Congratulations to Dr. Rotenberg, Pediatric Neurologist, and Dr. Susarla, Pediatric Pulmonologist, named as Houston Top Docs for 2014

Congratulations to Houston Specialists nominated for recognition by their colleagues!

Dr. Rotenberg, Pediatric Neurologist, Sleep Specialist, Epileptologist &

Dr. Susarla, Pediatric Pulmonologist, Sleep Specialist

named as Houston Top Docs for 2014

Read the article here

Study Finds Increased Risk of Cancer and Cancer Death With Sleep Apnea

The Wisconsin Sleep Cohort and its Spanish counterpart provide striking data about the association of sleep apnea and drops in oxygen saturation with cancer and cancer mortality.  SS

Sleep Apnea Tied to Increased Cancer Risk

Two new studies have found that people with sleep apnea, a common disorder that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer. The new research marks the first time that sleep apnea has been linked to cancer in humans.

About 28 million Americans have some form of sleep apnea, though many cases go undiagnosed. For sleep doctors, the condition is a top concern because it deprives the body of oxygen at night and often coincides with cardiovascular disease, obesity and diabetes.

“This is really big news,” said Dr. Joseph Golish, a professor of sleep medicine with the MetroHealth System in Cleveland who was not involved in the research. “It’s the first time this has been shown, and it looks like a very solid association,” he said.

Dr. Golish, the former chief of sleep medicine at the Cleveland Clinic, said that the cancer link may not prove to be as strong as the well-documented relationship between sleep apnea and cardiovascular disease, “but until disproven, it would be one more reason to get your apnea treated or to get it diagnosed if you think you might have it.”

In one of the new studies, researchers in Spain followed thousands of patients at sleep clinics and found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. The second study, of about 1,500 government workers in Wisconsin, showed that those with the most breathing abnormalities at night had five times the rate of dying from cancer as people without the sleep disorder. Both research teams only looked at cancer diagnoses and outcomes in general, without focusing on any specific type of cancer.

In both studies, being presented in San Francisco this week at an international conference organized by the American Thoracic Society, the researchers ruled out the possibility that the usual risk factors for cancer, like age, smoking, alcohol use, physical activity and weight, could have played a role. The association between cancer and disordered breathing at night remained even after they adjusted these and other variables.

Dr. Mitesh Borad, a cancer researcher and assistant professor of medicine at the Mayo Clinic who was not involved with the studies, called the findings “provocative” but said more research was needed to confirm the association. The studies were observational, and other, unknown factors may account for the correlation between sleep apnea and cancer.

Recent animal studies have suggested that sleep apnea might play a role in cancer. When mice with tumors were placed in low-oxygen environments that simulate the effects of sleep apnea, their cancers progressed more rapidly. Scientist speculate that depriving mice of oxygen may cause their bodies to develop more blood vessels to compensate, an effect that could act as a kind of fertilizer for cancer tissue and cause tumors to grow and spread more quickly.

The researchers wondered whether a similar relationship might exist in people with sleep apnea, in whom throat muscles collapse during sleep, choking off the airway and causing gasping and snoring as the body fights for air. Severe sleep apnea can produce hundreds of such episodes each night, depleting the body of oxygen.

In one study, a team at the University of Wisconsin School of Medicine and Public Health examined data on state workers taking part in the long-running Wisconsin Sleep Cohort, who since 1989 have undergone extensive overnight sleep studies and other measures of health about every four years. The landmark project was one of the first to reveal the widespread occurrence of sleep apnea in the general population.

The researchers found that the more severe a person’s breathing problems at night, the greater the likelihood of dying from cancer. People with moderate apnea were found to die of cancer at a rate double that of people without disordered breathing at night, while those in the severe category died at a rate 4.8 times that of those without the sleep disorder.

“That is really striking,” said Dr. F. Javier Nieto, one of the study’s authors and chairman of the department of population health sciences at the University of Wisconsin. “It could be something else, but it’s hard to imagine that something we didn’t control for is causing this.”

