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How to Help Prevent Hypertension, Cardiovascular disease, and Stroke by Managing Sleep Apnea

How to Help Prevent Hypertension, Cardiovascular disease, and Stroke by Managing Sleep Apnea

Webinar Date:
February 18, 2015

Presented by Dr. Mayoor Patel, DDS, MS & Rose Nierman

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Course Description

This webinar is designed to give a brief overview of the dangers of sleep apnea, and how to incorporate the treatment of obstructive sleep apnea into general practice. In addition, Rose Nierman will cover an overview of how to bill the treatment to the patient’s medical insurance, making care easily accessible for them.

Learning Objectives

  • Understand how obstructive sleep apnea affects the body
  • The Co-morbidities of obstructive sleep apnea (OSA)
  • Screening for OSA Incorporating dental sleep medicine into a general practice
  • Why dentists should be billing medical insurance

Speaker Bio

Dr. Mayoor Patel, DDS, MS limits his practice to treating sleep apnea, TMD, and craniofacial pain. He is a Diplomate of the American Academy of Dental Sleep Medicine, as well as the American Academy of Craniofacial Pain. Dr. Patel regularly lectures across the country on implementing sleep apnea, TMD, and pain treatment.

Rose Nierman has been at the forefront of educating dental practices on medical billing in dentistry, crosscoding and services expansion for over 25 years. A pioneer in the industry of TMJ treatment and dental sleep medicine, she wrote the first manual on cross-coding for TMD and implants and developed DentalWriter™ and CrossCode™ Software to assist dentists with documentation and billing medical insurance. Ms. Nierman is a frequent presenter at major dental CE programs, teaching dentists and their teams how to implement and expand medically necessary services.


Clip Transcript. Full Core Curriculum E-Learning is available on your AAOSH Member Dashboard.

As you can see along the bottom line if you look at the vertical column is basically suggesting the cumulative incidence of non-fatal cardiovascular event what you'll find is in a control group or in the blue line the treated group of patients with abstraction sleep apnea on path therapy the risk of having non-fatal cardiovascular events is quite nominal as opposed to a severe group of patients that are untreated and as the years of follow-up progress the risk of non-fatal cardiovascular events significantly improved so there's a definite correlation here that by having a control group that does not have apnea and having a group that has emptiness being managed in this instance with cpap you can reduce the incidence of non-fatal cardiovascular events as opposed to no treatment at all the strain same way applying to stroke and obstructive sleep apnea may be a risk factor for having a stroke it's also been shown that to recover after having a stroke might be delayed if the person have a structural sleep apnea has not been managed conversely people who had had a stroke are more at risk of developing obstructive sleep apnea and the graphic here maybe illustrates us a little bit better when you look at this graphical on the x-axis we have years of follow-up but actually on the y-axis we have the adjusted risk of not having a stroke in which you'll find some interesting correlations here the green lines suggesting no apnea basically control population followed by the purple orange and red and as you see as the severity of apnea increases in an untreated population the adjusted risk of having a stroke correlatedly increases as well over time so once again if we can find these patients identify these patients and manage this patient you could reduce the risk of heart disease hypertension and of course stroke in these instances now diabetes is one that we need also take into consideration there's some coincidence there's some increase in the fact that obesity is becoming a problem in the united states there's also a respective increase in type 2 diabetes and the research has indicated that blood sugar glucose levels are higher primarily in patients with obstructive sleep apnea have not been managed so treatment of patients with sleep apnea may improve blood sugar levels now this next graphical may be a little too busy but the end point here is to understand that there's a lot of responses and reactions that take place that may contribute to type 2 diabetes if we just look at sleep apnea on the upper aspect of this graphical there's two significant pathways one which is sleep fragmentation where the individual repetitively wakes up at night whether it be from an arousal or the effort of trying to breathe and on the right hand side we have this intermittent hypoxia where we have this drop in oxygen level this response of fragmentation hypoxia does set off a multitude number of reactions you'll get an increase in catecholamines increasing cortisol oxidative stress increases we activate a whole cascade of inflammatory pathways along with messing with the adopting pro profiles such as increasing leptins and so forth or indirectly affecting insulin and by affecting insulin also affecting the pancreatic b cell dysfunction which ultimately would lead to glucose intolerance there hurricane we've had and have had stories of patients that have had diabetes they were unable to manage it appropriately with medication but once diagnosed with apnea and have the apnea managed the diabetes was a lot more easier for them to control now to finish off the comorbidities i do want to touch on premature death but that itself is an important alarming fact a product for sleep apnea is definitely associated with an increased likelihood of premature death but you'll find that middle-aged men appear to be at greatest risk with the cause of death most commonly related cardiovascular diseases and everything prior to this led to reduce the risk of cardiovascular related diseases and this last graphical i'll demonstrate is basically showing survival rate and what you've got here is a percentage of survival on the vertical axis and the number of years on follow-up and we have a population here that was followed that looked at no apnea a control group followed by mild moderate and severe and what you'll find is that about year 12 to 13 and up the survival rate drops significantly in the severe population of ethnics so once again we want to take this into consideration that reducing premature death by indirectly affecting apnea can have a big impact on your patient's healtA