF
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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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