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Monday, July 25, 2011

Sleep Apnea: “Why am I so Tired?”


Sleep apnea, interrupted breathing while sleeping, has been linked to hypertension, heart disease, elevated blood sugar and stroke. There are a variety of diagnostic and treatment options available to treat sleep apnea and help sufferers regain a good night’s sleep. Penn is pioneering one of the latest options, which uses minimally invasive robotic surgery to treat sleep apnea patients who have problems with excess tissue at the base of the tongue.

Sleep apnea tends to be more common in men, and the bed partner often has sleep issues because of the snoring or gasping. In fact, it is often the wife who nudges her husband to seek treatment for this disorder, according to Ronald Barnett, MD, pulmonologist and sleep medicine specialist at Penn Medicine Valley Forge.

Grace Pien, MD, a specialist in women’s sleep issues, says a woman’s risk of developing sleep apnea increases after menopause. Dr. Pien is currently studying the role of estrogen and other reproductive hormones in protecting women from sleep apnea.

“Women appear to be protected from sleep apnea during their child-bearing years, but the risk increases once they enter perimenopause, and the risk for post-menopausal women is three times greater compared to premenopausal women,” said Dr. Pien.

A thorough sleep evaluation reviews all aspects of a person’s sleep habits, physical characteristics and associated medical conditions to help physicians make a diagnosis of sleep apnea. Usually, patients undergo an overnight sleep study, which can be performed in a sleep laboratory, or increasingly, in patients’ homes using home sleep monitors. About 80 percent of people tested are diagnosed with sleep apnea, according to Dr. Barnett.

Sleep studies are often recommended for patients who are overweight and have a history of hypertension and cardiac arrhythmias because of the link between sleep apnea and heart disease, according to Theodhor Diamanti, MD, Penn cardiologist. “Sleep apnea causes the oxygen levels to drop and low oxygen levels can lead to life-threatening cardiac arrhythmias,” said Dr. Diamanti.

Patients treated for sleep apnea are better rested, have higher oxygen levels, and are more active and able to live healthier lives.

The most common, and most successful treatment for sleep apnea is CPAP — continuous positive airway pressure. The positive airflow blows into the nose and/or mouth and keeps the airway open so that breathing is not interrupted. The treatment works for about 90 percent of patients.

Continuous positive airway pressure (CPAP) helps many patients who suffer from sleep apnea. But for those patients who can’t tolerate CPAP, surgery – including minimally invasive robotic surgery — may help break the sleep apnea cycle.

The muscles that hold the airway open relax during sleep. When the loose tissue vibrates, someone snores. If the tissue in the back of the throat collapses, it blocks the airway and results in sleep apnea. Uvulopalatopharyngoplasty is the most common procedure for removing the excess tissue in the throat.

“In surgical management of sleep apnea we can remove the tonsils and trim the uvula and palate,” said Erica Thaler, MD, Penn otorhinolaryngologist. “Now with the introduction of transoral robotic surgery (TORS) we can also help patients who have issues with the tissue at the base of the tongue.”

Dr. Thaler said about 20 patients have been treated for sleep apnea using TORS with good results. “This is a new procedure so we are continuing to follow these patients through sleep studies,” Dr. Thaler said, “but so far our outcomes have been positive.”

To learn more about transoral robotic surgery (TORS), visit the Department of Otorhinolaryngology-Head and Neck Surgery. To schedule an appointment, please call 800-789-PENN (7366).

