aveoTSD HPK Manual

A first line
treatment for
Sleep
Disordered
Breathing
A first line
treatment for
Sleep
Disordered
Breathing
®
Good Health Through Quality Sleep™
Contents
3
Why aveoTSD for Sleep Disordered Breathing ?
18
What causes Sleep Disordered Breathing ?
4
What is aveoTSD ?
19
Who has Sleep Disordered Breathing ?
5
aveoTSD Health Professional Patient Sizing Kit
20
6
How aveoTSD works
Common causes of
Sleep Disordered Breathing
8
Conducting an aveoTSD consultation
21
9
How to use aveoTSD
Social & health consequences of
Sleep Disordered Breathing
10
aveoTSD fitting guide
22
Health consequences of
Obstructive Sleep Apnea
12
aveoTSD Clinical Trials
23
14
aveoTSD issues, solutions and support
Obstructive Sleep Apnea
signs & symptoms
16
aveoTSD care & cleaning
24
References
17
aveoTSD Health Professional
Patient Sizing Kit sterilization
1
2
Why aveoTSD for Sleep Disordered Breathing ?
The aveoTSD is recommended for Sleep Disordered Breathing (SDB) because:
It is simple to use.
It gently holds and stabilizes the tongue forward
during sleep to prevent it from obstructing
the airway.
It can be given to the patient the same day they
agree to sleep disordered breathing treatment
because it requires no impressions, no adjustments
and has no moving parts.
It has clinically proven efficacy in the treatment of
snoring and mild to moderate
Obstructive Sleep Apnea.
It is indicated for patients without teeth, as it does
not fit to the teeth or jaw.
It can be used for patients with periodontally
compromised dentition.
It is ideal for patients with Temporomandibular Joint
Dysfunction ( TMD/TMJ ).
It works by increasing the three-dimensional
airway space.
3
What is aveoTSD
The aveoTSD is a simple, inexpensive,
non-invasive and clinically proven
medical device. It provides a simple
solution that effectively deals with
Sleep Disordered Breathing.
The aveoTSD is available as a primary
health care initiative for snoring & mild
to moderate Obstructive Sleep Apnea.
The aveoTSD supports a wider primary health care
base and assists people who need specialist
diagnosis to reach CPAP treatment.
The aveoTSD has been approved by all food and
drug, and therapeutic goods administrations in
Australia, Canada, EEC, Japan, New Zealand.
USA (by prescription only.)
aveoTSD is made from a ISO 10993-1
medical grade silicone.
4
Attaches to the end of the
tongue, using gentle suction
to stabilize the tongue
forward during sleep.
Is an intuitive fit and
simple to use.
Available in 3 sizes as a
large, medium and small.
aveoTSD Health Professional Patient Sizing Kit
Utilize the aveoTSD Health Professional Patient
Sizing Kit to help patients achieve a comfortable
fit for clinical efficacy. The fit can be sterilized
between patients using autoclave sterilization.
The medium-sized aveoTSD fits the majority of
patients. However, for the most accurate fit, order
the aveoTSD Health Professional Sizing Kit.
The kit includes:
One small, one medium and one
large aveoTSD anti-snoring device.
One 4mm and one 7mm clip-on
Uni-Spacer for extra titration.
One blue tray that can be
autoclaved with individual pieces
for reuse.
5
How aveoTSD Works
Clinically proven to open the airway more than other oral appliances
on a cross-sectional area basis through gentle tongue protrusion.
Blocked Airway
In this M.R.I.* image, the tongue falls to the back
of the airway as a person lies asleep. This blocks
the airway, leading to Obstructive Sleep Apnea
and /or snoring.
*Magnetic Resonance Imaging
GE Signa Profile EXCITE 0.2T
6
®
Open Airway
This M.R.I. image shows the aveoTSD stabilizing
the tongue gently forward, preventing it falling back
and obstructing the airway. Note how the airway is
now open and clear. This stops or greatly reduces
snoring and prevents obstruction of airway, treating
Obstructive Sleep Apnea.
