Army Physicians Present New Research Showing Surgery Cures Sleep Apnea

MINNEAPOLIS, June 14, 2011 /PRNewswire/ -- This week U.S. Army sleep specialists presented new research at SLEEP 2011, a joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society. As sleep disorders such as obstructive sleep apnea and insomnia are increasingly common in soldiers, they have become an important and growing research focus for the Army.

The two poster presentations are as follows:

Surgical Treatment for Adult Obstructive Sleep Apnea

Six in ten soldiers with moderate-to-severe obstructive sleep apnea (OSA) were cured after undergoing maxilla-mandibular advancement (MMA), a surgery to increase the diameter of the upper airway, according to a study presented today by Lt. Col. Vincent Mysliwiec, MD, Chief of Pulmonary, Critical Care Medicine and Sleep Medicine Service at Madigan Healthcare System, Joint Base Lewis-McChord, Tacoma, Wash. The study, titled "Surgical Treatment for Adult Obstructive Sleep Apnea: A Systematic Review of High-Level Evidence," was a retrospective review of 37 soldiers who underwent the procedure. Study findings showed that 22, or 59.6 percent, reduced their apnea-hypopnea index (AHI), a score of OSA severity, by at least half, which met the criteria for a surgical cure. In fact, 16 soldiers, or 43 percent of total patients, had no residual disease at all after undergoing MMA. Only one of the study participants did not experience a clinically significant reduction in OSA following MMA.

"While a CPAP mask and positive airway pressure are the preferred civilian treatment for sleep apnea, it is not well-tolerated in all patients, and may be impractical for soldiers deploying to some locations," said Dr. Mysliwiec. "MMA significantly reduced the severity of sleep apnea for our patients, and improved the quality of their sleep. These findings could improve the standard of care for civilians and active duty service members with OSA."

Quetiapine Prescriptions in Active Duty Patients

A retrospective review of 692 active duty soldiers who received prescriptions for quetiapine (brand name Seroquel), an atypical antipsychotic, measured the extent of side effects associated with the drug, including weight gain, onset of diabetes and heart beat irregularity (prolongation of the QT interval). Findings from the study, titled "Quetiapine Therapy and Monitoring in Active Duty Patients," included an average 6.3 pound weight gain and increased chance of QT prolongation, which could lead to arrhythmia and sudden death. None of the study participants developed diabetes or arrhythmias during the study period.

Quetiapine is indicated by the FDA for treatment of schizophrenia and other serious mental illnesses, but the vast majority of soldiers received prescriptions for other symptoms, primarily insomnia (57 percent of prescriptions written) and anxiety (20 percent). Lt. Col. Mysliwiec was the lead author of the study.

"While this study is limited in that it is a retrospective review, it highlights the growing number of soldiers with insomnia and need for evidence-based therapies," Lt. Col. Mysliwiec stated.  "The findings have led to increased efforts for provider education on the diagnosis and management of insomnia to include cognitive behavioral therapy, a form of non-pharmacologic treatment, in our Sleep Medicine Service.  If a trial of quetiapine is deemed medically necessary for treatment, appropriate monitoring and counseling of the patient should occur."  

The Army offers two sleep medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education, at Walter Reed and San Antonio Military Medical Center. Madigan Healthcare System is one of the largest health care systems in the military associated with a base, and conducts 1,000 sleep studies each year.

About the U.S. Army Medical Department

One of the largest health care networks in the world, Army Health Care offers more than 90 professional health care career paths – more than any other military service. The U.S. Army's F. Edward Hebert Armed Forces Health Professions Scholarship Program is one of the most comprehensive health scholarships available today, and covers the complete cost of tuition, school fees and books, a monthly stipend of more than $2,000, as well as a $20,000 signing bonus for select areas of practice. Practicing physicians and health professionals can join the Army Reserve at any time in their career – up to age 60. For more information, visit www.healthcare.goarmy.com.

SOURCE U.S. Army Medical Department

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