Penn Develops Robotic Approaches for Treating Lung Disease


The thoracic surgeons at Penn Medicine are leaders in developing and applying minimally invasive surgical techniques to treat chest and lung diseases, including cancer.
Minimally invasive alternatives to traditional open-chest surgery, including robotic-assisted surgery, are used to treat many diseases in the chest and lungs, including lung cancer, thymic and mediastinal tumors, emphysema, hiatal hernias, fluid in the chest and chest infections, according to Taine Pechet, MD, Penn thoracic surgeon and vice chief of surgery at Penn Presbyterian Medical Center.
Lobectomy (removal of a section of the lung) is a common surgical treatment for lung cancer. Dr. Pechet said last year nearly half of all lobectomy surgeries were performed minimally invasively using video-assisted thorascopic surgery (VATs). With the recent addition of robotic-assisted thoracic surgery, Penn surgeons are extending the minimally invasive surgical options available to treat patients.
"Robotic-assisted thoracic surgery is relatively new in the U.S.," Dr. Pechet said. "Penn Medicine is an early innovator in the use of robotic-assisted surgery and is developing the techniques and strategies that will define the role of robotic-assisted surgery in the treatment of lung diseases."
For patients, the benefits of minimally invasive and robotic-assisted surgery may include:
  • Less early post-operative pain
  • Less risk of infection
  • Less anesthesia
  • Less blood loss
  • Less risk of abnormal heart rhythms
  • Better early lung function
  • Shorter hospital stay
  • Faster and more complete recovery
  • Quicker return to normal daily activities
For surgeons, the surgical robot's 3D visualization and added degree of movement allow increased control and precision, a key element in performing successful lung surgery. Dr. Pechet said Penn's thoracic surgeons are currently developing the best ways to apply this technology to chest surgery. As new technology and surgical techniques emerge, Penn's experienced surgeons are positioned to use the new techniques as soon as they become available.
Dr. Pechet sees patients and performs surgery at Penn Presbyterian Medical Center, and sees patients at The Penn Lung Center at Shore Memorial Hospital. For more information, visit the Penn Lung Center. Appointments can be made online or by calling 800-789-PENN (7366).

Tuesday, July 5, 2011

More Ways to Save Your Life: CyberKnife® at Pennsylvania Hospital

CyberKnife® delivers high dose radiation to tumors with extreme precision. With a dynamic linear accelerator and sophisticated image-guided technology, CyberKnife treats cancerous and non-cancerous tumors primarily in the prostate, lung, spine, brain, liver, pancreas and kidney. It can also be used for patients who have tumors that cannot be treated with conventional surgery or lesions that were previously treated with radiation therapy.

Penn Medicine is pleased to offer every form of advanced radiation therapy, including CyberKnife, Gamma Knife® and proton therapy, which allows Penn physicians to determine the most effective treatment with the least side effects for each patient. Patients can be evaluated for CyberKnife and other radiation therapy treatment options at Pennsylvania Hospital, the Ruth and Raymond Perelman Center for Advanced Medicine and locations throughout the Philadelphia region through the Penn Radiation Oncology Network.

Learn more about the benefits of CyberKnife
Watch Penn Radiation Oncology’s Patient Guide Video
Find out more about Penn Radiation Oncology Network

Penn Microsurgical Breast Reconstruction: Leading the field in experience

Penn Medicine is one of the premiere centers for breast reconstructive microsurgery both nationally and around the world. Since 2005, Penn Medicine has performed over 2,000 free-flap reconstructions, making it one of the highest volume centers for reconstructive microsurgery. The plastic surgeons at Penn Medicine offer patients the most advanced surgical treatments options performed by highly experienced surgeons in a supportive, caring environment.

Learn More about Breast Reconstruction
Meet Our Team of Plastic Surgeons

Support Cancer Survivorship: Take the LIVESTRONG™ Challenge

Penn's Abramson Cancer Center and The Cancer Center at The Children's Hospital of Philadelphia are proud to support the LIVESTRONG™ Challenge on August 20 and 21, 2011 at Montgomery County Community College in Blue Bell.

The LIVESTRONG Challenge is a two-day event that benefits Penn’s Living Well after Cancer™ Program. On Saturday, August 20, there is a 5K and 10K run/walk and health and wellness expo. On Sunday, August 21, there is a multi-distance bike ride with 10-, 20, 45-, 70- and 100-mile options through the Pennsylvania countryside.

Penn’s nationally recognized survivorship program is a member of the LIVESTRONG™ Survivorship Center of Excellence Network. This status reflects Penn’s excellence in providing clinical care and education to adult and childhood cancer survivors.

Join Team Penn/CHOP
Watch footage from Lance Armstrong’s visit to Penn
Learn more about Penn’s Living Well After Cancer™ Program
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