7
Conducting an aveoTSD consultation
The purpose of a patient consultation is to better
understand the patient's medical condition. This
information allows you to identify the severity of the
patient's Sleep Disordered Breathing and determine
if the aveoTSD is a suitable treatment option.
Patients who continue to experience negative health
conditions after using aveoTSD should be referred
to a sleep specialist. The patient's SDB condition
may require a more intensive treatment, such
as CPAP.
Many patients, especially females, may be
embarrassed to talk about the symptoms. Remind
these patients that 40 percent of adult women snore.
8
Less than 5 percent of patients will not be
suitable candidates for the aveoTSD.
These individuals are easily determined by
asking the patient to stick out his or her
tongue:
1. If the patient's tongue does not extend
beyond the lips, aveoTSD will not be a
suitable treatment option.
2. If the patient cannot stick out their
tongue beyond his or her teeth, he or she
may be tongue tied. This can be corrected
by the snipping of the lingual frenulum
under the tongue, and will allow use of the
aveoTSD.
How to use aveoTSD
Detailed user instructions are included with each aveoTSD anti-snoring device. Encourage the
patient to read them. These instructions cover all areas of use and care so that the potential
benefits of the device are met to treat snoring and prevent possible Obstructive Sleep Apnea.
Advise the patient to run the aveoTSD under hot
water. This softens the silicone and makes it slightly
easier to position onto the tongue.
It is advised to practice wearing the aveoTSD while
watching TV or reading a book. Getting used to the
sensation of the device on the tongue will ensure it
is comfortable during sleep.
Through routine practice, patients will find a position
and suction level that will gently stabilize the tongue
forward and prevent it falling into and obstructing the
airway.
Most people will experience hypersalivation during
the first week of use. Urge them to continue use, as
this side effect will eventually subside. Remind your
patients that a quality sleep equals better health !
9
aveoTSD fitting guide
1. Preparing to fit the device
The medium-sized aveoTSD fits the
majority of patients.
Before use, rinse the aveoTSD under warm water.
This helps to ease the device onto the
patient's tongue.
Make sure the V-notch in the aveoTSD is facing
down, to fit around the patient's lingual frenulum.
In some extreme cases, a patient may require more
room for the frenulum.The V-notch can be modified
to provide this room.
2. Attaching the device to tongue
The device attaches through negative suction:
Advise the patient to push his or her tongue gently
into the aveoTSD, until it touches the sides
of the device.
Gently squeeze the upper and lower ends of the
bulb with forefinger and thumb. By using a gentle
repeated pumping action, the tongue will be drawn
gently into the aveoTSD. Draw the tongue into the
aveoTSD device until it is firmly attached; make sure
it’s not too tight or too loose.
Place on the outside
of the lips
1
Notch
10
Notch
1.Tongue touches sides
2
2.Suction control
3. Recommend initial practice
Trouble shooting
To achieve optimum results:
Excessive salivation is common during the initial
stages. This subsides over time. If the patient finds
this to be a problem, recommend placing a towel
over the pillow.
Help the patient practice getting used to the best fit
(correct suction level) to ensure the aveoTSD stays
on throughout the night. This will help the patient
become accustomed to having the device attached
to his or her tongue. To achieve correct fit, it is
important for the patient to be absolutely relaxed
when wearing the device.
Checking tongue-tied status:
Ask the patient to stick out his or her tongue to verify
it is free-moving and to ensure the aveoTSD
will be suitable.
A small percentage of people cannot stick out
their tongues beyond their lips. These are highly
exceptional but very obvious cases. In such
cases, the aveoTSD will not be suitable
unless this is first resolved.
If the patient continues to snore or the airway is still
obstructed, there may be a need for the tongue to
protrude further. To achieve this, the patient may
require a Uni-Spacer for extra titration. If the patient
is unable to get a good fit ( i.e., device keeps falling
off or is too tight ), a different size may be rquired.
The majority of patients will fit the medium sized
aveoTSD. However, some patients will require a
smaller or larger version of the aveoTSD.
