Sleep apnea linked to toddlers with pneumonia

Dear Dr. Rosenberg,

My 4-year-old granddaughter has been hospitalized with pneumonia twice in two years. The doctors have been unable to find a cause. When she sleeps over at our house she snores and appears to stop breathing. Could the snoring have anything to do with these infections?

A: Yes, they just might. In a recent study, performed in Israel and published in the journal Chest, the incidence of childhood pneumonia in children younger than 5 was much higher in those with underlying sleep-related breathing disorders, especially sleep apnea. The authors postulate that the increased effort to breathe against a closed airway results in a large amount of negative pressure. This causes aspiration of nasopharyngeal contents into the lungs, possibly resulting in pneumonia. In most cases of childhood sleep apnea, removing the tonsils and adenoids can be curative.

Dear Dr. Rosenberg,

I have diabetes and sleep apnea. My healthcare provider says that, if I wear my mask and use my CPAP, it could help with my diabetes. Is this true?

A: Yes, numerous studies have shown that sleep apnea causes insulin resistance and thus elevated blood sugar. A recent study in the May issue of the journal Sleep showed, that after eight weeks of CPAP, insulin resistance improved in patients with severe sleep apnea. Your healthcare provider is giving you good advice.

Dear Dr. Rosenberg,

I have sleep apnea. I also have a great deal of trouble falling asleep since starting treatment. My healthcare provider suggested I take the sleeping pill Ambien to help me sleep and adjust to my CPAP treatment. Won't that make my sleep apnea worse?

I am a bit anxious.

A: Actually the answer is no. Ambien (Zolpidem) does not worsen sleep apnea. In fact, Ambien and some other of the newer sleep aides can be very helpful in getting new CPAP users compliant. The important thing is to adjust to the CPAP. After a few weeks most people find that they can do without the medication.

Dear Dr. Rosenberg,

I have sleep apnea and am having surgery performed on my knee. My doctor says having the painkiller given through a needle around my spine is a safer way to go. Why not just give me a general anesthetic?

A: There are several reasons for choosing an epidural delivery in patients with sleep apnea. It avoids the potentially dangerous possibility of severe airway closure after removal of the breathing tube (endotracheal tube), which is seen in many patients with sleep apnea in the immediate postoperative period. This is compounded by the use of pain medications and sedatives, which further depress the ability to breathe. It also cuts down or eliminates the use of pain medications in the first few days after surgery. These medications worsen sleep apnea.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Pres-

cott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.