In the second study, researchers with the Spanish Sleep Network took a slightly different approach, looking not at cancer mortality among apnea patients, but at the incidence of cancer. They used a measure called the hypoxemia index, which looks at the amount of time the level of oxygen in a person’s blood drops below 90 percent at night.

About 5,200 people were followed for seven years, none of whom had a cancer diagnosis when the study began. The researchers found that the greater the extent of hypoxemia, or oxygen depletion, during sleep, the more likely a person would receive a cancer diagnosis during the study period.

People whose oxygen levels dropped below 90 percent for up to 12 percent of the total time they were asleep, for example, had a 68 percent greater likelihood of developing cancer than people whose oxygen levels did not plummet at night, said study author Dr. Miguel Angel Martinez-Garcia of La Fe University and Polytechnic Hospital in Spain. As time spent without oxygen increased, so, too, did cancer risk.

Although the study did not look for it, Dr. Martinez-Garcia speculated that treatments for sleep apnea like continuous positive airway pressure, or CPAP, which keeps the airways open at night, might reduce the association.

The Wisconsin study also did not specifically look at the impact of treatment for apnea on survival, either, but when people who were being treated with CPAP were removed from the analysis, the cancer association became stronger, “which is consistent with the hypoxemia theory,” Dr. Nieto said.

“I would say that this is one more instance that shows that sleep apnea can have profound impacts for people’s health,” he added. “Not breathing while you’re sleeping is a serious problem.”

Read link here

ADHD and Stuff That's Like It

No doubt ADHD is real, but it can be confused with other conditions including sleep disorders.  SS

Think your child has ADHD? Think again …

“My child is having trouble at school. The teacher says I should ask about ADHD.”  Sound familiar to you? It should.
The diagnosis of ADHD is being made more frequently than ever before. In 2010, a whopping 10 million children were diagnosed with ADHD, which is a 66 percent increase from 10 years ago! What concerns me is that many are being incorrectly diagnosed with ADHD by busy pediatricians who don’t take the time to ask some important questions.
I once had a hyperactive 9-year-old patient with sleep apnea who snored so badly that he would stop breathing dozens of times each night. An operation by the ENT (Ear, Nose and Throat) surgeon cured his apnea and improved his behavior.
So what is ADHD? It stands for “Attention Deficit Hyperactivity Disorder.”  Children with ADHD can be impulsive and often have trouble waiting their turn. They are often forgetful, sloppy with schoolwork and chores, and have short attention spans. They are fidgety, squirmy and can be excessively talkative. Parents describe them as being so active that they seem to be “driven by a motor”.  I know what you’re thinking … don’t all children act like this? Yes, but children with ADHD have severe symptoms that impair the child’s functioning, specifically, their ability to do well in school, make friends and avoid injury due to reckless behavior.
While ADHD treatment is generally safe and very effective, it is important to make sure that we are treating the right condition. With that being said, here are some important questions to consider before visiting your pediatrician:
Does your child get a restful sleep every night? Unlike adults who become groggy and slow after a bad night of sleep, children can become hyperactive and rowdy. Inform your doctor of any sleep disturbances such as frequent nightmares, fidgetiness, bedwetting, trouble falling asleep or trouble staying asleep. Make sure your child gets at least 8-10 hours of sleep each night. 
Does your child behave violently? Do they do things just to spite you? Violent behavior is not a criteria for ADHD. The real question is where did your child learn this behavior? At least once a month I see a child for “ADHD” who lives in a home where one parent is emotionally or physically abusing the other. Children are like sponges that can easily pick up on violent tendencies from their parents, television, movies and video games. Other possibilities to explain violent behavior include oppositional defiant disorder and conduct disorder.
Is your child easily embarrassed? Does he or she have low self-esteem? Is your child a worrier? Again, these are not part of the ADHD criteria. Your child might have depression or anxiety. I know it sounds strange to think that a young child could have depression, but it is more common than you may think.
Does your child misbehave only in school? If so, are there specific teachers, students or situations that seem to elicit this behavior? Perhaps your child has a learning disability? Perhaps vision or hearing problems make it difficult for your child to concentrate in school? Maybe your child is being bullied? All of these can be terribly distracting for a young child and can contribute to poor behavior. School problems may warrant an evaluation by the child’s school for learning disabilities and a hearing and vision screening by your pediatrician.
Want to really impress your doctor? Fill out the “Vanderbilt” ADHD assessment tool. There is a parent form and a teacher form. Your doctor will score the sheet. This very simple tool can help determine whether your child has ADHD or something else.
Are you concerned about your child’s behavior? Has anyone told you that your child should be evaluated for ADHD? Please share your experiences.
Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher's Hospital for Children.