11
ORIGINAL ARTICLE
aveoTSD Clinical Trials
aveoTSD has been clinically proven to treat
mild to moderate Obstructive Sleep Apnea.
The Efficacy of a Novel TongueStabilizing Device on Polysomnographic
Variables in Sleep-Disordered Breathing:
A Pilot Study
Ruth N. Kingshott, Ph.D.,1 David R. Jones, R.P.S.G.T.,1 D. Robin Taylor,
M.D.,1 and Christopher J. Robertson, M.D.S.2
ABSTRACT
The polysomnographic efficacy of a novel tongue-stabilizing device
(TSD) in the treatment of snoring and sleep-disordered breathing (SDB) was
evaluated in this pilot study. Six current users of the TSD with SDB underwent
polysomnography with and without the TSD in situ in a randomized crossover
design. The TSD significantly lowered the frequency of snores per hour slept
(61- to 70-dB range) (no TSD: mean = 41/h slept 52 SD; TSD: 8/h slept 16
SD; P = 0.046) but did not alter snoring in the other decibel ranges (all Ps > 0.1).
Trends were found for reductions in the frequency of apneas plus hypopneas (no
TSD: 26/h slept 17/h slept; TSD: 15/h slept 13; P = 0.06) and oxygen desaturations of 4% or more (no TSD: 10/h slept 10; TSD: 5/h slept 5; P =
0.09). Significant improvements in microarousal frequency with the TSD were
found (no TSD: 34/h slept 16; TSD: 22/h slept 14; P = 0.004). Significant
reductions in percentage of Stage 1 sleep with the TSD were also demonstrated
(no TSD: 10 3%; TSD: 8 2%; P = 0.03). The results of this small pilot study
indicate that the TSD may be effective in reducing snoring severity and microarousals, with favorable trends for reducing SDB severity in selected individuals. Additional larger prospective studies are required to identify suitable candidates for TSD use in the treatment of snoring and SDB.
KEYWORDS: Oral appliances, tongue retainers, sleep-disordered breathing,
snoring
12
Sleep and Breathing, volume 6, number 2, 2002. Address for correspondence and reprint requests: Christopher J. Robertson, M.D.S.,
Department of Oral Sciences and Orthodontics, School of Dentistry, University of Otago, P.O. Box 647, Dunedin, New Zealand. E-mail:
[email protected]. 1Respiratory Research Unit, Dunedin School of Medicine and 2Department of Oral Sciences & Orthodontics,
University of Otago, Dunedin, New Zealand. Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY
10001, USA. Tel: +1(212) 584-4662. 1520-9512,p;2002,06,02,069,076,ftx,en;sbr00206x.
69
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13
aveoTSD issues, solutions and support
Is device too small, or too big ?
Fit patient with alternative size, or advise a
new size will be supplied.
Can patient stick tongue out between lips ?
If not, patient maybe tongue-tied*.
This is quite common.
A simple procedure** can free the tongue.
Procedure snips the lingual frenulum
(webbing) under tongue.
Advise visit to dentist or physician.
14
*Ankyloglossia, commonly known as tongue tie,
is a congenital oral anomaly which may decrease
mobility of the tongue tip and is caused by an
unusually short, thick lingual frenulum, a membrane
connecting the underside of the tongue to the floor
of the mouth.
** The removal of the lingual frenulum under the
tongue can be accomplished with either frenectomy
or frenuloplasty. This is used to treat a tongue tied
patient. Immediately after this minor oral surgery, the
tongue can often dramatically extend out of the
mouth which it could not do before. This can help
improve speech, swallowing and allow use of the
aveoTSD.
Falls off during sleep
Check to see if size issue.
Too little suction: advise patient move tongue
farther into device or increase suction.
Discomfort & sensation
Too much suction: advise patient move tongue
farther out of device or reduce the level of suction
with bulb.
Increased Saliva
Most patients experience this, it is automatic when
object is placed between jaws. Advise patient to
continue use of the device; salivation will stop with
time. Some people place a towel on their pillow for
the first few nights of use.
