Research Medical Center June 11, 2014

Dr. Tannaz Montee

By Linda Cruse, Special Writer to the Kansas City Star

Featuring  Dr. Tannaz Montee of KC Pulmonology Practice at Research Medical Center. 

Chuck Brandt of Merriam didn't know it, but he stopped breathing 75 times each hour when he slept.

Despite being tired and unfocused during the day, the only other symptom he knew about was that he snored.  

"I have always snored to some extent, but ifs gotten worse in the last five to 10 years," said Brandt, 50, a computer programmer.

Brandt said his snoring increased as he gained weight. Additionally, having asthma and allergies seemed to exacerbate his snoring and sleep issues, he said.

Two years ago he went to see Dr. Michael Anderson, director of the Sleep Disorders Center at Overland Park Regional Medical Center.

Anderson conducted sleep lab tests on Brandt and concluded that he has severe obstruction sleep apnea. If not treated, Anderson said, serious health problems could develop, including a much higher risk of heart attack and stroke.

A new study by the American Academy of Sleep Medicine shows that moderate to severe obstructive sleep apnea is associated with an increased risk of stroke, cancer and death. Results of the 20-year study showed that people with moderate to severe obstructive sleep apnea were four times more likely to die or have a stroke and three times more likely to die from cancer.

"Sleep apnea ranges from mild to moderate to severe, which is more than 30 apneas per hour," Anderson said. "Chuck's sleep apnea was very severe."

Obstructive sleep apnea is caused by the col­ lapse of the soft tissue in the back of the throat and tongue during sleep, he said.

He recommended that Brandt begin using a Continuous Positive Airway Pressure (CPAP) device to treat the apnea. A CPAP is a compressor that blows air into a mask that is worn snugly over the nose or mouth nightly during sleep.

The flow of air acts like a splint to keep the upper airway from collapsing, said Dr. Sidney Devins, a pulmonary care, critical care and sleep physician who oversees Menorah Medical Center’s Sleep Disorders Center.

“The column of air splits the airway and reduces the number of sleep apneas,” he said. “It is the most effective way of dealing with sleep apnea.”

Brandt said, “I have used it every night since I have received it. I’m snoring less, I feel less tired during the day and I feel healthier. I’m working out now and hoping I won’t need to use the device forever.”

Causes and Symptoms

Dr. Tannaz Montee, director of the Research Medical Center Sleep Disorders Lab on the Brookside campus, said 44 percent of men between the ages of 30 to 60 snore compared to 28 percent of women. Of the estimated 18 million Americans who have sleep apnea, twice as many are men as women.

Montee said the reason more men have sleep apnea than women is that they have longer airways than women that are more vulnerable to collapse. Also, the space behind the tongue, called the oropharynx, is larger in men. The tongue relaxes during sleep and falls into that space, causing an obstruction.

Snoring is one sign of sleep apnea, she said. Other symptoms include excessive daytime sleepiness, multiple awakenings and restless sleep. People who have sleep apnea can gasp and choke during the night and feel tired during the day.

Sleep apnea has been linked to obesity, as well as having a smaller airway, and habits such as smoking.

One unusual thing about sleep apnea is that the severity of the case often doesn’t correlate with the patient’s symptoms, said Devins.

“I will see women complain about multiple symptoms who have only a mild case of sleep apnea and men with severe sleep apnea who complain of only a few or minor symptoms, he said. “In fact, some men with sleep apnea believe they sleep well during the night.

Such was the case with one of his patients: Tony Aussem, 54 of Lee’s Summit. Although he always snored, he was unaware that he had sleep apnea. He didn’t experience many of the symptoms associated with the condition.

Aussem, who drives a commercial truck, was required by the Department of Transportation to have an annual physical. It was during the physical that he first learned he might have sleep apnea.

A trip to the sleep lab confirmed the diagnosis, he said. “I didn’t recognized the symptoms, but now I realize it was affecting the quality of my life. “

Aussem began using the CPAP device at age 49 and has used it consistently for the last five years. “I’m picking up a new CPAP machine soon that is designed to be of a higher quality and easier to use,” he said. I’m ecstatic about the machine and how much it’s helped me.”

Benefits of Treatment

Devins said treating sleep apnea could help resolve other health issues facing men. For example, he said, men with atrial fibrillation, a heart rhythm disorder, often find that until their sleep apnea is treated they can’t successfully conquer AFIB.

Other issues helped by sleep apnea treatment include high blood pressure, depression, anxiety, fatigue and emotional stability, he said.

Self-help measures to combat sleep apnea, Montee said, include weight loss, smoking cessation, elimination of alcohol several hours before bedtime and sleeping on the side rather than the back. Treating allergies and asthma can also reduce sleep apneas, she said.

Montee said that while the CPAP device “is the gold standard for sleep apnea,” some people can’t tolerate the device. In certain cases, surgery is used to address sleep apnea by removing the tissue from the soft palate and upper airway, she said.

“There isn’t enough data to recommend these surgeries at this time; however, it’s something people might want to discus with an ENT surgeon,” she said.

Devins said the surgery is called uvulopalatopharyngoplasty, or UP3. The surgery can involve removing the uvula, soft palate, tonsils, adenoids and pharynx.

“It opens up the back of the throat,” Devins said. “Another procedure that is pretty effective is called the pillar procedure.”

The pillar procedure is minor surgery to treat mild to moderate obstructive sleep apnea. It involves surgically placing small polyester rods in the soft palate. The implants stiffen the soft palate to reduce relaxation and vibration of the tissue.

Anderson said another device providing some relief is called the Winx Sleep Therapy System. The system uses Oral Pressure Therapy to draw the soft palate forward and stabilize the tongue during sleep. 

Oral appliances fitted by a qualified dentist can help reduce sleep apneas in some patients, physicians said. “The one-size-fits-all appliances typically don’t work,” Montee said. “It needs to be a device custom-designed for each patient.