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Surgery may help sleep apnea patients who struggle with CPAP

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Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



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Study links epidural in childbirth to slightly higher risk for autism

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Children whose mothers were given an epidural during labor may face a slightly heightened risk of autism, a large, new study suggests.

Researchers found that the rate of autism was a little higher among those kids, versus their peers whose mothers did not get epidural pain relief during childbirth: 1.9% versus 1.3%.

The reasons for the difference are not yet known. And experts stressed that the findings do not prove epidurals directly raise the odds of a future autism spectrum disorder, or ASD, diagnosis.

“I don’t think people should be panicked,” said senior researcher Anny Xiang, of Kaiser Permanente Southern California’s Department of Research and Evaluation.

For one, she said, the rates of ASD were low in both study groups.

Instead, the findings point to a need for more research to better understand what is going on, Xiang said.

Other experts agreed. Autism is a complex brain-based disorder, and it’s thought that many factors — before, during and after birth — may influence the risk, said Dr. Rahul Gupta, chief medical and health officer for the March of Dimes.

“It’s quite unlikely that just the drugs used in epidural would cause ASD,” he said.

Gupta pointed to a bigger-picture question: Women who did or did not have epidurals during delivery may have differed from each other in various ways that the study could not take into account: They may have had different exposures to infections, environmental toxins or medications during pregnancy, for example.

Gupta noted that a large U.S. government study, called SEED, is digging into potential risk factors for autism. It recently found an elevated risk among kids whose mothers were prescribed opioids painkillers shortly before they became pregnant.

When it comes to medications in general, Gupta said, researchers need to learn more about the possible effects during pregnancy.

Autism is a brain disorder that affects social skills, communication and behavior control. It affects about 1 in 54 children in the United States, according to the U.S. Centers for Disease Control and Prevention.

The disorder varies widely from one person to the next: Some children have milder problems with socializing and communicating, while others are profoundly affected — speaking little, if at all, and getting wrapped up in repetitive, obsessive behaviors.

Genes are thought to account for much of the risk of autism, but experts have long believed that environmental factors also play a role.

Past studies have looked at mode of delivery: Some have found that children born by cesarean section or labor induction have a higher risk of autism.

This latest study, published Oct. 12 in JAMA Pediatrics, is the first to look at epidural use and autism risk.

Xiang’s team scoured electronic medical records for nearly 148,000 children born at Southern California hospitals between 2008 and 2015. All were delivered vaginally, and about three-quarters were exposed to epidural analgesia.

Children in that exposed group had a somewhat higher rate of ASD diagnosis. The researchers used the medical records to try to account for other factors — including the mother’s age and education level, and health issues such as diabetes, obesity and smoking.

Even then, children exposed to epidural analgesia remained at 37% greater risk of ASD, compared to unexposed kids.

Xiang’s team also looked at one possible explanation: Epidurals can cause a fever and, in theory, that might affect newborns. But there was no clear link between moms’ fevers during labor and the risk of autism.

Several medical groups responded to the study, saying it “does not provide credible scientific evidence that labor epidurals for pain relief cause autism.”

The groups, including the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, said women should not be scared away from opting for an epidural.

“Very low levels of these [epidural] drugs are transferred to the infant, and there is no evidence that these very low levels of drug exposure cause any harm to an infant’s brain,” the groups said.

Thomas Frazier, chief science officer for the advocacy group Autism Speaks, called the study “high-quality,” and said it will hopefully spur more research.

Frazier agreed there may be other explanations for the connection between epidural use and higher ASD risk — such as infections or other prenatal factors.

More information

Autism Speaks has more on ASD.

Copyright 2020 HealthDay. All rights reserved.



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Study: Immediate breast reconstruction during cancer treatment doesn’t impact survival, recurrence

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Oct. 14 (UPI) — Women who undergo immediate breast reconstruction with nipple-sparing mastectomy or skin-sparing mastectomy while on chemotherapy for breast cancer have similar rates of survival and disease recurrence as those who have a conventional mastectomy, study published Wednesday by JAMA Surgery reported.

Researchers said data on the safety of performing mastectomy and reconstruction has been “insufficient” compared with conventional mastectomy — performed after cancer treatment — but the new study suggests it is an effective and safe treatment method.

The analysis of breast cancer patients at Asan Medical Center in Seoul found that rates of localized disease recurrence — or the development of tumors in the same area — were 3.7% for women who underwent immediate breast reconstruction and 3.4% for those who had a conventional mastectomy, the data showed.

Meanwhile, just over 17% of the women who had an immediate breast reconstruction suffered a distant metastases — or cancer that spread to other areas of the body — while nearly 19% of those who opted for a conventional mastectomy did so, the researchers said.

In addition, after 10 years, overall survival among women who had immediate breast construction was 92%, compared to 89% for those who had a conventional mastectomy, according to the researchers.

“In this study, there was no significant difference in prognosis between the two groups during the follow-up period,” the researchers wrote.

“Further studies should be conducted in more patients with axillary [lymph node] metastasis” — or cancer that has spread to the lymph nodes, they said.

About one in eight women in the United States will suffer from breast cancer during their lifetime, and about 300,000 are diagnosed with the disease annually, according to BreastCancer.org.

Just over half of women with breast cancer nationally opt for immediate breast reconstruction following mastectomy, research suggests.

For this study, the South Korean researchers compared outcomes in 626 women with breast cancer, half of whom opted for immediate breast reconstruction, while the rest had a conventional mastectomy.

About 7% of the women who had immediate breast reconstruction experienced regional disease recurrence, compared to 5.3% of those who had conventional mastectomy, the data showed.

Five-year, local tumor recurrence-free survival was 96% among women who had immediate breast reconstruction and 97% for those who had conventional mastectomy, according to the researchers.

Disease-free survival was also comparable between the two groups — 77% versus 80% — as was distant metastasis-free survival — both 83% — the researchers said.

“The long-term oncologic outcomes of immediate breast reconstruction with nipple-sparing mastectomy or skin-sparing mastectomy for breast cancer in this study appeared to be comparable to those of conventional mastectomy alone after neoadjuvant chemotherapy,” the researchers wrote.



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Limiting TV ads for foods high in sugar, salt, fat may reduce child obesity

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Limiting TV ads for sugary, salty and high-fat foods and drinks might help reduce childhood obesity, British researchers suggest.

They looked at advertising of these products between 5:30 a.m. and 9 p.m. If all such ads were withdrawn during those hours, the number of obese kids in Britain between the ages of 5 and 17 would drop by 5% and the number of overweight kids would fall 4%, the study found.

That’s equivalent to 40,000 fewer kids in Britain who would be obese and 120,000 fewer who would be overweight, the researchers said.

The findings were published online this week in the journal PLOS Medicine.

Oliver Mytton, an academic clinical lecturer at the Center for Diet and Activity Research at the University of Cambridge, led the study.

“Measures which have the potential to reduce exposure to less-healthy food advertising on television could make a meaningful contribution to reducing childhood obesity,” the authors said in a journal news release.

But they also pointed out that they could not fully account for all factors that would affect the impact of the policy, if implemented.

They added: “Children now consume media from a range of sources, and increasingly from online and on-demand services, so in order to give all children the opportunity to grow up healthy it is important to ensure that this advertising doesn’t just move to the 9-10 pm slot and to online services.”

More information

For more on childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

Copyright 2020 HealthDay. All rights reserved.



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