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Dr K K Aggarwal

Snoring how boring

By Dr K K Aggarwal
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When this irritating sound blasts through the quietness of the night it can drive the sanest of people insane – well almost! There are many couples who have divorced on this ground. It’s no joke to be accused of snoring – neither for the snorers nor for the sufferers who have to endure sleepless nights! Even the fair sex is not immune to this malady howsoever they might deny it. The cause of snoring is air flowing through the open mouth and causing the soft palate (side area around the back of the tongue and the tonsils) to vibrate. This results in the production of sound – the snore! Medically, snorers are found to be more prone to heart attacks and sudden death. Certain conditions can predispose to snoring. These are: • Enlarged tonsils or adenoids • Congestion in the nasal sinuses • Deviated nasal septum • Loose dentures • Nasal polyps • Sleeping on your back (causes the tongue to fall back and block the windpipe partially) • Aging causes the throat muscles to become flabby. This is also caused by alcohol, and certain drugs – tranquilizers, pain killers, or sedatives, all of which depress the brain and cause the muscles to be loose. Practical remedies for this malady • Find the cause and treat it if snoring is due to any of the above conditions. Corrective measures should be undertaken ant it may stop snoring. • Sleeping on the side: The tongue does not block the airway and hence helps to prevent snoring. For this purpose a ball is stitched on the back of the night suit shirt to remind the person to sleep on the side. • A special anti-snoring pillow can be made in which the portion under the neck is higher than the one under the head, hence extending the neck this prevents snoring. • Lose weight if you are overweight, especially around the belly. • Stop smoking as smoke irritates the nasal mucosa and the throat. • Sleep without dentures if you use them. • For the sufferers, one last line: Stuffing your ears with cotton wool (or your partner’s mouth) or sleeping in another room may be the best answer to the solution. If nothing helps – just pray to God for endurance.

Managing Diabetes

By Dr K K Aggarwal
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• People with pre diabetes are at increased risk for developing type 2 diabetes, heart disease and Paralysis.

• More than 25% people have pre diabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes.

• Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test

• Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence. • Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.

Revisiting 2012

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  • A large randomized trial (14k men) of multivitamins has shown a small, statistically-significant reduction in total cancer risk (JAMA 2012;308(18):1871-1880).
  • Vitamin D does not prevent cold (JAMA 2012;308(13):1333-1339).
  • A large randomized trial in patients at increased risk for heart disease because of dysglycemia found no effect of fish oil supplements in reducing the rate of cardiovascular events (N Engl J Med 2012;367:309-318). 
  • A systematic review and meta-analysis of 9 randomized trials evaluating supplementation with beta-carotene, vitamin C, and vitamin E for one year found no evidence that vitamin supplementation reduced the risk of cataract or of cataract extraction (Cochrane Database Syst Rev 2012;6:CD004567).
  • Portable monitoring is a reasonable alternative to in-laboratory sleep study in patients with a high pre-test probability of moderate to severe obstructive sleep apnea.
  • Systemic high BP is more common among individuals who have untreated obstructive sleep apnea (snoring) than among those who do not.
  • Antiretroviral therapy is now recommended in all HIV-infected patients, regardless of CD4 cell counts.
  • Prolongation of the QT interval and torsades de pointes in ECG is associated with antibiotics, such as erythromycin and clarithromycin.
  • After a heart attack, beta-blockers may not be required for more than 4 years unless specifically indicated.
  • Anti-depression drugs SSRIs may lead to one additional brain hemorrhage for every 10,000 patients treated for one year.
  • All pregnant women should receive tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine in each pregnancy
  • Tdap should be administered after 20 weeks and optimally between 27 and 36 weeks of pregnancy.
  • Previously, Tdap was recommended only for women who had never received the acellular pertussis vaccine.
  • Tenofovir-emtricitabine is now used for pre-exposure prophylaxis among confirmed HIV-negative individuals at high risk for sexually-acquired HIV infection
  • In areas of high HIV prevalence, the daily use of tenofovir-emtricitabine reduced risk of HIV by 48 to 75%.

 

Do Not Ignore Day time Sleepiness

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Obstructive sleep apnea (OSA) with snoring is related to several cardiovascular diseases. It is a cause of systemic hypertension.

Mild lung hypertension is also associated with OSA. Heart blockages are associated with severe OSA but not mild OSA. Night cardiac arrhythmias with OSA are known and therefore all patients with nocturnal cardiac arrhythmias should be evaluated for possible OSA. Treatment of OSA may reduce systemic blood pressure, lung pressure, cardiovascular events and eliminate nocturnal ventricular bradycardia and asystole in many patients with OSA.

The throat is surrounded by muscles that control the airway for speaking, swallowing and breathing. During sleep, these muscles are less active, and this causes the throat to narrow. In most people, this narrowing does not affect breathing. In others, it can cause snoring, sometimes with reduced or completely blocked airflow.

A completely blocked airway without airflow is called an obstructive apnea. Partial obstruction with diminished airflow is called a hypopnea. A person may have apnea and hypopnea during sleep.

Insufficient breathing due to apnea or hypopnea causes oxygen levels to fall and carbon dioxide to rise. Because the airway is blocked, breathing faster or harder does not help to improve oxygen levels until the airway is reopened. Typically, this requires the person to awaken to activate the upper airway muscles. Once the airway is opened, the person then takes several deep breaths to catch up on breathing. As the person awakens, he or she may move briefly, snort or snore, and take a deep breath. Less frequently, a person may awaken completely with a sensation of gasping, smothering, or choking.

Many people with sleep apnea are unaware of their abnormal breathing in sleep, and all patients underestimate how often their sleep is interrupted. Awakening from sleep causes sleep to be unrefreshing and causes fatigue and daytime sleepiness.

Symptoms of OSA

The main symptoms include loud snoring, fatigue, and daytime sleepiness. However, some people have no symptoms. Fatigue and sleepiness have many causes and are often attributed to overwork and increasing age.

Other symptoms may include one or more of the following:

  • Restless sleep
  • Awakening with choking, gasping, or smothering
  • Morning headaches, dry mouth or sore throat
  • Waking frequently to urinate
  • Awakening unrested, groggy
  • Memory impairment, difficulty concentrating, low energy

Certain factors increase the risk of sleep apnea.

  • Increasing age: Sleep apnea occurs at all ages, but it is more common in middle and older age adults.
  • Male sex: Sleep apnea is two times more common in men, especially in middle age.
  • Obesity: The more obese a person is, the more likely they are to have sleep apnea.
  • Sedation from medication or alcohol interferes with the ability to awaken from sleep and can lengthen periods of apnea (no breathing), with potentially dangerous consequences.
  • Abnormality of the airway

Complications of sleep apnea

  • Daytime sleepiness
  • Difficulty concentrating
  • Increased risk of accidents and errors in daily activities
  • More than twice as likely to be involved in a motor vehicle accident
  • Increased risk of cardiovascular problems such as high blood pressure, heart attack, abnormal heart rhythms, or stroke

Diagnosis of sleep apnea

  • A complaint of snoring and ineffective sleep
  • Neck size (greater than 17 inches in men or 16 inches in women) is associated with an increased risk of sleep apnea.
  • A small upper airway: Difficulty seeing the throat because of a tongue that is large for the mouth.
  • High blood pressure, especially if it is resistant to treatment
  • If a bed partner has observed the patient during episodes of stopped breathing (apnea), choking, or gasping during sleep, there is a good possibility of sleep apnea.