Cannot swallow with device
The tongue is stretched; advise patient to move
tongue out of device to give tongue more flexibility.
With initial use and increased salivating, this
exasperates the difficulty swallowing.
As salivating reduces, the difficulty swallowing will
disappear. With use, the patient will learn to swallow
with the device in mouth with practice.
Causes gagging sensation
Some people are sensitive to objects placed in the
mouth. The few who experience a gagging
sensation will get use to the device in the
mouth with practice. Encourage to keep practicing;
the gagging feeling does go, especially once
salivation reduces.
Physical changes / odour to aveoTSD
How long has the patient been using the device?
Does patient have daily cleaning regime in place?
Has a chemical been used to clean the device?
Does the patient suffer from reflux / GERD?
Does the patient have any dental /
periodontal problems?
If device has been used for less than six months and
device has changed appearance: advise patient to
visit their dentist for a routine dental check-up.
If device has been used for more than 12 months
advise patient to replace device to ensure they are
receiving the best possible therapy from the device.
Encourage patient to keep practicing; any initial
side effects will reduce with practice and use of
the aveoTSD.
15
aveoTSD Care & Cleaning
Cleaning
aveoTSD should be rinsed under hot water daily.
Instruct the patient to wash the aveoTSD once a
week, giving it a thorough cleaning using denture
cleaning solution.Using mouthwash to clean or store
the device in is not recommended, as the liquid
may contain alcohol that will damage the medical
silicone. The aveoTSD can be sterilized by cold
sterilant or clinical procedures such as autoclave.
Discolouring of silicone
Patients who suffer from GERD may find that their
aveoTSD will discolour. This is due to the acidity of
the bile that comes from the stomach into the mouth
during a nighttime reflux episode. The acidity may
discolour the aveoTSD silicone. Every person’s
saliva chemistry is different. Human saliva can vary
in pH level from 4.5 - 8 pH ( which is a huge range );
healthy saliva has a pH of 7.4. The medical silicone
tends to react to saliva with a low pH level. The low
pH saliva may cause the silicone to discolour
over time. Some patients may find their device
16
discolours after only a few months, even with a
good cleaning regime in place. This is an indication
that the individuals saliva has a low pH level.
If a new device discolours badly after only a few
months, it may be an indication that the patients
saliva is more acidic than it should be. Advise the
patient to have a full health check, as acidic saliva is
an indication of poor health. Research has shown a
strong link between acidic saliva and possible
cancer, so an aveoTSD that does not last long could
be a diagnostic that not all is well with the patient’s
body chemistry.
Smell of silicone
A device that smells after only a few months of use,
even with a good cleaning regime in place, could
indicate the patient has periodontal disease. They
should be advised to visit their dentist for a routine
dental check-up.
Warranty
The aveoTSD comes with a six-month replacement
warranty from the date of purchase for product
defects determined to be caused by manufacture.
The life expectancy of the aveoTSD is 12 months
with proper use and care.
aveoTSD Health Professional Patient Sizing Kit Sterilization
The aveoTSD Health Professional Fitting Kit can be
sterilized between patients using
autoclave sterilization.
The silicone components can be sterilized placed in
the kit tray, or by being placed directly into the
autoclave. Both the lid and base of the kit can be
sterilized also, as required.
Both the Fitting Kit Enclosure and aveoTSD medical
silicone components can be steam sterilized in a
standard gravity steam sterilization cycle of 30
minutes at 1 Bar and 125ºC, or the aveoTSD
medical silicone components can separately be
sterilized in a high speed flash sterilization cycle of
15 minutes at 2 Bar and 131ºC.
The aveoTSD medical silicone will change appearance after the sterilization process where the parts
will appear opaque.The material will return to
transparency, this does not affect the working
properties of the device.
The Fitting Kit Lid, Base and Tray sterilization
temperature should not exceed 125ºC, otherwise
the molded parts may become deformed. Care must
also be taken to ensure that the kit is not damaged
by any substances added to the boiler feed water,
such as alkaline corrosion inhibitors, and that the kit
is positioned correctly so that no condensation can
accumulate inside it.