Posted by Mario Cruz, M.D. @ 6:53 AM 

http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554

Read more: http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554#ixzz1rG6nyNBK

Back-To-School Sleeping Tips on Texas Public Radio

Dr. Josh Rotenberg, pediatric neurologist and sleep specialist, interviewed about sleep problems in children...

Back-To-School Sleeping Tips on Texas Public Radio

With the first day of school right around the corner, parents are trying to get their kids back on a school-year sleeping schedule. Texas Public Radio’s Eileen Pace reports it’s not too late to get some use out of the tips from a local sleep expert.

August 18, 2011 · Dr. Josh Rotenberg says kids sleep when they get sleepy during the summer — sometimes 11:00 or midnight — and then sleep late the next morning.

“When kids have social constraints removed from them, they live naturally. They’re like free-range chickens,” Rotenberg says.

In fact, he says those studies showing kids have a later wake-up clock than adults do are true.

“What’s really interesting is that I see over the summer many fewer kids for headaches and ticks because I think kids are allowed to sleep longer over the summer. And there are a number of studies that show that a delayed school start time — so when you move a school start time in high school from 7:30 to 9:00 — grades go up,” Rotenberg says.

Schools generally have not pushed back their start times.

Listen to the report here....

http://www.tpr.org/news/2011/08/news1108181.html

Sleep and Epilepsy

As part of a comprehensive approach to treating epilepsy and preventing seizures, sleep disorders should be addressed.

Watch this short video by Dr Rotenberg on the topic

http://www.youtube.com/watch?v=Fll_WIxqy9s&feature=related

Adolescents With Chronic Fatigue May Suffer Long-Term Effects

Adolescents With Chronic Fatigue May Suffer Long-Term Effects

Keeping up with healthy peers results in increased fatigue, sleep need Sep 8, 2010

WEDNESDAY, Sept. 8 (HealthDay News) -- Adolescents who do not recover from chronic fatigue syndrome (CFS) continue to experience extreme fatigue, to use medical services at a high rate, and to miss school and work; and, those who attempt to keep up with their healthy peers experience greater fatigue and need for sleep, according to two articles published in the September issue of the Archives of Pediatrics & Adolescent Medicine.

Stefan M. van Geelen, of the University Medical Center Utrecht in the Netherlands, and colleagues followed 54 adolescents with CFS for a mean of 2.2 years to describe the long-term outcomes, use of health care, and risk factors associated with non-recovery in this patient population. They found 28 (51.9 percent) had a near-complete improvement in symptoms, while 26 (48.1 percent) did not improve. Those in school had missed 33 percent of classes on average in the last month, while the other subjects had worked 38.7 percent of a full-time job on average. Of all the subjects, 66.7 percent were treated by a physical therapist, 38.9 percent received clinical treatment in rehabilitation, 48.1 percent had received psychological support, and 53.7 percent had used alternative treatment.


http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Adolescents-With-Chronic-Fatigue-May-Suffer-Long-T/ArticleNewsFeed/Article/detail/686284?contextCategoryId=40133