All articles by Jerry Kram, MD, FCCP

Jerrold Alan Kram, MD, FCCP, D-ABSM Medical DirectorDr Kram is one of the country’s most experienced sleep specialists. He began his work in the field in 1980, opened the California Center for Sleep Disorders (CCSD) in 1983 and received his Board Certification in Sleep Medicine in 1989. He graduated with honors from the New York University School of Medicine and completed his pulmonary fellowship at University of California, San Francisco.Dr. Kram brings an inclusive philosophy to the practice of Sleep Medicine and his running of CCSD. He is actively engaged in programs to spread sleep expertise throughout the local medical community and is a featured speaker in professional and community lectures nationwide. Most recently he has been named to the board of directors at the National Sleep Foundation.

New Positional Obstructive Sleep Apnea Therapy

By Jerrold Kram, MD, FCCP

A recently published study found that over 70% of those diagnosed obstructive sleep apnea and having an apnea-hypopnea index less than 60 are at least twice as severe when sleeping on their back as compared to other (non-supine) position.

This condition is referred to as “positional obstructive sleep apnea” (POSA). The most commonly recommended approach for treating POSA is to sew tennis balls into a night shirt. Several manufacturers (REMatee and Zzoma) developed commercial adaptations of the tennis-ball approach using cushions held in place by a waist belt or shoulder harness to restrict back-sleeping.

I recently read very promising study results using a novel position therapy device called the Night Shift. Worn on the back of the neck, Night Shift begins to vibrate when users start to sleep on their back and slowly increases in intensity until a position change occurs. For patients with POSA, 90% responded to Night Shift therapy and had a median apnea-hypopnea severity reduction of 79%!  

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Sleep Apnea Is A Children’s Disease !!

There is a surprising incidence of obstructive sleep apnea in children with between 2% and 6% of all children having it. And, that number may be growing as the incidence of childhood obesity grows. Why is this a big deal? Because poor sleep impacts childhood growth and development. Some years ago Dr. David Gozal studied a population of elementary school children for sleep apnea. He identified about 5% with sleep apnea. Almost all were in the lower 10% in their class in terms of learning and behavior. About half had surgery to remove their adenoids and tonsils, a major factor in childhood sleep apnea. Of those who had surgery almost all improved school performance and had increased growth where those who declined to have surgery had no improvement.

More recently a 5 year study of children between 6 and 11 years old was completed. Some of the findings included:

  • 263 kids had overnight sleep studies
  • 43 either had or developed sleep apnea
  • Another 41 had apnea initially but it resolved spontaneously
  • The children with persistent apnea were 6 times more likely to have behavioral problems with parents reporting hyperactivity, attention disruptive behaviors, communication and social competency problems.
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