The Fitting Kit has shown that up to 100 cycles at
120ºC to 125ºC, the components retain their
material properties. Repeated sterilization may
make the parts appear slightly milky.
17
What causes Sleep Disordered Breathing ?
Snoring is caused by a narrowing of the upper airway during sleep.
This can be due to large tonsils, a
long soft uvula ( small piece of soft
tissue that can be seen dangling
down from the soft palate over
the back of the tongue ), or in
people who are overweight, with
excessive flabby tissue in the
throat. All of these areas relax
during sleep.
In other cases, nasal congestion
from allergies or deformities of the
cartilage between the two sides of
the nose can contribute to
narrowing of the airway.
However, The most common cause
of narrowing of the upper airway is
a tongue muscle that relaxes too
much during sleep.
18
Tongue falling back
into airway
When relaxed, it gets sucked back
into the throat with each breath
taken. This greatly restricts the
airflow in the airway.
Because snoring occurs when air
travels faster through a narrow
tube than through a broad one,
this rapidly moving air causes the
relaxed soft tissues of the throat
( tonsils, soft palate, uvula or
excessive flabby tissue ) to vibrate.
It is this vibration which causes the
sound of snoring.
By keeping the airway open, air
travels more slowly, reducing throat
vibrations and thus reducing or
stopping snoring. One of the most
effective ways of keeping the
airway open during sleep is by
holding and stabilizing the
tongue forward.
Who has Sleep Disordered Breathing ?
Over 40 percent of the population experience Sleep Disordered Breathing (SDB)
Over 40 % of the population
experiences Sleep Disordered
Breathing. This percentage
increases in people 50 and older,
as tissues in the upper airway lose
elasticity, resulting in increased
vibrations during breathing and
snoring.1 Reduced airway size
increases the velocity of air with
each breath taken, increasing the
incidence of the tongue being
sucked into the back of the throat
and obstructing the airway.
More than 50 percent of patients
who visit primary health care
provider have undiagnosed
Sleep Disordered Breathing,
which can be the
underlying cause for many
chronic health problems.1
Sixty percent of men over the age
of 40 snore.1
Forty percent of women and 60
percent of men between the age of
41 to 65 are habitual snorers.1
Snoring and OSA are common in
children aged 2 to 7, particularly at
times of upper respiratory tract
infection when the tonsils enlarge.2
Many women also experience SDB
during the third trimester
of pregnancy.3
19
Common causes of Sleep Disordered Breathing
Supine body position ( lying face upwards ).
Large tonsils, long soft palate or uvula.
A tongue that relaxes too much during sleep.
Being overweight: A recent study showed that a 10
percent weight gain is associated with a six-fold
increase in the odds of developing Obstructive
Sleep Apnea.
Nasal congestion from colds, allergies or deformities
of cartilage in the nose.
Smoking, alcohol or medication
( which causes drowsiness ).
Menopause: Post menopausal women were shown
to have more than twice the risk for SDB and three
times the risk for severe SDB.
Hypothyroidism: Due to lack of thyroid hormone,
sufferers tend to have a larger tongue, as well as
increased fat deposition in the tissues of the
upper airway.
20
Risk factors for OSA
A primary risk factor for OSA is that it can
be a hereditary condition
Male
Large neck circumference:
Women > 40cm, Men > 43cm
correlates with an increased risk of OSA
Obesity, BMI > 30
Excessive use of alcohol or sedatives
Smoking
Social and health consequences of Sleep Disordered Breathing
Snoring is number three on the list of reasons for
divorce in married couples. Only infidelity and
finances are blamed before snoring.4
Snorers experience tiredness, morning headaches,
dry mouth, relationship difficulties, lower blood
oxygen levels and other associated consequences.
Snoring can be very distressing for sleep partners,
with banishment from the bedroom for the snorer.
New Research has shown that loud snoring poses
health risks similar to Obstructive Sleep Apnea.6
Sleep disturbance/deprivation to sleep partners is
very real, with a negative impact on well-being and
quality of life.
Eighty-six percent of snorers say they would like
help to stop snoring.
Embarrassment/humiliation when traveling
with others.
21
Health Consequences of Obstructive Sleep Apnea
Obstructive Sleep Apnea occurs when the
tongue falls into the back of the throat and
obstructs the airway. Apnea episodes, in
which the snorer gasps for breath, can
happen hundreds of time per night,
reducing blood oxygen levels.
Apnea episodes cause disrupted sleep, leading to
excessive tiredness and sleepiness during the day,
and can severely impair intellectual performance,
and increase the risk of car accidents.7,8
Obstructive Sleep Apnea (OSA) may be a risk factor
for the development of other medical conditions.
High blood pressure (hypertension), heart failure,
heart rhythm disturbances, atherosclerotic heart
disease, pulmonary hypertension, insulin resistance,
and even death are some of the known complications of untreated Obstructive Sleep Apnea.
22
Obstructive Sleep Apnea
is directly linked to:
Hypertension / high blood pressure 9,10,11
Cardiovascular disorders 12,13,14
Reflux / Heartburn / GERD 15
Depression 16
Obesity 17
Diabetes 18
Insomnia 19
Nocturia 20
Strokes 21
Impotence 22
Dementia 23,24
Nocturnal Asthma, COPD 25
Obstructive Sleep Apnea signs and symptoms
Snoring, gasping, choking, irregular or
stopped breathing during sleep
Hypertension/high blood pressure
Diabetes
Morning headaches
Extreme daytime sleepiness
Memory deficit
Depression
Nighttime reflux/heartburn/GERD
Nocturia, or frequent nocturnal urination
Sleep hygiene
Behavioural modifications known to improve the
overall quality of sleep are also recommended.
Below are some common practices that can induce
sleep and enhance its quality:
Reduce lighting and noise in a cool bedroom;
Avoid reading or watching TV in bed;
Avoid eating or exercising prior to sleep;
Reduce alcohol intake and sedatives;
Use the bedroom only for sleeping;
Keep work related activities outside of the bedroom;
Try a period of physical and mental relaxation before
going to bed.
Lifestyle changes
Lose weight; exercise more; quit smoking. All three
of these lifestyle changes will reduce risk of snoring
and associated Obstructive Sleep Apnea.
23
References
1. 6 out of 10 of all adults (59 percent) say they snore. More than one-half
(57 percent) of those who snore say their snoring bothers others.
National Sleep Foundation, 2005 Sleep in America Poll.
2. Kryger, Meir H., Roth, Thomas, Dement, William C. Principles and Practice
of Sleep Medicine, 2nd Edition.Philadelphia, Pennsylvania: W.B. Saunders
Company, 1994.Goblin, Alexander Z., The World of Children's Sleep,
Parents' Guide to Understanding Children & Their Sleep Problems.
Michaelis Medical Publishing Corp., 1994.
3. Lefcourt LA, Rodis JF. Obstructive sleep apnea in pregnancy.
Obstet Gynecol Surv 1996; 51: 503–6.
4. The causes of snoring: A nemesis in many a bedroom. Dr David W. Sparks.
5. Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight
change and sleep-disordered breathing. JAMA 2000; 284:3015-3021.
6. The Epidemiology of Adult Obstructive Sleep Apnoea, N.M Punjabi,
Pro Am Thorac, Vol.5, pp136-143, 2008.
7. The Association between Sleep Apnea and the Risk of Traffic Accidents J.Terán-Santos, M.D., A. Jimenez-Gomez, M.D., J.Cordero-Guevara, M.D.,
for The Cooperative Group Burgos-Santander
8. Risk factors for traffic accidents in patients with obstructive sleep apnea
syndrome Akiko Yoshino, 1,2 Maki Higcuhi, 1,2 Fusae Kawana, 1,2 Mitsue
Kato, 1,2 Minae Kamata, 1,2 Shigemoto Nakanishi, 1 Takatoshi Kasai 3 and
Koji Narui 2. 1 Department of Clinical Physiology and 2 Sleep Center,
Toranomon Hospital, and 3 Department of Cardiology, Juntendo University,
School of Medicine, Tokyo, Japan.
9. Schaefer et al. Obstructive Sleep Apnoea as a Risk marker in Coronary
Artery Disease. Cardiology 1999;92(2) 79-84.
10. Thirty to 80 percent of patients with hypertension have sleep disordered
breathing (Logan et al. J Hypertension 2001; 19:2271-2277)
11. Fifty to 90 percent of obstructive sleep apnoea patients have hypertension
( Peppard 2000, Lavie 2000 ) 12. Milleron et al. Benefits of Obstructive Sleep Apnoea Treatment in Coronary
Artery Disease: a Long-Term Follow-Up Study. European Heart Journal
2004;25:728-734. )
24
13. Somers et al. Sleep-Disordered Breathing and Cardiovascular Disease.
Circulation 2003; 108(1):9-12.
14. Schaefer et al. Obstructive Sleep Apnoea as a Risk marker in Coronary
Artery Disease. Cardiology 1999;92(2) 79-84. 15. Laryngeal inflammation assessed using the reflux finding score in
obstructive sleep apnea Otolaryngology - Head and Neck Surgery, Volume
134, Issue 5,Pages 836-842 R. Payne, K. Kost, S. Frenkiel, A. Zeitouni, G.
Sejean, R.Sweet, N. Naor, L. Hernandez, R. Kimoff
16. Psychiatr News November 4, 2005Volume 40, Number 21, page 20
17. Obesity and obstructive sleep apnea. Gami AS, Caples SM, Somers VK.
Endocrinol Metab Clin North Am. 2003 Dec;32(4):869-94.
18. Einhorn et al. The prevalence of sleep apnoea in a population of patients
with type 2 diabetes mellitis. ADA Presentation 2005
19. Krakow, B, Melendrez, D, Ferreira, E, et al (2001) Prevalence of insomnia
symptoms in patients with sleep-disordered breathing.
Chest 120,1923-1929
20. The relationship between obstructive sleep apnea, nocturia, and daytime
overactive bladder syndrome in women. L. Lowenstein, K. Kenton, L.
Brubaker, G. Pillar, N. Undevia, E. Mueller, M. FitzGerald. American
Journal of Obstetrics and Gynecology, Volume 198, Issue 5.
21. Yaggi, HK, Concato, J, Kernan, WN, et al. Obstructive sleep apnea as a
risk factor for stroke and death. N Engl J Med 2005; 353:2034.
22. Lubooshitzky et al. Decreased Pituitary - Gonadal Secretion in Men with
Obstructive Sleep Apnoea. The Journal of Clinical Endocrinology &
Metabolism 87(7):3394-3398, 2002.
23. Bliwise DL. Is sleep apnea a cause of reversible dementia in old age? J
Am Geriatr Soc 1996;44:1407–1409.
24. Alchanatis M, Zias N, Deligiorgis N et al. Comparison of cognitive
performance among different age groups in patients with
obstructive sleep apnea. Sleep Breath 2008;12:17–24.
25. Mohammed Alharbi et al. The prevalence of asthma in patients with
obstructive sleep apnoea. Primary Care respiratory Journal, 2009.
Simple
Effective
Clinically
Proven
®
Good Health Through Quality Sleep™
www.aveotsd.com
© 2011 Innovative Health Technologies (NZ) Limited. All rights reserved.
aveoTSD and Good Health through Quality Sleep are trademarks of
Innovative Health Technologies (NZ) Limited.
HGW Health Board House, 229 Moray Place, Dunedin.
PO Box 17572, Christchurch 8840, New Zealand.
[email protected] www.aveotsd.com
Protected by patents: AU776822, CA2432023, EP1349521,
HK1060041, JP4294902, NZ526404, US7073506. Others pending.